Investigating the truth behind sports drinks

Rhodes Scholarship recipient Braden O’Neill is a third-year MD student at the University of Calgary currently on a leave of absence to study at the University of Oxford in the Department of Primary Care Health Sciences.  

The Rhodes Scholarship, often dubbed the world’s most prestigious scholarship, is a postgraduate award supporting exceptional students and the academic elite. The scholarship includes tuition, college fees, and a stipend covering living expenses for two to three years of study at the University of Oxford. O’Neill is the 11th University of Calgary student to receive the scholarship since 1969. Once he has completed his studies at Oxford, he will return to the University of Calgary to complete his MD degree.

With the Olympics nearly upon us, and the Tour de France just having wrapped up, sport performance is the hot topic right now. Even our office here in Oxford – normally a hotbed of discussion about relative risks and numbers needed to treat – is abuzz with talk of who has tickets to what, and if Usain Bolt is really going to repeat his titles in the 100m and 200m.

A combination of Olympic fever and recent reports that being sedentary is really bad for us has people all over dusting off their runners and racquets and deciding to get back in shape.

And after a long workout there’s nothing quite like a specially-formulated sports drink to replace those electrolytes and help you recover.

Whether it’s ‘faster, stronger, for longer’, ‘enhances recovery’, or ‘gives you that extra boost’, sports product marketing is everywhere. Even the official drink of the Olympics this year is Powerade, whose ads claim that ‘Water is Not Enough’.

One of the research groups I work with here – the Centre for Evidence-Based Medicine – recently completed a study on sports performance products which I had the great privilege of being a part of. What we found didn’t quite support all those bold claims.

You can see the series of studies here – released last Thursday in the British Medical Journal (BMJ) – and we also helped with an hour-long BBC Panorama investigative journalism report on ‘The Truth Behind Sports Products’.

Here’s how this worked:

We poured through magazine adverts and found all the ones about sports products. We then looked at the websites for all these products, and extracted all the evidence that companies report backs up their claims. Then, we contacted all the companies and asked them if they agreed that they were making certain claims, and asked if they had any more evidence to back them up. There were lots of interesting responses, and you can see all their responses in a web appendix to the articles.

My personal favourite was from Nike, who directed our attention to a video of a shoe with a voice-over of someone explaining how it worked. Dear Nike: in a field where ‘high quality evidence’ means an appropriately powered randomized controlled trial, a video of a shoe doesn’t quite cut it.

Overall, here’s what we found:

Of 431 studies we assessed for quality and risk of bias, there were only three that were of sufficient quality to be able to trust their results. Most of the studies companies reference to underpin their claims are narrative reviews or position papers – in other words, expert opinion, which is the lowest level of evidence.

Then we went a bit further, and looked at specific common sports myths and the evidence behind them:

‘Branched chain amino acids improve performance or recovery after exercise’ No objective performance improvements, but there is decent evidence that people report that they help. (you can decide how to interpret that finding for yourself!)

‘Energy drinks with caffeine and other compounds improve sports performance’ Caffeine improves performance, if you want to abstain from it for seven days before you use it, and only if you are going to be exercising for more than 60 minutes at high intensity.

‘You should drink before you feel thirsty’ Ridiculous. Absolutely ridiculous. Your body is awfully good at regulating this and telling you when you need to drink something. Listen to it.

‘Urine colour to assess dehydration’ Surprisingly useless, unless you have been trained to be able to do this.

‘Compression garments improve performance or enhance recovery’ Maybe, if you want to wear them continuously for 24 hours after a workout.

‘Carbohydrate and protein combinations improve post-workout performance and recovery’ Useless. Stick to delicious Alberta beef instead.

So there you have it, just in time for the Olympics.

Our conclusions? Get some shoes you find comfortable and want to wear, and if you’re thirsty after exercising, have some water.

It’s all in the evidence.

Braden O’Neill
Proud University of Calgary Medicine Student
Follow me on Twitter @BradenONeill

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Baby Boomers Facing Hepatitis Time Bomb

By Mark G Swain, MD, MSc, FRCPC
Professor of Medicine and Cal Wenzel Family Foundation Chair in Hepatology
Snyder Institute for Chronic Diseases
Head, Division of Gastroenterology, University of Calgary 

Hepatitis C is a virus which was first identified in 1989. Very quickly it came to be appreciated that hepatitis C was a significant health issue, infecting roughly 250,000 Canadians; a five-fold higher number than are infected with HIV. Hepatitis C is mainly acquired through exposure to contaminated blood; through transfusions and through the use of intravenous drugs. In fact, after exposure to hepatitis C, even after one exposure, up to 85 per cent of people will keep the virus in their bodies for the rest of their lives. Hepatitis C lives in the liver where it multiplies, and as part of its’ life cycle, hepatitis C kills liver cells. In response to these dying liver cells the liver tries to heal itself with scar tissue, and in roughly 20 per cent of infected people after 2-3 decades of infection, the amount of scar tissue in the liver can get to the point where these individuals have developed cirrhosis of the liver. Many people believe that excessive alcohol intake is the cause of liver cirrhosis; however, there are in fact many causes of cirrhosis, with hepatitis C being an important cause of cirrhosis in Canada.

Typically people infected with hepatitis C have no symptoms, and so they do not suspect that they are infected. Over time they often forget that they have a risk factor for hepatitis C acquisition, and it is not until 20 or 30 years later that they are discovered to have hepatitis C infection, and in many instances have advanced liver scarring. This issue has been recently brought to light by the findings, in a large American study, of a significant increase in the incidence of hepatitis C infection amongst baby boomers (prevalence rate of 3 per cent of people within this age group). This finding in general reflects lifestyle choices made by individuals who lived during the 1960’s and 70’s, when experimentation with injection drugs occurred widely.  Often this experimentation took the form of a single exposure, and was soon forgotten. However, it is becoming increasingly apparent that hepatitis C was acting in a stealth fashion, silently destroying the livers of many of these people.  As a result of this, hepatitis C has now overtaken AIDS as a cause of death. Hepatitis C is currently the most common indication for liver transplantation in Canada; however, as a result of organ shortages up to 20 per cent of people with hepatitis C-related liver failure will die waiting for a liver transplant. In addition, hepatitis C-related cirrhosis leads to the development of liver cancer in up to 3 per cent of infected people per year.

Despite these concerning statistics, not all is doom and gloom for these baby boomers. Treatments for hepatitis C have made astounding breakthroughs through research over the past few years. Specifically, just recently Health Canada has approved 2 new therapies which, when combined with standard treatment protocols, can cure hepatitis C in up to 75 per cent of people infected with the most common type of hepatitis C in Canada. Unfortunately, these new therapies are very expensive, potentially limiting access to those infected and in need of treatment most. In Calgary we are fortunate to have a world leading Hepatitis Unit, located in the Snyder Institute of Chronic Disease at the University of Calgary, which has specialized expertise in the treatment of hepatitis C and its’ complications, providing those infected with leading edge hepatitis C care.

