In 2007, a group of Canadian cardiologists found themselves in a unique position. New – and expensive – implantable cardiac defibrillators were being used by fewer than a dozen doctors. And the Institute for Clinical Evaluative Sciences was offering to help them create a registry that would track outcomes for five years. Soon, they had the largest registry …
If you’re looking for evidence-based health information in Canada, a lot depends on who – and where – you are. A physician in a teaching hospital? No problem. But family doctors in rural areas, nurses or physiotherapists have a much harder time accessing up to date materials. And the general public is more likely to find …
Rahel Yetbarek sits with her feet up, looking out onto the city and the large swath of treed land that surrounds the freeway below her. The nurse is taking in the view over her lunch break, from the 10th floor rooftop garden at Bridgepoint, a Toronto hospital. Nearby, a few patients do the same. The …
Hip and knee replacement surgeries are among the most cost effective medical interventions developed, with the vast majority of patients enjoying a greatly improved quality of life as a result. They are also among the most popular surgeries. You might be surprised to learn that Canada’s yearly 75,000 joint replacements, at an estimated $15 000 …
When the human genome was mapped in the 90s, everybody from scientists to Silicon Valley CEOs believed it would revolutionize medicine by making it personalized. This carried enormous medical and financial opportunities, as well as ethical and legal challenges. But after decades of research, it has become evident that our genome is not nearly as …
Joanne MacPhail was diagnosed with breast cancer in 1993 at the age of forty three. At that time, her treatment included two surgeries, as well as a lengthy course of chemotherapy that had profound physical and emotional side effects. MacPhail details how she sought out reflexology, therapeutic touch and massage therapies to help her cope with side …
Vaccines do not cause autism. Yet when one peer-reviewed paper suggested otherwise, on the basis of results that were both wrong and fraudulent, there were terrible consequences. It launched 15 years of unnecessary studies to confirm what we already knew – and sowed confusion, eliminated rational debate about the merits and risks of vaccination, and …
During this week’s The Rounds Table, Amol Verma (a senior medical resident) mentions that he thinks that the introduction of a new class of blood thinners – New Oral Anticoagulants (NOAC) – is the most important pharmaceutical advance that he has seen to date in his career. I was a bit surprised by that, but …
Read Healthy Debate’s analysis on Regulating the ‘wild west’ of e-cigarettes. As respirologists, we are frequently asked for our opinion on e-cigarettes. At first glance there appears to be some potential positives. While one study suggested that there could be a role for these devices in helping active smokers quit tobacco, a more recent small study …
Vaccination programs are based on the old adage that an ounce of prevention is worth a pound of cure. Since 2007 Canada has had a vaccination program for the Human Papillomavirus (HPV) administered to girls, although the age of vaccination varies by province: Grade 5 in Alberta and Grade 8 (with catch up until Grade …
Herbal marijuana is not an approved drug in Canada, but court rulings have required reasonable access to a legal source of marijuana when authorized by a physician. On April 1st, Canada’s current regulatory system for medical marijuana will be replaced entirely by a new set of rules. These new regulations will have important implications for …
The world is watching athletes in Sochi compete in sports such as hockey and downhill skiing. Concussion poses a risk, not only to the highly trained individuals competing in the Olympics, but also to ordinary Canadians who play sports occasionally. Concussions are the result of a blow to the head, and are the most common …
Sadly, the creep of pseudoscience – as manifested in the provincial legitimization of unproven alternative approaches to health – continues. Ontario naturopaths are pushing hard to become a self-regulating profession, with expanded rights to prescribe drugs and order tests. Thankfully, the Ontario Medical Association is pushing back. This is not a turf war – there …
Of all the pregnancy taboos I’ve heard in my 34 weeks of this surreal, at times ache-inducing, but ultimately incredible state, caffeine has caused me the greatest chagrin. Strangers in line at Coffee Central offered helpfully: “You’ll get decaf, of course.” My four-year-old nephew looked at a cup of tea in my hands, his brow …
Psychiatric medications are valuable tools for treating many mental illnesses. Some psychiatric conditions, such as schizophrenia, can only be effectively treated with medication. However, pharmaceuticals have become the default treatment for all mental illnesses in Canada, even when the evidence suggests that medications are not effective for all of the conditions for which they are …
In Canada, doctors’ associations regularly incorporate new evidence about medications into clinical practice guidelines that are intended to influence patient care. The Ontario Ministry of Health and Long-Term Care reviews the same evidence to decide which medications it will pay for, and often comes to different conclusions. This results in doctors recommending medications which are …
In recent years, health care has embraced the concept of “evidence based” practice. We incorporate this daily in our diverse work settings. We invoke it when we mentor students. We know, for example, that rigorous control of blood sugar levels in people with diabetes reduces their risk of organ damage – and so we aim …
Some breast cancers detected by screening mammography are cured and would have led to death had they not been detected early. Other breast cancers detected by screening can be treated just as effectively if diagnosed later, may not have needed treatment at all, or may be so advanced that treatment does not prevent death from …
The Canadian Task Force on Preventive Health Care recently released recommendations about screening for breast cancer. These recommendations have been criticized by some because they emphasize the results of randomized trials. This article explores the advantages and limitations of randomized trial evidence regarding screening mammography. The recent recommendations by the Canadian Task Force on Preventive …