Sunday 29 March 2020


Quarantine instructions by... Isaiah 26:20

Go, my people, enter your rooms
and shut the doors behind you;
hide yourselves for a little while
until his wrath has passed

Oh, how things can change in a short time!  

  Just a while ago our government was recommending Bill C-7 proposing to remove the requirement for a "reasonably foreseeable natural death" to qualify for "MAID" (medical aid in dying).  
See article below  ( Concerned Ontario Doctors.

   "Canada’s initial euthanasia legislation was passed in June 2016. In 2017, Ontario had become the only jurisdiction in Canada and the entire democratic world to violate physicians’ fundamental freedom of conscience despite it being protected under the Canadian Charter of Rights and Freedoms, the United Nations Universal Declaration of Human Rights and the Declaration of Geneva. The International Code of Medical Ethics demands a physician practice his or her profession with conscience and yet, Bill C-7 does not contain any conscience protection for physicians.

The amendments proposed by Bill C-7 have been tabled even prior to the commencement of the 5-year parliamentary MAID study. No jurisdiction in the world with legalized euthanasia has moved this quickly towards a state of unrestricted euthanasia. In 2016, Canada’s government failed to first pass legislation for the right to palliative care and assistance to live with dignity, as exists in other jurisdictions with legal euthanasia. Canada is the only nation with legalized euthanasia under a socialized single-payer healthcare system. Canadian governments have failed to plan for its rapidly growing and aging senior population: Its healthcare system is in crisis. Hallway medicine has become the norm, more than 85% of Canadians do not have access to essential palliative care, more than five million patients do not have a family doctor, and patients are suffering and dying on multi-year wait-lists for specialists.

Bill C-7 proposes to create two tracks and would remove the existing key criterion for a “reasonably foreseeable natural death”. The legislation follows a 2019 Quebec court’s decision in Truchon and Gladu. However, advocates for people with disabilities, including the Council of Canadians with Disabilities and the Canadian Association for Community Living, have said the court decision was discriminatory and sent the message that "having a disability is a fate worse than death". They urged the Trudeau government to appeal the Quebec court ruling, which it declined to do."

The Bill further proposes to remove many existing safeguards that serve to protect vulnerable Canadians, including decreasing the number of witnesses required for a MAiD request to one individual, the removal of the ten-day reflection period and the allowance of advanced consent. The Canadian government has also signaled its intention to allow for further expansion of euthanasia for children and mental illness, possibly as early as next year.
   Despite protests to the contrary, as I blogged previously, once descent of the slippery slope begins it quickly  gains momentum. (Free fall in a vacuum will accelerate at approximately 9.8m/s2).  It doesn't take the politicians and their satraps long to realize that the 'MAID' program liberally applied will result in huge financial savings to the health care system, since the elderly consume a great amount of the health care resources.  With the predilection of the coronavirus to obliterate the elderly, the accelerating drift into a geriatric demographic could be reversed.  Governments are well aware what that would save the declining health care system.  
   Failure of preparedness for the catastrophic situation that exists now is partly due to lack of insight and unwillingness to invest adequately in the safety of health care professionals. This impairs the efforts of those with the expertise to deal with the crisis.  The pre-occupation  of our Prime Minister with 'virtue-signalling' by sending sixteen tonnes of facial masks and other protective gear to China as the present international  coronavirus cataclysm was gaining increasing momentum left Canadian health care providers unprotected and vulnerable.  Other protective measures for health workers have also been ignored.
   We expect a great deal from our health care providers.  They expose themselves to considerable risks on our behalf, the least we can do is stand up and demand they have state of the art protection so that they can continue to look out for you.  Call your local MPP and tell him/her that's the least you expect.

