Some Doctors' Oaths Hypocritical, Study Says

By Jesse Stanchak, CQ Staff | taken from Washington Health Policy Week in Review

December 3, 2007 -- Many doctors have trouble living up to their own professional standards, according to a new study published Monday in the Annals of Internal Medicine.

The study, performed by David Blumenthal and Eric Campbell of Massachusetts General Hospital, surveyed 1,600 doctors across a range of specialties and found widespread agreement among doctors on a range of ethical standards, but considerable disparities in how well they live up to those ideals.

According to the study:

• If a colleague was "significantly impaired," by drugs or alcohol or some other problem, 96 percent of doctors felt they should always report the problem, but 45 percent had let it slide at least once.
• Ninety-three percent of doctors felt all serious medical errors should be reported, but 46 percent said they'd failed to report such an error.
• A quarter of doctors would refer a patient to a facility that presented a clear conflict of interest for the doctor, even though 96 percent of physicians said their duty to their patients outweighed financial concerns.
• While 93 percent of doctors felt they should treat anyone regardless of ability to pay, only 69 percent are currently taking patients who cannot pay for their treatment.
• Only 25 percent of doctors have looked for disparities in care based on patient gender or race in the last three years, even though 98 percent of doctors agreed they should be working to minimize these inequalities.

"There is a measurable disconnect between what physicians say they think is the right thing to do and what they actually do," Campbell said in a news release. "This raises serious questions about the ability of the medical profession to regulate itself."

At a forum Monday at the National Press Club to discuss the study's findings, James Thompson, CEO of the Federation of State Medical Boards, argued that doctors were penned in by the American the health care system, fighting giant bureaucracies while fearing legal action if they make a mistake.

"We need to replace this system of punitive measures with non-punitive remediation," said Thompson, arguing that fear of punishment, for themselves or other doctors, makes it difficult for doctors to act on problems.

Sara Rosenbaum, head of the Health Policy Department at George Washington University, agreed that the problem was best addressed by state medical boards and other private regulatory groups, not with law suits and legislation.

"The social ideal is to avoid heavy-handed use of the law," said Rosenbaum, "It's too slow. By the time the money or the changes are ready to effect the people who made a complaint, its too late for the individual." She added that doctors and hospitals already have difficulty meeting their regulatory burden, limiting the effectiveness of new rules.

Rep. Michael C. Burgess, R-Texas, a physician, was in the audience but did not speak on the panel. He has long taken an interest in limiting medical liability suits. While he found himself agreeing with Rosenbaum that the medical industry would have to work harder to regulate itself to correct the issues brought up by the study, Burgess said he also knows how hard it can be effect change at a medical practice.

"The trouble is that it's almost impossible to bounce a physician out of a practice, no matter what they've done, even if you think you've got just an iron clad case against them," said Burgess. "Of course no one wants a doctor that's been drinking in an operating room, but what about the guy with the anger management problem? It's trickier."

Burgess cited a particularly extreme example. "I knew a doctor, years ago, who'd killed his wife, strangled her in fact. And everyone who worked with him knew it, absolutely. But it took 10 years for a case to be built against him and for him to be convicted and until then there was nothing anyone could do, because you're innocent until proven guilty."

Reporting the performance of HIT vendors: Smart Pumps

In 2006, the Institute of Medicine (IOM) reported that "when all types of errors are taken into account, a hospital patient can expect on average to be subjected to more than one medication error each day." To help counteract patient safety issues, the IOM report suggested that hospitals "make greater use of information technology in prescribing and dispensing medications … including the adoption of smart infusion pumps."

Recently, KLAS conducted a study on smart pump usage, with extra attention being given to issues such as the functional strengths of the available pumps, missing functionality, pump tracking and quantifiable benefits reported by providers. KLAS found that while there are difficulties in using, tracking and quantifying benefits for smart pumps, 90% of purchasers would buy their smart pump again. However, there are kinks to be worked out in the areas of functional strengths, missing functionality, pump tracking and benefits.

Functional Strengths

While the majority of study participants (92%) are using smart pumps in all areas, the functional strengths of those smart pumps vary. Collectively, the smart pump vendors KLAS studied scored highest in ease of use of the dose error reduction system (DERS), scored weakest in reporting capability and are most alike in preventing medication errors.

When drilling down into specific vendor scores, KLAS found that reporting capability is each vendor's lowest-rated functional capability. In many cases, providers expressed frustration with pulling data from the pumps. A lack of wireless implementation means that each pump must be located, brought to the download station and manually downloaded. Once more hospitals have wireless features implemented, the data pulls will be substantially less difficult.

But for now, much functionality is simply not accessible. One provider stated, "We are not currently pulling alert data from the system. Not having a way to easily pull the alarm data seems to be the missing link for not being able to do a lot of things, such as monitor which nurses are using the software and which alerts are firing."

Another common concern is that the generated reports are not user friendly. Providers say they have difficulty understanding portions of the reports or that the data are almost useless because of the way in which they are presented.

However, not everyone is unhappy. Many providers like the ability to track what caused an alarm to go off. One provider shared, "We like the event history reporting features. We can access the last 1,000 keystrokes when an alarm goes off, print out the data and save the reports for future reference." Another said, "I like that I can go in and see every button that the nurses push. They will often say it was the pump that was the problem, and oftentimes it was the clinician. This functionality was especially nice in times past when the colleague's on/off button was next to the start button and people would turn off the pump instead of starting it."

Missing Functionality

As mentioned above, wireless connectivity and interfaces are considered essential for ease of pulling data. Unfortunately, wireless connectivity (and interfaces to support it) is the functionality most often identified as missing in organizations' current smart pump arsenal (Figure 1).

Wireless communications needs are varied and range from updating drug libraries, dose guard protection ranges and medication flow rates - which need to be done manually to each machine if not connected - to communicating with the pharmacy. Future anticipated functions involve five rights protection, bar-coding, electronic medication administration record (eMAR) documentation, electronic medical record (EMR) nursing content and other point-of-care functions.

At this point, only 30% of respondents have wireless communication with their pharmacy, and most also do not have wireless access to pump data. For those who do have wireless capabilities, the story is positive. One such provider stated, "The reporting capabilities are great for those who have the server. Without the server, it takes a bit of effort to get the data. I love it with wireless. I can log onto the server in the morning and discover that there has been a reprogramming event, or three or four reprogramming events, during the night on a certain patient, and I can find the patient and see if the changes were appropriate. I can also see if there has been an override on a guardrail that worries me."

In addition to wireless issues, 17% of providers mentioned bar-coding functionality as a missing element in their smart pumps. Most agree that being able to tie data to a specific patient through bar-coding is a desired functionality. One respondent explained, "I can take a look at how many times a user has overridden a particular alert in the guardrails. I can't tie this data to a particular patient or nurse, but I can see general trends around when the alerts are happening, for which drugs and what the corrective actions are. In order to tie this to a particular patient, I would need bar-code scanning technology. This would allow me to scan the patient's wrist and tie the pump to that patient."

