Tuesday 29 December 2015

The Medical History.

          This is a not a story  to criticize health care providers, but to criticize what has happened to a health care system that was once an example of excellence but despite  many technological advances has deteriorated over recent years.  That is because the medical history and physical examination, once the sine qua non of good medical care has faded in significance when compared to the apparent ease and precision (and to some the glamour) of high tech investigation.  It is often forgotten that those investigations, valuable as they are should be to confirm or correct the impressions the physician has formed from the patient history and physical examination.  It has been well established that indiscriminate investigations can result in much harm and expense.   Usually, the patient will tell you the diagnosis if you listen carefully and discriminatingly.
           After an accident in Hilton Head, S. Carolina, my seventy-seven year old wife tripped over a concrete parking marker and hit the ground with an impact that was potentially disastrous.   After observing her throughout the night and deciding her condition was stable.   I headed back to Canada the following morning.  By then, she had a black eye, the whole side of her face was swollen and her right hand was swollen and bruised.  We arrived home, in London Ontario, two and a half days later, after an ordeal, that I’m sure you can imagine.  She looked as though she had been badly beaten up and the sunglasses she wore to try to disguise her injuries merely emphasized them.  To cut a long story short, first thing in the morning, after arriving home, we took a trip to the emergency room, at University Hospital, and that’s where this story really starts.
            On the morning of Wednesday, twentieth of February, 2013,  I brought my much bruised and battered wife to the Emergency room at University Hospital, in London.    We sat there for five hours.  I am a physician and I was satisfied that my wife was in no immediate danger.  I couldn’t help speculating on what might have happened  if a patient  was bleeding from a subdural hematoma or worse during that period of time, with no one to monitor her.
             Because her hand and arm were grotesquely swollen and bruised, they were the immediate focus of attention.    So, after five hours, arm and hand were x rayed and the splint that I had already applied were considered to be adequate treatment for the moment.  Her head was either not noticed or considered to be important, despite extensive bruising and tenderness over the zygomatic bones of the face and a black eye.   I brought her home from the emergency room at University Hospital where she had been sitting for five hours without having been seen by a physician, when she was so uncomfortable that she insisted on signing herself out.   Being a physician I was satisfied that she was not bleeding into her brain.  However, this was not known by the staff and it concerns me that someone whose cognition may have been impaired was allowed to leave emergency without any attempts to assess cognition or to explain the possible risks involved .  Equally unbelievable, was the fact that despite the fact that as Professor and Head of the Department of Family Medicine at the University of Saskatchewan and as a life long teacher of Family Medicine students and Residents I had tried to make my students aware of the fact that they must screen for family abuse, nobody asked my wife if she had been beaten up by her husband or otherwise abused.. No-one ever took an adequate history.
            Next morning, since my wife (understandably!) refused to go back to emergency at University Hospital, and her head had not yet been looked at, other than by me. We went to St. Joe’s Hospital, where the experience was much more acceptable.  The appropriate investigations were carried out and the damage recognized and treated.  In fact, she sustained a maxillary bone fracture.  I have spent much of my life working (and sometimes living) in hospitals and I understand the difficulties that health care workers have to contend with.  Nevertheless this is not good enough, more focus being directed to the documentation than to the patient.    Suffice it to say, that something is amiss in the state of Health Care, that in my opinion is closely related to the deterioration of the conversation between the physician and the patient that all the technology in  the world can't replace. 

Friday 25 December 2015

A lesson in child education.

   2 little Girls and a Curmudgeon.
   A lesson in child education.

    For the last few years my niece and nephew come to visit us around the holiday season, with their two little girls.  Three years ago, when they were about seven years old, we were looking for something to do, (when you are 80 you really have to use your wits to keep two little girls entertained) so I decided to show them my fountain pen collection.  It was not without some trepidation, as my collection ranges from the almost priceless to the almost worthless.  Anyway, under careful supervision, I showed them pens, old and new, colourful and variably shaped.  These girls are totally different in every way, so I was pleasantly surprised at the overwhelming enthusiasm both of them exhibited.
   "Can I write with them, can I  write with them, Uncle Stan?"  they both screamed pleadingly.
   Now, these are mostly old or vintage fountain pens with sharp nibs and multi - coloured inks in bottles, that must be sucked up into the pens, unlike the cartridges that are used today.  Still, we were down in our basement, so I decided that with careful supervision I could risk it.  After all, an ink-catastrophe can  usually be fixed if one make sure to use washable ink.
    So I searched about for two of my most valueless pens and a bottle of washable ink, got each girl a notebook and carefully monitoring the filling of the pens with ink, with their participation, sat them down at the desk, 'a l'ecole', and showed them how to write with a real live fountain-pen.  The were thrilled.  Their initial attempts, while not stellar, were surprisingly acceptable.
    Soon after they got home to  Montreal, I had a call from my niece telling me that the girls' enthusiasm for fountain pens was persisting and asking me for recommendations for reasonably priced and designed pens, preferably of the cartridge using type since she didn't think they were ready for bottles of ink just yet.

   The following year's visit was initiated by the girls requesting to see the fountain pens as soon as they burst through the door.  It wasn't long before they were demanding their writing lessons and I felt as though I was running a school in my basement.  I gave the girls a couple of nice colourful pens, with which they were delighted, and told them that they better practice because during the next visit there was going to be a test!

