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MEDIA

MÉDIA

Communications Directorate / Direction des communications Media Monitoring Unit / Unité de surveillance des médias (613) 957−1388

2006−03−02

Read the news online at: http://206.75.155.80/health/newlook/browseclips.asp?Lang=E

Lire les nouvelles à l'internet à: http://206.75.155.80/health/newlook/browseclips.asp?Lang=F


Table of Contents/Table des Matières Front Page − Health Canada.............................................................................................................................1 ALBERTA'S THIRD WAY Klein willing to defy Ottawa Premier says medicare plans 'may violate the Canada Health Act' (Globe and Mail)...................................................................................1 'We want to hear what Albertans think': Benefits of reform may be worth violating law: premier ( Calgary Herald)........................................................................................................................................3 Klein to premiers: butt out: Outrage in Ontario 'premature speculation' over alleged violations of health act, premier says (Edmonton Journal)..........................................................................................6 Klein plan under attack: Ontario calls on PM to stop Alberta health reforms (National Post)...............9 Boissons gazeuzes; Des traces d'un produit cancérigène retrouvées aux É.−U. et en G.−B. (La Presse)...................................................................................................................................................12 Foolish funding? Not a bit, MDs say Botox eases MS pain, tuck stops infection (WINNIPEG FREE PRESS).......................................................................................................................................14 Front Page − Public Health Agency................................................................................................................16 Health official: being prepared best medicine; (The Daily Gleaner (Fredericton)................................16 Le spectre de la grippe aviaire atteint le Québec; "Au pays, c'est la première fois que nous atteignons ce niveau d'alerte" (La Presse)............................................................................................18 Fear is greater than the risk; Breast cancer myths worry MDs (The Hamilton Spectator)....................20 FAT POLICE TARGET POP FOR U.S. SIN TAX (The London Free Press).....................................23 Top Broadcast Summaries...............................................................................................................................25 BOWDENS MEDIA MONITORING LTD TELEPHONE (Bowden's)...............................................25 Minister..............................................................................................................................................................28 Clement sees 'opportunities' in health care talk: Watching Alberta closely: Federal Health Minister says 'a lot' can be accomplished within the Canada Health Act (National Post)...................28 ALBERTA'S THIRD WAY Taking a trip to Wonderland with Stephen and Ralph (Globe and Mail)......................................................................................................................................................31 A welcome health care revolution (National Post)................................................................................33 Experts' free advice for PM; Policy leaders offer strategies Tell how to handle health proposals ( The Toronto Star)...................................................................................................................................34 Health Canada...................................................................................................................................................35 Editorials................................................................................................................................................35 Necessary experiments (The Ottawa Citizen).................................................................................35 Klein challenges medicare system (The Toronto Star)...................................................................37 The real deal−breaker in Klein's health plan (Globe and Mail)......................................................39 Flimsy framework for health reform (Edmonton Journal)..............................................................41 Parameters of meaning (Edmonton Journal)...................................................................................43 Alta. 'third way' alters medicare in all provinces (The StarPhoenix (Saskatoon))..........................44 Klein on slippery slope (The Leader−Post (Regina))......................................................................46 Ralphicare unveiled (The Chronicle−Herald).................................................................................47 Alberta challenges the status quo (Montreal Gazette).....................................................................49 Is medicare on life support?: Existing health−care system isn't perfect, but let's not be stampeded into making it worse (Times Colonist (Victoria)).................................................51 A little chocolate, unfortunately, goes a long way (Vancouver Sun)..............................................53 Columns.................................................................................................................................................54 Take action, Tony (Calgary Herald)................................................................................................54 This 'cure' makes me ill (Calgary Herald).......................................................................................55 Klein's tantrum in legislature bizarre: Says he's frustrated with health care, but the public i


Table of Contents/Table des Matières Health Canada consultation he's planning is a joke (Edmonton Journal)...............................................................57 Vers un système à deux vitesses? (L'Acadie Nouvelle)..................................................................60 Harper wise to watch and wait as Klein crosses Rubicon of health care (The Province)...............62 In search of primary−care renewal (Times Colonist (Victoria)).....................................................64 Pandemics and my kids How will we know that avian flu is spreading in schools? ( WINNIPEG FREE PRESS)......................................................................................................66 Le CHUM en PPP? (Le Devoir)......................................................................................................68 Our linguistic imbalance (The Ottawa Citizen)..............................................................................70 Centre acted on its mandate (The Ottawa Citizen)..........................................................................72 Queen's Park Even reporters can't get excited about LHINs (Globe and Mail)..............................73 Fortified white wheat flour adds essentials to our diets (The Ottawa Citizen)...............................75 POOR EDUCATION HAS DOMINO EFFECT (The Edmonton Sun).........................................76 SOUTH DAKOTA TURNS BACK TIME ON ABORTION (The Edmonton Sun)......................78 Warning: Life can make you ill: Believing what you read can be a health hazard (Calgary Herald).....................................................................................................................................80 Drugs......................................................................................................................................................82 Antibiotic poses risks, researchers say: Tequin more likely than alternatives to cause blood sugar swings: study (Montreal Gazette)..................................................................................82 Research links antibiotic to lethal blood−sugar levels (Globe and Mail).......................................84 Study links antibiotic to fatal blood−sugar woes (The Kingston Whig−Standard)........................86 Antibiotic can pose serious risk for elderly Study; Tequin prescribed 500 times daily 'Think twice' about whether to use it (The Toronto Star)...................................................................87 STUDY LINKS DRUG, HEART WOES (The Edmonton Sun)....................................................89 Computer scientist develops life−saving drug programs: U of A prof helps U.S. Food and Drug Administration avoid naming mix−ups (Edmonton Journal).........................................90 Patch approved for depression (The Chronicle−Herald).................................................................93 LOCAL TESTS SUPPORT MS DRUG (The Ottawa Sun)............................................................94 Health Care............................................................................................................................................95 Santé; Harper se montre prudent face aux intentions albertaines (La Presse)................................95 L'Alberta devra respecter la Loi sur la santé; Harper fait une mise en garde à Ralph Klein, qui ouvre la porte au secteur privé (Le Devoir).............................................................................97 Harper embêté par la position de Klein sur la médecine à deux vitesses; Il invite de nouveau les autres provinces à s'inspirer du modèle québécois (Le Soleil)...........................................99 ALBERTA'S THIRD WAY Wild week started with the big reveal In Klein's final term, 'the time is now' to unveil sweeping health−care changes (Globe and Mail)..............................101 ALBERTA'S THIRD WAY: Analysis Is Klein prepared to be the bad boy of Confederation? (Globe and Mail)..........................................................................................103 Harper touts Quebec reforms in response to Alberta plan; But says he needs time to study Klein proposals Critics say delay casts doubts on medicare stand (The Toronto Star).........105 Alberta premier willing to risk violating health act; Province may have to weigh penalties against benefits (The Chronicle−Herald)...............................................................................107 Harper, Klein may clash; PM wants to ensure Alberta's plans for change respect Canada Health Act (The Chronicle−Herald)......................................................................................109 Third Way plan splits backers of private medicine: Doctors 'might exploit situation' ( Calgary Herald).......................................................................................................................111 Alberta proposal not for us: Couillard: Doctors must be public or private; Studies in countries with blend of systems show increase in public sector waiting times (Montreal Gazette)..................................................................................................................................113 ALBERTA'S THIRD PLAN WHAT'S THE PLAN (Globe and Mail)........................................115 ii


Table of Contents/Table des Matières Health Canada ALBERTA'S THIRD WAY 'Two−tier' proposal denounced by Ontario (Globe and Mail)........117 THIRD WAY HOT TOPIC SPEEDIER HEALTH SERVICE FOR PATIENTS WHO CAN PAY (The Edmonton Sun).....................................................................................................119 RALPH THROWS A FIT 'I THREW IT AT THE PAGE AND I SAID: "I DON'T NEED THIS CRAP." AND THEN I APOLOGIZED' (The Edmonton Sun)...................................120 NEW−FOUND RESPECT? KLEIN HOPEFUL OF BETTER RELATIONSHIP BETWEEN FEDS, PROVINCES (The Edmonton Sun).......................................................122 MEDICARE AT RISK: MCGUINTY CALLS ON HARPER TO DEFEND AGAINST ALBERTA'S PROPOSALS TO ALLOW DOCTORS TO WORK IN PUBLIC AND PRIVATE SYSTEM (The Toronto Sun)...............................................................................123 Ralph sorry for venting on teen page Klein health proposal a hot potato (WINNIPEG FREE PRESS)..................................................................................................................................125 An efficient public system best answer to private care, orthopedic specialist says (Edmonton Journal)..................................................................................................................................127 Stephen Harper entend faire respecter la Loi canadienne sur la santé (L'Acadie Nouvelle)........129 Health restructuring gets nod in Ontario; Liberals pass controversial bill Critics say patients will pick up the tab (The Toronto Star).................................................................................131 GRITS SLAM UNION CLAIMS, PUSH HEALTH BILL THROUGH (The London Free Press)......................................................................................................................................133 Cardiac funding in doubt; Doctor who helps heart patients worries he may have to privatize (The Record (Kitchener, Cambrid).........................................................................................135 AGING BOOMERS LINING UP FOR DIALYSIS (The Ottawa Sun).......................................137 L'Outaouais obtiendrait jusqu'à quatre cliniques−réseau (Le Droit).............................................138 Premiers' demands too costly Harper (The Toronto Star).............................................................140 Food Products/Nutrition......................................................................................................................142 Le Guide alimentaire révisé risque de nuire à la lutte contre l'obésité; Deux spécialistes de la santé s'en prennent au projet de Santé Canada (Le Devoir)..................................................142 Smoking...............................................................................................................................................144 Fight cancer by toughening up anti−smoking laws −− groups (Edmonton Journal)....................144 Children...............................................................................................................................................145 Poverty hits one in six kids in Ontario; Study blames increase in part−time, contract work Report urges hike in minimum wage, quality child care (The Toronto Star)........................145 Consumer Prod. Safety........................................................................................................................147 Soft drinks tested after benzene detected (Vancouver Sun)..........................................................147 Public Health Agency of Canada...................................................................................................................148 Pandemic Influenza..............................................................................................................................148 Une maladie qui est là pour rester (La Presse)..............................................................................148 Huit fermes québécoises en quarantaine; Simple précaution, dit l'Agence canadienne d'inspection des aliments (Le Devoir)...................................................................................150 Avian flu fears spark quarantine in Quebec (Calgary Herald)......................................................151 Des producteurs inquiets (Le Soleil).............................................................................................153 Russia: Avian flu claims half a million fowl (Montreal Gazette).................................................154 Grippe aviaire en France: plus un chat dehors dans la région touchée (L'Acadie Nouvelle).......155 Deadly bird flu spreads to Switzerland (The Province)................................................................157 Grippe aviaire en Amérique ?; Enquête sur la mort d'une vingtaine d'oiseaux aux Bahamas ( Le Soleil).................................................................................................................................158 Bird flu probe in the Bahamas (National Post).............................................................................160 Jours fastes pour le fabricant de Tamiflu et de Relenza; Washington achète davantage iii


Table of Contents/Table des Matières Public Health Agency of Canada d'antiviraux (La Presse)................................................................................................................161 Grippe aviaire : l'Amérique retient son souffle (La Presse)..........................................................162 NEW LAW NOT TOOL TO COERCE DOCTORS, AIDE SAYS (The London Free Press)....163 Influenza: un calme plat inhabituel, mais apprécié (La Tribune (Sherbrooke, Qc)).....................164 Diseases/Research................................................................................................................................165 Medical journal's new editor quits: Editorial independence may be reason for resignation after past editor fired (Edmonton Journal).............................................................................165 N.B. bucks super−bug trend; No cases of C. difficile bacteria reported to date in province's hospitals (Times &Transcript (Moncton)).............................................................................167 Lemieux's broken heart likely mended Surgery performed on the hockey superstar this week restores a regular heartbeat in 74 per cent of cases, new research shows (Globe and Mail).......................................................................................................................................168 No free lunch: Fast−food meals are a financial burden on businesses −− globally, losses could be in the billions, a new study says (National Post)....................................................170 Sask. pumps in $2.5M for research (The Leader−Post (Regina)).................................................172 AIDS....................................................................................................................................................174 Province announces program to safely dispose of needles; AIDS P.E.I., pharmacist say province needs to set up needle exchange program to stem spread of deadly diseases. ( The Guardian (Charlottetown))..............................................................................................174

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Front Page − Health Canada ALBERTA'S THIRD WAY Klein willing to defy Ottawa Premier says medicare plans 'may violate the Canada Health Act' (Globe and Mail) PUBLICATION: IDN: DATE: PAGE: BYLINE: SECTION: EDITION: DATELINE: WORDS: WORD COUNT:

GLOBE AND MAIL 060610199 2006.03.02 A1 KATHERINE HARDING, GLORIA GALLOWAY National News Metro EDMONTON, OTTAWA 654 634

KATHERINE HARDING, GLORIA GALLOWAY EDMONTON, OTTAWA Alberta's sweeping health−care proposals aren't "written in stone," Premier Ralph Klein said yesterday, but warned he would not shy away from a fight with Ottawa to get what he wants. Mr. Klein said he doesn't know yet how much of his 10−point plan will remain intact after a public consultation period, scheduled to last a month. If the subsequent legislation breaches federal health rules, however, he's ready to do battle with the new Conservative government. "It may violate the Canada Health Act," he told reporters. Mr. Klein's comments came hours after Prime Minister Stephen Harper warned the province that any changes to its health−care system must conform to the Canada Health Act and suggested that he greatly prefers Quebec's solution for reducing waiting times for treatment. Mr. Harper did not directly condemn any part of his home province's new health policy, which includes a proposal to allow doctors to work in both the public and private systems and to permit patients to pay to have some non−emergency procedures done quickly. But he served notice that his government will be carefully examining the Alberta plan, which, at this point, is little more than a discussion paper, and will have a full response in the days to come. "As we do our own review of the proposals that Alberta has put out, we are going to want to satisfy ourselves that they are within the Canada Health Act," Mr. Harper told reporters during a news conference in the lobby of the House of Commons. "And I would think the government of Alberta would want to do the same thing, given that I know the Premier and the government of Alberta have long committed −− and repeatedly committed in legislation and elsewhere −− that they will respect the Canada Health Act." Mr. Harper continued: "And that's a commitment they've made not just to the government of Canada, that's a commitment they've made to Alberta citizens." Mr. Klein said, however, that he wouldn't rule out changing a provincial law that currently enshrines the Canada Health Act in Alberta's own legislation. 1

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Despite his tough talk, Mr. Klein said he was "frustrated" that critics of his proposals were focusing only on the aspects that deal with the private delivery of health care. He told reporters that if Alberta goes ahead with legislation that breaches federal health rules, he would prefer to sort out any resulting problems with Ottawa using a special dispute−resolution process. Mr. Klein did strike a conciliatory note, however, saying it is conceivable that the most controversial aspects of his 10−point plan could eventually be scrapped and that he's open to ideas from not just Albertans, but the rest of the country. One of the five key principles of the Canada Health Act is accessibility; all insured residents of a province must have access to the same level of health care. Critics of the Alberta plan argue that principle would be violated if rich patients were permitted to pay for faster service in the private system. And, while Alberta Health Minister Iris Evans has said all doctors will be required to perform work in the public system, opponents of private care fear that allowing them to also work for profit will drain public health−care resources. Mr. Harper suggested yesterday that Quebec, which issued its own proposal for health−care reform less than two weeks ago, had developed a better solution for reducing the lengthy waiting times that are jeopardizing public health care. The Quebec plan also involves the use of private treatment, but on a more limited basis than the one put forward by Alberta. "Quebec has put out significant major changes, reforms to the health−care system but reforms that clearly respect principles of the Canada Health Act. I would encourage all provinces to do that," he said. ADDED SEARCH TERMS: GEOGRAPHIC NAME: Alberta; Canada SUBJECT TERM:health care; reform; privatization; federal− provincial relations PERSONAL NAME: Ralph Klein; Stephen Harper

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'We want to hear what Albertans think': Benefits of reform may be worth violating law: premier (Calgary Herald) PUBLICATION: DATE: EDITION: SECTION: PAGE: BYLINE: SOURCE: DATELINE: ILLUSTRATION: WORD COUNT:

Calgary Herald 2006.03.02 Early News A1 / Front Jason Fekete Calgary Herald; with files from CanWest News Service EDMONTON Colour Photo: Calgary Herald Archive / Premier Ralph Kleinsaid Wednesday his health reforms are still just proposals, making criticism from Ontario Premier Dalton McGuinty and others premature.; Photo: Jennifer Huygen 693

A political firestorm is erupting between Alberta and other provinces over controversial health−care reforms, with Premier Ralph Klein conceding his proposals "may" contravene the Canada Health Act, and Ontario Premier Dalton McGuinty urging Prime Minister Stephen Harper to intervene. While violating the health act could spark a feud, Klein said the risks −− including possibly having health transfer payments cut −− could be worth it if his reforms can slash health−care costs and create greater access to care for Albertans. "If the new legislation is tabled, it may −− may −− violate the Canada Health Act," Klein told reporters, noting the legislation will be tabled unless he receives a separate plan to achieve health−care sustainability. The battle for the Tories could also be a provincial one, opposition parties say, as appetite for private care in affluent Calgary could be greater than other parts of Alberta and possibly create friction with the rest of the province. Entrenched Alberta legislation requires the province to adhere to the spirit and law of the Canada Health Act, which sets out accessibility and other public health−care principles. But Klein wouldn't guarantee that stipulation will appear in the new legislation −− expected to be introduced next month −− that would allow for the health reforms. Alberta's new health−care framework proposes private, for−profit care that would allow queue jumping, while permitting doctors to practise in both the public and private systems. Critics and some health policy analysts say that would violate the act. The reforms would allow the public to pay out of their pockets for non−essential surgeries, including hips, knees, cataracts and possibly hernia operations, according to Alberta Health officials.

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Klein noted the reforms are just proposals and "nobody has violated anything yet" −− but it came with a caveat: "I'm not saying we won't (violate the act)." McGuinty, along with other provincial leaders −− including Saskatchewan NDP Premier Lorne Calvert −− expressed concern over the health−care proposals, arguing the reforms would create two−tier health care. Calvert said Saskatchewan is "not interested in the Americanization of health care in Canada." McGuinty, meanwhile, said the onus is on Harper to act on the issue. "When it comes to reducing wait times, for example, we should do that for everybody, not just for those who can afford to jump to the front of queue," McGuinty said. "The ball is clearly in the prime minister's court now." Harper vowed Wednesday his new government is committed to the Canada Health Act and will closely monitor Alberta's health framework −− one he emphasized was just a "working document." "Obviously, as we do our own review, the proposals that Alberta has put out, we're going to want to satisfy ourselves that they're within the Canada Health Act," the prime minister said during a news conference. "I would think the government of Alberta would want to do the same thing." Harper's comments came a day after federal Health Minister Tony Clement said he's "concerned about queue jumping." Klein reminded Clement and the other premiers the reforms are only proposals. "I'm no doctor, but I think that Mr. McGuinty has got a case of premature speculation, Klein quipped. "Nothing is written in stone. We want to hear what Albertans think of these ideas, and what Albertans think of these ideas, to me, is a lot more important than what Mr. McGuinty thinks." Federal Liberal health critic Ken Dryden said Alberta's proposals appear to threaten the principles of the act. "Every Canadian fears the slippery slope," Dryden told reporters. Klein admitted the health−care battle "may" be forced to the dispute resolution mechanism, a process in place in case of a disagreement between Ottawa and the provinces over the interpretation of the act. The premier vented his "frustration over health care" Wednesday in the legislature during question period, when he tossed the opposition Liberals' health policy book after it was presented to him by legislature page Jennifer Huygen. The 78−page plan flew through the air in the direction of the page. "I threw it at the page and said, 'I don't need this crap,' and then I apologized (to the legislature)," Klein told reporters after question period. He also vowed to deliver a personal apology to her. The opposition zeroed in on the incident, labelling it shameful and appalling. "The premier is out of control. The government is out of control," said Alberta Liberal Leader Kevin Taft. "On the first official day of public consultations, the premier is throwing documents at people? It's a sad state of affairs." Taft later focused on the proposed reforms, saying private insurance will drive up the costs. Also, he said 4

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allowing doctors to practise in the private system will add to waiting lists, not shrink them. NDP Leader Brian Mason agreed, highlighting studies from Australia that he said prove just that. jfekete@theherald.canwest.com

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Klein to premiers: butt out: Outrage in Ontario 'premature speculation' over alleged violations of health act, premier says (Edmonton Journal) PUBLICATION: DATE: EDITION: SECTION: PAGE: BYLINE: SOURCE: DATELINE: ILLUSTRATION: WORD COUNT:

Edmonton Journal 2006.03.02 Final News A1 / Front James Baxter The Edmonton Journal EDMONTON Photo: Larry Wong, The Journal / Alberta Health MinisterIris Evans outlines her government's health care proposals on Tuesday. 692

EDMONTON − The rest of Canada should mind its own business and let Alberta examine all possible ways to cut health−care costs, Premier Ralph Klein said Wednesday. Klein said Ontario Premier Dalton McGuinty is "suffering from premature speculation" after McGuinty called on Prime Minister Stephen Harper to step in to protect the Canada Health Act. Klein said he doesn't know whether the 10−point legislative framework unveiled Tuesday, which would allow doctors to work simultaneously in public and private systems, will violate the act, because public consultations haven't been held. It may come to the point when Alberta will have to weigh the possibility of federal penalties against the benefits of the reforms, Klein said. "Weighing one against the other, that is precisely it." Klein left open the possibility that no legislation will be tabled after the one−month consultation period, saying he plans to table the legislation "unless we receive a better proposal. "What Albertans think of those ideas, to me, is a lot more important than what Mr. McGuinty thinks," Klein said. "The ball is clearly in the prime minister's court now," McGuinty told reporters earlier in the day. "He (Harper) restated his position once again at our dinner this past Friday. He specifically said he was going to encourage experimentation and innovation within the Canada Health Act." McGuinty said Ontario's health reforms, unlike Alberta's, are aimed at all citizens, "not just those who can afford to jump to the front of the queue." Ontario Health Minister George Smitherman went further, saying Alberta's plans amount to a "pretty deliberate" attempt to circumvent the Canada Health Act.

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Harper put the ball squarely back into Klein's court, saying he believes Alberta's commitment to the Canada Health Act is enshrined in provincial legislation. "This government is committed to the Canada Health Act," Harper said. "My understanding is that the Alberta government is not just committed to the Canada Health Act, but the Alberta government has enshrined the Canada Health Act in Alberta's own legislation." Harper was likely referring to the preamble to Alberta's Health Care Protection Act, better known as Bill 11. In it, the government commits to "the preservation of the principles of universality, comprehensiveness, accessibility, portability and public administration as described in the Canada Health Act as the foundation of the health system in Alberta." Asked whether that language would be included in the government's proposed Health Care Assurance Act, the backbone of his 10−point plan, Klein said it's a matter to be resolved through consultations. While Harper has signalled his government is open to innovation in the public system, interpretation of what violates the federal law remains Ottawa's exclusive domain. A chief difference between Klein's plan and proposals being made by Quebec is that Alberta would allow doctors to work in both the private and public health−care systems, while Quebec would force them to choose. Critics say Alberta's plan would lead to a shortage of doctors in the public system, and that allowing private insurance for medically necessary surgery would lead to queue−jumping. Klein said Alberta and Ottawa are a long way from a showdown. "No one has violated anything yet," he said. "There is, I would remind you, a dispute resolution mechanism in place that has never been used." Klein said he believes Harper and the federal health minister are keeping an open mind about the proposals, and said he appreciates that. "And I welcome any comments that the prime minister or the federal health minister might have in order to achieve sustainability and bring costs in line with the rate of inflation." Liberal Leader Kevin Taft said Klein isn't interested in fixing health care, but rather is blindly following conservative ideology that private−sector solutions must be better. "It's a death of a thousand cuts," he said. "Since Ralph Klein became premier in 1993, he has been raising the bogeyman of health−care costs being out of control. He has been relentless. "Here we are 13 years later and he's still playing the same cards." Taft said the premier has never successfully made the case that the public system is sufficiently broken to warrant the creation of two−tiered health care, adding that he thinks the plan is more about making some of Klein's "friends" in Calgary rich at the expense of something most Albertans hold dear. "It's time for this game to end," he said. Ken Dryden, health critic for the federal Liberals, said Harper's ringing endorsement of the Canada Health Act helped get his party elected. The time is fast approaching, he said, for Harper to take a stand. 7

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"The clear message that needs to come from the government of Canada is (it) will uphold the Canada Health Act −− the words of it, the spirit of it, the understanding that Canadians have of it." With files from Kelly Cryderman, the Ottawa Citizen and The Canadian Press jbaxter@thejournal.canwest.com

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Klein plan under attack: Ontario calls on PM to stop Alberta health reforms (National Post) PUBLICATION: DATE: EDITION: SECTION: PAGE: BYLINE: SOURCE: DATELINE:

National Post 2006.03.02 All but Toronto News A1 / Front Lee Greenberg and Juliet O'Neill, with files from KellyCryderman and Aaron Derfel CanWest News Service TORONTOCANADA Black &White Photo: Greg Southam, CanWest News Service /Alberta health care ILLUSTRATION: reforms would allow patients to pay for faster treatment.; Black &White Photo: Stethascope. WORD COUNT: 768 TORONTO − Ontario Premier Dalton McGuinty yesterday called on Stephen Harper to block planned Alberta health care reforms that would allow patients to pay for faster access to some medical procedures. "The ball is clearly in the Prime Minister's court now," Mr. McGuinty said. "[Mr. Harper] restated his position once again at our dinner this past Friday. He specifically said he was going to encourage experimentation and innovation within the Canada Health Act." Mr. McGuinty said Ontario's health reforms, unlike Alberta's, are aimed at all citizens, "not just those who can afford to jump to the front of the queue." Mr. McGuinty's Health Minister, George Smitherman, said Alberta's plans amount to a "pretty deliberate" attempt to circumvent the Canada Health Act. A day earlier, Alberta Premier Ralph Klein unveiled his long−awaited health−reform framework −− dubbed the "third way." It includes a 10−point policy plan that aims to slash waiting times for a range of medical procedures and increase access for all Albertans, while corralling out−of−control health budgets and keeping costs in line with the rate of inflation. The reforms would allow the public to pay out of pocket for non−essential surgeries, including those involving hips, knees, cataracts and possibly hernias, according to Alberta Health officials. But as soon as it was released, critics warned it violated the Canada Health Act and could force a showdown with Ottawa, especially since Mr. Harper has vowed to protect the act, which sets out accessibility and other public health care principles. Mr. Klein acknowledged on Tuesday the proposals could "perhaps" change the face of medicare in this country should they be passed into law. Yesterday, however, he said he does not want to contravene the Canada Health Act. 9

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"All we're doing is consulting. And, you know, I'm no doctor, but I think that Mr. McGuinty's got a case of premature speculation," he said about the Ontario Premier's comments. "No one has violated anything yet." Mr. Harper said yesterday his minority government will carefully examine Alberta's proposals before issuing a full response within the next few days. "Obviously as we do our own review of the proposals that Alberta has put out, we're going to want to satisfy ourselves that they're within the Canada Health Act," he said. Mr. Harper also made a pointed reference to Quebec's new health care reforms, saying they "clearly respect the principles" of the act and that all provinces should do likewise. A chief difference between Alberta and Quebec's proposals are that Alberta would allow physicians to work in both the private and public health care systems, while Quebec would force doctors to choose one or the other. Critics of the Quebec plan say it will lead to a shortage of doctors in the public system and that allowing private insurance for medically necessary surgery will lead to queue−jumping. The principles of the Canada Health Act, which authorizes the federal government to transfer billions of dollars to the provinces, are comprehensiveness, universality, accessibility, portability and public administration. Federal Liberal health critic Ken Dryden said Alberta's proposals appear to threaten the principles of the act. "Every Canadian fears the slippery slope," he told reporters. "The clear message that needs to come from the government of Canada is the government of Canada will uphold the Canada Health Act −− the words of it, the spirit of it, the understanding that Canadians have of it." Mr. Dryden declined to say what the Liberals would have done if they had been in government when Alberta released this discussion paper. "The Conservatives were elected in part on giving a ringing endorsement to the Canada Health Act," he said. "It's Mr. Harper's obligation to live up to the CHA because that is what Canadians expect." Mr. Klein has argued his reforms are needed to control ballooning costs and to ensure Alberta's health care system is sustainable into the future. "There's virtually no disagreement that the health system must change to survive," Mr. Klein told reporters on Tuesday. "People are waiting too long. The system is too expensive and growing more expensive day by day.... Alberta's population is growing and it's ageing, and the health system hasn't changed with the times." In Quebec, an aide to Health Minister Philippe Couillard said yesterday the province will not follow Alberta's proposal to allow doctors to work in both the public and private systems. However, Quebec seemed to take a more neutral position on the divisive issue than Ontario.

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"Health care is a provincial jurisdiction," Isabelle Merizzi said. "The provinces can set out their orientation according to their needs and priorities." Saskatchewan Premier Lorne Calvert said Alberta's proposed reforms are not an option in Saskatchewan. "You will know this province will stand square behind the principles of the Canada Health Act," he told reporters. "This province and its people say very clearly, 'We are not interested in the Americanization of health care in Canada. We're not interested in two−tier systems. We're not interested in systems that allow people who have resources to bump the queues and get ahead.' Our health care needs to be provided to those who have the health care needs, based on your needs and not your ability to pay." Mr. Klein has promised his government is "not going to move forward until Albertans have had a chance to see what we're proposing and weigh in with their opinions."

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Boissons gazeuzes; Des traces d'un produit cancérigène retrouvées aux É.−U. et en G.−B. (La Presse) PUBLICATION: DATE: SECTION: PAGE: BYLINE: WORD COUNT:

La Presse 2006.03.02 Nouvelles générales A1 Côté, Charles 654

Santé effectuera des tests dans ses laboratoires sur les boissons gazeuses en vente au pays, a appris La Presse hier. La décision survient alors qu'un produit cancérigène, le benzène, a été trouvé dans des boissons gazeuses aux États−Unis et au Royaume−Uni, à des taux qui dépassent les normes pour l'eau potable. Les compagnies canadiennes de boissons gazeuses devront fournir de l'information à ce sujet. Cependant, les autorités canadiennes " ne recommandent pas que les consommateurs changent leurs habitudes ". Aux États−Unis, l'industrie n'a pas contesté la présence de benzène dans certaines boissons gazeuses. Il proviendrait de l'interaction de deux ingrédients fréquemment employés dans ces boissons: l'acide ascorbique et le benzoate de sodium. L'industrie américaine des boissons a promis de régler le problème. Cependant, souligne un groupe américain de défense des consommateurs, l'industrie a déjà fait cette promesse en 1990. " Cela montre qu'on ne peut pas s'en remettre à l'industrie pour protéger volontairement le public ", a affirmé Lauren Sucher, porte−parole du Environmental Working Group. Selon un document interne daté de janvier 1991 et rendu public récemment, certains fabricants de boissons gazeuses ont informé discrètement l'agence américaine de surveillance des aliments, la FDA, du problème de benzène. Toujours selon ce document interne, les autorités américaines, en concertation avec Santé Canada, ont acquiescé à la demande de l'industrie de passer le problème sous silence, en échange de la promesse de le régler. Hier, Santé Canada a confirmé à La Presse que, " au début des années 90, il a été déterminé que des traces de benzène pouvaient se former dans certaines boissons... Santé Canada a travaillé avec l'industrie pour comprendre le problème ". Santé Canada affirme que le benzène a été " virtuellement éliminé " à la suite de l'implantation de nouvelles techniques de fabrication. Effet cancérigène Le benzène est l'un des produits dont l'effet cancérigène est le plus solidement établi. Il est associé en particulier à la leucémie, parce qu'il pénètre facilement dans le sang. Pratiquement tout le monde est exposé au benzène. Il est l'un des éléments de la fumée de cigarette et des échappements d'automobiles. La réaction chimique qui produit le benzène, par le contact du benzoate de sodium et de l'acide ascorbique, a été prouvée scientifiquement dans un article publié en 1993 par un chimiste de la FDA. Le benzoate de sodium est un agent de conservation et l'acide ascorbique est le nom chimique de la vitamine C. 12

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Pour les autorités, le problème semblait réglé, mais un laboratoire indépendant américain a réalisé une nouvelle série de tests ces derniers mois. Leurs résultats ont été dévoilés par une revue spécialisée, Beverage Daily. Certaines boissons aurait une teneur en benzène de " plusieurs fois la norme de l'Organisation mondiale de la santé, qui est de 10 parties par milliard ", affirme Beverage Daily. Ces révélations ont eu des impacts en Europe. Hier, la BBC a rapporté que la Food Standards Agency britannique a détecté jusqu'à 8 parties par milliard (ppb) de benzène dans des boissons gazeuses, après en avoir testé 230. En Angleterre, la norme de benzène dans l'eau potable est de 1 ppb. Au Québec, elle est de 5 ppb. Mais ces normes s'appliquent à l'eau, et pas aux aliments. L'agence britannique a affirmé que les taux détectés " n'étaient pas inquiétants ", mais qu'elle allait dialoguer avec l'industrie afin de mieux surveiller la situation. États−Unis Aux États−Unis, Environmental Working Group a demandé à la FDA de rendre publique toute information à ce sujet. EWG s'inquiète d'avoir trouvé dans le commerce une trentaine de produits, dont plusieurs destinés aux enfants, qui contiennent les deux ingrédients dont l'interaction peut être problématique. " Les enfants sont beaucoup plus sensibles que les adultes à l'exposition de produits chimiques comme le benzène ", affirme Lauren Sucher. De son côté, La Presse n'a trouvé qu'une seule boisson contenant les deux ingrédients, une canette de Cplus Orange Éclatée, fabriquée par les Breuvages Cadbury. Joints par La Presse hier, les responsables de l'industrie canadiennes des boissons gazeuses n'étaient pas encore en mesure de commenter le dossier.

