BeetleGirl

Through work I come across numerous Canadian medical media articles that may or may not be of interest but I figured I may begin to pass some of them on to those of you that maybe interested....


Six words that might save your life

National Post
Tue 27 Mar 2007
Page: A23
By: Jonathan Kay

An unshaven 73-year-old sailor named Charles Carver walks into a Toronto hospital complaining of swelling in his abdomen. An ER intern notes that the patient is a lifelong drinker and that his liver is enlarged and hardened. He has dirty clothes and smells of liquor. The diagnosis is clear: alcoholic cirrhosis.
An emaciated 30-something Massachusetts woman named Anne Dodge steps into the office of a Boston gastroenterologist. Dodge weighs just 82 pounds. Over 15 years, she's been treated with four separate anti-depressants and repeatedly confined to mental institutions, yet she refuses to gain weight. The diagnosis is clear: anorexia nervosa.
An internal medicine resident at Massachusetts General Hospital treats an unpleasant middle-aged woman--a patient "whose voice sounded to me like a nail scratching a blackboard." The harpy is concerned about discomfort in her chest. The resident orders routine tests, which come back normal. The diagnosis is clear: heartburn.
Or not so clear. In fact, every one of these cases was botched so badly that the patient's life was put at risk. This isn't unusual: Research based on autopsy data shows that between 10% and 15% of all medical diagnoses are wrong. The vast majority of these botch-ups can be traced not to technical errors, but to cognitive mistakes made by doctors.
In an amazingly candid new book, How Doctors Think, Harvard Medical School professor Jerome Groopman writes that doctors are all too human. Their diagnostic calculus and clinical habits are warped by pity, disgust, prejudice, shame and irritation. By the time you actually sit down on the white, crinkly paper and begin telling your story, your doctor may have already made up his mind.
Charles Carver is a good example. While he may have enjoyed his nightly rum tumbler, he was no alcoholic. Yet the intern couldn't get beyond the man's boozy scent and dishevelled appearance. In the end, it turned out Carver had Wilson's disease, a treatable condition by which copper deposits afflict the vital organs.
Eighty-two-pound Anne Dodge lost 15 years of her life to the same kind of lazy medical thinking. Her doctors thought she was anorexic largely because she looked anorexic, and because that's what her six-inch thick dossier said she was. But one MD put that dossier aside and actually listened to what Dodge had to say. After a few tests, he found the real culprit: Dodge was allergic to gluten, a primary component of all the starchy breads she'd been wolfing down on doctor's orders.
Groopman's book is aimed primarily at doctors: While MDs can't extinguish all irrational thoughts, the author acknowledges, they can at least be conscious of their prejudices and correct for them.
For patients, on the other hand, the lesson is that going to the doctor is something like a job interview: You're being judged not only on your story, but how you tell it. Six simple words -- "Doctor, what else could it be?" --might be enough to knock your physician out of his programmed thought track, and have him reassess your symptoms with fresh eyes.
Those words might even save your life. Recall the annoying woman who showed up with chest pain at Massachusetts General Hospital. Several weeks after her exasperated doctor hurriedly shooed her away with antacids, she died. It turns out that what she had wasn't heartburn, but a dissecting aortic aneurysm, a tear in the large artery that transmits blood from the heart.
"I have never forgiven myself for failing to diagnose it," the doctor recalls. "There was a chance she could have lived."
That doctor's name? Jerome Groopman.

Should HPV vaccinations be extended to young men?

