Rebecca Cheung/ Troy Media/ – When he was starting out in medicine, Dr. Lawrence Cheng was hit with a realization about his patients.

“By the time they reached me it was too late,” Cheng said. “I didn’t feel like I had the correct tools and I didn’t feel like I could do the right thing for my patients.”

Cheng, who has practiced emergency medicine at St. Paul’s Hospital in Vancouver for over 15 years, explained that many of the cases he came across on the job were related to chronic health conditions – and that many of these illnesses were preventable. As waiting rooms continued to fill up every year, he became frustrated.

“There was a lot of symptomatic treatment and not getting to root causes,” said the UBC-trained doctor.

Together with Dr. Ashley Riskin, who was also trained at the UBC School of Medicine, Cheng launched the Vancouver-based integrative medicine clinic, Connect Health, in October.

Connect Health is among a handful of clinics popping up across the province that incorporate new approaches to health and health care delivery. The staff draws from complimentary and western approaches to healing. In addition to M.D.s and certified nutritionists, the clinic also offers naturopathic services, acupuncture and Chinese medicine.

It’s clear that increasing numbers of Canadians are beginning to rethink health and health care options.

But many patients are not only seeking guided advice – like Connect Health — but experimenting with alternative and unconventional medical approaches. Before making any major healthcare decision, important considerations, including safety, costs and personal comfort, need to be addressed.

Many Canadians turning to other options

Current criticisms regarding health care delivery in Canada are far from new.

According to critics, the same issues seem to come up again and again: The system is too focused on disease rather than prevention. Many Canadians don’t have family doctors. Wait times in emergency rooms are getting longer.

At the core, all of these criticisms are interrelated, says Dr. Alan Katz a public health researcher at the University of Manitoba, a family physician, and an expert advisor at EvidenceNetwork.ca, which is a comprehensive and non-partisan online resource designed to help journalists covering health policy issues in Canada.

“The system is very much disease-focused,“ says Katz. “You have a system that appears to be functioning at full capacity dealing with the current disease load.”

Primarily interested in ways of evaluating the efficacy of primary care, like family physicians, Katz says that the current system needs to be remodeled to be more patient-centred.

In fact, 4.1 million Canadians don’t have a family doctor, according to the Canadian Community Health Survey, which was published in 2007. And it’s not always an issue of access, but that patients might not see the importance of seeing a family physician regularly, Katz says.

Not surprisingly, many Canadians are turning to other approaches – including integrative health clinics that merge conventional MD services with complimentary and alternative medicine (CAM). CAM, which includes practices such as acupuncture, Chinese medicine therapy and mind/body healing, is known for focusing on spiritual and holistic health to treat conditions.

According to the World Health Organization’s Global Atlas of Traditional, Complementary and Alternative Medicine, in one year Canadians spent about $3.8 billion on CAM products and therapies. More than half of this total is invested towards practitioners and clinic visits.

And most patients are doing this on their own dime. In most provinces, like in B.C., CAM services aren’t fully subsidized by the provincial medical service plan. Patients with premium assistance benefits are partially covered for services like acupuncture, massage therapy and naturopathy.

As Canadians continue to invest in integrative or completely alternative health approaches, it’s important to take a closer look at the evidence backing up new healthcare movements.

Informed decision-making

Some proponents argue that complementary or alternative medicine incorporates spiritual practices and can’t be evaluated by conventional clinical studies. Still, there’s a danger in not taking a critical look at these procedures and blindly submitting to or ignoring alternative therapies.

And this can be dangerous.

Tracy Truant is a UBC graduate student and researcher with the Complementary Medicine Education and Outcomes (CAMEO) program, a Vancouver-based group that is currently collecting data on how cancer patients make treatment decisions. She’s interested in how to help patients make informed decisions based on evidence.

Though Truant can respect and sympathize with patients for choosing complimentary and alternative approaches, she cautions that health care decision-making comes back to being critical and looking at the evidence.

One issue “is combining common therapies. The idea that more is better,” she said.

Truant has seen one patient who blindly combined two dozen different natural health products with chemotherapy without consulting her physicians and healers.

“She was using the right doses but when she combined them, they all had this anti-platelet effect. She was covered in bruises,” Truant explained. “That is really a problem when you combine it with conventional chemo…it’s life threatening.”

In many cases, she’s seen patients mix and match therapies without telling their doctors or considering the risks.