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Foolish funding? Not a bit, MDs say Botox eases MS pain, tuck stops infection (WINNIPEG FREE PRESS) PUBLICATION: DATE: PAGE: SECTION: WORD COUNT:

WINNIPEG FREE PRESS 2006.03.02 A1 City 604

Mia Rabson Mia Rabson Manitoba doctors and health officials are defending a health program that was ridiculed across Canada yesterday for public funding of Botox and tummy tucks. The treatments were lampooned by the right−wing Canadian Taxpayers Federation as an example of government frittering away taxpayers' money. But Manitoba officials say their critics got it wrong. The procedures weren't to give patients a sexier body for the beach, or fewer wrinkles. The treatments actually reduced pain, allowed patients to see, and ended health risks for people with chronic skin infections. Accusing the government of paying for vanity treatments is "simply unfair," said Jackie Sul, director of insured benefits for Manitoba Health. "It makes it out that all of these procedures are cosmetic and that's not true. We work really hard to make sure they all meet the test for medically necessary. Every single case is reviewed." The issue was sparked yesterday when the taxpayers federation handed out its annual Teddies Waste Awards for the worst examples of government waste. It nailed Manitoba with its "top" provincial prize for spending $981,000 on 218 tummy tucks, and $10,900 on Botox in 2003−04. Botox is a drug made from a toxin known to cause food poisoning that causes muscles to relax. It is most commonly used for patients wanting to smooth out facial wrinkles. "It's certainly not the type of fat taxpayers were hoping the government would be trimming," the CTF said in a statement. However, two doctors who treated many of the people receiving the treatments said the CTF was mistaken. The Botox was used for patients with spastic muscle disorders such as multiple sclerosis and the tummy tucks helped others with chronic skin infections on their stomachs that would not stay away, despite repeated treatments with IV antibiotics. "These are people with ongoing medical conditions," said Dr. Edward Buchel, section head of plastic surgery inWinnipeg. "These are not just fat people. Yes, this is removing fat and skin, but not because they don't look good in a bathing suit." He said these patients are often unable to work and go on disability at taxpayers' expense, and there is also a large expense to the health system −− $100 a day on average −− to treat the repeated infections. 14

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"This (surgery) returns them to work, it pulls them off chronic long−term antibiotic use, it pulls them off disability," he said. Dr. Andy Gomori, a Winnipeg neurologist, uses Botox for about 100 patients a year who have facial spasms that can prevent them from opening their eyes, and for patients who have extreme spasticity in their muscles after a stroke or because of multiple sclerosis. A single Botox treatement can relieve symptoms of spasticity for four to six months, he said. Tracy Brown, a client services manager with the Multiple Sclerosis Society of Canada, said Botox can greatly improve the quality of life for patients with MS, whose muscles will not relax on their own, causing severe disability and in many cases, severe pain. She said most people hear the word Botox and think celebrities and face lifts, so it gets sensationalized. "I can't speak for someone who has MS, but if I was a person with MS and Botox helped me and enhanced my quality of life, I would be pretty upset that this was flashing across the news," said Brown. "People speak before they get all the information." Adrienne Batra, Manitoba director of the Canadian Taxpayers Federation, said the point of including the tummy tucks and Botox in the awards was to point out that there are growing waiting lists for things such as CT scans and MRIs, but instead the province is spending money to give people flatter stomachs. "These types of services do not fall within public expectations," said Batra. She said she doesn't discount that some of them may be medically necessary and that is why the government needs to be much more open about what it pays for and why. mia.rabson@freepress.mb.ca

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Front Page − Public Health Agency Health official: being prepared best medicine; (The Daily Gleaner (Fredericton) PUBLICATION: DATE: PAGE: SECTION: BYLINE: WORD COUNT:

The Daily Gleaner (Fredericton) 2006.03.02 A1/A2 News JOEL O'KANEjokane@dailygleaner.com 361

River Valley Health is preparing for a potential flu pandemic that, at its worst, could kill 42 people, hospitalize hundreds and afflict one−third of its medical staff. Dennis Doherty, director of emergency management, told the health authority's board Wednesday night there's no reason to panic because the numbers are based on worst−case scenarios and computer modelling. It's likely a real pandemic will be less severe, he said, but it doesn't hurt to be ready. Using the World Health Organization's (WHO) standard infection rate of 35 per cent, River Valley Health combined that number with local demographic information and plugged it into two computer modelling programs developed by the U.S.−based Center for Disease Control. River Valley Health also based its information on a pandemic taking three months to spread across the globe and lasting about eight weeks in one area. "It's just a rough model," Doherty said. "We could be widely off, but it gives us useful information for planning." In particular, he said, the model provides information on what resources will be needed and how the health system will be expected to react. Intensive care units, for example, might have to operate at 200 per cent of capacity. "There is a reason for concern," Doherty said. "People should be interested so we can start talking about this now." One computer model, FluAid, predicted about 8,475 people aged 0−18 would be infected, along with 4,003 people in the 65−plus age range. The vast majority of infections, 19,409, would affect the 19−64 age range. About 32,180 doses of flu vaccine would be required, tying up 2,682 hours in labour. Doherty said the amount of workers affected in the 19−64 age range could have implications for more than just River Valley Health. He said it could impact staffing levels in emergency and municipal organizations, retail stores and factories. He said more awareness is needed among municipalities and the private sector to start preparing now.

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The main problem for River Valley Health is figuring out how to work with a reduced staff and increased workload during a pandemic. Some of the suggestions so far have ranged from restricting elective surgeries to asking medical staff to help out in other areas, such as administering vaccines. Doherty said it's also possible temporary medical sites could be established outside health−care facilities or resources could be concentrated in certain areas to reduce the number of staff needed to manage and run operations. Whatever the case, staff will be ready, he said. "Planning is always a work in progress," he said. "You never reach an endpoint. You just keep building." Doherty said he expects a draft of the plan to be available in June. It's been about 40 years since the last flu pandemic spread around the world. Historic evidence suggests a new flu strain appears three to four times each century. Scientists are watching the H5N1 avian flu virus closely and its potential to trigger a pandemic. So far, the World Health Organization reports the virus has killed 94 people. What could happen The numbers below show how a flu pandemic could affect the areas served by River Valley Health. They are based on worst−case scenarios: People affected: Ages: 0−18: 8,475 Ages: 19−64: 19,409 Ages: 65+: 4,003 Vaccines required (double dose): 32,180 Hours required: 2,682 Hospital admissions: 832 (194 to ICU, 96 on mechanical ventilation) Deaths: 42

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Le spectre de la grippe aviaire atteint le Québec; "Au pays, c'est la première fois que nous atteignons ce niveau d'alerte" (La Presse) PUBLICATION: DATE: SECTION: PAGE: BYLINE: PHOTO:

La Presse 2006.03.02 Nouvelles générales A1 Breton, Pascale Mailloux, Robert Les éleveurs de volaille devront s'y faire, la grippeaviaire est là pour rester, estime Jean−Pierre Vaillancourt, professeur de médecine vétérinaire à l'Université de Montréal. Les foyers d'infection se multiplient en Amérique du Nord, même s'il ne s'agit pas de la ILLUSTRATION: même souche que celle qui dévaste les élevages en Asie. Et les règles draconiennes de confinement des volailles sont elles aussi là pour rester. " On voit des choses qui n'existaient pas avant ", dit−il. WORD COUNT: 733 La grippe aviaire est à nos portes. Craignant le virus H5N1, l'Agence canadienne d'inspection des aliments vient de placer huit fermes québécoises en quarantaine par mesure de prévention. Les propriétaires de ces huit élevages de volaille ont récemment importé des canards et des oeufs de couvée en provenance de la France. Vendredi dernier, la France a confirmé que la grippe aviaire a atteint la région de l'Ain, dans le centre−est du pays. La veille, 400 dindes d'un même élevage ont été retrouvées mortes. Des tests ont révélé qu'elles étaient contaminées par le virus H5N1, celui−là même qui fait craindre une pandémie de grippe aviaire. L'élevage de 11 000 oiseaux a été abattu. Quelques jours auparavant, toujours dans la région de l'Ain, des canards sauvages ont été retrouvés morts. Eux aussi étaient porteurs du virus de la grippe aviaire. Cette annonce a entraîné un embargo sur l'importation de volaille en provenance de la France. Le Canada a fermé ses frontières vendredi. Le Japon et les États−Unis ont fait de même. Les huit fermes visées ont importé des oiseaux moins de 30 jours avant l'embargo. C'est pourquoi les mesures de prévention sont renforcées. " Au pays, c'est la première fois que nous atteignons ce niveau d'alerte ", a reconnu hier le porte−parole de l'Agence canadienne d'inspection des aliments (ACIA), Alain Charrette. Le risque que le virus mortel ait atteint le Québec est faible. La quarantaine imposée aux huit fermes québécoises est d'abord une mesure de routine. Tous les animaux importés doivent subir une période d'isolement à leur arrivée au pays. " La différence dans ce cas−ci, c'est que nous allons visiter les fermes chaque jour pour nous assurer que les oiseaux sont en bonne santé. Pour l'instant, il n'y a aucun signe de maladie. C'est une mesure de précaution ", a expliqué M. Charrette.

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Selon les informations disponibles, les canards et les oeufs importés ne proviendraient pas de la région de l'Ain. Des échantillons ont été envoyés au laboratoire pour une investigation plus poussée. Les résultats des tests seront connus au cours des prochains jours. En fin de journée hier, M. Charrette n'était pas en mesure d'identifier les huit fermes qui sont visées par les mesures. Il n'a pas non plus précisé le nombre d'oiseaux concernés. Pour l'Union des producteurs agricoles, la rapidité de l'ACIA à réagir est une bonne nouvelle. " C'est plutôt rassurant de voir que l'Agence canadienne d'inspection des aliments ne prend aucune chance avec les oiseaux qui arrivent ici. C'est une mesure de précaution supplémentaire ", a déclaré la porte−parole de l'UPA, Sylvie Marier. La crainte de la grippe aviaire fait mal aux éleveurs, surtout aux petits. La Ferme Basque, dans Charlevoix, ne figure pas parmi les fermes placées en quarantaine. Elle n'importe pas de canards. Mais hier, plusieurs consommateurs inquiets posaient des questions aux propriétaires. " C'est dommage. Il y a un risque que les gens se détournent de la viande de canard. C'est notre crainte et il faut souhaiter que ça n'arrive pas ", a raconté à La Presse l'une des propriétaires, Isabelle Mihura. La grippe aviaire se propage Ce n'est pas la première fois que la menace de la grippe aviaire plane sur le Canada. L'automne dernier, quatre canards sauvages porteurs d'une souche H5 avaient été découverts. Un canard d'élevage contaminé en Colombie−Britannique avait aussi mené à l'abattage de tous les oiseaux de l'élevage. Dans les deux cas, les tests ont révélé qu'il ne s'agissait pas de la souche asiatique du virus H5N1. Depuis, une loi oblige toutefois les éleveurs à confiner leurs élevages d'oiseaux à l'intérieur. L'Organisation mondiale de la santé (OMS) vient par ailleurs de faire le point sur la situation. Depuis le début du mois de février, 17 nouveaux pays se sont ajoutés à la longue liste des pays touchés par la grippe aviaire. Des oiseaux contaminés ont été découverts en Asie, en Afrique, en Europe et au Moyen−Orient. Des humains qui avaient été en contact avec des oiseaux porteurs du virus ont aussi été contaminés. En date du 27 février dernier, l'OMS recensait 173 cas de contamination et 93 décès. A ce jour, le virus ne se transmet pas d'une personne à une autre. Un premier cas de grippe aviaire a aussi été recensé sur un chat au cours du week−end. L'animal a été trouvé mort dans l'île allemande de Rugen, près de la mer Baltique. Il aurait mangé un oiseau infecté. Par contre, l'OMS assure qu'aucun décès humain n'est lié à la consommation de volaille ou de produit dérivés convenablement cuits.

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Fear is greater than the risk; Breast cancer myths worry MDs (The Hamilton Spectator)

PUBLICATION: DATE: EDITION: SECTION: PAGE: BYLINE: SOURCE: WORD COUNT:

The Hamilton Spectator 2006.03.02 Final Local A1 Joanna Frketich The Hamilton Spectator 570

Young women are too afraid of breast cancer and older women don't fear it enough. A survey released yesterday by the Canadian Breast Cancer Foundation found women drastically overestimate their chances of getting the disease. Of 800 Ontario women surveyed, 38 per cent believe they will be diagnosed with breast cancer. In reality, 12 per cent will get the disease. Those most at risk −− women over 50 −− reported feeling the least susceptible to breast cancer. It raises concern that women who need to get screened won't go and those at low risk will be needlessly worried. "The movement that was so important 20 years ago to raise awareness has to shift," said Sharon Wood, executive director of the Canadian Breast Cancer Foundation Ontario Chapter. "We need to make sure people have the right information." Of particular concern are immigrant women and those with the lowest incomes because they know the least about breast cancer, the most commonly diagnosed cancer in women. Hamilton's public health department is trying to change this with a unique program that trains women from different cultures about a variety of health issues including breast cancer and screening. The women health educators then spread the information in their own communities. They also arrange for women to have screening such as mammograms and will even take them to the appointment. It's a small step, but one that could have dramatic results. Dr. Slobodan Franic, regional co−ordinator of the Ontario Breast Screening Program, says far fewer women would die of breast cancer in Hamilton if 70 per cent of women 50 years of age or over got a mammogram every two years. Right now, it's only 40 per cent in Hamilton and that's one of the highest percentages in the country. With increased screening, "we would bring down breast cancer mortality in this area by 35 per cent," he said. "It's vital to pick up tumours while they're tiny ... and a physical exam is not going to pick it up." The survey was conducted in October by the Institute for Social Research at York University and was funded by Re/Max and the Princess Margaret Hospital Foundation Breast Centre Women's Committee. 20

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It shows the medical profession and advocacy groups like the foundation have done a good job of raising awareness about breast cancer but have fallen short on providing a realistic picture of the disease. Women are more scared of breast cancer than they need to be; they don't know the symptoms of the disease or what puts them at risk for getting it. "It can be absolutely paralysing," said Dr. Jennifer Everson, of the misinformation women have about the disease. "They won't eat anything that might give them breast cancer, they check their breasts every day and may ask for inappropriate investigations." Everson, who is a family doctor and vice−president medical at Hamilton Health Sciences, said education is key. "Family physicians need to bring the topic of breast cancer up with all ages," she said. "They need to have a discussion." Otherwise, women might be so focused on breast cancer that they ignore other health problems. "Women aren't as aware of their risk of heart disease," said Angela Frisina, a Hamilton public health nurse. "They're more likely to get heart disease." She said part of the reason why breast cancer gets all the hype is because it has such an impact on women's self−esteem. "It's a more personal issue," she said. "A more physical issue." jfrketich@thespec.com 905−526−3349 THE TRUTH ABOUT BREAST CANCER: * It's the most common cancer in Canadian women. * About one in nine women get it. One in 27 die from it. * The death rate has been falling since 1993. * The older you get, the more likely you are to get it. * The faster it's detected, the more likely you are to survive. * Mammograms are the most effective way to diagnose the smallest tumours. * Women 50 years of age and over should get a mammogram once every two years. The biggest risks for getting breast cancer are: * Being overweight. * Taking hormone replacement therapy for a long period of time. * Never having a baby or giving birth for the first time after the age of 30.

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* Never breastfeeding. * A family history of breast, colorectal, ovarian or uterine cancers. * Starting to menstruate before the age of 12. * Late menopause after the age of 55. Women 50 or over can get a mammogram by calling 905−389−0101 or 905−573− 7777, ext 8309.

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FAT POLICE TARGET POP FOR U.S. SIN TAX (The London Free Press) PUBLICATION: DATE: EDITION: SECTION: PAGE: BYLINE: WORD COUNT:

The London Free Press 2006.03.02 Final News A1 MARILYNN MARCHIONE, AP 672

One of every five calories in the American diet is liquid, making pop the country's single biggest calorie source. In response, nutrition experts are stepping up their long−standing fight against sugary soft drinks. In reports to be published in science journals this week, two groups of researchers hope to add evidence to the theory that pop and other sugar−sweetened drinks don't just go hand−in−hand with obesity, but could actually be a leading cause of it. Proving this could help make the case for higher taxes on pop, restrictions on how and where it is sold −− maybe even a U.S. surgeon general's warning on labels. "We've done it with cigarettes," said one scientist advocating this, Barry Popkin at the University of North Carolina in Chapel Hill. "I think that's laughable," said Richard Adamson, a senior science consultant to the American Beverage Association. Lack of exercise and poor eating habits are far bigger contributors to America's weight woes, he said. Ludwig wants a "fat tax" on fast food and drinks. Beverage companies seem worried. Some are making pop "healthier" by adding calcium and vitamins, and pushing fortified but sugary sports drinks in schools that ban pop. This could help them duck any regulations aimed at "empty calorie" drinks, said Jennifer Follett, a USDA nutritionist at the University of California in Davis. Proving that something causes disease is not easy. It took decades with tobacco, asbestos and other substances now known to cause cancer, and it would be especially tough for a disease as complex as obesity. Diet is hard to study. Most people drink at least some sweetened beverages and also get calories from other drinks, such as milk and orange juice, diluting the strength of any observations about excess weight from pop alone. Children are growing and gaining weight naturally, "so we have this added complication" of trying to determine how much extra gain is due to sweet−drink consumption, said Alison Field, a nutrition expert at Harvard−affiliated Children's Hospital in Boston. "Given these caveats, it's amazing the association we do see," she said. 23

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She was among hundreds of scientists who packed a "mock trial" of such drinks at a conference of the Obesity Society last year in Vancouver. Here is the "food police" indictment of pop and its sugar−sweetened co−conspirators. You be the judge: − Count One: Guilt by association. Soft drink consumption rose more than 60 per cent among adults and more than doubled in kids from 1977−97. The prevalence of obesity roughly doubled in that time. Numerous studies link sugary drink consumption with weight gain or obesity. One by Ludwig of 548 Massachusetts schoolchildren found that for each additional sweet drink consumed each day, the odds of obesity increased 60 per cent. − Count Two: Physical evidence. Biologically, calories from sugar−sweetened beverages are fundamentally different in the body than those from food. The main sweetener in pop −− high−fructose corn syrup −− can increase fats in the blood called triglycerides, which raises the risk of heart problems, diabetes and other health woes. This sweetener also doesn't spur production of insulin to make the body "process" calories, nor does it spur leptin, a substance that tamps down appetite, as other carbohydrates do, explained Dr. George Bray of the Pennington Biomedical Research Center in Baton Rouge, La. − Count Three: Bad influence on others. Sugar−sweetened beverages affect the intake of other foods, such as lowering milk consumption. Popkin contends they also may be psychological triggers of poor eating habits and cravings for fast food. He examined dietary patterns of 9,500 American adults in a federal study from 1999−2002. Those who drank healthier beverages −− water, low−fat milk, unsweetened coffee or tea −− were more likely to eat vegetables and less likely to eat fast food. Conversely, "fast−food consumption was doubled if they were high pop consumers and vegetable consumption was halved," he said. − Count Four: Consistency of evidence. Many studies of different types link sugary drinks and weight gain or obesity. Some even show a "dose−response" relationship −− as consumption rises, so does weight. One of the U.S.'s leading epidemiologists who has no firm stake in the debate, the American Cancer Society's Dr. Michael Thun, thinks the evidence adds up to a conviction. "Caloric imbalance causes obesity, so in the sense that any one part of the diet is contributing excess calories, it's contributing causally to the obesity," Thun said. "It doesn't mean that something is the only cause. It means that in the absence of that factor there would be less of that condition." Adamson, the beverage industry spokesperson, disagrees. He cites a 2004 Harvard study of more than 10,000 children that tied consumption of sugar−added beverages to body mass index gain in boys but not girls, a gender difference that warrants a "jaundiced eye" to claims that pop is at fault, he said.

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Top Broadcast Summaries BOWDENS MEDIA MONITORING LTD TELEPHONE (Bowden's)

BOWDENS MEDIA MONITORING LTD TELEPHONE (613) 789−7777 Broadcast coverage/Health Canada Couverture

électronique/Santé Canada Date: 2 March 2006/ 2 mars 2006 Minister/Ministre − 19 reports/reportages *Alberta Premier Ralph Klein unveils ‘Third Way’ health care plans. −2 CTV−TV, CKAL−TV *A look at the ‘Third Way’ of health care announced by the Klein government, and the federal government’s reaction to it. −1 CBR−AM *Alberta is considering changes to the provincial health care system that may lead to a showdown with Ottawa. −2 CBCT−FM, CBN−AM *Alberta outlines its 10−point plan to reshape medicare and in the process has unleashed what could become a major challenge to the Canada Health Act. −1 CBN−AM *Le gouvernement Klein a d

éposé son projet de réforme du systPme de santé. −1 SRC−R *L’Alberta veut r

éformer son systPme de santé pour ouvrir la porte au privé. −1 CKAC−AM *Alberta is opening the door to private health insurance. −1 CFCF−TV *Albertans are being asked to study the government’s plan to reform health care. −1 CBCT−FM *Canadian Prime Minister Stephen Harper says his government will review whether new health care reforms by Alberta will violate the Canada Health Act. −1 25

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CBC−NW *Le Premier ministre Stephen Harper aborde la question de l’introduction du priv

é dans le systPme de santé du Canada. −1 RDI−TV *A look at the Alberta government proposed health care reforms. −2 CHQR−AM, CKUA−AM *The Alberta Premier says he is not looking for a fight with anyone over health care reforms for his government. −1 CHQR−AM *Proposals for reforming the health care system in Alberta may contravene the Canada Health Act. −3 CBC−R *Comments on Ralph Klein’s ‘Third Way’ of health care. −1 CFRA−AM Department/Minist

Pre – 12 reports/reportages *Tom Shapiro will be getting the marijuana plants back that had been seized by the police. −3 CBK−AM, CKCK−TV *Report on an inhaler diabetics can use to get their dose of insulin. −1 GLOBAL *There is a new needle−free way to take insulin, but it is not available in Canada yet. −1 CHEK6−TV *So−called child proof lighters aren’t as effective as some may believe. −2 CBHT−TV, CBAT−TV *Cases of flu are remarkable down this year. −2 CBLT−TV, CBC−NW *A new research into the side effects of a popular drug was rushed into publication because of seriousness. −1 CTV−TV *Health Canada is planning a revision of the Food Guide, since the new guide is obesogenic. −1 CINW−AM *A discussion about research that shows following the Canada Food Guide can cause people to gain weight. −1 CHQR−AM

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******

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Minister Clement sees 'opportunities' in health care talk: Watching Alberta closely: Federal Health Minister says 'a lot' can be accomplished within the Canada Health Act (National Post) PUBLICATION: DATE: EDITION: SECTION: PAGE: BYLINE: SOURCE: ILLUSTRATION:

National Post 2006.03.02 National Canada A5 John Ivison National PostCANADA Black &White Photo: The shadow of a wheelchair. jivison@nationalpost.com; tblackwell@nationalpost.com; Ranwith fact box "Health NOTE: Care" which has been appended to the story. WORD COUNT: 967 Stephen Harper and his Health Minister, Tony Clement, are still studying the new health care proposals from Ralph Klein's Alberta government, which the Prime Minister yesterday dismissed as a "discussion paper." When they do issue their formal response, it is unlikely they will welcome a specific recommendation that permits payment for faster access to some procedures −− clearly a breach of the Canada Health Act. But neither man is likely to lose sleep over the general direction in which Alberta is heading. "How we are judged by the public is our ability to maintain and augment accessibility, so that really is what the debate is about," Mr. Clement said in an interview yesterday. He is reluctant to talk about specifics in advance of Ottawa releasing its response, but the language he uses to refer to the current health care debate suggests he relishes the willingness to consider new ways of doing things. Where the Liberals saw challenges, he talks of "opportunities." Once christened "Two−tier Tony," when he was Ontario's health minister, Mr. Clement is keen to encourage innovation −− but within the parameters of the Canada Health Act. "The public doesn't want us to create a parallel private system −− that's not on the agenda from the public's point of view. So how can we work within the framework of the Canada Health Act to deliver greater accessibility and greater innovation? There is a lot, a lot, a lot that can be accomplished within the four corners of the Canada Health Act," he said. It is no coincidence that both Mr. Clement and Mr. Harper were effusive in their praise of Jean Charest's announcement last month that Quebec will provide public funds for private care if the public system fails to offer timely treatment. This seems to be the model they want to see the other provinces adopt. While Alberta's plan goes beyond this, Mr. Clement will take encouragement from the passage in the Alberta framework that says innovation will not be allowed to adversely affect the provision of essential services through the public 28

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system. A bigger problem for the federal government, and its commitment to reducing wait times, may be the ideological opposition from the Ontario government to any reforms that include increased private−sector participation. George Smitherman, Mr. Clement's successor as Health Minister, has already stated that the province is not interested in expanding the role of private health care. That seems to set him on a collision course with the Harper government. "Both the Prime Minister and I have indicated that the status quo won't be sustainable in terms of demands on our system," Mr. Clement said in a veiled shot at his former adversary. He is encouraged that a debate over health care has finally broken out in the country. "Different people will disagree as to what's inside the Canada Health Act and what's outside, but that is the framework of the discussion," he said. "We're finally catching up to have a very mature debate about a very important topic −− a debate that has been happening in many other OECD countries." That he is a key player in this debate is a surprise to those who have seen Mr. Clement dust himself off after successive defeats in the Ontario Conservative leadership race, the Ontario election, the federal Conservative leadership race and the 2004 election. By late 2004, he had turned his back on politics, joined a major law practice and was sitting on a couple of corporate boards. He was dragged back into the political game by the Conservative riding association president in Parry Sound−Muskoka, who badgered him until he agreed to accept the nomination to run against then−agriculture minister Andy Mitchell. He ended up the winner by 28 votes, after 11 days and a judicial recount. Mr. Clement tells a story from the campaign trail that sums up his determination to rid himself of the tag of the nice guy who always finished last. In a visit to remote Pointe Au Baril on Georgian Bay in terrible weather, he scaled a driveway along the cliffy road he described as "Mount Olympus" to find two unchained dogs barking maniacally. Since he'd already been bitten three times in his political career, he was nervous but still knocked on the door. The woman of the house was so surprised that someone had bothered to climb all the way to her house, she promised the votes of both her and her husband. "That was repeated day in, day out. We literally went the extra mile, and it encapsulated the campaign," he said. He will likely need every ounce of that tenacity if he is to make progress with the notoriously obdurate provinces. HEALTH CARE Key points in recent announcements by Alberta, Quebec and B.C. that opened the door to more private−sector involvement in health care ALBERTA Ralph Klein, the Premier, announced a 10−point "Third Way" plan to reform health care on Tuesday. − Consider shifting some day surgeries and other treatments to specialized clinics and private surgery facilities. − Allow some enhanced services and treatments to be offered on a priority basis to Albertans with private 29

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health insurance. − Expand both the public and private system where it makes sense in response to clear needs. − Allow doctors who meet yet−to−be−determined guidelines to practise in both the public and private systems. QUEBEC The Quebec government released a report on Feb. 16 outlining its response to the Supreme Court's Chaoulli ruling. − Guarantee Quebecers access to elective surgery for knee and hip replacements and cataracts within six to nine months. − Pay for public−system doctors to offer knee, hip and cataract surgery in privately run clinics affiliated with hospitals. − Guarantee access to cancer and heart care, with maximum wait times to be developed. − Lift ban on buying private insurance, but only for hip and knee replacements and cataract surgery. Privately paid surgery only to be done by doctors who opt out of the public system. BRITISH COLUMBIA The B.C. Liberal government's Throne Speech on Feb. 14 announced the province would conduct a review of the health care system. − Need to update the Canada Health Act to make it stronger and more consistent with original goal of providing health care to all Canadians. − Examine other delivery models for health care. Does not matter whether surgery is offered by public or private facilities, so long as it is paid for with public funds. − Add a sixth principle to the Canada Health Act: sustainability of the health care system.

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ALBERTA'S THIRD WAY Taking a trip to Wonderland with Stephen and Ralph (Globe and Mail) PUBLICATION: IDN: DATE: PAGE: BYLINE: SECTION: EDITION: DATELINE: WORDS: WORD COUNT:

GLOBE AND MAIL 060610193 2006.03.02 A4 JOHN IBBITSON Column Metro 665 693

JOHN IBBITSON Stephen Harper has a very large problem. He wrote an election platform, and he wrote a letter. At a press conference yesterday, the Prime Minister promised to respond within "the next few days" to Alberta's proposed introduction of two−tier medicine in the province's health−care system. Mr. Harper clearly believes Ralph Klein has gone too far, wishing the Alberta Premier had limited himself to the more modest reforms under way in Quebec. The Liberals, who have long warned that the federal and provincial Tories were in unholy cahoots, have wasted no time in exploiting the situation. "We'll hold the government to account to ensure they enforce the Canada Health Act," acting Liberal leader Bill Graham promised yesterday. As well he should. After all, Mr. Harper co−wrote and signed his name to the Conservative election platform, which declared: "We are committed to a universal, publicly funded health−care system that respects the five principles of the Canada Health Act." No reasonable citizen can accept that the act and the Alberta proposal are compatible. Only in Wonderland do you get to say: "We have looked at the Canada Health Act, and decided it now means something completely different from what we used to think it meant." If, however, Mr. Harper does declare the proposed Alberta legislation ultra vires , then he will look like a fool and a hypocrite: A fool, because Ottawa has no real power to punish Alberta by withholding health−care transfers −− those transfers are now the equivalent of a rounding error in the Alberta budget; and a hypocrite, because everyone knows the Prime Minister supports increased private−sector participation in the health−care system. After all, Mr. Harper was co−author of the notorious "firewall" letter that he and several others sent to Mr. Klein in 2001, demanding greater autonomy for Alberta. That letter urged Mr. Klein to "resume provincial responsibility for health−care policy. If Ottawa objects to provincial policy, fight in the courts. If we lose, we can afford the financial penalties that Ottawa may try to impose under the Canada Health Act," the letter continued. "Albertans deserve better than the long waiting periods and technological backwardness that are rapidly coming to characterize Canadian medicine." Think of it: If Mr. Harper imposes penalties on Alberta under the Canada Health Act, he will be the Prime Minister he advised Mr. Klein to defy in the letter he wrote five years ago. Maybe it is Wonderland after all. 31

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Even opponents in Alberta to the Klein government's proposals are telling Mr. Harper to butt out. Brian Edy, who ran for the provincial Liberals in the 2001 election, warned against any intrusion by the federal government in this debate. "This is not an area where we should look to the federal government to attempt to enforce their vision on what is sole provincial jurisdiction," he wrote yesterday in an e−mail. "The people of Alberta must decide one way or another in the next provincial election." In Alberta, there are sovereigntists and federalists, but everyone's a nationalist. So if Mr. Harper acts against the Alberta government, he'll betray his own past, infuriate Albertans of every stripe, and risk a schism within his party. Yet, if he does nothing, he will break an election promise and alienate middle−class urban voters in Ontario who, as a whole, are a lot more supportive of protecting public health care than are their Alberta counterparts −− which is why Dalton McGuinty's Liberal government lost no time in criticizing the Alberta initiative. Somehow, Mr. Harper and Health Minister Tony Clement must navigate their way through these political rapids, trying not to get too close to either shore, while avoiding submerged rocks. Maybe they'll invoke an arcane dispute−resolution mechanism; maybe they have something planned that no one else has figured out yet. Or maybe they'll just capsize and get wet. Right now, this corner is taking no bets. jibbitson@globeandmail.ca ADDED SEARCH TERMS: GEOGRAPHIC NAME: Alberta; Canada SUBJECT TERM:health care; privatization; reform; federal− provincial relations PERSONAL NAME: Stephen Harper; Ralph Klein

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A welcome health care revolution (National Post) PUBLICATION: DATE: EDITION: SECTION: PAGE: SOURCE: WORD COUNT:

National Post 2006.03.02 National Editorials A16 National PostCANADA 423

Perhaps the timing is a coincidence. But just five weeks after the Conservatives won power, the push for serious health reform is gaining serious traction. This week, the two westernmost provinces demonstrated an openness to the sort of flexibility that could save the public system. Combined with last year's landmark Supreme Court decision in the Chaoulli case, and the more limited reforms announced by Quebec in January, it seems we are at a turning point for Canadian medicare. In Alberta, a proposal unveiled Tuesday by provincial Health Minister Iris Evans will allow doctors to work in both public and private health care systems, and patients to pay to have certain procedures −− including hip and knee replacements, and cataract surgeries −− done privately. While the proposals are not as revolutionary as some suggest −− most essential procedures would still be conducted pretty much the same as always −− Alberta's government clearly realizes it's time to move past the rigid adherence to a state monopoly on health care. While British Columbia is not so far along in terms of specific reforms, the message sent this week by Premier Gordon Campbell is just as valuable. In touring Scandinavia, France and the United Kingdom, Mr. Campbell has signalled that he has an open mind toward the mixed public−private models those nations embrace. It is about time our politicians started looking seriously at Europe. Advocates of the status quo tend to frame our health care future as an all−or−nothing choice between the current government monopoly and the United States' user−pay system. But this is a false dichotomy: Most Western countries fall somewhere between the two. And that is clearly where Canada's future lies. What makes the developments in both Alberta and British Columbia all the more exciting is that, for the first time in eons, we have a federal government that will not be inclined to respond with demagogic rhetoric about protecting Canada from the evils of "American−style" care. In the coming weeks and months, Stephen Harper and his Health Minister, Tony Clement, will come under considerable pressure to take on any perceived affronts to the Canada Health Act with the same gusto as the Liberals before them. They should resist. Without the introduction of private−care options, our public health care system is destined to collapse. Now that a few provinces have finally acknowledged this truth, the Conservatives should not stand in their way.

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Experts' free advice for PM; Policy leaders offer strategies Tell how to handle health proposals (The Toronto Star) PUBLICATION: DATE: EDITION: SECTION: PAGE: WORD COUNT:

The Toronto Star 2006.03.02 MET News A7 250

Four leaders in Canadian health policy were asked If you were Stephen Harper, how would you respond to Klein's so−called Third Way plan for health−care reform? Dr. Michael Rachlis, a Toronto physician and health consultant "If I was Stephen Harper I would recognize that Mr. Klein has been proposing doctors be able to practise in both systems for over 10 years and hasn't been able to get the idea out of his own caucus. "I would be hoping that internal opposition even within the Conservative party will derail Mr. Klein's proposals." Michael Decter, chair, Health Council of Canada "I would do exactly what (Harper) has done, which is to take a few days to carefully study it and get some advice because this is complex business. "The second thing I'd do is compare the Quebec proposal, which he and his health minister found (was) acceptable and within the Canada Health Act, and see where Alberta is going further than Quebec. "Thirdly, I'd say to Premier Klein that Quebec has an acceptable solution and maybe you should consider following the Quebec course of action − which, of course, is probably not a popular thing to tell an Alberta premier." Maude Barlow, national chair of the Council of Canadians "If I was Stephen Harper ... I would tell Alberta there was no more federal funding whatsoever for medicare until they back away from this move. I think Ralph Klein would go it alone ... I think he's that determined. But at least the Canadian government would be standing up for health care." Dr. Ruth Collins−Nakai, an Edmonton cardiologist and president of the Canadian Medical Association "I can't place myself in Stephen Harper's shoes so I can't answer your question directly. "However, the Third Way is a high−level policy document with not enough detail to make a comprehensive assessment. It's time for meaningful and inclusive discussion."

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Health Canada Editorials Necessary experiments (The Ottawa Citizen)

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The Ottawa Citizen 2006.03.02 Final News Editorial A14 The Ottawa Citizen 548

After years of national paralysis there is finally −− and thankfully −− a willingness to experiment with new approaches to health− care policy, the latest such laboratory being Ralph Klein's Alberta. Quebec opened the first less than two weeks ago with its own health−reform proposals, but Alberta is considering more radical experiments, particularly in allowing patients to pay privately for joint−replacement and cataract surgeries. There's no specific proposal on the table yet, but Premier Klein says he hopes to have new health rules in effect by fall, after long public consultations. Alberta has oil money underwriting its experiments, which gives the province a lot of freedom. Under the Canada Health Act, Alberta's federal transfer payments could be docked if Mr. Klein doesn't pay for all medically necessary treatments in the province. But so what?, Mr. Klein can say. A province with a $7.4−billion annual surplus can do without the $1.9 billion in health money the federal government sends it. So Mr. Klein and Health Minister Iris Evans can muse about letting Albertans jump the queue for joint replacements by paying out of their own pockets, and letting doctors take public money for some services and private money for others. The first measure would pretty definitely violate the Canada Health Act and the second might, depending on how it's administered. Mr. Klein swears that a patient's ability to pay won't affect access to medical care in Alberta, but it's hard to believe him: Your ability to pay affects your treatment in any province, even public−medicare−mad Ontario. Here, most patients pay out of their pockets (or through private insurance) for medicines, eye exams, dentistry and physiotherapy, to name just a few things that might reasonably be considered "medically necessary." Patients with money have the option of paying for virtually any service they want in the United States; others cross into Quebec to pay for diagnostic scans. Joint replacements and cataracts are in a grey zone close to dentistry and eye exams. Bad knees and hips might be agony and failing vision a major handicap, but they don't necessarily kill you, which is why governments have let waiting lists for replacement surgery grow so long. Quebec's solution is a promise to pay for hip and knee replacements outside the province for patients who are stuck in wait−list purgatory. Alberta's solution is to let patients pay for the surgery themselves if they don't want to wait. This is good. At last, we'll start to see hard evidence for or against each approach. 35

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That in turn could force us to make other decisions. Suppose Alberta's patient−pay system benefits the rich more than anybody else, but still leads to shorter waiting lists for everyone? Albertans (and anyone keen to copy them) will have to decide between a) better but unequal services and b) worse but equal ones. Then again, maybe Alberta will provide proof positive that some privatization moves are bad ideas. At least we'll finally have some data and clinical experience, and be able to move the public debate on health reform out of our ideological prisons and into the real world. The more labs at work on the problem, the better.