The Globe and Mail
Tue 27 Mar 2007
Page: A21
By: Andre Picard
The debate over plans to vaccinate girls and young women against the common sexually transmitted disease HPV has, to date, focused on the ability of such a plan to prevent cervical cancer and on the wisdom of investing in a $400-a-dose vaccine with no proven track record.
But now a new issue has arisen to further enliven debate among supporters and detractors alike: Why not boys?
"If the vaccine is being given to young women, then it should be given to young men," said Gail Beck, president of the Federation of Medical Women of Canada.
Of course, men cannot get cervical cancer, but they do, the same as women, get infected in large numbers by human papillomavirus, and pass it on to their sexual partners. HPV can also cause penile, anal and throat and mouth cancers in men.
Yet, when Health Canada approved Gardasil, the vaccine's brand name, in July, 2006, it did so only for use in girls and women aged 9 to 26. And the National Advisory Committee on Immunization is, so far, recommending the vaccine's use only in females. (It should be noted, though, that despite the recommendations, doctors can prescribe the vaccine "off-label" to men, and many gay men have opted to be vaccinated.)
However, the recommendations target only younger females because, to date, they have been the focus of clinical trials. The vaccine prompts an immune response in boys as well as girls, but tests to see whether it was effective in preventing disease were conducted only on young women.
Michael Fung Kee Fung, director of the gynecological oncology program at the University of Ottawa, said decisions on whom to vaccinate should be guided by research findings, not wishful thinking.
Science does indeed offer a cautionary tale. Attempts to develop a vaccine for genital herpes have shown a lot of promise in women and utter failure in men, and the gender difference is difficult to explain.
On the other hand, for years, vaccination for rubella (German measles) targeted only girls and pregnant women because they had much higher rates of the disease, and suffered more harm. But rubella was brought under control only after boys were immunized, too.
At least two countries, Australia and Austria, have opted to vaccinate both girls and boys.
In Canada, the federal government announced last week that it would provide funding of $300-million to the provinces for the HPV vaccine, but it is up to individual provinces to decide how they will proceed.


New protein primed to fight superbugs

CBC.CA News
Tue 27 Mar 2007

A protein that kick-starts the immune system's first-line defence may help fight bacteria immune to antibiotics, researchers at the University of British Columbia said in a study released this week.
The discovery of the chain of amino acids - or peptide - could provide a powerful weapon in fighting "hospital superbugs" immune to antibiotics, said UBC Prof. Robert Hancock, principal investigator for a study in this week's Nature Biotechnology.
Hancock and UBC researchers tested the peptide's effectiveness by injecting it in mice both before and after infecting them with salmonella and both MRSA and VRE.
While the peptide didn't eliminate the bacteria entirely, the treated mice were nearly twice as likely to survive infection, the researchers reported.
The IDR-1 peptide - which stands for innate defence regulator - works by activating the host subject's innate immunity response system, Hancock said.
Innate immune response is how the body first responds to invading bacteria. It is effective, Hancock said, but it isn't pretty.
"It is an immediate local response, but it's akin to a tactical nuclear strike. It's designed to destroy the invading organism before it spreads, and in doing so, sometimes there is what we'd call collateral damage in the form of sores or scarring," he told CBC News Online.
At its worst, innate immunity can cause conditions such as sepsis, an overly aggressive inflammatory response to infection that kills as many as 200,000 annually.
The trick was to find a way to activate innate immunity's quick response while supressing its other, less than desirable side-effects, Hancock said.
The peptide achieves this delicate balance by stimulating the production of certain white blood cells that combat the invading bacteria while curbing the production of neutrophils, an aggressive white blood cell more likely to cause sepsis, he said.
Bacteria also cannot develop immunities to the peptide since it does not interact directly with them, he said.


Alberta to review measures for infection control

Times Colonist (Victoria)
Tue 27 Mar 2007
Page: A5

Alberta Health Minister Dave Hancock has ordered a sweeping review of infection-control practices throughout the province after another incident surfaced where hundreds of patients were potentially exposed to diseases such as HIV from poorly sterilized medical equipment.
Less than a week after a scandal erupted over dirty surgical tools at St. Joseph's General Hospital in Vegreville, Hancock announced regulators are investigating a physician for improper sterilization of medical equipment.
Hancock responded yesterday by mandating health authorities review infection prevention and control programs and report their findings back to Alberta Health by April 30.


Angioplasty little better than exercise

The Vancouver Province
Tue 27 Mar 2007
Page: A8
Section: News

People with heart disease who are treated with a regime combining heart drugs and lifestyle changes did just as well as patients who had a common medical procedure known as angioplasty to unblock clogged arteries, a big international study has found.
The results, revealed at the American Cardiology Conference in New Orleans yesterday, are likely to fuel the debate between cardiologists who stress long-term approaches to treat the underlying heart disease and cardiologists who favour inserting small metal tubes called stents into arteries to fix blockages.
It may relegate angioplasty to the ranks of a procedure cardiologists resort to only if drugs and counselling to encourage lifestyle changes -- weight loss, increased exercise, smoking cessation -- don't achieve the desired effect, some experts said.
In 2003-04, the most recent year for which there are statistics, there were 167 angioplasties performed for every 100,000 Canadians over the age of 20.



