News and analysis · Nouvelles et analyses
- Victoria physicians sponsor Chinese students
- Why are physicians avoiding New Brunswick?
- "Success by 6" the catchphrase for Ottawa's MoH
- Dr. Abbott makes an impression
- Pulse: Ontario leads way for tuition fees
- National organ-donor plan in works
- Interview with Osler biographer goes online
- Frederick Banting and the Group of Seven
- MDs should pay more attention to young women's sexual health: report
- Research Update
Victoria physicians sponsor Chinese students
A decades-old interest in China has prompted 2 Canadian physicians to "adopt" 7 high school students from Suzhou, China. Each year since 1992, Drs. Fleming and Aileen McConnell have financially sponsored 1 new Chinese student attending L.B. Pearson United World College of the Pacific in Victoria. For them, sponsorship involves more than financial assistance. They have become surrogate Canadian parents for the visitors, welcoming the students into their home during Christmas and other holidays and meeting their families in China. "They've become very much family," says Dr. Aileen McConnell.
 | Drs. Aileen and Fleming McConnell with 2 of their clan, Fang Hua (right) and Xian Xiang, during a visit to Boston, where the women attend university |
Like any parents, the McConnells, who have no biological children, are proud of their students' accomplishments. One is completing a PhD in finance at the Wharton School of Business in Pennsylvania, a second is studying economics at Harvard University and a third is studying computer science and mathematics at the Massachusetts Institute of Technology (MIT). Another is taking premedicine courses at BC's Simon Fraser University. "It's satisfying to see young people seize an opportunity to do things and do them well," she says.
The sponsorships are a natural fit with the couple's longtime interest in China. Fleming McConnell, a retired radiologist, is passionate about Chinese history, philosophy and culture. Over the past 20 years he has made about a dozen visits to China, while his wife has visited 7 times. Both have studied in China and speak Mandarin. When the McConnells moved from the Edmonton area to Victoria in 1990, they noted that the local United World College had no students from China. Since Victoria and Suzhou are sister cities, it was decided to select students from there.
The BC college is 1 of 12 around the world that recruits pupils in their second-last year of high school in 80 different countries. The students finish their high school at the college, which is renowned for its high academic standards and commitment to responsibility in social services, and graduate with an international baccalaureate.
"The college has an outstanding reputation," says Aileen McConnell, a semi-retired internist who also raises sheep and trains border collies. "Stanford, Harvard, MIT, Cambridge, Penn State . . . they all send scouts, and many students go on full or partial scholarships to leading universities in North America and the United Kingdom."
Although it seemed appropriate for students to come from Suzhou to Victoria, it was difficult to arrange the trips because the Chinese government is reluctant to let high school students travel abroad. After much negotiation through the Canadian and Chinese consulates, 2 prestigious Suzhou high schools were selected to provide students for the Victoria college.
"The students have all responded well to the challenge of Pearson," Fleming McConnell said this fall, as he prepared to welcome yet another student. — Barbara Sibbald, CMAJ
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Why are physicians avoiding New Brunswick
New Brunswick needs about 300 additional physicians to bring its physician:patient ratio in line with the national average. The province now has a ratio of about 1:748, compared with the national ratio of 1:541 (CMAJ 1999;161[6]:679). For now, however, the New Brunswick Medical Society (NBMS) is concentrating on filling 28 positions, including 13 funded vacancies and 15 new positions proposed in the last provincial budget.
Remuneration is the underlying problem. Salaried NB physicians now earn less than their counterparts in other Atlantic provinces, while their fee-for-service colleagues, who face global and individual caps, are the second lowest-paid in the country. Only Newfoundland doctors rank behind them. The NBMS says this longstanding inequity has led to higher patient volumes and problems with recruitment and retention that affect the province's 1146 physicians. To make matters worse, a provincial physician resource plan that dictates where physicians can practise has medical residents convinced that the province is essentially closed to new doctors.