However, currently only 6% of respondents indicate that patient medication orders are entered using bar codes. This finding is consistent with other bar-code and nurse findings in KLAS surveys, namely computerized physician order entry (CPOE), where the use of bar-code scanning at the patient bedside for positive patient and medication identification (closed-loop medication administration) was still in its infancy, with 84% of respondents showing none to very low adoption (0-15%).

Pump Tracking

Pump tracking also appears to be its infancy. Users of Hospira pumps were the most successful at tracking the physical location of pumps via radio frequency identification (RFID) or other technology with 53% reporting in the affirmative. This is compared with 19% reported by users of Cardinal Health pumps and 0% reported by users of B. Braun and Baxter pumps. As to the technology used to track the pumps, approximately one-third of study participants reported using RFID, while others reported tracking by noting which wireless hub a group of pumps is transmitting to, and determining general location in this manner.

For those who do not have RFID or other tracking methods (which is the vast majority of users), various manual tracking methods are employed. One provider explained, "Nobody really understands how the pumps move throughout the hospital. For a time, we tried a serial number check-in/checkout process for the pumps, but that failed. Nurses wouldn't trust the fact that they would get clean pumps back if they would just turn in those they were using. Even if the pumps needed repairs, they were hesitant to turn them in. Now, until we get RFID or something like it, we just do the best we can at trying to keep tabs on all the pumps."

Another provider stated, "Right now, we have a system where each pump has a bar code on it, and every day a central service-person goes around the hospital and scans each device to make sure they are all accounted for. The scanner then talks to our ADT [admissions, discharge and transfer] system and makes sure it is on the right patient. Some pumps are kept on standby in departments, but most are assigned to a particular patient. When the patient is discharged, the pump is returned to central services for cleaning."

Nurses are reported to guard their pumps carefully - too carefully in some cases. For instance, one organization reported, "Tracking the pumps is a major issue. We can locate about 95% of the pumps, but there is always a group of them that we just cannot find. We aren't able to really make timely delivery of the pumps, so nursing does hoard them in dropped ceilings or anywhere else they can find."

Quantifiable Benefits

Nurses aren't the only ones who value their smart pumps. Study respondents were asked if they had achieved any quantifiable benefits from their smart pumps purchase, and many answered in the affirmative. Their responses are grouped by category in Figure 2.

As one would expect, reducing errors/patient safety is the top benefit reported, though it is surprising that more respondents did not respond in a like manner. Also surprising is that the number two benefit reported was "too soon to tell." This response suggests that there is more than meets the eye regarding successful implementation and usage of smart pumps. Interestingly, the majority of study participants were seasoned smart pump users who reported that they have used their solutions for more than one year. One would expect that, with such use, the benefits would be realized by now - unless implementation and usage are more difficult than previously suspected.

Another possible explanation is that return on investment (ROI) and other analyses have simply not been conducted yet. As one provider stated, "The data we get from the pumps are only gathered when there is a problem, so it has pieces of data here and there but nothing consistent. It is way too early for us to even try to determine an ROI. I know that we are reporting more errors than before, so that is a good thing. However, for us to get a consistent stream of data from the pumps, either we need them to have a wireless interface to the pharmacy or we need a lot of people to go out and pull the data out of them. We just do not have the personnel to do this."

However, some organizations have done quantifying based upon the cost of an adverse drug event. One provider stated, "We have had a lot of what we call 'great catches,' where a programming error was stopped by a hard limit. We have calculated the average cost of an adverse drug event at $4,500. We had 11 of those last month from the patient-controlled analgesia units alone."

Again, not all organizations have conducted studies to see the rate at which errors have been reduced, and there are difficulties with such an effort (e.g., it is hard to find an accurate baseline since errors often went unreported previous to smart pump implementation); however, those who have conducted basic research generally estimate they are experiencing fewer errors.

One such provider reported, "We have had some good cost avoidance through medication error prevention. We see about four or five medication error preventions every month." Another stated, "I know that in the last year, we have gotten between 30 and 50 calls from nurses who got warnings from the pumps, which prevented medication errors. I do not know the value of these saves."

Complicating matters is the fact that a drug error can be defined in different ways. Should one count a "safe error" as an error? One provider explained this difficulty: "We are constantly looking at drug errors, and I would like to say we are preventing them with the pumps, but I do not know. It is hard to say if going slightly outside the limit would have any kind of effect on the patient, so I do not know what to count as a prevented medicine error."

However, 90% of those who have purchased smart pumps say they would buy them again. Clearly, while each organization's pump data are not all in (or downloaded!), smart pump purchasers are finding enough benefits to warrant continued use and purchase.

For further information on the smart pump study or other KLAS findings, go to www.healthcomputing.com. Providers receive free access to KLAS Online, where one can access ratings on hundreds of medical equipment and HIT vendors and products.

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About KLAS

KLAS , founded in 1996, is the only research and consulting firm specializing in monitoring and reporting the performance of healthcare's information technology ( HIT ) vendors and products. Our senior management staff and advisory board average 25 years of healthcare information technology experience.

How We Serve the Healthcare Industry: KLAS , in concert with thousands of healthcare executives, CIO s, directors, managers and clinicians, has created a dynamic database of information about the performance of HIT vendors. The KLAS database represents the opinions of healthcare executives, managers and clinicians from over 4,500 hospitals and 2,500 clinics on more than 750 different products. The information is continually refreshed with new performance evaluations and interviews daily.

The KLAS database is dynamically and effectively used by:

• Healthcare organizations, to align expectations with a vendor's actual performance, to assist in strategic planning and contract negotiations and to validate decision processes


• Vendors, to monitor their performance in comparison with competitors


• Consultants, for current performance information on a specific company or product


• Healthcare investment firms, to evaluate publicly traded HIT company performance and trends or the competition for a new entrant.

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About the Author
Stacilee Whiting is the manager of corporate publishing for KLAS, Orem, Utah.

Jason Hess is research director of Clinical Ancillary Systems for KLAS, Orem, Utah.

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References
The Institute of Medicine. July 20, 2006. Preventing Medication Errors. Washington, DC. Author. < http://www.iom.edu/Object.File/Master/35 /943/medication%20errors%20new.pdf >.

Ontario's Doctors Applaud Move to Reduce Junk Food in Schools

Ontario's doctors support the action taken by theprovincial government today to remove trans-fats and junk food from schools.In 2005, The Ontario Medical Association (OMA) called for a restriction onnutrient-poor foods for students while under the care of school boards inorder to help curb the rate of childhood obesity. Doctors have also beencalling on the provincial government to mandate one hour per day of structuredaerobic physical activity and exercise for elementary and secondary schoolstudents in order to help reverse this dangerous trend.

"The evidence is clear, obesity rates in children can be siginificantlydecreased with appropriate physical activity and healthy food options," said Dr. Janice Willett, President of the OMA. "It is essential that school be ahealthy environment for children, where they can experience healthy behavioursthat will continue into adulthood."

The OMA report, An Ounce of Prevention or a Ton of Trouble: Is there anepidemic of obesity in children? showed that from 1981 to 1996, the proportionof overweight boys increased from 15 to 28.8 per cent and overweight girlsfrom 15 to 23.6 per cent. The report also highlighted the severe andpotentially life-threatening consequences of obesity. Obese children face anincreased risk of heart disease, high blood pressure, Type 2 diabetes,breathing problems (such as obstructive sleep apnea) and orthopediccomplications.

