School-based health promotion: the physician as advocate

At the August 1995 meeting of the General Council of the CMA, a resolution supporting school-based health promotion (comprehensive School Health) was adopted. This article briefly reviews the research supporting this integrated approach to school and community programs, applies the recommended approach to reducing tobacco use and outlines a role for physicians in promoting Comprehensive School Health in their communities.     

Smoking and health

Cigarette smoking is the leading cause of preventable death and disease in Canada, accounting for some 30 000 deaths annually. This enormous health cost to Canadians has led the Canadian Medical Association (CMA) to promote initiatives regarding smoking prevention programs in schools, legislation to prevent smoking in government buildings and controls on smoking in private buildings, particularly places of work. The CMA recommends the prohibition of all forms of tobacco advertising/promotion in Canada, including advertising in conjunction with athletic events. The CMA also supports the taxation of tobacco products at a level to discourage their purchase, with revenue earmarked for health budgets, and the association is encouraging the federal government to develop alternative crop incentives for tobacco farmers. The norm of nonsmoking is a social attitude the CMA is working toward developing in all Canadians.     

Focus groups confirm that MDs,public differ on role of private health care

Polls conducted by the CMA in 1995 indicated that most physicians favour more private funding for Canadian health care. However, new information gathered in a series of CMA-sponsored focus groups confirms earlier findings that the public does not yet share these views. In March, a polling expert told the Board of Directors that physicians must be cautious in advocating a position on the issue.     

Collaborative care receives stamp of approval in CMA,CNA study involving HIV/AIDS.

The CMA wants to work with national health care groups, such as the Canadian Nurses Association (CNA), to explore ways providers can work collaboratively to provide quality health care. A joint working group of the CMA and the CNA recently examined collaborative care, focusing on examples provided in HIV/AIDS care. The group developed principles to help people work collaboratively in a variety of settings.     

The relative risks and etiologic fractions of different causes of death and disease attributable to alcohol,tobacco and illicit drug use in Canada

BACKGROUND: In 1996 the number of deaths and admissions to hospital in Canada that could be attributed to the use of alcohol, tobacco and illicit drugs were estimated from 1992 data. In this paper we update these estimates to the year 1995. METHODS: On the basis of pooled estimates of relative risk, etiologic fractions were calculated by age, sex and province for 90 causes of disease or death attributable to alcohol, tobacco or illicit drugs; the etiologic fractions were then applied to national mortality and morbidity data for 1995 to estimate the number of deaths and admissions to hospital attributable to substance abuse. RESULTS: In 1995, 6507 deaths and 82,014 admissions to hospital were attributed to alcohol, 34,728 deaths and 194,072 admissions to hospital were attributed to tobacco, and 805 deaths and 6940 admissions to hospital were due to illicit drugs. INTERPRETATION: The use and misuse of alcohol, tobacco and illicit drugs accounted for 20.0% of deaths, 22.2% of years of potential life lost and 9.4% of admissions to hospital in Canada in 1995.     

Right to bill may affect amount of tobacco counselling by MDs

Unpublished data from Health Canada indicate that only 32% of Canada''s family physicians believe they can bill their health plans for providing smoking-cessation counselling to patients with no smoking-related illness. A CMA study of provincial billing codes determined that all provinces and territories except British Columbia and Alberta have billing codes for clinical tobacco interventions, which include counselling. Ontario leads the way with 4 separate codes.     

A dialogue between naturopathy and critical medical anthropology: what constitutes holistic health?

Building on a dialogue between three trained naturopaths and a proponent of critical medical anthropology (CMA), this article highlights the relationship between health and society from the viewpoint of two fields that share this focal concern. Both naturopathy and CMA are committed to the notion of holistic health, although their approaches have historically been somewhat different. The responses of the three naturopaths to CMA exhibit both similarities and differences, particularly in terms of insights that CMA may make to naturopathy. This essay also articulates the CMA perspective of naturopathy and posits lessons that naturopathy can teach CMA.     

Conflicts of interest in e-cigarette research: A public good and public interest perspective

The tobacco industry’s involvement in the electronic cigarette research that informs public health policy is controversial. On the one hand, some are concerned that their involvement presents conflicts of interest that bias research outputs and invalidate the policies that use them. On the other hand, some have argued that the tobacco industry may support valid research and contribute to the goals of public health, for instance, if the interests of the e-cigarette industry could be part of a tobacco smoking cessation policy. We approach this debate from the ethical perspective of the public interest and the public good, considering how legitimate researchers can square their expert opinion with validating tobacco industry-funded research, given the perfidy of the tobacco industry and paucity of robust, conclusive evidence on the public health impacts of liberalizing e-cigarette use.     

Future of health care has top priority at CMA's 1995 annual meeting

The CMA Board of Directors has taken the unprecedented step of organizing a series of strategic-issue sessions focusing on the future of health and health care. They will be held during the annual meeting Aug. 13-16. The objective is to establish a set of principles that will guide the board in developing short- and midterm policies and give direction for a CMA action plan dealing with the future Canadian health care system.     