This column was written in response to a study from the US Centers for Disease Control and Prevention (CDC), published in the February 21 2012 issue of the Annals of Internal Medicine.

The research paper can be found here:

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Impressions from rural Laos


Robert G Lee MD
Professor Emeritus
Department of Clinical Neurosciences

The district hospital at Virabouly, the site of a gold and copper mine started by Australians - and now taken over by Chinese.

In January 2012 my wife and I spent one month in Laos as part of the University of Calgary – Laos partnership project to improve medical education and train family doctors to serve in the rural areas of Laos. The family medicine training program has been very successful and has now produced more than 100 new family doctors in Laos since its inception in 2006. Most of my time during this visit (my 16th trip to Laos since 1999) was spent in the southern city of Savannakhet (SVK), one of the provincial training sites for the family medicine (FM) program, where I worked with other colleagues from Calgary and our Lao partners to conduct the end of year evaluations for first- and second-year FM residents. I also helped the Lao teachers conduct the orientation for the new batch of residents who are just starting the program.

Since a substantial part of the FM training takes place in rural villages and district hospitals, we were interested in visiting some of these sites. For three days in late January we travelled to the eastern regions of SVK province with Dr. Phetvilay, a remarkable young woman who was one of the first graduates from the FM program and who now serves as the coordinator for family medicine training at the SVK provincial hospital.

We visited four district hospitals.  Family Medicine graduates are working at three of them. Our first stop was at Phalansay,  Phetvilay’s home town – about two hours east of SVK city. This is the place where dinosaur footprints and some fossils have been discovered and we learned that it was Phetvilay’s father who actually first discovered the footprints and arranged for French paleontologists to start investigating.

From there we headed farther east to Phine where we stayed overnight. There is a district hospital there which has been renovated with funding from CIDA. It is clean and well maintained with mostly single rooms and en suite toilets for the patients – something we have not seen before in Laos. The hospital director is the only doctor but he has three medical assistants working with him, one of whom has some training in anesthesia so they are able to do Caesarians and other emergency surgery. It would be an ideal place for a family medicine grad to start working.

The OSCE exams for family medicine residents. Dr. Noot (in the background) is role playing as a mother with a child who has had a febrile seizure

The next day we travelled up part of the old Ho Chi Minh trail to a town called Virabouly where there is a district hospital with one of the FM grads working there.  Along the road to this town we passed several  Lao Teung villages, one of the ethnic minority groups in that part of Laos. We stopped at one of these villages to look around and take some photos. It was interesting to note that there seemed to be only one man in the village who spoke Lao and was able to communicate with Phetvilay. The poverty was even more obvious than what we have seen in other parts of rural Laos. We had a long discussion about this after we left and I asked Phetvilay what she would do if she were a senior government official and had a lot of money to improve the standard of living in villages like this. Without any hesitation she said she would put it into education. She said that as long as people in villages like this remain uneducated things will not change.

Our next stop was in Sephone where there is a good district hospital which has been renovated with assistance from Belgium. We met the director who took us on a tour of the hospital, and it was an impressive facility. One of the FM grads is working there but he was not around at the time of our visit.

From there we headed on to the Vietnamese border where we had lunch. This part of Laos is mostly scrub bush with no large trees – a reminder of the extensive defoliation from agent orange and other chemicals used by the Americans during the war. Along the way we had an interesting lesson from our driver on the different types of development assistance. The road from SVK city to Sephone is in terrible condition – full of potholes and broken pavement. From Sephone to the Vietnam border the road is as good  as the Transcanada  from Calgary to Canmore. Our driver told us that the eastern section had been built with assistance from Vietnam who sent in their own engineers who supervised the construction. The section from Sephone west to SVK city was built with assistance from Japan which gave the money to Laos and let them do it on their own  – draw your own conclusions!

One of the family medicine grads in the OR at the Virabouly District Hospital

The following day we visited another district hospital at Songkhone, a town about 70 km south of SVK city. This is a fairly new hospital which was built about five years ago with funding from JICA (Japan). The director and one of the FM grads who works there took us on an extensive tour. This is an impressive facility – like the hospital at Sephone, they do about 50 deliveries and 20 surgical procedures a month, and have a busy out-patient clinic. Both hospitals would be very good training sites for FM residents. Phetvilay thinks that, with the family medicine program expanding to three years, that it might be a good idea to add one or two more district hospitals as training sites – I fully agree.

For more photos, please visit:!i=1672300763&k=vMDwQPJ

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I arrived in Oxford under deceptively sunny skies

Rhodes Scholarship recipient Braden O’Neill is a third-year MD student at the University of Calgary currently on a leave of absence to study at the University of Oxford in the Department of Primary Care Health Sciences.  

The Rhodes Scholarship, often dubbed the world’s most prestigious scholarship, is a postgraduate award supporting exceptional students and the academic elite. The scholarship includes tuition, college fees, and a stipend covering living expenses for two to three years of study at the University of Oxford. O’Neill is the 11th University of Calgary student to receive the scholarship since 1969. Once he has completed his studies at Oxford, he will return to the University of Calgary to complete his MD degree.

I arrived in Oxford under deceptively sunny skies. Some of the other Canadians met us upon our arrival, and took our bags and helped us with banal logistics like where to buy bed sheets and soap and plates. After being up for over 30 hours it was a welcome relief to have (somewhat) familiar faces to take care of us on the first day.

It was when I arrived at Rhodes House and saw Adele sitting there that I knew I would be well taken care of.

Many of you may be aware that Adele Meyers is not in fact in Oxford with me, although having benefited from her problem-solving abilities many, many times over the past few years it would be understandable how one might want her to come with. Those of you who are unfamiliar with Adele should know that she is essential to our Undergraduate Medical Education program in Calgary. Most of her work goes on behind the scenes, but what is obvious is that when there is a problem, she ameliorates it with grace and efficiency.

Rhodes House, which is the home and office of the Rhodes Scholarships, also has an Adele – her name is Mary Eaton and she has a similarly indefinable, transcendent role in the organization. Some say that she has worked for MI5 and/or the Queen. This may be quite accurate.

In his seminal biography of Sir William Osler, Dr. Harvey Cushing wrote about how all great institutions have this kind of defining figure, someone who maintains the institutional legacy while sitting comfortably outside its competitive hierarchy. I say this to indicate two things: that we are lucky as medical students in Calgary, and that University of Calgary Medicine is a truly great institution even when compared with some of the very best in the world. I couldn’t provide the first-hand account of this until recently, but I can now say with certainty that it is true.

Now that I am at an appropriately belated point in this post, I will undertake an introduction so that this all makes a bit more sense. My name is Braden O’Neill. I am a third-year MD student at the University of Calgary currently on a leave of absence to study for a DPhil at the University of Oxford in the Department of Primary Care Health Sciences. Yes, this is the same thing as a PhD, but at Oxford they have to be different and call it a DPhil. This experience has been made possible by an extraordinarily fortunate thing that happened to me – I was awarded a Rhodes Scholarship. Now you know me a little better. Let’s continue.