“That’s the thing that people often forget – your oncologists and Chinese medicine doctors don’t always talk to each other,” Truant explains. “Sometimes treatment and healing programs might not mix very well. In terms of the herbs that are prescribed, there’s a lot of mushrooms that interact with cancer treatment.”

Negotiating your way to better health

There’s actually a lot that patients interested in non-western approaches can do to make wise decisions.

The first is to read up, says Truant. She refers patients who are interested in using herbs with their cancer therapy to reference materials that describe interactions and risk.

Additionally, there is on-going research aimed at confirming whether or not non-conventional therapies work. Last year, German scientists reported that acupuncture could ease nerve pain in cancer patients. But before that, British and South Korean researchers mined through hundreds of clinical studies and reported that placebos seemed just as effective.

Still, there’s also mounting evidence that alternative therapies might even induce harm in patients. Earlier this year, two different high-profile genetic studies suggested that some popular Chinese medicines contain toxic plants and animal products.

The key is to think rationally, say Connect Health medical chairs Drs. Cheng and Riskin. The doctors spend over an hour with all new patients, reviewing their personal health issues.

“When you spend that time, that 60 to 90 minutes, you really do start getting the story, you start getting the narrative of the patient’s life,” Cheng said. “That’s just the beginning, then you can truly understand how to help that patient heal.”

Drs. Cheng and Riskin said that their staff – which includes a naturopath and a Chinese medicine healer – collaborate on medical cases and compare approaches to treatment and healing.

The clinic is currently using data collected on their patients as a way of evaluating whether their approaches are working. The doctors are also hoping to develop facilities so that other doctors and naturopaths can be trained.

Connect Health is one example among a number of integrative health centres, including the Burnaby-based clinic, Integrated Wellness, which are emerging in the Vancouver area. Questions regarding how these clinics should be funded and whether they will be accessible to the public remain.

“Health, it’s more than just the absence of disease, which is what we’ve been taught,” Dr. Riskin explained. “For me, health has to do with what the patients are seeking . . . and helping them get to a point where they wake up feeling good.”

Connect Health patient Karry Desmone agrees. Desmone has suffered from shoulder aches for over 20 years. She’s noticed a difference since she started taking supplements recommended by Connect Health.

Desmone has studied nutrition and worked in health food stores before. So she’s knowledgeable of what she’s putting into her body. And she knows the risks.

“I’ve never felt that safety with an MD like I do with Dr. Cheng,” she says. “What I feel is important, that I want to work with food and natural supplements, is important to him.”

Ultimately, whether patients seek solutions from integrative clinics, conventional medicine, or private complementary and alternative medicine clinics, they need to be prepared to do their research. And making informed decisions means including health care providers in decision-making processes.

Rebecca Cheung is a freelance writer. She is a former journalist intern at EvidenceNetwork.ca.

See: Troy Media

See: Troy Media

Mulcair said  “We’ve hollowed out the manufacturing sector,” he said. “In six years since the Conservatives arrived, we’ve lost 500,000 good-paying, manufacturing jobs … more than half of them because we’re not internalizing the environmental costs.”

Course, we don’t expect them to agree.

• Canada receives a “D” grade and ranks 14th out of 17 countries. The Canadian economy remains a below-average performer on its capacity to innovate.
• Relative to its peers, Canada has improved only on the export market share of its aerospace industry and the number of scientific articles published. On the new indicator that measures trademarks by population, Canada ranks second to last and scores another “D.”
• Countries with the highest overall scores not only spend more on science and technology but also have policies that drive innovation supply and demand.

See: Conference Board

On the face of it, following guidelines seems a very reasonable approach. What could be the problem?

Well, a recent evaluation of cardiovascular patient guidelines reveals that only 12 per cent of the recommendations are based on randomized controlled trials (the highest level of evidence). In contrast, 54 per cent of the recommendations are based purely on opinion and consensus.

Here’s what we know well: Evidence from the last 30 years provides pretty solid support that lowering what would be considered higher levels of blood pressure (above 160 to 170 mmHg systolic), especially in type 2 diabetics, reduces cardiovascular events (heart attacks and strokes) to what many, if not most, would consider a clinically important degree. Statins reduce the chance of cardiovascular events and one can control symptoms and improve outcomes when very high glucose levels are reduced.

But the evidence for reducing the risk of cardiovascular disease is not nearly as impressive or definitive when it comes to aggressively getting numbers below the commonly recommended lower number thresholds for blood pressure (<140/90 mmHg), diabetes (hemoglobin A1c <7 per cent) and cholesterol (LDL < 2.0 mmol/L). This is important because reducing the chance of cardiovascular events is the only reason we aim to change numbers in the first place.