'Majority' will agree to health guarantees, Clement says
Provinces facing March 31 deadline to meet promise on treatment timelines

The Globe and Mail
Sat 24 Mar 2007
Page: A4
By: Gloria Galloway

Ottawa will finally extract health-care guarantees next week from provinces that have spent more than a year arguing that they would not offer those types of commitments without more cash, the federal Health Minister said yesterday.
A "majority" of provinces will say, by the March 31 deadline imposed in this week's federal budget, that they will guarantee to provide at least one medical treatment within clinically approved time frames, Tony Clement told The Globe and Mail.
Mr. Clement did not specify which provinces will sign on to the plan but he said: "I will be in a position in the next few days to roll out some specific agreements with specific provinces."
Each province must name at least one treatment and agree that, if it is not available through the local public health system within that recommended time, it will pay to send the patient to another jurisdiction for care.
By agreeing to the guarantees, the provinces can access their share of a $612-million trust established by the federal government.
And where the federal government had previously specified that the guaranteed treatment had to come from one of five areas -- cancer care, heart treatment, cataract surgery, joint replacement and diagnostic imaging -- that has been expanded to include other medical services.
The problem of patient waiting times has not been solved, Mr. Clement said, "but we will definitely have cleared a hurdle and we can say without hesitation that patient wait-time guarantees will become a feature of the Canadian health-care system."
Guaranteed limits on waiting times was one of the five policy priorities named by Prime Minister Stephen Harper shortly after he took office; ultimately it was the one that proved the most difficult to advance.
Mr. Harper and Mr. Clement maintained from the outset that there was enough money included in a 10-year, $41-billion accord signed by the provinces and the former Liberal government in 2004 to pay for the guarantees on waiting times. So they said there would be no more cash coming
But the provinces countered that the accord said nothing about guarantees. With the exception of Quebec, they refused to concede to the federal plan without receiving more money from Ottawa.




Alberta to launch screening for colorectal cancer
People at highest risk will be urged to take test at home to catch early signs of disease

The Globe and Mail
Sat 24 Mar 2007
Page: A13
By: Dawn Walton

Alberta will begin a screening program targeting those most at risk of developing colorectal cancer, which is almost always lethal when it is not caught early, but highly curable when it is.
The announcement comes on the heels of similar plans unveiled in Ontario and Manitoba designed to help flag signs of the country's second-biggest cancer killer and improve survival rates.
"The evidence is very strong that screening saves lives," said Dr. Huiming Yang, medical leader for Alberta's colorectal screening program.
"It's important that we start people talking about it."
The Canadian Cancer Society and related advocacy groups have long been pushing the provinces to adopt routine screening programs for the disease.
In January, Ontario announced a $193.5-million screening program targeting those with a family history of the condition and people aged 50 to 74, which are the two groups considered to be at the greatest risk for developing the disease.
Beginning in 2008, those 50 and older -- an estimated 3.8 million people -- can pick up screening kits from their family doctor and pharmacist to conduct a fecal-occult blood test in their homes.
This test looks for blood in the stool, which may help pinpoint polyps before they become cancerous.
Those who receive abnormal tests will then be put on a priority list for a colonoscopy.
Manitoba is contacting those at a higher risk directly by mailing screening kits to an estimated 20,000 people, while physicians will hand out kits as well.
Alberta's plan is similar to Ontario's and will begin this fall, but a direct mail program could be added, officials said.


Scientific breakthrough or unproven fix?
Hailed as an advance in cancer prevention, HPV vaccine sparks debate