   This year, soon after arriving, they wanted to know when they were going to have to do 'the Test'!
"Well, " said I, " you are going to have to do some little practice exercises first."  I brought them down to the 'school-room' and gave them some of the old headline books aphorisms to transcribe, and found they were both writing block letters.  I was aware and horrified that some schools were no longer teaching cursive writing .I wrote out some cursive headlines for each of them.  One of the girls knew how to write cursively, but because of differences in their education for complex reasons I won't go into, the other didn't.  So I tailored her test accordingly (still cursively inclined).  After a period of practice, the girls wanted to know when their test would be held.  
   "Now,"  said I.  Great excitement ensued.  I administered the tests, collected them and graded them.
   "Did I pass? Did I pass?" both of them screamed.  Of course both of them passed!
   "Yes," I said, "you will both be getting your prizes before you go home!  Your certificates will arrive in the mail, but these things take a couple of weeks!"
    Now I'm trying to design appropriately impressive certificates!
    And that's how you educate children! 

Thursday 17 December 2015

More for Less!

    Everyone seems to know more about medicine today than the professionals.  Fortunately, I am now a  medical has-been so  can say anything I believe.  After all, my years of education and effort, lack of finance, lack  of security, not to mention lack of sleep,  and most of all, lack of certainty that I may eventually graduate, (not everyone who got in to medicine then came out with an M.D., you had to actually meet the standard) really doesn't matter, because doctors "make so much money".  This is, of course, how it appears in the eyes of the public, who are presented with misrepresented figures which sometimes look huge, since the physicians billings represents total revenue without considering the sometimes huge overhead, that often include several salaries, nurses, receptionists, equipment etc.  Gross incomes, presented deliberately without explanation serves to deflect attention from the greatly inflated salaries of the administrative group.   Most physicians have no pension,no sick benefits, no safety net if  ill-fate or misfortune befalls them and must provide for themselves those benefits that no civil servant would consider working without.  Now physician earnings are being seriously clawed back and there is no doubt that this will have an effect on physician supply and service.  So expect things to  change decidedly for the worst in the health care industry.

Let me point out the state of the Canadian Health Care system, using a report that the Department of Health has quoted itself: 

"With regards to international comparison, the 2014 Commonwealth Fund report on the health system performance of 11 countries ranked Canada 10th overall, indicated particularly low scores in quality, safety, access, timeliness, efficiency and equity.17 "
Commonwealth Fund, Mirror, Mirror on the Wall: How the Performance of the US Health Care System Compares
Internationally, 2014 Update.  Note the broad range of care in which we are at the bottom of the heap.

   The decline is, of course, a carefully guarded secret, the politicians see to that.   They want Canadians, to continue to think that they are still enjoying a 'world-class' health care industry, while the decline continues.
   Administridiots, with business training, are in charge now.  They really have no idea of what good medicine is, other than from  the economic point of view, and even then, often have little real insight.  They understand little about physician - patient relationships, and care less, unless, of course, they, their families, or their political friends are involved.   Things are different then.  I was the Chairman of a Department of Family Medicine, based out of a University Hospital, and not infrequently, would  get a subtle message that an important political figure or one of their family members was coming in.  Just to let me know, you know.  Not that any special treatment was being solicited, God forbid.  (Nod nod, wink wink!)   And , of course, when any of the  administrators or their families came into the department, they never failed, ever so tactfully, to let us know who they were.  So it's time to discard all that BS about everyone getting the same level of care.  It's just not so, and the people who crow most loudly about it are often the ones who are most demanding. 
   Soon, our already overburdened health care system,is going to be furthered burdened by twenty-five thousand Syrian refugees, at least some of them are refugees.   Physicians, who can't adequately cope with the already heavy patient load, and who are being treated in an unbelievably unacceptable manner, including unilateral claw-backs from government, are being asked by the same politicians to provide the coverage that the  politicians have so generously promised.  If physicians do that, they will deserve the consequences.  The government made a promise so they could look like 'good guys' , let them not fulfill it on the backs of physicians.
   I cannot help asking, where are the CMA and CPSO?

Saturday 12 December 2015

S-Myth Buster.

An excellent summary of the  of the Euthanasia controversy in the U.K.s Daily Mail.


And now for  something entirely different! 

     Once a month or so, I'm going to do a reader-inspired research/investigation piece on any medically related topic or phenomenon you request.   I will take special delight in debunking the myths of the  Dr. Oz type quacks and other snake oil salemen.  I might just call it S-Myth Buster!  So try it out!                         

     Here are some of the things I've been consulted on in the last few weeks, in addition to the ones described in  the last blog.    Retinal hemorrhage, broken  bones, gall stones in  seventeen year old, supraventricular tachycardia, facial papilloma, plantar callous, occipital neuralgia, cervical arthritis, dry eyes,digital  arthritis, bladder tumour.    Not bad for a retired old curmudgeon!!              

      Let me hear from  you.                                                               

Wednesday 9 December 2015

Don't ask me, I'm not a Doctor!