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Klein challenges medicare system (The Toronto Star)

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The Toronto Star 2006.03.02 ONT Editorial A16 695

In an otherwise thoughtful white paper on health care released Tuesday by the Alberta government, one proposal in the long−awaited 18−page document stands out like a red cape in a bullfight ring. The proposal is the one where Premier Ralph Klein's government says the province's doctors should be allowed to split their time between the publicly funded health−care system and private practice where they would charge patients directly, presumably at higher rates than they get from the province for performing the same medical services. Common sense tells us that doctors would almost certainly give preferential treatment to private patients paying the higher fees, if all other factors such as health of the patient were equal. And that, in effect, could be considered two−tier medicine, which politicians from all political parties, including the new Conservative government in Ottawa, say they oppose. That's why the proposed changes to the Alberta health−care system pose a real challenge to medicare and to Prime Minister Stephen Harper, who repeated his support yesterday for the Canada Health Act. Details of Alberta's proposed changes still need to be made public. When they are, Harper and premiers in other provinces will have to look hard and long at what the changes would mean if patients in the public system are forced to wait longer for service than those in the private system. If wait times were reasonable for everyone, in Alberta or anywhere else, almost no one would be willing to pay their way to the front of the line. Accordingly, long wait times for the people who cannot afford to pay are an essential condition of such preferential systems. The inevitability of long wait times under this kind of two−tier system was confirmed by University of Toronto Professor Colleen Flood, who said "Countries that allow the free movement of physicians between public and private systems, like the United Kingdom, New Zealand and Australia, have big problems with waiting lists. In such countries, patient wait times have actually increased." How Harper responds to the red flag Klein has waved in his face will have an effect on all Canadians, not just Albertans. The reason is that Klein's plan to boost doctors' incomes with fees from private patients amounts to a gold−plated invitation to doctors in other provinces to relocate to Alberta. And such a move only would exacerbate the doctor shortage that exists in every other province, including Ontario. Sooner or later, Harper will have to confront the issue head on because the intent of the Alberta paper is clear "If the public health system does not meet (Albertans') needs or expectations, they feel they should have the ability to choose other options − including the option of paying privately for quicker access." Even strong supporters of the existing medicare system agree that with costs skyrocketing, reforms are 37

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needed to reduce wait times and make adequate care available without bankrupting provincial treasuries. And most agree some flexibility should be available to provinces to experiment with ways of easing wait times and providing key services such as home care − without jeopardizing the basic principles of the Canada Health Act, which was designed to protect against preferential treatment. In Ontario, provincial health minister George Smitherman was right to say the Alberta proposal is not one that Ontario is willing to adopt. And it may not be the right one for Alberta to follow either, given that, ironically, it is Alberta that has made more progress than any other province in cutting wait times for hip and knee replacements. It did so not by letting some Albertans pay their way to the front of the line, but by concentrating resources on the specific need. That is how it slashed wait times for hip and knee replacements from 19.5 months to just 11 weeks. Shortening wait times for rich and poor alike should be the goal of Harper and every premier who wants to experiment with health−care delivery. That is the only way to allay the fears of second−class treatment by millions of Canadians who cannot afford to buy a spot at the front of the line.

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The real deal−breaker in Klein's health plan (Globe and Mail)

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GLOBE AND MAIL 060610208 2006.03.02 A20 Editorial Metro 677 725

It is a pity that the Alberta government could not resist the temptation to go too far in its quest to reform health care. Most of its proposals, tabled this week, are savvy adjustments that would save money and pare waiting times. But the government undercuts its own sound economic medicine with the radical suggestion that individuals should be allowed to pay for faster access to publicly funded services. Doctors, in turn, should be allowed to straddle the public and private systems to provide those services. "We're not talking about taking the roof off," Health Minister Iris Evans argued. "We're talking about opening the door." That door is labelled two−tier medicine. And the province, despite economic and medical evidence to the contrary, appears intent on blessing the creation of a parallel private system that would somehow deliver the same care as its public system. Other provinces, such as British Columbia and Quebec, are astutely exploring ways to allow more private provision of publicly funded care, so that everyone's treatment will be faster and better. In contrast, Alberta would allow those who want faster services to buy them, straining public resources and undermining its own highly sensible reforms. It is an astounding perversion within an otherwise excellent 10−point framework. Alberta would allow pharmacists, nurses and other professionals to deliver primary, preventive and chronic care, probably within interdisciplinary teams. Physicians could then spend more time on complex cases. Doctors and other professionals would be paid for the quality of their care, not on a fee−for−service basis. Regional health authorities would work together to exploit their individual specialties. Urban hospitals could become specialized centres; rural hospitals could find space for rehab or less complicated acute−care cases. There would be greater reliance on specialized, privately owned clinics to deliver public care. The document fairly bubbles with smart notions. And then it imperils those hard−won efficiencies with the possibility of a parallel system. In a major comparative study in 2004, University of Toronto health−law expert Colleen Flood, who holds the federal research chair in health policy and law, compared health systems in five Western nations, including two that permit parallel private care. The result? Perhaps because specialists in New Zealand and England can practise in both sectors, public−sector waiting lists there did not decline. In fact, Dr. Flood concluded that specialists "may even have an incentive to maintain long waiting lists in the public sector to generate demand for services on a private basis." She added chilling estimates: If 10 per cent of Canadian specialist capacity were diverted to the private sector, the public wait for hip replacements could rise to 146 days from 126; the wait for knee replacements could rise to 205 days from 177; and the wait for cataract surgery could rise to 93 days from 80.

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It is not as if Premier Ralph Klein needed to conduct experiments to figure out what works. In 2002, after a three−year effort that probed international models with an avowedly open mind to private systems, the Senate social affairs committee concluded: "A single−funder system yields considerable efficiencies over any form of multi−funder arrangement including administrative, economic and informational economies of scale." The committee, under chairman Michael Kirby, added a firm corollary: "Current restrictions which prevent doctors from operating in both parallel public and private systems should be maintained." In fact, the Premier already has an intriguing delivery model that apparently works beautifully: the Alberta Hip and Knee Replacement Project. Patients are referred to a central clinic that shepherds them through the system. Waiting and hospital times have been cut. Cost analyses are being done as the model expands to other ailments. Clearly, the key is to figure out how to use public resources with concentrated efficiency, not to bless their dispersal. It may be that Premier Klein is simply being mischievous, suggesting radical solutions as a ploy to win approval for his more modest, if still controversial, suggestions. He should take his parallel system off the table soon. ADDED SEARCH TERMS: GEOGRAPHIC NAME: Alberta SUBJECT TERM:health care; reform; privatization

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Flimsy framework for health reform (Edmonton Journal)

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Edmonton Journal 2006.03.02 Final Opinion A14 The Edmonton Journal 651

Why is it Ralph Klein's government can't provide some straightforward, concrete proposals for health−care reform? Albertans are ready and willing for a vigorous public debate on important questions of sustainability and access. But instead of clear options, the government this week dished out more vague principles and empty rhetoric that don't really help us evaluate the "third way". Beneath bafflegab about "putting patients first," two things emerge. Doctors would be allowed to work in both the private and public systems, and people with the cash will be able to buy faster service in the private system for unspecified procedures. That adds up to a two−tier, parallel system and it will surely violate the Canada Health Act, which requires doctors who work in a private system to opt out of medicare. If Premier Ralph Klein wants Albertans to agree to this, he has to provide a lot more detail, including how he'll ensure that a private system won't simply erode the public system when there's plenty of evidence that's exactly what will happen. Health Minister Iris Evans hasn't been much help either. "You can talk about it being two−tiered health care −− but it's no different from what's going on in Quebec, no different than what's going on every place they have a private clinic," the minister told reporters. But that's patently wrong. Quebec does not propose to allow doctors to work in both systems. Doctors have to opt out if they want to work in private surgery clinics. Quebec proposes to bolster access in the public system by guaranteeing that unless patients receive treatment in a specified time, the province will pay for service from a private clinic or an out−of−province provider. Alberta is going in a different direction, encouraging a parallel, private system with the hope it will take pressure off the public system, reduce waiting times and somehow reduce costs to government. The Health Policy Framework, however, gives no indication of how far privatization would extend. Klein and Evans say hip and knee replacements and hernia operations will be opened up to the private sector. But what might come next? And how will doctors determine what to charge privately; whatever the market will bear?

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Evans acknowledged that doctors will be drawn out of the public system to the private system where they can make more money. That's why they'll be required to file a business plan addressing how they will contribute to the public system. But there's no detail on what constitutes "contribution." Klein is right to worry about the sustainability of the health−care system. All provinces are watching health costs eating up more of their budgets. Klein's goal −− to limit the increase in health budgets to the rate of inflation −− is laudable. So why can't we have some straight talk from this government? If the issue is that Albertans have to pay more for health care, let's talk about that and how we might do it: through higher taxes, de−listing, private insurance or increased medicare premiums. Evans threw out a surprising figure: she says 30 per cent of what Alberta covers under health insurance is not required under the Canada Health Act. Does this mean de−listing is on the table? Klein says he doesn't want a battle with Ottawa over health reform. But this clearly raises a red flag for Prime Minister Stephen Harper, who spent the winter election campaign saying he's committed to the Canada Health Act. Harper's reaction so far is cautious. These are "working proposals" and not the final document, he noted. That's more of a problem than Harper realizes. Klein appears ready to pass vague "enabling legislation" in the legislature this spring to change Alberta laws that prevent doctors working in both systems. That means many critical details will be worked out in the secrecy of cabinet meetings and never debated by the public. How wrong that would be. These reforms are potentially the biggest change to medicare the country has seen. They need a full and thorough airing. What a travesty of democratic process it would be if Klein settles for a token one−month debate on these vague and ill−defined proposals.

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Parameters of meaning (Edmonton Journal)

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Edmonton Journal 2006.03.02 Final Opinion A14 The Edmonton Journal 260

Every Albertan who can stomach reading documents full of terms like "parameter" and "multi−disciplinary" should obtain and study Health Minister Iris Evans's 18−page Health Policy Framework. It is an innovative, reader−centred approach to results−based knowledge and opinion acquisition whose value can't be overestimated. (Really!) True, Evans does not place clarity on quite the same plane of strategic importance as, say, strengthening inter−regional co−operation, but you will get the general drift of the government's ideas. The following is a glossary of terms that might be of help as you plow through the verbiage. 1. Flexible Funding Options: New ways for you to give money to doctors, nurses, etc. for their services. 2. Alternative Compensation Structures: New ways for the above health−care professionals to receive your dough. 3. Health−care professionals: Possibly a doctor, but maybe a nurse or a pharmacist that the public system would prefer you saw in the name of economy. 4. Choice (as in "Albertans expect to have choice in the types of services available to them"): This term seems to refer only to options the government has selected for you to choose from (See Number 3 above.). If you live outside the major centres, for example, "improved consumer choice" does not mean you will be allowed to choose "big−city services provided locally." 5. Parameters, as in "Establishing Parameters for Publicly Funded Health Services": Limits. Of course, some terms do not yet have satisfactory meanings assigned to them in the government's vision of the sustainable public health−care system of the future −− essential services, timely and fair access, affordability. Finishing the glossary for the language in the Health Policy Framework −− online at www.health.gov.ab.ca −− is what the coming debate will be all about.

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Alta. 'third way' alters medicare in all provinces (The StarPhoenix (Saskatoon))

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The StarPhoenix (Saskatoon) 2006.03.02 Final Forum A8 The StarPhoenix 649

The "third way" of medicare long−promised by Alberta Premier Ralph Klein finally took form on Tuesday. The changes proposed to medicare in Alberta hold the potential to alter Canada's health−care system for all Canadians permanently. One of its main effects is that Alberta's move to allow certain medical specialists a dual income stream from public and private sources could lead to a shortage of these skilled doctors elsewhere in Canada. Should Saskatchewan not meet the challenge with its own innovations to improve patient access, reduce wait lists and give medical specialists the opportunity to maximize their skills and incomes, the quality of health services for provincial residents could be among the most adversely affected by Klein's long−anticipated move. The irony is that it was Alberta that demonstrated in a pilot project last year that a relatively modest infusion of cash and a good dose of innovative thinking was what it took to tweak the public health system and eliminate bottlenecks. The much−lauded Calgary pilot project on hip and knee replacements, led by surgeon Cy Frank, demonstrated how specialized teams, using surgical suites designated only for these orthopedic procedures, could dramatically reduce waiting times to 11 weeks from nearly 20 months. And there is a school of thought, espoused by Dr. Tom Noseworthy of the Western Canada Waiting List Project, that using such one−time cash injections and even recruiting medical personnel in the short−term to catch up on surgical backlogs could unclog the system so that health−care spending at close to current levels will ensure wait times in the future will remain acceptably low for all. But Alberta's new direction undermines the public expenditures already made to streamline the system. Will those new specialty orthopedic surgical suites developed with public money be efficiently used throughout the day a year from now if surgeons working there are allowed to do two or three obligatory surgeries at a public hospital and then rush off to more lucrative private clinics? There would not be much of a stir in the rest of Canada if Klein merely had announced he would not stand in the way or more private clinics being built, with surgical procedures performed by specialists working solely in the private sector. In this regard, a Calgary eye clinic, founded by Dr. Howard Gimbel, has demonstrated for the past 40 years that people will pay for timely cataract surgery outside of medicare.

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It is hardly the case that the Gimbel Clinic has attracted only the well off −− his clinic's cataract procedures can still be had for less than $1,000 an eye −− so it is puzzling why Klein and his cabinet didn't stop at blessing similar clinics for orthopedic surgery in a self−contained private system. Surely, there are orthopedic surgeons in Alberta with an entrepreneurial mindset who have confidence they could make a living outside medicare, trusting that people from all over North America will pay out of pocket to receive skilled treatment. Prime Minister Stephen Harper still has a few months to shape his response before Klein enacts legislation. Politically, however, Harper soon should take the stand that access is weakened for all when health−care providers double−dip. In the meantime, the Alberta announcement provides a clarion call for Saskatchewan to come up with a strategy to improve the quality of a public system whose public support politicians here take as an article of faith. Faith is one thing, but strategic spending is required to sharpen medicare's ability to produce results in Saskatchewan that mirror the Alberta project's success at reducing waits for hip or knee replacements. Dedicated surgical suites for specific procedures could be part of the tri−hospital reorganization that Saskatoon District Health is so gingerly trying to finesse. That reorganization is all up in the air as the health region, the provincial government and stakeholders such as the college of medicine dance around the issues. Saskatchewan needs its own success story in public health care, and it needs it quickly before practitioners and patients alike start finding themselves attracted to the Alberta alternative for the lack of any here.

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Klein on slippery slope (The Leader−Post (Regina))

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The Leader−Post (Regina) 2006.03.02 Final Viewpoints B7 The Leader−Post 354

In Brief: Alberta Premier Ralph Klein's suggestions for health−care reform have set pulses racing across Canada. The right diagnosis, but the wrong course of treatment −− Alberta Premier Ralph Klein's plans to allow for−profit health care are simply too radical. Most controversial is Klein's proposal to allow doctors to practise in both the public and private systems, similar to the UK's two−tier health care. In the UK, patients are routinely told there's a waiting list for a particular procedure in the public system, but speedy access if they're prepared to pay a fee and see the same physician privately. We do not believe this is what a majority of Canadian want to see. Klein's long−awaited "third way" on health reform is a response to a real problem, one Klein himself neatly sums it up: "People are waiting too long. The system is too expensive and growing more expensive by the day." Health care eats up almost 40 per cent of Alberta's operating budget. In Saskatchewan it's even higher −− 44 per cent. Even with billions in extra federal transfers, provincial health budgets continue to soar. Klein insists people's ability to pay will "never" determine access to health care, but how can it be otherwise with the plans outlined Tuesday? For example, Alberta Health officials say the proposals would allow patients to pay for procedures like hip and knee surgeries, which have some of the longest wait times. So a patient languishing on the public list would be able to access quicker care simply by stroking a cheque? Isn't this queue−jumping? And what about those patients who can't afford to pay? There is a place for private delivery within the public health−care system −− it already exists in services like private laboratories that provide blood testing. But nobody gets preferential treatment for a fee. Prime Minister Stephen Harper could threaten to withhold medicare funding from Klein, but wealthy Alberta can afford to go it alone, dumping medicare and creating a two−tier system funded by Albertans through their taxes −− or their chequebooks. If Klein goes ahead, the lure of lucrative private practice could provoke a stampede of physicians to Alberta, creating shortages across the country unless other provinces also go two−tier. Let this genie out of the bottle and medicare will suffer.

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Ralphicare unveiled (The Chronicle−Herald)

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The Chronicle−Herald 2006.03.02 Editorial A6 532

IS RALPH KLEIN knee−capping medicare? Many defenders of public health care are saying so in response to the Alberta premier's release Tuesday of his "Third Way" proposals for health coverage. The "framework" is billed as a balance between an American system where private health insurance dominates, and the status quo in Canada where physician and hospital services are the near monopoly, by federal law, of the provincial public health plans. Mr. Klein, like every premier, is worried demand is driving up costs unsustainably and creating unacceptable bottlenecks in service. Unlike most premiers, he's ready to try something dramatic, because he's in legacy−building mode, because Alberta has the money to defy federal penalties if Ottawa wants a showdown, and because he's Ralph Klein. Ralphicare would shrink the health monopoly in Alberta to control costs and to focus on better service in the areas covered publicly − a mandate vaguely described as "essential kinds of health services." For non−covered services, and even to fund growth in the public system, the plan proposes such "alternative funding" options as co−payment, private insurance and health savings accounts. To further address wait times, recruit doctors and provide options to patients (or to those who can afford them), it would allow physicians practising in the public system to charge for quicker private access to some non−emergency services (notably joint and eye surgeries) as long as essential public service isn't impacted. Health Minister Iris Evans says doctors would probably be required to perform a defined level of service in the public system before being free to work privately. Some crucial questions and risks are not addressed. A big one is where Alberta would draw the line between essential (i.e. covered) and non−insured services, and thus how much private insurance people would have to carry and whether this is realistic. There are potential hazards in letting doctors practise both publicly and privately. Diverting patients to the private stream is in their financial interest. And the policy only helps reduce overall waits if it attracts new physicians, rather than just shifting current practitioners' to private work. Other provinces will be concerned that if eye and joint doctors are lured to Alberta, they'll be coming from their bottlenecked systems. But provinces do have to try new things in health, and not only for financial reasons. The Supreme Court of Canada has ruled Quebec must provide care within a reasonable time or allow competition from private insurers and providers.

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Quebec's response is a plan to provide a guarantee of service backed up with a commitment to purchase private services under public coverage if necessary. Mr. Klein's approach is very different from Quebec's, which doesn't encourage queue jumping, creates an incentive for the public system to perform, and harnesses the private sector for efficient delivery. By comparision, hoping that people buying their way out of line will reduce overall waits seems like the quick and easy response. Still, provinces should be able to try different methods, and we can all learn from the results whether the Alberta plan works or doesn't. Mr. Klein also has to sell his public on Ralphicare, and they may not buy every detail. So it's wise Ottawa isn't rushing into a confrontation over Ralphicare. It's still early days on health reform in Canada and there are other provinces yet to be heard.

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03/02/2006


Alberta challenges the status quo (Montreal Gazette)

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Montreal Gazette 2006.03.02 Final Editorial / Op−ed A16 The Gazette 587

"People are waiting too long, the system is too expensive and is growing more expensive day by day." So said Alberta Premier Ralph Klein as his government introduced its Health Policy Framework, and who could disagree? The controversy resides rather in the proposals put forward by this 10−point discussion paper, which has been interpreted variously as a program for managing the inevitable or the beginning of the end of public health care. Opinion is divided also on whether the Alberta Framework contravenes the Canada Health Act of 1984, the legislated holy scripture that every federal government, including the Conservatives of Stephen Harper, has promised to uphold. True to bureaucratic form, the most interesting points in the Framework are the last two. No. 9 proposes that "patients may be given the option of purchasing services they're waiting for now − like hip, knee or cataract surgery" and buying insurance for these procedures. Essential surgery, whatever that is, must remain public. Quebecers will recognize this as the every−day reality they live with. Many specialists in Quebec offer a patient surgery within a year on the public tab or within a week for an extra fee, paid ostensibly to a clinic for other services. This circumvention of the public system is illegal but goes undisciplined for the simple reason that the patients who want it do not complain to the authorities. The situation is further complicated by the Supreme Court ruling of last June that declared unconstitutional the Quebec law prohibiting private insurance for medical procedures covered by the public system. "Access to a waiting list is not access to health care," two judges wrote in their decision. The Liberal government of Jean Charest has responded with an agreement to pay private bills where the public wait time is unreasonable. Point No. 10 observes that "more health−care providers will come to Alberta" if the provinces enhances its "world−class reputation." Reputation, that is, for low taxes and private practice. Quebec is protected somewhat from migration by the language barrier, but it is obvious that opportunities for enrichment will draw good professionals westward if the Framework morphs into legislation. One senses in this Alberta document and other recent developments a concert of forces − driven by need, by the market, by the medical profession and by the courts − urging the abandonment of the unworkable ideal of fully public medicine. Indeed, it is a chimera already. Medical care is free, but pharmaceuticals are costly. How many ailments, in reality, are treatable without drugs? Why is dental care privately insurable while medical care is not? There is no longer much doubt that private and public care needs to be balanced. Nonessential operations seem quite essential to patients who need them. If such procedures are routinely postponed, the system will crack. This was precisely what happened when the Supreme Court rendered its decision. 49

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As for private delivery of health care, this does not necessarily entail private payment by users. The Charest proposals of last month crossed this threshold. The big question is how Harper and his Conservatives will manage changes to the Canada Health Act. Beloved as that act is, it is too idealistic to implement. Its very first criterion is that health care be "administered and operated on a non−profit basis by a public authority." The unfortunate reality is that its other provisions − comprehensiveness, universality, portability, accessibility − are undermined by the first.

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03/02/2006


Is medicare on life support?: Existing health−care system isn't perfect, but let's not be stampeded into making it worse (Times Colonist (Victoria))

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Times Colonist (Victoria) 2006.03.02 Final Comment A10 Times Colonist 506

Saskatchewan was the cradle of our medicare system. Is Alberta going to be the province that kills it? "Perhaps," says Premier Ralph Klein, and he doesn't sound as if that concerns him. His long−promised "third way" health−care policy that he released Tuesday would allow doctors to work in both public and private systems and give patients the ability to pay for quicker access to some procedures. Ontario Premier Dalton McGuinty immediately called on Prime Minister Stephen Harper to stop Alberta from implementing a system that would allow rich people to jump the queue. Harper, though, is dismissing the plan as a "working document" and expressing confidence that Klein's government is still committed to the principles of the Canada Health Act. That shouldn't impress those who believe in the universal, publicly funded, equally accessible health care that the law is supposed to guarantee. The system is in tiers benefitting people injured on the job, police officers, prisoners, friends and family members of doctors, and those whose treatment in private clinics is paid for by taxpayers. Private insurance is available for some procedures, private clinics are sprouting up −− an MRI clinic opened in Victoria in January −− and where public funds are drawn upon they sometimes end up in private facilities. And there's not equal access: There are different waiting times for different procedures in different communities. Rural Canadians are especially disadvantaged. Some of the details about Alberta's plan are missing −− for instance, Health Minister Iris Evans says there would be restrictions of some kind on doctors working in the proposed mixed system −− and Klein says he's open to "better" ideas if someone can come up with them before April 1. But what we've seen looks as if Alberta intends to proceed with private medicare in parallel to the public system and allow doctors to top up their government incomes by charging private patients whatever the market will bear. That invites another form of tiered system in which privately paying −− i.e. rich −− patients would get more attention than those in the public queues. It's not clear, either, how that would reduce waiting lists that Canadians have said are the worst part of our present system. The Quebec system, in which doctors must opt to practise in either the public or private system, but not both, seems better, but there has to be a way of ensuring that enough professionals are left to handle the demands of the public system or first−class health care will be a privilege of the wealthy. 51

03/02/2006


Premier Gordon Campbell seems impressed with the Swedish system where for−profit hospitals and clinics function −− with a faster patient turn−around −− in a publicly funded health−care system. But in that country patients pay a small user fee and doctors are paid according to the number of patients they have instead of getting fees for services. These, and other options, are worth exploring. But nothing is going to improve if the Canada Health Act is regarded as being written in stone, or Klein stampedes us into useless confrontations.

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03/02/2006


A little chocolate, unfortunately, goes a long way (Vancouver Sun)

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Vancouver Sun 2006.03.02 Final Editorial A16 Vancouver Sun 296

A little learning might be a dangerous thing, but too much learning is a definite downer. Take, for example, the increasing evidence that chocolate is good for you. Over the past few years, scientists discovered that people who regularly consumed chocolate had lower rates of heart disease than those who didn't. The reason, it seems, is that chocolate contains flavanoids, the powerful antioxidants also found in fruits and vegetables that help prevent platelets from clumping and forming a blood clot. As if that weren't enough, further research found that high antioxidant levels also help guard DNA against cancer. None of this was news to those cognizant of chocolate "history": The Aztecs had used chocolate to soothe stomach problems and doctors in the 18th century "prescribed" it for angina. But all of this was certainly good news to the legions of people who considered chocolate a guilty pleasure, a sinfully sweet indulgence. So chocolate lovers had a reprieve, though dietitians warned that people shouldn't substitute chocolate for fruits and vegetables, that overindulgence in the dark delights could still lead to obesity and all its attendant problems. And now along comes a new study that tells us something we'd just as soon not know −− that we don't need to eat nearly as much chocolate as previously thought to benefit from its antioxidant properties. According to the study, which is published in the current issue of the journal Archives of Internal Medicine, Dutch men who consumed just 10 grams of chocolate (4.2 grams of cocoa) a day were half as likely as others to die from cardiovascular disease. The bad news for chocolate lovers is that 10 grams is fully 10 times less than what researchers previously thought was necessary to realize a benefit. The even worse news is that 10 grams amounts to only a third of a chocolate bar. All of which means that while chocolate is still good for us, a little definitely goes a long way. That's a little learning we could have done without.

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03/02/2006


Columns Take action, Tony (Calgary Herald)

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Calgary Herald 2006.03.02 Final Q: Queries − Quibbles − Quirks A15 Inbox: Your Space − Your Time Richard Lamontagne Calgary Herald What You Have to Say About the Klein Government's Third Way 172

Ottawa − After reading about King Ralph's Third Way, the Liberals are starting to look good. When I move back to Calgary, after my wife's death −− she has terminal cancer −− I think I will be voting Liberal for the first time since the 1960s. Ralph Klein has not done anything important since he killed the provincial debt. I will probably be settling in Klein's riding, and I have a lot of time to kill, so it might be time to get involved with the Liberals in the next election. I think Klein's move will cost the Conservatives votes. I would go along with allowing private clinics to address knee, hip, and possibly hernia operations paid for by the government, but Ralph's way is two−tier. I hope federal Health Minister Tony Clements has the will to kill this plan. Klein is turning the average Albertan into a second−class citizen. He has lost sight of his own roots. To think I once looked up to him! Richard Lamontagne, Shediac, N.B.

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This 'cure' makes me ill (Calgary Herald)

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Calgary Herald 2006.03.02 Final The Editorial Page A14 Naomi Lakritz Naomi Lakritz Calgary Herald 480

Three weeks ago, Health Minister Iris Evans was breathing fire over a concierge health−care service wanting to set up shop in Calgary. The service would allow doctors to work in both the public and private systems. Evans made much noise about how violating the Canada Health Act wouldn't be tolerated. Now, she's all set to violate it herself with the Third Way, and allow doctors to work in both systems at once, to the detriment of the public system. The concierge service would have seen doctors put public patients' appointments on hold to run out to tend to their rich clients' boo−boos first. The Third Way will require doctors to log an undefined "minimum" of time in the public system before heading off to heal the rich. The rich may get healed this way, but the public system sure won't. Wait times are already long because there aren't enough specialists. Just imagine how much longer the un−rich will wait once these overworked specialists in short supply spend a bare "minimum" with public patients. Sure, the number of people in line will drop when the rich jump the queue, but they'll take their doctors with them and those in the public lineup will wait even longer. According to the government's Waitlist Registry, as of January, 3,389 Albertans were waiting for knee replacements. The largest percentage −− 28 per cent −− will wait seven to 12 months. The median wait is four to six months. Perhaps Iris in Wonderland could explain how requiring the surgeons who do these operations to spend "minimum" time in the public system will benefit these people. Silly me. I forgot! If patients don't have $10,000 −− the government's estimate of the cost of a knee replacement −− to buy their own way back to health, too bad! Pull yourself up by your bootstraps, people! Surely, you can scrounge up $10,000. Have you checked under your sofa cushions for loose change? Diana Gibson, of the Parkland Institute, pointed out in February that European two−tier systems don't allow doctors to practise in both public and private arenas, as Alberta intends to. When doctors do both, they spend more time in the private because they make more money there. Speaking of money, just wait till the insurance companies get their mitts on Alberta. Doctors will be spending even less time seeing patients because they'll be busy filling out forms −− the bugaboo of U.S. doctors.

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In 2003, the American College of Physicians said doctors spent more time on insurance and less on patients, insurers questioned the doctors' professional judgment too often, probably in a bid to get out of paying claims, and doctors had to hire more staff to deal with the paperwork. Of course, if you're already ill or elderly, nobody will offer you insurance coverage anyway, so you're still out of luck. But that's OK because the principle behind the plutocracy's Third Way is that the rich deserve to be first in line. Profit as a cure for what ails public health care? Now, that's sick. nlakritz@theherald.canwest.com

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03/02/2006


Klein's tantrum in legislature bizarre: Says he's frustrated with health care, but the public consultation he's planning is a joke (Edmonton Journal)

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Edmonton Journal 2006.03.02 Final Opinion A14 Graham Thomson Graham Thomson The Edmonton Journal 523

There was no camera recording the moment −− and for that Premier Ralph Klein should be forever grateful. The only video we have is the look of shock and then outrage on the faces of the Liberal opposition members watching the moment unfold over on the government's side of the assembly. What so astonished them was what Klein did during question period when the Liberals sent over a 78−page copy of their health−care policy booklet via one of the legislature's teenage pages. When the page handed Klein the booklet, he looked at it, realized what it was and then angrily whipped it at the page, saying, "I don't need this crap." Imagine the picture −− the premier of Alberta throwing a temper tantrum in the face of a 17−year−old girl. Now imagine that picture on the front page of newspapers across the country. Klein's approval rating would have dropped so fast you'd be able to hear it whistle on its way down. Question period is televised −− but there is no picture of Klein's outburst because the legislature−controlled camera was focused on Liberal Leader Kevin Taft asking Klein a question. What you see are Liberals Rick Miller and Harry Chase, one row behind Taft, react with astonishment, point at Klein and then look towards Speaker Ken Kowalski for help. After question period was over, Klein rose in the assembly and apologized to the page, Jennifer Huygen. "I ought not to have thrown the Liberal health policy at our page," said Klein. "To Jennifer, I apologize most sincerely. I also apologize for referring to the document as crap." Then he apologized again at his daily news conference with reporters.

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But why, wondered the reporters, would he throw something at a page? "Frustration," responded Klein. Reporters: frustration with what? "Frustration over health care," responded Klein. Reporters: what do you mean by that? "Well, lookit, what I'm trying to do is the best I possibly can relative to a public consultation process and the last thing we want to do is contravene the Canada Health Act ... ." Uh−huh. So, Klein is feeling pressure over his health−care reforms and he's frustrated that people don't appreciate he's just doing the best he can. So, he feels like the victim, but he reacts like a bully. And when the Liberals get up his nose he takes out his frustration on the nearest available target. It's no secret Klein has a thin skin and a short fuse and he can be a bully with the opposition. But it's completely out of character for him to take out his anger on such an innocent target as a legislative page dutifully doing her job. Taft says it's proof that Klein is out of control and that the Conservatives "are no longer fit to rule." If nothing else, it demonstrates Klein is buckling under the pressure generated by his own government's health care proposals. The proposals manage to be both frightening and ambiguous at the same time. It's difficult to know if they're as ethereal, and ultimately meaningless, as the world's largest trial balloon, or if they're as substantial, and potentially destructive, as the world's biggest sledgehammer. For example, will the proposals for private health care entice doctors to abandon Alberta's rural areas to move to lucrative clinics in the cities? That's a good question, responds Klein. "That's what public consultation is about." Public consultation? The government's plans for public "consultation" are such a joke they should be delivered by Jay Leno. As an Albertan you won't be able to do much more than e−mail the government. Health Minister Iris Evans will meet with "stakeholders" behind closed doors. Evans is a smart and shrewd politician and she still has credibility on this file, but you have to wonder for how much longer. Klein says there won't be any town hall meetings because they'd just degenerate into a media "circus" where "people can get up and yell and scream." Yes, there's no need for critics to throw temper tantrums and embarrass the government in public. Klein can do it so much better himself in his one−man circus on the floor of the legislature. 58

03/02/2006


gthomson@thejournal.canwest.com GRAHAM THOMSON Off the Ledge In Graham's new blog he digs through the political rhetoric. To read Graham's blog go to www.edmontonjournal.com and click on blogs

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Vers un système à deux vitesses? (L'Acadie Nouvelle)

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L'Acadie Nouvelle 2006.03.02 Éditorial 12 Serge Rousselle 649

L'Alberta a confirmé, mardi, son intention d'ouvrir la porte à un système de soins de santé à deux vitesses en permettant à des patients de payer pour avoir accès plus rapidement à certaines chirurgies et en autorisant les médecins à pratiquer à la fois dans les systèmes de santé public et privé. Or, cette proposition de permettre la privatisation de certains soins de santé risque non seulement de créer une brèche importante dans notre système public de santé, mais elle met également le nouveau premier ministre canadien dans une situation où il n'aura d'autres choix que de démontrer clairement ses couleurs. De prime abord, force est de constater que la proposition albertaine risque de contrevenir à la Loi canadienne sur la santé et de mettre en danger les fondements mêmes de notre système de santé public universel et gratuit. Ainsi, les riches pourraient avoir plus rapidement accès à certaines chirurgies, dont celles de la hanche et du genou, en passant devant ceux moins riches qui devraient attendre patiemment leur tour sur la liste publique. De plus, permettre aux médecins de pratiquer dans le public et dans le privé peut contribuer à un déplacement des ressources vers le privé, alors qu'il y a déjà une grave pénurie de spécialistes et de professionnels en ce domaine. En ce sens, il n'est pas certain que cette proposition va permettre des économies au système public et écourter les listes d'attente en déplaçant les professionnels vers le privé, alors que le pays tout entier fait face à une pénurie importante en ce domaine. D'ailleurs, selon un expert en droit de la santé de l'Université de Toronto, Coleen Flood, des études ont démontré que les délais d'attente ont augmenté dans des pays comme l'Espagne, l'Irlande et la Nouvelle−Zélande qui ont permis aux médecins de travailler simultanément dans le public et dans le privé. Devant pareille situation, le nouveau premier ministre canadien n'aura d'autres choix que d'intervenir s'il désire préserver l'intégrité de notre système public de soins de santé. M. Harper se retrouve ainsi dans une situation difficile face à son compatriote et allié politique Ralph Klein, une situation qui lui offre cependant l'occasion de démontrer ses vraies couleurs. Il a fréquemment déclaré durant la dernière campagne électorale qu'il appuyait la Loi canadienne sur la santé. A cet égard, il lui reste maintenant à démontrer que, dans son coeur et dans ses tripes, il croit vraiment en un régime universel gratuit de soins de santé offerts par le système public. Pour ce faire, il ne doit pas se contenter de faire croire que la proposition albertaine ne viole pas le sacro−saint principe de l'universalité au pays et n'est pas contraire à la Loi canadienne sur la santé. Il doit démontrer du leadership en disant clairement que la proposition albertaine va trop loin et qu'il prendra les mesures appropriées pour qu'elle ne devienne jamais réalité.