"That's not true," said NBMS Past President Jeanne McNeill of Moncton. "We have to get beyond that perception. If we don't get this problem solved soon, it's going to be really bad. Every month more physicians are leaving." (Six doctors left Fredericton in the spring, and 2 pathologists have since departed.)
Among other things, the medical society is lobbying the new Progressive Conservative government to remove the caps and address fee-schedule issues. The new health minister is Dr. Dennis Furlong, a former rural community physician and past president of the NBMS.
The medical society is heavily involved in the NB rural summer medical student program, through which about 10 first- or second-year medical students from Dalhousie or Sherbrooke universities work alongside a rural physicianpreceptor for up to 10 weeks. The program, now in its second year, aims to encourage the students to practise in New Brunswick. In addition, the society hosts a spring job fair in Moncton to recruit new physicians.
To help ease the workload, a new collaborative practice model — government funded nurses working in physicians' offices — is now being piloted at 2 sites. "A lot of things could be done with a trained nurse," said McNeill. "We could see more patients more efficiently, with less burnout."
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"Success by 6" the catchphrase for Ottawa's MoH
Ottawa's medical officer of health is a driving force behind a $10-million fund-raising effort aimed at improving services for children under age 6. Dr. Robert Cushman, a public health physician who has spent many years working with families in Canada and Africa, believes that we "aren't doing a good job looking after our children." In Africa, he witnessed "entire villages" caring for a child; in Canada, he says, the entire community should be raising children. "These are our future customers and workers," he says, "and our caregivers. It doesn't cost much and this is the time to invest."
Cushman, a father of 2 and chair of the Success by 6 Funders Working Group, says Ottawa's Success by 6 program is a grassroots community effort to raise $10 million over the next 5 years for programs that range from teaching parents the importance of safety to teaching them the importance of reading to children. The aim is to promote healthy early childhood development from birth to age 6 and ensure that all children are ready to learn when they enrol in Grade 1.
After studying current services, Success by 6 identified 5 areas that need improvement: prevention of abuse and neglect; promotion of healthy birth; support for parents; promotion of early development; and learning activities and support for neighbourhood programs.
The money will go toward expanding existing programs that work and new community-based programs. The working group plans to use proven best practices, including outreach visiting, neighbourhood-based prenatal and postnatal services, respite care, parenting skills development and flexible child care.
Similar programs are already running in 5 other Canadian cities and in more than 200 US communities. In the Ottawa region, 23 groups, including the United Way of OttawaCarleton and school boards, plus a range of other individuals and organizations, will make funding decisions. Fund-raising is being led by the United Way.
"We need to make those ages — 0 to 6 — a priority when it comes to funding," said United Way spokesperson Colleen McKernan. "Not only do these kids flourish, you also save money in the long run. Every dollar spent in the early years saves $7 down the road." — Barbara Sibbald, CMAJ
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Dr. Abbott makes an impression
See also: You say she looks like a tomato, I say she looks like a tomahto [letter]
The work of medical pioneer Maude Abbott (18691940) is being commemorated with a special millennium stamp from Canada Post. Abbott, author of The Atlas of Congenital Cardiac Diseases and a world authority on heart defects, helped found the Federation of Medical Women of Canada in 1924. The FMWC, which first lobbied for a stamp in 1989, called it a "fantastic tribute." The stamp, one of 68 commemorating prominent Canadians, will be available Jan. 17, 2000.
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Pulse
Ontario leads way for tuition fees
| Other Pulse articles / Autres chroniques Médicogramme |
Most first-year medical students in Ontario are paying substantially higher tuition fees this fall than last year. According to data from the Association of Canadian Medical Colleges, the University of Western Ontario was the only school in the province to maintain fees at 1998 levels. Tuition fee increases at the other 4 Ontario medical schools ranged from 26% at McMaster University to 51% at the University of Ottawa. McMaster still has the highest tuition fees in the country, with both first- and second-year students paying $12 600.
For many schools outside Ontario, tuition fees have increased only slightly, if at all. In 2 of the Quebec schools, fees actually dropped slightly for first-year students. The University of Manitoba, at 16%, had the largest increase outside Ontario.