   It will soon be two years since I retired and gave up my license to practice medicine.  Despite the fact that I regularly remind people that I'm not a doctor (vide supra), my illegitimate practice is steadily building up.  Although we used to  pride ourselves on our comprehensive health care service, since we changed it into a health care industry it has been steadily deteriorating.  Even as the technology becomes more miraculous, expensive and often  misused, some of the basics of the healing sciences are now relegated to the scrap-heap.  Much of this is because experience is now disregarded in  an era when everyone's opinion has to be equal, no matter how egregious their ignorance.  In the desire to be politically correct, we have tolerated politicians and administridiots with little health care experience or understanding taking the reins and directing the industry to the disgraceful  place it is in today.  With that rant out of the way let me entertain you with tales of my contemporary, unscientific and unlicensed medical practice in  the past week..
   1.Pt.A  had bowel problems resulting in major surgery.  He spent twenty-one days in hospital recovering from the surgery and on-going complications.  He had some job related problems before the surgery.  He was distraught about the possibility of losing his  job and his future.  Despite the massive social services expenditures we incur, no one had attempted to address these problems at all.   It took some time to unravel this complex situation and explain the options available to  the patient.  He certainly felt somewhat better after that had been partially addressed.
    2.Pt.B.  An early middle-aged man on some potent medications who could no longer get the precise medication preparation that had been working well.  This appears to have been a manufacturing glitch.  Generic brands had a component that caused him problems. We discussed some make-shift solution to try. Fortunately, he contacted another physician in his family who managed to pick up a supply that was still available in pharmacies in another city, that will  last him a couple of months.  The long-term solution remains uncertain.
     3.Pt.C.  A close friend I usually swim with who is  having radiotherapy at present and has to stay out of  the water right  now.  I volunteered to take him for his therapy, so that I could railroad him to the pool hall for a few games of pool.  If it wasn't one pool it would have to be another!  Anyway, he beat me consistently and I figure that was at least as therapeutic as his other treatment.
      4.Pt. D.  A young man who barely managed to make it  to my eightieth birthday party in  Toronto a few weeks ago because of a knee injury.  This young man appeared at my party on a pair of crutches because he had injured his knee at work.  He had reported his injury and was given a few days off.  When he got home the knee was very painful and he went to the Emergency Room.   After a seven hour wait he had his knee x-rayed and  saw the doctor.    He was told he had a bruised knee and sent home.  About 36 hours later he was phoned and told he had a fractured patella (knee-bone).  He is now in a dispute with the Workers Compensation Board who think  he is ready to come off benefits and go back to work.  He disagrees.  I didn't know the answer to  the problem, but I have had enough of a working relationship with the Board to know that if you don't think you have been treated fairly there is an appeal process and I so  advised him.
        5. Pt. E.  Last night, after arriving home from a pub dinner at my local, there was a knock at my door.  I recognized the lady standing on one foot. She is my neighbour of many years.  Although she has numerous significant health problems of her own, she spends a considerable amount of time helping elderly neighbours.   She was cleaning windows for an elderly neighbour when she slipped, twisting her ankle.  After a while, it became painful, swollen and bruised.  Since the pain was getting worse, she decided that she had better consult me.  I looked at the ankle, it was swollen and bruised below and anterior to the lateral  malleolus (look it up!).  However, it passed the Ottawa criteria for absence of  an ankle fracture, so I advised the age old remedy of rest, ice, elevation  and compression. 
   Other issues I have had to deal with recently include retinal hemorrhage  and supraventricular tachycardia.
       If I go back a little further, I can regale you with more of the same.  In the meantime, I just might have to go on strike unless the pay improves!  

Sunday 6 December 2015

Physician Killings.

   The debate re euthanasia continues to rage and Quebec has put a hold on its imminent introduction.  Indeed it seems the Supreme Court decision may be delayed beyond the original one year mandate.  The  issue of the  influence of euphemism (a mild or indirect word or expression substituted for one considered to be too harsh or blunt when referring to something unpleasant or embarrassing.) is eloquently dealt with by Barbara Kay in a recent article in  the National Post.  We cannot deal with the phenomenon until we have the courage to call it by its true name.  Just as the American administration cannot address terrorism until they recognize it as that, so the medical  administration ( mostly composed of non physicians ), cannot possibly deal with medical killings until they call it by its true name.  For the most part when we use the word euthanasia, we are not talking about suicide, assisted suicide, physician assisted suicide, we are talking about physician killings.  If society cannot even tolerate its name, physicians should be even more aggressive about defining it.  We must define issues related to killing patients clearly, even if just to make sure future generations of young physicians are not socially engineered to accept this non medical function as an  obligation of medical care.
     I  would suggest that what we refer to as euthanasia  and other euphemisms for that act be redefined so as to  describe exactly what it is - Social Killing.   As I have emphasized before, if physicians allow killing to become part of their duties they will have done  the profession irreparable damage.  Physician involvement in end-of -life care is called palliative care.  If society wants social killing others can easily trained to provide the service.  Physicians are not 'service providers', much as the political/administrative ranks would like to  make them so.  The feckless role of the College of Physicians and Surgeons is regrettable. 

" We have now sunk to a depth at which restatement of the obvious is the first duty of intelligent men."
George Orwell.

 Has nobody any views on this issue?

Wednesday 2 December 2015

The Secret of Immortality. Pt. 2.

  I have already, albeit somewhat facetiously, shared with you the secret of immortality, at least until the age of 80.  It will require several more blogs to get to what seems to be, by popular consensus, the next step, one hundred and twenty years old.  At least, that is what my local newspaper told me with a headline that read "Anti-aging drug could help you to live to one hundred and twenty.  As I scanned through the article I discovered the miraculous drug that the article informed me would be the world's first anti-aging drug to be tested on humans. It was also hoped it would help to dramatically reduce the incidence of such diseases as Alzheimer's and Parkinson's. 
   This is a drug that physicians have been using for many years for the treatment of  type 2 diabetes.  The researchers at the University of Cardiff, in Wales, wanted to know if the drug METFORMIN helps to lower the risk of early death in diabetes.  The study involved 180,000 people.  Previous studies in mice showed that the drug increased their lifespan.  In this study lifespan was compared in metformin treated patients to patients on another anti-diabetic drug. Patients treated with metformin had a small statistically significant improvement in survival compared with a cohort of age and gender matched non diabetics.  Those treated with another anti diabetic drug, sulphonylurea, had a significantly reduced survival compared with non diabetics.
   The researchers said that metformin not only reduces cancer and heart problem risk but also reduces pre-diabetic risk  of developing diabetes.  Obviously, this is going to require much further investigation.

   Meanwhile Nir Barzilai, of the Albert Einstein School of Medicine in New York and other researchers, plan to test that notion in a clinical trial called Targeting Aging with Metformin, or TAME. They will give the drug metformin to thousands of people who already have one or two of three conditions — cancer, heart disease or cognitive impairment — or are at risk of them. People with type 2 diabetes cannot be enrolled because metformin is already used to treat that disease. The participants will then be monitored to see whether the medication forestalls the illnesses they do not already have, as well as diabetes and death.
On 24 June, researchers will try to convince FDA officials that if the trial succeeds, they will have proved that a drug can delay ageing. That would set a precedent that ageing is a disorder that can be treated with medicines, and perhaps spur progress and funding for ageing research.
Let me know if yua're interested in living forever!