Chaperone-mediated autophagy in health and disease

Chaperone-mediated autophagy (CMA) is a lysosomal pathway that participates in the degradation of cytosolic proteins. CMA is activated by starvation and in response to stressors that result in protein damage. The selectivity intrinsic to CMA allows for removal of damaged proteins without disturbing nearby functional ones. CMA works in a coordinated manner with other autophagic pathways, which can compensate for each other. Interest in CMA has recently grown because of the connections established between this autophagic pathway and human pathologies. Here we review the unique properties of CMA compared to other autophagic pathways and its relevance in health and disease.     

Health,Health Inequality,and Cost Impacts of Annual Increases in Tobacco Tax: Multistate Life Table Modeling in New Zealand

BackgroundCountries are increasingly considering how to reduce or even end tobacco consumption, and raising tobacco taxes is a potential strategy to achieve these goals. We estimated the impacts on health, health inequalities, and health system costs of ongoing tobacco tax increases (10% annually from 2011 to 2031, compared to no tax increases from 2011 [“business as usual,” BAU]), in a country (New Zealand) with large ethnic inequalities in smoking-related and noncommunicable disease (NCD) burden.ConclusionsOngoing tobacco tax increases deliver sizeable health gains and health sector cost savings and are likely to reduce health inequalities. However, if policy makers are to achieve more rapid reductions in the NCD burden and health inequalities, they will also need to complement tobacco tax increases with additional tobacco control interventions focused on cessation.     

CMA membership survey: opinions on issues facing the medical profession

A sample survey of Canadian Medical Association (CMA) members, conducted in early summer 1985 and designed to provide information to help guide the association''s activities and policies, shows that most Canadian physicians support involvement in political activities both by CMA and by indivudual physicians. A majority wishes to maintain the concept of extra/balance billing, to pursue the position that the health care system is underfunded and favours medicare premiums and hospital user fees as the preferred methods for increasing revenue.Most respondents believe that the number of doctors in Canada is about right but would prefer any reduction to be achieved by cutting medical school admissions or reducing postgraduate training positions open to graduates of foreign medical schools.Most of those members who know of CMA policies on a number of health care issues agree with them and also find them useful, but a significant proportion are not aware of their content.There is support for compulsory payment of dues by all licensed physicians to both their provincial medical association and CMA. A majority would like more information on pharmaceutical products and additional membership surveys.     

Recovery characteristics of a rigid,nonmetallic microdialysis probe for use in an electromagnetic field

It is well known that metal objects perturb electromagnetic fields. Therefore, a conventional metal microdialysis probe cannot be used to determine the bioeffects of electromagnetic radiation. Using fused-silica tubing, we developed an inexpensive nonmetallic, rigid microdialysis probe for use in electromagnetic radiation research or during magnetic resonance imaging. This probe has a concentric tube design, with the membrane length adjustable to the size of the area to be dialyzed. The probes tested had regenerated-cellulose membranes that were 3 mm in length. This report describes how to make this probe. Average relative recovery rates at flow rates of 2.0, 1.0, and 0.5 μl/min were 21%, 27%, and 42%, respectively. These rates were slightly lower than the 30%, 42%, and 68% obtained with the commercially available metallic CMA10 microdialysis probe with a 3 mm membrane. This may be due to the fused-silica probe and CMA10 probe being made with different types of dialysis membranes. © 1995 Wiley-Liss, Inc.     

Health risk perception in Canada II: Worldviews,attitudes and opinions

In this article, we present the results of a national survey of 1500 Canadians on their attitudes and opinions about health risks. Ratings of perceived risk, sources of information on health risks and responsibility for risk management were also investigated, with findings reported separately. A high degree of concern about health risks was associated with industrial pollution and chemical products (with the exception of medicines), with almost complete agreement that the land, air and water are more contaminated than ever. In addition, there was widespread belief that a risk‐free environment was an achievable goal, and an unwillingness to accept some health risks to improve the economy. Lifestyle factors such as diet, exercise, and tobacco smoking were perceived to be important modifiers of health risk. On the other hand, many respondents endorsed the idea that they had little control over the risks to their health.     