"The provincial government has shown that health prevention is a priorityand tackling junk food in schools shows they are committed to improving thehealth of our children," said Dr. Willett. "This action, in combination withmore physical activity and public education, will help address this growingpublic health issue."

Disparities in Healthcare Access and Use: Yackety-yack, Yackety-yack

Healthcare Policy / Politiques de Santé, 3(2) 2007: 10-18

Despite change, uncertainty and disarray in Canada's healthcare system(s), some observations about Canadian medicare still seem beyond challenge:

access to healthcare based solely on need is the core value that gave rise to and sustains medicare; the advent, through medicare, of universal, publicly funded physician and hospital services substantially reduced disparities in access to, and outcomes of, healthcare based on socio-economic status (Enterline et al. 1973; James et al. 2007); despite those gains, disparities remain - factors other than need continue to influence access to and use of services. The last point deserves elaboration. A growing body of research evidence indicates that use of hospital services in Canada is generally consistent with relative need across income groups (e.g., Manga et al. 1987; van Doorslaer and Masseria 2004; Allin 2006). Some studies (van Doorslaer and Masseria 2004; Allin 2006) show greater use of hospital services by those with lower income after controlling for healthcare need - perhaps calling into question the adequacy of existing measures of need. On the other hand, studies of specialist services have demonstrated a direct relationship between use and income, education or both (McIsaac et al. 1993, 1997; Roos and Mustard 1997; Dunlop et al. 2000; Finkelstein 2001; van Doorslaer et al. 2006; Allin 2006) - wealthier and better-educated Canadians use more specialist services independent of need. The picture with respect to primary care physicians' services is less clear. Some studies show an equitable (i.e., needs-based) distribution across education and income groups (McIsaac et al. 1993, 1997; Roos and Mustard 1997; Dunlop et al. 2000), while others do not. For example, Birch et al. (1993) found the use of family physician services to be positively associated with level of education (and extent of contact with friends and relatives). Based on data from the 2001 Canadian Community Health Survey (CCHS), van Doorslaer et al. (2006) found that, after standardizing for healthcare need, higher income was associated with a greater likelihood of seeing a primary care physician but a lower number of visits. Using 2003 CCHS data and a similar methodology, Allin (2006) observed a pro-rich inequity in the probability of visiting a family physician, a finding that was inconsistent among the provinces and territories. In the 2002/03 Joint Canada/US Survey of Health, Canadians with low income were less likely to have a regular doctor and more likely to report unmet healthcare needs than those with high income (Lasser et al. 2006). In an earlier international population survey, Canadian respondents with below-average income were more likely than those with above-average income to report having difficulty getting needed care (Shoen et al. 2000). Data from the 1994/95 National Population Health Survey showed that the likelihood of women in the appropriate age groups having either a Pap smear or a mammogram was associated with higher education level and being born in Canada (Gentleman and Lee 1997; Lee et al. 1998). Income level was also independently associated with having a Pap test (Lee et al. 1998). In the 2005 CCHS, respondents in the highest two (of four) income categories were more likely than those in the lowest income category to report having a flu shot in the previous 12 months (Kwong et al. 2007). Ontario-based studies have shown a positive association between income and access to coronary angiography and revascularization (Alter et al. 1999) and to in-hospital occupational therapy, physiotherapy and speech pathology following a stroke (Kapral et al. 2002). Patients from the lowest-income neighbourhoods waited much longer for coronary angiography (Alter et al. 1999) and carotid artery surgery (Kapral et al. 2002) than those from the highest-income neighbourhoods. Recently published studies in Healthcare Policy/Politiques de Santé point to inequities in access to radiation therapy for breast cancer based on income level (Fortin et al. 2006) and to mental health services for anxiety or depression provided by both family physicians and psychiatrists based on education level (Steele et al. 2007). This summary, reflecting a brief and unsystematic scan of the literature, describes only the tip of a much larger evidence iceberg. Clearly, Canadian medicare has failed to achieve healthcare access (and use) based on need, even for those services within the purview of the Canada Health Act: hospital and physicians' services. Being poor, poorly educated or both impairs access to specialist and (probably) family physician services, to preventive care (e.g., Pap tests, mammograms and flu shots) and to services for specific health problems (e.g., cardiovascular and mental health). But income and education are not only associated with access to services; they are themselves determinants of health, and often cluster together with other determinants such as Aboriginal status, early life experiences, employment and working conditions, food security, housing, social exclusion, social safety net, unemployment and employment security (Raphael 2004). The very people who need care the most are the least likely to get the care they need. Evidence of the continuing relationship between socio-economic characteristics and access to health services under medicare is abundant, long-standing and persistent. This evidence is without doubt well known (at least in part) to health system decision-makers. Why, then, is there so little sign of concerted heath policy or health system design and management initiatives at the federal or provincial/territorial levels to address this violation of the fundamental rationale for Canadian medicare? It may be more than coincidence that those on the receiving end of inequitable access are among the least politically and economically powerful members of Canadian society. Although many Canadians are passionately committed to the principle that access to essential health services should be based only on need, they may, given a lack of media and political attention to the issue, assume that the elimination through medicare of (most) financial barriers to obtaining hospital and physicians' services has solved the access problem. Under these circumstances, politicians and governments at the federal and provincial/territorial levels are under little or no pressure to mount a response. As a result, current policy complacency seems likely to continue unless equity of access emerges as a public issue that resonates with Canadians who support the core principles of medicare and mobilizes civil society. Now, there's a challenge for knowledge translation. Meanwhile, there will undoubtedly be lots of talk (research on access inequities and acknowledgment - out of public view - of their existence), but little policy action.

Transforming Healthcare Organizations

Imagine you are a member of a hospital's executive team, having just left a meeting in which you and other members discussed the possible introduction of an ambitious Computerized Physician Order Entry (CPOE) system. Around the conference table you and others questioned whether CPOE would be the most effective way to realize your hospital's commitment to patient safety. Other issues that were raised included whether clinicians would support or resist the change, whether staff would have sufficient skills, where to begin, affordability and whether to proceed incrementally or with a "big bang." While there was much disagreement with respect to each of the issues, there was near unanimity around two important decisions - CPOE would be implemented and you would be the executive responsible for the system's design and implementation. This article, based on the experiences of a multi-site hospital, and drawing on past research on organizational change, provides a Four-Stage model to help change leaders in healthcare. Although relying on Toronto's University Health Network to illustrate the change model, the model is intended to speak to change leaders implementing various types of complex changes in all healthcare organizations. [from Healthcare Quarterly, 10(Sp) 2006: 10-19. Author:Brian Golden]. For the full article go here.

