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.     

Guidelines for physicians reviewing proposed legislation on health care occupations

The premise of the CMA guidelines is that legislation on health care occupations should protect the public and therefore should be based on the needs of the patient rather than on the wishes of the health care worker. Health care should be provided by personnel with appropriate training; thus, the scope of practice of any group must be based on relevant educational preparation. In a review of legislation the procedure for amending both the statutes and the regulations should be examined.     

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.     

CMA leads drive to improve physicians' management skills

The Physician Manager Institute, developed 12 years ago by the CMA and the Canadian College of Health Service Executives, provides training that is designed to improve physicians'' management and leadership skills. Changes within health care are prompting more doctors to seek this training in order to become managers within a reformed health care system.     

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.     

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.     

Toronto centre hopes to cash in on growing demand for private health services

When the CMA held its 1996 annual meeting, part of the debate on the future of health care involved the "appropriate balance of the roles of the public and private sectors" in delivering health care. The King''s Health Centre in Toronto is now doing its own balancing act: providing publicly funded care to Canadians, and private care to non-Canadians and Canadians who can afford it. This article discusses some of the niche markets King''s is attempting to develop.     

Suicide totals for MDs sad reminder of stresses facing medicine,conference told.

A recent conference on physician health cosponsored by the CMA and American Medical Association provided some sobering news. One physician reported on the suicides of physicians practising in the US. Another reported that inroads being made by managed health care is affecting physician morale. "Physicians'' lifetime calling of caring for the sick is being called into question," said Dr. Patricia Tighe. "They have become like factory workers who can''t take pride in their work and are denied a sense of belonging. They are part of a corporate enterprise, to be dispensed with when they are not profitable, and subjected to penalties if their work doesn''t measure up".     

Zinc bone loss in chronic renal failure and chronic metabolic acidosis

The effects of chronic metabolic acidosis (CMA) on zinc (Zn) bone content and urinary excretion were examined in the presence of normal or reduced renal function together with some aspects of calcium (Ca) metabolism. Four groups of rats were compared. All were fed a 30% protein and 9 mg Zn/100 g diet. Two were uremic (U): The first developed acidosis (UA), which was suppressed in the other (UNA) by NaHCO₃ supplement. Two other groups had normal renal function: One was normal (CNA), and the other had NH₄Cl in the drinking water and acidosis (CA). Femur total Zn and Ca content was markedly reduced by CMA and was not affected by uremia. Zn urinary excretion was increased by CMA and unaltered by uremia. Ca urinary excretion was markedly reduced in uremic rats, but was enhanced in both acidotic conditions. Urinary Ca and Zn showed a strong correlation in uremic and in control rats. Plasma parathormone and 1,25(OH)₂D₃ were unchanged by CMA. These data are in agreement with a direct primary effect of CMA on bone in releasing buffers. CMA induces bone resorption and a parallel decrease of mineral bone components, such as Ca and Zn, with little or no role of PTH, 1,25(OH)₂D₃ and of uremia itself.     

Physicians and the pharmaceutical industry (update 1994). Canadian Medical Association.

The history of health care delivery in Canada has been marked by close collaboration between physicians and the pharmaceutical and health supply industries, this collaboration extending to research as well as to education. Since medicine is a self-governing profession physicians have a responsibility to ensure that their participation in such collaborative efforts is in keeping with their duties toward their patients and society. The following guidelines have been developed by the CMA to assist physicians in determining when a relationship with industry is appropriate. Although directed primarily to individual physicians, including residents and interns as well as medical students, the guidelines also govern the relationships between industry and medical associations. These guidelines focus on the pharmaceutical companies; however, the CMA considers that the same principles apply to the relationship between its members and manufacturers of medical devices, infant formulas and similar products, and health care products and service suppliers in general. These guidelines reflect a national consensus and are meant to serve as an educational resource for physicians throughout Canada.     

