The road to Wisconsin

In this article Lynne Sears Williams of Calgary describes her family''s decision to leave for the US, where her husband, Dr. Jim Williams, will pursue his career in family medicine. The decision was not made easily, she writes, but eventually a love for Canada was outweighed by her husband''s desire to practise medicine without the financial and other constraints facing physicians in Canada.     

A new primary care rostering and capitation system in Norway: Lessons for Canada?

Providing every patient with a personal primary care physician or, from the physician''s perspective, establishing a stable roster or list of patients is currently being actively debated in Canada. Norway''s system of primary care medicine, similar to Canada''s, faces many of the same problems. In 1992 a trial rostering system with blended funding (capitation, fee-for-service and user fees) was established in 4 Norwegian municipalities. After 3 years of close monitoring, the results of system evaluations have attracted strong interest. This article reports on the benefits and problems encountered with the new rostering system in Norway. If Canada is moving in the same direction, some of the lessons learned may be helpful.     

Origin and Migration of Huntington's Chorea in Canada: Preliminary Report

This preliminary report is part of a fullscale investigation of Huntington''s chorea throughout the world. Data were obtained on some 820 possible cases of Huntington''s chorea in Canada, and they were of sufficient quality in 633 cases to enable pedigrees to be drawn up of 104 families. The origin of 75 of these families was traced outside Canada. It was found that 55 of these kinships originally came from the British Isles, contrary to the prevalent feeling that incriminated United States sources. Only 57 of the 633 cases had moved from their first province of residence at the time of reporting. Thus, large and frequent migrations are not the rule, in the Canadian group, as had been previously reported by other authors.     

Eye bank's success due to vision of its founders.

In 1955, the Eye Bank of Canada introduced Canadians to the idea of postmortem tissue donation. The long-time administrator of the bank''s Ontario Division, Anne Wolf, recalls the organization''s early days and how the management of donated corneas became a family affair.     

Rural background and clinical rural rotations during medical training: effect on practice location

BACKGROUND: Providing health care services in rural communities in Canada remains a challenge. What affects a family medicine resident''s decision concerning practice location? Does the resident''s background or exposure to rural practice during clinical rotations affect that decision? METHODS: Cross-sectional mail survey of 159 physicians who graduated from the Family Medicine Program at Queen''s University, Kingston, Ont., between 1977 and 1991. The outcome variables of interest were the size of community in which the graduate chose to practise on completion of training (rural [population less than 10,000] v. nonrural [population 10,000 or more]) and the size of community of practice when the survey was conducted (1993). The predictor or independent variables were age, sex, number of years in practice, exposure to rural practice during undergraduate and residency training, and size of hometown. RESULTS: Physicians who were raised in rural communities were 2.3 times more likely than those from nonrural communities to choose to practise in a rural community immediately after graduation (95% confidence interval 1.43-3.69, p = 0.001). They were also 2.5 times more likely to still be in rural practice at the time of the survey (95% confidence interval 1.53-4.01, p = 0.001). There was no association between exposure to rural practice during undergraduate or residency training and choosing to practise in a rural community. INTERPRETATION: Physicians who have roots in rural Canada are more likely to practise in rural Canada than those without such a background.     

Health Canada/BIOTECanada Summit on regulatory and clinical topics related to subsequent entry biologics (biosimilars), Ottawa,Canada, 14 May 2012

In May 2012, Health Canada and other participants held a National Summit on Subsequent Entry Biologics (SEBs). Health Canada released a guidance document in March 2010 describing policy positions and data requirements for approval of SEBs. While Health Canada and health agencies in other regulatory jurisdictions are aligned on many scientific principles related to biosimilar drugs, Health Canada's specific requirements may not be widely understood by many Canadian stakeholders. The Summit provided an opportunity for education and dialog among physicians who prescribe biologics, provincial payers, and industry on the following topics: preclinical and clinical comparability studies; manufacturing and other product differences; extrapolation of indications; substitution and interchangeability of SEBs with reference biologic drugs in clinical practice; payers' current perspective; pharmacovigilance and naming. It is anticipated that the consensus reached at this meeting will further educate Canadian healthcare professionals, provincial payers, and insurers about the appropriate use of SEBs, and may be of general interest to others internationally.     