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Conscient que les autres provinces vont certainement regarder du côté du gouvernement fédéral pour voir comment il réagit à la proposition albertaine, il lui revient de trancher que les besoins des patients sont plus importants que leur porte−monnaie pour la livraison des soins médicaux dans des délais acceptables au pays. Ce faisant, il mettra clairement de côté les vieux démons de son passé réformiste et permettra à son parti de ne plus être continuellement accusé de vouloir mettre la hache dans le programme social dont les habitants de ce pays sont le plus fiers. A cet égard, à ne pas en douter, les libéraux, déchargés du fardeau du pouvoir, et les néo−démocrates vont défendre bec et ongle notre système universel public gratuit. Il doit faire de même, car s'il permet les chirurgies privées aux genoux et aux hanches par des médecins passant d'un système à l'autre, personne ne sait où ce système parallèle s'arrêtera face à une logique privatiste dangereuse pour notre système public de soins de santé. canadasr02@hotmail.com

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Harper wise to watch and wait as Klein crosses Rubicon of health care (The Province)

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The Province 2006.03.02 Final Editorial A16 Don Martin Don Martin CanWest News Service 401

The first premier to call Stephen Harper after the election was Ralph Klein. Worry not, a chatty Klein told the incoming prime minister, you'll have no problem with Alberta's health−care reforms −− we are, after all, one big happy Conservative family now. That Ralph. Such a tease. On the second−last line of his government's 10−point, mostly motherhood policy direction, Klein handed his federal brother a world of medicare pain, namely in No. 9: Paying for choice and access while protecting the public system. A policy giving Albertans the right to buy hip and joint replacements privately has precedent. If you've got a tragically bad hip now, fly to Montreal with $12,000 in your suitcase, head for the Duval Orthopedic Clinic and you'll be right as rain in a couple weeks. But giving physicians and surgeons permission to moonlight for cash after spending part of their time in public service? Well, that's new and had Harper sounding slightly queasy yesterday. Klein had confided to cabinet ministers he'd wade no further into privatized care than Quebec's intrusions. He must've missed reading the fine print of Quebec's plan, because it permits no such two−tiered two−step by its doctors. Quebec dances close to the line in spots, the classic example being Sheldon Elman, former prime minister Paul Martin's personal physician, who sees patients in the public system while operating a lucrative fee−for−service executive health service on the side. But allowing doctors and surgeons to cross what has been the Rubicon of health care −− public paycheque one day, private the next −− has unleashed another of those screeching condemnations that immediately follow all Alberta health−care plans. The Globe and Mail went particularly hysterical, blasting Klein as the father of MasterCard medicare. Yadda, yadda, yadda.

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Truth be told, this has the look of just another Klein balloon, the sort of notion he's floated endlessly as premier, with no discernible change in the system. And he may yet be overruled by his own MLAs, who fear a backlash from the electorate. Look, every premier is talking about doing something to fix the health system. B.C. Premier Gordon Campbell is checking out Sweden's two−tiered system, and vows to amend the sacred Canada Health Act in his province to link service to sustainability. Besides, the notion of multiple−tiered treatment is increasingly a Canadian reality. And there are increasingly extreme examples of treatment denied and accessibility compromised inside the public system. Don't speak French? You will be denied care at five clinics in Ontario. Not a woman of colour? A women's clinic in Toronto will turn men and white women away for falling outside their mandate. For the time being, Harper is correct to do nothing but watch and wait, hoping Klein's forward charge into uncharted territory will be followed by a hasty retreat. Stay tuned.

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03/02/2006


In search of primary−care renewal (Times Colonist (Victoria))

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Times Colonist (Victoria) 2006.03.02 Final Comment A11 Chris Pengilly Special to Times Colonist Photo: Times Colonist file / Full−service family physiciansare a bargain in B.C. ILLUSTRATION: considering the amount of unpaid patient care they provide, a general practitioner writes. WORD COUNT: 711 A recent survey has shown that British Columbians are above the national average for parameters of health, but are more discontent with their health delivery service. This might sound like a paradox, but I think reflects a healthy lifestyle, and the failure of both levels of government to complement this. A failure that results in inappropriate funding, and failure to recognize the value of family practice. There seems to be a fundamental flaw in the thinking of the health−care bureaucracy −− but more about that later. The federal government has launched a program entitled National Primary Health Care Awareness Strategy. At the moment the program seems to comprise little except an expensive advertising campaign on the television, newspapers and the Internet. I feel this money would be much better spent being directed to patient care. Primary health care is probably the bargain of the century. Physicians' fees make up 20 per cent of the entire health−care budget −− and family practice comprises 30 per cent of this. So for seven per cent of the health−care budget the public gets the physician and all the infrastructure required to deliver primary care −− that is the physician services, support staff, offices, medical supplies −− the works. All for seven per cent. If the strategy is looking for a less expensive way of delivering primary health care, I cannot see how this could be achieved. I think it should be looking for inefficiencies in the other 93 per cent of the budget. If the strategy is looking for a way of attracting more physicians into full−service family practice then the answer is easy. No need for a multimillion−dollar program. Federal and provincial governments should start paying for services that have hitherto been delivered for free. The government will have a taste of its own medicine −− feeling like the public does when having to pay for parking in the provincial parks −− not popular, but apparently necessary. Currently, a full−service family physician in British Columbia is not paid for: − Being on call and available 24/7; − Telephone advice; 64

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− E−mail and electronic advice; − Completing forms enabling PharmaCare to save a great deal of money; − Hospital committee work; − A significant proportion of hospital visits; − Referral letters to specialists and hospital programs. These are all services that take a considerable amount of time and carry a full medicolegal liability. They are services for which physicians should be compensated, according to Justice Allan McEachern in his binding arbitration of 2002 −− the binding arbitration that was scrapped by the provincial government. The result is that full−service family physicians feel undervalued and unappreciated −− and new graduates are not interested in entering this field. Twenty per cent of medical graduates now choose to go into family practice − as compared to more than 50 per cent about 10 years ago. In an effort to address this the provincial government negotiated a fee increase for family physicians. It began with the physicians having to repay to the government $30 million that would be put toward the fee increase. Doesn't make sense? I agree −− and the provincial government was surprised when this "increase" was rejected. With regard to the health−care bureaucracy there is certainly evidence of fundamentally flawed thinking. In frustration concerning several unpaid services, I wrote to the B.C.'s health minister saying that retirement looked more attractive every day. His deputy minister replied on his behalf stating "British Columbia ... has an enviable track record for attracting family practitioners ... to the province;" "we hear about some people having difficulty finding a doctor;" and "B.C. has a higher number (of family physicians) per capita than Alberta, Saskatchewan, Manitoba or Ontario." This does not say much when Canada rates at the bottom of the developed world in terms of physicians per thousand population −− for example: Canada has 1.9 doctors per 1,000 residents, Norway has 3.7 per 1,000 and France 3.3 per 1,000. The "some people" who do not have a family physician in British Columbia is in fact 160,000. The minister also wrote of an "enviable 111 general practitioners per 100,000 residents" which would be wonderful if all 111 were full−service family physicians. They are not. Many are part−time, and others are "Docs in a Box" delivering fragmented and crisis− intervention medicine −− the only option to earn a reasonable income to pay off student loans and have some sort of family lifestyle. As long as we are bogged down with such inaccurate and biased thinking −− and as long as family physicians are considered to be the problem rather than the solution −− I am anxious for the future. Chris Pengilly is in family practice in Victoria.

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Pandemics and my kids How will we know that avian flu is spreading in schools? (WINNIPEG FREE PRESS)

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WINNIPEG FREE PRESS 2006.03.02 A11 Focus 1021

Catherine Mitchell Catherine Mitchell My husband and I react to stress differently, and we react to news of impending disaster or social calamity differently, too. We've had some interesting talks on global warming and how to keep kids safe from pedophiles. One of us wants to pull up the drawbridge −− indeed, that one began chopping wood and sizing up the interior doorways for tarpaulin when Quebecers lost power for days in the 1998 ice storm. The other sits back and peevishly shoots holes in the latest scare campaign and solutions to societal ills. But we are on the same page about the next flu pandemic. He'd like to move to the hinterlands; I'd want to stay close to hospitals −− there's nothing like a respirator when you need one −− and a reliable source of heat. We've compromised: We'll all stay at home, to ride out the viral storm. That means pulling the kids out of school, out of those festering pools of bacteria and viruses. That conversation is probably not unique to my house. That's what I said to Joel Kettner, Manitoba's chief medical officer of health last Friday, at a media conference with federal and provincial officials about preparations for the next flu pandemic. The preparations to keep Canada safe from catastrophe when the next global killer influenza virus hits are complex, reaching across all sectors of society. The last pandemic, in 1968, killed a million people in the world. In 1918/19, the Spanish flu killed up to 50 million. Medicine and human health has changed and the next pandemic is not expected to take as many lives. But it is also considered overdue, and can come at any time. Canada is said to be well−prepared, largely because the federal government has a contract with a private firm for the production of a vaccine. The next pandemic will be caused by a strain of the influenza A virus no one has met. Provinces are stockpiling antivirals (Manitoba has enough for 60,000 people, or six per cent of the population: nurses, doctors, the sick and people like Dr. Kettner and Premier Gary Doer will get it) and a global strategy has been laid down to share information rapid−fire to get a vaccine made once the virus strain is confirmed. But chew on this: It will take four to six months for a vaccine to be produced, another three months before all Canadians can be vaccinated. The most forgiving scenario for Canada −− the flu emerges in Asia, let's say, and not Toronto or New York −− allows less than three months to prepare before the virus reaches our country. The vaccine will not be ready for the first batch of people falling sick. My first question: How, and how quickly can Dr. Kettner inform me that there is flu in my kids' schools? Right now, there is no notice home when the seasonal flu scourge hits the class, although schools are among the screening grounds used to pick up its arrival each year. And when 10 per cent of a school's population is absent during flu season, nurses may be sent in to do swabs for testing, to confirm influenza's presence. One 66

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year, flu knocked out about two−thirds of my kid's kindergarten class. The public health nurse was not notified because less than 10 per cent of the school was sick. When the pandemic is verified, health officials will know quickly −− due to its virulence −− when the virus arrives in their communities and people will be told, Dr. Kettner assured. Parents will get information about the flu through their children's schools, but plans specific to schools will depend on context −− whether the virus hits children harder, with higher mortality rates, than the rest of the population, for example. That didn't happen in the 1957 Asian flu pandemic nor the 1968 Hong Kong outbreak, Kettner noted. If flu has been detected in schools, I'd want to know where, so I can decide the relative risk to my children. Meanwhile, in the time required to detect it, the little virus mills can be churning out flu for days. Unlike ordinary flu, which hits hardest the very young, the old and the sick who have weak immune systems, the Spanish flu, also believed to have sprung from birds, hit the hale and hearty hard, with most deaths among those 15 to 40 years old. Typical flu in Canada hits five to 15 per cent of the population hard, killing 4,000 people on average. The pandemic flu spreads faster, makes people sicker and kills at a higher rate. Public health officials predict 220,000 Manitobans will get really sick, some 4,900 needing hospitalization and anywhere from 700 to 1,600 will die. I'm not overly worried for my chances: Washing my hands and veering away from sneezing, coughing co−workers is the best defence, and I'm in excellent health (although that may not help me if I'm stricken.) But none of that gives me comfort about my kids' chances. Dr. Kettner said the Health Department is working with schools on a response plan tailored to a pandemic. Schools may be closed in a pre−emptive strike to contain the spread of influenza, he said. Public health officials are cognizant, in the wake of the SARS scare, of the havoc that can be wreaked by poor flow of information among health professionals and to the public. Toronto's economic hangover was extraordinary in light of the limited threat of disease. There are lots of lessons still to be learned by most of us: Did you know surgical masks are not seen as a good way to protect the public against infection? Health officials balance their decisions on how to keep people safe with regard for economic consequences. My first concern is my kids. I think Dr. Kettner is confident the plans have them covered. I'm still thinking I'll be yanking them out of school when the big bug hits Canada. If a lot of other parents are thinking the same, there seems small chance of escaping an economic backlash. catherine.mitchell@freepress.mb.ca

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Le CHUM en PPP? (Le Devoir)

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Le Devoir 2006.03.02 ÉDITORIAL a6 Sansfaçon, Jean−Robert 661

Aux dernières nouvelles, la construction des deux grands hôpitaux universitaires montréalais, le CHUM et le CUSM, serait une fois de plus retardée à cause des coûts plus élevés que prévu par Québec. La solution à ces dépassements se trouverait−elle dans la fusion des deux projets en un seul, ou dans le recours à la formule de partenariat public−privé? Si l'on en croit leur direction respective, l'ouverture des deux grands hôpitaux est toujours annoncée pour 2010. Pourtant, plusieurs signaux permettent de croire qu'il s'agit là d'une vision optimiste. A Québec, on n'accepte toujours pas la dernière évaluation présentée par le directeur exécutif des projets, Clermont Gignac, qui estime les coûts à 600 millions de plus que les 2,2 milliards envisagés. Pour le président du conseil du CHUM, Patrick Molinari, ces dépassements ne seraient plus aussi importants qu'on le dit et n'atteindraient désormais que 120 millions pour son établissement, surtout causés par l'inflation. Ce qui ne semble pas avoir convaincu le premier ministre Charest, qui a décidé de former un comité ministériel pour étudier la question. Devant le risque d'explosion des coûts, certains reviennent à l'idée d'un seul grand hôpital. Or la chose est difficilement envisageable pour des raisons culturelles et historiques, mais aussi très concrètes: un seul grand hôpital devrait accueillir le même nombre de lits que les deux grands hôpitaux projetés et offrir des équipements et des locaux pour le même nombre de médecins et d'étudiants. N'oublions pas que les deux projets viendront remplacer une bonne demi−douzaine d'hôpitaux et d'instituts affiliés à deux universités de langue différente. S'imaginer qu'on puisse générer de réelles économies en regroupant tout ce beau monde dans une seule bâtisse n'est pas réaliste. Par ailleurs, on sait que l'Agence des partenariats public−privé doit évaluer la pertinence d'emprunter la voie d'un PPP pour réaliser ces projets. Grand bien lui fasse! Mais voilà de l'argent gaspillé. Un PPP implique que le partenaire finance lui−même la construction de l'hôpital dont il aura la gestion pendant 40 ans. En plus de l'obligation de dégager un rendement satisfaisant dans un secteur structurellement déficitaire, le partenaire privé n'a pas accès à des taux d'intérêt aussi bas qu'un gouvernement. Et comme l'hôpital appartiendra à ce dernier en bout de piste, le Trésor public doit ajouter la totalité de la dette contractée par le partenaire privé à la sienne, ce qui aggrave sa propre situation. En Angleterre, où le gouvernement Blair a lancé un programme de construction d'hôpitaux en PPP, on a mis un frein au plus important d'entre eux avant Noël, la rénovation des hôpitaux Barts et Royal London. Sans remettre en cause le contrat de PPP, la ministre de la Santé doit annoncer ces jours−ci une réduction de la taille de ces projets, à cause des coûts. Dans d'autres cas, les fiducies locales de santé en sont réduites à sabrer les services pour être en mesure de respecter les engagements financiers contractés auprès du partenaire privé gestionnaire de l'établissement.

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Autre problème: compte tenu des difficultés budgétaires récurrentes des hôpitaux anglais, les agences de notation ont récemment revu à la baisse la cote des obligations émises par des sociétés en PPP, avec pour conséquence une augmentation des taux d'intérêt. En somme, l'expérience anglaise est loin d'être un modèle pour le moment. A Londres comme ici, la modernisation des vieux hôpitaux est une nécessité. Là−bas pas plus qu'ici on n'a trouvé la formule magique au problème des coûts de construction et de fonctionnement des hôpitaux. Tant mieux si, à force de travail, on réussit à construire le CHUM et la CUSM à l'intérieur des budgets fixés par Québec, mais qu'on ne s'y trompe pas: deux années de plus pour concevoir et réaliser un projet en PPP dans un secteur méconnu du secteur privé ne fera qu'ajouter des dizaines de millions à la facture refilée aux contribuables. j−rsansfacon@ledevoir.com

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Our linguistic imbalance (The Ottawa Citizen)

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The Ottawa Citizen 2006.03.02 Final News Editorial A14 Brigitte Pellerin Brigitte Pellerin The Ottawa Citizen 801

Never mind the fiscal imbalance where, the theory goes, all the money is on one side. Now we've got a linguistic imbalance. Where, as we now know thanks to the Affair of the French−Only Health Clinic, all the fairness and common sense are on one side only. Guess which one. I'm pretty sure Shirley Ravary did not mean to create a big fuss when she showed up at the Centre de sante communautaire de l'Estrie in Cornwall to see her family physician about a stubborn cold. Her doctor had recently started working some of the time at the Centre de sante, and Ms. Ravary figured she could ask to see him even though she did not have an appointment. She was summarily turned away, not because the doctor could not see her or because the clinic does not take walk−in patients, but because Ms. Ravary is not a francophone. Nobody asked her whether she needed emergency care or whether she would like to, I don't know, use their phone to schedule an appointment with her doctor at his other clinic. All the staff at the Centre de sante cared about was that Ms. Ravary clear the premises of her annoying anglo presence. Of course she's mad. And so is her francophone husband. But apparently, there's nothing wrong with turning away a non−francophone patient at this Ontario health clinic because, Ontario Health Minister George Smitherman explained, her case wasn't urgent. (Yes, Mr. Smitherman is that good. He can tell from a distance. I am suitably impressed.) Look, offering targeted services to minority groups who may otherwise have difficulty obtaining them is not necessarily a bad idea. It's good that there's a Montfort. In a perfect world, there'd be enough doctors for everybody and there would be no problem having francophone doctors treating francophone patients, Mandarin−speaking doctors treating Mandarin−speaking patients or bridge−playing doctors treating bridge−playing patients. But there aren't enough doctors, and in any case we expect those there are to put patients ahead of politics. It's certainly not fair to punish Ms. Ravary, whose doctor obviously speaks enough English to treat her anyway, just because he decided to work at a French−only clinic some of the time. To test this proposition, just imagine if St. Michael's Hospital in downtown Toronto turned away a patient who spoke only French, let alone if one in Quebec did. Can you hear the uproar in Montreal, Trois−Rivieres, Quebec City, Sherbrooke and Gatineau? Me, too. And I'd think folks would be right to protest. But turn away an anglo woman from a French−only clinic and you'll hear nary a peep. 70

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Yes, the Citizen covered the story pretty extensively. But even Montreal's anglophone paper the Gazette buried the story on page 10 last Friday, and I didn't see any mention in the French−language dailies. There was no outraged op−ed, no indignant editorial, not even a letter to the editor. Why not? If a francophone patient had been turned away from an English−only health clinic in Westmount, we would have heard about it. What's that? You say there are no English−only health clinics in Westmount or anywhere else in Quebec? Well, that's because they are not necessary, according to Health Minister Philippe Couillard. Of course. A few years ago, a report funded by the Department of Canadian Heritage found virtually no English services outside of Montreal for victims of conjugal violence. Do you remember the outrage at the time? Me, neither. Apparently anglos aren't necessary in Quebec, let alone welcome. For dare expose your customers to English lettering that's not at least twice as small as the French, and you're in big trouble. Even if you're displaying English expressions that are used every day by pizza−loving pure−laine French speakers. In 2003, a museum in Trois−Rivieres promoted an exhibit on the evolution of the family meal with a billboard showing, in the words of the news story, "a giant nipple dripping with milk." The museum received complaints, but not about the explicit image. It was the title of the show that was found offensive: "Quebec All Dressed." Few were upset by the picture. And just this week, while people everywhere praised his televised performance, Bloc Quebecois MP Real Menard found the time to complain that Justice Marshall Rothstein couldn't speak French, which Mr. Menard says should be mandatory for Supreme Court justices. Evidently, it's not enough to have at least three judges (out of nine) from Quebec on the highest bench. They all have to speak French as well. Yes, we do have a linguistic imbalance in this country. I don't know about you, mais moi, je n'aime pas ca du tout. Brigitte Pellerin's column appears Tuesday and Thursday.

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Centre acted on its mandate (The Ottawa Citizen)

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The Ottawa Citizen 2006.03.02 Final City City Editorial C4 George Smitherman The Ottawa Citizen 272

After reading the press coverage of the Cornwall resident and the Centre de Sante Communautaire de L'Estrie, I want to put these events into context. First, had this individual required urgent medical attention, she would of course have received it immediately. This is true for every patient, and it is true for every medical facility in this province. However, as the press coverage has indicated, it appears this person did not require urgent medical attention. Next, it is important to understand that community health centres are not the same as hospitals or walk−in clinics. These centres have a very specific mandate: to serve particular groups that experience disproportionate challenges accessing health care, for example for reasons of poverty, physical disabilities, homelessness or linguistic barriers. In this particular instance, the centre this individual chose to visit, the Centre de Sante Communautaire de L'Estrie, acted quite properly. It acted, in fact, precisely as its mandate dictates. The individual was anglophone and this centre is one of the few points of access for primary health care for Cornwall's underserviced francophone community. Because this centre was specifically established to serve francophones, and because the individual did not require immediate medical attention, she was asked to go to one of the many other places where an anglophone in Cornwall can receive medical attention. This was not a case of unfair discrimination. It was common sense exercised by a medical facility dedicated to ensuring that all Ontarians are able to receive the care they need, when and where they need it. George Smitherman, Toronto, Minister of Health and Long−Term Care

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Queen's Park Even reporters can't get excited about LHINs (Globe and Mail)

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GLOBE AND MAIL 060610228 2006.03.02 A18 MURRAY CAMPBELL Column Metro 728 688

MURRAY CAMPBELL First OMERS, now LHINs. It has been a particularly cruel few weeks for those with a low tolerance for ponderously detailed, acronym−heavy legislation. Last week, Premier Dalton McGuinty sent union leader Sid Ryan packing on the issue of how pensions for municipal workers are administered. Now, he's acquired a new set of adversaries who are upset with his government's plan to shake up how Ontario's $33−billion health−care system is administered. Hardly anyone understands or cares about either measure but that hasn't stopped the controversy. The fun never stops at Queen's Park. LHINs are local health integration networks, and the 14 of them that are being set up are the vehicles for restructuring health−care delivery. Health Minister George Smitherman believes the networks will provide more local control over hospitals and other health−care providers (but not doctors) and allow for improved care. Critics, including the two opposition parties, health unions and some health−delivery agencies, fear the dismantling of the health system through privatization and the offloading of expenses to patients. It's quite an intellectual gap and it persisted right up until the passage yesterday afternoon of Bill 36, which established the networks in law. This fundamental disagreement about the aim and impact of the legislation remains despite five days of debate in the legislature, 10 days of committee hearings and 56 amendments. Every time Opposition Leader John Tory wails about the "vast powers of centralization" the legislation gives to a health minister, Mr. Smitherman counters that such interpretations are "not plausible." This firefight has occurred largely out of view of the public. Bill 36 is so arcane −− and its provisions seemingly so benign −− that the news media have largely avoided it. Its ability to slip under the radar was enhanced by the fact that it was introduced on Nov. 24, when attention was diverted to the federal election.

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It's not surprising that a poll commissioned by the health unions found that 82 per cent of Ontarians know little or nothing about LHINs. The astonishing thing is that 18 per cent claim to know what the fuss is all about. Rest assured that few of these people work in the Queen's Park press gallery. The Health Minister says Bill 36 recognizes that ministry bureaucrats in Toronto cannot run the sprawling health system efficiently or ensure equal treatment across the province. The LHINs, he adds, will be able to provide "seamless" delivery of health care by the appropriate institution. Mr. Smitherman is, however, a politician who believes that eggs have to be broken to make an omelette, and he loves confronting his critics. He argues that the status quo, where expensive hospitals provide an extraordinary range of services, is no longer the best way to go. (He said that he had his wisdom teeth extracted 25 years ago in hospital and sniffed "there are those among the status−quo set who still believe this is the place to do that kind of thing.") One problem he faces is that LHINs are not like school boards or city councils, in that their members will be appointed by the government and not elected locally. The other is the powers of oversight that Bill 36 gives to a minister. Together, they lead critics to believe that the "integration" of services that Mr. Smitherman talks about is, in fact, a cover for a wholesale restructuring. The bill's wording offers little guidance about who's right. A minister could dissolve or amalgamate any health−service provider on the advice of a LHIN, but Mr. Smitherman says this would all be done in the open. "There is no nefarious power here," he said. On the other hand, an analysis by lawyers at Cassels Brock found the bill gives the minister "far greater powers" than earlier legislation to restructure the health system without cabinet approval. We won't know who's right until the regulations accompanying the bill come down and the "strategic plan" required by the legislation is divulged in about a year. Meanwhile, the unions, which already launched a $1−million ad campaign, plan to keep up the pressure with protests and town hall meetings, and pledge to punish the Liberals in the election if their fears are realized. The rest of us, meanwhile, can go back to sleep. mcampbell@globeandmail.com ADDED SEARCH TERMS: GEOGRAPHIC NAME: Ontario SUBJECT TERM:legislation; health care; reform PERSONAL NAME: George Smitherman

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Fortified white wheat flour adds essentials to our diets (The Ottawa Citizen)

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The Ottawa Citizen 2006.03.02 Final News Letters A13 Laura Pasut The Ottawa Citizen 250

Re: Follow new food guide and you'll get fat: MD, Feb. 28. Dr. Yoni Freedhoff criticizes the proposed revision of Canada's Food Guide, and specifically the recommendations of the grain products food group. It is unfortunate that he suggests Canadians should not consume "refined" carbohydrates such as white wheat flour. White wheat flour and food products made from it provide Canadians' diets with complex carbohydrates and similar levels of thiamin, riboflavin, niacin and iron found in whole wheat flour products. Since 1998 white wheat flour has been fortified with folic acid, which while important for the production of healthy body cells in everyone, is also vital for infants because it prevents life−threatening neural−tube birth defects such as spina bifida. Fortification of white wheat flour has been directly attributed to a dramatic 50 per cent reduction in these types of birth defects. And there has been an improvement in the folate status of Canadian women, a reduction in neuroblastomas (a tumour seen in infants), and a reduction in serum homocysteine levels (an indicator of cardiovascular disease). On the website www.GrainsEssential.ca, there are fully referenced reviews on the addition of the folate to white wheat flour and the benefits of whole grains to inform health professionals, including dietitians and physicians, and fact sheets for consumers. Laura Pasut, Barrie Ms. Pasut is the nutrition consultant for GrainsEssential program, which is sponsored by the Baking Association of Canada, the Canadian Wheat Board and the Canadian Pasta Manufacturers Association.

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POOR EDUCATION HAS DOMINO EFFECT (The Edmonton Sun)

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The Edmonton Sun 2006.03.02 Final Editorial/Opinion 11 MINDELLE JACOBS, EDMONTON SUN 479

The difficulties that aboriginals continue to face often seem so staggering that we overlook the gains that ordinary natives are making every day to improve their lives. A record number of aboriginal apprentices are now working in Alberta, the provincial government announced this week. There are 1,126 native apprentices in the province, up dramatically from 238 four years ago. Eager to grab a piece of the good life in Alberta's booming economy, they've joined dozens of trades, as have almost 50,000 apprentices overall. There are native heavy equipment technicians, electricians, plumbers and pipefitters. Other aboriginals are apprenticing as cabinetmakers, ironworkers, hairstylists and motorcycle mechanics. The list goes on. More than 500 of the 1,126 apprentices are in the Edmonton area alone. "Reaching this milestone demonstrates that aboriginal people are ready, willing and able to work with industry to build Alberta's economy," says Aboriginal Affairs Minister Pearl Calahasen. "Within a decade, aboriginal workers will represent one of every five new entrants into the labour market, so apprenticeships are critical." Because our need for skilled workers is so critical, Alberta is probably doing a better job than any other province promoting the trades − and higher education in general − among aboriginal youth. Every educated aboriginal is another role model for the community and they're certainly desperately needed because we still lack a critical mass of self−reliant, achieving natives to make a significant difference. Aboriginals with advanced education are still more the exception than the rule and, as a new study by the C.D. Howe Institute points out, poor education has a domino effect on other social outcomes. "Low education induces low employment rates and the intergenerational perpetuation of poverty," says the study, Creating Choices: Rethinking Aboriginal Policy, written by social policy analyst John Richards. "In turn, low employment is linked to criminal activity and depression − among men in particular − abuse of alcohol, a high suicide rate and an epidemic of diabetes." Most aboriginals have education levels that are so low they can't earn a good income, the study says. The poorest natives live on reserves on the Prairies, where the median income in 2000 was $12,000 and employment rates were below 45%, it adds. While there are more natives who have high school diplomas and trade certificates than in the past, comparatively few are heading to university, according to the report. 76

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"Here is evidence that should prompt a sense of urgency among those responsible for aboriginal education," Richards writes. "Low education outcomes are condemning the next generation to poverty." He is particularly critical of local school boards and provincial education ministries for not making public the performance of aboriginal students. B.C. is the exception. Detailed tracking of native educational outcomes and a willingness to experiment with new initiatives are crucial to boosting aboriginal achievement, Richards argues. He cites Edmonton's Amiskwaciy Academy, which combines a core curriculum with aboriginal cultural studies, and the Edmonton Catholic Schools' enrichment program as examples of innovative approaches. "The links among education, employment and income hold as much for aboriginals as they do for other Canadians," writes Richards. Unfortunately, that message is being ignored by many native parents who don't care whether their kids are in school or not. s among education, employment and income hold as much for aboriginals as they do for other Canadians," writes Richards. Unfortunately, that message is being ignored by many native parents who don't care whether their kids are in school or not.

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SOUTH DAKOTA TURNS BACK TIME ON ABORTION (The Edmonton Sun)

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The Edmonton Sun 2006.03.02 Final Editorial/Opinion 11 LYN COCKBURN, EDMONTON SUN FREELANCE 715

They're singin' along with Cher in South Dakota. "If I could turn back time ..." they warbled in the state legislature last Friday as legislatures approved a bill that would outlaw abortion in all cases (including rape and incest) except when the mother's life is in danger. Nice of them to allow the mother to live. Not so nice to condemn the 13−year−old victim of incest to bear her father's child. Oh well. The baby will no doubt be adopted by some deserving childless couple who will bring it up right. That should make the other child, the one who is the mother, (who is probably now in foster care) feel better. Not so nice for the victim of rape who was accosted on her way home from work and forced at gunpoint to suffer a violation upon her body. Already traumatized, she soon found out she was pregnant. Oh well. She can offer the child up to another well−deserving couple who've been waiting years to adopt. That'll make her feel better. The South Dakota legislators are likely to switch singers, as soon as somebody tells them Cher starred in the 1996 movie If These Walls Could Talk, which took a frank look at abortion in the 1950s, '70s and '90s. Speaking of the '50s, that's exactly where South Dakota (in a move that is seen as the first step in an attempt to overturn Roe vs. Wade in the U.S. Supreme Court) wants to put abortion. When women had little recourse to abortion. When poor women either resorted to back street abortions or they did it themselves. Whoopi Goldberg is on record as having given herself an abortion at the age of 14. With a coat hanger. Whoopi survived, many others did not. During one of Whoopi's standup comedy routines, she was loudly harassed by a member of the audience. "Murderer," the man shouted at her and other imprecations far less polite. Whoopi ignored him for awhile, but he only got louder and ruder. Finally, she walked over to the edge of the stage, looked down at him and said: "Honey, you against abortion? Fine, shoot your (rude slangy euphemism for the male appendage that supplies the canal through which those little wriggly things swim and meet up with the egg things) off." But in the end, it's not just the legislators in South Dakota who want abortion stopped. I do, too, and I'm pro−choice. I want it stopped through rendering it obsolete, not by making it illegal. The anti−abortionists are putting the emphasis in entirely the wrong place. Rendering abortion illegal will not stop it. The well−to−do will go to other countries to have their abortions and the poor will go to the back streets.

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There are so many ways to render abortion obsolete that the mind cannot quite grasp why people put any energy into trying to criminalize it. (Any doctor in South Dakota who does an abortion would risk a prison sentence of up to five years under the new bill). The solution to abortion, of course, is not restrictive laws. It is to ensure that unwanted pregnancies are reduced through birth control measures and education. With a concerted effort, the incidence of abortion can be vastly reduced. But the prospect of easy access to birth control does bring up the interesting point of whether that 13−year−old incest victim should be able to get birth control without parental consent. This is a conundrum that when it comes to sex, there is always lots of grey involved. Other grey areas include the "morning after" pill, already on sale in Canada, and RU−486, the so−called abortion pill. Couple these medications with new advancements in research and in education, and the time spent on trying to make abortion itself illegal is questionable. In other words, technology may eventually render the entire argument moot. And that's as it should be. That's not how the legislators in South Dakota see it. On the one hand, they understand the likelihood that their bill will be struck down as unconstitutional. On the other hand, they hope they'll be able to take their bill all the way to the U.S. Supreme Court where they will strike down Roe vs. Wade. Estimates of the time and money that process could take range between three and five years and millions of dollars. What a waste. That time and money could be better spent in rendering abortion obsolete − through scientific research, easy access to all forms of birth control and education.

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Warning: Life can make you ill: Believing what you read can be a health hazard (Calgary Herald)

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Calgary Herald 2006.03.02 Final Real Life F4 Julie Mason For CanWest News Service Photo: Herald Archive, CanWest News Service / Responding tothe latest media−fed ILLUSTRATION: health trends, our kitchen shelves often look like a pharmacy, with vitamins, supplements and oils to replace the food we're told we shouldn't eat. WORD COUNT: 765 Sister and I contemplate the week's headlines over lattes and croissants. "Here's good news," says sister. "Low−fat diets don't prevent anything. Studies show that women who eat cream puffs don't get any more bad diseases than babes who ban butter." I find a headline, too: "Experts who warned that hormone replacement therapy would kill us now say we can pop a pill or slap on a patch instead of dissolving into a hot−flash puddle." Sister licks croissant crumbs off her fingers. "There's more," she says. "All those calcium tablets the size of dinosaur eggs we've been choking down every day −− they don't do a thing." I turn the page of the newspaper with croissant−greasy fingertips, "Remember everyone raving about fortysomething Madonna's twentysomething body on the Grammy show and how she worked out to get it? She was admitted to hospital with a hernia a few days later." (See page F3.) Sister and I share a little schadenfreude and the last croissant. "Here's the bad news," she says. "Experts say that 60 is the new 70, and baby boomers are heading for the big roundup faster than their parents." In fact, this may be good news to our children, who whine that boomers are taking all the jobs and ruining the music industry with endless Rolling Stones tours. Also, financial experts say none of us have enough RRSPs to afford to live past retirement, so our children will put us on ice floes and shove us out to sea, if there are any ice floes left after global warming. Then sister and I contemplate our mother, still enjoying her daily Laura Secord chocolate bar at a hale and hearty 93, and our grandmother, who at the same age made fried kidneys for breakfast and butter tarts for tea. Neither of them did pilates or aerobics. These days, there's hardly any medical research with results that have stood the test of time longer than a year. Even new studies are instantly qualified by other experts who tell us, for example, that the women in the low−fat study weren't low−fat enough −− if they'd just eaten bread and water, they'd all have lived to a thin and grumpy 110. Other research shows women who glug back olive oil and red wine age as beautifully as the stuff they 80

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consume; still more studies prove women who dine on rice and raw fish stay petite and perfect into their golden years. We're bombarded with so−called health news, and we gobble it up with the same enthusiasm we used to reserve for french fries. Our kitchen shelves look like a pharmacy, with vitamins, supplements and oils to replace the food we're told we shouldn't eat because the calories will make us fat, which will make us sick with the diseases that could be prevented if we ate the foods that contain the nutrients that we're taking the vitamins, supplements and oils to replace. Things aren't much better on the exercise front. Our homes are full of labour−saving devices because we're too busy to do the physical work that we replace by squeezing in an hour to go to the gym to run like rats on a treadmill. We consider our world so dangerous that we bus our kids to school instead of letting them walk on their own, then regularly hand the little sweeties over to complete strangers to teach them swimming or ballet. Every TV newscast has a health segment with a photogenic Dr. Whosit who simplifies all the medical gobbledygook into digestible sound bites. As you struggle to get a tofu burger down the gullet of little Brendan before you rush him out the door to karate lessons, you linger when Dr. Whosit worries you with "What you're eating for dinner may be ruining your sex life and causes osteoporosis in lab rats −− more after the break." If you watch American TV, you're treated to dozens of ads for pharmaceuticals, everything from cholesterol−lowering drugs through the best in faux hip joints to cancer treatments. Maybe it's the difference between the American consumer−style health care and our Canadian version, but I can't imagine someone with cancer phoning up to say, "Gee, Doc, I've just seen a TV ad for Neulasta to boost my white blood cells during chemotherapy, and I've just got to get me some." While sister and I have been pondering our health futures, the resident puppy dogs have broken into the cupboard where all the previously recommended low−fat foods are stored and devoured a package of fat−free fudge bars, which they're now barfing up on the living room rug. Sister wonders if the required carpet cleaning counts as the half−hour of moderate exercise currently recommended by health experts.

