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“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.

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.

Gutsy research: UCalgary GI doctor receives international award

March 26, 2009 3 comments

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By Laurie Wang

Dr. Martin Storr

Dr. Martin Storr

Dr. Martin Storr loves your guts. Well, he certainly likes to study them.

Winning the Junior Investigator Research Award from the International Foundation for Functional Gastrointestinal Disorders (IFFGD), the Faculty of Medicine clinician-scientist was thrilled when he found out.

“I opened a bottle!” Storr smiles.

The IFFGD recognizes active investigators who have a record of research interest in basic mechanisms or clinical aspects of functional gastrointestinal and motility disorders. The foundation honors young scientists who have done strong translational research, taking the basic science at the lab bench to the patient’s bedside.

“To me, the gut is central to the body. We start with the gut in the morning at the washroom and the breakfast and we end with a gut feeling at night,” he says. “That’s why it’s always attracted me.”

To date, Storr has published 77 peer-reviewed studies in his field.

“I study how the gut functions and how it protects itself. I’m looking specifically at the regulatory role of the endocannabinoid and endoopioid systems,” explains Storr, an associate professor in the Division of Gastroenterology.

Both the endocannabinoid and endoopioid systems are regulatory systems in our bodies that control gastrointestinal function. Storr is interested in developing potential therapeutics that target these systems in hopes of battling functional gastrointestinal disorders.

“Functional gastrointestinal disorders are associated with numerous symptoms like nausea, vomiting, bloating, difficulties swallowing, abdominal discomfort and pain, as well as altered bowel habits,” he says.

Storr thanks the people at UCalgary for supporting his ideas, protecting his time and encouraging his academic endeavours.

“I came here as a full-time member in 2007 because in this position, I have enough protected time to plan and perform sophisticated research and to develop concepts and strategic plans for my translational approaches,” he says. “I used to have to wait until nighttime to think academic thoughts, but now, I get to think about my studies during the day and I have time to do the research I like.”

Martin Storr will receive his award at the 8th International Symposium on Functional Gastrointestinal Disorders in Milwaukee, Wisconsin, in mid April.

About the Faculty of Medicine at the University of Calgary

The U of C’s Faculty of Medicine is a national leader in health research with an international reputation for excellence and innovation in health care research, education and delivery. Through its educational programs, the Faculty of Medicine trains the physicians and scientists who will lead the next generation of health practitioners. Through its clinical work, continuing medical education programs, and close relationship with the Calgary Health Region, the Faculty of Medicine moves new treatments and diagnostic techniques from the laboratory bench to the hospital bedside efficiently and effectively, improving patient care.

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Faculty of Medicine professor awarded national research chair

Dr. Lynn McIntyre (front row, third from left) with five other researchers awarded chair in New Perspectives in Gender, Sex and Health from CIHR.

Dr. Lynn McIntyre (front row, third from left) with five other researchers awarded chair in New Perspectives in Gender, Sex and Health from CIHR.

A UCalgary Faculty of Medicine professor and researcher–whose passion for eradicating global food insecurity has taken her as far away as Bangladesh to study the issue–has been awarded a research chair in New Perspectives in Gender, Sex and Health by the Canadian Institutes of Health Research (CIHR).

As part of research chair program created by the CIHR’s Institute of Gender Health (IGH), Dr. Lynn McIntyre, professor, Department of Community Health Sciences, was awarded the chair along with five other leading health researchers from across Canada.

“The chairs are producing cutting-edge research with enormous potential to improve the health of Canadians, such as Dr. McIntyre’s research on hunger and food insecurity domestically and internationally,” says Dr. Joy Johnson, Scientific Director of the Institute of Gender and Health. “Her work focuses on women and children, the most frequent victims of food insecurity both in Canada and in other countries.”

McIntyre’s work–which is in line with the first Development Millennium Goal of halving world hunger by 2015–took her to Bangladesh where she studied hunger amongst both urban and rural populations.

During the in-depth study, McIntyre spoke to groups of highly vulnerable woman, living on less than one dollar a day and responsible for providing for their families. The intense field work included door-to-door recruitment and speaking to these women about food insecurity and hunger in various remote locations and in the slums of Dhaka.

In Bangladesh to present findings

Her principal finding was a need for a whole person development approach–a readjustment of available health care services to ensure they meet the needs of these women and others like them. McIntyre is currently in Bangladesh sharing her findings with government officials and non-profit agencies.

“The women have told me, ‘We knew when we met you that you were going to do something for us,’ and I am doing my best to bring improved understanding to those who really can do something for millions of women like them,” says McIntyre.

Closer to home, McIntyre is part of a study looking at social policies in Canada created between 1996 and 2006, focusing on their impact on national food insecurity. She’s also working with Alberta Health Services as they begin investigating the impacts of food insecurity on their patient population, the first clinical site in Canada to do this.