The Globe and Mail
Mon 26 Mar 2007
Page: A11
By: Andre Picard
When the family doctor recommended to Anna Janes that her 16- year-old daughter be vaccinated against human papillomavirus, which can cause cervical cancer, she did not hesitate for an instant.
"This vaccine prevents cancer. I couldn't imagine who wouldn't want their daughter protected."
The vaccine, sold under the brand name Gardasil, has created a buzz in business, scientific and public-health circles because it has the potential to virtually wipe out cervical cancer.
In last week's federal budget, Finance Minister Jim Flaherty announced $300-million in funding to kick-start provincial programs that will likely see nine- and 10-year-old girls vaccinated against HPV, the world's most common sexually transmitted infection.
The unexpected announcement has been greeted with a combination of praise, disbelief and disdain, and it has laid bare some furious debates among scientists, physicians, public-health officials, health educators and women's groups, all of them magnified by the fact that discussions of HPV are always intertwined with hot-button issues such as teen sexuality, gender equality and cancer.
Scientists and medical specialists, for the most part, have hailed the vaccine as a major advance.
"This vaccine is the best thing to happen to women's sexual health since the Pill," said Diane Francoeur, a pediatric gynecologist at Ste-Justine Hospital in Montreal.
In Canada, one woman a day dies of cervical cancer, and four others are diagnosed with the disease.
But Madeline Boscoe, executive director of the Canadian Women's Health Network, said enthusiasm for the vaccine is misplaced and its potential greatly overstated.
"If this goes ahead, young girls will be unwitting subjects of a massive research experiment."
Ms. Boscoe said that existing screening methods like Pap tests work well, but are grossly underfunded and not well targeted.
The result is that two in three women who develop cervical cancer have never had a Pap test, and most of them are from marginalized groups -- largely refugees, immigrants, aboriginals, the poor, those with compromised immune systems -- not well served by the current system and unlikely to benefit from the new vaccine..
There are more than 150 types of HPV, about 40 of which can cause cancer; in addition to cervical cancer, HPV can cause penile, vulvar, anal, oral, pharyngeal, and head and neck cancers.
Scientific research has focused on a handful of strains of HPV. Types 16, 18 and 45 are, between them, responsible for 70 per cent of cancers of the anogenital tract; Types 6 and 11 account for about 90 per cent of genital warts.
Deborah Money, executive director of the Vancouver-based Women's Health Research Institute, said the "wow moment" in vaccine research came in 2002 when a study showed that a vaccine reduced the risk of contracting HPV 16 by an eye-popping 99.7 per cent.
Similar results came out in 2004 with a vaccine against Types 16 and 18.
Then, in 2005, research showed that a vaccine targeting Types 6, 11, 16 and 18 was almost 100-per-cent effective. That is the current formulation of Gardasil, a product of Merck Frosst Canada Ltd. and, based on that research, it was approved for sale in Canada in mid-1996. (Cervarix, a vaccine from GlaxoSmithKline Inc., is expected to be approved later this year; it targets HPV Types 16, 18, 35 and 41.)
Critics note that research was conducted almost exclusively on young women 16 to 23, while the vaccine is now being promoted for use in girls as young as 9.
That is because a person must be immunized before becoming sexually active for it to be effective.
There are also questions about how long the vaccine will confer protection. "We don't know the durability," Dr. Money said, so booster shots may be required.
Another key scientific question is whether stopping transmission of known cancer-causing strains will actually stop cancer, or whether it will emerge over time that many other strains of HPV also cause cancer.
Anne Rochon Ford, co-ordinator of Women and Health Protection, said she is troubled by the assumptions being made by scientists and policy makers.
Further, Ms. Rochon Ford said, the hype surrounding the vaccine could leave women with a false sense of security and create a boomerang effect that results in even lower rates of Pap testing and more cervical cancer. (Already, up to 35 per cent of women are untested in some provinces and the untested account for the majority of cases of cervical cancer.)
If there is one matter that vaccine supporters and detractors agree on it is that screening for cervical cancer must continue for the foreseeable future, and be improved.
While some scientists have made bold claims that the vaccine will eradicate cervical cancer within a generation, the reality is that it will prevent, at best, 70 per cent of cases of such cancers (based on clinical trials) and, in the real world, that figure is likely to be significantly lower.
Ian Gemmill, co-chairman of the Canadian Coalition for Immunization Awareness and Promotion, said those concerns should underscore that an education campaign needs to be an integral part of a HPV vaccination campaign.
In a survey conducted by the Halifax-based Canadian Centre for Vaccinology, only 4 per cent of parents said they were worried that vaccination would lead to earlier sexual behaviour. (Their overwhelming concern was safety, followed by doubts about the necessity, and worry over cost.)
Dr. Gemmill noted that preteens are already vaccinated against hepatitis B and that Canadians are very supportive of vaccination overall.
"The biggest complaint I expect is that we're not vaccinating enough children," he said.
"Because, while $300-million seems like a lot of money, it won't go as far as people think."