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Drugs Antibiotic poses risks, researchers say: Tequin more likely than alternatives to cause blood sugar swings: study (Montreal Gazette)

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Montreal Gazette 2006.03.02 Final News A3 SHARON KIRKEY CanWest News Service TORONTO 515

An antibiotic prescribed about 500 times a day in Canada is dramatically more likely than other antibiotics to cause potentially deadly swings in blood sugar. In the latest drug scare to link a widely used medicine with serious health risks, Toronto researchers found that people prescribed the antibiotic Tequin − chemical name gatifloxacin − were more than four times more likely to develop hypoglycemia, or low blood sugar, in the month after taking the pills than patients given other antibiotics in the same class. Patients were nearly 17 times more likely to experience hyperglycemia, or high blood glucose levels. Tequin's maker, Bristol−Myers Squibb Canada, issued a "dear health professional" letter and public alert in December about a possible link between the drug and potentially serious blood glucose disorders. Two weeks ago, Health Canada advised people with diabetes not to take Tequin as a precaution. But the Toronto researchers found the blood sugar swings occurred whether or not people were diabetic. The New England Journal of Medicine released the study early because of its potential impact on patients. In some patients, low blood sugar has no warning. As it worsens, they become confused and have trouble speaking, making it difficult to call for help. Low and high blood sugars can eventually lead to coma and death. "Personally, I think doctors should think twice before prescribing this drug," says study co−author Dr. David Juurlink, of the Institute for Clinical Evaluative Sciences. "For every infection, there are many alternate antibiotics that could be used instead of this one that simply don't cause the same problems with blood sugar." In the journal article, Juurlink and his colleagues said some doctors "may elect to avoid the use of gatifloxacin altogether." Nearly 140,000 prescriptions for Tequin were filled in Canada last year, according to drug−tracking firm IMS Health Canada. Health Canada has received 14 reports of people who died after taking Tequin since the drug was first marketed in Canada in January 2001. The department says the deaths "are potentially linked to instances of 82

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hypoglycemia or hyperglycemia." "The causality of these cases is currently being assessed − a link between the drug and the outcome has not yet been established," spokesperson Jirina Vlk wrote in an email. In a public advisory in December, Bristol−Myers Squibb said there have been reports of "very rare events" of abnormal blood sugar levels that were life−threatening. The firm says most of these patients had other underlying medical problems and were on other medications that may have contributed to blood sugar problems. As of Dec. 31, 2005, Health Canada had also received 169 reports of hypoglycemia and 109 reports of hyperglycemia potentially associated with the drug. Health Canada is reviewing Tequin's labelling information, including whether to add a "black box" warning, the strongest it can issue. Bristol−Myers Squibb says it is not considering taking the drug off the market. "We're going to continue to market the drug because, when used in appropriate patients, it's a well−tolerated medicine," spokes−person Marc Osborne said. Drug safety has become a hot issue, from the withdrawal of the blockbuster painkiller Vioxx to safety concerns over antidepressants and drugs used to treat attention deficit disorder. Tequin "now takes its place among an ever−growing list of medications that have been associated with very serious adverse events," a New England Journal of Medicine editorial says.

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Research links antibiotic to lethal blood−sugar levels (Globe and Mail)

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GLOBE AND MAIL 060610249 2006.03.02 A8 ANDRE PICARD Health Metro 634 579

ANDRE PICARD PUBLIC HEALTH REPORTER The antibiotic gatifloxacin −− which is commonly used to treat pneumonia and urinary tract infections in the elderly −− can cause life−threatening changes in blood−sugar levels, according to a new Canadian study. The unusual side effect has already prompted regulators in Canada and the United States to warn that the drug, sold under the brand name Tequin, should not be used by diabetics, those with kidney problems and people over 75. But the authors of a new research paper, published on−line yesterday by the New England Journal of Medicine, go much further, suggesting that physicians should think twice about prescribing it to anyone. "Given this potentially lethal side effect, I would never prescribe this drug again," Dr. David Juurlink, a clinical pharmacologist and researcher at the Institute for Clinical Evaluative Sciences in Toronto, said in an interview. The study found that patients admitted to hospital in Ontario with dangerously high blood−sugar levels (hyperglycemia) were almost 17 times as likely to have been treated with gatifloxacin as with another antibiotic. Among those treated for abnormally low blood−sugar levels (hypoglycemia), patients were four times as likely to have received gatifloxacin. "The risk is not confined to people with diabetes," Dr. Juurlink said. He also noted that the research was done using hospital records, and does not include people who were not put in hospital, some of whom likely died. The good news, the researcher said, is that several other antibiotics are as effective as gatifloxacin and do not have the same side effect. "This is not a class effect. It's something particular to this molecule," Dr. Juurlink said. Tequin is part of a family of antibiotics known as fluoroquinolones, the most prescribed antibiotics in North America. In Canada alone, more than three million prescriptions for fluoroquinolones are dispensed annually, with sales of $140−million, according to IMS Canada, a company that tracks prescription drug trends.

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Last year, Tequin accounted for 140,000 prescriptions and $10.2−million in sales for its manufacturer, Bristol−Myers Squibb Canada. The drug has been available in Canada since 2001. Health Canada said yesterday that it had already ordered the company to strengthen warnings on the label of the product and in the monograph. "We are reviewing all the safety data," said Jirina Vlk, a spokeswoman for Health Canada. She said that 169 cases of hypoglycemia and 109 cases of hyperglycemia associated with Tequin had been reported. Ms. Vlk said removing the drug from the market was not being considered at this time. Marc Osborne, director of Bristol−Myers Squibb Canada, said yesterday that the drug is safe when used properly. He said the company was co−operating fully with regulators, and has no plans to withdraw the antibiotic from the market. "Tequin is generally well tolerated in appropriate patients," Mr. Osborne said, and he urged patients who had concerns to discuss them with their physician. Fluoroquinolones are highly potent antibiotics that are considered relatively safe. Like all drugs, they can have serious side effects. These include severe allergic reaction, nerve damage, tendon rupture, heart problems (prolonged QT interval), muscle wasting and Steven Johnson syndrome (a potentially deadly skin disease caused by a drug reaction), as well as changes to blood sugars. To conduct the new study, researchers reviewed records of Ontario residents over the age of 66 who received antibiotics between 2002 and 2004. Researchers identified 788 patients who were treated for hypoglycemia and 470 patients treated for hyperglycemia within 30 days of antibiotic treatment. Then, data were re−examined to determine what sort of antibiotics were used, which revealed much higher rates of blood−sugar problems among users of gatifloxacin. Dr. Juurlink said that, among other things, the study shows the need for the monitoring of drugs to track side effects in the real world. ADDED SEARCH TERMS: SUBJECT TERM:health care; prescription drugs; health hazards; regulation ORGANIZATION NAME: Bristol−Myers Squibb Canada

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Study links antibiotic to fatal blood−sugar woes (The Kingston Whig−Standard)

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The Kingston Whig−Standard 2006.03.02 Final National / World 11 / Front Sheryl Ubelacker The Canadian Press TORONTO 265

TORONTO − One of the most widely prescribed antibiotics in North America appears to dramatically boost the risk of potentially life−threatening blood sugar abnormalities, a large−scale study by Canadian researchers has found. The study found that the antibiotic gatifloxacin, sold under the brand name Tequin by manufacturer Bristol−Myers Squibb, is associated with an increased danger of both low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia), when compared with other antibiotics. "What we found was that people taking gatifloxacin had more than a fourfold increase in the risk of being treated in hospital for low blood sugar than people who were on other antibiotics," study co−author Dr. David Juurlink said yesterday. "And the people on gatifloxacin had almost 17 times more risk of developing high blood sugar," said Juurlink, a senior researcher at the Institute for Clinical Evaluative Sciences in Toronto. The research, released online yesterday by the New England Journal of Medicine, involved patients over age 65 admitted to hospital in Ontario. While younger patients were not part of the study, Juurlink believes they, too, could be adversely affected by the drug. He warned that both low and high blood sugar, or glucose, can be fatal, although plunging levels can cause death more quickly. It's unusual for a drug to have two opposing effects, but it's believed Tequin may interfere with regulation of insulin secretion from the pancreas, which controls blood sugar levels. Symptoms of low blood sugar include sweating, shakiness, confusion, light−headedness, a racing heart beat and trouble speaking. As the levels drop further, a person may experience seizures, coma and eventually death. The hallmarks of high blood sugar include excessive urination and thirst, confusion, and nausea. Both conditions can lead to coma and death.

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Antibiotic can pose serious risk for elderly Study; Tequin prescribed 500 times daily 'Think twice' about whether to use it (The Toronto Star)

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The Toronto Star 2006.03.02 ONT News A2 Elaine Carey Toronto Star 398

One of the most popularly prescribed antibiotics in Canada causes potentially life−threatening side effects in seniors, a new study says. The drug Tequin, also known as gatifloxacin, leads to an increased risk of hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) compared to other antibiotics in the same class, said the Canadian study, released yesterday by the New England Journal of Medicine. The drug belongs to a class of antibiotics called fluoroquinolones, the most prescribed antibiotics in North America. But in recent years, several of the drugs in the class have been withdrawn or restricted because of serious side effects. The study, by the Institute of Clinical Evaluative Sciences, an independent non−profit organization, was released early online − ahead of the March 30 publication date − because of the potential implications. Tequin, made by Bristol−Myers Squibb, is prescribed about 500 times a day in Canada for pneumonia and other infections including those of the bladder, urinary tract and sinuses and for sexually transmitted diseases, said the study's lead author, Dr. Laura Park−Wyllie. The study found that Ontario patients over 66 who were treated in emergency departments or hospitalized for low blood sugar levels were over four times more likely to have taken gatifloxacin in the preceding 30 days compared to other common antibiotics. Patients treated for high blood sugar levels were almost 17 times more likely to have taken the drug. No major increased risk of blood sugar problems was found with any other antibiotic in the class. "Gatifloxacin now takes its place among an ever−growing list of medications that have been associated with very serious adverse effects," says a journal editorial accompanying the study. "It seems clear that the drug's place among broad−spectrum antibiotics available for outpatient use is tenuous at best." "There are many other antibiotics out there to treat infections that don't cause these serious problems with blood sugar," Park−Wyllie said in an interview. "It's important to think twice about whether to use this antibiotic." There have been reports of serious blood sugar problems in younger people who have taken the drug since it was introduced in 1999, Park−Wyllie said.

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Health Canada issued a warning about the drug in February, saying that Bristol−Myers Squibb, after reviewing its data, had decided it should not be used by diabetics and that it also planned to enhance its warning about blood sugar problems. It's now considering putting a black box warning on the drug regarding potential blood sugar risks to those over 75, said spokesperson Jirina Vlk.

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STUDY LINKS DRUG, HEART WOES (The Edmonton Sun)

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The Edmonton Sun 2006.03.02 Final Lifestyle 50 AP WELLINGTON, New Zealand 275

People taking the pain reliever Celebrex were at nearly twice the risk for heart attacks as those using rival treatments, according to a study released yesterday conducted by New Zealand's Medical Research Institute. Celebrex, which is manufactured by Pfizer Inc. and is commonly used to treat arthritis pain, belongs to the class of drugs known as cox−2 inhibitors. Two other drugs in the class, Pfizer's Bextra and Merck &Co's Vioxx, were removed from the market because of safety concerns. Vioxx was withdrawn in September 2004 after a study showed it doubled patients' risk of heart attack and strokes after 18 months of use. The research published yesterday reviewed six studies of 12,780 patients in an attempt to determine if the increased risk of cardiovascular problems with Vioxx was also present with Celebrex. It found a 1.88−fold increased risk of heart attack when Celebrex was compared with the other arthritis treatments. "These findings are critical" because Celebrex's risk is similar in magnitude to Vioxx's risk, said Prof. Richard Beasley, the institute's director. The research was published in the Journal of the Royal Society of Medicine. "Given the popularity of celecoxib (Celebrex) in the treatment of arthritis ... drug regulatory authorities need to urgently re−examine the assessment of the drug in light of these findings," Beasley said. Pfizer New Zealand general manager Mark Crotty said the finding was "extremely misleading" as it is "very much an incomplete review of the data − selecting six studies out of 48 available." Last December the U.S.−based Cleveland Clinic announced it would lead an international study to learn whether painkillers taken for arthritis, including Celebrex, Ibuprofen and Naproxen, are safe for those at risk of heart problems. Pfizer is slated to face its first patient lawsuit over Celebrex in June in Alabama.

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Computer scientist develops life−saving drug programs: U of A prof helps U.S. Food and Drug Administration avoid naming mix−ups (Edmonton Journal)

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Edmonton Journal 2006.03.02 Final News A2 Jodie Sinnema The Edmonton Journal EDMONTON Photo: John Lucas, The Journal / Computer scientist GregKondrak in his office Ran with fact box "Drug Mix−Ups", which has been appended tothis story. 800

EDMONTON − Greg Kondrak isn't a doctor or pharmacist, but his work as a computer scientist is saving lives by helping prevent confusion between similar−sounding and similar−looking drug names such as Isordil and Plendil, morphine and hydromorphone. "There is a lot of confusion. There are a lot of errors," said Kondrak, a professor at the University of Alberta who developed two computer programs now being used by the U.S. Food and Drug Administration to create drug names that won't be confused with others. "There are thousands and thousands of cases where people are actually taking the wrong drug because of that confusion and sometimes in some cases it ends tragically." Each year, 1.3 million people die in the United States from medical errors such as receiving the wrong dosage of a drug or getting the wrong drug from a pharmacist because the doctor's handwriting is illegible. Approximately 12.5 per cent of these errors, about 162,500, happen because of drug name confusion, says the FDA, the agency that makes sure consumer medical products are safe before they head to market. In 1995, for instance, a man from Texas died after he was given Plendil −− a drug for high blood pressure −− instead of Isordil, a drug to help with heart pain caused by valve problems. The pharmacist misread the doctor's handwriting and mixed up the similar−looking drug names. Both medical professionals were later held liable. In 2004, a man from Bowden, Alta., died hours after he was given hydromorphone −− a painkiller typically used for palliative care patients −− instead of morphine at a Red Deer hospital. Similar sounding drug names, combined with look−alike packaging and workplace distractions, led to the fatal error. A report on the death suggested Health Canada should change the generic name of hydromorphone. "I think it's my responsibility to help," said Kondrak, who originally created his computer program to help linguists find similarities between words in their search for language histories. Kondrak, who speaks Polish, English and Spanish, and has studied Italian, Russian and German, was approached by a U.S. software company in 2002 to see if his programs could be used in the medical field.

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"I see this as research that should benefit everybody," Kondrak said, noting that he presented his work at a Health Canada conference in 2003. He doesn't know if his program is being used in Canada on new drug names. "That is the nature of scientific research, that it should be public." Before Kondrak came along, the FDA had medical professionals pore over a list of more than 4,400 drug names to make sure new ones wouldn't be confused with old ones. That was inefficient and time−consuming. According to a background document, of the 300 drug names reviewed each year, the FDA rejected about one−third that drug companies proposed. In 2003, the FDA started using new software based on Kondrak's computer programs. He did the work as a graduate student with a $35,000 Natural Sciences and Engineering Research Council grant. The program used by the FDA can identify more than 90 per cent of words that people may confuse, compared to 40 to 80 per cent of names identified by other programs, says a study co−authored by Kondrak and published in January's edition of Artificial Intelligence in Medicine. "There are many errors that people haven't found and the computer finds them," Kondrak said. "It helps people. It does help prevent those errors that can be dangerous for people." When a drug company submits a snappy, short, easy−to−remember drug name, the FDA pops that name into the program. It spits out a list of drugs with names that either sound the same or look the same. Then, a group of medical professionals goes through the short list to further determine how easily the drugs might be confused. Are they given out in the same dosages? Are they used for similar medical problems? "You can't leave these kinds of decisions to the computer because computers are dumb," said Kondrak, whose original programs are available free on his website. "(Computers) don't know everything about drugs, how people use them. I always see this as a tool people use, but ultimately you want to have a professional, an expert, decide whether these names are confusable or not." jsinnema@thejournal.canwest.com DRUG MIX−UPS Other drug mix−ups reported to the FDA: − A physician ordered Taxol for a patient. The pharmacist prepared Taxotere instead. Both are chemotherapy drugs used for different types of cancers. The patient died several days later, though the death couldn't be linked to the error because the patient was already severely ill. − In 1994, the FDA changed a drug name because the thyroid medicine Levoxine was being confused with the heart medicine Lanoxin, requiring some people to be hospitalized. Now the thyroid medicine is called Levoxyl. No other errors have been reported. − Other examples: Serzone for depression and Seroquel for schizophrenia. Lamictal for epilepsy, Lamisil for nail infections, Ludiomil for depression, and Lomotil for diarrhea Zantac for heartburn, Zyrtec for allergies, and Zyprexa for mental conditions

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Celebrex for arthritis and Celexa for depression. Source: The U.S. Food and Drug Administration consumer magazine

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Patch approved for depression (The Chronicle−Herald)

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The Chronicle−Herald 2006.03.02 Living F3 161

WASHINGTON (AP−CP) − The first skin patch to treat depression won approval in the United States this week, providing a novel way to administer a drug already used by Parkinson's disease patients but that belongs to a class of medicines that is rarely a first or second choice antidepressant. The Food and Drug Administration approved the selegiline transdermal patch, agency spokeswoman Susan Cruzan said. The drug will be marketed as Emsam, said Somerset Pharmaceuticals Inc., which developed the drug, and Bristol−Myers Squib Co., which will market it in three sizes as a once−a−day treatment for major depression. "We believe Emsam will help physicians treat their patients living with this illness through a new and unique delivery system," said Peter Dolan, chief executive officer of Bristol−Myers Squibb. The patch containing the drug to treat depression is not approved in Canada and no submission has been made by the company seeking approval, Health Canada spokeswoman Jirina Vlk said from Ottawa.

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LOCAL TESTS SUPPORT MS DRUG (The Ottawa Sun)

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The Ottawa Sun 2006.03.02 Final News 16 HOLLY LAKE, OTTAWA SUN 191

A promising multiple sclerosis drug that was suspended from the U.S. market because three people developed a rare brain disease now appears relatively safe and quite effective. In one of three studies in today's New England Journal of Medicine, 942 participants took Tysabri only. Researchers found nearly twice as many people on a dummy treatment got worse over two years. The Tysabri group had 68% fewer relapses. Touted as a significant advance for MS treatment, the drug also reduced the risk of disability progression and brain lesions in patients with relapsing MS. Ottawa was one of 10 trial sites across Canada. Led by Dr. Suzanne Christie, a clinical neurologist at the Elisabeth Bruyere Health Centre, the trial involved 12 local patients. When Christie spoke to the Sun last year, she was happy with what she had seen in her patients. "Based on the results, I think Tysabri will most likely be the first line therapeutic choice among MS patients," she said. The drug has not been approved by Health Canada, but is under priority review. In a second study of 1,171 patients published yesterday, the rate of relapse was cut in half when Tysabri was added to interferon. A quarter more patients got worse on interferon alone. The release comes days before U.S. government hearings on whether to allow sales of the drug to resume.

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Health Care Santé; Harper se montre prudent face aux intentions albertaines (La Presse)

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La Presse 2006.03.02 Politique A12 Morissette, Nathaëlle Ottawa 561

Le premier ministre Stepen Harper affiche la plus grande prudence concernant les intentions du gouvernement albertain qui, à l'instar du Québec, ouvre la porte au secteur privé dans les soins de santé. Le chef conservateur préfère étudier en profondeur les mesures proposées mardi par son homologue de l'Alberta, Ralph Klein, avant de se prononcer sur la question. Du même souffle, il encourage les provinces à suivre les traces du Québec en proposant des réformes qui respectent la loi canadienne sur la santé. M. Klein a annoncé mardi ses intentions de procéder à une réforme du système de santé, notamment en donnant le feu vert aux patients qui veulent payer pour avoir accès à un nombre restreint de chirurgies, en ouvrant la porte à l'assurance privée et en permettant aux médecins de pratiquer à la fois dans les secteurs privé et public. Deux vitesses " Vous pouvez bien dire que c'est à deux vitesses, mais ce n'est pas différent de ce qui se passe au Québec ", a soutenu la ministre de la Santé de l'Alberta, Iris Evans, lors de l'annonce de son gouvernement, mardi. " Il y a un désir des provinces de régler les problèmes de la santé, a reconnu M. Harper lors d'un point de presse, hier. J'ai dit à plusieurs reprises que ce gouvernement est prêt à travailler avec les provinces dans le cadre de la loi canadienne sur la santé. Heureusement, le gouvernement du Québec a proposé des réformes majeures qui respectent clairement la loi canadienne sur la santé. " La loi canadienne sur la santé repose sur cinq principes: l'universalité, l'accessibilité, la transférabilité, l'intégralité et la gestion publique. Il y a deux semaines, dans sa réponse au jugement Chaoulli, Québec a entrouvert la porte aux assurances privées pour certaines chirurgies (chirurgie de la cataracte et remplacement du genou ou de la hanche) et s'est également engagé à améliorer l'accès aux soins de santé. Contrairement au plan proposé par l'Alberta, le gouvernement Charest oblige les médecins à choisir leur camp: ils ne pourront pratiquer à la fois dans le secteur public et dans le secteur privé. Le premier ministre Harper n'a pas tari d'éloges à l'endroit du gouvernement Charest pour avoir adopté de telles mesures. Inquiétude Malgré tout, les intentions de Ralph Klein sèment l'inquiétude dans les rangs libéraux où l'on estime que les réformes annoncées violent les principes de la loi canadienne sur la santé. " Je pense qu'on doit avant tout protéger le système public, a déclaré hier le député libéral Denis Coderre, en marge d'une réunion du caucus de son parti. On ne doit pas faire en sorte d'avoir un système de soins de santé (que les patients devront payer) avec une carte de crédit. On doit appliquer la loi tout simplement. " 95

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Responsabilité " Quand on regarde ce que M. Klein propose, c'est certain que ça heurte directement la loi canadienne, a ajouté l'ancien ministre libéral Jean Lapierre, Le gouvernement (Harper) a une responsabilité face à ça. " Pour sa part, le critique libéral en matière de santé, Ken Dryden, a été avare de commentaires concernant l'annonce de M. Klein, se contentant d'affirmer que la balle était maintenant dans le camp des conservateurs et que c'était à eux de gérer ce dossier. " M. Harper a le devoir de respecter la loi canadienne sur les soins de santé ", a−t−il dit. − Avec la Presse Canadienne

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L'Alberta devra respecter la Loi sur la santé; Harper fait une mise en garde à Ralph Klein, qui ouvre la porte au secteur privé (Le Devoir)

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Le Devoir 2006.03.02 LES ACTUALITÉS a2 Castonguay, Alec 714

Ottawa − Le plan de réforme du système de santé que vient d'élaborer le gouvernement de l'Alberta, et qui ouvre toute grande la porte à une intrusion plus forte du privé, devra être conforme à la Loi canadienne sur la santé, a prévenu hier le premier ministre canadien Stephen Harper. Mais avant de prendre position officiellement, Ottawa veut d'abord étudier attentivement le document albertain dévoilé mardi. Le gouvernement fédéral fera connaître sa réponse dans quelques jours. Le gouvernement Harper ne veut rien précipiter dans ce dossier qui pourrait devenir le premier accrochage majeur entre Ottawa et une province depuis son arrivée au pouvoir. C'est que le plan de Ralph Klein, qui vise à remodeler son système de santé, va beaucoup plus loin que celui présenté par le Québec il y a environ deux semaines. L'Alberta ne veut pas simplement permettre des garanties pour les délais d'attente, mais permettre carrément aux gens de passer par le privé s'ils en ont les moyens pour certaines chirurgies, notamment celles de la hanche et du genou. De plus, les médecins pourraient à la fois travailler dans le secteur public et le secteur privé. Une pratique interdite au Québec. Conscient qu'une telle réforme pourrait faire grincer des dents le reste du pays, le premier ministre albertain Ralph Klein a précisé mardi qu'il ne s'agissait que d'un document de consultation et que des modifications pouvaient encore être apportées. D'ailleurs, plusieurs choses restent à préciser dans cette réforme, notamment le nombre d'heures qu'un médecin devra effectuer dans le système public avant de se mettre au service d'une clinique ou d'un hôpital privé. Un point qu'a repris le premier ministre Stephen Harper hier. «Le document en Alberta est seulement un document de travail», a−t−il dit en marge d'un point de presse visant à confirmer l'entrée du juge Marshall Rothstein à la Cour suprême. «Le gouvernement du Canada a l'intention d'en étudier le contenu et je peux vous dire que nous aurons une pleine réponse dans un proche avenir.» Le gouvernement Harper a la délicate tâche de déterminer si une aussi grande place faite au secteur privé est conforme à la Loi canadienne sur la santé, devenue une loi symbole, particulièrement au Canada anglais. Cette loi stipule qu'Ottawa peut refuser de transférer sa part du financement des soins de santé à une province qui ne respecte pas cinq critères: 1) une gestion publique du système; 2) un système qui couvre tous les coûts des soins prodigués dans un hôpital; 3) un système accessible à tous les habitants; 4) un système qui interdit l'imposition de frais qui entravent l'accès aux soins; 5) un système qui couvre les coûts d'hospitalisation d'un de ses résidants qui doit être soigné à l'extérieur de la province. Les critères très larges de la loi pourraient permettre à l'Alberta de passer le test. C'est ce que détermineront les experts du gouvernement fédéral, qui avaient jugé la réforme du Québec tout à fait correcte. Mais une chose est certaine, la loi doit être respectée, a soutenu Stephen Harper. «Mon gouvernement s'est engagé à faire respecter la Loi canadienne sur la santé. Dans notre évaluation, nous allons donc en tenir compte. Mais je suis certain que l'Alberta aussi veut respecter la loi, comme elle l'a toujours fait.» Stephen Harper a plutôt encouragé les provinces à suivre l'exemple du Québec, devenu un modèle selon lui. «Les provinces comprennent qu'il y a des problèmes dans le système de santé, a−t−il dit. On a besoin de 97

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réforme, de vraies réformes pour régler ces problèmes, et j'ai dit à plusieurs reprises que ce gouvernement est prêt à travailler avec les provinces dans le cadre de la Loi canadienne sur la santé. Heureusement, le gouvernement du Québec a proposé des réformes majeures qui respectent clairement cette loi. J'encourage toutes les provinces à suivre l'exemple du Québec. J'encourage l'Alberta et les autres provinces à avoir les mêmes cibles.»

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Harper embêté par la position de Klein sur la médecine à deux vitesses; Il invite de nouveau les autres provinces à s'inspirer du modèle québécois (Le Soleil)

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Le Soleil 2006.03.02 Actualités A8 Giroux, Raymond Ottawa Stephen Harper 626

Fort embêté par la proposition de Ralph Klein d'ouvrir les portes toutes grandes à la médecine à deux vitesses, Stephen Harper a invité une nouvelle fois l'Alberta et les autres provinces à suivre le modèle québécois mis de l'avant par Philippe Couillard, il y a deux semaines. Le premier ministre canadien a refusé hier, en conférence de presse, de se prononcer sur le contenu de la réforme de M. Klein et a demandé quelques jours encore pour l'étudier "avec beaucoup d'attention". M. Harper a également détourné la question des sanctions financières possibles contre l'Alberta, dans le contexte où cette dernière vient d'annoncer un excédent budgétaire de 10 milliards $, ce qui la rend de fait imperméable aux menaces. Mais la lecture du document soumis à la consultation populaire et tout axé sur la liberté de choix ne laisse planer aucun doute sur les intentions du gouvernement conservateur de l'Alberta. "Les Albertains, y lit−on, (...) sont prêts à payer eux−mêmes pour un accès plus rapide" aux services de santé si le régime public ne répond pas à leurs besoins. "Il s'agit seulement d'un document de travail, a expliqué M. Harper. Ce gouvernement croit à la Loi canadienne sur la santé, et celui de l'Alberta l'a inscrite dans sa propre législation. "Le gouvernement et le premier ministre de l'Alberta ont toujours dit qu'ils respecteraient la loi", a−t−il ajouté, et le fédéral s'assurera que la proposition albertaine respecte cette loi. "Évidemment, il y a un désir des provinces de régler les problèmes de la santé, a dit le premier ministre. Les provinces comprennent comme la majorité de la population qu'on a besoin de vraies réformes, et j'ai dit à plusieurs reprises que ce gouvernement est prêt à travailler avec les provinces. "Heureusement, le gouvernement du Québec a proposé des réformes majeures qui respectent clairement la Loi sur la santé, a−t−il insisté. J'encourage toutes les provinces à suivre l'exemple du Québec qui propose des réformes qui garantissent l'accès des services aux gens ordinaires." M. Harper a par ailleurs confirmé qu'il ne peut plus garantir l'abolition totale du Registre des armes à feu promise dans son programme électoral. Armes à feu

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"Évidemment, la situation minoritaire limite notre capacité d'agir et nous sommes en train d'étudier nos options, a−t−il dit. Nous voulons dépenser les fonds publics dans le dossier de la justice criminelle de façon efficace. "Je n'ai pas l'intention de tenir un vote (aux Communes) à moins que ce soit clair que nous puissions gagner ce vote, a−t−il ajouté. Il y a des limites et nous ferons ce que nous pourrons faire dans des circonstances réalistes." Sur la question des deux Canadiens assassinés au Mexique, la semaine dernière, M. Harper a invité les politiciens à la modération et à résister à la tentation de spéculer et de faire la manchette avec cette histoire. Le premier ministre a aussi donné l'assurance que la GRC est en "contact actif" avec la police mexicaine et que les deux collaborent étroitement pour résoudre cette affaire. Aucune demande d'extradition n'a été faite par le Mexique jusqu'ici, a−t−il dit en faisant allusion aux deux femmes de Thunder Bay qui se croient piégées dans cette affaire, leur nom ayant été cité de source policière comme témoins importants, dans la presse locale. Finalement, question de faire taire les rumeurs, M. Harper a donné l'assurance qu'il n'avait aucun projet de déplacement prévu sur l'Afghanistan, où quelque 2000 militaires canadiens veillent à la sécurité dans la région de Kandahar. Le premier ministre a cependant insisté sur l'importance de cette mission mal perçue par la population, selon certains sondages, et maintenant critiquée par certains députés libéraux. "Nous avons fermement appuyé le gouvernement précédent, dans cette mission, et j'ai été très ébranlé de voir que certains d'entre eux veulent maintenant un vote des Communes sur cet engagement, a−t−il dit. "Le gouvernement libéral a envoyé nos troupes dans une mission très dangereuse, a−t−il dit. On ne décide pas de questionner une telle décision après avoir envoyé des troupes dans une telle situation et notre gouvernement appuie nos troupes sans équivoque." RGiroux@lesoleil.com

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ALBERTA'S THIRD WAY Wild week started with the big reveal In Klein's final term, 'the time is now' to unveil sweeping health−care changes (Globe and Mail)

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GLOBE AND MAIL 060610197 2006.03.02 A4 (ILLUS) KATHERINE HARDING National News Metro Edmonton AB 636 572

KATHERINE HARDING EDMONTON Day one of Premier Ralph Klein's public consultations on his sweeping health−care changes didn't go smoothly yesterday. The 63−year−old politician had to apologize to a 17−year−old female legislature page after throwing a booklet of the provincial Liberals' health−care ideas at her and yelling: "I don't need this crap." It's already been a wild week in Alberta politics since Mr. Klein finally pulled the curtain back on his long−promised health−care proposals, which his critics charge could open the door to formalized two−tier medicine. While Mr. Klein has been musing for years about introducing more private health−care delivery to the province's $9−billion system, Tuesday's announcement took many by surprise here and in Ottawa. Mr. Klein's 62−member Conservative caucus and Prime Minister Stephen Harper's office received the glossy 18−page document on Tuesday morning, and by noon it was distributed to reporters. Mr. Klein's office brushed off speculation that the Premier, who is serving his fourth and final term, caved in to rampant criticism that he needed to come clean with his secretive plans, especially as a crucial leadership review by his party is set for later this month. "The time was now," Gordon Vincent, a senior Klein political aide, said about why the document was released. He added that it was appropriate to publicize it early in the spring legislature session, which began last week. In recent weeks, even Mr. Klein's own caucus has been privately prodding him to get out in front of the issue and frame the debate after years of government reports, meetings, public consultations and even an international symposium last year in Calgary. "We had to get it out there. There was too much speculation, and a lot of it was wrong," one rural Tory MLA said. But first, Mr. Klein had to calm concerns among members of his caucus, especially rural MLAs, that his proposed changes wouldn't bleed already scarce doctors from the country into the province's cities. His office and Health Minister Iris Evans worked hard at assuaging frayed nerves, and finally received a thumbs−up to move ahead with the proposals earlier this week. 101

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The government's white paper, which would allow patients to pay for non−emergency procedures such as hip and knee replacements, to get faster care and let doctors practise in both the private and private health−care system, has been in the works since last year. Mr. Klein wanted to start rolling it out last fall, but decided to delay. He explained that the document needed more work and he didn't want the federal Liberals to use it as political ammunition during the election campaign. The Premier was still smarting over complaints that he "single−handedly" cost the federal Conservatives the 2004 federal election when he mused that he was preparing to release health−care reforms that could violate federal laws. However, since the Jan. 23 election, many details of the health−care plan have been leaked to the media in Alberta. Steve Patten, a political scientist at the University of Alberta, said Mr. Klein has been talking about transforming health−care delivery for so long that it's not surprising as his political career winds down that he finally acted. "If this seems rushed in any way, it's because this is important to Ralph Klein and he is leaving some time in the next couple of years and still needs to take action on this," he said. What has stumped Mr. Patten and many others in Alberta, including the three opposition parties, is the lack of details attached to the white paper. "It's still at a high level of abstraction," Mr. Patten noted. "I was expecting a lot more." ADDED SEARCH TERMS: GEOGRAPHIC NAME: Alberta SUBJECT TERM:health care; reform; privatization PERSONAL NAME: Ralph Klein

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ALBERTA'S THIRD WAY: Analysis Is Klein prepared to be the bad boy of Confederation? (Globe and Mail)

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GLOBE AND MAIL 060610201 2006.03.02 A5 BRIAN LAGHI National News Metro 627 585

BRIAN LAGHI OTTAWA BUREAU CHIEF Stephen Harper doesn't realistically have a lot of financial muscle at his disposal to stop Ralph Klein from letting wealthy Albertans buy their way to the front of the health−care line. But, if the past is any guide, the Prime Minister won't need much. A little shame and national opprobrium, courtesy of the Canada Health Act, may do the trick. There is a misconception among many Canadians that the CHA is a big financial stick with which the federal government can beat provincial governments that violate medicare. But a close look at the penalties levied under the act over the past decade demonstrates that this isn't really the case. The real reason provincial governments such as Alberta have backed away from controversial health−care schemes is that the CHA has become such a sacred document that breaking it is akin to drunk driving. The jail sentence may not be so severe, but the community censure is overwhelming. The CHA is the best and most effective weapon Mr. Harper has if he wants to prevent Mr. Klein from pushing forward. In 1995−1996, the Alberta government and three other provinces were slapped with penalties for letting private clinics charge so−called facility fees to patients. The fees were defined as extra−billing, a significant violation of the act. Alberta was docked $3.9−million in penalties from its federal health transfer payment, a paltry amount compared to the surpluses the province was starting to run at the time. But the financial penalty paled in comparison to the criticism Mr. Klein had to absorb. Officials close to the Premier at the time said that what persuaded Mr. Klein to comply with the CHA, and ban the facility fees, was the embarrassment the Alberta government was being caused at the national level. The Premier's decision to break the law had also given the opposition Liberals in the province the opportunity to portray Mr. Klein as the bad boy of Confederation. The new Alberta plan is a little more ambitious than the one that caused such a stir 10 years ago. Penalties would probably be a little more substantial than they were in the 1990s because the amounts individuals pay for operations such as knee replacements are expensive.

