Madely Health Headlines Commentary for January 11, 2011

Reference:

Community Water Fluoridation: Questions and Answers

Preventing Dental Caries: Community Water Fluoridation

Related articles:

1. Detecting the early onset of tooth decay without the need for dental x-rays
2. Not much evidence that we all drink eight glasses of water per day
3. No evidence that Ginkgo Biloba prevents or slows cognitive decline

Dr. Yoni Freedhoff outlines in an article written in this month’s CMAJ how Health Canada is pushing a policy that will allow fortification of foods with vitamins and minerals without any evidence that it will improve public health. Moreover, there is a real risk of overconsumption of said additions to our food supply that can lead to harnful effects.

So, in effect, you will see junk food among others fortified with vitamins and minerals and marketed as an improved product. How utterly shameful.

Related articles:

1. Parents should be aware that certain vitamins may interact with other medications
2. The vitals on vitamins
3. More vitals on vitamins

Ottawa Citizen journalist Dan Gardner castigates, and rightly so, how Olympic athletes sell out to corporations for oodles of cash without any consideration for the potential harm to public health outcomes. His column can be read here.

Related articles:

1. An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All
2. Should Canadian Olympic athletes receive immediate priority for the H1N1 vaccine?
3. Fish oil trial shows some benefit for people with depression but without anxiety

Madely Health Headlines Commentary for December 9, 2009

Sources:

British researchers say little evidence Tamiflu works, but WHO says the drug is useful

Swine Flu Pandemic May Be Less Severe Than Expected

Related articles:

1. Why the H1N1 vaccine program is focusing on high-risk groups first
2. H1N1 may crowd out seasonal flu this year
3. Why the headline “Healthy women at high risk of severe swine flu: study” is misleading

Originally published in The Ottawa Citizen April 22, 2003
Original Title: The Death of Tony Hsu

Dr. Tony Hsu, a Welland pediatrician in practice for 30 years died last week, his body recovered from Lake Ontario. Humiliated and abused by the Medical Review Committee (MRC), his plight, profiled by CTV’s Avis Favro last November, showed us a caring and dedicated physician destroyed by the committee. Dr. Hsu worked on-call one every two nights, provided free service to the Children’s Aid Society and was respected and admired by his patients and colleagues alike.

Last December I wrote about the draconian MRC. The MRC has a mandate from the Minister of Health to “go after” physicians who do not fit a particular computer program billing practice profile. This program will digest and average out the number of specific fee codes a family doctor or specialist should bill in a year. It flags any significant deviation from the “specialty average”. These deviations can occur because of different patient demographics, location of practice (rural North versus Urban setting), the physician’s area of interest or fraud.

The MRC is not a judiciary body. They do not have to listen to evidence, legal arguments or expert opinion. The physicians under investigation have provided the service to their patients. There are no fraudulent acts. Indeed, fraudulent actions are the domain of the Anti-Rackets Squad of the Ontario Provincial Police, not the MRC.

Whatever the reason for the computer flag, the General Manager of OHIP may decide to send a letter to the physician stating he believes the physician has been overbilling for several years. The letter will sometimes state that for a large sum of upfront settlement money, they will drop the file. Should you not agree to make an offer they cannot refuse, the general manager refers the matter to the MRC.

If the physician wishes to mount a defence and submit to a full review, he/she must bear the costs of the entire proceeding.

The physician must prove their innocence instead of the onus on the MRC to prove guilt. Even if only one of the hundreds of reviewed billings is deemed in error, the physician will have to pay all legal costs including the $1000 per day cost of the auditor(s).

Once proclaimed “guilty” the physician must pay back OHIP within one year all overbilling with interest including the MRC and OHIP legal costs (about $15,000 to $25,000) irrespective of an appeal. Exoneration is a rare event.

Should the physician not have sufficient funds to pay the penalty, the government will seize their assets. Further, the MRC can re-audit the physician for a different billing period for the same perceived infraction.

These physicians, aptly described by Dr. Doug Mark, president of the Coalition of Family Physicians, are the “Living Dead”.

The computer flagged Dr. Hsu because he allegedly billed more annual check-ups than the average. What the computer did not reveal was that he billed one-third less consultation fees. In other words, he billed less than his counterparts.