Transforming Healthcare Organizations

Imagine you are a member of a hospital's executive team, having just left a meeting in which you and other members discussed the possible introduction of an ambitious Computerized Physician Order Entry (CPOE) system. Around the conference table you and others questioned whether CPOE would be the most effective way to realize your hospital's commitment to patient safety. Other issues that were raised included whether clinicians would support or resist the change, whether staff would have sufficient skills, where to begin, affordability and whether to proceed incrementally or with a "big bang." While there was much disagreement with respect to each of the issues, there was near unanimity around two important decisions - CPOE would be implemented and you would be the executive responsible for the system's design and implementation. This article, based on the experiences of a multi-site hospital, and drawing on past research on organizational change, provides a Four-Stage model to help change leaders in healthcare. Although relying on Toronto's University Health Network to illustrate the change model, the model is intended to speak to change leaders implementing various types of complex changes in all healthcare organizations. [from Healthcare Quarterly, 10(Sp) 2006: 10-19. Author:Brian Golden]

It's time to balance fight for life with ballooning health costs. Robert Cushman

By Andrew Thomson, Ottawa Citizen
Published: Wednesday, October 31, 2007

With acute-care beds being filled at area hospitals with chronically ill seniors, the time for a serious public discussion on the collision of rising medical costs and the "death with dignity" debate is now, says the man charged with co-ordinating health care in Eastern Ontario.

It's the ethical responsibility of doctors to encourage discussion regardless of the painful moral, ethical, and political questions that arise, said Dr. Robert Cushman, CEO of the Champlain Local Health Integration Network, who added that the demand for such health care is likely to rise.

"Do I have personal opinions on this? Yes I do," he told the Citizen editorial board this week during a wide-ranging, candid meeting.

"But my professional and my public opinion is that we need to have this healthy debate."

Legislatures and courts across North America and Europe have long grappled with the right to die.

For Dr. Cushman, it's a matter of money and higher levels of respect and care for seniors. The strain on acute care resources has to be addressed as Canada's population ages and pressure mounts on health services, said the former medical officer of health for the City of Ottawa.

Dr. Cushman described a number of 80- or 90-year-olds on ventilators being sent to intensive care units, some of whom have Do Not Resuscitate orders lost in the system. His own 87-year-old mother "would not be happy" with such a scenario, he said.

"It's bad enough with our parents' (generation) but when we get these it's going to really burst the bubble," he said of himself and fellow baby boomers.

Health care administrators now face a zero-sum ethical game where dollars are used for chronic patients in "high-end" acute-care facilities instead of community programs and home care, Dr. Cushman argued, reminding his interviewers that bottom lines aren't his only motivation for seeking public dialogue.

"What kind of heroics can you do in the last six months or two or three years of a life?" he asked. "For someone who's over the age of 80, a hospital is a pretty scary place, and a pretty dangerous place.

"We're talking about the frail elderly. And we have too much of an emphasis on the cure when the returns for the cure can be very low. I think we need to respect seniors' independence and their dignity."

Dr. Cushman, who oversees health care funding and delivery for more than a million residents between Cornwall and Algonquin Park, hopes the growing popularity of living wills is one solution.

He also wants to stop seniors from bouncing around the health care system like a "ping-pong ball." That includes improving "ordinary" procedures such as basic nursing care, home support, and meal delivery.

For more on this story go here

Hospital Standardized Mortality Ratio (HSMR) in Canada

The hospital standardized mortality ratio (HSMR) is an important new measure of patient safety that compares a hospital's mortality rate with the average Canadian rate. It examines observed versus expected deaths and is adjusted for various factors such as the age, sex, diagnoses and admission status of patients. The ratio provides a starting point to assess mortality rates and identify areas for improvement, which may help to reduce preventable deaths.

Developed in the United Kingdom in the mid 1990s, the HSMR has also been used in hospitals in Holland and the United States. When tracked over time, the ratio can be a motivator for change, by indicating how successful hospitals or health regions have been in reducing inpatient deaths - leading to improved patient care. CIHI has led the effort in calculating HSMRs for Canada and later in 2007, will be releasing its first public report on results for facilities in all provinces outside Quebec. To learn more about the HSMR, see the documents below: What is HSMR? Saving More Lives Understanding the Report The HSMR Public Release Technical Notes Getting Started Resources Frequently Asked Questions New! HSMR Cases Validation Tool. To download the tool, click here. To see the instructions, click here . To learn more about the public release: Targeted information sessions (via WebEx) are being held prior to the public release. Each topic will be presented twice at the dates and times that follow: For analysts: Session 1: September 18, 2007, 10:00-11:00 EST Session 2: September 18, 2007, 15:30-16:30 EST Objective: To review methodology changes and ask questions of HSMR analytical staff Click here for presentation slides To listen to a recording of the session, you can stream the presentation from the CIHI site or download the WebEx player (http://www.webex.com/downloadplayer.html) and then click here (offline option). For senior leadership audiences (part 1 of 2): Session 1: September 20, 2007, 10:00-11:00 EST Session 2: September 24, 2007, 13:00-14:00 EST Objective: To give a high-level overview of HSMR and outline strategy for public release Click here for presentation slides To listen to a recording of the session, you can stream the presentation from the CIHI site or download the WebEx player (http://www.webex.com/downloadplayer.html) and then click here (offline option). Source: http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=hsmr_e

Canada in a Flat World: A Health & Science Superpower

The following article written by Dr. Alan Bernstein, President of the Canadian Institutes of Health Research (CIHR), ran in the May 23, 2007 edition of the Globe and Mail. It is an abbreviated version of an address Dr. Bernstein gave to the Canadian Club of Toronto on March 26, 2007

The rise of India and China as economic powerhouses, the development of new global communication technologies, global warming, the emergence of new infectious pathogens like SARS, powerful new insights into the workings of the human body, are all creating tremendous challenges and opportunities for countries like Canada. In a flat world, no country is immune from these global tectonic shifts.

We are in a race without a finish line

The 20th century has been characterized by remarkable improvements in human health, virtually everywhere, except sub-Saharan Africa. Longevity in the West has increased by almost two years per decade for the past sixteen decades. New drugs and diagnostic technologies, fuelled by profound advances in the biological sciences, are increasingly based on a detailed molecular understanding of human biology and disease. We are reaching the stage where we can prevent or slow down the onset of some diseases before clinical symptoms are even apparent.

Information and communication technologies (ICTs) will also play a key role. As our population ages, and as we move increasingly from the acute diseases to the chronic conditions of aging (dementias, diabetes, arthritis, frailty), ICTs will link together our homes, our bodies, our clinics and our hospitals. Regenerative medicine, including nanotechnology, bioengineering and perhaps stem cells, will transform how we repair or replace defective or worn out body parts.

But, most profoundly, it will be the synergy that will come from combining this new science and new technology and a heightened sensitivity of our personal responsibility for our own bodies, that will transform human health and our health system.

This profound transformation of health care into a knowledge-based activity has huge economic implications. In our country, health care is a $140 billion industry. In the U.S., that number is $2 trillion. China currently spends $60 per person per year on health care. For Canada, that number is $4,600. So, as China's spending on health care goes from $60 to $600 million over the next decade, the health care industry in China will become a $800 billion industry.

Despite all our concerns about our own health system, Canada has arguably one of the best and well run health systems in the world. That know-how, that knowledge is as exportable and profitable as lumber or oil. Health care is Canada's largest knowledge industry, an industry that will experience phenomenal growth and export opportunities over the next twenty-five years. It is an example of the importance of knowledge and knowledge industries to Canada's future. And, it is a model for how we should structure our thinking about Science and Technology (S&T).