The dilemma posed by minority medical traditions in pluralistic societies: The case of China and Canada

Pluralistic societies such as China and Canada frequently find themselves pursuing potentially contradictory goals. China's contradiction results from a desire to preserve cultural diversity while eliminating ‘backward tendencies’ which work against the economic and social development of the country as a whole. Canada's contradiction results from a desire to preserve cultural diversity while maintaining an emphasis upon equality of rights and responsibilities for all Canadians. Behind these differences in ideology, however, is a more basic structural contradiction ‐ namely, that cultural pluralism, while considered an asset as long as it is restricted to preserving unique cultural traditions, is nevertheless a threat to a strong central government if interpreted to imply the power to set policy at the local level. To explore this issue, this article compares China and Canada in terms of three related topics. First, it briefly examines the multicultural policy of China and Canada. This is followed by a discussion of medical pluralism in China and Canada, with an emphasis upon the health of minority groups and the status of minority healing traditions. Finally, common perceptions of shamanic healing traditions in both China and Canada are considered. It is in relation to shamanism that the dilemma posed by cultural pluralism is most clearly delimited.     

Causes of mortality in a subarctic settlement (York Factory,Man.), 1714-1946.

A 250-year retrospective mortality study of York Factory, on the shores of Hudson Bay, was undertaken. The daily journals of the Hudson''s Bay Company and the records of the Anglican Church of Canada were the principal sources examined. From 1714 to 1801 the death rate among the Europeans was 0.015 per year, about 10 times today''s level but in line with American figures of the period. The high mobility of the population during the 19th century precluded statistical assessment. In the first half of the 20th century the Europeans left; among the Cree Indians who stayed 316 out of 401 deaths were caused by infection. As in the preceding eras, tuberculosis and influenza, sometimes in epidemic form, were the most commonly diagnosed diseases. The settlement''s overall mortality rate in those last 45 years was 0.03 per year, triple that for the rest of Canada in 1932.     

Refugee MD not wasting skills even though door to medical practice in Canada is closed

Dr. Lula Hussein, a Somali refugee with a medical degree from East Germany, is not licensed to practise in Canada, but she is making her mark in Ottawa''s Somali community by counselling, advising and helping her fellow refugees. One of her particular interests is in ending the practice of female genital mutilation, which still finds favour among some of Canada''s refugees and immigrants.     

The Class of 1989 and physician supply in Canada

BACKGROUND: "The Class of 1989" is a study of 1722 people who were awarded an MD degree by a Canadian university in 1989. This paper reports on migration, specialty choices and patterns of post-MD training in order to assess the contribution of the graduating cohort to the physician workforce of Canada. METHODS: A longitudinal study was conducted over 7 years after graduation to trace the current location, the post-MD training history and the professional activity of the graduating cohort. Several medical professional and educational associations in Canada and the United States provided year-by-year information on field and location of post-MD training, certification achieved, whether in practice and location of practice through to spring 1996. Information from all sources was linked to a list of 1989 medical school graduates. RESULTS: From entry to medical school through to 7 years after graduation the cohort was diminished by about 16%. The main reason for loss was migration to other countries: 193 graduates (11.2%) were outside Canada in 1995-96. Internal migration was extensive also; for example, by 1995-96 relatively few of the graduates were located in Newfoundland or Saskatchewan. Of the 1516 graduates active in Canada in 1995-96, 878 (57.9%) were in general practice/family medicine, and only 638 (42.1%) were practising or training in a specialty. INTERPRETATION: The "yield" of the Class of 1989 for Canada''s physician workforce is insufficient to meet annual physician inflows from Canadian sources to serve population growth and to replace retiring or emigrating physicians. As output from Canada''s medical schools drops even further, the gap between requirements and supply will grow even wider.     

Concerns of patients,MDs are transforming transfusion medicine.

Fear of HIV and AIDS has been the driving force in reducing physicians'' use of blood and blood products. Nancy Robb interviewed doctors across the country to determine steps they are taking to lower the number of transfusions and discovered that transfusion medicine in Canada has undergone a sea change.     

Canadian-Trained Basic Medical Scientists, 1946-47—1963-64

The number of master''s and doctoral degree holders who obtained their degree in a basic medical science under the supervision of a Canadian medical faculty between 1946-47 and 1963-64 was obtained from the medical schools. Of the total degree holders, 69% are currently residing in Canada, 23% in the U.S.A., and the remaining 8% in overseas countries.Questionnaire returns from doctoral degree holders revealed that citizenship status at the time of graduation is positively related to migration; migration rates were lowest for Canadian-born and highest for landed immigrants and foreign students. Geographic mobility during training was also found to be a significant factor which increased the propensity to migrate. One-half of those who took further postdoctorate training in the United States are currently living in the United States, compared to 15% of those who received all their training in Canada. Information on current type of employment revealed that only a quarter of the Ph.D. respondents are in a basic science teaching position in Canada.     

Lung disease in farmers.

Lung diseases in farmers attributable to their occupation include (a) farmer''s lung, caused by exposure to mouldy hay, (b) the asthma caused by exposure to grain dust and (c) silo-filler''s disease. Their prevalence in Canada is unknown. Farmer''s lung results from inhalation of mould spores in hay; the mechanism is immunologic. The exact cause and mechanism of grain dust asthma are unknown but may be immunologic. Silo-filler''s disease is caused by the toxic effects of inhaled nitrogen dioxide.     