The IGH created the research chair program to expand and strengthen research capacity relevant to gender (socio-cultural experiences), sex (biological factors) and health in Canada. It is intended for health researchers who have developed a reputation for excellence in research, and to support outstanding research programs that enhance the health of Canadians.


Lack of strategies to manage MRI wait lists a key reason for excessive wait times

By Jordanna Heller

MRI wait times excessive

A new study headed by Dr. Tom Feasby, Dean of UCalgary’s Faculty of Medicine, shows that while Canada lags behind other countries in the number of diagnostic imaging devices, more machines are not the only solution to long wait times. The study’s authors say it is critical to prioritize MRI (magnetic resonance imaging) requests effectively.

“This study shows there are important deficiencies in the current system. We hope this research will help health system decision-makers and managers improve the provision of this important service,” says Feasby, the senior author of “Management of MRI Wait Lists in Canada,” published in Healthcare Policy.

A MRI provides detailed images of the body, and is technology that is being used more frequently, especially in the areas of abdominal, pelvic, cardiac and breast imaging. The technology can be used to evaluate tumours, show abnormalities in the heart, brain and joints.

To determine how requests for MRI studies are managed the study’s authors surveyed public MRI facilities in Canada. Although almost all of the facilities have some methods to triage MRI requests, less than half documented their guidelines for prioritization, and none used quality assurance methods to ensure guidelines were followed. The report determined that despite wait times of up to several years in some facilities, strategies to reduce wait times are diverse, uncoordinated and largely ineffective.

Dr. Derek Emery, one of the report’s authors, says, “most MRI facilities in Canada have a substantial wait list problem. Improvement in wait list management will be necessary for better access, fairness and quality in the provision of MRI services in Canada. We do not currently know the extent of inappropriate overuse of MRI, nor do we know the extent of inappropriate underuse.” Emery is an Associate Professor in the Department of Radiology and Diagnostic Imaging at the University of Alberta.

“This paper shows that many MRI centres do not employ effective and standardized processes to track and manage the appropriateness of the scans they perform. Such processes are crucial to ensure that patients in different regions of Canada have equitable access to MRIs, and that patients who really do need an MRI get one rapidly. This is a challenging problem, and needs the focused attention not only of radiologists, but particularly the physicians who are ordering the scans,“ says Dr. Andreas Laupacis,  a general internist, the Executive Director of the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto, and a professor in the Departments of Medicine and Health Policy Management and Evaluation at the University of Toronto.

This study was supported by the CIHR (Canadian Institutes of Health Research).

Full text of the study available here.

About the Faculty of Medicine at the University of Calgary
UCalgary’s Faculty of Medicine is a national leader in health research with an international reputation for excellence and innovation in health care research, education and delivery. We train the next generation of health practitioners and move new treatments and diagnostic techniques from the laboratory bench to the hospital bedside, improving patient care. For more information visit http://medicine.ucalgary.ca. or follow us on twitter.com @UofCMedicine.

U of C remembers Doc Seaman, philanthropist

doc-seamanThe Faculty of Medicine was saddened to hear of the passing Sunday of Daryl K. Doc Seaman. He was 86.

Seaman was one of Calgary’s biggest philanthropists and a huge supporter of the University of Calgary. Oh, and he was also instrumental in bringing the National Hockey League to Calgary in 1980 as one of the original owners of the Calgary Flames!

Though he shied away from publicity, his time, effort and funds did not go unnoticed, particularly at the University of Calgary.

In 2001, along with his brothers, B.J. and Don, Doc provided $2 million in funding for the establishment of the Seaman Family MR Research Centre at the Calgary Health Region/University of Calgary Faculty of Medicine. In 2007, the centre became home to the neuroArm, the world’s first MRI-compatible surgical robot, which revolutionized neurosurgery and other branches of operative medicine by liberating them from the constraints of the human hand.

Seaman supported other student awards and was a Chancellor’s Club member since 1992. He received a U of C honorary degree in Law in 1993 and a Faculty Association Recognition Award in 2005. His most recent gift to the U of C came this summer in the form of $500,000 to fund scholarships for student-athletes in football, hockey, basketball, volleyball, soccer and women’s field hockey.

Seaman will be missed greatly. The University of Calgary and the Faculty of Medicine express condolences to the family and friends of Doc Seaman.

Read a more in-depth story at: http://www.ucalgary.ca/news/january2009/seaman-memoriam

About the Faculty of Medicine at the University of Calgary

The U of C’s Faculty of Medicine is a national leader in health research with an international reputation for excellence and innovation in health care research, education and delivery. Through its educational programs, the Faculty of Medicine trains the physicians and scientists who will lead the next generation of health practitioners. Through its clinical work, continuing medical education programs, and close relationship with the Calgary Health Region, the Faculty of Medicine moves new treatments and diagnostic techniques from the laboratory bench to the hospital bedside efficiently and effectively, improving patient care.

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