My first few weeks in Oxford have consisted primarily of tasks like obtaining a bank account (which is considerably more challenging over here than you can imagine), purchasing duvets, buying a bicycle, and having the lights stolen off it shortly thereafter. There have been some substantially less mundane moments, like sitting with my DPhil supervisor to talk about what I am going to be doing for the next three years. Briefly, my interest is in health literacy, and how it affects patients’ experiences of illness and their interactions with the health care system. I am also looking at how people use online resources to obtain and to share health information. This has broad implications for physician-patient interaction (think of patients who come to the clinic with internet printouts!) and related implications for medical education, but I am still mainly at the stage at which I am trying to replace the stolen lights from my bicycle. I will report back when I have something of consequence on those other subjects.

As I alluded to earlier, the University of Oxford is not really a university in the traditional sense of the word but rather a confederation of 38 constituent colleges in which you live, socialize, and work. It has also occurred to me that when I say the “traditional” sense of the word, what I really mean is that Oxford is the definition of traditional, and that every other university does things differently. But now I think we are into semantics.

I am at University College, which is the oldest, and famous for being the college Bill Clinton attended but from which he did not graduate. It also rejected Cecil Rhodes, who was promptly admitted to Oriel College just next door down the High Street. I will leave this to you to decide whether or not this was the right decision, but suffice it to say, I am here on his beneficence, and that what Mr. Rhodes ended up doing with his fortune (however it may have been earned) was an inspiring and visionary thing in a time when there was not a lot of that going on in the world. The history of the Rhodes Scholarship will be saved for another entry, but let’s just say it is in fact primarily about “rendering war impossible,” which is about as noble a cause as I can imagine. But I digress.

While Stephen Hawking did his undergraduate work at my college, he was denied re-acceptance for his graduate work and ended up at Cambridge; probably not the best decision the college has ever made.

Interesting fact: when Stephen Hawking was signing the college register, he made a significant error and had to cross out a line and start over (I got to see his signature a few hundred pages before mine in the book). Now when we sign the register, the head of the college watches over us to make sure we do it correctly!

Recently I had my “matriculation” ceremony, which is the formal ceremony where you are accepted as a student into the university. It involves getting up early on a Saturday and being very, very cold as you are arranged with military precision to take a group picture. Subsequent to this, you are brought by the head of your college (variously called the don, the dean, the head, the warden, the master, or various other names depending on the whim of your individual college) to the Sheldonian Theatre (designed by Sir Christopher Wren, who also designed St. Paul’s Cathedral in London) where you are presented to the vice-chancellor of the university who accepts you as a student. The best part of all of this is that you dress up in something called “sub fusc,” which involves a gown, white bow tie, white shirt, dark suit, and black socks. They are very particular about the black socks. Tourists actually plan to be in Oxford for matriculation day, which is the Saturday of first week of Michaelmas Term (this being the first of the Michaelmas, Hilary, Trinity three-term system here), so that they can take pictures. It was as amazing and overwhelming as it sounds.

After matriculation there is a tradition that you go to a pub and have a pint in your sub fusc, which I did with a friend who is a chemistry student from Germany. We drank warm, non-fizzy beer (I can report with certainty that Canadian beer is just better than British beer, and would challenge anyone who thinks otherwise) and talked about the future of point-of-care testing for malignancy. As you can appreciate, unusual and enlightening conversations abound around here, even (mostly?) in pubs.

The photo attached to this entry is of me in front of the Radcliffe Camera, which is one of the most beautiful buildings I have ever seen. It is a reading room for the Bodleian Library, which is essentially the main library at Oxford. The “Bod,” as it is called, has a copy of every book ever published in the U.K., and there is an electric train system that goes underneath it all so that if you need a book, someone puts it on a train and will deliver it to the desk of the reading room. I couldn’t make this stuff up if I tried.

For those unfamiliar with the University of Calgary Medicine hockey jerseys and are therefore wondering why I am holding a hockey jersey with a very strange animal on it in the picture with this article, let me inform you. One of our best-loved traditions is that every medicine class has an animal name. Mine is the Blobfish; at some point in the early 1990s the animals started getting progressively more unattractive. We then all get hockey jerseys with the animal on the front. I brought mine over to Oxford with me and could not have been prouder than to have a friend take a picture of me holding it in Oxford’s most iconic location immediately following the matriculation.

A final description of my next week, to give you a sense of the kind of outrageous, unbelievable opportunity this experience has already provided: on Monday, a seminar with Professor Paul Anand (who worked with Amaryta Sen on welfare economics), then dinner with the governor of Lagos, Nigeria; Wednesday, a talk and dinner with the former Australian foreign minister; then a black tie dinner on Friday for Rhodes Scholars “coming up” to Oxford (arriving at Oxford is called “coming up,” leaving is called “going down,” not sure why this is, but it is true); and then another black tie dinner on Saturday for the Sir Richard Doll Society, which is a medical society at one of the other colleges here.

I hesitate to make this statement because it will make me sound hopelessly bourgeois, but I really did just describe to you what can most appropriately be called an average week in Oxford. Again, I couldn’t make it up if I tried.

Hope you have enjoyed this inaugural entry, and keep looking if this interested you, because I will from time to time post updates here.

Thanks so much for reading. My email follows, and I would be happy to hear from anyone who has questions or comments!

With best wishes,

Braden O’Neill
Proud University of Calgary Medicine Student
Follow me on Twitter @BradenONeill

Categories: Uncategorized

Rebuilding Haiti

Dave Campbell (far right) and his fellow travellers on the journey to Bouly, Haiti

Second-year Faculty of Medicine  student Dave Campbell is doing a six-week medical elective in Haiti.  He wanted to write a blog about his time spent in the wounded nation.  We were happy to offer him the forum; this is his story.

The last two weeks of my elective in Haiti I did a clinical observership with the Internal Medicine Department of the Hôpital Bon Sauveur de Cange (HBSC) – the original hospital operated by the Boston-based international NGO Partners-in-Health (PIH). Cange is a remote village in Haiti’s Central Plateau. Many of its residents were originally inhabitants of the fertile Peligre valley, home to some of the most fertile land in all of Haiti. In the 1960s the river was dammed to provide electricity to many of Port-au Prince’s rich and powerful. This displaced many thousands of people away from their fertile valley to the arid and desolate mountaintops – which formed the small township of Cange.

PIH was started by Dr. Paul Farmer when he was a medical student at Harvard Medical School. He had been coming to the area for many years and was touched by the plight of the peasants in the area and founded the small clinic that is now the HBSC. PIH was founded upon the notion of social justice and strives to provide a preferential option for the poor. This was initially focused on providing second-line drugs for resistant tuberculosis (TB) and antiretroviral agents for HIV – neither of which were traditionally offered to individuals in resource-poor settings. They have since transitioned to a more comprehensive model including offering services in primary care, medicine, surgery, women’s health and rehabilitation. PIH petitioned the WHO and drug companies to make this possible for their patients. PIH now operates 12 hospitals throughout Haiti’s central plateau; they also have operations in a dozen other countries in Central and South America, Africa and Central Asia.