Saturday 28 November 2015

Advertising drugs directly to the public.

     In recent years American pharmaceutical companies direct-to-consumer advertising has become increasingly intrusive, aggressive and misleading to the extent that it is driving consumer demand for their product and that is their objective.  The success of the strategy is supported by the almost five billion dollars last year spent by the drug companies on dtc advertising.   Unfortunately Canadians are plugged into U.S. TV much of the  time and are bombarded with this material although that sort of advertising is not permitted in Canada.  In the last few years before my retirement the increase in patients coming into the office with requests for specific medications that they had seen advertised on television was remarkable.  The requests or demands were often inappropriate and for off-label conditions (i.e. not approved by the FDA or Health Canada) suggested in carefully couched advertisements.   This unethical practice, which is banned in most countries in the world, makes a physicians life difficult as, in a volume family practice at least, it can consume time and effort in explaining why this is not a suitable treatment for the patient.  One of the easier ways I found in dealing with the situation was to pull  my smart phone out of my shirt pocket and read the list of drug interactions and of side effects, many ending in "sudden death".  This was quite effective most of the time, nevertheless one was just compelled to say no sometimes. This sort of advertising certainly damages big pharma by presenting the picture that their sole objective is to sell drugs and to  put additional  pressure on physicians already bombarded with sales strategies.
       The  American Medical Association has voted in favour of a ban on direct-to-consumer advertising, so perhaps in the  near future I will  no longer have to listen to the tasteless advertisements on diarrhea, hemorrhoids and the like over my dinner.
Let me know if you enjoy ads relating to similar complaints to the above over your meals!

Direct-to-consumer (DTC) advertising should be banned in order to reduce the demand for expensive, unnecessary drug treatments, the American Medical Association’s (AMA) House of Delegates voted on Tuesday.
“Today’s vote in support of an advertising ban reflects concerns among physicians about the negative impact of commercially-driven promotions, and the role that marketing costs play in fueling escalating drug prices,” AMA board chair-elect Patrice A. Harris, MD, MA, said in a statement issued after the vote at the association’s interim meeting here. “Direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate.”
The policy also advocates for a campaign to urge prescription drug affordability — including demanding more competition in the drug industry — and for urging more transparency in drug costs; it also calls for convening a physician task force on the issue.
“Physicians strive to provide the best possible care to their patients, but increases in drug prices can impact the ability of physicians to offer their patients the best drug treatments,” said Harris. “Patient care can be compromised and delayed when prescription drugs are unaffordable and subject to coverage limitations by the patient’s health plan. In a worst-case scenario, patients forego necessary treatments when drugs are too expensive.”
Banning DTC advertising would be a really good idea, said Sunny Linnebur, PharmD, associate professor of clinical pharmacy at the University of Colorado Skaggs School of Pharmacy, in Aurora. “I can see the potential risks that occur when patients watch commercials and immediately think they need to be on that medication,” she said in a phone interview.
“Number one, it puts pressure on providers — doctors, nurse practitioners, and physician assistants — to prescribe those medications. Number two, patients are not always in the best place to make decisions about which medications they should and should not take, and commercials are targeting patients and can make them think that medicine is for them, when it’s not safe for them.”
In addition, such ads can increase providers’ workloads because “we [may] have to discuss medications that were never going to be on the table to begin with,” said Linnebur.
David Holdford, PhD, professor of pharmacotherapy and outcomes science at Virginia Commonwealth University, in Richmond, said that although too much money is being spent on marketing and too little on drug research and development, it’s doubtful that banning DTC ads will serve to either increase spending on drug research or bring down the price of drugs.
“DTC spending is approximately $3 billion per year — 11% of all promotional spending,” he said in an email, citing a report by the Pew Charitable Trusts. “Direct-to-provider [advertising] is the other 89%.”
“MDs are still in control of the prescription pad,” Holdford said. “They do not have to prescribe for heavily promoted DTC drugs, but they do. In fact, studies consistently show that physicians are not cost-effective in their prescribing behaviors.”
The AMA has grappled with the DTC issue before. In April, the association wrote to the Centers for Medicare and Medicaid Services complaining about the misuse of Medicare’s annual wellness visit by commercial firms that promote whole-body scans as a means of disease prevention.
“We note that some consumer groups have asked the Federal Trade Commission to investigate the direct-to-consumer marketing of some of these commercial entities on the grounds that their advertisements contain false or misleading representations or material omissions,” wrote the AMA along with several other physician organizations. “This raises serious concerns for us about potential program integrity threats that these entities may pose to Medicare.”
The FDA also has been studying the issue for some time. In 2003, the agency presented results from surveys of patients and physicians, which found that of 500 doctors surveyed, 60% said that when they discussed a medication with a patient who had seen an ad for it, the ad had no beneficial affect on the discussion. And fewer than 20% said their patients understood how to get more information about a drug as a result of seeing an ad for it.
In other meeting news, the House of Delegates also passed resolutions in support of:
  • Revising quality standards and Meaningful Use requirements to make the program more streamlined and less burdensome.
  • Passing federal, bipartisan legislation to speed up paramedic training for returning veterans who received emergency medical training while in the military.
  • Developing model state legislation to increase use of prescription drug monitoring programs (PDMPs). “The AMA strongly supports ensuring patient privacy protections, interstate interoperability of PDMPs as well as improving the functionality and workflow of these tools to help physicians make informed prescribing decisions,” the association said in a statement.
  • Lifting a Congressional ban on coverage of in vitro fertilization treatment by the Department of Veterans Affairs. Current law prohibits the department from covering this service, even though it is covered for active-duty military.

