Author Archives: CMAJ

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Ally Fleming is a writer and publicist at Anstruther Press

 

Illness doesn’t end when you leave the doctor’s office. Affliction is carried, and pain is, as Shane Neilson writes, “a concerto in your back pocket.” As a writer with bipolar disorder and chronic pain, I’ve often felt utterly lost, blinded by what Rita Charon calls the “glare of sickness” . For many, the fundamental question of medicine is not how to be fixed (for it’s often not possible), but how to live one’s life, broken. Physician and pain researcher Shane Neilson’s trilogy of poetry collections from Porcupine’s Quill leads by example.

“Practitioners, be they health care professionals to begin with or not, must be prepared to offer the self as a therapeutic instrument," (p. 215) writes Charon in Narrative Medicine: Honoring the Stories of Illness. Neilson, with one foot perpetually planted in medical practice and the other in love, unflinchingly offers himself to his readers ...continue reading

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

 

Have we lost something in the success of academic family medicine? We produce quality research, have created successful interdisciplinary academic teams, demonstrate competitive publication outcomes and generate significant grant income. But, academic primary care may have drifted away from, and perhaps even alienated, some family medicine colleagues. There are thoughtful and reflective family doctors who read, write, discuss and debate many aspects of general practice but feel undervalued as they do not fit the university based academic profile. ...continue reading

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Wendell Block is a family physician at the East End Community Health Centre and the Canadian Centre for Victims of Torture

 

In the thirty-odd years I have worked with torture survivors, I have heard countless versions of the following story. When Azad* was a 22- year-old university student in his home country, he participated in a public demonstration, criticizing the government’s financial cuts to social programs important to his minority group. He and many other demonstrators were apprehended and brought to a crowded holding centre. They slept on the floor, had limited access to a dirty toilet, and were given a cup of water with a small amount of non-nutritious food twice a day. Azad was taken for interrogation on three occasions. He was accused of having links to terrorist organizations outside the country, and of spreading seditious ideas (his interrogators had found political leaflets in his backpack). They demanded the names of organizers. While being questioned he was struck repeatedly on his back and thighs with police batons, and on the third occasion they beat the soles of his feet. Afterwards he could not ...continue reading

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

 

Was I wrong!

Pioneering Professional Practice doesn’t sound like the most stimulating title of a Plenary Address but Helen Stokes-Lampard, Chair of the UK's Royal College of General Practitioners (RCGP) Council, gave an uplifting, encouraging and inspiring address on the topic on day 2 of the SAPC ASM 2017. Helen encouraged us all to rediscover the joy and sparkle of general practice despite poor morale, a constant feeling of being under siege, and increasing resource limitations in the profession. I liked her analogy that primary care, secondary care and social care were interdependent and need to be together- a three legged stool that depended on all three components to remain stable. ...continue reading

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

 

Shakespeare’s Warwickshire was the background to last week's 46th Annual Scientific Meeting of the Society of Academic Primary Care (SAPC) where Professor Christine Ennew, Provost of the University of Warwick, introduced the meeting by emphasising the importance of primary care in the development of their young medical school. She also underlined her belief in the transformational power of universities and how their contribution to academic medicine can alter clinical practice.

It saddened me that her optimism and enthusiasm contrasted with the stark reality of general practice as outlined by Candace Imison, Director of Policy at the Nuffield Trust ...continue reading

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

 

This is not going to make me popular with my beer-drinking Morris-dancing friends, or with a lot of other people I imagine, but we need to put higher taxes on alcohol and implement other proven policies that make it less accessible and less glamorous. This is the conclusion one must come to on reading the report on Alcohol Harm in Canada just released by the Canadian Institute for Health Information (CIHI) and a 2015 report by Canada’s Chief Public Health Officer (CPHO). ...continue reading

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Sophie Soklaridis is an Independent Scientist and the Interim Director of Research in Education at The Centre for Addiction and Mental Health (CAMH)  in Toronto, Canada

 

Almost 23 years ago, I wrote a Master’s thesis that emerged from my experience with breastfeeding my son. After writing the cathartic 260-page thesis, I thought I was done with thinking about breastfeeding. Then I read about a woman with postpartum depression who died by suicide, with one of the main explanations she wrote in a note being that she was unable to exclusively breastfeed her baby. I also read Chaput and colleagues’ enlightening article in CMAJ Open on the link between breastfeeding difficulties and postpartum depression. When I recently started talking to new and expecting mothers, I realized that very little seems to have changed in the discourse around breastfeeding and the experience of being a “good” mother since I went through that lonely and painful time in my life. ...continue reading

Barbara Sibbald is editor of News and Humanities at CMAJ, and author of the recently published collection of short stories, "The Museum of Possibilities"

 

Health policy pundits should look to André Picard’s new book for a dose of common sense on some of Canada’s most urgent health issues. Picard, as most Canadians know, is the long-time health columnist for The Globe and Mail. The book, Matters of Life and Death: Public Health Issues in Canada (Douglas & McIntyre), is the best-of those columns over the past 15 years, updated and conveniently packaged under 14 topic headings like opioid use, medical assistance in dying, cancer, marijuana, indigenous health and infectious disease. Most importantly Picard delves into medicare itself.  Canadians spent $228-billion in 2016 on health care: Do we get value for our money? Is it sustainable? Picard not only asks the right questions, he provides some very credible answers. ...continue reading

Bill Jeffery is the Executive Director of the Centre for Health Science and Law (CHSL), and  publisher of Food for Life Report magazine

 

The new Director General (DG) of the World Health Organization (WHO) will soon be elected. If the upcoming election does not effectively hold to account all candidates, especially the successful one, the WHO risks losing its influence as the leading global public health authority.

On May 23, 2017, for the first time in WHO’s history, all 194 Member States of its governing body, the World Health Assembly, will cast a vote for the new WHO DG at its annual meeting in Geneva. (Previously, the DG was selected by the WHO's 34-member Executive Board.)

But, public health challenges are too great to allow the vote to descend into geo-political horse-trading and unchallenged controversy-dodging in an environment where opportunities for public vetting are few.

The WHO DG is head of a global staff of 7,000 and chief global ambassador to national health ministries world-wide. The WHO’s prominence and the need for its leadership in global public health have long been greatest in low- and middle-income countries where national health systems suffer a relative lack of financial resources and specialized technical expertise.  But high-income countries draw on the WHO’s work, ranging from graded distillations of nutrition and alcohol research to annual advice about the best flu vaccine to administer globally.

The three candidates shortlisted for the position of DG have been persistently ambiguous about their stances on important governance issues. ...continue reading

Matt Eagles is soon to graduate from Memorial University's medical school, and is headed to a Neurosurgery Residency program at the University of Calgary; he is a former Major Junior and University hockey player and a founding member of Concussion-U

 

On Monday May 1, 2017, the Pittsburgh Penguins entered their second-round playoff game against the Washington Capitals with a tight 2-0 grip on their best-of-7 playoff series. An important reason for this was the play of their star captain: Sidney Crosby.

Through 2 games in the series, Crosby had scored 2 goals and added 2 assists. He was, as he had been for much of the preceding year, playing at a level higher than anyone else in the sport of hockey. However, in the first period of game three, the fortunes of the Pengiuns and their superstar appeared to change when he was cross-checked in the face by the Washington Capitals’ Matt Niskanen.

Crosby lay on the ice for several minutes, and was eventually helped up by his teammates before skating off the ice under his own power. ...continue reading