Reflections

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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 →

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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 →

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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 →

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nichollsStuart Nicholls is a Clinical Investigator and Methodologist at the Children’s Hospital of Eastern Ontario Research Institute and Methodologist at the Ontario Child Health Support Unit (OCHSU). He recently attended the 66th Annual meeting of the American Society of Human Genetics (ASHG) in Vancouver

 

The ASHG annual meeting takes place every fall towards the end of October or in early November, as the leaves are changing from green to reds and golds. Every four years the meeting also takes place against the backdrop of the US presidential elections. In 2012, in San Francisco, when the meeting ran from the 6th to the 10th of November, I recall standing in the main hall as part of the opening ‘mixer’ event, where several thousand scientists watched a big screen projection as President Obama was re-elected to office.

This year's meeting, which ran from the 18th to the 22nd of October, took place against the backdrop of a very different election ...continue reading →

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

 

Dear Linda,

I have just read your book - or, should I say, it completely captivated me. I couldn’t put it down. What a compelling life story. When you lectured about depression at those Masterclass lectures I chaired years ago I was so impressed with your grasp of the topic, your understanding of the difficulties facing family doctors, and your overall approach to managing the condition. You had such a clear understanding and appreciation of depression and the difficulties of treating it in practice. And, you were so assured, confident, on top of your subject. I had chaired many similar sessions but yours were outstanding. There wasn’t even the slightest hint that your understanding extended so far into your personal experience. ...continue reading →

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bonnie-larsonBonnie Larson is Family Physician at Calgary Urban Project Society (CUPS) Health Centre

 

Recently I called the emergency department from my outreach clinic in an urban shelter.  Near the end of the day, the nurse mentioned that one of the clients staying there, a young aboriginal woman I will call Ms. Rain, was supposed to follow up on an abnormal lab result from a few days earlier.  As I looked the patient up on the ancient clinic laptop, I thought about the promise I had made to my daughter that morning to try to be home by suppertime.   I willed the computer to load the results a little faster so I could get home to my family.

Finally, several abnormal results, including an elevated D-Dimer, appeared.  ...continue reading →

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berghDr Rod Bergh is a general pediatrician who has practiced medicine since the early 1960s.

 

I have practiced Pediatrics for most of the 59 years since I graduated from Medical School and I have seen tremendous changes in our knowledge. For the past 16 years, I have restricted my practice to children with ADHD and have experienced the great satisfaction of seeing in this period about 3000 children turn their lives around.

Change is based on knowledge gained by research. However, I would like to point out an area where I believe we have ignored evidence, which has resulted in some less-than-optimal therapy for ADHD.  ...continue reading →