Paul Farmer is also a medical anthropologist and I have been a fan of his work and writings for many years, since I began my studies in medical anthropology. It was a like a dream come true to be able to spend some time at the epicentre of PIH activities and to see their model. I was able to meet many wonderful physicians – both Haitian and expatriates whose dedication and commitment to the PIH model of equitable access of healthcare for the poor was truly inspiring.  Many of the patients we saw had come from Port-au-Prince (three hours away) or even further because the PIH facilities have the reputation of being among the best hospitals in the country and also the only hospitals that are truly free. Many patients seen in the outpatient clinic (which sees nearly 300 patients per day) had walked or come in on the backs of donkeys from the surrounding mountains – some of whom had been on foot for six or seven hours. There are many people who bring bed spreads and sprawl out on a piece of concrete on the grounds as they await the results of various lab tests before being diagnosed and given treatment for their conditions.

While the work PIH does in the plateau central is amazing and inspiring, being involved in medical care in such a setting was also very sobering. Only those with the severest conditions were admitted the 24-bed medicine ward. There were many patients with advanced stage TB and HIV as well as cancer and congestive heart failure. As a second-year medical student it was one of my first opportunities to have patients that I felt responsible for and who I got to follow as they progressed through their illness – including being present when many patients that I had become close to passed away.

I was invited to be part of a small group of PIH people involved with the construction of a dispensary in Bouly, a small mountain village. In order to maximize my involvement we decided to make a trip to the community so that I could meet local leaders who will be helping us with construction and operation. It was a seven hour hike from the Boucan Carre hospital – the nearest health facility, which is also the furthest point reachable by vehicle. We hiked up and down two mountains and across four rivers. It was very strenuous and I could not imagine having to do that in a time of health crisis. This community is very over represented in cases seen in the Boucan Carre hospital and we hope that the building of this dispensary which will be staffed by a local nurse and a part-time physician can reduce this incredibly high burden of advanced disease in this community.

We are hoping to have the construction completed by January 2011 and to open immediately.

For anyone who would like to learn more about the incredible work done by Paul Farmer and Partners-in-Health, I recommend reading Mountains Beyond Mountains by Tracy Kidder. For anyone interested in Critical Medical Anthropology I also recommend any of Paul Farmer’s works, but notably, Pathologies of Power.

Thanks to everyone who read my blog from my elective in Haiti.

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Heavy rains make a bad situation worse

Second-year Faculty of Medicine  student Dave Campbell is doing a six-week medical elective in Haiti.  He wanted to write a blog about his time spent in the wounded nation.  We were happy to offer him the forum; this is his story.

Saturday was busy as we had a whole bunch of new patients come in from the Partners In Health facility in Cange and I was able to interview several of them.  Sunday afternoon I had visitors come from Handicap International in Port-au-Prince who wanted to see the operation here and what I do as an anthropologist.

I got back to the village just before the deluge arrived – there was a huge rainstorm, which is not uncommon for this time of year, but what is uncommon is how long it lasted. It poured for hours on end, the canals and even the major drainage river in the area overflowed. I tried to leave when it slowed up a little but everyone out in the streets told me to go back because I wouldn’t be able to cross the river since the bridges were washed out.

This morning on my way down to the clinic I was shocked at the destruction from the water. Many houses beside the river were washed right out and the houses beside the canals were all flooded.

Many people lost their goats, cows and chickens – which is tragic for these people since in many cases, these animals are the biggest investment they will make in their lives. As destructive as the rain was here in Deschapelles, I sure hope that Port-au-Prince didn’t get it this badly because it would be absolutely devastating, particularly for the many hundreds of thousands living in tents and makeshift tents made of bedsheets, still scattered throughout the city.

Monday is our big discharge/intake day for patients from Port-au-Prince.

Seeing patients come and go so frequently is definitely the worst part of this job! It is always so sad to see many of my friends leave – people that I have come to know really well over the past couple of weeks. It is particularly hard because of my internal conflict of being sad to see them go, but being elated for them for their progress on their new limb and for being able to go home to their new lives.

Five patients went home today, the smallest discharge group that we’ve had since I’ve been here, and they were all excited to show their kids and families their new limbs and to experience a life where they don’t have to hobble through the rough streets on crutches.

I had an interview this morning with a woman named Michelle (pseudonym) and it was a great experience. She is a 40-year-old lady from the mountains who is a bilateral amputee from poor control of her type 2 diabetes. She has such poor control of her blood sugars largely because it costs 30 Haitian dollars OR $4 U.S. each time she wants to get her sugars checked at the hospital or dispensaries. That’s quite a steep price in a place where the average income is $1 U.S. a day, so she struggles to check her sugars even on a monthly basis, and prays everyday that someone will give her a blood glucose monitor. Not to mention the costs of her oral hypoglycemic medications, and the fact that it is pretty difficult to make lifestyle changes in a place where the only affordable foods are very high in sugars and starches and it’s tough to get a lot of exercise when you’re a bilateral amputee.

The generalization of mountain-dwellers is that they are uneducated and therefore unintelligent. My interview with this woman was a great example of someone who was completely uneducated but far from being unintelligent. She had many very insightful things to say about being disabled in Haiti and was very astute in talking about the perceptions of people like her by the rich and powerful in the country. She also had a lot of great suggestions for how amputees and other disabled persons could be better cared for in the country.

Unfortunately due to a non-healing wound on her stump, thanks to her diabetes, she was sent home without being able to be fitted for her prosthetic limbs and told to return in several weeks if it heals which is easier said than done when paying the money to return is a costly endeavour.

So today has been another day full of tragedy for some and joy and excitement for others, which seems to be quite typical here in the L’Artibonite.

Categories: Opinions

Working through the weekend in Haiti

Med student Dave Campbell in Haiti with double amputee Garioul Voltaire

It was a busy July weekend here in Deschapelles – the small town built around the Hopital Albert Schweitzer, about two and a half hours north of Port-au-Prince in the L’Artibonite Valley. On Friday, my local research assistant and I had four interviews scheduled in different locations throughout the valley. I had imagined that the people would have lived out in the mountains and outlying towns, so I thought it would be easiest for us to ride our bikes. However, it turns out all of the people live directly on the highway and in retrospect we probably should have taken a taptap, pickup trucks that serve as public transport – often carrying more than 25 people.

We rode our bikes to Liancourt first, which is about seven kilometres away and we rode the whole way on the highway – which has no shade like everywhere else around here. I’ve been in the shade so much since I got here, that I haven’t had to wear sunscreen – needless to say, I should have today! I got quite sunburned riding my bike around.

The first person we interviewed in Liancourt was a 31-year-old bilateral amputee who lost both legs when his house burned down when he was a year old. His name is Garioul Voltaire and his story was very illuminating. Since he was a child he has been getting around in a wheelchair and a cart that resembles a wagon with hand pedals similar to a bicycle. He is incredibly good at getting around – he gets himself to and from Port-au-Prince several times per month.