Given this, it is unfortunate how many patients and their families worry and become obsessed with these quite arbitrary breakpoints. A recent British Medical Journal analysis goes so far to say that our idolizing obsession with changing patient numbers is “damaging patient care.”

Beware the spin

One of the more tricky aspects surrounding cardiovascular disease numbers is how the magnitude of the cardiovascular benefits is typically presented.

A news report may, for example, state that a five-year study of a drug has shown it reduces cardiovascular disease by 25 per cent. Sounds convincing, right?

While this number may be technically correct, it’s actually misleading.

That’s because a typical study result may find those patients who go without medication over five years have an 8 per cent chance of a cardiovascular event, whereas if they take the medication in question, their chance decreases to 6 per cent.

Mathematically, it is true that six is 25 per cent lower than eight (a ‘relative’ difference). But the number that matters — the ‘absolute’ number — is actually 2 per cent (8 minus 6). In other words, 2 per cent of people obtained a benefit, but 98 per cent of people on the medication received no cardiovascular benefit. The benefit is hopefully greater over a longer period of time, but studies rarely extend beyond five years.

In the case of statins, a class of drugs routinely prescribed to lower cholesterol, evidence shows the absolute difference in cardiovascular events achieved over a five year period is roughly 1 to 1.5 per cent in patients who have never had a heart attack or a stroke. Other popular drugs (ezetimibe, niacin, fibrates) that lower cholesterol numbers have not been shown to consistently reduce the chance of cardiovascular events.

Most blood pressure drugs (but not atenolol or doxazosin), when used in patients with systolic blood pressures around 160 to 170 mmHg, lead to a difference in cardiovascular events of around 2 per cent to 5 per cent, and there is a 5 to 8 per cent reduction when a drug called metformin is used in newly diagnosed diabetics.

Interestingly, other drugs used to lower blood glucose in diabetes have either been shown to have less of a benefit, no benefit at all or have not been studied to see if they reduce the chance of cardiovascular disease. And we can’t forget the possible side effects and the costs for medications, which patients must consider. Since the majority of patients will not get a cardiovascular benefit from these medications, any side effects really become unacceptable.

Informed decision making

Medical guidelines are oddly silent on patient preferences. A recent look at five main Canadian cardiovascular guidelines reveals that only 99 of the 90,000 words in the documents addresses patients’ values and preferences.

So, given all of this, what’s a patient to do?

Let’s forget the numbers for a moment and focus on what patients can and should do for themselves. The best available data show that stopping smoking, eating in moderation (the Mediterranean diet has the best evidence), and being active are the three most important things a person can do to reduce cardiovascular risk (even if these things don’t change your numbers).

Patients should ask their doctors, if a medication is recommended, whether that specific drug has been shown in well-designed clinical trials to reduce cardiovascular disease, and if so, by how much (in absolute numbers). They should also always have a discussion about the possible side effects and costs of any medication.

The bottom line: The goal is reducing the chance of cardiovascular disease not just lowering numbers.

In the end, a health care provider should support the patient decision regardless of the path the patient chooses and not make them feel guilty if they don’t blindly follow the latest guideline recommendations.

James McCormack is an expert advisor with EvidenceNetwork.ca and professor with the Faculty of Pharmaceutical Sciences at the University of British Columbia in Vancouver.

See: Troy Media

Mike Robinson/ Troy Media/ – The rehash going on this week in the mainstream media (MSM) about Monday’s Albertan election is extremely boring. It is largely a group rethink by the legions of media bloviators who really got it wrong in the first place. Pollsters missed it too, with all of their currently trendy reliance on algorithms to predict with certainty the voting behaviour of crowds. Even the prescient Andrew Coyne definitively nailed down the Wildrose majority the day before the election, in a National Post article that was pulled from the blogosphere at warp speed as soon as the real trend was discerned. 

What remains to be said?