To start, we need to rethink our view of productivity and competitiveness. Productivity today is not about lowering the unit costs of manufacturing picture-tube TVs. Productivity today is about inventing flat screen technologies. Productivity today is not about lowering the unit production costs of bovine insulin. Productivity today is about invention of recombinant DNA technology to produce human insulin in bacteria.

Productivity today is not about improving the efficiency of our health system through training fewer doctors and nurses. Productivity today is about the invention and system-wide application of new ideas and new technologies that will speed up and improve health delivery.
The process of discovery is itself transforming the nature of competition. In a resource-based economy, scarcity drives up price. But in a knowledge economy, it is just the opposite. Software's value goes up the more it is shared. The first fax machine or phone was useless.

And there seems to be no end to new knowledge. Knowledge is not like oil or a piece of capital equipment. Knowledge is not used up, worn out or consumed. Quite the opposite - knowledge and new ideas are different: the more you use them, the more valuable they become.
The centrality of S&T to Canada's future raises other issues such as the need for partnerships and collaborations. In a knowledge economy, knowledge is the most precious commodity. Often, the ideas or intellectual property generated in one company or one university acquires value only when combined with the ideas from another company or university.

Companies, universities and countries must therefore strike strategic and dynamic collaborations in an attempt to create the synergies and complementarities that can only come by merging ideas, creating partnerships and building relationships.

Canada is well positioned to take leadership in this area. Science diplomacy, particularly health science diplomacy, will be a powerful way for Canada to reach out to the world. We place importance on good health and a public health system. I believe that those values, coupled with Canada's exceptionally strong health research enterprise and the universal nature of science that transcends language and culture, will make health science diplomacy as important a diplomatic tool in this century as Pearsonian diplomacy was for Canada in the last century.
For our cities to become a knowledge-based hub, proximity to market is no longer the issue. But, proximity to the world's best universities and to the best research talent is.

We are witnessing the 'death of distance'
The last point is obvious. A successful knowledge economy is built on a highly educated workforce and a society that understands what research is all about and engaged in the issues raised by science. Science is, quite simply, the best way humanity has come up with to solve important problems. Indeed, some of the greatest opportunities for economic progress will come from helping the world solve its biggest problems - in human health, in energy, the environment, in building sustainable cites. This is how, I believe, we will generate the new jobs, wealth for our country, and well-being for our citizens.

This is what science and innovation is all about - discovering and applying new scientific ideas, new knowledge to change the world.

Real, cutting-edge research is tough to do
But transforming science into new products and new policies is even tougher - it is a complex process that involves iterative interactions between the producers and users of new knowledge.
Canada is in a race without a finish line. It's a race to build a nation that provides rewarding careers for our children, that has a sustainable health system, a strong education system, and that is a paradigm for the planet. We're in a race to generate new ideas and to transform those ideas into economic advantage.

I believe Canada can win that race. But how on earth do you win a race without a finish line? First, you have to enter the race. And second, you have to enter it to win.

CBC Toronto - Features - Keeping Dignity Alive

CBC Toronto - Features - Keeping Dignity Alive

Breakfast with the Chiefs :: Longwoods Publishing

We have added a new location to our Breakfast with the Chiefs :: Longwoods Publishing series. This year BWTC is going to Montreal.

Uh-oh, Canada

Uh-oh, Canada

By Bill Steigerwald
TRIBUNE-REVIEW
Sunday, August 26, 2007

If Canada's national health-care system is so dang wonderful, why are so many Canadians coming to America to pay for their own medical care?

Why is the hip replacement center of Canada in Ohio -- at the Cleveland Clinic, where 10 percent of its international patients are Canadians?

Why is the Brain and Spine Clinic in Buffalo serving about 10 border-crossing Canadians a week? Why did a Calgary woman recently have to drive several hundred miles to Great Falls, Mont., to give birth to her quadruplets?

It's simple. As the market-oriented Fraser Institute in Vancouver, B.C., can tell you, Canada's vaunted "free" government health-care system cannot or deliberately will not provide its 33 million citizens with the nonemergency health care they want and need when they need or want it.

Courtesy of the institute, here are some unflattering facts about Canada's sickly system: story continues here:

Of Course Nurses Know What's Right: A Focus on Front Line Nursing

15 papers providing intelligence, policies and practices. Assembled August 20, 2007

Broadening the Patient Safety Agenda to Include Home Care Services
Ariella Lang, Nancy Edwards, Carolyn Hoffman, Judith Shamian, Kathleen Benjamin and Marguerite Rowe
A coordinated and collaborative approach to generate new knowledge pertaining to safety in home care in Canada has been undertaken by the Canadian Patient Safety Institute (CPSI), VON Canada, and Capital Health (Edmonton).

Building the Canadian Paediatric Trigger Tool
Anne Matlow, Virginia Flintoft, Elaine Orrbine, Barbara Brady-Fryer, Catherine M. G. Cronin, Cheri Nijssen-Jordan, Mark Fleming, Mary-Ann Hiltz, Michele Lahey, Margaret Zimmerman and G. Ross Baker
Research on adverse events (AEs) has highlighted the need to improve patient safety.

Can we afford to sustain Medicare? A strong role for federal government
This report urges provincial and territorial premiers to call for federal "uploading" of provincial drug programs. CFNU President Linda Silas says that if Pharmacare is embraced by premiers, it could grant relief to the provinces and provide genuine benefits for all Canadians.

Creating Positive Solutions at the Workplace: Time to Work Together
Creating Positive Solutions at the Workplace: Time to Work Together, was presented by Linda Silas, at the March 22-23 international conference A Call to Action: Ensuring Global Resources for Health. The paper highlights examples of positive initiatives that will make a difference to nurses bringing research to action.

Enhancement of Patient Safety through Formal Nurse-Patient Ratios: A Discussion Paper
A strong body of evidence exists to suggest that by achieving optimal nurse staffing levels that closely match the acuity level of patients, the quality of care is improved. Furthermore,achieving optimal nurse staffing levels also enhances the quality of worklife for nurses. The study shows that Nurse-Patient Ratios could provide a useful roadmap, pointing the way for legislators to put enough nurses where they are needed, when they are needed.

Getting Better Health Care: Lessons from (and for) Canada
Economist Armine Yalnizyan's 2006 book, with translated Executive Summary, reviews the evolution of Canada's health care system and points the way forward with solutions for today's problems.

Getting Healthy Work Environments in Health Workplaces
Linda Silas discusses how unhealthy work environments result in unhealthy workers and reduced health outcomes for patients. This commentary focuses on getting real change in the workplace, changes that workers and patients will talk about.

Nursing sector recommends strategies for addressing nursing HR issues
The Nursing Sector Study's Phase II Final Report outlines all of the pan-Canadian opportunities for collaboration identified by stakeholders. It also provides linkages to other health human resources projects underway in Canada.

Our Health, Our Future: Creating Quality Workplaces for Canadian Nurses
The final report of the Canadian Nursing Advisory Committee, released in 2002, makes 51 recommendations to improve the retention and worklife of Canadian nurses. Linda Silas was a member of the author committee.

