Reflections

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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 →

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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 →

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Ijaz Rauf is President at Eminent Tech Corporation and an Adjunct Professor of Physics, School of Graduate Studies at York University

 

Growing evidence of problems in the level of quality and safety of care across healthcare organizations, along with public awareness, has made the quality of health care the talk of town. This has drawn significant government and regulatory attention to healthcare systems across the country. Health Quality Ontario (HQO) was established with the mandate to monitor and report on healthcare performance in Ontario and the mission to bring about meaningful improvement in health care. Besides reporting on the key performance indicators, HQO holds quality rounds to share knowledge and best practices. Recently, I attended one of HQO’s quality rounds,  and I left with the impression that quality in health care is not considering the right measures, using the right experts or measuring the right data. ...continue reading →

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Praveen Ganty is a Consultant in Pain Medicine & Anesthesia in Toronto

 

There is a new fashion in the world of Medicine, and in the world of primary care in particular. It is the reluctance to continue prescribing, or to prescribe, opioids. There are two sides to the situation. As medical professionals, we have realized the potential harm that opioids can cause to potentially any patient, especially if prescribed for chronic non-cancer pain. However, many of us have also decided to stop prescribing opioids to patients who have been on them for many years, which raises some concerns.  The first principle in the practice of Medicine is Primum non nocere-first do no harm - (modified to ‘first do no further harm’ by some authors).

Managing chronic pain is not easy and - let’s face it - most of us don’t have enough training in this area. A 2011 survey revealed that only an average of 19.5 hours are devoted to the management of pain in an average medical school curriculum. ...continue reading →

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Charlie Tan is a medical student at McMaster University

Lawrence Loh is Associate Medical Officer of Health at Peel Public Health

 

Too often, physicians forget that they might be just one of many sources of health advice that patients access. Behind every physician-patient encounter is a difference in how health and wellness are perceived and pursued. For many physicians, their views and advice are shaped by formal education and training, the Hippocratic Oath, and the insights of colleagues, researchers, and experts. Their patients, by contrast, have a different and often wider range of influences, be it personal beliefs, social networks, or cultural traditions.

Over the last three decades, physician practice has been transformed by two important movements ...continue reading →

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Sarah Currie lives in Ottawa, Ontario

 

I changed jobs this week. On Monday, my first day, when I should have been primarily concerned with learning the office microwave-cleaning rota and orienting myself to a new Xerox print centre, I was a little preoccupied. At 8 pm on Sunday, I found out that my father had fallen, broken his hip, undergone emergency surgery, and was in isolation in a hospital in southwestern Ontario. Details were fuzzy. Hospital staff would not share much with my aunt, my father’s sister. He had managed to call her on Sunday morning, 24 hours after his fall, once he had come round after anaesthesia. He needed her to go to his house to make sure my mom was okay. My mom wasn’t answering the phone.

Unanswered phone calls are not uncommon at my parents’ house. My father is quite hard of hearing, after spending 37 years as an infantry officer. My mother tends not to answer the phone because she is self-conscious. She has a severe cognitive disability ...continue reading →

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

 

The Iroquois Confederacy’s Great Law is said to include the principle of making decisions taking into account impacts on the  seventh generation, which means thinking 140 – 175 years ahead. That is a far cry from our modern politicians, who can barely think past the next election, never mind our businesses and stock markets that are too often focused only on the next quarter’s bottom line.

As Canada celebrates its 150th anniversary, it seems a particularly good time to think about the next 150 years. Of course we can’t predict that far ahead; imagine how much of today’s world we could have predicted in 1867. But there is no doubt that what we do today will have impacts at least 150 years into the future, and probably much further. ...continue reading →

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Cory Peel is a GP-Anesthesiologist who locums throughout British Columbia, Alberta and the Yukon

 

A couple of months ago I read Mike Hager’s article in the Globe and Mail about Dr. Reggler’s tribulations at St. Joseph’s Hospital in Comox, BC, and I was overcome by a realization that, despite having been a practicing Family Physician for 7 years, I had culpably little understanding of the prejudicial impact of faith-based hospitals in determining patient access to care.

The article detailed the refusal of the “Catholic hospital” in Comox to provide medical aid in dying to its patients despite having a staff physician willing and able to do so, thereby forcing them to be transferred elsewhere. That such a policy could exist stunned me. It is the work of “the bishop [a.k.a. the Diocese of Victoria] and the hospital board,” with the board’s CEO maintaining that “minimizing patient discomfort and pain is always the highest priority,” which seems to me to fly in the face of logic.

It is not, however, an isolated example. Canada contains many hospitals whose delivery of healthcare to its patients is directed by Church doctrine. ...continue reading →

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Jesse Kancir is a resident in Public Health and Preventive Medicine at the University of British Columbia, and former Policy Adviser to Canadian federal Minister of Health, Jane Philpott

 

Donald Trump’s inauguration as president of the United States is a cause for worry for population and public health. An early policy victim appears to be Obama’s Affordable Care Act (ACA). The ACA’s founding policy debates influenced my own interest in public health and health systems as a young medical student so the early steps taken by US Congress to dismantle it have affected me deeply. But it’s not just nostalgia. Concerns are real that Trump’s administration may impact global welfare, yet I’ve been comforted by thinking that a Trump administration highlights several opportunities for progress in Canadian healthcare. In 2017, Canadian healthcare can strive to contrast with negative developments in the US and be the highest expression of our commitment to each other and to a better society. ...continue reading →

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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 →