When a public payer employs private care

The Globe and Mail
Mon 26 Mar 2007
Page: A16
By: Susan Zettell
Religious police of medicare, lay down your weapons.
What New Brunswick and Nova Scotia are heading toward is not two-tier care. It is not a slippery slope leading to the Americanization of medicare. The private, profit-making medical clinics being contemplated are not scary at all. They might even help cut waiting lists for, say, knee operations, and save money. Or maybe not. But isn't it worth trying?
This is not radical stuff. It isn't Ralph Klein on a soapbox threatening to pull Alberta out of medicare. These are politicians who believe the health system needs change and experimentation, and who put their belief forward as tentatively and inoffensively as possible, as if to avoid a visit from the enforcers of the medicare creed.
"Many people are asking the question, 'Are there aspects where the private sector can help?' " New Brunswick Health Minister Mike Murphy said last week in a speech to the Saint John Board of Trade. In a subsequent interview with The Globe and Mail, he elaborated on the government's vision. "To me, it is not acceptable to have a system for the rich and system for the poor, or queue-jumping." No two-tier care coming here.
Nova Scotia made the same point in a discussion paper last November accompanying a bill to regulate private medical clinics.
Even then, the religious police awakened. "It's like putting a big screen door on health care -- anything can go through," said Joan Jessome, president of the Nova Scotia Government Employees Union. She complained that services now provided in big public hospitals might become available in small private clinics, as medical technologies advance. (Well, yes. That is the idea.) The Liberal Party critic, Dave Wilson, seemed to like the government bill, but according to a Canadian Press report changed his tune after reporters pushed him to do so. "If you're asking me if I'm okay with private clinics taking the place of public facilities, then the answer is no."
That may be a discussion; it's not the only discussion. Many provinces are looking for new answers because the old answers don't work.
But would clinics run by the private sector be more costly? Frankly, New Brunswick doesn't have a clue how much it spends now, so how would it know? "We spend $5.6-million a day in health care in New Brunswick," Mr. Murphy said, "but don't know what the broken wrist or the blood test cost, on average, that we treated yesterday in Sackville."
Alberta, British Columbia and Manitoba have begun contracting out essential services such as cataract surgery and hip replacements to private clinics. But Ontario said no to a Toronto clinic's offer to perform knee-replacement surgical operations that would have saved $1,082 each compared with the average cost in public hospitals. It said no, despite an enormous waiting list, purely on the principle that, as Health Minister George Smitherman put it, the public system "is the best expression of Canadian values."
The medicare faith is frightening in its imperviousness to change. Lay down your weapons, Mr. Smitherman. Medicare needs practical new answers to its chronic and urgent problems.


Medics 'too busy' to wash hands:
Health professionals get too caught up in job demands to be hygienic, expert says

The Vancouver Sun
Mon 26 Mar 2007
Page: B1 / Front
By: Doug Ward

Physicians and other health professionals know that hand-washing is important -- but they are often too caught up in the demands of their jobs to get around to it, says an infectious disease expert.
"Studies have shown that the frequency of hand-washing depends on how busy people are," said Dr. Sarah Forgie, an Alberta pediatric infectious disease physician.
"People are in a hurry and they are trying to do their jobs."
An auditor-general's report found that poor hand-washing has led to the spread of superbugs in B.C. hospitals.
Forgie said that bacteria can be found on most surfaces in hospitals, including scissors, pens, pagers, telephones, stethoscopes, computer keyboards, faucets and door handles.
Dr. John Shepherd, vice-president of clinical quality and safety for the Vancouver Coastal Health Authority, said infection control requires a cultural change in major urban hospitals.
Shepherd said that, in some hospitals, physicians and other health care workers wear buttons which say: "Ask me if I washed my hands."
The problem is that it's easy to forget to reach for the soap or hand gel, added Shepherd.
"Health care workers are busy and, in moving from patient to patient, from changing a dressing on one patient to rushing to another patient who is in pain, it is difficult to remember to wash your hands."
Vancouver Coastal Health's Shepherd said that one of the problems in the Lower Mainland is that the older hospitals -- including pavilions at St. Paul's Hospital and Vancouver General Hospital -- often don't have enough sinks available for quick use.
St. Paul's spokesman Shaf Hussein said his hospital has tried to make it more convenient to wash hands by placing sanitizing gel dispensers on walls and also by providing hand gels that can be carried.
St. Paul's is also trying to developing a network of "infection control champions," added Hussein. These are hospital staff members who actively raise awareness of the issue in their units.
Shepherd said that hand-washing is also important at home. "It's a good habit for all of us to get into, especially when it's the infection time of the year with flu season."
Two health care unions, the Hospital Employees Union and the nurses union, say that the contracting-out of cleaning services at major hospitals has undermined the effort to counter infection.
HEU secretary-business manager Judy Darcy said that nursing staff must call off-site corporate call centres to request cleaning services.
Shepherd countered that the contracted cleaning workers must meet the same standards met previously by unionized housekeeping and laundry workers.



