Author Archives: CMAJ

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

1 Comment

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

1 Comment

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

2 Comments

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

1 Comment

TH - PHSPTrevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy

 

In 2002 Donald Rumsfeld, then US Secretary of Defence, mused about what we know and don’t know. He suggested there are the ‘known unknowns’ – for example, we know we don’t know how life began – and the ‘unknown unknowns’ – the things we don’t even know we are ignorant about.

But he forgot one important category – the ignored knowns; the things we know but prefer to ignore. This is what Al Gore called the inconvenient truth and is the realm of the science denial industry. With the election of Donald Trump, who seems to make a habit of ignoring science, evidence and fact, we are entering an era of what Stephen Colbert called ‘truthiness’ back in 2005: ...continue reading

jack_westfallJohn M (Jack) Westfall is a Professor of Family Medicine and Director of the High Plains Research Network. Dr Westfall will be speaking at the forthcoming North American Primary Care Research Group (NAPCRG) annual meeting.

 

The High Plains of eastern Colorado have been referred to as a dwindling remnant of the “worst hard time”, reminding us of a not too distant past that included the dust bowl and westward out-migration to the West Coast. Rural Colorado has become mostly a crop-circle curiosity or a time to “put your seat into the upright and locked position” for the thousands of travelers that fly over at 30,000 feet. The small town of Last Chance, Colorado sits at the junction of 2 blue highways. It is home to just 22 residents.

Last Chance once had a Dairy King and 2 gas stations, and was for many, the last chance for food and fuel before heading east into the vast open plains of eastern Colorado. ...continue reading

CSE_photoshot_KPKirsten Patrick is Deputy Editor at CMAJ. She is currently attending the North American Primary Care Research Group (NAPCRG) annual meeting in Colorado Springs, CO.

 

In the plenary session on providing primary care for refugees, one of the speakers, Kim Griswold, shared an image, now familiar to many, that is designed to help people to understand the difference between equality and equity. It demonstrates how some people start off at a relative disadvantage and need extra help to be able to achieve or access things that more advantaged people are able to experience equityeasily. This image, and similar ones, have been criticized by some social justice thinkers who point out that ...continue reading

Domhnall_MacDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK. He is currently attending the North American Primary Care Research Group (NAPCRG) annual meeting in Colorado Springs, CO.

 

Not many primary care doctors have an 8 billion dollar budget. Mitch Katz, who gave the opening keynote address at NAPCRG 2016, is director of the Los Angeles County Health Agency which combines the Departments of Health Service, Public Health and Mental Health into one service. He continues to see patients and described how he had become so specialised in his career in a primary care AIDs clinic in San Francisco, that he found returning to generalist practice extremely difficult. When he focused on AIDS he was on top of his topic like any specialist, but, as a generalist, he had to cope with anything from a heart attack to broken heart.

Los Angeles, until recently, had no ambulatory care ...continue reading