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When calculating penalties, the federal government simply reduces the transfer payment by the overall amount of cash paid to doctors out of patients' pockets. But even if that were to run in the tens of millions of dollars, it still wouldn't amount to a hill of beans when compared to the Alberta surplus. The real problem facing Mr. Klein will be if Mr. Harper brands the Alberta Premier a scofflaw by ruling that he has broken the act. Before he does that, however, Mr. Harper might want to use his bully pulpit to persuade Mr. Klein to back off. Yesterday, the Prime Minister began that effort by saying Quebec was doing a better job at wrestling with health−care reform than is Alberta. By doing so, the newly minted Prime Minister, who moved to Alberta in his early 20s, is demonstrating to Mr. Klein's voters that there's a better way than the one being put forward by their Premier. Mr. Harper can't be too categorical in his criticism, lest he make Mr. Klein a hero in his province for standing up to the feds. But that's what Mr. Klein banked on in 1995 when he took on the feds and it didn't work then because, contrary to conventional wisdom, a lot of Albertans like their system as it is. It's hard see why Mr. Klein's gambit would work now, at a time when his popularity has never been so low. ADDED SEARCH TERMS: GEOGRAPHIC NAME: Canada; Alberta SUBJECT TERM:health care; privatization; federal−provincial relations PERSONAL NAME: Ralph Klein

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Harper touts Quebec reforms in response to Alberta plan; But says he needs time to study Klein proposals Critics say delay casts doubts on medicare stand (The Toronto Star)

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The Toronto Star 2006.03.02 MET News A7 Andrew Mills Toronto Star OTTAWA FRED CHARTRAND CP Prime Minister Stephen Harper saidyesterday he needs time to study health−care reforms proposed by Alberta but the situation could prove tricky ILLUSTRATION: because he has promised to both support the Canada Health Act and give provinces more freedom to set their own policy. WORD COUNT: 613 Prime Minister Stephen Harper is encouraging the provinces to follow Quebec's − and not Alberta's − proposals for health care reform. That was about as far as Harper was willing to go yesterday in pronouncing an opinion on Alberta's radical plan − the "Third Way" that would, among other measures, allow patients to pay cash for some treatments, including hip and knee replacements, to get faster treatment. Experts say this is a clear breach of the Canada Health Act, which Harper has promised to uphold. Klein himself admitted yesterday that the proposed reforms may violate the health act, but added he's willing to take that risk. But Harper, despite criticism from federal opposition parties and Ontario, who urged him to state the proposals contravene the act, refused to say what he thinks of the Alberta proposals, explaining he needs more time to study them. For the Prime Minister, using provisions in the health act to punish Alberta could prove politically dicey for a number of reasons. For one, Harper has promised Ottawa will give the provinces more freedom to set their own policies. And rapping Alberta's knuckles risks alienating Conservatives both in Alberta − Harper's strongest base of support − and those in the party who prefer an expanded role for privately provided health care. But Harper did praise Quebec's plans for health reform, which allow the health system to sub−contract to private clinics only in cases where patients have waited more than six months for treatment and only for hip and knee replacements and cataract surgery. Unlike Alberta, Quebec has also said doctors cannot work in both the public and for−profit sectors, but must choose one or the other. "I would encourage Alberta and the other provinces, as they talk about reforms, to always keep in mind the importance of access for patients and I would encourage all of them to look at particularly Quebec's proposal," 105

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Harper told reporters. He also reminded the Alberta government that it has "repeatedly committed in legislation and elsewhere they will respect the Canada Health Act." The act obliges Ottawa to withhold cash payments to the provinces if their provincial health systems don't meet certain federal requirements, including ensuring universal access to insured health care and outlawing extra−billing and user charges. Klein told reporters in Edmonton yesterday that it may come to the point where Alberta will have to weigh the possibility of federal penalties against the benefits of the reforms. Still, critics called on Harper to threaten Alberta with consequences if the province goes ahead with its proposals. "We'll hold the government to account to ensure they enforce the Canada Health Act," interim Liberal leader Bill Graham told reporters. Premier Dalton McGuinty called Alberta's plan a threat to medicare and said Harper must act quickly to stop it. "The ball is clearly in the Prime Minister's court now," McGuinty said outside his government's weekly cabinet meeting. Ontario Health Minister George Smitherman said the longer Harper waits to respond to Alberta's plan, the more doubts it could create about his desire to protect medicare. Allowing doctors to work in both public and private care in Alberta will make waiting lists longer in the public system because there's already a shortage of doctors, and doctors tend to see fewer patients in the private system, Smitherman said. McGuinty said Harper told premiers over dinner Friday in Ottawa that he supports medicare as defined by the Canada Health Act, which requires that medically necessary services be made available to all citizens at public expense without regard to an individual's ability to pay. Alberta's plans go way beyond the bounds of the health act, McGuinty said, noting Harper "specifically said that he was going to encourage experimentation and innovation within the Canada Health Act." Klein, also facing a tricky political situation, with fellow Conservatives now in power in Ottawa, took aim at McGuinty, accusing the Ontario premier of overreacting to proposals that have yet to be drafted into legislation. "I'm no doctor, but I think that Mr. McGuinty's got a case of premature speculation." WITH FILES FROM ROB FERGUSON and cp

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Alberta premier willing to risk violating health act; Province may have to weigh penalties against benefits (The Chronicle−Herald)

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The Chronicle−Herald 2006.03.02 Canada A3 The Canadian Press Jim Macdonald 363

EDMONTON − Premier Ralph Klein says Alberta's health reforms may violate the Canada Health Act, but he's willing to take that risk. It may come to the point when Alberta will have to weigh the possibility of federal penalties against the benefits of the reforms, Klein said Wednesday. "Weighing one against the other, that is precisely it," Klein told reporters. "It may violate the Canada Health Act and if it does, there is a dispute resolution mechanism." The so−called Third Way plan would allow patients to pay cash for some treatments, including hip and knee replacements, in order to get faster treatment. Klein's Conservative government is facing a growing barrage of criticism over its 10−point health−reform plan, which would also set a precedent for Canada by allowing doctors to perform surgeries in both private and public hospitals. Ontario Premier Dalton McGuinty urged Prime Minister Stephen Harper on Wednesday to take action against Alberta. McGuinty said waiting times should be reduced for all patients, not just those who can afford to jump to the front of the queue. But Klein fired back, accusing the Ontario premier of overreacting to proposals that have yet to be drafted into legislation. "I'm no doctor, but I think that Mr. McGuinty's got a case of premature speculation." Alberta Health Minister Iris Evans said the province doesn't want to "go to war" with anyone over health care. "The opinions of a few people don't constitute the opinions of Canadians," she told reporters. "I think we stand proud on the Canadian horizon." Evans also downplayed the significance of McGuinty's criticisms.

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"Every province and territory is of equal importance, regardless of the number of people and regardless of the weighting of their politicians." Manitoba Premier Gary Doer also criticized Alberta's planned health reforms, saying they won't shorten waiting lists and will simply make the health care system more expensive. Meanwhile, Klein has apologized for throwing a booklet at a page in the legislature during an emotional debate Wednesday over Alberta's health−care reforms. The 17−year−old page had delivered a soft−covered, 80−page booklet of Liberal policy proposals to Klein's desk in the assembly, when he grabbed it and tossed it at her. The premier was heard to say, "I don't need this crap," referring to the booklet that was sent to him by the opposition as they fired pointed questions over the Third Way health reforms. The page refused comment to the media and there was no confirmation that the booklet actually hit her. Speaker Ken Kowalski was clearly miffed over the incident and Klein later rose and apologized to the page and to the Liberals for calling their policy booklet "crap." The premier said he was simply frustrated over health care, but Liberal Leader Kevin Taft described the incident as "appalling" and said it shows the premier is "out of control."

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Harper, Klein may clash; PM wants to ensure Alberta's plans for change respect Canada Health Act (The Chronicle−Herald)

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The Chronicle−Herald 2006.03.02 News The Canadian Press Dennis Bueckert Alberta Premier Ralph Klein waves to the media as he isgreeted by Prime Minister ILLUSTRATION: Stephen Harper in Ottawa recently. (TOM HANSON / CP) WORD COUNT: 557 OTTAWA − Prime Minister Stephen Harper signalled Wednesday he is not about to rubber stamp Alberta's "third way" health reforms, saying he wants to make sure any changes respect the Canada Health Act. Harper didn't offer a detailed assessment of Alberta's proposal at a news conference, noting that it's just a working document at this time, but he promised his government will have more to say within days. Still, his statement suggested he is not about to knuckle under to Alberta Premier Ralph Klein without a serious test of wills. "This government is committed to the Canada Health Act," he said. The implication is that Harper will defend the act if necessary, but his comment didn't address what Ottawa can do to ensure compliance by a cash−flush province that may no longer be hobbled by a cut in federal transfer payments. Harper's caution on health care is born out of experience. Many Conservatives believe Klein's musings about medicare gave the Liberals the opening they needed to sow fear of Harper into the minds of voters during the 2004 election. Similar questions raised by the Liberals were blunted by Harper's unequivocal support for the Canada Health Act during this winter's campaign. The act has traditionally been enforced by withholding transfer payments from provinces breaking the rules. Harper seemed to place his hopes in Albertans themselves. "My understanding is that the Alberta government is not just committed to the Canada Health Act, but the Alberta government has enshrined the Canada Health Act in Alberta's own legislation." Klein has a history of putting forward highly controversial proposals before retreating. Although Alberta's proposal lacks detail it would appear to permit queue−jumping by patients willing to pay for faster treatment, and would allow doctors to work in the public and private systems simultaneously. Michael Decter, chairman of the Health Council of Canada, said his early reading of the Alberta plan is that it would in fact contravene the federal health law. 109

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"The Alberta paper, if I'm reading it correctly, seems to propose a private, parallel system . . . and it is difficult for me to see how you can do that without violating the Canada Health Act. He noted that Alberta's plan goes farther than Quebec's recently announced health reforms. Quebec would force doctors to choose between the private and public systems, while the Alberta plan would allow doctors to work on both sides simultaneously. Experts believe giving doctors access to medicare patients as well as those willing to pay for private care represents a threat to the public system. Quebec would give patients access to private care only if the public system cannot deliver the care within a reasonable time, while the Alberta plan lacks any such restriction. "It looks as though they may be preparing to allow people to simply buy insurance for medically necessary service and that, absent some waiting list test, strikes me as unlikely to pass muster," said Decter. Tom McIntosh of the Health Policy Research Networks said Alberta's plan, if it does proceed, does have the potential to undermine Canada's medicare system. "Harper's in a difficult place," said McIntosh. "He's got 26 MPs from Alberta who form one of the core bases of his support, so picking a fight with the government of Alberta two months into office is probably not what he wants to do." Even if Ottawa imposes fines, it's far from clear they would have any deterrent effect, he said. "We've never been in a situation where one of the provinces could afford to say with very little problem, you know what, you can keep the money." Interim Liberal leader Bill Graham said Harper should take a tougher stance with Alberta. "My concern is that because it's Alberta, at the moment it's `Oh well, we'll be careful about what we say here.' I think we want to hear something a little more forceful than we heard from the health minister and the prime minister today on this.

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Third Way plan splits backers of private medicine: Doctors 'might exploit situation' (Calgary Herald)

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Calgary Herald 2006.03.02 Final News A4 Michelle Lang Calgary Herald 405

Alberta's plans to overhaul health care with an eye to privatization are sparking an expected political debate, but the proposed changes are also dividing some advocates of private medicine. While many proponents are in favour of reforms that include allowing physicians to work in both the public and private systems, others are leery. George Zeliotis −− the Montreal patient who won a landmark Supreme Court of Canada battle for the right to buy private medical insurance −− said Alberta's proposal could lead to unethical practices. "Some (doctors) might exploit the situation and use the public system to lure people to their private clinics," said Zeliotis, who fully supports Alberta's move to allow private health insurance. The debate came one day after Premier Ralph Klein's government unveiled its much anticipated health−reform framework that seeks to increase access for patients while slashing growing medical costs. Under the proposal, Albertans would be able to purchase private medical insurance or pay out of pocket for a handful of operations, including hip and knee replacements and cataract surgery. Physicians would also be allowed to straddle the public and private systems if they submit business plans that are approved by government. While private surgical clinics exist in Alberta, they currently generate their revenues from contracts with the public health system and are not allowed to charge Canadian patients. Private health−care advocates such as Dr. Brian Day are hailing the province's proposals as innovative. Day, president of the Canadian Independent Medical Clinics Association, argues that the increasing use of private clinics will create competition and force efficiencies in the health system. He points to mixed public−private European health systems as an example. "Canadians may not realize there are many other countries without waiting lists who spend less than we do," said Day. Dr. Mark Godley of the private False Creek Surgical Centre in Vancouver also applauds the Alberta proposal.

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But he cautions that government must tread carefully when it comes to private health insurance, noting companies may not want to insure Albertans with chronic diseases such as arthritis. "The private insurance industry needs to be regulated extremely carefully," he said. And a Calgary physician who runs a private MRI clinic believes many patients aren't ready to buy surgery. "The Canadian population is not ready and hasn't been conditioned to pay those sums (for surgery)," said Dr. Benjamin Wong, medical director of Canada Diagnostic Centres, who said he supports Alberta's plan nonetheless. Wong notes the number of Albertans willing to pay for MRIs, for example, has stabilized, despite the province's wealth. Others, like Dr. Howard Gimbel, who operates the private Gimbel Eye Centre in Calgary, believe there are many patients willing to pay for surgery. He said his clinic has the capacity to perform significantly more surgeries if patients were allowed to pay for operations. mlang@theherald.canwest.com

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Alberta proposal not for us: Couillard: Doctors must be public or private; Studies in countries with blend of systems show increase in public sector waiting times (Montreal Gazette)

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Montreal Gazette 2006.03.02 Final News A2 AARON DERFEL The Gazette 539

Quebec will not follow Alberta's lead and let doctors work both in the public and private systems, an aide to Health Minister Philippe Couillard said yesterday. "Given the shortage of doctors (in Quebec's public system), it's out of the question for us to re−examine the idea," Isabelle Merizzi, Couillard's press attache, told The Gazette. On Tuesday, the Alberta government unveiled a two−tier health plan that would permit doctors to switch back and forth between public and private systems. Alberta Health Minister Iris Evans said doctors who choose to straddle both systems would be subject to certain restrictions. Quebec announced its health−care reform last month, which would let Quebecers purchase private insurance to cover the cost of joint replacements and cataract operations. Quebec also proposed the establishment of affiliated private clinics. However, Couillard maintained that doctors cannot work in a public hospital and then bill patients in a private clinic for services covered under medicare. Physicians must either work exclusively in the public system or opt out. More than 90 doctors have gone private in Quebec − a figure that has increased steadily in the last five years. Still, there are more than 15,000 doctors practising in the public system. Under the Quebec reform, a patient facing a lengthy hospital wait could take out insurance to pay for a knee operation in a private clinic. However, the doctor in that clinic would not be allowed to work in the public system at the same time. Despite the prohibition on straddling the two systems, a small number of doctors in Quebec do work in hospitals and in private clinics that charge patients for joint replacements. This is a violation of the Canada Health Act, as well as the Quebec Health Insurance Act. Yet the Quebec government has not cracked down on these physicians. What's more, by a quirk of law, Quebec does permit radiologists to practise in hospitals and then bill patients for MRI scans in private clinics. The province's rationale for this exception is that an MRI scan is a diagnostic service and not a medical procedure. 113

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Unlike Ontario Premier Dalton McGuinty, who called upon Prime Minister Stephen Harper yesterday to stop some of Alberta's plans, Couillard has taken a neutral stance. "Health care is a provincial jurisdiction," Merizzi said. "The provinces can set out their orientation according to their needs and priorities." The moves by Alberta and Quebec come after last June's Supreme Court ruling that overturned the ban on comprehensive private health insurance in this province. Antonia Maioni, director of the McGill Institute for the Study of Canada, said there's a gathering momentum toward more private health care in the country. "You could make the point that there seems to be a certain pushing of the envelope of the Canada Health Act," she said. "We're seeing British Columbia go shopping for (private) models abroad. Alberta and Quebec are looking at ways to involve the private sector more as a partner in the health−care system. "But whether or not this is going to satisfy Canadians remains to be seen," Maioni added. Proponents of two−tier health care argue that use of the private sector would reduce waiting lists in the public system. However, studies in Ireland, New Zealand and Spain − where a blend of private and public medicine exists − have demonstrated that waiting times have increased in the public sector. Research has also shown that patients who resort to private−for−profit care suffer higher rates of illness and death, according to a commentary published last October in the Canadian Medical Association Journal. aderfel@thegazette.canwest.com

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ALBERTA'S THIRD PLAN WHAT'S THE PLAN (Globe and Mail)

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GLOBE AND MAIL 060610200 2006.03.02 A5 National News Metro 580 578

HOW DOES ALBERTA'S PROPOSED HEALTH−CARE REFORM COMPARE TO QUEBEC'S? THE METHODS ALBERTA −Both plans embrace an increased reliance on private care, but Alberta is offering to allow doctors to work in both the public and the private sector and would permit patients to pay for faster access to some procedures. QUEBEC −Quebec has promised to provide hip and knee replacements and cataract operations within six months or else pay to have them done at private clinics. If the treatments are not available within nine months, the province will pay to send patients to another province or to the United States. HOW THE PLANS DIFFER ALBERTA −Province would not merely permit doctors to work simultaneously in both the public and private systems, it would insist upon them doing so. −All doctors would have to devote a minimum amount of their practice to public care. −Private care would not necessarily be paid for by the public system, and patients who can afford it could get faster access to surgery by dipping into their own pockets. −There is no discussion of a waiting−times guarantee. QUEBEC −Quebec would require doctors to choose between the public and private systems. −It would consider restricting the number of doctors who could opt out of the public system if the exodus threatens to deplete resources. −In the initial phases, it would restrict the types of private care that would be paid for by the public system for knee, hip and cataract surgeries. −It is talking about a waiting−times guarantee. THE STRENGTHS ALBERTA −Proposals come after many years of complaints by the province that the existing public−care system was too restrictive. −Supporters of private care argue that it will allow flexibility, while at the same time, the amount of care provided is increased. 115

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They argue that the queues for services will diminish as doctors perform more operations. And they say the insistence that all doctors do some work in the public system will guarantee that all patients have access to treatment, regardless of the ability of the patient to pay. QUEBEC −Proposal would increase access to private care in areas where there are long lines of patients waiting for treatment. It was forced to do so after the Supreme Court ruled that Quebeckers must be able to buy insurance to cover private treatments when those treatments are not available in a timely fashion through the public system. −Plan addresses that court decision by providing a waiting−times guarantee and expanding the capacity of the system in areas where there are backlogs. But it also allows the government to retain a large amount of control. THE WEAKNESSES ALBERTA −It could prompt doctors to trade time spent in public practice for private, profit−making, ventures. −It could also lead to a system in which the wealthy have access to faster and better service than those who cannot afford to pay for medical treatments. −It may even violate the Canada Health Act, a move that could ultimately jeopardize the national health system. −There is no mention of a waiting−times guarantee. QUEBEC −Plan could be expensive. The province estimates it could cost an additional $20−million a year but critics say that figure is unrealistically low. −It does not increase the capacity of the public system −− something that experts say could be done by permitting more work to be done by other health−care professionals such as pharmacists, nurses and paramedics.ADDED SEARCH TERMS: GEOGRAPHIC NAME: Alberta; Quebec SUBJECT TERM:health care; reform; policy; privatization

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ALBERTA'S THIRD WAY 'Two−tier' proposal denounced by Ontario (Globe and Mail)

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GLOBE AND MAIL 060610198 2006.03.02 A5 KAREN HOWLETT National News Metro 299 289

KAREN HOWLETT Alberta's bold proposal to reshape its health−care system by allowing patients to pay for some services clearly falls outside the country's long−standing medicare program, Ontario government officials said yesterday. "The suggestion of two−tier medicine, which is one of the elements of that plan, is a very, very deliberate and obvious threat to medicare," Ontario Health Minister George Smitherman said. Premier Dalton McGuinty, asked whether he thinks Alberta's so−called third way complies with Canada's publicly funded health−care system, said: "Not the way I see it. When it comes to reducing wait times for example, we should do that for everybody, not just for those who can afford to jump to the front of the queue." Mr. Smitherman said the Alberta government's proposal, which would allow doctors to work in both the public and private health−care systems, would create an even greater shortage of doctors. Every doctor in the public system treats 1,300 patients on average, he said, citing Ontario Medical Association statistics. The ratio of doctors to patients in private clinics is 1 to 500. As a result, he said, every doctor who exits the public system leaves behind 800 "orphaned" patients. However, Mr. Smitherman said he is not worried about an exodus of Ontario doctors to Alberta because the government has found ways to better compensate them. As part of an accord with doctors last year, Ontario gave pay increases averaging 23.8 per cent over four years, tax breaks and an end to a cap on billings effective tomorrow. Mr. Smitherman said there are only so many people, even in resource−rich Alberta, who can afford high fees for private health− care services. "There's only so much gravy that can be lapped up," he said. ADDED SEARCH TERMS: GEOGRAPHIC NAME: Alberta; Ontario SUBJECT TERM:health care; privatization; statements 117

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PERSONAL NAME: George Smitherman

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THIRD WAY HOT TOPIC SPEEDIER HEALTH SERVICE FOR PATIENTS WHO CAN PAY (The Edmonton Sun)

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The Edmonton Sun 2006.03.02 Final News 12 CARY CASTAGNA, EDMONTON SUN ST. ALBERT 236

Several patients at Sturgeon Community Hospital said yesterday if the Klein government's Third Way helps reduce wait times, then they're all for it. But some fear the controversial healthcare reform will hurt the public system by dipping into the already short supply of health professionals. "I would be afraid that there would be too many doctors opting for private care. That would probably create a shortage on the public side," Esther Rankin, 77, told the Sun. Rankin, whose husband underwent bypass surgery in 2001 following a heart attack, said she needs more details on the Third Way before she makes up her mind on its merits. Harvey Voogd, co−ordinator of the advocacy group Friends of Medicare, said he's seen enough, and believes the Third Way violates the Canada Health Act and Albertans' fundamental sense of fairness. "Why should somebody be allowed to jump the queue just because they have money?" he asked. And Voogd said it's only logical to assume that for every hour a doctor spends in private care, that's an hour taken away from public care. "When you have a private−public mix, you want to make sure the private sector doesn't take away from the public sector," said Dr. Zaheer Lakhani, a consultant cardiologist at Sturgeon. The contentious reform includes allowing health providers in both public and private systems to charge for enhanced services and speedier access for knee, hip, cataract and hernia surgery. "For the most part, health care will not depend on your ability to pay and if you need that service right now ... we'll try our very best to look after that in the public system," said Health Minister Iris Evans, who was in St. Albert to open a new intensive−care unit and cardiac clinic at the hospital.

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RALPH THROWS A FIT 'I THREW IT AT THE PAGE AND I SAID: "I DON'T NEED THIS CRAP." AND THEN I APOLOGIZED' (The Edmonton Sun)

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The Edmonton Sun 2006.03.02 Final News 5 photo from Sun files Premier Ralph Klein threw a book at a page during question period ILLUSTRATION: in the Legislature yesterday. BYLINE: DARCY HENTON, LEGISLATURE BUREAU WORD COUNT: 327 Alberta's premier blew a gasket in the Legislature yesterday, hurling a Liberal health−care book three metres at the schoolgirl page who delivered it to him. Frustrated after two days of fending off criticism of his Third Way health reforms, Ralph Klein admitted he lost it. "I threw it at the page and I said: 'I don't need this crap'," the premier later conceded to reporters. "And then I apologized." The incident occurred midway through question period in front of a packed gallery of schoolchildren. In addition to apologizing to the page, Klein apologized to the House for calling the Liberal book "crap." The Liberals brought their health policy book into the assembly after repeated calls from Klein to come up with better ideas if they didn't like his Third Way. Asked why he tossed the 75−page soft−covered book, Klein said he didn't think there were any useful ideas in it. Liberal Leader Kevin Taft called the incident "appalling." "The premier is out of control," he said. "In my view, these people are no longer fit to govern." Liberal Rick Miller, who raised a point of order with the Speaker over the premier's behaviour, said the premier's behaviour reflects poorly upon all MLAs. "I was embarrassed," Miller said. Although the incident wasn't caught on camera, NDP Leader Brian Mason said he wished Tory delegates could see it before Klein's leadership review. "It typifies how much he has become out of control and unstable," Mason said. "It is far beyond anything that I have ever seen from a public official."

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Alberta Alliance Leader Paul Hinman said there's little chance Albertans will be rushing forward with their ideas after Klein's display on the first day of so−called public consultation over the reforms. "I don't know how many Albertans will want to line up and say anything in public when he treats pages like that," he said. Klein was also called on the carpet during yesterday's session for calling Taft a liar. He apologized. The premier has been under fire from medicare supporters and even the premier of Ontario over a proposal to allow Alberta doctors to practise both in the public health−care system and in private clinics. Klein conceded yesterday that if the province is accused of violating the Canada Health Act, its first recourse will be to challenge that through a dispute resolution mechanism that he lobbied to put in place. "If the new legislation is tabled, it may... violate the Canada Health Act and if it does... we'll use that process before anything else," he said. Mason said Klein needs only to look at Australia for proof that privatizing health care actually lengthens waiting lists, rather than shortening them. He was referring to Professor Stephen J. Duckett's study of Australia's efforts to shorten waiting lists.

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NEW−FOUND RESPECT? KLEIN HOPEFUL OF BETTER RELATIONSHIP BETWEEN FEDS, PROVINCES (The Edmonton Sun)

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The Edmonton Sun 2006.01.25 Final News 36 photo by Mark O'Neill, Sun Media Premier Ralph Klein talks to the C.D. Howe Institute ILLUSTRATION: yesterday in Toronto. BYLINE: DARCY HENTON, LEGISLATURE BUREAU WORD COUNT: 253 Canada's premiers are looking forward to a fresh start in federal−provincial relations after the demise of a Liberal government that failed to respect the division of powers, says Premier Ralph Klein. The premier told the C.D. Howe Institute in Toronto yesterday that he expects Stephen Harper's Conservative government −− unlike his predecessors Paul Martin and Jean Chretien − to respect provincial jurisdiction. "The past 15 years of federal−provincial wrangling over everything from health care to day care can be traced to a federal government that did not respect that division of powers," Klein said in the speech provided to Alberta legislature reporters. He said he wasn't rejecting the role of the federal government, but "you either have a constitution or you don't." Klein said he and his fellow premiers simply want to be able to deliver programs and services "without a continual stream of directives from Ottawa saying 'don't do this' and 'don't do that.' " "My understanding is Mr. Harper has promised just that: not a downloading of new responsibilities to the provinces, but rather a respect for the existing responsibilities we already have," Klein said. The premier said Ottawa must recognize that one size doesn't fit all the provinces. Its duplication of provincial efforts creates "needless overlap" and reduces accountability, he said. "The fundamentally different views of this country that provincial governments and the last federal government held led to difficult negotiations on many fronts, which in turn has created hard feelings and mistrust," Klein said. "Now we can start anew." The provinces and federal government can work together to develop labour markets, invest in transportation infrastructure, build a better education system and improve Canada−U.S. relations, he said. NDP Leader Brian Mason warned that Harper's hands−off approach could enable Klein to violate the Canada Health Act by introducing a private system. "I think he will find an ally in Mr. Harper in that agenda," Mason said.

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MEDICARE AT RISK: MCGUINTY CALLS ON HARPER TO DEFEND AGAINST ALBERTA'S PROPOSALS TO ALLOW DOCTORS TO WORK IN PUBLIC AND PRIVATE SYSTEM (The Toronto Sun)

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The Toronto Sun 2006.03.02 Final News 16 1. photo of DALTON MCGUINTY "PM's court" 2. photo of STEPHEN HARPER ILLUSTRATION: Respect act BYLINE: ANTONELLA ARTUSO, QUEEN'S PARK BUREAU CHIEF WORD COUNT: 231 Premier Dalton McGuinty is calling on Prime Minister Stephen Harper to come to the defence of public health care. McGuinty told reporters yesterday that he views Alberta's proposal to allow doctors to work in both a public and private system and to permit patients to buy quicker access to hip and knee surgeries as a violation of the Canada Health Act. Last week Harper told premiers he would allow "experimentation and innovation" only within the confines of the Act, which does not permit patients to purchase medically necessary health care out of pocket. Meanwhile, Alberta Premier Ralph Klein admitted the reforms may violate the Canada Health Act, but he's willing to take that risk. It may come to the point when Alberta will have to weigh the possibility of federal penalties against the benefits of the reforms, Klein said yesterday. "The ball is clearly in the prime minister's court," McGuinty said. Yesterday Harper praised recent Quebec health care reforms but refused to pass an early judgment on proposals by his home province. Ontario Health Minister George Smitherman said yesterday that the Alberta scheme would weaken the public system. "It's a threat to public medicare and it looks like a pretty deliberate offence to the Canada Health Act," he said. But critics said McGuinty's government is no great defender of public health care. The Liberals powered through a bill yesterday to create local health integration networks (LHINs) over the objections of four major health care worker unions. The unions argue that LHINs will allow the Ontario government to do by stealth what Alberta has done more 123

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openly −− move public services into private hands. Smitherman dismissed the unions' doomsday scenario. "They've basically said that the sky is going to fall as soon as that legislation passes, and I assure you that it isn't." The bill allows for planning and budgeting functions now carried out in the health ministry to be handed over to regional health authorities.

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Ralph sorry for venting on teen page Klein health proposal a hot potato (WINNIPEG FREE PRESS)

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WINNIPEG FREE PRESS 2006.03.02 A3 Canada Wire 563

CNS Kelly Cryderman EDMONTON −−Alberta Premier Ralph Klein made a formal apology in the provincial legislature yesterday after he vented his "frustration" over health care by hurling a Liberal policy booklet at a young page. Jennifer Huygen, 17, had delivered the health−care policy document to the premier at the request of the Liberal party during a heated question period debate over Klein's controversial health policy framework. Upon realizing what it was, Klein called the soft−cover booklet "crap" and threw it at Huygen. TV footage at the exact moment of the incident is not available and there are conflicting statements as to whether it actually hit Huygen. She would not comment to reporters. Politically speaking, all eyes in Canada are on Klein, who has introduced health reforms which would allow patients to pay for faster access to some medical procedures. "I'm interested to see what the Government of Canada's going to do," Manitoba Premier Gary Doer said last night.. "People shouldn't be able to access health care on the basis of wealth," the Manitoba premier said. Ontario Premier Dalton McGuinty called on Harper to block Alberta's plans. McGuinty said Ontario's health reforms, unlike Alberta's, are aimed at all citizens, "not just those who can afford to jump to the front of the queue." McGuinty's health minister, George Smitherman, went one step further, saying Alberta's plans amount to a "pretty deliberate" attempt to circumvent the Canada Health Act. The reforms would allow the public to pay out of their pockets for non−essential surgeries, including hips, knees, cataracts and possibly hernia, according to Alberta Health officials. But as soon as it was released, critics warned it violated the Canada Health Act and could force a showdown with Ottawa, especially since Harper has vowed to protect the venerable act, which sets out accessibility and other public health−care principles. Even Klein admitted Tuesday the proposals could "perhaps" change the face of medicare as Canadians know it −− if they're agreed to by his legislature. Yesterday, however, he gave mixed messages, saying the last thing he wants to do is contravene the Canada Health Act. "All we're doing is consulting. And, you know, I'm no doctor, but I think that Mr. McGuinty's got a case of premature speculation," he said about the Ontario premier's comments. 125

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"No one has violated anything yet." Harper said his minority government will carefully examine Alberta's proposals before issuing a full response within the next few days. "Obviously as we do our own review of the proposals that Alberta has put out, we're going to want to satisfy ourselves that they're within the Canada Health Act," he said. The principles of the Canada Health Act, which authorizes the federal government to transfer billions of dollars to the provinces, are comprehensiveness, universality, accessibility, portability and public administration. In Quebec, an aide to Health Minister Philippe Couillard said Wednesday the province won't follow Alberta's lead in letting doctors work in both the public and private system. However, Quebec seemed to take a more neutral position on the divisive issue than Ontario. "Health care is a provincial jurisdiction," Isabelle Merizzi said. "The provinces can set out their orientation according to their needs and priorities." Saskatchewan Premier Lorne Calvert said Alberta's proposed reforms are not an option in Saskatchewan. "You will know this province will stand square behind the principals of the Canada Health Act," he told reporters. "This province and its people say very clearly, 'We are not interested in the Americanization of health care in Canada. We're not interested in two−tier systems. We're not interested in systems that allow people who have resources to bump the queues and get ahead.' Our health care needs to be provided to those who have the health care needs, based on your needs and not your ability to pay." −− CanWest News Services

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An efficient public system best answer to private care, orthopedic specialist says (Edmonton Journal)

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Edmonton Journal 2006.03.02 Final News A3 Mike Sadava and Kelly Cryderman The Edmonton Journal EDMONTON Photo: The Canadian Press / HIP REPLACEMENT OPERATION: A newAlberta ILLUSTRATION: program has slashed wait times for hip and knee replacement surgery from a year on average to less than 10 weeks. WORD COUNT: 477 EDMONTON − The public health−care system has the potential right now to become so efficient that there will be little demand for care from a parallel private system, says a prominent orthopedic specialist. Dr. Don Dick said Wednesday that a pilot project to change the way hip and knee replacements are processed has been so successful in cutting wait times that at the end of the month it will be fully implemented in three health regions −− Edmonton, Calgary and Red Deer −− and eventually the entire province. The Alberta Hip and Knee Replacement Project cut the wait times from close to a year in many cases to less than 10 weeks on average to see a surgeon and to get the operation done, and Dick thinks it could be implemented in other health disciplines. "We're not against choice, but choice only after you fix the public system. Our passion is to make the public system as efficient and effective as possible... "We consider that the need for this parallel system would be very small because if we could reduce the wait times down to this level, the number of patients who would want to go forward quicker than that is very small." Under the pilot program, the waiting list and patient intake systems were centralized, while operating rooms were designated only for hip and knee replacements so that nurses became more efficient and there was less downtime in the operating room to prepare for other types of operations. Post−operative patient care was improved so people were out of hospital two or three days earlier. Dick said he is not exactly certain how the third way would work, but "if you fix the public system the need for this will be small." The provincial NDP says a recent study of the Australian health−care system shows an expanded private system will not reduce wait times in the public system. "This study suggests that policymakers should be cautious about pursuing policies based on expanding private access as a strategy for achieving reductions in public sector waiting times," wrote Prof. Stephen J. Duckett of 127

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La Trobe University in Melbourne. The author acknowledges his 2005 study is limited, but he said his models indicate wait times for public hospital care decline with increased public sector activity. However, he noted that two different Australian studies suggested a private health−insurance plan was in fact associated with a reduction in wait times. The study was brought forward by the NDP Wednesday as evidence against the Alberta government's proposals for increased health−care privatization. "We're getting from this government considerable disinformation with respect to their plans and the results that we could expect from their plans," said NDP Leader Brian Mason. Health Minister Iris Evans said she has seen Australian studies that show that wait times increased in that country when private care was provided. "I think we have to do it very carefully (in Alberta) so that the public system is always strengthened," she said. msadava@thejournal.canwest.com kcryderman@thejournal.canwest.com

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Stephen Harper entend faire respecter la Loi canadienne sur la santé (L'Acadie Nouvelle)

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L'Acadie Nouvelle 2006.03.02 Canada 16 Presse Canadienne Presse Canadienne: TOM HANSON OTTAWA Ralph Klein se dit prêt à prendre le risque de violer la Loicanadienne sur la santé en instaurant un système public−privé dans sa province. 346

Le premier ministre fédéral Stephen Harper a fait savoir hier qu'il n'avait aucunement l'intention d'approuver automatiquement le projet de réforme des services de soins de santé en Alberta, affirmant qu'il souhaitait s'assurer que toute modification apportée par la province n'aille pas à l'encontre de la Loi canadienne sur la santé. En conférence de presse, à Ottawa, M. Harper n'a pas offert d'évaluation détaillée du projet albertain, faisant remarquer que ce dernier n'en était pour le moment qu'à l'étape du document de travail. Il a cependant promis que son gouvernement aurait davantage à dire à ce sujet au cours des jours à venir. Néanmoins, les propos tenus par le premier ministre fédéral laissent entendre qu'il n'a aucunement l'intention de céder face à son homologue albertain, Ralph Klein, sans combattre. "Ce gouvernement a des obligations vis−à−vis de la Loi canadienne sur la santé", a−t−il déclaré. Cela implique que M. Harper défendra la loi si nécessaire. Le premier ministre n'a cependant pas précisé ce que son gouvernement ferait afin de contraindre à respecter la législation fédérale une province qui ne se sent peut−être plus menacée par l'éventualité d'une réduction des paiements de transfert. Ottawa a à l'occasion obligé les provinces à respecter la Loi canadienne sur la santé en procédant à une retenue de ses paiements de transfert. A Edmonton, M. Klein a reconnu, hier, que son projet pourrait violer les dispositions de la législation fédérale, se disant cependant prêt à courir ce risque. Par ailleurs, le premier ministre de l'Ontario, Dalton McGuinty, a demandé à M. Harper d'empêcher l'Alberta d'aller de l'avant avec son projet, devant permettre à des patients de payer pour avoir accès plus rapidement à certains soins de santé. L'Alberta a annoncé mardi qu'elle ouvrirait également la porte à l'assurance privée et autoriserait les médecins à pratiquer à la fois dans les systèmes privé et public de santé. M. McGuinty a indiqué que la "troisième voie" préconisée par M. Klein n'était pas celle de l'Ontario. Les temps d'attente, par exemple, devraient être réduits pour tout le monde, "non pas seulement pour ceux qui peuvent se permettre de passer devant la queue", a−t−il dit. 129

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M. McGuinty a rappelé que le premier ministre fédéral avait prévenu ses homologues provinciaux de respecter la Loi canadienne sur la santé, la semaine dernière, ajoutant qu'il devrait par conséquent s'opposer au projet albertain.