Returning students at some universities also faced tuition fee increases, albeit of a lesser magnitude. Increases ranged from 5% at Dalhousie University to 29% at the University of Ottawa.
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This column was written by Lynda Buske, Chief, Physician Resources Information Planning, CMA. Readers may send potential research topics to Patrick Sullivan (sullip@cma.ca; 613 731-8610 or 800 663-7336, x2126; fax 613 565-2382).
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National organ-donor plan in works
Canada should establish a national organ-donation goal, the House of Commons Standing Committee on Health says. This country, with a current donors-per-million-population (DPMP) rate of 14, lags far behind the world leader, Spain, which has a DPMP of 31. The committee also wants Canada to have a coordinated and comprehensive donation and transplantation strategy, which would be directed by a newly created council. It also agreed that it will not be easy to convince more Canadians to sign donor cards. "Governments should recognize the critical role of social attitudes in increasing organ donation and share the costs of a collaborative ongoing social-marketing strategy that crosses all societal groups to assist individuals in making personal decisions about organ and tissue donation."
Federal Health Minister Allan Rock described organ-related decisions as "very personal. As governments, our role is to create a comprehensive system that enables Canadians to make their wishes known and ensures that those in need can benefit from the donations that are made." More information is available at www.hc-sc.gc.ca/english/archives/releases/99picebk5.htm.
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Interview with Osler biographer goes online
CMAJ's first online audio interview features Professor Michael Bliss, author of the first full-length biography of Sir William Osler in 70 years. Bliss, who wrote William Osler: A Life in Medicine (University of Toronto Press), was interviewed by Dr. Ken Flegel, an associate editor at CMAJ and the editor in charge of the journal's tribute to Osler that appeared in the Oct. 5, 1999, issue. Visitors to the eCMAJ section can either listen to the complete conversation or select specific questions and answers.
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Frederick Banting and the Group of Seven
In 1925, fame rested heavily on the shoulders of Sir Frederick Banting, whose name had become closely associated with the discovery of insulin 3 years earlier. A reticent man, Banting found public speaking difficult and the hounding of the press unbearable. He found relief from the rigours of professional life through his passion for water colours and sketching.
This interest led him to membership in Toronto's Arts and Letters Club, the meeting place for some of Canada's best-known artists, including the Group of Seven. Banting became friends with the group's founding member and one of Canada's leading landscape artists, A.Y. Jackson.
At first glance the scientist and artist might appear to have little in common, but there were many common threads. Both men served on the Western Front during WW I, and both had been wounded and convalesced in England. Both had an interest in military art and a passion for the outdoors and landscape painting.
Over the next 16 years, Jackson invited Banting to accompany him on a number of his sketching trips — some lasting as long as 2 months. They sketched from the Georgian Bay area to wintertime rural Quebec; there, they billeted with local farm families. They also travelled to the Eastern Arctic, where they became the first artists to sketch Hudson Bay trading posts.
For Banting, these trips meant a break from the pressures of his medical research. Jackson was a mentor and teacher, often looking over Banting's work and making suggestions for improving it.
 | Near Ste Irenée (1931) by Frederick Banting, from Banting & Jackson: An Artistic Brotherhood, by the Canadian Medical Hall of Fame and London Regional Art & Historical Museums (1997) (Photo: London Regional Art & Historical Museum) |
At the time of his death in 1941, Banting was one of Canada's best-known amateur painters. It was reported that Banting's death in a plane crash hit Jackson just as hard as the death of another good friend and sketching partner, Tom Thomson, a quarter of a century earlier. — Peter Wilton, Toronto
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MDs should pay more attention to young women's sexual health: report
Physicians have much to learn about helping young women achieve sexual health, a report from Dalhousie University's Department of Community Health and Epidemiology states. It says that even though Canadian data indicate that most young people are sexually active by the time they are in their final year of high school, medicine appears to be lagging behind this reality.
Dr. Donald Langille, one of the principal researchers for the report, Lessons for Helping Young Women Achieve Sexual Health, says the authors wanted to learn more about the obstacles young people face in accessing sex education and sexual health services.