Report: Taking Steps Forward: Retaining and valuing Experienced Nurses January 26, 2006
This report, informed by a 2005 survey of nurses reminds policy makers and managers that keeping experienced nurses in the workforce is essential to addressing Canada's worsening nursing shortage as recruitment is not keeping pace with retirement. It points out that linking experienced and novice nurses is the only way to guarantee quality patient care.

Research Report: More for Less: A National Pharmacare Strategy
This report, prepared by the Canadian Health Coalition, makes a compelling case for why Canadians need a public national drug plan.

The Pulse of Renewal: A Focus on Nursing Human Resources
The Pulse of Renewal: A Focus on Nursing Human Resources is a report of work commissioned by Health Canada's Office of Nursing Policy and is focused on strategies for augmenting and enhancing nursing human resources. The research covers a diverse spectrum

Under Pressure: Implications of Work-Life Balance and Job Stress
This report presents new findings from two national surveys, one of employers and the other of workers, on work-life balance and job stress. The report discusses the implications of these issues for employers and points to actions they can take to...
Updated: Aug 2007

Control Over Time and Work-Life Balance
This report was prepared for the Federal Labour Standards Review Committee. It examines the research and relevant Canadian empirical evidence on work schedules, work time and work-life balance. It assesses trends and current practices in Canada.

It's a matter of trust
Graham Lowe
This article discusses the key to building a trust-based corporate culture.

Salaries and Other Compensation for Healthcare Workers in Canada

FROM CANADA'S ACADEMIC HEALTH SCIENCES CENTRES . . . AND MORE

• BC Health Sector Summary Financial Statements, 2007 Download PDF
• Vancouver Island H.A. Staff Remuneration, 2006 Download PDF
• VCH 2005-2006 Health Services Redesign Download PDF
• Vancouver Coastal Health Employee Remuneration, 2006 Download PDF
• Fraser Health Employee Remuneration, 2006 Download PDF
• Provincial Health Services BC Employee Salaries, 2007 Download PDF
• Capital Health Edmonton Annual Report, 2006 Download PDF
• Capital Health Edmonton Review, 2006 Download PDF
• Capital Health Edmonton - 3-Year Health Plan 2006-2009 Download PDF
• Calgary Health Chief Top Paid Among Western Peers, 2006 Download PDF
• Calgary Health Region CEO compensation details Download PDF
• Ontario Ministry Salaries 06 Download PDF
• Ontario Hospital Salaries 06 Download PDF
• Capital Health Nova Scotia, Titles & Salaries, 2007 Download PDF
• Statistics Canada. Wages. Salaries. Other earnings. Download PDF

Canadian Medicare: through the eyes of Peter Gzowski

Canadian Medicare: through the eyes of Peter Gzowski

Health Care 1: Diagnosis

I am sitting on a hard chair in the X-ray wing of a very good—I am to learn—hospital. I have two gowns on: one that opens from the back, one from the front. The combination protects my modesty, I suppose, but I still feel vulnerable. They can get at me either way and stick things in me where I don’t want them to. The gowns don’t match; one is pale blue, the other green. I can’t figure out how to tie them. My scrawny legs jut out from under their hems. My knees show. My feet are encased in floppy cotton slippers, which tie at the ankle, like mukluks, except I can’t figure out how to do them up, either. My dignity is back in the changing cubicle, along with my trousers. The receptionist, young enough to date one of my sons, calls me Peter, as if I have no last name. A technician passes by without looking at me. She is in a peach pantsuit made, like my gown ensemble, of cotton. She looks sharp. Why can’t I have something like that?

I’m tense and, to tell you the truth, a bit scared. I’m sure at least one of my charts will reflect what doctors call “white coat syndrome”—blood pressure that rises because someone’s taking your blood pressure. Except as a visitor, hospitals—health-care facilities of any kind—are foreign turf for me. Not that I’ve looked after myself all these years. More, in fact, that I haven’t. And now I’m getting the works. “Chest X-ray,” the doctor said last week when, at last, I’d actually gone for a visit. “Blood tests, CAT scan, ultrasound, something-oscopy, barium ene—”

“Barium?” I said. “Don’t they—?”

“We’ll make the arrangements,” he said. “Don’t worry.”

Yeah, don’t worry. He isn’t sitting in borrowed jammies, in a world where strangers who call you by your first name stick things into places on your body even you haven’t seen.

Emmett Hall died recently, in a nursing home in Saskatoon. He was ninety-seven. The Globe and Mail called him the “father of medicare,” and so, on the radio, did I. At least one Globe reader and at least one Morningside listener wrote in to say, “Hold on, now, Mr. Justice Hall was a great man, all right, but the father of medicare was Tommy Douglas.” Well, sure, if you want. Tommy Douglas was premier of Saskatchewan when the first provincial health-insurance legislation came in, in 1962, and it wasn’t until 1964 that Mr. Justice Hall’s report was published. But that report gave us the plan for universal, national health care, and that plan, amended and expanded over the years, has been one of the defining characteristics—perhaps the defining characteristic—of the Canada we have built. Medicare helps to make us who we are. And now, as I sit bare-legged in an unfamiliar waiting room, edgily anticipating the end of my privacy, the man who mapped it out for us is gone.

The technician in peach returns. “Peter…?” she says, glancing at her clipboard. I have the impression she would try my last name, but the extra consonants dissuade her. An occupational hazard where she works, I guess. I realize, too, that my revery on Mr. Justice Hall has lasted perhaps five minutes at the most; I have scarcely been waiting at all. “Come with me,” the technician says, and leads me down the hall.

It’s not nearly as bad as I’d feared. I have been, as a doctor I know puts it, “hanging crêpe”—imagining the worst. When I actually get in to the darkness of the ultrasound room, my fears turn out to be unfounded. People are nice to me. They work quickly. They explain what they’re doing. They warm the gel before spreading it on my tummy. They make me feel…not at home, but as if I’m being looked after, cared for. Even the barium ene…well, let’s not talk about the barium, okay? The point is I’m in good hands.*

There’s a lot of pressure on those hands these days. Everywhere, governments are wondering how much of this we can afford. But the politicians haven’t been sitting in their jammies, either, thinking of Mr. Justice Emmett Hall.

I worried about a lot of things when I was in the hospital—maybe some of them too much. But one of them wasn’t money. I like it that way, don’t you?

* As you’ll see in the piece that follows, those hands and their instruments, as it turned out, almost certainly saved my life.

Taken from Peter Gzowski’s book: Friends, Moments, Countryside. Selected columns from Canadian Living, 1993 -98. Here is a review and a place to order. http://januarymagazine.com/nonfiction/gzowski.html. Great summer reading!

Methadone maintenance. Reforming practices in Ontario

The Government of Ontario has responded to task force report recommendations recommending reform to methadone maintenance practices in the province.