In addition, the delegates called on the federal government to analyze the consolidation of the health insurance industry over the last 5 to 10 years before approving any further mergers.
last updated

Wednesday 25 November 2015

New Health Hazzards.

The Prime Minister seems more concerned with making a 'warm and fuzzy' gesture than he is about causing potential health and other hazards to Canadians.  Instead of carrying out appropriate health and security investigations of the twenty-five thousand refugees before admitting them to Canada, he is determined to ignore the inherent risks in the situation  and to "meet his deadlines", regardless of the consequences.  Apart from the obvious security issues, which he must be well aware of, there are health issues of which he is apparently ignorant.   Before going into the specific issues, let me point out the state of the Canadian Health Care system, using a report that the Department of Health has quoted itself: 

"With regards to international comparison, the 2014 Commonwealth Fund report on the health system performance of 11 countries ranked Canada 10th overall, indicated particularly low scores in quality, safety, access, timeliness, efficiency and equity.17 "
Commonwealth Fund, Mirror, Mirror on the Wall: How the Performance of the US Health Care System Compares
Internationally, 2014 Update.

Note the broad range of care in which we are at the bottom of the heap.  The much vaunted health care system of which we were once so justly proud is now near the bottom of the heap in the most developed countries.  Canadians are frequently awaiting appointments for periods that much exceed the bounds of safety.  We should be ashamed of ourselves and trying to  upgrade.  Instead the Province of Ontario is cutting services and doctors salaries quite shamelessly.   An additional twenty-five thousand refugees may not seem much of an additional burden until one realizes that these folks have not had the prophylactic care and immunizations that Canadians take for granted and there is a very real possibility of introducing  diseases that are entirely foreign to our population.   Apart from measles and polio and other vacccine preventable diseases that have almost been wiped out in our country (though the anti-vaxxers are doing their best to undermine their total eradication), there are diseases which Canadians have never even heard of.  We have no idea of the diseases that may be carried into Canada until the refugees are adequately screened.  Let's look at a few:                1. Middle East respiratory syndrome MERS-coV.  A virus infection with a high mortality rate.  This is a new virus which we still know little about, but it looks dangerous, spreads from person to person and is associated with considerable mortality.

2.Malaria.  Although not as prevalent as at one time malaria is still a risk and is becoming increasingly resistant to the anti-malarial medications.

3. Leishmaniasis.  A parasite that effects animals and humans and is not rare in Syria.

4.Dengue fever.  A mosquito transmitted fever that can deteriorate into the often fatal Dengue Haemorrhagic Fever.

5.Vaccination deficiency.      Diseases almost wiped out in Canada by widespread vaccination will be re-introduced by a population that is frequently unvaccinated.  Further, the irresponsible and ignorant attitude of the growing anti-vaccination population is resulting in a waning of the herd immunity that we enjoy.  Expect to see measles and other childhood diseases popping up, including some like polio and TB. 

   I am concerned that Canadians in need of health care, who often are put at risk by having to wait unacceptably long times to obtain the care that they need, may find that their much loved  health system is growing ever more tardy and  falling below first world standards.

And don't think a few Jihadi sleepers won't be among the immigrants.  


Sunday 22 November 2015

Minister for Science?

    Mr Trudeau has appointed a Science Minister with very questionable credentials.  Her name is Dr. Kirsty Duncan and her doctorate is in geography, but this did  not prevent her from presenting herself as an expert in both neurology and virology. It is true that Dr. Duncan contributed to a panel that was awarded a Nobel Prize for its work on climate change.  She played a major part in organizing an expedition in the late 1990s to find frozen samples of the epidemic 1918 flu.  It was a futile event which  eventually led to nothing apart from acrimony and ill will.  Her greatest fiasco was her commitment to a treatment for multiple sclerosis due to a hypothetical condition  known as chronic cerebrospinal venous insufficiency — CCSVI described by Dr. Paolo Zamboni.   This was supposed to be due to narrowing of the veins in the neck restricting drainage.  Dr. Zamboni corrected this surgically.   Duncan continued to support the treatment long after it had been proved useless and deteriorated into a cult philosophy, just as she had disputed the judgement of world class virologists in her previous endevour.

 “This is the most curious appointment since Caligula named his horse as consul,” scoffed McGill University’s Dr. Michael Rasminsky, calling the Zamboni ideas “profoundly non-scientific.”    Her behaviour in a number areas would not seem to have been conducive to nurturing the scientific method.  I will be monitoring her leadership and activities as will many others over the next few years.

Let me know if you have any  views on this appointment.

Thursday 19 November 2015

Medical Murderer ?.

    When people ask me why I am opposed to euthanasia, I explain to them I am not opposed to euthanasia, I am  opposed to killing patients being regarded as a physicians responsibility. That directly contravenes the healing role.  If society decides it wishes death on demand to be available, which it does in Canada, then  it is the democratic right of citizens to take this option.  It becomes the responsibility of the state to make this available, but it does not have the right to force physicians to terminate life.  There are some who will find this perfectly acceptable, but to include this as an expectation of all physicians will damage the medical profession irreparably.
       It would  be relatively easy to train a corps of 'terminators' who would  not need to be physicians at all, in  the technical details of the procedure.  Once the guidelines were laid down the decision could be made by a designated group and the 'terminator' could administer the deadly potion.  There is no reason at all that the protocol would require a physician and in fact I don't think it should.       
     Dr. Marc Van Hoey is President of Belgium's Flemish death with dignity association and one of the country's most active practitioners of euthanasia, performing between fifteen and twenty a year.  He has become the first physician to face possible criminal prosecution, for giving an eighty-five year old fit woman, at her request a glass of lethal syrup to drink.  (Yes, it's that easy, doesn't need a doctor at all.)  Her daughter had died and she no longer wanted to live.  Thus, there was no medical reason for her termination   It is possible  he will face prosecution for violating Belgium's euthanasia laws.
   Carine Brochier, project manager of the Brussels based European Institute for Bioethics said, "It's an illusion to believe  you can control what goes on between a doctor  and a patient in a room."  In Belgium, patients who have been diagnosed with depression have been terminated.  Dr. Van Hoey himself said that it was possible to  skirt the requirements for a written request from  the patient.  It would appear that there is considerable laxity about the required second medical opinion and an additional psychiatric opinion, if death is not imminent. Physicians who allow themselves to become part of the termination team will be on a slippery slope that can only damage the profession.  It is shameful that the College of Physicians and Surgeons are lacking the moral fibre to  apologetically  support those physicians who do have those principles.      
What do you think?      