His story was interesting because he never stayed in the Hanger inpatient rehab program and has never completed his rehab as an outpatient, and therefore hasn’t even been given his prostheses. He perfectly exemplified the social determinants of health: When I asked why he wasn’t in the inpatient program he told me that it was because he has a young daughter that he couldn’t leave for an extended time because of lack of a social support network. When asked why he doesn’t commute to outpatient therapy sessions, of course it was because he doesn’t have money to take the taptap and moto taxi to get to therapy. Because of these factors, he still doesn’t have his prostheses that were made for him even though he claims he would like to have them.

Possibly the most interesting part of our discussion was when I asked him what he wants to do with his life. He told me that he would like to get more involved with his handicap organization. Apparently he started an organization but hasn’t really done too much with it. He doesn’t know where to begin or what they could do to help.

He said that he would like to help out with getting disabled persons bursaries or help them by buying merchandise to sell. He seemed to be quite discouraged but still had a great vision for the future and is hoping to find someone to help him realize his dream. I found it very inspiring to see how dedicated he was to his goal of helping other people with disabilities in the area here, despite being of such scarce means himself.

I thought that the next person we were going to visit was in Liancourt too, but when I talked to him it turns out that he is actually in Pont Sonde, the next town down the road, another six kilometres. He was going to get on a taptap to come meet us in Liancourt but I offered to go to him before I knew how far it was, so off we went!

Needless to say, by the time we got back I was exhausted! I stay up at the amputee village in a depot room beside the nurses’ station. I generally haven’t slept very well since I’ve been here – could be partly because we have no electricity and therefore no fan in 32 degree heat, or because I am sleeping on a desk that is too short and because I’ve had some problems with my bug net – this caused me a lot of problems sleeping after I killed a poisonous spider called a brown recluse in my room last week. But after that long day on a bike – riding more than 25 km, I slept like a baby!

Categories: Opinions

Summer in Haiti an inspiration

My name is Dave Campbell. I am a second-year medical student at the University of Calgary. I am doing my six week summer elective in Haiti.  Rather than doing a clinical observership for the entire time, I have decided to spend the first four weeks doing a research project. Under the supervision of Dr. Wilfreda Thurston (Community Health Sciences), I designed a study entitled ‘Patient Perspectives of a New Prosthetics Provision Service in Rural Haiti’. Prior to entering medical school I obtained a Masters degree in Medical Anthropology and I also speak Haitian-Creole fluently.

Following the earthquake on January 12th, a group of American philanthropists as well as the philanthropic arm of the largest prosthetics provider in the United States (Hanger Prosthetics and Orthotics) joined together with Hôspital Albert Schweitzer (HAS) to form the Haitian Amputee Coalition for Prosthetics and Rehabilitation (HACPR).This body functions out of a building on the HAS campus in the rural community of Deschapelles in the L’Artibonite valley. It is unique among the eight prosthetics providers in the country in that it provides inpatient rehab services. When patients come here to receive their limb, they stay on a small compound about a mile from the hospital and go to the rehab centre everyday during their stay.

My study is important in that it provides local feedback to the program directors that are now at a decision point for the future of the project. I am conducting interviews and focus groups with prospective and retrospective users of the service. I am also utilizing participant observation as a means of collecting ethnographic data with the current patients.

I live at Escale, the amputee village, and follow patients to the clinic most days and spend a lot of time with them in order to be seen as an insider and this has allowed me to observe their natural interactions in a way that would not be possible through more traditional data gathering methods.

The past two and a half weeks have been wonderful! As much as I love to study medicine, it’s hard to beat a life where my life is to talk to people who I respect incredibly.

I would just like to tell the stories of a couple of the people that I have had the chance to live with for the past few weeks because they are inspiring and show the strength of the Haitian people. I have used pseudonyms to protect their identity.

Magda arrived here around the same time that I did. She is a middle-aged woman who is a below-knee amputee from an injury sustained in the earthquake. She always has such a wonderful demeanor about her, she is a very positive person and is truly a strength to her peers both during therapy sessions and just during the day-to-day lows that many people experience.

I knew her for 10 days before she really told me her story. One night she opened up about herself. She was in the market selling her wares during the earthquake. A pole fell and crushed her leg. Unfortunately at her home, not too far away, the situation was worse. Her husband was there with her two sons. Her husband and one of her children died, and the other boy had his hand amputated. Here is a woman who was quite poor to begin with who has now lost her leg, her business, her home, and most of her family–yet even with the extensive interactions I had had with her, you would never have guessed that this was the case. While she did tear up while telling me the story of her experience with January 12th, that was the only time I ever saw her without a huge smile on her face.

Magda was discharged from the program last Thursday. I thought of Magda today because I saw her earlier when she came in for a follow-up appointment–she was walking much better on her prosthetic limb and didn’t even bring her crutches with her for the appointment. The therapists were astounded by her progress in the past week while being away from formal rehabilitation. She said that she has to learn to walk again so that she can go back to selling her wares to support her and her son. She knows he is going to have difficulty being able to work in manual labour (which comprises the vast majority of jobs here), and wants him to go to university to get a good job. She realizes that without an advanced education, someone with a handicap such as his would struggle to get by in this environment.

I never cease to be amazed at the courage and resilience of the Haitian people, and I said that even prior to the earthquake. The citizens of this country have never had it easy and it is truly impressive to see how they deal with their enormous challenges with faith and hope for the future.

Categories: Uncategorized

“Canada’s First Embryo Donation Service”: The Unregulated Business of Creating Children for Separation from their Families

The Saturday, April 3 edition of the Globe and Mail gave front-page coverage to the announcement that Canada’s “first embryo donation service” will open for business.  A Hamilton, Ontario enterprise proposes to charge prospective parents $13,500 for connecting them with people who have ‘left over embryos’ in the freezer.  The Executive Director says, “We are not there to make a whack of money off this.  It’s not about making money.”

Trading in the origins of human life, this enterprise appears unimpeded in pursuing its goals.  But enterprises that risk causing significant negative effects on stakeholder groups and society at large must typically obtain regulatory approval before embarking on a new scheme.  For example, a company would need to demonstrate before a public body how it would satisfactorily mitigate any harmful effects before engaging in an oilsands project.

By contrast, this Hamilton enterprise has decided to do as it wishes and apparently there is no one to stop it or, at least, to slow it down by asking difficult questions.

The questions are many: What evidence currently exists that the deliberate creation of children to separate them from their genetic families is good for children?  How does the Hamilton agency propose to collect data on the psychosocial outcomes for children of what is, in fact, an experiment?  And why should we accept the organization’s claim that infant adoption and embryo donation are morally equivalent?

They are not morally equivalent.

Adoption usually occurs when pregnancy is unintended.  It aims to minimize the harm of a sad situation – that the genetic mother cannot rear her own child.  Adoption is usually a last resort for the mother who surrenders her child to the care of others.

By contrast, the Hamilton outfit plans to initiate a pregnancy with the very purpose of separating the child from its genetic parents and full siblings who are its family.  The purpose isn’t to find a good home for a baby; the goal is to create a baby for a home – a home in which the child’s genetic parents and siblings will not live.