The full report can be found at:
http://www.methadonetaskforce.com

Here are the links to two Toronto Star articles:
http://www.thestar.com/News/Ontario/article/239983

http://www.thestar.com/News/article/240446

Here is the governments response:

July 26, 2007: McGuinty Government Increasing Access to Methadone Treatment: Investing $2 Million To Improve Treatment For People With Opioid Addictions

TORONTO- The McGuinty government is increasing access to methadone maintenance treatment for people with opioid addictions by investing an additional $2 million in treatment initiatives across Ontario, Health and Long-Term Care Minister George Smitherman announced today.

“Our government is committed to providing better treatment for people who are addicted to heroin and other opioids,” said Smitherman. “This new funding will allow for continuous improvement of professional services and increase awareness in communities about the value of methadone maintenance treatment.”

The $2 million announced today will be allocated to improve methadone maintenance treatment (MMT) in Ontario as follows:

$1 million to recruit more doctors to prescribe methadone and other treatments, expand training and professional supports at the Centre for Addiction and Mental Health and develop best practice guidelines for nurses, counsellors and pharmacists

$200,000 to the College of Physicians and Surgeons of Canada to enhance enforcement of best practice guidelines and quality assurance initiatives related to methadone services

$500,000 to increase public awareness regarding the benefits of MMT and issues related to opioid dependence.

$300,000 to develop a resource guide to assist in the proper introduction of MMT into local communities including the funding of local “Citizen Engagement Committees”

This brings the province’s annual total funding for MMT initiatives to $4.3 million.

After having consulted with experts in the field, the government intends to finalize changes to the OHIP fee codes that govern payment for testing performed in physician's offices related to methadone maintenance programs. This move will provide greater accountability and help to eliminate unnecessary testing and is expected to save approximately $3 million per year.

In April 2006, the government created the Methadone Maintenance Treatment Practices Task Force to provide advice on access to methadone, best practices and training, payment models, quality assurance and assessment, and community engagement. As part of today’s announcement the government also released the Report of the Methadone Maintenance Treatment Practices Task Force which outlines 26 recommendations directed at all key stakeholders involved in methadone maintenance treatment in the province.

“We want to thank the task force members for their hard work, analysis and dedication in participating in the Task Force and for lending their collective expertise to this important matter,” said Smitherman. “The government is working with stakeholders to implement several of the recommendations.”

“We are pleased the government is taking action on the recommendations of the Task Force report by increasing access to methadone treatment for people with opioid addictions,” said Anton Hart, Chair of the Methadone Maintenance Treatment Practices Task Force.

It is estimated that the social, economic and health care costs of untreated opioid addictions exceeds $1 billion including lost productivity and premature mortality along with costs associated with law enforcement and the use of the criminal justice system.

Diet soda linked to higher heart disease risk: study

[blog editors note] Pharmacists inducing their customers to drink cheap pop -- please take note.

Written by: SHERYL UBELACKER

TORONTO (CP) - For those who drink diet pops in the belief that sugar-free beverages are healthier than regular soft drinks, new research suggests they should think again.

A huge U.S. study of middle-aged adults has found that drinking more than one soft drink a day - even a sugar-free diet brand - may be associated with an elevated risk for metabolic syndrome, a cluster of factors that significantly boosts the chance of having a heart attack or stroke and developing diabetes.

"We found that one or more sodas per day increases your risk of new-onset metabolic syndrome by about 45 per cent, and it did not seem to matter if it was regular or diet," Dr. Ramachandran Vasan, senior investigator for the Framingham Heart Study, said Monday from Boston.

Because the corn syrup that sweetens most regular soft drinks can cause weight gain and lead to insulin resistance and diabetes, "you would expect to see an association with regular soft drinks - but not diet soft drinks," he said. "Our findings suggest that this is not the case."

"That for me is striking."

Metabolic syndrome is associated with five specific health indicators: excess abdominal fat; high blood sugar; high triglycerides; low levels of the good cholesterol HDL; and elevated blood pressure.

"And other than high blood pressure, the other four . . . all were associated with drinking one or more sodas per day," said Vasan, a professor of medicine at Boston University.

The study included nearly 9,000 observations of middle-aged men and women over four years at three different times. The study looked at how many 355-millilitre cans of cola or other soft drinks a participant consumed each day.

The researchers found that compared to those who drank less than one can per day, subjects who downed one or more soft drinks daily had a:

-31 per cent greater risk of becoming obese (with a body mass index of 30 or more).

-30 per cent increased risk of adding on belly fat.

-25 per cent higher risk of developing high blood triglycerides or high blood sugar.

-32 per cent higher risk of having low HDL levels.

But Vasan and his colleagues, whose study was published Monday in Circulation: Journal of the American Heart Association, are unsure what it is about soft drinks that ratchets up the risk of metabolic syndrome.

"We really don't know," he said. "This soda consumption may be a marker for a particular dietary pattern or lifestyle. Individuals who drink one or more sodas per day tend to be people who have greater caloric intake. They tend to have more of saturated fats and trans fats in their diet, they tend to be more sedentary, they seem to have lower consumption of fibre."

"And we tried to adjust for all of these in our analysis . . . but it's very difficult to completely adjust away lifestyle."

While soft drink consumption is declining in Canada, statistics from 2006 showed that Canadians overall still gulp down an average of 85 litres each per year.

Dr. David Jenkins, director of the Risk Factor Modification Centre at St. Michael's Hospital in Toronto, said previous studies have suggested that diet pops did not have the same effects on weight and health as do naturally sweetened soft drinks.

"The unusual thing that needs comment is they (the study authors) say that the diet colas are the same as the calorically sweetened colas," said Jenkins. "So I think that is the piece that they've put into this puzzle . . . I think we need a lot more scrutiny of that."

Jenkins said he believes that high consumption of soft drinks likely goes along with eating a high-calorie diet.

"I think the disappointing thing is if you thought you were doing (yourself) a major service . . . by taking diet drinks, this is not helping you," he said. "Before we were saying take the diet (drink) and you're OK. Now we're saying: 'Watch it."'

The study findings also beg the question whether there is some ingredient in soft drinks - both regular and diet - that may encourage metabolic syndrome.

Caramel, used to colour colas, is an ingredient that goes through a chemical reaction that has been shown in studies to "be quite toxic," said Jenkins. "It's possible that (such products) increase insulin resistance and cause oxidative stress and damage and all the other things we don't want."

Dr. Arya Sharma, chair of cardiovascular obesity research at McMaster University, said one explanation for the link between diet drinks and metabolic syndrome is that their just-as-sugary taste may condition consumers to crave other foods that bring sweetness to the palate.

"So people who drink diet pop may be eating other sweets, whether that comes in the form of dessert or other things, I don't know," Sharma said Monday from Hamilton. "It may be that people who are drinking diet pop - and we have this effect often with people who go on diets or when people go running or whatever - that you do a little bit of something that you think is good, and then you overcompensate by doing more of something that is bad."

"The idea could be because I'm drinking diet pop, I can afford to splurge on dessert."

Vasan said he cannot out-and-out recommend that people stop drinking pop based on this study, because the findings are based on association, not clear cause and effect. More research is needed, he said.

"The simple message is eat healthy, exercise regularly and everything should be done in moderation," he said. "If you're a regular soda drinker you should be aware that this study adds to the evidence that regular soda may be associated with metabolic consequences."