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Health restructuring gets nod in Ontario; Liberals pass controversial bill Critics say patients will pick up the tab (The Toronto Star)

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The Toronto Star 2006.03.02 ONT News A9 Rob Ferguson Toronto Star 406

Patients will pay out−of−pocket for more medical care and travel farther for treatment under a controversial law passed yesterday to revamp Ontario's health system, critics charge. Nonsense, says Health Minister George Smitherman, who is ceding control over delivery of care at hospitals and publicly funded health facilities to 14 regional agencies as Ontario becomes one of the last provinces to regionalize health care. Smitherman maintains doomsday claims are "manufactured," adding the law is aimed at allowing the agencies to co−ordinate local health providers, bringing seamless care to patients who often complain the right hand doesn't know what the left is doing. The agencies are called local health integration networks − and dubbed "disintegration networks" by New Democrat Leader Howard Hampton, who discounts Smitherman's hopes that the revamping will trim waiting lists. The networks will have the power to consolidate services − ordering one or more hospitals to stop providing one service such as hip replacements so the operations can be concentrated at another hospital. Both opposition parties voted against the bill, which has been vigorously opposed by unions representing 200,000 health−care workers. The Ontario Nurses Association warned the legislation encourages the transfer of services such as physiotherapy and some drugs out of hospitals − services funded by provincial health insurance in hospitals. "Patients may have to pay out−of−pocket for services, for medications that would have been covered," said association president Linda Haslam−Stroud. But David Spencer, a spokesman for Smitherman, said, "we're not seeking to expand out−of−pocket payments." Natalie Mehra, of the Ontario Health Coalition, said she wants to know "how far will people be required to travel? Nobody's saying." Although the networks, to be run by government appointees, come into being April 1, 2007, Mehra said it would be "political suicide" for them to order consolidations before the provincial election six months later.

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Smitherman downplayed travel concerns, saying consolidation will be limited in remote areas and won't cause much trouble in urban areas. He noted the new Kensington Eye Clinic near College St. and Spadina Ave. has taken cataract surgeries from downtown hospitals just a few blocks away. "I don't believe there's any hardship." Unions warn that cleaning, laundry and other services will be contracted out to the lowest bidders, resulting in lower standards and wages, as the government tries to control costs in the $33 billion health−care system. Smitherman said the networks − including five serving Greater Toronto and outlying areas − will have to consult the public on changes to health service delivery within their boundaries. Instead of decisions being centralized at the health ministry, decisions will be made at open meetings under the scrutiny of the public, he said.

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GRITS SLAM UNION CLAIMS, PUSH HEALTH BILL THROUGH (The London Free Press)

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The London Free Press 2006.03.02 Early City &Region C5 photo of GEORGE SMITHERMAN KEITH LESLIE, CP TORONTO 372

Doomsday scenarios painted by unions over changes to the way health services are administered in Ontario should not be believed, the health minister said yesterday as his Liberal government used its majority to push through the legislated changes. Health−care workers say the legislation, which will replace Ontario's district health councils with Liberal−appointed officials, will lead to more privatization of services, but Health Minister George Smitherman insisted that is not the case. "I'm disappointed that there are those levels of fears," he said yesterday before the bill was passed by a 60−26 vote. The opposition parties voted against it. Union leaders would have the public believe that "the sky is going to fall," Smitherman said, adding, "I assure you that it isn't." Unions representing nurses and other health workers warned the bill would lead to the delivery of more health services by for−profit providers, as well as more user fees for patients. "The legislation actively encourages the transfer of services out of the hospitals and into independent health facilities," said Linda Haslam−Stroud, president of the Ontario Nurses Association. "Patients may have to pay out of pocket for services, for medications that would have been covered if they had been provided in the hospital." Smitherman defended the government's decision to appoint people to local health networks instead of having them elected. "It's appropriate that we appoint people that we think reflect the capacity that we see as important," he said. "Those people who said they wanted to elect them, they just want to set up what works for them around here, the constant tension game." Smitherman said the local networks will help improve health care by giving patients the opportunity to move seamlessly through the system in their communities. The networks will gain control, he said, by having the power to decide how to spend provincial money in their district rather than leaving administration of the entire $33−billion health−care budget to provincial 133

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bureaucrats in Toronto. "Right now, it's all about what's happening down at Queen's Park and billion−dollar figures, and no one can get their heads around that," he said. "Forcing it into the open with public meetings where people can go is a powerful step." Ontario's opposition parties said the bill gives the government unprecedented power to close hospitals or force them to merge with other institutions, even over the objections of the local networks. Smitherman said he already has the power to close hospitals, but wants to put that authority into the hands of local decision makers. "If Dalton McGuinty does not intend to use these powers, then why are they in the legislation?" asked Opposition Leader John Tory. The Conservatives complained the government was spending more than $160 million to create another layer of health−care bureaucracy that Smitherman can override. KEYWORDS=REGIONAL

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Cardiac funding in doubt; Doctor who helps heart patients worries he may have to privatize (The Record (Kitchener, Cambrid)

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The Record (Kitchener, Cambridge and Waterloo) 2006.03.02 Final LOCAL B1 ANNE KELLY RECORD STAFF BRESLAU Photo: PETER LEE, RECORD STAFF / Dr. John Schaman is worriedhe may lose ILLUSTRATION: provincial funding to treat cardiac and other patients at the Ontario Aerobics Centre in Breslau. WORD COUNT: 588 The future is uncertain for a popular cardiac rehabilitation clinic near Breslau, which has been guaranteed provincial funding only until June. A contract between the Health Ministry and the Ontario Aerobics Centre, led by Dr. John Schaman, was to have expired at the end of March, prompting nervous patients to launch a letter−writing campaign to Health Minister George Smitherman and local politicians. The province has said it is reviewing the centre's services and funding. Ministry spokesperson John Letherby said yesterday that funding has been renewed until June 30, but he couldn't say why the centre is under the microscope. "It would be premature to speculate while the ministry is reviewing the funding," Letherby said, adding the ministry will contact the clinic's owners in the coming weeks. Schaman, who has done pioneering work in cardiac rehabilitation, is hoping for a solution that will prevent him from having to close his 28−year−old clinic or convert it to a private, user−pay facility. "I hope the government will see, as the previous one did, that this is extremely cost−effective type of work," Schaman said. "Many patients would not be in a position to pay the kind of fees they would be required to pay." Since 2001, the ministry has been paying Schaman under something called an alternate payment plan, effectively a salary based on workload. From that, he pays his staff and the operating expenses of the clinic, which has extensive equipment for exercise, cardiac assessment and monitoring and as well as for its other speciality, the treatment of musculoskeletal and sports−related conditions. The contract, which replaced an earlier fee−for−service arrangement, was was supposed to be renewed every three years. Schaman said he was told by ministry staff that renewal was only a formality. 135

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But since July of 2004, the ministry has been giving only short−term extensions, leaving Schaman, his staff and patients worried the clinic might close. "This is what we fear," said Evelyn Playford, a 73−year−old patient of Schaman's since 2001. The Waterloo woman said she has been able to control her heart condition without surgery or other costly procedures because of his program, which combines a low−fat diet, exercise and education. "It is incomprehensible to me that the ministry charged with protecting and improving the health of Ontarians would withdraw support from a health promotion program with a proven record of success," Playford wrote to Smitherman. The program follows one developed by American physician Dean Ornish, which Schaman said is proven to prevent and reverse heart disease. After paying a one−time $60 administration fee, patients can stay in the program indefinitely, unlike hospital−based cardiac rehabilitation. Schaman is a general practitioner, but took three additional years of training in cardiac rehabilitation and sports medicine before opening his clinic. "I'm paid the lowest fee level, yet I do work very similar to specialists," he said. "My practice is unique in the province." Assuming he had long−term stability, the doctor spent $800,000 in 2002 for an expansion to meet growing demand. Since 1978, the clinic has seen 35,000 patients. Schaman estimated that 80 to 100 patients have written to Smitherman. Barb White, 58, of Cambridge, has been going to Schaman's clinic since 2002. "Dr. Schaman is keeping people healthy and fit and we desperately need his services," she wrote to Smitherman and several local politicians. Elizabeth Witmer, the Kitchener−Waterloo MPP and Tory health critic, said that when she was health minister, the clinic and 16−hospital based cardiac rehabilitation programs were given funding for a pilot study to determine which model of care was best. But she never learned what was gleaned from the pilot, because her government was voted out. Witmer said she doesn't know why the clinic's funding is in question. She said Smitherman seemed to know little about the issue when she approached him earlier and she was hoping to talk to him again yesterday. Waterloo−Wellington MPP Ted Arnott has asked Smitherman to intervene so the centre's cardiac rehabilitation services continue. akelly@therecord.com

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AGING BOOMERS LINING UP FOR DIALYSIS (The Ottawa Sun)

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The Ottawa Sun 2006.03.01 Final News 5 JORDAN MICHAEL SMITH, OTTAWA SUN 208

Local dialysis clinics are being forced stay open around the clock to meet the growing demands of an aging population. "We're having people coming in at four in the morning with problems, so some of them have to stay open," said Pam Logan, spokeswoman for Kidney Foundation of Eastern Ontario. The problem? There are just too many people needing dialysis and not enough clinics to serve them. "We're seeing a 12% to 14% increase in patients per year. That kind of increase is relatively new," Logan said. 'NEED FUNDING' Several new dialysis facilities have opened recently in rural areas such as Barry's Bay and Pembroke. "People used to have to travel for maybe five hours, three times a week, to get dialysis treatment, so that's certainly improved," Logan said. "But we're going to need funding if we're going to keep it up." The two most common causes of kidney failure are high blood pressure and diabetes −− health problems that are occuring more often in an ever−fattening Canadian population. But, even without their expanding waistlines, more Canadians may be having kidney trouble simply because an increasingly large part of the population is middle−aged and older. In 1990, 12% of the Canadian population was aged 65 or older, according to Statistics Canada. By 2030, that number will rise to 20%. And Canadians are living longer than ever before, requiring more and more health services. The average Canadian now lives until about age 80. In 1922, that number was 60. Compounding these problems is the fact that Canada has one of the lowest rates of organ donation in the industrialized world. "People are sometimes waiting for five or six years in pain, and getting constant medical treatment, waiting for a donation," Logan said. jordan.smith@ott.sunpub.com

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L'Outaouais obtiendrait jusqu'à quatre cliniques−réseau (Le Droit)

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Le Droit 2006.03.02 Manchette 4 Bélanger, Mathieu Le Dr Marcel Reny, chef du Département régional de médecinegénérale. 371

L'intention d'implanter le modèle montréalais des cliniques−réseau en Outaouais prend de l'ampleur. Le Droit a appris que non pas une, mais bien quatre de ces cliniques nouveau genre pourraient voir le jour dans la région. Deux de ces cliniques seraient établies dans le secteur Gatineau, alors que les deux autres auraient pignon sur rue dans les secteurs Hull et Aylmer, précise le chef du Département régional de médecine générale (DRMG), le Dr Marcel Reny. Il ne manquerait plus que de la volonté politique et environ 500 000 $, soutient le Dr Reny. Ce modèle de clinique médicale qui attire de plus en plus l'attention des omnipraticiens de l'Outaouais a vu le jour à Montréal il y a quelques mois. Les cliniques−réseau assurent une accessibilité à des médecins de famille sept jours par semaine. Le médecin qui y adhère accepte de donner 50 % de son temps de pratique au sans rendez−vous. Le déploiement de cliniques−réseau permettrait aux 25 000 patients de l'Outaouais sans médecins de famille de bénéficier d'un suivi médical en attendant la fin de la pénurie, soit dans cinq ans, selon le ministre de la Santé, Philippe Couillard. "Des discussions ont eu lieu à ce sujet et déjà plusieurs médecins de Gatineau et Hull démontrent de l'intérêt dans le projet", laisse savoir le Dr Reny. Le ministre de la Santé parle de garantir l'accessibilité à certaines chirurgies spécialisées comme celles de la hanche et du genou, mais il reste beaucoup de travail à faire pour simplifier l'accès à la médecine générale", rappelle le Dr Reny. L'Agence mis au parfum Questionné par Le Droit sur la possibilité de voir apparaître des cliniques−réseau en Outaouais, l'Agence de la santé avait indiqué, au début février, ne pas avoir eu vent de tels projets dans la région. Elle se dit maintenant ouverte à étudier les tenants et les aboutissants de la création d'une clinique−réseau en Outaouais. "Oui, il y a des discussions à ce sujet entre les médecins, mais il n'y a toujours pas de projet concret qui a été déposé à l'Agence", explique le porte−parole de l'organisation, Martin Saint−Louis. Les GMF sont privilégiés 138

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L'Agence n'est pas fermée aux cliniques−réseau, mais elle indique privilégier la création de Groupes de médecine familiale (GMF). "Nous devons montrer la plus value qu'aurait une clinique−réseau sur notre territoire avant de la financer", ajoute M. Saint−Louis. Le Dr Reny précise que le développement de cliniques−réseau est une priorité du DRMG et que les pressions vont s'accentuer pour obtenir le financement nécessaire à leur création. C'est l'Agence de la santé qui devra financer à 100 % l'ouverture d'une telle clinique. L'argent servirait à embaucher des infirmières et du personnel administratif afin d'alléger la tâche des médecins. mabelanger@ledroit.com

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Premiers' demands too costly Harper (The Toronto Star)

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The Toronto Star 2006.03.02 ONT News A8 Les Whittington Toronto Star OTTAWA 365

Ontario's Dalton McGuinty and other premiers could bankrupt Ottawa if it gave in to all their demands, the prime minister says. Commenting on his first meeting with his provincial counterparts, Stephen Harper said yesterday, "I was glad I didn't have my cheque book there. "There were a lot more potential bills being talked about than certainly I could possibly afford to pay or that the taxpayers of Canada could afford to pay." The Conservative Prime Minister met McGuinty and other premiers on Friday. The provincial leaders pressed for more financial support for post−secondary education, health care, child care and agriculture. As well, the premiers want the Conservatives to ensure the provinces have access to more tax revenues at Ottawa's expense to end the so−called fiscal imbalance under which the federal government runs large surpluses while most premiers struggle with deficits. Yesterday, Harper again expressed doubts about McGuinty's call for a royal commission to study the way revenues are divvied up nationally among various levels of government. The Ontario premier had repeated his demand on Tuesday, pointing out that the federal Tories would be taking a risk to ignore the complaints coming from the country's most populous province. "Fiscal imbalance, as I've said repeatedly, is a significant concern, one that our government shares. I know that one premier, Premier McGuinty, has proposed that we look at a royal commission," Harper commented. But, before calling for a royal commission, he wants to look at two in−depth studies of fiscal federalism that Ottawa expects to have in hand by spring, the Prime Minister said. One analysis, which is being put together by a panel of experts commissioned by the federal government, will examine how to improve the equalization program. That's the system under which Ottawa transfers $10.9 billion a year from richer provinces to so−called have−not provinces. The other study, set in motion by the premiers' Council of the Federation, will seek to measure the dimensions of the fiscal imbalance and what can be done to eliminate it.

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"We'll take a look at those two reports," Harper said. "Quite frankly, my own inclination would be probably not to have another (royal) commission but would be to proceed with some proposals, at least federal proposals, and see if we can get any kind of buy竏段n from the provinces on resolving this problem." But this process would probably take a year, the Prime Minister stated.

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Food Products/Nutrition Le Guide alimentaire révisé risque de nuire à la lutte contre l'obésité; Deux spécialistes de la santé s'en prennent au projet de Santé Canada (Le Devoir)

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Le Devoir 2006.03.02 LES ACTUALITÉS a4 Deglise, Fabien 748

La nouvelle version du Guide alimentaire canadien, à paraître cet automne, pourrait bien faire augmenter le nombre d'obèses au pays plutôt que le réduire. C'est du moins ce qu'estiment deux spécialistes de la santé dans un article publié cette semaine dans la dernière livraison du Journal de l'Association médicale canadienne (JAMC). Pour le spécialiste canadien en traitement de l'obésité Yoni Freedhoff, le nouveau guide risque d'être en effet «obésogène», dit−il dans les pages de la revue scientifique. Comment? En encourageant l'adoption d'habitudes alimentaires propices à la prise de poids plutôt qu'au maintien d'un poids santé. Selon lui, le contenu de ce document de référence, dont plusieurs pans sont actuellement soumis à une consultation en ligne sur Internet, est loin d'améliorer la version précédente datant de 1992. Les lacunes seraient même nombreuses, à commencer par le manque d'accent mis sur la consommation de gras polyinsaturés et de produits de grains entiers reconnus pourtant depuis quelques années comme des éléments à favoriser dans des régimes alimentaires équilibrés. Autres sources d'inquiétude: les aliments frits ou riches en sucre pour lesquels Santé Canada, l'organisme à l'origine de la révision du guide, ne semble pas avoir ajouté d'avertissements pertinents pour inciter les Canadiens à en réduire la consommation. Freedhoff juge également avec sévérité la confusion dans les portions d'aliments à consommer, mais aussi les incohérences dans le nombre de calories auquel il faut quotidiennement s'exposer pour ne pas prendre du poids. Ainsi, selon ses calculs, en suivant les recommandations préliminaires du nouveau guide, plusieurs groupes de consommateurs pourraient bien consommer près de 3200 calories par jour, sans faire d'abus, estime−t−il. Or cette valeur devrait, pour des personnes sédentaires, se tenir entre 2000 et 2500 calories par jour pour éviter la surcharge pondérale. Pour Bill Jeffrey, coordonnateur canadien du Centre for Science in the Public Interest, Santé Canada échoue aussi dans sa démarche de révision en suggérant désormais de réduire sa consommation de fruits et légumes et d'augmenter celle de viande, selon lui. «Cela va être désastreux pour la santé des Canadiens», dit−il dans les pages du JAMC. Dans sa cuvée 2006, le guide devrait en effet recommander aux consommateurs d'ingurgiter de cinq à huit portions de fruits et légumes par jour, contre cinq à dix portions aujourd'hui. La viande, elle, suivrait une trajectoire inverse: de deux ou trois portions dans la version antérieure à quatre portions par jour pour les hommes dans la version révisée. Ces changements ne seraient d'ailleurs pas étrangers à la présence de représentants de l'industrie dans le Comité consultatif sur le guide alimentaire mis en place par Santé Canada pour orchestrer la réforme, dénonce M. Jeffrey. Le regroupement des transformateurs alimentaires et de produits de consommation, le Conseil de 142

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l'industrie de l'huile végétale et la Fondation laitière de la Colombie−Britannique y sont représentés par plusieurs des 12 membres. «C'est obscène que l'industrie soit impliquée [dans ce processus], dit M. Freedhoff. On ne demanderait pas à Exxon de développer la politique énergétique du Canada.» Tout en rappelant que la révision du guide suit son cours, Santé Canada s'est montré hier particulièrement étonné par les critiques émanant du JAMC. «Nous allons certainement répliquer par une lettre à l'éditeur», a expliqué hier au Devoir Chantale Martineau, une des responsables de la révision. Pour elle, le Guide alimentaire canadien ne peut être tenu responsable de la montée de l'obésité, dont les sources sont multiples. «Nous avons travaillé pour nous assurer que les gens ne prennent pas de poids», ajoute la porte−parole. Quant au tir croisé sur le nombre de calories et sur les portions, Santé Canada l'estime induit par une lecture erronée du document. «Les chiffres avancés sont étonnants, dit Mme Martineau. Nos experts cherchent d'ailleurs à comprendre les calculs qui ont été présentés dans cette revue.» Passant de deux à huit pages, la nouvelle version de ce document actuellement sur les tables à dessin conserve la notion des quatre groupes d'aliments (fruits et légumes, céréales, produits laitiers et viandes), qui s'accompagnent désormais de plus de conseils sur l'achat de produits. Les apports caloriques sont aussi présentés désormais par tranche d'âge et par sexe. Livrée à la discussion par l'entremise d'Internet jusqu'au 24 mars prochain, cette révision va faire l'objet d'une nouvelle ronde de consultations dans plusieurs villes canadiennes ce printemps. La publication de la version finale est prévue cet automne.

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Smoking Fight cancer by toughening up anti−smoking laws −− groups (Edmonton Journal)

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Edmonton Journal 2006.03.02 Final CityPlus B6 Ryan Cormier The Edmonton Journal EDMONTON 203

EDMONTON − Though they applaud the Alberta governments' goal to combat cancer rates, anti−smoking groups wonder how progress can be made without stronger anti−smoking legislation. Alberta's current laws, they say, will make it hard to put a significant dent in cancer rates. "The announcement by the Klein government to focus on cancer rates was definitely good news for us," said Lorie Boychuk, a spokeswoman for the Canadian Cancer Society. "These goals are ambitious and we applaud them for it, but it may be difficult to achieve. You can't just ignore tobacco, it carries too much weight in terms of cancer cases." Tobacco causes 30 per cent of Alberta's cancer deaths, according to the Canadian Cancer Society. The government has recently committed $1 billion to cancer prevention and treatment programs. Half the money will go to various programs and the other $500 million to the main cancer centres in Edmonton and Calgary. The government committed to cutting cancer cases by 35 per cent and deaths by half by 2025. However, a diluted smoking ban, no restrictions on cigarette advertising and low taxes on cigarettes work against such goals, according to the Campaign for a Smoke−Free Alberta. The campaign is a coalition of 15 anti−smoking groups. Dr. Charl Els, an addictions psychiatrist and a member of Physicians for a Smoke−Free Canada, would like to see a tax increase on tobacco, 100−per−cent smoke−free public places and a ban on cigarette sales in pharmacies. rcormier@thejournal.canwest.com

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Children Poverty hits one in six kids in Ontario; Study blames increase in part−time, contract work Report urges hike in minimum wage, quality child care (The Toronto Star)

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The Toronto Star 2006.03.02 ONT News A14 Naomi Carniol Toronto Star 595

One in six children in Ontario lives in poverty, a study being released today found. That's 443,000 people under 18 across the province. Adrian is one of them. The 11−year−old Toronto boy loves music and wants to learn to play the guitar, but his mom, Myriam Canas−Mendes, can't afford lessons. Some days she can't afford groceries. She visits a food bank or skips breakfast so Adrian and his 7−year−old sister, Olga, can eat. Canas−Mendes works part−time as an outreach worker at a community cafe, but only gets to work when someone else can't make it. To pay for her family's basement apartment, she relies largely on social assistance. The money falls short each month no matter how hard Canas−Mendes tries to stretch it. "Sometimes you can't even sleep. There is so much tension in your life," she said. The federal government promised in 1989 to eliminate child poverty by 2000. The child poverty rate in Ontario reached 16.1 per cent in 2003, compared with 11.6 per cent in 1989, today's study by Campaign 2000 found. The network of more than 90 organizations is devoted to ending child and family poverty in Canada. Despite economic growth in Ontario, the child poverty rate "has been stuck" between 15 and 16 per cent since 2000, the study said. That's partly because of an increase in part−time, contract and temporary work, said Jacquie Maund, one of the report's lead authors. Parents aren't "finding jobs that provide enough hours at a sufficiently high pay or any benefits to lift their families above the poverty line," Maund said. Thirty−three per cent of children living in poverty had at least one parent who worked full−time year−round in 2003, the study found. Another reason the child poverty rate has remained steady is "huge holes to our social safety net have not been adequately repaired," Maund said. Cuts to social assistance in the 1990s, combined with inflation, caused a 40 per cent decline in the past decade of what people on social assistance can afford to buy, the report said. "A family of four on (social assistance in Ontario) would receive a monthly benefit of $1,250 in 2005 − one−half of what a four−person family needs to purchase the basic necessities of food, clothing, shelter and transportation." 145

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Child poverty hits some families disproportionately hard, the study found. Forty per cent of children living in poverty are cared for by single mothers. Poverty rates for children in aboriginal, visible minority and immigrant families are double the average rate in the province. "Good quality child care is one essential pathway out of poverty" because it allows parents to receive training and work, the report said. In Ontario there are only regulated child−care spaces for 10.7 per cent of children up to age 12, the report noted. A co−ordinated approached to fighting child poverty is needed, Maund said. "We're looking for the Ontario government to make children a priority in the upcoming budget and to make a commitment to spend up to $1 billion to jumpstart an Ontario action plan to reduce child poverty." The action plan should include "social investments" in affordable housing and quality child care. Social assistance rates should be raised and tied to inflation. Ontario must stop deducting the national child benefit supplement from the cheques of families on social assistance, the report argued. The action plan also needs to improve the quality of Ontario's labour market by raising the hourly minimum wage from $7.75 to $10 and indexing it to inflation and investing in more programs that ensure immigrants have access to jobs that match their training, the report stated. "Growing up in poverty is linked to poor health, lower school performance and low pay and unemployment as adults," Maund said. "There are long−term costs to not addressing our child poverty problem now."

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Consumer Prod. Safety Soft drinks tested after benzene detected (Vancouver Sun)

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Vancouver Sun 2006.03.02 FINAL C News A6 Canadian Press MONTREAL 106

MONTREAL −− Health Canada is testing soft drinks sold in Canada after a cancer−causing ingredient used in gasoline was found in similar beverages in the U.S. and Britain. The federal health department has not advised consumers to change their purchasing habits. The decision to test follows the discovery of levels of benzene in soft drinks in the U.S. and Britain that are higher than the levels normally found in drinking water. Benzene is a minor component of gasoline. In the U.S., the soft drink industry has not contested the presence of the ingredient in some beverages and says it's caused by an interaction of two other ingredients, absorbic acid and sodium benzoate.

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Public Health Agency of Canada Pandemic Influenza Une maladie qui est là pour rester (La Presse)

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La Presse 2006.03.02 Nouvelles générales A2 Perreault, Mathieu 583

Les éleveurs de volaille sont mieux de s'y faire: la grippe aviaire est là pour rester. Les foyers d'infection se multiplient en Amérique du Nord, même s'il ne s'agit pas de la même souche que celle qui dévaste les élevages en Asie. Les règles draconiennes de confinement des volailles sont là pour rester. Tel est l'avis de Jean−Pierre Vaillancourt, professeur de médecine vétérinaire à l'Université de Montréal. " Il va falloir que les gens réalisent que les choses ont changé, dit le Dr Vaillancourt. Il y a eu beaucoup plus d'épidémies d'influenza aviaire ces dernières années en Amérique du Nord. On voit des choses qui n'existaient pas avant: la souche H5 dans la sauvagine canadienne, par exemple. " Entre 1955 et 2004, il y a eu 25 épidémies de grippe aviaire dans le monde, principalement chez le poulet et la dinde, et une seule chez des oiseaux sauvages, selon une étude française fournie à La Presse par le Dr Vaillancourt. En 2004 et 2005, il y en a eu 19 seulement en Asie. Moins de 25 millions d'oiseaux ont été touchés par la grippe aviaire entre 1959 et 1999; depuis, plus de 200 millions d'oiseaux ont été abattus. En Amérique du Nord, il y a eu deux épidémies de grippe aviaire en 2004, avec la souche H7N3 en Colombie−Britannique et avec la souche H5N2 au Texas. En Colombie−Britannique, 17 millions de poulets ont dû être abattus. En novembre dernier, des souches H5 faiblement pathogènes ont été détectées chez des canards sauvages canadiens, notamment au Québec. La souche identifiée au Manitoba était une H5N1, mais elle était différente de celle qui dévaste l'Asie depuis 2003. Au Canada, ce n'est pas tant la souche asiatique de la grippe aviaire qui inquiète, mais les autres. Toutes les souches H5 et H7 hautement pathogènes doivent être déclarées à l'Organisation mondiale de la santé animale. Les souches faiblement pathogènes ne doivent pas être déclarées. " On n'a pas le choix de déclarer une éclosion de ces deux souches, même si on s'expose à un embargo, dit le Dr Vaillancourt. C'est pour ça que les mesures de confinement vont être maintenues. Remarquez, il y a des assouplissements. On a convenu que les toits pleins n'étaient pas nécessaires, que les grillages suffisaient. Et on a fait des exceptions pour les émeus, qui ne peuvent vivre à l'intérieur. L'important, c'est d'éviter les contacts avec la sauvagine. " L'apparition de la souche asiatique en France va resserrer les contrôles douaniers, selon le Dr Vaillancourt. " On va voir plus de chiens douaniers dans les aéroports, plus de fouilles. Un sandwich au poulet acheté à l'aéroport d'Orly n'a pas grand chance de poser un problème, mais il faut détecter tout ce qui pourrait avoir été en contact avec des fèces d'animaux malades. La bonne nouvelle, pour nous, c'est que les oiseaux morts ou très malades ne peuvent pas traverser l'Atlantique. " 148

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Cette attention particulière portée aux voyageurs montre bien leur importance dans la transmission de la grippe aviaire. En Russie, où la souche asiatique est apparue l'été dernier, les foyers suivaient le chemin de fer transsibérien. Le Dr Vaillancourt estime qu'une partie des cas nouvellement déclarés de grippe aviaire s'explique par une attention plus soutenue des autorités. " Peut−être qu'il y a deux ans, quand on voyait des oiseaux morts, on pensait qu'ils avaient été victimes du virus du Nil, alors qu'ils avaient plutôt la grippe. "

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Huit fermes québécoises en quarantaine; Simple précaution, dit l'Agence canadienne d'inspection des aliments (Le Devoir)

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Le Devoir 2006.03.02 LES ACTUALITÉS a4 PC 267

Huit fermes québécoises sont en quarantaine depuis samedi à la suite d'une décision de l'Agence canadienne d'inspection des aliments informée de l'importation au cours des derniers mois de plusieurs milliers de canards vivants et d'oeufs de couvée provenant de la France, le dernier pays frappé par le virus de la grippe aviaire. Il a été impossible de connaître les endroits où sont situées les fermes en question. Un porte−parole de l'agence fédérale, Doug Steadman, a indiqué hier que l'agence a procédé à des prélèvements afin de vérifier la présence du virus H5N1 sur les oiseaux des fermes en quarantaine. Ils ont été acheminés au laboratoire de Winnipeg pour analyse. Les résultats devraient être disponibles au cours des prochains jours. «Nous avons pris cette mesure par précaution», a dit M. Steadman. «Aucun de ces oiseaux ne semble être porteur de signes d'infection à la grippe aviaire. Ils ont tous l'air en bonne santé», a−t−il dit. Les autorités sanitaires s'attendent à ce que les résultats d'analyses soient négatifs. M. Steadman a également mentionné que des visites quotidiennes étaient faites dans les fermes en quarantaine. Interdiction d'importer L'Agence canadienne d'inspection des aliments a décrété la mise en quarantaine des huit fermes québécoises samedi, au moment où il a été décidé de frapper d'interdiction l'importation d'oiseaux vivants en provenance de la France de même que les produits de volaille n'ayant pas fait l'objet d'un procédé de chauffage qui a la propriété de détruire le virus. Des cas de grippe aviaire ont été retrouvés dans une ferme d'élevage de dindes située dans les environs de Ain, dans le sud−est de la France. La souche H5N1 soulève d'autant plus de craintes qu'elle a, dans de rares cas, infectée des humains en contact étroit avec des oiseux infectés, ce qui s'est produit surtout dans le Sud−Est asiatique.

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Avian flu fears spark quarantine in Quebec (Calgary Herald)

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Calgary Herald 2006.03.02 Final News A12 Your Health: Trends − Discoveries Dene Moore The Canadian Press MONTREAL 321

The Canadian Food Inspection Agency has quarantined eight Quebec poultry farms that recently imported live ducks and unhatched eggs from France, one the latest countries hit by the deadly avian influenza virus. Swab samples have been sent to Winnipeg for testing for the H5N1 avian influenza virus and results are expected within the next few days, said Doug Steadman, the agency's acting executive director of the animal products directorate. It's a precautionary measure, Steadman said Wednesday from Ottawa. "At this point in time, none of these birds are showing any evidence of avian influenza," he said. "They all look fairly healthy." Several thousand day−old chicks were imported in the past month. The locations of the farms were not released. Live poultry imported into Canada is automatically under quarantine for 28 days. The extra attention, including the testing and daily monitoring by agency staff, went into effect after Canadian officials implemented a ban Saturday on live birds from France as well as poultry products that have not undergone heat processing. Meanwhile, officials were testing whether dead birds found in the Bahamas, a country less than 100 kilometres from Florida, have avian flu, the Pan American Health Organization said Wednesday. The results are expected to be ready in about four days. A positive case would be the first confirmation the virus has spread into the Western Hemisphere. "This is just a case of unexplained deaths in birds and we are not excluding anything at this point in time," said Yitades Gebre, adviser for disease prevention and control for the PAHO office in Nassau. "We are not panicking." France has confirmed cases of the highly pathogenic H5N1 avian influenza virus on a commercial turkey farm near Ain, in the southeast of France.

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The H5N1 strain is feared largely because it has, in rare cases, infected humans in close contact with infected birds, mostly in Southeast Asia, and scientists are concerned the virus could mutate to pass from human to human and spark a human flu pandemic. "The ban will not be lifted until we have sufficient evidence from France that they have dealt with the virus and there's none of it circulating within their domestic population," Steadman said. The quarantine will stay in effect in Quebec at least until test results come back, he said.

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Des producteurs inquiets (Le Soleil)

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Le Soleil 2006.03.02 Actualités A3 Collaboration spéciale Desmeules, Sylvain Saint−Urbain Isabelle Mihura et Jean−Jacques Etcheberrigaray n'étaientnullement préoccupés par la grippe aviaire à l'époque où cette photo a été prise, en 2003. 363

"C'est inquiétant, c'est triste également", dira Isabelle Mihura, elle qui a démarré la Ferme Basque de Saint−Urbain, dans Charlevoix, avec son mari Jean−Jacques Etcheberrigaray en 2003. Heureusement, elle n'importe pas de France, ni d'ailleurs. Elle ne fait affaire qu'avec des couvoirs du Québec, ses canards sont en pleine forme, n'empêche que c'est toute l'image de la production de palmipèdes qui prend un dur coup. "On trouve dommage la situation parce que ça évolue en Europe, mais pour l'instant, ce n'est pas au Québec et on va se croiser les doigts pour que jamais ça ne le soit. On n'a pas le choix de s'adapter à la situation, on espère que tout ça est très alarmiste et que la grippe aviaire ne nous touchera pas en Amérique du Nord", souhaite−t−elle, certifiant qu'il n'y a aucun danger à consommer les produits de sa fermette. Comme les autres producteurs, depuis novembre, le couple de producteurs doit confiner ses animaux à l'intérieur et suivre des mesures de biosécurité dans les bâtiments. Un inspecteur du MAPAQ est passé, mais son rapport n'a toujours pas été envoyé. Les clients ne sont pas plus "frileux" qu'avant, constate−t−elle, mais avec cette nouvelle de mise en quarantaine spéciale, on craint néanmoins la réaction des consommateurs. Avec 2000 canards produits en 2005, l'entreprise avait gagné le coeur des gastronomes et des chefs cuisiniers, grâce à un canard gavé à la méthode basque et élevé à l'extérieur. "On voulait augmenter notre production et aller chercher de nouveaux marchés, mais je pense que nous allons nous en tenir à la production de 2005 ou même produire un peu moins à cause de ça", continue Mme Mihura, prédisant une pénurie de canards dès cette année avec le trop grand danger de l'exportation. "On espère qu'il s'agit d'une mesure ponctuelle et qu'on pourra revenir un jour à un élevage extérieur comme on aime le faire", rêve à voix haute la productrice, mais en même temps, elle et son mari devront soit construire de coûteux bâtiments, soit réduire la production pour la prochaine année, un choix qui découle de cette crise de plus en plus sentie.