Sunday 15 November 2015

The Brain Computer Interface Pt 2.

        A while ago I wrote about the brain-computer interface, where man meets machine.   Last year, Dr. Phil Kennedy, a sixty seven year old neurologist emulated many of the great physicians of the past in  using  himself as  a guinea pig in  the cause of advancing science and humanity.  Dr. Kennedy had electrodes implanted into his brain to establish a connection between his brain  and a computer.  At his own expense and  of course outside the U.S., he had the surgery performed at a cost of $25,000.  
        Kennedy's aim was to build a speech decoder that could translate the signals produced by the neurons by transforming imagined speech into actual words coming  out  of a speech synthesizer.   He decided to do this because he could not get adequate funding and could not find research subjects and his whole research project of many years was about to die.  He presented the studies of his own brain at  the Society for Neuroscience in Chicago.  His finding were greeted with interest as well as criticism for carrying out invasive research on himself.  He developed an electrode of gold wires in a container with a blend of growth factors that induced neuron growth.  He eventually got FDA approval to implant electrodes in patients so paralysed that they could not even speak.  He oversaw implantation in at least five severely paralysed patients, who could turn a switch on  or off, or move a cursor on a screen by just thinking.  Because 'locked-in' people cannot communicate it became very difficult to provide the detailed information that the FDA demanded and they withdrew their permission despite Kennedy's publications in reputable journals.  He needed a patient with sufficient speech to be able to confirm what he was thinking when a particular batch  of neurons fired.  Kennedy decided that he needed a subject who could speak sufficiently to corroborate the similarity of the neural relationship between speaking sounds and thinking them.  He couldn't find a volunteer for the surgery, so he decided that he would have to do  it himself.  He had designed the electrodes and just had to find a neurosurgeon to implant them He knew that would be impossible to arrange in  the U.S. for reasons I don't have to explain.
     He arranged his surgery at a small hospital in Belize, well outside the purview of the FDA.  He had his skull opened and the electrodes implanted.  Some thought the procedure unwise, but in days of yore it was not unheard of for physicians to try new treatments out on themselves before subjecting their patients to the risk.  After returning home, Kennedy worked in  his speech lab recording his neuronal activity as he repeated certain sounds out loud and then imagining saying them.  He says he determined that different combinations of the neurons he was recording from consistently fired every time he spoke certain sounds aloud, and also fired when he imagined speaking them—a relationship that is potentially key to developing a thought decoder for speech.  Others had used only electrodes placed outside the skull which was obviously much less sensitive and we will also examine their work later .   Unfortunately, Kennedy had to cut his experiment short for medical reasons related to his skull incision.   He did, fortunately, get four weeks of good data which he is continuing to work on.    I will be reporting on the progress of this science-fiction like work by Kennedy and others.

Wednesday 4 November 2015

The declining Health Care System. Pt 2.

"With regards to international comparison, the 2014 Commonwealth Fund report on the health system performance of 11 countries ranked Canada 10th overall, indicated particularly low scores in quality, safety, access, timeliness, efficiency and equity.17 "
Commonwealth Fund, Mirror, Mirror on the Wall: How the Performance of the US Health Care System Compares
Internationally, 2014 Update

So what are the administridiots proposing to remedy this awful situation?

The same old cheese! 
 Primary Health Care is the cornerstone.
Well, no kidding!  The College of Family Physicians was promoting that since the 60s. In those days we used to say that would lead to better, more organized care that would be less expensive and that consultative services would be appropriately planned, avoiding unnecessary consultations and expenses.  Further, we flattered ourselves by thinking that personal relationships and continuity of care were the patients primary considerations when, in fact, convenience was what was rated most highly.
      The Ministry of Health janissaries  are saying exactly the same things, offering nothing new other than their prolix memoranda.
      It then  goes on to answer the four aforementioned questions (discussed in a previous blog) with answers that only gives rise to further questions. 
Electronic Medical Record adoption
There are currently more than 11,600 primary care providers enrolled in an EMR
adoption program, representing coverage for more than 10 million Ontarians.  This is simply a statement of fact.  There is as yet no evidence to indicate that the EMR, as it is currently set up has contributed to the quality of medical care.  Nor has it contributed to the patient - doctor rapport.  It has certainly contributed to the much lamented increase in cost of care.
      The discussion goes on  to bemoan the lack of funds and the growing geriatric population and the long wait times, inaccessible after hours services and difficulties for various groups to access various services.  It mentions efforts in the past (similar, it would seem, to their present effort) that that failed to  achieve the goals.  The previous expert advisory committee produced over a hundred recommendations and by the their own admission this group found them  not to have achieved noteworthy success. I have no  doubt that these efforts cost a great deal  despite their failure to address the problem satisfactorily. So far there is no reason to anticipate greater success with the present efforts.  There is little doubt that it also will cost a great deal. 
     Here are their recommendations:
1. Groupings of Ontarians will be formed based on geography, akin to the assignment of students within the public school system. Citizens within each grouping are assigned to a primary care group (PCG) and then rostered to a primary care provider (physician or nurse practitioner) contracted by the PCG.
2.    Each PCG will develop a system of coordinating the capacity of the delivery models in their region to ensure unattached patients are connected to a provider, thus ensuring universal access. 
3. A system for managing exceptions will be developed. For example, patients with pre-existing relationships with providers who reside outside the PCG catchment area could be included in a neighbouring PCG allocation through PCG to PCG transfer payment agreements. Such a system could also be used to address commuters, seasonal vacationers, and patients accessing specialized primary care services (e.g., a falls prevention clinic, primary care of the elderly) in a neighboring PCG, or patients needing particular culturally sensitive care delivery. 
4. Patients difficult to assign (e.g., those without permanent housing or without health cards) will be identified and assigned to the PCG in collaboration with Public Health, community health centres and the local municipal services. The funding formula would reflect the needs of this patient group; however, it is recognized that supplemental funding may be required.
    I have little doubt that all these machinations will result in the generation of a whole additional cadre of well rewarded administrators.   
    Funny, seems like the system I left in NHS in Britain in 1963!! 
 Make a comment if you have any views.