Negative feedback effects of chlormadinone acetate and ethynylestradiol on gonadotropin secretion in patients with prostatic cancer and male rats

Serum LH and FSH levels were determined before and after LH-RH injection (100 micrograms, i.m.) in patients with prostatic cancer who were chronically treated with either chlormadinone acetate (CMA, 100 mg/day) or ethynylestradiol (EE, 1 mg/day). In patients treated with EE, the levels of serum LH and FSH before and after injection of LH-RH were significantly lower than those in controls. On the other hand in patients treated with CMA, the basal levels of serum gonadotropins did not differ from those in controls, and the increase in gonadotropin after LH-RH injection was comparable to that in controls. To examine the effects of these steroids on the hypothalamo-hypophysial axis in the regulation of gonadotropin secretion, CMA or EE was implanted in castrated male rats. CMA, EE or cholesterol (control) was implanted in the hypothalamic median eminence-arcuate nucleus region through a stainless doublecannula. EE implantation resulted in a 75% decrease in serum LH (p < 0.001) and a 38% decrease in serum FSH (p < 0.05) from the control levels on day 5 of implantation. On the other hand, CMA implantation induced a 33% decrease in serum LH (p < 0.05) from the control level on day 3 of implantation, but no significant change in serum FSH levels. The injection of 2 micrograms/kg of LH-RH on day 7 of implantation induced significant lowering of LH and FSH levels. There was no significant difference between serum levels of the hormones 20 min after LH-RH injection for these two groups and those for the control group. These studies suggest that EE has a potent negative feedback effect on both LH and FSH secretion, and that CMA has a mild negative feedback effect on LH secretion.     

Chromosomal Mapping and Molecular Characterization of Ribosomal RNA Genes in Lebias fasciata (Teleostei, Cyprinodontidae)

Chromosome location of major (18S, 5.8S and 28S) and 5S ribosomal RNA genes (rDNAs) was examined in Lebias fasciata collected from different Italian blackish-waters, using silver (Ag)- and chromomycin A3 (CMA3)-staining and/or fluorescence in situ hybridization (FISH). Both 18S and 5S rDNA probes for FISH were obtained with polymerase chain reaction-directed cloning from genomic DNA of the examined species. Nucleolar organizer regions (NORs) containing the major rDNAs showed intraspecific polymorphism in number as detected by Ag-and CMA3-staining and FISH with the 18S rDNA probe. On the other hand, 5S rDNA loci constantly occurred on one chromosome pair and co-localized with a pair of the major rDNA loci as evidenced by two-color FISH using the 5S and 18S rDNA probes. Sequential CMA3- and Ag-NOR staining and FISH revealed apparent inactivation of some NORs. The cloned 5S rDNA was found to contain some TATA-like sequences that might play an important role in the regulation of gene expression.     

Family planning/contraception

It is the position of the Canadian Medical Association (CMA) that family planning advice and assistance should be readily available to all residents of Canada. This is viewed as a responsibility of practising physicians that is to be shared with other health and educational agencies. CMA has recommended the establishment of facilities in addition to physicians'' offices for the dissemination of advice on family planning. These facilities should be developed in consultation with and under the supervision of the medical profession. CMA believes induced abortion should not be an alternative to contraception as a method of responsible family planning. In the event of an unwanted pregnancy, full counselling services should be provided. Within the context of preventive medicine, CMA supports the development of educational programs in family living and the promotion of sex education in the school system by knowledgeable persons sensitive to the needs of students.     

CMA brief offers suggestions as federal commission studies country's blood-gathering system

The CMA hopes the Commission of Inquity on the Blood System, chaired by Mr. Justice Horace Krever, “will restore faith in a system that is essential for the health and safety of all Canadians.” However, the cost implications any recommendations may have for the health care system must also be taken into consideration. The CMA made several recommendations in response to the commission''s interim report.     

Corporate Philanthropy,Political Influence,and Health Policy

Background

The Framework Convention of Tobacco Control (FCTC) provides a basis for nation states to limit the political effects of tobacco industry philanthropy, yet progress in this area is limited. This paper aims to integrate the findings of previous studies on tobacco industry philanthropy with a new analysis of British American Tobacco''s (BAT) record of charitable giving to develop a general model of corporate political philanthropy that can be used to facilitate implementation of the FCTC.

Method

Analysis of previously confidential industry documents, BAT social and stakeholder dialogue reports, and existing tobacco industry document studies on philanthropy.

Results

The analysis identified six broad ways in which tobacco companies have used philanthropy politically: developing constituencies to build support for policy positions and generate third party advocacy; weakening opposing political constituencies; facilitating access and building relationships with policymakers; creating direct leverage with policymakers by providing financial subsidies to specific projects; enhancing the donor''s status as a source of credible information; and shaping the tobacco control agenda by shifting thinking on the importance of regulating the market environment for tobacco and the relative risks of smoking for population health. Contemporary BAT social and stakeholder reports contain numerous examples of charitable donations that are likely to be designed to shape the tobacco control agenda, secure access and build constituencies.

Conclusions and Recommendations

Tobacco companies'' political use of charitable donations underlines the need for tobacco industry philanthropy to be restricted via full implementation of Articles 5.3 and 13 of the FCTC. The model of tobacco industry philanthropy developed in this study can be used by public health advocates to press for implementation of the FCTC and provides a basis for analysing the political effects of charitable giving in other industry sectors which have an impact on public health such as alcohol and food.