Demand for babies to adopt is high and supply is low.  Adoption agencies may have less work than they are able to perform.  So embryos in the freezers of the nation create a new opportunity.  As a surrogacy broker once said, “I saw a demand and I knew I could fill it.”

Thus the Hamilton outfit has announced that it will experiment on the health and wellbeing of children; and this announcement has received free, national publicity.

Where are the voices of donor-conceived persons, one of whom has lamented that she went from being a bundle of joy to a person of sorrow?  Why do we not hear from these adults first about the effects on them of being conceived for separation from their kin?

Of course, the Hamilton agency has said that the prospective parents must permit an open relationship with the biological parents because it is “crucial” that “children must know their genetic origins.”

But this assertion seems disingenuous.  If knowing your genetic origins is crucial, then why deliberately rupture the genetic and social aspects of parenting?  Moreover, who would be in a position effectively to advocate for the child?  The rearing parents would have no legal obligation even to tell the child about its unusual conception or that it has a genetic family elsewhere.

Canada has affirmed that every child has a right, as far as possible, “to know and be cared for by his or her parents.”  Canada has agreed to respect the right of the child “to preserve his or her identity, including nationality, name and family relations as recognized by law without unlawful interference.”  Where children are illegally deprived of some or all elements of their identity, Canada has promised to “provide appropriate assistance and protection, with a view to re-establishing speedily his or her identity.”

Canada is not doing much of that right now.  The federal Assisted Human Reproductive Agency appears paralyzed as it awaits the Supreme Court decision on the constitutionality of major portions of statute under which it was created.  Likewise, Parliament seems reluctant to begin its review of the Assisted Human Reproduction Act, a statutory duty it has had for more than one year.  Such a review should, at minimum, cause Parliament to reverse its current acceptance of donor anonymity and the possibility that the donor-conceived might not ever learn the truth about their origins.  After all, Parliament has recognized and declared that the health and wellbeing of children is the highest priority.

So, for Canadian regulation, one might need to look elsewhere – to the professional organizations that govern physicians.  Provincial colleges of physicians and surgeons have ethics codes that require physicians to consider the wellbeing of society in matters affecting health, and to refuse to participate in or support practices that violate basic human rights.

Indeed, the Canadian Medical Association has expressed concern about assisted reproductive practices given that they aim to create children.  It has stated unequivocally:  “The Association believes that a child is entitled to the same respect and to the same treatment as all other people.  It, therefore, wishes to go on record as maintaining that if developments in the domain of reproductive technology cannot sustain such a perspective, if these developments reduce the child to the status of an object, or if they require that those who are involved adopt an instrumentalistic outlook toward children, the Association opposes such developments fundamentally and unalterably.”

The Hamilton agency’s announcement is certainly news but it is doubtful that it is good news.  Why should we applaud yet another means by which children are created to be reared apart from one or both of their genetic parents?

These children grow up to be adults.  Such adults (including some of the undersigned) already exist.  Many are asking how anyone could have let this happen.

Juliet Guichon is Senior Associate in the Office of Medical Bioethics, and Ian Mitchell is Professor of Paediatrics in the Faculty of Medicine University of Calgary.  Michelle Giroux is Associate Professor in the Civil Law Section, University of Ottawa.  Olivia Pratten, a Toronto journalist; Barry Stevens, a Toronto filmmaker; and David Gollancz, a solicitor in London, England are all donor-conceived persons and members of the International Donor Offspring Alliance.

Categories: Opinions

Save your brain – wear a helmet!

My head hit the pavement last week.  Biking to work, I turned in the gravel on the side of the road and the bike went out from under me in an instant while I went flying to the  sidewalk landing literally on my head;  or more precisely on my helmet.   I am black and blue this week but not even a headache from my collision with the concrete.

As a family doctor, I have heard all the arguments but still can’t fathom why anyone would not wear a helmet when riding a bike or roller blading.  Since my fall, I have been very aware of the number of cyclists I see in Calgary who do not wear a helmet; young, old, male, female.  Few on roller blades wear appropriate protective gear.   The paths I ride on are busy.   The pavement is not always even.  There are geese, dogs, children and squirrels.  There is gravel.

Working in the office and in emergency over the years I have seen many injuries from cycling and roller blading mishaps.  We all think it won’t happen to us but we would be wrong.    The greatest risk is in not protecting our brain – the simple two second act of donning a helmet can be lifesaving.  Many argue this is a matter of personal choice; the risk is theirs and the consequences are theirs.

As a family physician who has cared for brain injured patients I can tell you it is not just the patient that suffers – it is also the family and loved ones, coworkers and employers, friends and more.    It is all of us that pays – for the prolonged care, the multiple visits, the lost access for others, the tests, and treatments, services and specialist care.  We have limited healthcare resources – we cannot afford to pay for care that is preventable.  Save your brain – wear a helmet.  Let’s be vocal and make a difference.  We can’t afford not to!

Dr. Cathy MacLean,
Head, Family Medicine Department
University of Calgary, Faculty of Medicine

Categories: News, Opinions

Body World’s exhibit an incredible learning tool

I have taught the anatomical sciences for nearly three decades, introducing the intricacies of human and animal form to thousands of young people. In the dissecting lab, I constantly witness awe and appreciation from students who recognize that it is an honour to be allowed such an intimate glimpse of the body’s inner workings. Gunther von Hagens invented the technique of plastination because he was an anatomist looking for a better way to present specimens for students’ appreciation. The fact that the development of this technique, which is used by the faculties of medicine and veterinary medicine at the University of Calgary, has led to popular exhibitions demonstrates the fascination with witnessing the details of the human form presented in a realistic format. Unfortunately, the commercial success of the von Hagens exhibits has spawned imitators who may not be as scrupulous (and certainly not as high quality). I urge the public to move beyond morbid hysteria and culturally driven bias and appreciate what the gracious individuals who donated their remains for this purpose intended — the wonder of the exhibition — as natural as any national park, and no less an adventure.

John Bertram, Calgary

John Bertram is director of the body donation program an the University of Calgary Faculty of Medicine.

Categories: News, Opinions

“Baby by Stealth” covers only one side of complex argument

March 23, 2010 6 comments

In her front-page National Post article, “Baby by Stealth”, journalist Kathyrn Blaze Carlson, suggests that a Canadian statute is causing Canadians to break the law. Quoting some professionals whose income is derived at least in part from assisted human reproduction, Carlson writes that the Assisted Human Reproduction Act is “forcing a slew of prospective parents underground”.

The article suggests that Parliament is wrong to treat people who just want to be a mom or a dad like criminals. But the one-sided argument hardly helps advance debate on this complex issue.

Regulating human reproduction in Canada has not been easy, especially for politicians who face re–election by citizens who can disagree fundamentally on reproductive matters.

Not surprisingly, every Canadian effort at regulation has been controversial. The Ontario Law Reform Commission bravely tackled the matter in 1982. But that all-male body recommended that “surrogacy” deals be enforced, even by taking a breast-feeding infant from its mother.

