Mr. Floatie

Victoria dumps untreated sewage waste into the Ocean.

The public’s reaction?

Mr. Floatie

More to come…

Oh, (Health) Canada

Over the past month or so, Health Canada has had to make some clarifications about an organ donor ban targeted at sexually active gay men. According to the Public Health Agency of Canada’s HIV/AIDS Epi Updates (2007), about 50% of the prevalence of HIV/AIDS is attributed to men who have sex with men (MSM). Another 30% is attributed to individuals who contract the virus through heterosexual contact and other means (excluding intravenous drug use). I’m not sure what the percentages of homosexual males who have contracted HIV/AIDS from MSM transmission, and I am not sure if there are any accurate statistics available on this subject. In any case, Health Canada’s organ donor restriction is a poor risk management strategy. Health Canada has targeted the ‘high risk population’ of sexually active gay men, which is essentially a discriminatory policy. There are other means to solve this problem; a notable solution would be additional screening procedures for organ donors. Mandatory HIV/AIDS tests would work as efficiently as this restriction, and would not be accompanied with controversy.

The restriction also targeted injection drug users (IDU). I find no reason why this aspect of the restriction should be contested. A rational justification for this regulation is that other forms of bloodborne disesases can be transmitted through IDUs.

Clinical Guidelines II

Clinical guidelines. They’re useful tools that can be used by physicians as a guide for treating their patients. They provide suggestions for and evaluations of treatments, diagnostic techniques, and cover a variety of other areas that stand to improve physician care. An example of a clinical guideline could be one that evaluates the effectiveness of screening tests for cervical cancer. Another type of clinical guideline could be the treatment process for an individual suffering with symptoms of colorectal cancer.

A main criticism of clinical guidelines is that they have the characteristics of ‘cookbook medicine.’ Critics argue that guidelines encompass broad scenarios, and generalize treatment(s). Consequences of this would be physicians not paying attention to specific complexities of their patients’ cases, or following the guidelines in situations that wouldn’t necessarily be appropriate. While there is reasonable merit in this argument, these are not sufficient arguments to stop using and producing clinical guidelines. Although certainly not always the case, physicians should possess the proper discretion when following guidelines. Physicians who are able to think critically and sensibly should be able to discern when a guideline is appropriate for their patients.

Clinical guidelines are created through academic institutions, health care institutions, as well as organizations such as the American Lung Association, cancer associations, etc. Guidelines may be critically appraised by evaluating bodies or other institutions. Guidelines that have been critically reviewed with good results are generally the best to follow.

How does the patient stand to benefit from these guidelines? There are a few places where guidelines are made available to the public. The National Guideline Clearinghouse, for example, contains thousands of clinical guidelines – all available to the general public. Anyone can browse through the guidelines; it’s fairly easy to find anything specific that you may be looking for. In an age where patients are second-guessing physician opinions, clinical guidelines may provide a background on what a doctor ‘should be doing.’ Patients, or ‘consumers’ as they are sometimes referred to, should be made aware that a clinical guideline is not a black and white outline for treatment/diagnosis/whatever the case may be. Guidelines can provide a reputable source of background information for patients, as opposed to some unreliable internet sources.

How is a guideline beneficial for a physician? I once worked with a physician who told me that everything he learned in medical school was outdated the very minute he had graduated. Of course, this is a slight exaggeration, but he had a very good point. There is a plethora of new information available for clinicians each day. It would be impossible for any human being to stay on top of all the new information, let alone be able to sift through and weed out the ‘bad’ research. Clinical guidelines provide a means to handle the information overload. Proper judgment, paired with a good, solid clinical guideline, a clinician should be well equipped to provide good patient care. Alternatively, if patients bring their own guideline research to their physicians, this also stands to improve patient care.

Its wishful thinking to hope that all clinicians keep abreast of the latest clinical guidelines, but one can assume that the research put into the guidelines is not going to waste. Clinical guidelines are valuable tools for knowledge translation among researchers and physicians, even among patients.

Clinical Guidelines

I’m now in the Population Risk Assessment and Management graduate program at the University of Ottawa, and taking a course in Health Technology Assessment. Although doing 2 years, and having an undergraduate degree in Health Sciences, I realized that I didn’t have a full understanding of what ‘health technology’ was. Broadly defined, health technology includes ‘anything’ that may improve clinical practice. Terrible definition, I know. This could include surgical procedures, MRI machines, research methods, and even clinical guidelines. Clinical guidelines are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances” (Field et. al, 1992).

I’ll be posting something a bit more detailed in the near future about these clinical guidelines. Prior to my seminar on the guidelines, I had no knowledge that they existed. I was also unaware that thousands of these guidelines are available free to the public. There is at least one set of clinical guidelines for virtually every single health ailment. Some ‘popular’ topics, such as breast cancer, has 210 guidelines at the National Guideline Clearinghouse alone.

Clinical guidelines are very useful tools, and from my understanding, not very well publicized.

Why So Fat?

I’ve traveled to the USA a bit more this year in comparison with previous years. I’ve gone to Baltimore, Tampa Bay, Orlando, Washington DC and New York City in the past three months. From my short journeys down south, the most startling thing that I’ve noticed everywhere I’ve gone is heavier nature of the population. While this may seem to be anecdotal evidence, it’s true that obesity is on the rise in the USA. It’s even gotten the attention of former President Bill Clinton, who has started initiatives to combat childhood obesity. [I myself cringe each time I see a heavier child eating at a fast food joint]

So what, Americans are getting fatter? But, the questions that I found myself asking were about the differences between Canadian and American eating habits. Of course our cultures are different (not many Canadians like to be referred to as an American), but even still there has been debate on the nature of our differences. Is it the type of food in the States? The amount of fast food available? The growth hormones in the meat? Why is the obesity rate growing so much faster in the USA than it is in Canada? In living in an obesophobic society, it’s interesting to see the morbidity of obesity on the rise.

While I have done no epidemiological studies into the relationships and amount of fast food locals with obesity rates in the two countries, I’d be interested in reading more. I recall a professor making a comment about how urban sprawl, aside from the environmental devastation it causes, contributes to the growing problem of obesity. In areas where individuals are required to sit in traffic for prolonged periods of time on their drive home (adding to air pollution), they would be more prone to grab a quick meal on the way home  instead of waiting until late evening to eat. All of this eating out would contribute to a fat nation.  Additionally, once these individuals reached their destination, they would be too tired from the work day to engage in any physical activity. At first I thought the idea to be a large generalization, but I suppose that if this situation occurred more than once a week, the empty calories would accumulate.

What about all of the weight loss programs? The public health initiatives? The risk of disease that accompanies unhealthy diets and weights? Who listens, and who doesn’t? I suppose I’ll have to pick up some books on the subject, read a bit more, etc.  I’ve read a bit about the prevalence of diabetes among Canadian Aboriginal population, and the implications of obesity, but I’m truly interested in this stark difference between the ‘fatness’ of neighbouring USA and Canada.