Controversies

American MDs reject moratorium on capital punishment

With capital punishment moving to centre stage in the US federal election campaign, the American Medical Association decided in mid-June to avoid the controversy by refusing to endorse a call for a national moratorium on executions. The AMA’s annual House of Delegates meeting characterized the death penalty as a legal rather than medical issue. They did endorse more use of "appropriate medical forensic techniques" such as DNA testing in capital cases. CMAJ 2000;163(2):197.

Canada’s only Di Bella cancer clinic a lonely place

One year after Canada’s first Di Bella method (DBM) cancer clinic opened in Toronto’s Italian district, it had treated only five to 10 patients. This is a far cry from the situation in 1997 and 1998 when the "cure" developed by Italian physiologist Luigi Di Bella attracted a firestorm of international attention. Di Bella’s controversial cocktail combines bromocriptine, melatonin and somatostatin or octreotide with complementary substances, including vitamin C and shark cartilage; it is taken with low doses of chemotherapeutic agents such as cyclophosphamide. CMAJ 2000;163(8):1030.

Genetically-modified foods need labelling

Better safe and sorry was the maxim of the week as the United Nations met to hammer out an international agreement on genetically modified foods in January 2000. UN delegates and environment ministers from 130 countries decided to abide by the "precautionary principle," which allows countries to block imports of GM seeds and foods if there is any suspicion that these organisms could be harmful. CMAJ 2000;162(6):874.

Hockey-related spinal injuries

At least 243 people suffered spinal injuries while playing hockey in Canada during 1966–1996, according to registry data updated by researchers. They found that a push or check from behind accounted for 74 (40%) of the 184 cases where the cause of injury was known. An impact with the boards accounted for 157 (77%) of the 204 cases of injury where the object hit by the player was known. The authors report an alarmingly low median age of injured players (17 years) and a wide regional variation in reporting (52% of the cases were in Ontario and only 9% were in Quebec). CMAJ 2000;162(6):787-8.

A related commentary posed the question of whether board checks and checks from behind should be made illegal. The author comments on the generally poor quality of Canadian data collected about these injuries and suggests that it reflects the indifference of health officials and the neglect of government. CMAJ 2000;162(6):792-3.

Last trial of Nazi doctor

The world has likely seen the last trial involving a doctor accused of killing people in the name of medicine and Nazi Germany’s euthanasia program and its perverse research involving human subjects. Dr. Heinrich Gross, who is suspected of murdering mentally and physically handicapped children at the Am Spiegelgrund Clinic in Vienna, went on trial March 21. But barely an hour into the trial of the 84-year-old Austrian physician, the judge suspended proceedings after hearing evidence that the defendant was experiencing dementia. CMAJ 2000;162(11):1599.

MDs get jail terms, fines as new police squad targets health fraud

Physicians are among the targets as Canada’s first police-operated health care fraud squad starts cracking down on swindles hat have cost Ontario taxpayers millions of dollars. Since 1998, more than 500 cases have been referred to the Ontario Provincial Police Health Fraud Investigation Unit. The vast majority — 395 cases — involved alleged fraud by people who use the Ontario Health Insurance Plan illegally. There were also cases of double doctoring in which patients used several doctors to obtain controlled drugs by prescription, as well as 60 alleged cases of fraudulent billing by health care practitioners, including physicians. CMAJ 2000;163(5):591.

MD makes legal history with huge libel award

In a blistering judgement released Apr. 20, Mr. Justice J.D. Cunningham of the Ontario Superior Court found the fifth estate, a CBC news program, was guilty of acting with malice against Ottawa hypertension specialist, Dr. Frans Leenen. The judge ordered the CBC to pay Leenen $950,000 in general, aggravated and punitive damages, plus his legal costs (which came to close to $1 million). This is the largest defamation award against the media in Canada'’ history. The hour-long TV program dealt with the safety of a calcium-channel blocker, nifedipine. CMAJ 2000;162(12):1735-6.

Medical ethics after apartheid

The role of the South African medical profession in apartheid is now acknowledged as generally shameful. The South African Truth and Reconciliation Commission revealed 2 failings: toleration or active promotion of inequities in health care and complicity in violations of human rights. A CMAJ article reviews the country’s contrariness to the basic principles of medical ethics under apartheid and the efforts since 1994 to develop a human rights ethos for the profession. CMAJ 2000:162(8):1167-70.

Both the author and an editorialist ask Canadian physicians to examine their own basic principles. CMAJ 2000:162(8):1147-9.

Medical marijuana

The Canadian federal government has a year to devise a better ways to monitor who can use marijuana for medical purposes after an Ontario court of Appeal ruling that the federal law prohibiting the possession of marijuana is unconstitutional. In October 1999, Health Minister Allan Rock lifted criminal sanctions for 14 Canadians suffering from a range of illnesses including AIDS and multiple sclerosis. This allowed them to grow and use marijuana without fear of arrest. The list has since grown to about 40 people. CMAJ 2000;163(5):581.

Hawaii became the first state to legalize growing, possession and use of marijuana for prescribed medical purposed. Under the new Hawaii law, which came into effect in June, patients with qualifying illnesses must obtain a doctor’s recommendation to use marijuana. They must then register with the state’s Department of Public Safety to avoid criminal charges. An estimated 500 to 1,000 people in Hawaii are eligible to register. CMAJ 2000;163(5):588.

The Canadian federal government’s decision in early 2000 to establish a Canadian source of quality and affordable research-grade marijuana is particularly good news for the 37 Canadians who have exemptions that allow them smoke the drug because of illness. Under the Health Canada plan, a grower would establish a processing operation, provide quality control and distribute the marijuana to "authorized recipients." CMAJ 2000;163(1):74.

The issue of medical marijuana has been debated widely by those who promote its use to alleviate cancer pain, reduce nausea caused by chemotherapy or mitigate the wasting syndrome of AIDS, but the drug itself remains the most popular illicit drug in many countries. To get an idea of the scope of need for medical marijuana, researchers conducted a telephone survey of Ontario residents over the age of 18 and asked how many had used marijuana in the previous year and how many had done so for medicinal purposes. The authors report that 49 of the 2,527 people surveyed (or 1.9%) had used marijuana during the previous year for a medical condition, while 173 (or 6.8%) had used cannabis for nonmedical reasons. Therefore, the authors conclude that about 2% of the population could claim the right to use marijuana for medical reasons, based on self-identified needs. CMAJ 2000;62(12):1685-6.

An accompanying editorial, found that rational discussion of the benefits and drawbacks of medicalizing the use of marijuana has been has been put in a straitjacket by a lack of real epidemiologic information on cannabis. "Cannabis policies are too important to be left to partisans of the false forced choices [legalize it or prohibit its use] presented by the media in what so often passes for public debate on this subject." CMAJ 2000;62(12):1690-2.

Copyright 2000 Canadian Medical Association or its licensors