Canadian women reacted by lobbying for the federal Royal Commission on New Reproductive Technologies. It reported in 1993, after spending $28 million hearing from individuals and groups throughout the country and commissioning volumes of original academic research.

Despite the cost and the effort, it would be eleven years before Canada’s Parliament enacted the Assisted Human Reproduction Act.

And then in June 2008, the Quebec Court of Appeal decided that Parliament acted unconstitutionally regarding many statutory provisions because they concerned health – a matter within provincial jurisdiction. The Federal Government appealed to the Supreme Court, whose decision we await.

Meanwhile, the Federal Government has, since January 2009, had a duty to review the existing statute. It is unclear whether Prime Minister Harper’s government has even commenced the statutorily-required task.

This history can perhaps unite all Canadians in agreement on two points: it is difficult to pass legislation in a federation about matters as sensitive as whether people can buy semen, ova and embryos; and some Canadians are bound to feel badly treated by everyone’s best efforts to regulate assisted human reproduction.

So maybe we should not ask, “How can we make everyone happy?” but rather, “Whom should we worry about the most?”  Parliament admirably answered this question in 2004 when it recognized and declared that, “the health and well-being of children born through the application of assisted human reproductive technologies must be given priority in all decisions respecting their use”.

So what are the health and well-being interests of the children? Some reproductive technology providers say, “The children should be grateful to be alive.” In other words, they believe that the children’s interests are in being born and the consequences of the methods are irrelevant.

But many disagree. Some people conceived by third party gametes say that not knowing half of their identity creates a significant loss. Many claim that not only must they grieve this loss; they must defend the legitimacy of their grief – a double blow.

Some donor-conceived people compare themselves to adoptees whose loss is recognized. Adoptees are encouraged to seek their birth parents and are aided by government registries in their search. By contrast, parents who use third party gametes need not tell children the truth about their conceptions. Nor is anyone who knows the identity of the genetic parent required to disclose this fact to the child, even when the child becomes an adult.

Whilst the donor-conceived and adoptees arguably suffer similar losses in being separated from their genetic parents, adoptees can find resolution of the loss in the knowledge that the decision to surrender them for adoption was arrived at with great emotional difficulty, as a last resort. The donor-conceived, however, can find it much harder to find resolution of this deliberate separation of genetic and social parenting.

The donor-conceived can believe that their genetic parents were only interested in money, and gave no real thought to the children they were helping to create. They can be devastated by the full import of what their genetic parents did – that their parents were motivated by the money. A condition of the sale can be the promise of anonymity, but the donor-conceived can be severely affected by their inability to meet their genetic parents or even know their names.

Curiously, the National Post article seems to lament, “We see donors who originally thought they didn’t want to be very involved, but who then want increased involvement after the child is born.” How is parental involvement with his or her child a bad thing, even if it is inconvenient for the rearing parents? Children are usually glad to know and to develop a relationship with their genetic parents.

Parliament’s decision to ban the sale of semen, ova and embryos is bound not to make everyone happy. But insofar as it attempted to protect human reproduction from becoming a commercial enterprise, its motivation is honourable.

In the reproductive technology business, some people claim that adults have a right to have a child no matter what the cost. Parliament and Canadian legislatures have a moral duty to investigate the costs to prospective children and to take steps to reduce them.

When regulating assisted human reproduction, the health and well-being of children and prospective children must be given priority, even if commercial or other adult interests might incidentally be thwarted.

Dr. Juliet Guichon is Senior Associate in the Office of Medical Bioethics and a faculty member of the Department of Community Health Sciences in the University of Calgary Faculty of Medicine.

The coming cancer crunch

By Dr. Peter Craighead
For The Calgary Herald — March 18, 2010

Publicly funded health care is only sustainable by focusing on and providing what is needed by its constituents.

During the boom years, many Albertans and their health-care leaders assumed we could ask for whatever we wanted. The truth is that Alberta’s health-care system now is forced to balance the needs of our public against the wants of its health-care leaders, whether this is in the provision of surgical services for joint replacement, caring for stroke patients or funding expensive cancer treatment.

The Rolling Stones aptly describe this in their song: “You can’t always get what you want, but if you try sometime you just might find, you get what you need.” The recent flurry of discussions around a new cancer centre in Calgary forces us to ask whether this is a need or a want.

Almost one in two Albertans will develop cancer in their lifetime, and one in four will die from this disease. Another way of looking at this is to realize that there were 14,500 new cancer cases diagnosed in 2009, and there are an estimated 80,000 people living with cancer in our province. About 85 per cent of these cancer patients will be seen and treated at cancer centres around the province. The Tom Baker Cancer Centre in Calgary is one of two major centres in the province, currently sees 150,000 patient visits annually and is the major referral centre for cancer care in southern Alberta.

So what is it that Albertans need when it comes to cancer care, and how has the system responded to this? Albertans with cancer need to receive state-of-the-art treatments in a timely, respectful manner; they should have access to care as close to home as possible; and they should not suffer pain or emotional distress. We also believe that Albertans should have access to prevention strategies that reduce the incidence of cancer and screening that finds the disease at an early, curable stage.

Until the second half of the last decade, Alberta’s health system responded well to these needs. For example, by the early 2000s the province had built up a network of facilities across the province, was highly responsive to cancer drug treatment requests and supported the purchase of expensive radiotherapy equipment in Edmonton and Calgary. Alberta was considered one of the best places to receive cancer treatment, and the place to work if you were a cancer specialist. This was evidenced by the successful recruitment of medical specialists, researchers, nurses and other professionals.

The rapid growth of Alberta’s population, continued increase in cancer numbers, success in recruitment and the change in our health system have all contributed to a growing capacity problem for us. Facilities in Edmonton and Calgary have outstripped their space, leading to a significant impact on patient experience. Cancer care has worked with the province to identify solutions, including the distribution of radiotherapy to smaller cities, plans to expand buildings in Edmonton and Calgary, and using leased space to tide us over for the medium term. We are also improving efficiencies within our centres to increase patient throughput.

The TBCC responded by moving some functions off site, because there was no available expansion space at Foothills Hospital. Since 2003, we have completed two phases of renovations in leased space at the Holy Cross Hospital, and the space we are currently renovating will allow us to expand treatment facilities at the Tom Baker site, so we can sustain our comprehensive service to cancer patients for southern Alberta for at least another three years. A few years ago, we also relocated many of the day procedures that we previously performed within the TBCC to the Foothills, but it is apparent that the rest of the system has minimal capacity to accommodate any further growth. Finally, we are in discussion with South Health Campus planners to see whether that space will provide us options for dealing with our space crunch in the medium term.

How have these decisions affected patient experience in Calgary? As I write this, patients experience serious overcrowding in our facilities, are made to travel between sites for various parts of their clinical care and some of them have excessive wait times to get in to see oncologists.