Being more of an anthropologist than a mathematician, I am struck by the power of observing individual voters and small groups in some detail. If I just confine my analysis to extended family, friends and workmates, the following was evident starting last weekend:

1. growing anger at the formulaic redneckism and anti-scientism in the Wildrose bench;

2. growing anger at the Ayn Randian ‘Dagny Taggart objectivism’ of Danielle Smith, which tolerated and excused unacceptable statements by Wildrose candidates. It is always a mistake to defend the indefensible;

3. growing awareness that the Wildbunch was actually getting close to the handles of the Alberta economy, which currently functions as Canada’s ATM. Where was the evidence that the 87 Wildrose candidates had the management experience to manage a $40 billion payroll?;

4. growing intolerance of social and fiscal conservatism at the expense of  all other values;

5. and perhaps most interestingly, a renewed commitment to the altruistic and embracing Canadian spirit, instead of mean-spirited and divisive firewall arguments.

Close to home, I also noticed something else: the voters under 30 were growing increasingly tired of the endless rehashing of Lougheed, Klein, Stelmach, Manning, Flanagan, and Harper histories. That was then and this is now. From a university student perspective, who cares anymore about firewall letters, the Calgary School, hating NEP-promoting Liberals, and evangelical approaches to politics, sex and oil?

Students right now care about getting good jobs, getting established in their first homes, and building families and careers. They also care about their friends, and are less loyal to place than to opportunity. In a funny way, Alberta is really more of a present opportunity than a place.

Maybe my biggest election takeaway was learning the obvious: that the youth perspective on the election was the future and not the past. I have an overwhelming and pervasive sense that the Wildrose pitch was and is dated, and premised on conceiving Alberta as a family farm, never to be left, sold, mortgaged or subdivided.

While Alberta is the national zone of opportunity, it is also a second home to all immigrants. Most of us have moms and dads and competing loyalties somewhere else, and that somewhere else is truly home. Having the push-pull of home and away is similar to the grandparents who spoke wistfully of the “Old Country.” Many new Albertans live this reality, and are inclined to a natural diplomacy when conducting inter-provincial family relations. Why would you build a firewall to keep mom out?

The young cohort of voters is also probably the best-educated generation yet produced by the Canadian public school (I say this with relish), community college and university system. The have grown up with a favourite and friendly TV ‘science uncle,’ David Suzuki, and they have an internet-sized awareness of everything from carbon capture technologies to melting Arctic sea ice. They get climate change.

They live in a world characterized by relationships and interrelationships, both personal and technological, and they understand that everything is connected to everything else. This is notably a world where burning lakes of eternal damnation and Caucasian advantage never existed.

Welcome back Joe Clark

I also detect that young voters are tired of a politics characterized by polarization and cheap-shot arguments, ever-present Levantine anger, vote suppressing robocallers, and mean-spirited attack ads. My youthful Facebook friends clearly prefer the values of altruism, diversity, community and reason to individualism and greed. When I look beyond Alberta, I see all of their energy and hope smiling back at me from the new NDP opposition in the House of Commons.

Whether or not the reborn Alison Redford Progressive Conservatives really embrace the values of youth will shortly be revealed. To maintain the political licence just granted, they will have to govern from the centre slightly to the left, just as premier Lougheed famously did from 1971 to 1985. But unlike Lougheed, they were elected from the centre, and not the right. In this respect, Redford resembles more her old mentor, the fundamentally decent Joe Clark from High River. Joe had a tough time as a Progressive Conservative prime minister back in 1980; perhaps his progressive values of internationalism, biculturalism and humanism (rather than objectivism) will play better in 2012 in the hands and heart of the new premier.

The young voters I know are watching with interest.

Troy Media columnist Mike Robinson has lived half of his life in Alberta and half in BC. In Calgary he worked for eight years in the oil patch, 14 in academia, and eight years as a cultural CEO. Now back In Vancouver, he is still a cultural CEO, but also has business interests in a resource company and mutual funds.

See: Troy Media

(Picture of Alison Redford)

By Anila Umarat – I became a PC party member in 2007 when my friend and mentor, Teresa Woo-Paw, decided to run for nomination in the riding of Calgary-Mackay where we both live. As most of my friends and acquaintances might remember, it was a shock to everyone that someone like myself, extremely socially progressive, would consider even voting Conservative let alone volunteering for them. But I found the experience very rewarding. Like many Albertans, I wasn’t very happy with some of the ‘old boys club’ type of politics that ran our province, and I honestly wasn’t sure whether I would actively participate in the 2012 election.

Alison has integrity. No one ever doubts how smart she is. She could have chosen any career in the world, but she chose to be a human rights lawyer, assisting people around the world in ways I could only dream of. She worked alongside Nelson Mandela and has taken assignments in Bosnia and Herzegovina, Serbia, Namibia, Uganda, Zimbabwe and Afghanistan. Quite frankly, going to those countries, under those conditions frightens me, and Alison’s bravery in chosing to go there leaves me in awe.