Tuesday 3 November 2015

So who's crazy?

     Have we gone completely crazy?
Luke Magnotta murdered a Concordia student, Jun Lin, under the most horrible circumstances. He was sentenced to life in prison. He now occupies a ? cell  (I know what those 'cells' are like and they are nothing like a cell) in his Quebec prison, decorated with pinups (he has a 'thing' for Marilyn Monroe, would you believe?) and via the letters he writes describes his life.  He enjoys keeping fit, reading, the prison food, which he describes as decent and casual clothes.  He further describes relaxing with art, music, sports and reading.  he described 'just bought Celine Dion's album and a lot of others.  I have a stereo and a portable for when I suntan outside'. He compares it to a University
     He corresponds with a number of outsiders some of whom send him money.  All in all, he seems to be having an enjoyable life  and making a reputation for himself, both within Corrections Canada and outside,  I am very familiar with Corrections Canada and how it works.  Always excessively lenient, it seems to have become worse.  I can tell you that many aged Canadians receive far inferior medical and general care than the often evil parasites that political correctness seems to favour.
     So who's crazy.  If we reward a pattern of behaviour we should not  be surprised to find it increases.     I think it s time for the people of Canada to re-think the meaning of justice and to correct some of the absurdities they have condoned.
     Personally, I think it is time to re-institute the death penalty.

Tuesday 27 October 2015

Who's Playing God?


  Headline in the 'National Post':


               MDs playing God on euthanasia, ethicists say

    You got it wrong NP!  The article by Ms Kirkey says that, according to ethicists, the 'regulators' are playing god and assumes that the regulators will be MDs.  Ms Kirkey, the writer of the article has it wrong.  Most doctors have no desire to play God and many of them are resisting attempts made as a result of the ruling by the Supreme Court to coerce them into doing that.   Indeed, if a profession is to be found guilty of playing God in this instance, it is the legal profession.  It is the Supreme Court and society  in general want to play God, not physicians.   The whole euthanasia position is a societal one and I believe that those who want to avail of that new option have a right to do so as determined by the law.  That does not obligate physicians to be the purveyors of death and I  would  strongly recommend that those who find this contravenes their principles have nothing to do with it.  If there are not enough physicians  to fulfill the public need, it would be easy enough to train a corps of 'terminators'.  
     I continue to feel and believe that euthanasia goes against the very core of  medicine and if we allow it to becomes a part of mainstream  medicine, it will forever change the nature of medicine and the physician patient relationship.  
    Get your facts right, Ms Kirkey.

Sunday 25 October 2015

New York Times Bestsellers.

Class Act.

          I can remember when books dealing with these topics didn't need crass 'shock jocks' to try to hook a customer..  They hooked their audience by skill and  eloquence and ability to express their ideas, rather than by crude exhibitionism.  Then the folks are surprised that their kids can't express themselves without f**king swearing!!
           The decline continues.  Feel free to comment if you have any views on this.


Friday 23 October 2015


A. Quickie for Ontarians.

The Gov of Ontario has just committed the taxpayer to providing the teachers union with $2.5 million for their negotiating expenses. (You know how well they are doing their jobs these days.)  This is unrelated to any gains they may make (and believe me they will make gains.)
Compare This with how they are treating their physicians and their refusal to negotiate.
Are you surprised that health care is deteriorating?
You ain't seen nuttin yet!

Comment, if you have anything to say.

Wednesday 21 October 2015

The declining Health Care System.

"With regards to international comparison, the 2014 Commonwealth Fund report on the health system performance of 11 countries ranked Canada 10th overall, indicated particularly low scores in quality, safety, access, timeliness, efficiency and equity.17 "
Commonwealth Fund, Mirror, Mirror on the Wall: How the Performance of the US Health Care System Compares
Internationally, 2014 Update