Fortunately, the wait times for treatment other than surgery continue to fall within our guidelines of two weeks for chemotherapy and eight weeks for radiotherapy. But the fragmentation of services into two sites means patients cannot take advantage of all services at one time. A further complication of providing clinical services across the city is that our clinical staff becomes less efficient by having to include transit times into their day. Simply put, distributing the services of one cancer centre within a city provides a suboptimal patient experience compared with full-service cancer centres.

Predictions tell us that by 2013, when the breathing room provided by Holy Cross will have been exhausted, we can expect to be seeing six to eight per cent more new cases, and to be treating 10 per cent more patients. Although the opening of Lethbridge radiotherapy facilities will help us deal especially with radiotherapy referrals, and the increase in throughput initiatives will gain some efficiencies in chemotherapy treatments, it is predicted that we will be facing severe shortages in Calgary by 2013. Given the budgetary pressures facing Alberta Health Services, it will take significant focus on our part to see a co-ordinated strategy for cancer in the next 12 months. The short-and medium-term solutions we have employed have allowed us to provide excellent care, albeit of a somewhat fragmented nature.

AHS has made efforts to respond to cancer patients’ needs in the short term, but we now must challenge ourselves to move away from a “building the new system” mode into focusing on how to address the longer-term needs of patients, including the particular needs of cancer patients in Calgary.

As a medical leader within AHS Cancer Care, I am ready to support any planning process that ensures that future patients in Calgary are provided a superior experience, and that we are able to address their need to receive timely, quality care.

Peter Craighead, MD FRCPC, is senior radiation oncologist and director of the Tom Baker Cancer Centre.

Read more:

Fatal Lobby

Re: “Ottawa ‘has gone too far’ on flavoured smokes ban,” Feb. 20.

I was dismayed to read about the federal government being pressured to rescind the ban on flavoured tobacco by congressmen from Indiana, Kentucky and Virginia. Tobacco is the leading preventable cause of heart disease, stroke, emphysema and cancer, the four leading causes of death in Canada and the U.S. I am a specialist in lung diseases and see the devastating effects of the tobacco epidemic daily.

Most people think tobacco-related diseases are primarily diseases of the elderly, but young people are also affected. One of my saddest memories was my last visit to a 38-year-old patient dying from lung cancer who was reading a pamphlet titled, How To Tell Your Young Children That You Are Dying. She had started smoking in junior high with friends and was unable to quit. Flavoured tobacco, not just the candy-flavoured types, but those blended to reduce the harshness of some tobaccos only have one purpose — to hook young people.

Once people are hooked, they will smoke anything to get their nicotine fix. These politicians are beholden to the tobacco industry and its lobby and don’t focus enough on the devastating effect tobacco has on Canadians and their families. Nor do they care about its huge costs to our healthcare system.

Non-smokers are also hurt by tobacco’s health consequences. A doctor’s office or a hospital bed used by a smoker only delays access to, and increases wait times for, non-smokers when they need health care.

Stephen Field, MD, Calgary Stephen Field is a clinical professor of medicine at the University of Calgary medical school

© Copyright (c) The Calgary Herald

Teaching hospitals and consent

From Tuesday’s Globe and Mail Published on Tuesday, Feb. 02, 2010 12:00AM EST

Re Time To End Pelvic Exams Done Without Consent (Life, Jan. 28): Medical students would not “parade” into the operating room after a gynecologic procedure is finished, to undertake a pelvic floor examination on an anaesthetized woman. The usual practice is for a single medical student to be present throughout as a member of the surgical team.

In Calgary, patients give written consent for medical students to be involved in their surgical care, including medically necessary examinations, and patients are specifically informed before surgery, by the surgeon, that they may be examined by a trainee. If a patient objects, their wishes are honoured.

A medical student can only undertake a pelvic exam if the exam is required as part of surgery and the student is part of the surgical team.

Dr. Sara Wainberg’s paper discussed women’s attitudes to pelvic floor examinations being undertaken by medical students, in relation to consent. The concern expressed by a number of scholars is whether implicit consent for pelvic-floor exam under anesthetic, by a trainee, as recommended by the Society of Obstetricians and Gynecologists of Canada guidelines, is sufficient.

Implicit consent should be supplemented by the surgeon explicitly informing the patient that she may be examined by a trainee, as stressed by the guidelines. Of paramount concern is the need for medical students to learn basic examination techniques in a safe, well supervised setting. In the case of pelvic examination on an anaesthetized woman, it is also important to ensure the patient is adequately informed.

Sue Ross, director of research; R. Douglas Wilson, head, Obstetrics and Gynecology, University of Calgary

H1N1 – Now is not the time to let our guard down

By Glen D. Armstrong, PhD, Thomas Louie, M.D., and John Conly, M.D., Faculty of Medicine, University of Calgary and The Calvin, Phoebe, and Joan Snyder Institute of Infection, Immunity, and Inflammation.

Although there appears to be a lull in the number of serious H1N1 cases appearing in our hospitals, now is not the time to let our guard down.  The H1N1 virus  has resulted in severe infection with respiratory failure and increased numbers of intensive care unit admissions.  And this is before the typical influenza season peaks in February or March.  There is still plenty of time to get vaccinated. Now would be the perfect time to visit a vaccination clinic because of the significantly reduced wait times.

We want to remind people of one irrefutable fact; the incredible freedom we all now enjoy from once devastating infectious diseases because of safe effective vaccines. A short list includes smallpox, polio, mumps, measles, rubella, meningitis, whooping cough, diphtheria, tetanus, and hepatitis A and B. We cannot overemphasize that these are all diseases that no longer kill or severely disable millions of youngsters and adults every year in the developed world, thanks to safe and effective immunization programs.

We openly acknowledge that none of these vaccines is 100 per cent safe. We have learned from experience that in any mass vaccination program, a very small proportion, less than one in a million people, will experience a severe adverse reaction to the vaccine. Such rare reactions may lead to lifelong physical or mental disabilities. In this regard, the H1N1 vaccine is no different than any of other.

The anti-H1N1 vaccination proponents are misleading and distorting the facts around the vaccine being distributed. They are making the minimal risks appear much greater than they really are. If you carefully read the articles the anti-vaccine proponents quote in their fear-mongering campaigns, the H1N1 vaccine is no more dangerous or different in formula or action than any of the other vaccines routinely and safely used for decades to prevent deadly infections from spreading in human populations.

With the exception of a minority of older individuals, our population has no natural immunity to the H1N1 virus. Unlike the typical seasonal flu strains, the H1N1 virus affects young and old, healthy, pregnant, or sick individuals in a capricious and unpredictable manner. The H1N1 virus also has more potential to cause societal hardship, and loss of income to families and businesses due to employee absenteeism.  So why not get vaccinated to protect ourselves, our family members, friends and society at large?

After all, the H1N1 vaccine is provided free of charge to all Canadians in order to protect themselves and probably more importantly, others around them. The societal benefits of vaccination far outweigh the risks. Despite the impression the H1N1 pandemic may be over, we still strongly encourage all Canadians to be vaccinated against H1N1.  Now is not the time to let our guard down.