The participants were 28 young women aged 15 to 18 who live in the small Nova Scotia town of Amherst. According to Langille, their responses provided strong evidence that, for many, an effective relationship between themselves and their physician, which is considered crucial to sexual education and health, doesn't exist.
The report also showed that many doctors don't take sexual histories from young people or ask about sexual orientation and practices. Many of the students interviewed by the Dalhousie researchers did not realize that they had a right to confidentiality and mistakenly believed that physicians require parental consent to prescribe oral contraceptives to women younger than 18.
Langille acknowledges that many physicians do an excellent job dealing with these patients, but he hopes the report will be a resource that doctors can use to develop strategies that will make their practices more "youth" friendly. More information is available from Langille, donald.langille@dal.ca — Dorothy Grant, Hammonds Plains, NS
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Research Update
Elderly most affected by seasonal variation in deaths due to MI, stroke
The very elderly are hit hardest by seasonal increases in deaths due to acute myocardial infarctions and stroke, new research indicates.
Besides confirming previous studies' findings that people are more likely to die of heart attack or stroke during the winter, Dr. Tej Sheth of the Hamilton General Hospital and colleagues identified a pronounced age effect in the seasonal variations in death rates (J Am Coll Cardiol 1999;33:1916-9), based on a huge database of deaths in Canada. Seniors over age 85 had up to 16% higher rates of MI deaths in winter than in summer, and 19% higher stroke rates.
MI deaths were highest in January and lowest in September. The seasonal variation in MI deaths (winter versus summer) climbed with age: 5.8% in the under-65 age group, 8.3% in the 65-to-74 group, 13.4% in 75-to-84 group and 15.8% for people over 85.
Similarly, stroke mortality peaked in January and was lowest in September. As with MI, seasonal variation in stroke mortality also increased with age. Researchers identified no seasonal variation in people under age 65, but an 11.6% variation in the 65-to-74 group, 15.2% in the 75-to-84 group and 19.3% in those over age 85.
Sheth believes winter-related changes in clotting, immune system activity and blood pressure — all factors that make atherosclerotic plaques unstable and vulnerable to rupture — may be more pronounced in the elderly and lead to a higher incidence of MI. The limited data available suggest that winter's colder temperatures trigger these physiologic changes. "This is only a hypothesis, though," says Sheth. "We will need to test it in careful studies to confirm whether this is the case."
The CanadianAmerican research team analysed seasonal variations by month and for the 4 seasons. For each of 4 age groups, scientists labelled the magnitude of seasonal variation as the difference in mortality between seasons with highest and lowest frequency of deaths. Researchers looked at 300 000 deaths from the Canadian Mortality Database for the years 1980 to 1982 and 1990 to 1992. It is the largest North American study to date on seasonal mortality.
The findings, says Sheth, open up a new avenue for research into the prevention of cardiovascular disease. — Greg Basky, Saskatoon
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Promising new therapy for cancer
Cancer therapy could well be revolutionized if the potent antitumour activity of a new molecule works as well in humans as it does in mice. The startling findings in mouse models of cancer were published in a recent issue of Science (1999;285:1926-8, www.sciencemag.org).
The research builds on the pioneering work of Judah Folkman, a coauthor of the report. He made headlines when he proposed that cancer could be reversed by cutting off the blood vessels that supply tumours and allow them to grow. The growth of new blood vessels (angiogenesis) occurs only in a few physiologic conditions, including tumour growth and pregnancy. Targeting angiogenesis could lead to new therapies that would be effective in all types of cancer. Folkman's research has spawned a huge effort in this direction.
In this experiment, scientists investigated antithrombin, a serine protease inhibitor (or "serpin"), whose usual job in the body is to inhibit clotting enzymes. By making a small change to the molecule, the researchers switched its role to inhibiting angiogenesis and tumour growth. The altered antithrombin acted to reverse angiogenesis and tumours in mice with cancer. The question for future researchers is whether it can do the same thing in humans safely and effectively.
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