Monday 9 March 2020


Headline in the National Post a couple of weeks ago: "Unilever takes aim at obesity in kids,".
Subheading -' Won't advertise ice cream to children'' It goes on to say the company will stop advertising foods and beverages to children under the age of twelve!
The word health organization names childhood obesity as one of the most serious health issues of the twenty-first century. Obesity rates for children and adolescents have more than tripled since the 1970s. A national survey of children's health just last year reported an obesity rate in the ten to seventeen group averaged 15.3 %
Whenever I go into Chapters/Indigo to browse, I find new books on Obesity assuring desperate potential readers that the book in question is the ultimate solution to the problem. Of course if that were the case there would be only one book. That's all that would be necessary. But, when I looked up books on weight management on Amazon, I got tired after I counted up to one hundred and fifty and abandoned the task. It's a multi -million dollar industry.
When I started in general practice in the early sixties it didn't take long for me to recognize the relationship between obesity and disease. Diabetes, hypertension, gall bladder disease, cardiovascular disease were all related to obesity. Aesthetically obesity was undesirable, making exercise physically and mentally uncomfortable and in those less politically correct days obese people were often stigmatized, jeered and generally deprecated. Then as now there were dozens of "miracle" diets, programs, medications, some of which helped to lose weight, most of which tended to be regained soon after the diet or program was abandoned. Millions of dollars were spent annually by patients looking for the "magic bullet". There is no magic bullet. The bottom line is that there was then as there is now only one rule: Calories in must equal calories out to maintain constant weight. If more calories are consumed than are burnt the excess calories are converted to fat at a rate of one pound of fat per 3,500 calories. If more calories are burnt than are consumed the fat bank contributes them, Certainly there are conditions that influence the rate that calories are burnt off, exercise and activity, metabolic rate and certain other conditions. In the vast majority of cases there is no underlying medical diagnosis to account for obesity. There is no easy way to lose weight and to keep it off. I used to take some time to raise the topic with patients I thought needed help to deal with obesity when I was in private practice, but it was time consuming, poorly paid and with a poor success rate. In a busy practice it was difficult to spare the necessary time.
When I became an academic physician I thought this would provide an ideal opportunity to develop a sound nutrition and weight reduction program and introduce it into the resident curriculum. Numerous patients expressed interest in attending such a program and it made sense to establish an evening group that would accommodate a dozen or so people to be held once a week for about eight sessions. This would avoid interference with the busy daytime clinical activity. The academic department of Family Medicine was in University Hospital. There was no budget available to establish such a program despite the important educational and research potential. When I submitted a modest budget primarily to reimburse staff for their evening involvement nurse, dietitian,physio etc, I was advised that my budget would be considered for the following year and if I had the group up and running it would help. Everyone realized the important role nutrition and weight control played in promoting good health, I was reassured. The entire budget was a few hundred dollars.
Full of enthusiasm, I put together an enthusiastic team who agree to work pro bono because they realized the importance of the problem we were adressing. One of our senior nurses, who had been a pediatric nurse in her younger years and become interested in overweight children had developed an unofficial 'mini-program' directed at fat kids and their parents, that carried over into her family practice nursing. She immediately offered her services in the organization of a weight control program. She understood we had no budget and that initially at least, there was no immediate prospect of being reimbursed for her time. She didn't care and was prepared to give up her Monday nights to 'help people'. Yes, there were people like that in health care in those days.(P.J. Barnum said, 'there's one born every minute'). Within the infrastructure of University Hospital, I found a dietitian who was interested in establishing the Monday Night Obesity Group, despite my informing her that there was no U.H. Budget and possibly there never would be one. She didn't care, she volunteered to be part of the group. A couple of our office staff volunteered to do the organizational things that are essential for any group to function effectively.
Next, I found a physiotherapist, a competitive athlete herself who was interested in being part of the group.
"Oh," said she, "I'm really interested in developing general fitness programs. I'm certainly interested in getting overweight people as fit as possible!.
"As long as you realize we are not dealing with competitive athletes here, for the most part we are looking at overweight patients with health problems that would benefit from a moderate exercise program that would improve their health rather than kill them."
"Point made" she said. "Still, I'm interested". And indeed she was and contributed significantly to the program, even though I occasionally had to remind her that our objectives were relatively modest - to keep folks mobile and functioning rather than train Olympic athletes.
Next, I had to recruit a few physicians who were prepared to take on yet another evening activity. In those days before family physicians were more than eager to slough off after hours stuff to walk-In clinics, hospital emergency departments, etc, many doctors had on-call obligations one, two or three nights a week. Most took these obligations very seriously. When a physician told patients to go to the emergency department, it was to MEET them there. It was difficult - and perhaps unfair to ask them to commit yet another of their evenings, but being the suckers we were in those days I managed to recruit a few. Some of the office staff had volunteered some of their Monday nights, so we got our crew together in a relatively short time, I was sure that when the next hospital budget came around we would be allocated at least enough to give those volunteers a modest stipend for their contribution.
  We posted a few notices around the department informing patients that a weight reduction program would be commencing in a month and anyone interested should register with the front desk for further information. We thought eight or ten people would be ideal but thought we would be lucky to get four or five to start with. Within a few days we had many more requests than we could handle. Until we had the protocol nailed down it would be a mistake to take on too many folks.
We were ready to go within a couple of weeks and had a growing waiting list for the next few eight week courses. We adopted a behaviour modification approach to weight loss which may be outlined later.
The program thrived, gained some local fame but no fortune. Despite the fact that patients benefitted and residents and students learned a little about nutrition and how to treat obesity, the hospital program budget committee turned down the request for a measly $700 budget.
The program continued for several months until the warriors grew weary of working without recognition or reimbursement. I guess obesity control is not very glamorous not matter how much ill health it prevents.
At least we all got our Monday nights back!!