 What an indictment!.
                  And now look at what the Administridiots are embarking on to 'fix'  things.    The Baker Price Report.   Let's deal with that later.   First, I want to deal with the appalling dictatorial arrogance of  the Ontario Government.
            If the citizens of Ontario think they have it bad now, just wait.  Further, if the  physicians of Ontario think they have it bad now, just wait.  Unless, of course, they drop their feckless stance and stand up for their profession.  I used to think the government objective was to convert physicians into civil servants.  Right now, their status is way below that of civil servants.  Physicians have none of the benefits of civil servants and no recourse to the corrective action that they enjoy.  In fact, if the administration tried to pull the unilateral reduction of pay stunt, without binding arbitration on civil servants the government would be shut down.  
           There is only one way to deal with such a bureaucracy.    If they won't negotiate with us, we can't negotiate with them.  There is no such thing as unilateral negotiation.  However, being the humanists that most physicians are, they know we will never deny patients needed care and rely on that factor to do  what they like.   Despite the lack of  support from the Royal College, which seems to have become a Ministry of Health satrap, there are steps that physicians can take that will not hurt patient care.  Of course any such  steps will require considerable fortitude, which I figure has become increasingly rare in recent years.  Unfortunately, the alternate is to tug your forelock, bow your head, do as you are ordered and stop complaining.  I will describe some of the measures that physicians could take in a separate blog.
           Now the Ministry of Health is introducing "A new model of  population based primary health care."   The objectives are four fold.
1. To ensure that all citizens have a regular primary care provider.  (We used to call them general practitioners.)
2. To make sure patients who need related care can obtain it.
3. To improve integration between GPs and other parts of the system.
4. To provide adequate care after-hours and on week-ends.
            All things that physicians have been doing with greater or lesser degrees of success as long as I've been in  medicine (and that's long!)   It's the same old cheese and in a subsequent blog I will explain to you how they are planning to do it.

Thursday 15 October 2015

The Secret of Immortality!

     My kids have taught my wife and me, both recent octogenarians that it's never too late to have a helluva bash!  We were both a little reluctant and despite being in good shape were opting for a quiet family dinner in a good local restaurant for our joint 80th birthdays.  After all, getting old is easy.  All you have to do  is stick around for long enough.  
      In any event, it  is no use trying to resist the bullying of ones children, so  we reluctantly agreed to let the kids have their fun and go  along with  their desires as we have done for most of their lives.   My wife and I  have known each  other for most of our lives and started 'courting' (as we used to say in the old days regarding serious relationships) at about the age of eighteen..  Despite our lousy genes on both  sides of  the family, we have remained alive, remarkably active and  (I think) compos mentis.  
       Outside the 'Home Smith Jazz Bar' (yes, that really was the  name of the bar in The Old Mill!) where we all initially got together, was a sign that read:
                                  " Irene and Stan's 80th birthday,"
                  A young woman walking by said, "Hey! They must be twins!"   

      Aubie Blake, the great Jazz musician said on  reaching the age of 90, " If I knew I was going to live this long, I'd  have looked after myself  better."    We have done pretty well, my wife is starting to  look young enough to be be my daughter, and I don't look too bad myself.  Reflecting on Aubie's comments re looking after one's self better, one wonders whether that would have resulted in a significantly different outcome, or whether, short of frankly abusive habits it would make much difference at all.    Sometimes we don't know what habits are abusive until many years later.  (My parents gave me a silver cigarette case for my twenty-first birthday.  I could probably sell it as a marijuana case now.)  Dietary recommendations change frequently and drug  use is increasingly accepted despite the accepted risks.  The older I get the more I believe my parents advice of 'all things in moderation' is as close to a solution as we are likely to get.      Not that it will confer immunity against anything, but when one looks at the conflicting results of evidence based medicine research, until hard irrefutable evidence emerges it seems to be as good or better advice for good health and longevity as the recommendation of the month.
       So, at the advanced age of eighty and without any scientific basis whatsoever, here is my subjective advice  for immortality - and you can't prove it wrong - just yet!
        Passion.  Live with a passion.  Far from living each day as though it's your last,  live each day as though you are immortal. If you are going to be here forever, things matter!
        Persistence.   Churchill has said everything, but when he said, 'never, never, never give up'  he was giving advice that few today remember, care about or follow.    Very important advice if one intends to live forever.
         Partners.  Persisting in perpetuity requires the right partners.  The right spouse is absolutely necessary to keep one mentally and physically intact.  Day to day survival requires constant mental agility, liberal doses of humour and  the ability to laugh at oneself and each other, as well as physical agility in getting out of the way in a hurry, on occasion.   Remember, your children are not partners, they are your children, even though you have to be a little more subtle in disciplining them when  they are over fifty. 
         Perpetual motion.  You have to keep  moving, preferable with some sense of purpose.  Inactivity, even for short periods can be dangerous or possibly lethal.
          Personal contacts.  Love and frequent contact with loved one's is an essential ingredient.  While social networking is better than nothing, it is no substitute for direct contact.  Eye contact, a hug and a kiss cannot be transmitted over the internet.  Unfortunately, fewer and fewer people  realize this.  Nothing is more rewarding than time spent with the 'kids', relatives and friends.
          Pens.  Collecting fountain pens and other writing implements maintain awareness of the great heights that humans achieved when they could connect the brain with the fingers and have ideas flow freely onto paper, where they were captured in a pleasing and artistic form.   This helped to develop the brain - fingers interface rather than the dumbing down  effect of the keyboard,which leads to neuronal atrophy.
           Phamily. and phriends.  Nothing is more important   Without them one wouldn't need immortality!   From our kids to our brothers and sisters (we don't recognize "in-laws" in our family, we are all truly brothers and sisters, but that's a whole story in itself ), nephews and nieces, grandnieces and grand nephews they are all a fantastic crew.
           I have also found (and this is personal and may not apply to everyone, in much the same way as any  other medication may not be suitable for all), that fairly liberal but not excessive, doses of a fine Scotch (not generic) on a regular basis, works wonders and may indeed actually be the elixir of life!  I'm still working on  it.
            Our recent fabulous party thrown by our kids, ensconced us in Toronto's finest hotel in almost obscene luxury, surrounded us with relatives and friends old and young, from far and near for a weekend of re-union, fun and love.  It was all so wonderful that Irene and I have decided to stick  around for ever!   I don't know how our kids are going to top this for our 90th, which is only 9 years and 11 months away!
             We are eternally grateful to our fantastic kids for the extraordinary lengths they went to for us and thank them for rejuvenating us.