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Russia: Avian flu claims half a million fowl (Montreal Gazette)

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Montreal Gazette 2006.03.02 Final News A14 Fast Track AP; Los Angeles Times; London Daily Telegraph; BloombergNews MOSCOW 66

The H5N1 strain of bird flu has killed nearly half a million domestic fowl in southern Russian regions near the Caspian and Black seas since Feb. 3 despite efforts to control the outbreak by culling poultry, the Emergency Situations Ministry said. A further 220,000 birds were killed in an attempt to stem the outbreak.

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Grippe aviaire en France: plus un chat dehors dans la région touchée (L'Acadie Nouvelle)

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L'Acadie Nouvelle 2006.03.02 Nouvelles générales 31 AP Associated Press: FRANK HORMANN PARIS Ce chat en est probablement à sa dernière escapade dehors,du moins pour un bout de ILLUSTRATION: temps. WORD COUNT: 662 Au nom du principe de précaution, le gouvernement français a demandé, hier, aux propriétaires de chats de la région de la Dombes, où des volailles et des oiseaux sauvages sont morts du virus H5N1 de la grippe aviaire, de ne pas laisser leurs félins domestiques se promener à l'extérieur. L'AFSSA (Agence française de sécurité sanitaire des aliments) doit rendre un avis d'ici la fin de la semaine sur le comportement à adopter pour protéger les animaux de compagnie de la maladie. Le week−end dernier, un chat porteur du H5N1 a été trouvé mort sur l'île allemande de Rugen, en mer Baltique, où plus de 100 oiseaux sauvages ont succombé au virus. Une hypothèse veut qu'il ait mangé un oiseau infecté. "La possibilité de transmission du virus au chat avait déjà été rapportée dans les zones à forte pression virale (Asie)", rappelle le ministère de l'Agriculture. Dans un communiqué, il précise que l'AFSSA a été saisie "dès la semaine dernière" sur ce risque et "les précautions à prendre". Le gouvernement attend l'avis de l'AFSSA "d'ici la fin de la semaine", a déclaré hier le premier ministre, Dominique de Villepin. Cet avis sera disponible "au mieux demain soir, au pire dans 48 heures", selon le ministre de l'Agriculture, Dominique Bussereau. Mais d'ores et déjà, et "en vertu du principe de précaution, il est demandé aux propriétaires de chats de ne pas les laisser divaguer dans les zones dans lesquelles le virus H5N1 a été détecté", a dit le premier ministre lors de sa conférence de presse mensuelle. Jusqu'à présent, seul l'Ain est concerné. Des canards sauvages, des cygnes ainsi que des dindes d'élevage sont morts du H5N1 dans ce département. En Allemagne, dans un rayon de trois kilomètres autour des sites où des oiseaux malades ont été découverts, les chats doivent rester confinés chez leur propriétaire et les chiens doivent être tenus en laisse à l'extérieur. Le vice−ministre allemand de l'Agriculture, Gerd Lindemann a annoncé hier que cet ordre prenait effet immédiatement. En France, la Société protectrice des animaux était submergée de coups de fil. Le vétérinaire Serge Belais, président de la SPA, a signalé "des appels beaucoup plus fréquents et beaucoup plus nombreux" que d'habitude. "Il y a plus de chats qui rentrent dans nos refuges", a−t−il déclaré à l'Associated Press sans pouvoir annoncer de chiffres. 155

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"On a des appels de gens qui sont propriétaires de chat pour savoir s'il y a des risques, des gens qui paniquent et qui se demandent ce qu'ils doivent faire de leur chat, et vous avez des gens qui abandonnent leur chat. On est en train de rentrer dans la panique, là." Le président de la SPA conseille aux propriétaires vivant dans les régions touchées par le H5N1 de ne pas laisser sortir leurs compagnons à quatre pattes. La préfecture de l'Ain a rappelé, hier, que 160 gendarmes étaient déployés en zone de surveillance et 75 en zone de protection. Ils pourraient être amenés à saisir "tout chat non identifié trouvé à plus de 200m des habitations ou tout chat trouvé à plus de 1000m du domicile de son maître et qui n'est pas sous la surveillance immédiate de celui−ci, ainsi que tout chat dont le propriétaire n'est pas connu et qui est saisi sur la voie publique ou sur la propriété d'autrui". Mais selon la préfecture, aucune consigne n'a encore été donnée. Les agents de l'Office national de la chasse et de la faune sauvage, qui ramassent les oiseaux morts, n'ont reçu aucune consigne particulière concernant les chats errants. "S'ils sont morts, on les ramasse. Mais pas s'ils sont vivants car on pourrait en ramener jusqu'à 200 par jour!", a déclaré Patrick Dafré, agent de l'ONCFS. Dans un communiqué diffusé hier, l'Organisation mondiale de la santé animale soutient une recommandation faite par le Centre européen de prévention et de contrôle des maladies aux propriétaires de chats. Il est conseillé à ces derniers d'emmener chez un vétérinaire leur animal sorti dans une zone où le virus H5N1 a été détecté, si le chat présente des symptômes de coryza.

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Deadly bird flu spreads to Switzerland (The Province)

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The Province 2006.03.02 Final News A8 The World AFP GENEVA 40

GENEVA −− Swiss officials have confirmed the first case of the H5N1 bird flu that can be deadly to humans. It was found in a wild duck that died by Lake Geneva.

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Grippe aviaire en Amérique ?; Enquête sur la mort d'une vingtaine d'oiseaux aux Bahamas (Le Soleil)

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Le Soleil 2006.03.02 Le Monde A10 AFP; AP Nassau 676

Des experts enquêtaient hier sur l'origine de la mort soudaine et suspecte d'oiseaux dans une île dans le sud des Bahamas pour déterminer s'ils étaient porteurs du virus H5N1 de la grippe aviaire. Si tel était le cas, ce serait la première fois qu'on aurait détecté sur le continent américain le virus H5N1, qui provoque la grippe aviaire. Ce virus hautement pathogène a déjà infecté près de 200 personnes dont environ la moitié en sont mortes, principalement en Asie et les craintes d'une pandémie mondiale sont très vives. Le cas du Canada Au Canada, un sous−type H5N2 faiblement pathogène avait été découvert en Colombie−Britannique en novembre. Les oiseaux morts des Bahamas, dont des flamants roses, ont été trouvés par un gardien sur l'île de la Grande Inagua qui abrite un grand centre de reproduction pour les flamants roses dont le nombre peut aller jusqu'à 55 000. Cette île est aussi une escale pour les oiseaux migrateurs traversant l'océan Atlantique. Quinze flamants roses, cinq spatules et un cormoran ont été retrouvés morts en deux jours, a indiqué le journal local Bahama Journal hier. "C'est indiscutablement un nombre inhabituellement élevé, normalement vous ne trouvez pas des oiseaux sauvages qui s'écrasent et meurent", a expliqué Eric Carey, responsable scientifique de la société qui gère le parc national d'Inagua, Bahamas National Trust. Il a indiqué que "plusieurs causes" dont l'empoisonnement ou la météo peuvent avoir provoqué ces décès. "Nous restons optimistes que (ces morts) soient liées à ces facteurs plutôt qu'à des spéculations de grippe aviaire ou d'une autre terrible maladie." Le directeur au ministère de l'Agriculture des Bahamas, Simeon Pinder, a souligné hier qu'aucune indication, à ce stade, ne permet d'établir la cause de la mort de ces oiseaux. "Je pense que la plupart des gens pensent que cela est relatif à la grippe aviaire, mais je veux être très clair en déclarant que nous ne le savons pas pour le moment", a−t−il dit. Des experts dont le responsable des services vétérinaires du gouvernement et des fonctionnaires des services de santé se sont rendus hier sur l'île pour enquêter. Aux États−Unis "Leur objectif est de rassembler des échantillons", a indiqué M. Carey, ajoutant que les tests seront conduits sur l'île de New Providence, où est située la capitale du pays, Nassau. "S'ils ont besoin de tests 158

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supplémentaires, ils (les experts) vont collaborer avec des services aux É.−U.", dit−il. Les Bahamas ont indiqué qu'en cas de nécessité les cadavres des oiseaux pourraient être envoyés pour examens auprès d'experts américains. M. Carey a souligné que les craintes sont étayées par le fait qu'Inagua est un point de transit pour les oiseaux migrateurs, qui font escale dans cette île avant de se diriger vers le nord, vers les États−Unis. Ceux−ci ont annoncé hier l'achat de 14,15 millions de traitements antiviraux supplémentaires pour faire face à une éventuelle pandémie sur leur territoire. Les oiseaux affectés ne sont pas des espèces migratoires, mais ils sont en contact avec des oiseaux qui le sont, comme les oies et les canards. M. Carey a également souligné que les 1000 habitants de l'île résidaient à une distance éloignée, environ 25 kilomètres du parc naturel. Les visites de ce parc ont été suspendues jusqu'à ce que la cause de la mort soit déterminée, a ajouté M. Carey. La Grande Inagua, l'île la plus méridionale de l'archipel des Bahamas, est située à 100 kilomètres de Cuba et d'Haïti. L'Organisation mondiale du tourisme a dit hier qu'il n'y a pour l'instant "aucune contre−indication" à voyager dans n'importe quel pays du monde pour peu que l'on observe les recommandations des autorités sanitaires et vétérinaires. Plus un chat dehors Au nom du principe de précaution, le gouvernement français a par ailleurs demandé hier aux propriétaires de chats de la région de la Dombes, où des volailles et des oiseaux sauvages sont morts du virus H5N1 de la grippe aviaire, de ne pas laisser leurs félins domestiques se promener à l'extérieur. En fin de semaine, un chat porteur du H5N1 a été trouvé mort sur l'île allemande de Rugen, en mer Baltique, où plus de 100 oiseaux sauvages ont succombé au virus. L'animal aurait mangé un oiseau infecté.

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Bird flu probe in the Bahamas (National Post)

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National Post 2006.03.02 All but Toronto Body &Health A18 Medical Report Agence France−Presse NASSAU Colour Photo: Flamingos. 202

NASSAU − Experts yesterday probed the unusual deaths of 14 birds on a southern Bahamian island to determine whether they marked the first cases of bird flu in the Americas. The dead birds were found by a park warden in a wildlife reserve on Great Inagua, which has a population of about 50,000 flamingos and a large lake popular with migrating birds. Ten flamingos, three roseate spoonbills and a cormorant were found dead in the park, authorities said. "It is definitely an unusually high number, normally you don't find wild birds dropping out and dying," said Eric Carey, director of Parks and Science for the Bahamas National Trust, which runs the Inagua National Park. He said, however "any number of things," including poisoning or weather could have caused the deaths. "We remain optimistic it is related one of these factors rather than the anticipated speculation of bird flu or some other terrible disease," he said. To date, the western hemisphere has had no confirmed case of bird flu.

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Jours fastes pour le fabricant de Tamiflu et de Relenza; Washington achète davantage d'antiviraux (La Presse)

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La Presse 2006.03.02 Nouvelles générales A3 AFP AFP Washington Le Portugal, comme bien d'autres pays, est sur le pied deguerre contre la propagation de ILLUSTRATION: la grippe aviaire. Le ministre de l'Agriculture du Portugal regarde un garde−chasse qui relâche une cigogne dans la région de Ria Formosa. WORD COUNT: 260 Les États−Unis ont accru leurs commandes d'antiviraux Tamiflu et Relenza pour pouvoir traiter 25 % de leur population en cas de pandémie de grippe d'origine aviaire, a annoncé hier le secrétaire à la Santé, Mike Leavitt. Le ministère a commandé 12,4 millions de traitements de Tamiflu (oseltamivir) produit par le groupe helvétique Roche et 1,75 million de traitements de Relenza (zanamivir), commercialisé par le laboratoire britannique GlaxoSmithKline, a−t−il précisé dans un communiqué. Ces 14,15 millions de traitements antiviraux s'ajouteront aux 5,5 millions déjà stockés dans la réserve nationale stratégique pour être distribués aux États si une pandémie apparaissait imminente. L'objectif de Washington est de disposer de 80 millions de ces traitements antiviraux. Le Tamiflu qui se prend sous forme de comprimés et le Relenza en inhalation, devraient permettre d'atténuer fortement les symptômes grippaux sans toutefois détruire le virus qui, dans ce cas, serait probablement une variation humaine du H5N1 responsable de l'épizootie galopante actuelle. L'Organisation mondiale de la santé (OMS) a recensé à ce jour près de 200 cas d'infection humaine avec ce pathogène très virulent, dont 91 mortelles, ayant résulté de contacts directs avec des volailles ou d'autres volatiles. Aucun cas de transmission de personne à personne n'a été constaté à ce jour mais les experts médicaux estiment qu'une mutation du virus H5N1, permettant une transmission facile entre humains, n'est qu'une question de temps. " Disposer d'un stock d'antiviraux est un aspect important de notre plan de préparation à une pandémie ", a encore souligné mercredi Michael Leavitt. " Ces achats s'inscrivent dans notre approche énergique pour répondre à un défi potentiellement sérieux pour la santé publique ", a−t−il ajouté.

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Grippe aviaire : l'Amérique retient son souffle (La Presse)

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La Presse 2006.03.02 Nouvelles générales A2 AFP On ne badine pas avec les oeufs dans l'État de NewYork.Chaque semaine, 1000 ILLUSTRATION: échantillons sont pris au hasard dans 90 marchés de volaille de l'État pour être testés en laboratoire.Quatre jours de tests sont requis pour déterminer s'ils sont porteurs d'un virus. WORD COUNT: 334 Depuis la réapparition de la souche du virus H5N1 de la grippe aviaire sous sa forme hautement pathogène, en décembre 2003 en Corée du Sud, le continent américain a été épargné. En Asie, en Europe et en Afrique, 180millions de volatiles ont été tués. L'Organisation mondiale de la santé a recensé près de 200 cas d'infection humaine, dont 93 mortels. Le Canada est sur le qui−vive. Des tests sont effectués depuis hier dans huit fermes du Québec qui ont récemment importé des canards français. FRANCE Depuis mardi, 43 pays ont décrété un embargo total ou partiel sur les importations de volailles françaises. Il y a une semaine, le premier cas de grippe aviaire de type H5N1 a été découvert dans un élevage de dindes à Versailleux dans l'Ain. Cette contamination de l'élevage est survenue une semaine après la détection du virus sur un canard sauvage dans la même région. CANADA Le Canada a cessé ses importations de volaille en provenance de la France, vendredi, en raison de la détection du virus H5N1 dans un élevage commercial français. Huit fermes du Québec ont commencé à être testées, hier, car elles ont récemment importé des canards de ce pays. En novembre 2005, un cas de grippe aviaire a été découvert dans un poulailler de Colombie−Britannique. Toutefois, il ne correspondait pas à une variété mortelle comme celle qui frappe les oiseaux d'Asie. BAHAMAS Des experts enquêtent depuis hier sur l'origine de la mort soudaine et suspecte d'oiseaux dans une île dans le sud des Bahamas − la Grande Inagua−pour déterminer s'ils sont porteurs de la grippe aviaire. Si tel est le cas ce serait la première fois que le virus H5N1 hautement pathogène serait détecté sur le continent américain depuis sa réapparition en Asie en 2003. ALLEMAGNE Un chat porteur d'un virus de type H5N1 meurt en Allemagne. C'est le premier cas de contamination d'un mammifère en Europe. Sources : AFP, PC Recherche : CAROLINE TOUZIN 162

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NEW LAW NOT TOOL TO COERCE DOCTORS, AIDE SAYS (The London Free Press)

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The London Free Press 2006.03.02 Final City &Region C1 JOHN MINER, FREE PRESS HEALTH REPORTER 234

Ontario's new emergency legislation isn't meant to force doctors and other health workers to stay on the job in an influenza pandemic, a government staffer said yesterday. "Absolutely not," said Andrew Hilton, speaking for Community Safety and Correctional Services Minister Monte Kwinter. Bill 56, tabled by Kwinter in December, gives the Ontario cabinet sweeping new powers to handle an emergency, including a disease outbreak. The law, which the Liberals hope to pass before summer, has raised alarm bells because it includes a section allowing cabinet to "authorize" any person to render services during an emergency. Penalties for violators are a fine of as much as $100,000 and a year in jail for each day the law is broken. Kwinter said in December the law would let the government tell emergency personnel: "No, you can't leave. We need you to do this job." But Hilton yesterday said the legislation doesn't contain provisions to keep people on the job and won't allow the government to conscript doctors to work. "If you want to pass a piece of legislation to do that, you have to use very specific language. 'Authorizing' doesn't even come close," said Hilton. What the legislation is really meant to do is permit people to do work they normally wouldn't do, but could reasonably be expected to do, he said. "A nursing assistant could be authorized to do the work of a registered nurse if it would be reasonable to expect he or she could do that," Hilton said. "It is about getting the help and resources we need quickly." The fines and jail penalties are aimed at preventing people from interfering with emergency workers and are not aimed at the emergency workers themselves, he said. "The last thing we want to do during any kind of an emergency, particularly an emergency having a medical component to it, is to dissuade doctors, nurses, any kind of health−care workers from doing their job," Hilton said.

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Influenza: un calme plat inhabituel, mais apprécié (La Tribune (Sherbrooke, Qc))

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La Tribune (Sherbrooke, Qc) 2006.03.02 Actualités 9 Gougeon, François Sherbrooke 350

C'est le calme plat, "inhabituel à ce temps−ci de l'année", en regard de la grippe, la sournoise influenza qui cumule normalement en pic à la fin de février. Mais ce n'est pas Dre Suzanne Ménard, spécialiste des maladies infectieuses à la Direction de santé publique de l'Estrie, qui va s'en plaindre. Alors qu'à pareille date, l'an passé, les cas d'influenza se comptaient par centaines dans les hôpitaux et établissements de soins de longue durée de l'Estrie, c'est un cas ici et là. Au CHUS, par exemple, la porte−parole, France Champagne, précise que depuis décembre, 21 cas d'influenza ont été diagnostiqués. De ce nombre, seulement sept personnes ont dû être hospitalisées. Au total, l'an passé, on comptait 362 cas qui avaient nécessité une hospitalisation. "Pourtant, signale Dre Ménard, les hôpitaux procèdent à beaucoup de tests (de dépistage), car des gens ont certains symptômes, mais tous ces examens sont négatifs. Ce n'est pas la grippe que ces gens ont, mais le rhume", a précisé Dre Ménard. Même constatation au CSSS−IUGS, où on en finissait plus l'an passé de mettre les unités de soins de longue durée en quarantaine. "On n'a pas un seul cas (d'influenza). C'est vraiment spécial, mais on se croise les doigts", soumet la porte−parole de l'établissement de près de 800 résidents, Annie−Andrée Émond. La situation est généralisée au Québec: on parle d'une dizaine de cas. Pourtant, l'influenza frappe plus fort dans l'Ouest du Canada et normalement, le virus se déplace vers l'Est. "On dit ça depuis novembre (le déplacement du virus), mais l'influenza reste toujours très limitée au Québec", dit encore la spécialiste. Cependant, comme une hirondelle ne fait pas le printemps, elle se croise aussi les doigts dans l'espoir que la situation ne changera pas du jour au lendemain. "Je n'ai pas de boule de cristal. Il faudra attendre les prochaines semaines avant de dresser le bilan", fait−elle valoir. Et pourquoi l'influenza ne frappe pas plus à ce temps−ci de l'année qu'à l'habitude? "Ça n'a rien à voir avec la météo. Différents facteurs peuvent être en cause, comme la présence d'une souche assez semblable à l'an passé, un virus qui ne circule pas, l'intensification des campagnes de vaccination et ainsi de suite", a livré Dre Suzanne Ménard. francois.gougeon@latribune.qc.ca

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Diseases/Research Medical journal's new editor quits: Editorial independence may be reason for resignation after past editor fired (Edmonton Journal)

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Edmonton Journal 2006.03.02 Final News A7 Helen Branswell The Canadian Press TORONTO 396

TORONTO − The acting editor of the embattled Canadian Medical Association Journal quit after the owners, the Canadian Medical Association, refused to accept a plan he drafted aimed at guaranteeing editorial independence for the publication, a member of the editorial board said Wednesday. Dr. Stephen Choi resigned Tuesday, only a week after stepping in to replace former editor Dr. John Hoey, who was fired along with his senior deputy editor, Anne Marie Todkill. Another editor, Sally Murray, tendered her resignation with Choi. Dr. Jerome Kassirer, a member of the journal's editorial board, said that when Choi agreed to serve as acting editor, he made it clear the publisher, CMA Media, had one week in which to accept a governance plan Choi would draft. That 10−point plan, posted on the CMAJ's website, would have given the editor−in−chief full authority over editorial content of the journal and would have given an arm's−length oversight committee the role of arbiter between the journal owners and its editorial staff. While Choi hasn't revealed publicly why he resigned, Kassirer said the publisher rejected the governance plan. "What a mess!" Kassirer, a former editor of the New England Journal of Medicine, said Wednesday from Boston. "I think it's really a serious disaster." The editor of the Journal of the American Medical Association agreed. "This is so disturbing," Dr. Catherine DeAngelis, who had been advising Choi, said from Chicago. "This is on the brink of destruction." Another member of the journal's editorial board, Dr. P.J. Devereaux, called the latest departures proof that Hoey and Todkill had been fired over issues of independence, and not because, as the publisher insists, that it was time for a leadership change.

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"No longer is it credible to say: Look, there is no issue of editorial autonomy, in that the firings were just a freshening," he said from Hamilton, where he teaches at McMaster University. "This latest development makes it clear. There is no one who cannot see through this." Devereaux said that to date about 2,500 people have signed an online petition calling on the CMA to reinstate Hoey and his team. None of the departed editors have spoken publicly about the situation, saying they are bound by confidentiality agreements CMA Media requires all employees to sign. But the editorial board of the journal says the firings were the product of a simmering feud between Hoey and the journal's owners over editorial independence. On Wednesday, publisher Graham Morris issued a statement expressing regret at the resignation of Choi and Murray. But he said the publication is moving forward and will name an interim editor within days.

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N.B. bucks super−bug trend; No cases of C. difficile bacteria reported to date in province's hospitals (Times &Transcript (Moncton))

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Times &Transcript (Moncton) 2006.03.02 A3 NEWS Times and Transcript Staff 206

A new strain of the super−bug responsible for hundreds of deaths in Quebec last year is causing more people to end up in intensive care across the country but so far New Brunswick seems to be bucking the trend, according to a new report. The Public Health Agency of Canada has analysed 615 strains of C. difficile bacteria from hospitals in nine provinces. Although preliminary results show the bacteria is present in seven other provinces so far none of the samples show the bacteria is in New Brunswick. "Of that initial group of strains there were no strains from Manitoba or New Brunswick," said Denise Gravel, an epidemiologist with the Public Health Agency. "However, by the time we finish doing the 2,300 we may very well find that the strain is also in Manitoba and New Brunswick." The so−called superbug attacks the large intestine and colon, causing severe cases of diarrhea. It can be deadly for seniors who are in hospital for long durations. The Moncton Hospital was the only hospital in the province to participate in the study. No one from The Moncton Hospital was available for comment yesterday. However, according to previous reports, in 2003 and 2002 the hospital had about 25 cases of the super−bug each year. The study shows that the incident rate of C. difficile is virtually unchanged from a study conducted in 1997. However the mortality rate has increased significantly since 1997. Gravel said the latest figures show six per cent − or 103 people − affected died. "It does represent a fairly significant increase of about 400 per cent and that's noteworthy," she said.

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Lemieux's broken heart likely mended Surgery performed on the hockey superstar this week restores a regular heartbeat in 74 per cent of cases, new research shows (Globe and Mail)

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GLOBE AND MAIL 060610196 2006.03.02 A19 (ILLUS) ANDRE PICARD Health Metro 633 578

ANDRE PICARD PUBLIC HEALTH REPORTER Hockey superstar Mario Lemieux recently retired after learning he was suffering from an abnormal heart rhythm, a common condition called atrial fibrillation. But on Monday, he underwent surgery that mostly likely cured him. New research, published today in the New England Journal of Medicine, shows that the simple operation, called catheter ablation, results in the return of a regular heartbeat to 74 per cent of patients. In the study, patients who had the surgery were able to stop taking rhythm−regulating drugs and the chambers of their heart −− which can be damaged by the condition −− returned to normal size and function. "We have shown objectively, and with rigorous follow−up, that this procedure is a very good option for patients with symptomatic, chronic atrial fibrillation who otherwise may have to live with atrial fibrillation for the rest of their lives," said Dr. Hakan Oral, an associate professor of medicine at the University of Michigan, and lead author of the study. Catheter ablation works by essentially short−circuiting the aberrant electrical impulses that are the source of heart rhythm problems. A small incision is made in the groin and wires (the catheter) are snaked through blood vessels to the heart. There −− in the left atrium specifically −− tiny bursts of intense radiofrequency waves are discharged, causing ablation (burning) around the pulmonary vein. "We try to isolate areas in the heart where the rhythm abnormality starts up. Then we put a run of little burns around the veins that come from the heart to the lungs," Dr. Paul Hendry, a cardiac surgeon at the Ottawa Heart Institute, said in an interview. "This approach seems to be effective," he said. Dr. Hendry, also a spokesman for the Heart and Stroke Foundation of Canada, cautioned, however, that the surgery is not for everyone: Generally, catheter ablation is most useful for those who suffer occasional bouts 168

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of abnormal heart rhythms, who have not suffered heart damage, and who have not responded well to medication. (He also cautioned that catheter ablation may not be appropriate for the frail elderly, who make up a large percentage of people with atrial fibrillation.) The usual treatments for atrial fibrillation include shocking the heart (a procedure called transthoracic cardioversion) and drugs to regulate rhythm and thin the blood. That is because abnormal heart rhythms encourage formation of clots, putting people at higher risk of stroke. The new study showed while 74 per cent of surgery patients were able to control their heart rhythm, so were 58 per cent of non−surgery patients who received medication and transthoracic cardioversion. Dr. Hendry said that while that those rates are "not hugely different, it shows we're on the right track." The new research involved only 146 patients, 77 of whom received catheter ablation. All had their heart rhythms monitored for a year. All the participants took the powerful rhythm−regulating drug amiodarone for six weeks before, and 12 weeks after, they were split into surgery and non−surgery groups. After one year, none of the surgery patients required medication to control the symptoms, but 96 per cent of the non−surgery patients still needed the drugs. Asked to comment on Mr. Lemieux's prognosis, Dr. Hendry said: "I can't say he will go back to high−level athletics but after this procedure, a lot of people go back to their normal lifestyle." He cautioned that catheter ablation may not be appropriate for the frail elderly, who make up a large percentage of people with atrial fibrillation. Cardiovascular disease is the leading cause of death in this country. According to Statistics Canada, about 74,600 Canadians died of heart disease in 2002, the most recent year for which data are available. Of that total, an estimated 1,300 died as a direct result of atrial fibrillation. ADDED SEARCH TERMS: SUBJECT TERM:heart diseases; surgery; health care PERSONAL NAME: Mario Lemieux

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No free lunch: Fast−food meals are a financial burden on businesses −− globally, losses could be in the billions, a new study says (National Post)

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National Post 2006.03.02 All but Toronto Body &Health A18 Deborah Zabarenko Reuters WASHINGTON Colour Photo: Burger. 617

WASHINGTON − That fast−food burger, monster take−out sandwich or bag of nutritional nothing you got from the vending machine at work does more than make you sluggish after lunch. It's probably making your company less productive. The global cost amounts to billions of dollars a year in lost productivity, considering that a diet loaded with fat and sugar puts workers at risk for diabetes and obesity−related illnesses, said Christopher Wanjek, who wrote the book on food in the workplace. Obesity accounts for as much as 7% of total health costs in industrialized countries, Mr. Wanjek reported in Food at Work, a review commissioned by the United Nations' International Labor Office. Fat workers are twice as likely as fit workers to miss work. In Canada, figures for 2001 claimed the economic cost related to obesity was estimated at $4.3−billion, including $1.6−billion in direct costs to the health care system. "We're not talking about polio. We're not talking about smallpox. Those diseases were hard to eradicate," Mr. Wanjek said. "We're talking about nutritional diseases. This should be a no−brainer. Provide access to better food, and the disease will go away." There are solutions, but most require imagination and a bit of investment, Mr. Wanjek said. One high−end example is Dole Food Co., which subsidized a healthy dining room for workers at its headquarters in Westlake Village, Ca., starting with an unlimited salad bar for $1.50, free fruit snacks in the morning, free vegetable snacks in the afternoon and encouragement to go to the gym and exercise, alongside the company's chief. After six months, tests on 60 volunteers found lower cholesterol, lower levels of certain proteins that are predictors of future heart disease, lower triglycerides and glucose levels, said Jennifer Grossman, director of the Dole Nutrition Institute. "It really is in the company's best interests to do it, in addition to boosting morale," Mr. Grossman said. 170

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Not every company can afford to do what Dole did, but U.S. health care giant Kaiser Permanente figured employees might eat more healthfully if local farmers set up stalls on the company's grounds. They turned out to be right. "Location is everything," said Dr. Preston Maring, a physician who came up with the farm market plan. "If we put markets in the pathway that people normally walk, it's very hard to pass up a fresh peach in the middle of August." Farm markets are a safe bet at Kaiser's northern California base, where local produce is easily available year−round, but Dr. Maring noted that the program has expanded to 24 locations around the United States. The company pays only for whatever government permits are required, he said. There are innovative programs elsewhere, Mr. Wanjek reported: − Healthy workplace canteens like the one at Husky Injection Molding Systems Ltd. in Bolton, Ont., where red meat and deep−fried items are banned and three helpings of vegetables come with every meal; − Training for street−food vendors in hygiene and food safety in South Africa, Tanzania and India; − Subsidized meal vouchers for use at restaurants and food shops in Brazil, Hungary, Romania, France, Britain, Sweden, India, Lebanon and China. The United Nations has been interested in worker nutrition for decades, but until now it focused on poor countries where the issue was getting enough food and clean water to employees, rather than heading off obesity. "The whole issue of obesity, how it affected workers' health and productivity and how the workplace could become one of the ways of reaching people to combat obesity, had not been explored," the Geneva−based labor organization's William Salter said in answer to e−mailed questions. Mr. Wanjek, himself a rail−thin 6−footer who makes a pot of soup each week and packages it to eat at work, described a vicious cycle based on poor nutrition in the workplace: Poor nutrition leads to poor health, bringing on a lack of energy, strength and co−ordination and a lower learning potential, making for a poorly qualified job pool with lower productivity, resulting in a loss of competitiveness, higher business costs and lower investment and economic growth. In the end this brings about lower wages and then, again, poor nutrition for workers, Mr. Wanjek wrote.

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Sask. pumps in $2.5M for research (The Leader−Post (Regina))

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The Leader−Post (Regina) 2006.03.02 Final Business &Agriculture B6 Jillian Pavlin Saskatchewan News Network; CanWest News Service SASKATOON Colour Photo: Mark Wartman 351

SASKATOON −− The Saskatchewan government has announced $2.5 million in new funding for Ag−West Bio Inc., which will further the development of vaccines for diseases in chickens and also increase the supply of essential fatty acids around the globe. Companies such as Guardian Biotechnologies Inc., which develops the vaccines, Bioriginal Food and Science Corporation, the world's leading supplier of essential fatty acids, and MCN BioProducts Inc., a Canola meal processing company, are just some of the many groups that have been assisted by Ag−West Bio. The industry's umbrella organization primarily funds promising technologies at the early stages of development. The investment announced Wednesday in Saskatoon will enable it to attract already established bio−technology companies to the province, says president and CEO Ashley O'Sullivan. "This government support will allow Ag−West Bio to continue with their efforts to unite science and technology with investment and enterprise, to turn Saskatchewan into a world renowned centre for bio−technology research, development and commercialization," Agriculture and Food Minister Mark Wartman announced to the plant bio−industrial oils workshop attendees. The investment consists of two parts. The first $1.8 million is a two−year extension of the existing $900,000 per year government funding contract with Ag−West Bio. The former Ag−West Biotech organization −− which joined Bio−Products Saskatchewan and the Saskatchewan Nutraceutical Network in April 2004 −− used to be a $1.1 million line item in the Agriculture and Food department's budget. After the formal announcement, Wartman called the $2.5 million a "part of an investment." "Is it enough? Never. We would love to be able to put more into this area." The minister says the government recognizes the need for significant private investment as well. The remaining $700,000 will be injected into the Ag−West bio commercialization fund. It will be used for corporate investment leading to the commercialization of emerging bio−economy opportunities in the province, like Guardian Biotechnologies and MCN BioProducts. Since its inception in 1989, over $10 million has been invested in 44 different companies, explained board of directors chairman Armand Lavoie. "These 172

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companies have contributed over half a billion dollars to the province's economy." Nearly 500 Saskatchewan竏知ade biotechnology products are on the market today.

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AIDS Province announces program to safely dispose of needles; AIDS P.E.I., pharmacist say province needs to set up needle exchange program to stem spread of deadly diseases. (The Guardian (Charlottetown))

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The Guardian (Charlottetown) 2006.03.02 The Province A3 WAYNE THIBODEAU Paul Jenkins, president of the P.E.I. PharmaceuticalAssociation, safely disposes of a needle while Barb Gibson of AIDS P.E.I. holds a new container for the safe disposal of ILLUSTRATION: needles. The buckets, available for free at pharmacies across the province, are part of a new safe needle disposal program. WORD COUNT: 454 The P.E.I. government announced a needle disposal program Wednesday but what's really needed is a needle exchange program, says AIDS P.E.I.'s Barb Gibson. Gibson says she hands out more than 11,000 free needles annually, many to injection drug users. The needles returned to AIDS P.E.I. are usually contaminated with diseases like hepatitis C and HIV. Gibson has been on a campaign to convince the P.E.I. government to set up a needle exchange program where Islanders can pick up free needles at sites across the province. That, she said, may stem the dangerous trend of reusing needles which can spread deadly diseases like HIV and AIDS. "About 48 per cent of my clients reuse needles which is a very dangerous practice," Gibson said in an interview with The Guardian. "We use donation money to buy needles. That's why it's so important for us to be able to get the provincial Health department to be onside with us and help us out." The P.E.I. government announced a safe disposal needle program Wednesday. New safe needle disposal containers will be available free of charge to all Island residents for syringes, needles, lancets and EpiPens. The containers can be picked up at any P.E.I. pharmacy, AIDS P.E.I., Diabetes Association or the Diabetes Education Centre. Islanders can then return full containers to local pharmacies for proper disposal, in exchange for a new container. The program, called Don't Get Stuck, is expected to cost the province about $9,000 annually. Gibson said that's a good start, but she wants the P.E.I. government to go one step further and provide free needles, as part of an overall needle exchange program. That is estimated to cost about $70,000 annually. 174

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Following meetings with Health Minister Chester Gillan, Gibson said she's more positive than ever the program will be established. "It looks as if the Department of Health has taken some initiative in supporting our needle exchange, what that will look like I do not know. It's too soon to tell," said Gibson. "We do have some very hopeful signs that this will be something that we can handle on their behalf." Paul Jenkins, president of the P.E.I. Pharmaceutical Association, agrees with Gibson that a needle exchange program is needed in P.E.I. Jenkins is a pharmacist in Charlottetown. He said many people are buying needles at pharmacies but he realizes many others would not feel comfortable buying needles in a public environment like a pharmacy. "Consistently, pharmacists across P.E.I. do sell needles to drug users not to encourage the habit of drug abuse but actually to make sure if there is drug abuse going on that at least they're doing it as safely as possible," he said. Health Minister Chester Gillan was in budget meetings all day Wednesday and could not be reached for comment. AIDS P.E.I. now receives more than 9,000 used needles annually for disposal. But Gibson warns that 9,000 figure only represents about 20 per cent of the needles that are being used. "The other 80 per cent end up in the garbage, down manholes or down toilets," said Gibson. "We're trying to encourage our clientele to come in and bring their used needles to us so we can dispose of them appropriately." Dropping needles in waste bins can pose serious safety issues for Waste Watch employees. "I want people who use injection drugs to know that this Don't Get Stuck program means them as well," said Gibson. "It doesn't just mean people who have diabetes, or people who use lancets or EpiPens."

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