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David Falk is a palliative care physician working in Calgary, Alberta

 

Recently the president of one of the Quebec medical federations published a request to the public to give the medical profession some time to accept physician assisted death (or medical assistance in dying - MAiD) “because they do not like change.”  I agree and disagree with him about this.  Yes, physicians are slow to change without measured assurance that the change would be beneficial to their patients, but, when it comes to the matters of the heart, these changes may not be beneficial nor become mainstream.  Suppression of visceral responses does lessen with repeat exposure, just as shoplifting becomes less traumatic the more often you do it, but whether continued suppression of the heart language is good is questionable. ...continue reading

Interview with Dr. Ian Kitai, tuberculosis specialist with the Hospital for Sick Children and associate professor in the Department of Pediatrics at the University of Toronto School of Medicine. Dr. Kitai co-authored a review article (subscription required) on the diagnosis and management of tuberculosis in children. Tuberculosis is generally uncommon in children and adolescents in Canada, but among some populations we still find high rates of the disease. A high index of suspicion is required to ensure timely diagnosis.

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Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

The concept of the “Salon” is based on the tradition of European intellectual gatherings that led to the great literary, artistic and political movements of our time. At a recent meeting of primary care researchers in Colorado Springs, Frank deGruy gathered a group of colleagues in this way together to create discussion, debate and perhaps generate ideas. Such gatherings might take place with any group and in any context - in a department, region or nationally. On this occasion, Frank attracted a group of about twenty delegates of the NAPCRG meeting from various international and professional backgrounds and I was fortunate enough to be included. ...continue reading

Jacalyn Duffin is a hematologist and historian who holds the Hannah Chair in the History of Medicine at Queen’s University

 

The sixth full year of the global generic drug shortage has drawn to a close. We Canadians can look back and marvel at how little we still know about the problem. Generic drug shortages do not get anything like the attention paid to the fraught relationship between the federal government and the provinces over a renewed health accord. They are also obscured by concerns over brand-name, on-patent pharmaceuticals, such as the shocking price hikes that occurred overnight last February when Martin Shkreli raised the price of Daraprim from $13.50 to $750, or when Valeant upped the price for a month’s supply of two drugs for Wilson’s disease to more than $25,000. Yet, looking back over 2016, Canada has reported shortages of reliable generic drugs for epilepsy, bladder cancer, psychosis, syphilis, asthma, and kits for treating overdose.  ...continue reading

Iona Heath was a general practitioner in inner-city London for 35 years and is a Past President of the UK Royal College of General Practitioners.  She is a co-chair of the Scientific Committee for the 2017 Preventing Overdiagnosis conference

 

Over the past several decades, the economic interests of the pharmaceutical and medical technology industries have both pressured and tempted medicine to overextend itself.  The traditional moral commitment of the medical profession to relieve suffering and to care for the dying has been gradually displaced by a futile and misguided attempt to solve humanity’s most profound existential problems through biotechnical means.  Doctors now apply more and more powerful treatments towards the end of life and try to prevent diseases by seeking out and correcting more and more risk factors.  All this has led to an epidemic of overdiagnosis ...continue reading

Pippa Hawley is the Head of the Division of Palliative Care at the University of British Columbia

 

The recent headlines about legalization of cannabis in Canada - a subject already fraught with bias - has illustrated the need for care when reporting on statistical observations. An example of things going badly wrong is a recent Vancouver Sun column headline “Fatal car crashes triple among drivers high on marijuana after legalization in Colorado; double in Washington state”. This was based on an article in the October issue of the BCMJ. The headline would seem to indicate that there has been a dramatic increase in fatal car crashes in those two states caused by people driving high on newly-legal cannabis.

This would be very important information and a pretty persuasive argument against legalization of cannabis, if it were true. ...continue reading

Barbara Sibbald, News and Humanities editor for the Canadian Medical Association Journal, reads the CMAJ Humanities Encounters article "Lives uncovered: reflections on encounters with newly arrived Syrians" (subscription required). The article is written by Dr. Janet Warren, a family physician at Hamilton Urban Core Community Health Centre in Hamilton, Ontario.

In the article, Dr. Warren describes what it’s like to be a Canadian physician caring for newly arrived Syrian refugees. The encounters are true but patient details have been changed to protect confidentiality.

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Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

How do you create a successful school of primary care research?  Measuring outputs through academic papers, presentations at international meetings, and the general impact of research, the UK primary care community has had remarkable success. The ten year celebration meeting of the School of Primary Care Research (SPCR) in England was an opportunity to reflect on their achievements and try to pick out the key factors in that success.

It wasn’t always this way. As an academic and an editor I know the struggle that researchers had in the early days. There were few grants, ...continue reading

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Li (Danny) Liang is a second year medical student at the University of Toronto with a BEng degree and a deep interest in the intersection of urban design and health

 

Growing up in Toronto's suburbs, I slowly began to realize what was wrong with how much of the city is designed. Most of the neighborhoods outside of the downtown core are clearly designed for cars, instead of pedestrians and cyclists. Most neighborhoods in the suburbs, composed of a sea single detached houses with small oases of high-rises sprinkled in, are not very walkable nor bike-friendly. Getting from point A to point B by walking becomes a huge odyssey: it often took at least half an hour to walk to the nearest library, movie theatre, grocery store or community centre. The way the city is designed is also unfair from a social justice perspective, as most of the people living in the Toronto Community Housing apartments I lived in could not afford to drive. The overall low population density of Toronto's suburbs means that there is not enough ridership to justify building rapid transit to the clusters of high-rises in the suburbs that are drowned by single-family detached houses. ...continue reading

Barbara Sibbald, News and Humanities editor for the Canadian Medical Association Journal, reads the CMAJ Humanities Encounters article "Cathartic narratives for chaotic thinking" (subscription required). The article is written by Dr. Richard Hovey, associate professor in the Division of Oral Health and Society with the Faculty of Dentistry at McGill University.

In the article, Dr. Hovey speaks from personal experience about life with severe chronic pain.

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