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