Conjugated nonadecadienoic acid is more potent than conjugated linoleic acid on body fat reduction

Conjugated linoleic acid (CLA) has shown a number of health benefits, particularly on controlling body fat while improving lean mass. As one of CLA cognates, conjugated nonadecadienoic acid (CNA, 19-carbon conjugated fatty acid) has been previously reported to have greater efficacy on body fat control. In this report, we compared the efficacy of dietary CLA and CNA on body fat regulation and also compared the mechanism of body fat control using a mouse model. Effects of 0.1% dietary CNA on body fat reduction were comparable to that of 0.5% dietary CLA. The mechanisms of dietary CNA on body fat control were similar to those of CLA: increased energy expenditure and increased fatty acid β-oxidation. Dietary CNA, but not CLA, also improved expression of hormone-sensitive lipase from white adipose tissue, and this may help explain how CNA has better efficacy on body fat control than CLA. Dietary CNA had similar effects as CLA on liver weights; however, unlike CLA, CNA improved glucose tolerance. Thus, CNA has potential to be used as a pharmacological agent to assist current efforts to reduce obesity with less adverse effects than CLA.     

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.     

Confidentiality,ownership and transfer of medical records

The Canadian Medical Association (CMA) regards medical records as confidential documents, owned by the physician/institution/clinic that compiled them or had them compiled. Patients have a right to information contained in their records but not to the documents themselves. The first consideration of the physician is the well-being of the patient, and discretion must be used when conveying information contained in a medical record to a patient. This medical information often requires interpretation by a physician or other health care professional. Other disclosures of information contained in medical records to third parties (eg. physician-to-physician transfer, lawyer, insurance adjuster) require written patient consent or a court order. The CMA is opposed to legislation at any level which threatens the confidentiality of medical records.     

Joint statement on resuscitative interventions (update 1995). CMA policy summary.

This joint statement includes: guiding principles for health care facilities when developing cardiopulmonary-resuscitation (CPR) policy; CPR as a treatment option; competence; the treatment decision, its communication, implementation and review; and palliative care and other treatment. This joint statement was approved by the Canadian Healthcare Association, the CMA, the Canadian Nurses Association and the Catholic Health Association of Canada and was developed in cooperation with the Canadian Bar Association.     

Confidentiality,ownership and transfer of medical records (update)

The Canadian Medical Association (CMA) regards medical records as confidential documents, owned by the physician/institution/clinic that compiled them or had them compiled. Patients have a right to medical information contained in their records but not to the documents themselves. The first consideration of the physician is the well-being of the patient, and discretion must be used when conveying information contained in a medical record to a patient. This medical information often requires interpretation by a physician or other health care professional. Other disclosures of information contained in medical records to third parties (eg. physician-to-physician transfer for administrative purposes, lawyer, insurance adjuster) require written patient consent or a court order. CMA is opposed to legislation at any level which threatens the confidentiality of medical records.     

Politician,MDs offer educators opinions on managing unprecedented health care change.

Three leaders in Canada''s health care debate recently told medical educators that the Canada Health Act needs to be revamped, but each had different views about how the change should be managed. Different perspectives were provided by Alberta Premier Ralph Klein, National Forum on Health member Dr. Tom Noseworthy and CMA President-Elect Judith Kazimirski.     

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.     

A renewed model of CNA regulation involving its C-terminal regulatory domain and CaM

Calcineurin is composed of a catalytic subunit (CNA) and a regulatory subunit (CNB). CNA contains the catalytic domain and three regulatory domains: a CNB-binding domain (BBH), a C-terminal calmodulin-binding domain (CBD), and an autoinhibitory domain (AID). We constructed a series of mutants of CNA to explore the regulatory role of its C-terminal regulatory domain and CaM. We demonstrated a more precise mechanism of CNA regulation by C-terminal residues 389-511 in the presence of CNB. First, we showed that residues 389-413, which were identified in previous work as constituting a CaM binding domain (CBD), also have an autoinhibiting function. We also found that residues 389-413 were not sufficient for CaM binding and that the CBD comprises at least residues 389-456. In conclusion, two distinct segments of the C-terminal regulatory region (389-511) of CNA inhibit enzyme activity: residues 389-413 interact with the CNB binding helix (BBH), and residues 457-482 with the active center of CNA.     

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.