Mark Rovere/ Troy Media/ – Question: Should patients in Rome or Detroit have faster access to new prescription drugs than someone living in Victoria or Windsor? If your answer to that is “no,” then here is another query: Why do government agencies tasked to approve or deny new drugs in Europe and the United States (and which presumably have the same high standards as Canada) act quicker when compared to Health Canada?

According to the most recently available comparable data, when compared with the European Medicine Agency (EMA) and the American Food and Drug Administration (FDA), Health Canada took the longest to approve new medicines in most years observed. The Europeans were quicker in every year surveyed (between 2006 and 2010) as were the Americans in six of the last seven years studied (between 2004 and 2010).

Slow approval process leads to higher drug prices

In an ironic twist, Canada has occasionally followed the FDA’s lead by pulling a prescription drug ‘off’ the market because of safety reasons – which is surely favourable for Canadians. So if we trust the FDA to pull drugs off’ the market for safety reasons, why don’t we trust the FDA for drug approvals? There is no reason why Canadians must wait for a new medication already approved and available elsewhere in the developed world.

It is expensive for manufacturers to re-apply for approval every time they want to bring a new drug to market – which adds to the price of drugs that both individual Canadians and taxpayers must pay.

But more importantly, Health Canada’s slower approval process potentially harms patients who otherwise might be able to buy the new drugs. Thus, the federal government could speed up access by harmonizing with the Europeans and Americans on regulatory approvals. It would save companies and taxpayers money and help those in need of the newer drugs.

The problem is magnified by lengthy delays about provincial government reimbursements for new drugs, affecting those that rely on public drug plans. In this case, it absolutely depends on where you live.

Once a new drug has been approved as safe and effective by Health Canada, provincial regulatory agencies must decide whether or not the new medication will be publicly covered under their respective drug plans. This lengthy process significantly prolongs access to new medicines for those dependent on such plans.

For example, Canadians (averaged across all provinces) reliant on public drug plans waited an additional 17 months on average for access to new drugs, this after approval by Health Canada in 2009 (which itself took over 15 months on average to approve the new pharmaceuticals in the first place).

Overall, those eligible for public drug coverage were forced to wait almost three years before gaining access to new prescription medications that were approved in 2009.

In many cases, patients are denied reimbursement by their respective provincial drug plans. As of January 1, 2012, and averaged across all provincial public drug plans, only 19 per cent of the new drugs approved by Health Canada in 2009 were eligible for public reimbursement. But actual approvals vary dramatically among the provinces: for instance, 40 per cent of those drugs were approved for public reimbursement in Quebec compared to four per cent in Manitoba.

This should come as no surprise since decisions regarding public drug coverage are highly politicized and are largely based on budget constraints. Nevertheless, there is one way to improve access to new drugs for those dependent on public assistance to pay for their medication: get governments out of the drug insurance business.

Data show that private drug insurers in Canada approve new drugs far more rapidly than public insurance plans, and more importantly, cover more new drugs altogether. In contrast to public drug plans, on average across the provinces, 82 per cent of new drugs approved by Health Canada in 2009 were covered by at least one private insurer as of the beginning of 2012.

Replace public drug plans

Therefore, one practical solution is to replace public drug plans with means-tested subsidies for those with catastrophic drug costs relative to income; health consumers in need could then purchase a private drug insurance plan of their choice in a competitive market.

Critically, this sensible reform would reduce the delay to obtain new medicines, allow low-income patients to choose the drug plan that best meets their medical needs, and ultimately reduce government-imposed restrictions on consumer choice.

Through international cooperation of the drug approval process and by replacing bureaucratic public drug plans with private plans and targeted subsidies for those with low incomes, needed drugs could more quickly be made available to those in medical and financial need.

Mark Rovere is Associate Director of Health Policy Studies at the Fraser Institute.

See: Troy Media

Canada’s inflation rate dropped sharply in March, as the pace of increase in food and gasoline prices slowed significantly.

The consumer price index dropped to 1.9 per cent in March from 2.6 per cent in February, Statistics Canada said Friday.

It’s the first time in 18 months that the rate has been below the two per cent threshold.

Food prices rose 2.2 per cent in the 12 months to March, following a 4.1 per cent increase the previous month. As well, the cost of energy advanced 5.1 per cent in the 12 months to March, after rising 7.2 per cent in February.

See: CBC