Canadian perspectives on seabed mining: The case of the production limitation formula

Abstract

This paper will analyze the position Canada took on seabed mining in the Third United Nations Law of the Sea Conference (UNCLOS III). Canada is a major land‐based producer of nickel, an industrialized country with private interests in seabed mining, a NATO member, a major ally of the United States, and a country with extensive ties to less‐developed countries. At UNCLOS III Canada was concerned primarily about the management and control of its coastal resources and the protection of the marine environment. After having secured these interests, Canada emerged as the leader of the land‐based mineral‐producer group advocating production controls on seabed mining. The production limitation formula was one of the major reasons for the United States’ decision not to sign the Law of the Sea Treaty. In so forcefully advocating a production limitation formula, the Canadian delegation relinquished Canada's potential as a middle power to bridge the gap between the Group of 77 and the Western industrialized countries in order to formulate a widely acceptable regime to govern the seabed. A production limitation formula was not in Canada's best interests, given her potential role in seabed mining, and was rejected by officials in the Department of Energy, Mines, and Resources, as well as the Canadian private sector.     

Time required for approval of new drugs in Canada,Australia, Sweden,the United Kingdom and the United States in 1996-1998

BACKGROUND: The timeliness with which national regulatory agencies approve new drugs for marketing affects health care professionals and patients. An unnecessarily long approval process delays access to new medications that may improve patients'' health status. The author compared drug approval times in Canada, Australia, Sweden, the United Kingdom and the United States. METHODS: Application and approval dates of new chemical or biological substances (excluding diagnostic products, and new salts, esters, dosage forms and combinations of previously approved substances) approved for marketing in the 5 countries from January 1996 to December 1998 were requested from the relevant pharmaceutical companies. Data on new drug approvals during the study period were also obtained from the national drug regulatory agencies in Canada, Australia and Sweden and from publications of the US Food and Drug Administration. RESULTS: A total of 219 new drugs were identified as being approved in at least one of the countries during the study period: 23 (10.5%) in all 5 countries, 23 (10.5%) in 4, 27 (12.3%) in 3, 42 (19.2%) in 2, and 104 (47.5%) in 1 country. By individual nation, 97 drugs were identified as being approved in Canada, 94 in Australia, 107 in Sweden, 55 in the UK and 123 in the US. Approval times in Canada and Australia were similar (medians 518 and 526 days respectively), but both countries had significantly longer approval times than Sweden (median 371 days), the UK (median 308 days) and the US (median 369 days). This pattern was consistent across all 3 years and for the 23 new drugs approved in all 5 countries during the 3-year period. Median approval times in Canada were similar in all of the reviewing divisions of Health Canada''s Therapeutic Product Program (539-574 days) except the Central Nervous System Division (428 days) and the Bureau of Biologics and Radiopharmaceuticals (698 days). INTERPRETATION: Median drug approval times during 1996-1998 decreased by varying amounts from the 1995 values in all 5 countries. However, the median approval time in Canada continues to be significantly longer than the times achieved in Sweden, the UK and the US, and it remains considerably longer than Canada''s own target of 355 days for all new drugs.     

Plasma-collection plant has to overcome tainted-blood fallout in search for donors

Canada''s lack of self-sufficiency in blood products has led to the opening of a blood-plasma collection centre in Thunder Bay, Ont.--the first of its type in Canada. In convincing donors to donate plasma, the new centre had to overcome some lingering public concern about the safety of the blood-collection system.     

Fear of black market means no RU-486 for Canada until US approves drug

Mifepristone, the "abortion pill" that is better known as RU-486, is no closer to arriving in Canada than it was 8 years ago. But that fact hasn''t slowed debate about the product.     

Jehovah's Witnesses leading education drive as hospitals adjust to no blood requests.

Jehovah''s Witness representatives have visited more than 10 Canadian medical schools and 200 hospitals in an attempt to educate future and practising physicians about nonblood medicine. The trend is becoming more popular since the advent of HIV, and there are now about 100 bloodless medicine and surgery centres around the world, including 52 in the US. However, a Jehovah''s Witness spokesman says Canada is "conspicuously absent" from the list of countries that offer bloodless-medicine programs.     

CMA-cosponsored conference raises many questions about future of regionalized health care.

Is regionalization better because it''s cheaper? Or because it provides better outcomes? Or simply because it''s different from whatever went before? Those were some of the questions asked during a recent conference cosponsored by the CMA and Queen''s University. With each successive speaker, says Charlotte Gray, the message became clearer: there are more muddled theories behind the trend and more pitfalls ahead than planners ever expected when they embarked on the exercise to decentralize health care in Canada and elsewhere.