Surviving the perils of a life without pain
disorder that prevents people from feeling injuries dangerous, but gene may give others hope

The Globe and Mail
Sat 24 Mar 2007
Page: A10
By: Carolyn Abraham
No good parent wishes pain upon her child, but Verna Mahar wished it for two of her sons -- the eldest, Owen, most of all.
From the time he was a baby he was a roughhouser -- banging his head against walls and table corners without a whimper. When he was a toddler he'd bite his fingers to the bone unless she made him wear mittens indoors. His lips she could do nothing about: Owen chewed them happily until they bled.
"Didn't it hurt?" she'd ask the growing boy. "No," Owen would say. "Well why not?" "I don't know, Ma."
Not until Owen was 3 -- the year he broke a bone in his foot and kept right on walking -- did the family from Bird Cove, Nfld., receive an explanation. Doctors told them their son had a rare and storied disorder -- a genetic condition that prevents the ability to perceive pain.
Scientists have found the mutant gene behind the bizarre condition and believe that mimicking its effects could lead to a new age of painkillers.
An international research effort led by Vancouver biotech firm Xenon Pharmaceuticals Inc. has confirmed that a single mutant gene is responsible for this rare pain disorder in nine families of different ethnicities in seven countries.
"It is somewhat surprising that one gene has such a profound effect," said study co-author Michael Hayden, co-founder of Xenon and a geneticist at the University of British Columbia. "This tells us that there is a primary target for pain perception that's most profound."
To be affected with an indifference to pain, a child has to inherit two defective copies of the SCN9A gene -- one from each parent. Researchers say those who carry a single copy seem to have normal pain sensation and tolerance, which helps to explain the rarity of the disorder. Only in certain pockets of the world have carriers, often distantly related, come together to pass two copies to the next generation.
After Owen's diagnosis, Ms. Mahar was told that she and her husband had a 25-per-cent chance of having another child affected; her youngest Joshua, was 10 months old when Dr. Ives examined him. (Their eldest son is unaffected.)
"He already had blisters on his hands that seemed to cause him no discomfort," Dr. Ives recalled.
Although CIP had since been recognized as a pervasive condition, Dr. Ives had to tell the Mahars a stark truth: "There is no specific treatment for this -- other than protection."
Dr. Hayden and geneticist Simon Pimstone, Xenon president and CEO, created the company more than seven years ago with a plan to learn the biological causes of common disorders by studying rare ones with opposite profiles.
Then, a few years ago, the Xenon team became interested in pain -- "probably the most ubiquitous disease in the world," Dr. Pimstone said.
The single gene behind the family's struggles suggests pain sensation is simpler than anyone thought.
"They are different mutations in different families, but it's all in the same gene [on chromosome 2]," Dr. Pimstone said. The defects are known as "nonsense" mutations that stop the SCN9A gene from working and producing a protein known as Nav 1.7. Previously, the gene has been implicated in extreme pain disorders and in conditions such as epilepsy and high blood pressure.
Both the protein and gene are already well known as belonging to a family of sodium-channel genes.
These channels, Dr. Henry said, are routes that allow pain signals to pass through the charged outer membranes of one nerve cell to the next. The channels, like gates, are normally closed. But they open for certain electrically charged signals and trigger a chain reaction.
Shutting off sodium channels is also well known to have analgesic effects, Dr. Henry said, noting that lidocaine, that dentist- office staple, blocks most or all of the known sodium channels. But it also leaves people numb and frozen, he said, making it no good as a general painkiller -- since people need to be able to feel something.
Dr. Pimstone said "it's like electricity that goes along a wire to provide light to a home." But at the moment, researchers cannot be sure exactly what role this wire plays and exactly where it blocks the light. "Certainly it is not the only gene implicated in pain."
Researchers have also been surprised that no other gene so far is known to compensate for such a profound deficit. As Dr. Ives put it: "Pain is one of the most fundamental protective devices that we have."