"If you're a diet soda drinker, stay tuned for additional research to confirm or refute these findings."

Michael Moore presents the facts in Sicko

There are nearly 50 million Americans without health insurance.

• The Centers for Disease Control and Prevention actually reported that 54.5 million people were uninsured for at least part of the year. Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2006. Centers for Disease Control. http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur200706.pdf
• The amount of uninsured is rising every year, as premiums continue to skyrocket and wages stagnate. From 2004 to 2005 the number of uninsured rose 1.3 million, and rose up nearly 6 million from 2001-2005. Leighton Ku, "Census Revises Estimates Of The Number Of Uninsured People," Center on Budget and Policy Priorities, April 5, 2007 http://www.cbpp.org/4-5-07health.htm. With 44.8 uninsured in 2005, in 2007 the number will be much higher. Professors Todd Gilmer and Richard Kronick, in "It's The Premiums, Stupid: Projections Of The Uninsured Through 2013," Health Affairs, 10.1377/hlthaff.w5.143, "project that the number of non-elderly uninsured Americans will grow from forty-five million in 2003 to fifty-six million by 2013." According to these authors, by now the number of non-elderly uninsured by this date clearly would be nearly 50 million.

SiCKO: 18,000 Americans will die this year simply because they're uninsured.

• According to the Institute of Medicine, "lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States. Although America leads the world in spending on health care, it is the only wealthy, industrialized nation that does not ensure that all citizens have coverage." Insuring America's Health: Principles and Recommendations, Institute of Medicine, January 2004.
  http://www.iom.edu/?id=19175
  

Don't follow your pharmacists lead. Drink Water Instead.

Pushing Sugar? On June 22, 2007, a major drug store chain held 10 of the “best deals ever reported” for soft drinks. And here's what a thousand cases of soft drinks on the store floor looks like. Download PDF

Fortunately (ya, sure) you can go to this pharmacy chain's web site and find out how the pharmacists can help you achieve a healthy lifestyle Read this:

How bad is the abusive consumption of soft drinks? Here’s a major report on this liquid candy. Download PDF

What do our health care economists think about this? Read this: Fat Zombies, Pleistocene Tastes, Autophilia and the “Obesity Epidemic”

Canadian Healthcare: not Michael Moore's perspective

Canadian Healthcare: another perspective watch video

Filmmaker Stuart Browning provides a cautionary lesson about a politicized health care system where politicians and bureaucrats determine medical priorities. To watch the video click here.

Canadian Healthcare: not Michael Moore's perspective

Canadian Healthcare: another perspective watch video

Filmmaker Stuart Browning provides a cautionary lesson about a politicized health care system where politicians and bureaucrats determine medical priorities. To watch the video click here.

A rebuttle to "Sicko" featuring Lindsay McCreath and his wife.

watch video

Film maker Stuart Browning highlights the plight of Lindsay McCreith, an Ontario man with a cancerous brain tumor who crossed the border to the U.S. to get the medical care that is rationed in his home country. Its called: Lindsay McCreath offers a short course in brain surgery -- American style. click here.

Lindsay McCreith speaks out about his brain tumor

Healthcare Reform, Michael Moore and a three-point strategy.

Michael Moore's answer to the problems facing US healthcare policy makers? Rip the system apart, give the federal government control, create a single-payer system that takes for-profit insurance companies out of the equation and regulate pharmaceutical companies "like utilities since they're just as important as electricity and water."

He's got friends. Hillary Clinton, John Edwards, and Barack Obama have all proposed radical overhauls of the health-care industry, with the goal of covering more Americans and lowering costs. California Governor Arnold Schwarzenegger has also laid out a plan for remaking California's health system, in the wake of a similar move by Massachusetts.

The proposal from Obama (D-Ill.) came on May 29 in a speech at the University of Iowa, where he outlined a $50 billion-a-year universal health-care plan for all Americans that would increase taxes on the wealthy and require virtually all employers to offer insurance to workers or face tax penalties.

(source: www.michaelmore.com)

Michael Moore, Lindsay McCreith and the Wall Street Journal

June 28, 2007
Health Care in Canada: What a Great Model

A view of Michael Moore's new propaganda film from a Canadian perspective. From today's Wall Street Journal

TORONTO--"I haven't seen 'Sicko,' " says Avril Allen about the new Michael Moore documentary, which advocates socialized medicine for the United States. The film, which has been widely viewed on the Internet, and which will officially open in the U.S. and Canada on Friday, has been getting rave reviews. But Ms. Allen, a lawyer, has no plans to watch it. She's just too busy preparing to file suit against Ontario's provincial government about its health-care system next month.

Her client, Lindsay McCreith, would have had to wait for four months just to get an MRI, and then months more to see a neurologist for his malignant brain tumor. Instead, frustrated and ill, the retired auto-body shop owner traveled to Buffalo, N.Y., for a lifesaving surgery. Now he's suing for the right to opt out of Canada's government-run health care, which he considers dangerous.

Ms. Allen figures the lawsuit has a fighting chance: In 2005, the Supreme Court of Canada ruled that "access to wait lists is not access to health care," striking down key Quebec laws that prohibited private medicine and private health insurance.

Elsewhere, the AFL-CIO aligns itself with Michael Moore and socialism. (Yes, yes. We know it's considered bad manners and politically crude to refer to socialism in these debates. But what else do you call eliminating the private sector from health care? Universal coverage? That may describe the end, but it certainly doesn't describe the system.)

Lawsuit Aimed at Stopping Junk-Food Marketing to Children

Kellogg Company Makes Historic Commitment, Adopting Nutrition Standards For Marketing Foods To Children

Advocacy Groups and Parents Applaud Efforts, Drop Plans to Sue

WASHINGTON: Kellogg Company will adopt nutrition standards for the foods it advertises to young children, and the Center for Science in the Public Interest (CSPI), the Campaign for Commercial-Free Childhood (CCFC), and two Massachusetts parents will not proceed with a lawsuit against the company.

Foods advertised on media including TV, radio, print, and third-party Web sites that have an audience of 50 percent or more children under age 12 will have to meet Kellogg's new nutrition standards, which require that one serving of the food has: (for more information click on the title of this posting)

Can we improve peer review ?

We have blatantly taken this blog topic from the pages of The Scientist. It seems a good idea to have this discussion.

How should NIH improve peer review? [And we add] How should Canadian research groups improve peer review?

The original post (below) came from Ivan Oransk

Today (June 08, 2007) the NIH announced that it was establishing two working groups to examine its peer review process. That process has been under increased scrutiny recently, as study sections have needed to read more and more grant applications with every cycle. And with NIH funding flat, it's no longer good enough to be in the top 30% or so to get funded; in some study sections, it's close to 10%. So many scientists may find the examination welcome.

In 2005, in the pages of The Scientist, David Kaplan proposed a number of ways to improve peer review at the NIH. What do you think of his suggestions, which include decreasing the length of the research plan to between two and four pages so that 20 to 30 reviews for each application could be solicited, and doing away with committee meetings? Where do you suggest the new committees look for improvements? Give The Scientist your ideas by commenting on The Scientist blog or provide your comments using the tools below.