ER kiosks speak Urdu

National Post
Sat 24 Mar 2007
Page: TO4
By: Philip Alves

We may not have two-tier health care, but The Scarborough Hospital (TSH) is plunging into self-service health care. No, it's not handing out suture kits or defibrillators to patients, but rather installing computer kiosks that will allow a patient to update his or her condition -- in eight different languages - - while waiting to be seen by the triage nurse or admitted into the ER.
The hospital's Grace and General campuses -- in the L'Amoreaux and Bendale neighbourhoods respectively -- will be equipped with at least 10 kiosks in a pilot project of both TSH and Canada Health Infoway, a non-profit health-care IT company. The machines will be installed in the late spring with an estimated test run of one month. They'll be fine tuned before their expected permanent return in the fall.
"Let's say you have a sore throat and … that you're getting hot, you feel like you may have a fever," posits Louise Le Blanc, patient-care director of TSH's emergency department. "If the nurse hasn't arrived in the waiting room area, you can input the information into the computer. It will flag the triage nurse at her desk area where she is taking care of other patients."
In addition to English, patients may update their information in French, Cantonese, Mandarin, Tamil, Punjabi, Farsi, Hindi and Urdu. The kiosks will ask questions, mostly yes or no, either audibly or onscreen.
"From those languages, [the system] will interpret into English for the triage nurse," Le Blanc says.



Spinal disc transplant patients 'free of pain'
report: Patients given discs from deceased donors, doctors say

The Vancouver Sun
Sat 24 Mar 2007
Page: A11
Section: News

The first humans to receive spinal disc transplants experienced no immune reactions and were relatively free of pain five years after surgery, Chinese doctors in Hong Kong and Beijing reported Friday.
Suffering from degenerative disc herniation -- a more technical term for one form of chronic back pain -- along the upper spine, the five patients, averaging 47 years in age, were given fresh-frozen discs from deceased donors.
Five years later, neurological symptoms for all five had improved, and there was only mild degenerative change in the transplanted discs, the doctors who performed the operation reported in the British medical journal The Lancet.
Millions upon millions of people the world over suffer from agonizing back pain caused by worn out or damaged discs.
The term "degenerative" in this context refers to physical erosion, not to any form of genetic or pathogenic disease.
"With further improvements in the areas of graft preservation, repopulation of the graft with living cells, and surgical techniques," wrote lead author Dike Ruan, an orthopedic surgeon at Beijing's Navy General Hospital, replacing human spinal discs could one day become a standard procedure.
The most common remedy today, a partial fusion of the disc to the spine, does not always relieve crippling pain. Full fusion works better in this regard, but often accelerates the degeneration of adjacent segments.
The five operations described in the study all focused on the cervical spine, near the neck area.



Alcohol nearly as harmful as heroin, scientists say:
new table ranks drugs according to harm done

The Vancouver Sun
Sat 24 Mar 2007
Page: A11
Section: News

Alcohol is nearly as harmful as heroin and tobacco is more dangerous than cannabis, LSD or ecstasy, according to a new classification table of drugs published in The Lancet medical journal Friday.
The table, drawn up by a group of leading British scientists, ranked heroin, cocaine, barbiturates and street methadone as the most harmful drugs, closely followed by alcohol in fifth place.
Tobacco was assessed to be the ninth most dangerous drug behind ketamine -- commonly used as a horse tranquilizer -- benzodiazepines, which are prescription tranquilizers, and amphetamines.
Cannabis was said to be the 11th most harmful. LSD was ranked 14th and ecstasy rated 18th, in third last place.
The classifications were based on individual drugs' so-called "harm scores" -- the physical damage to the user; how likely the drug was to induce dependency; and the effect on families, communities and society.
Each of the three categories was split into nine categories of risk and independent experts including psychiatrists, druggists and forensic scientists ranked each category on a scale from 0 ("no risk") to 3 ("extreme risk").
Heroin scored 2.7 on the harm scale with alcohol just under 2. Tobacco scored 1.7 and ecstasy scored just over 1.1.
One of the scientists, Professor Colin Blakemore, chief executive of the government-funded public health body the Medical Research Council, said findings differed markedly from the existing drugs classification in Britain.
His colleague, Professor David Nutt, from the University of Bristol, western England, said isolated cases of unpleasant and unpredictable responses to drugs were allowed to dictate policy.
"A more scientific view is that these risks have to be assessed against their effect on the whole population," he added.
Blakemore said he hoped policy makers would "take note" that their table differed substantially from the official classification, which a separate British study published on March 8 also criticized as inadequate.
The RSA Commission on Illegal Drugs, Communities and Public Policy said Britain's drug laws should be replaced by a system recognizing the harm to health of substances like alcohol and tobacco rather than crime prevention.