He had to pay back $108,000; close to his yearly net income. He had to cash in part of his RRSP lest the government garnish his entire yearly salary or seize his RRSPs. Dr Hsu was not a criminal, did not commit any fraudulent acts, honestly provided the medical services and diligently served his community. His crime according to the MRC was that did not write enough chart notes to justify billing for an annual check-up although he did perform the check-up. The MRC did not consider the letters of support from his patients and colleagues.

In a prophetic statement last November, Dr, Hsu wrote about the effect the MRC has had on physicians.

“The targeted physicians were by majority hardworking, accountable community pillars with over 15 years in practice. The allegations of wrongdoing were devastating to the unsuspecting physicians.

Initial reactions of disgrace, shame and humiliation were followed by self-doubt as to lifelong misinterpretation of acceptable billing methodology. All experienced overwhelming stress, questioned on what defined fraud, and considered the event an attack of personal integrity. These led to decreased professional work, family disruption, major clinical depression, constant anxiety and post-traumatic stress disorder akin to being subjected to repeated rape. Some practitioners opted for early retirement or gave up hospital privilege. Medical-legal intimidation paranoia was common.”

This trampling of basic human rights and unconstitutional actions destroys the careers and now the lives of Ontario doctors. Canadians are fair-minded people and should be outraged that Soviet-style justice or the English witch-hunting trials of 1650 exist in our country.

Rest in peace Dr. Hsu. Your death will not be in vain.

© Dr. Barry Dworkin 2003

Related articles:

1. How to reduce the doctor shortage
2. Sometimes a doctor can only listen
3. Billing reviews recall witch hunts

Originally published in The Ottawa Citizen December 24, 2002
Original Title: A Witch Hunt by Any Other Name

A recent column by Christina Spencer, John Robson’s radio commentary on CFRA and Citizen Editorial eloquently criticized the Quebec government’s abuse of legislative power over its physician population. In Quebec, all physicians who have worked in an emergency room in the previous four years will now be forced to work in them whether they wish to or not regardless of their qualifications to do so. Should they refuse they will be slapped with a $5000 daily fine.

Lest we direct all our disdain and ire towards the Quebec government’s draconian physician indentured slavery laws, we need not look further than our own backyard.

First, bear with me as we travel back to 1656 London, England. Thomas Ady in his Biblically-based book entitled A Candle in the Dark bravely criticized witch hunts as a scam “to delude the people.” The witchmongers explained any strange event or anything out of the ordinary was the fault of witches “else how should things be, or come to pass?”

Once accused of being a witch, for any reason whatsoever, the game was over. This scam quickly became a means to generate revenues for the “investigators”. All costs were borne by the accused and her family for the trial, investigation and execution materials (wood, tar and hangman’s rope). Each member of the prosecuting tribunal received a bonus for each witch burned. The bureaucracy flourished and grew to serve this industry. The remaining property of the accused was divided between Church and State all legally and morally sanctioned by the Vatican. The accused had no rights, no defense and no hope.

Physician’s billings to OHIP are monitored by a computer program. This program will digest and average out the number of specific fee codes a family doctor or specialist should bill in a year. Any significant deviation from this “norm” is flagged. These deviations can occur because of different patient demographics, location of practice (rural North versus Urban setting), the physician’s area of interest or fraud.

Whatever the reason the general manager of OHIP may decide to send the flagged physician a letter stating that they believe he/she has been overbilling for several years (for arguments sake let’s say $100,000). If the physician wishes to defend themselves and submit to a full review, he/she bears all the costs of the proceedings. The money is returned to the physician if he/she is exonerated; a rare event.

Even if only one of the thousands of billings reviewed is deemed in error, the physician will have to pay all legal costs. Some of these errors can be due to the use of the wrong billing code. For example, mental health counseling uses a K005 code while psychotherapy uses K007. Both pay exactly the same amount but the physician will have to reimburse OHIP if used incorrectly. The computer will flag the physician who it deems is using too many of one of these codes even though he/she indeed provided the service and is not overbilling.

However, should an offer of say $80,000 be made to settle they may drop the file and set their sites on someone else. Should you not make an offer they cannot refuse, the general manager refers the matter to the Medical Review Committee (MRC).

Part of the College of Physicians and Surgeons of Ontario (CPSO), the MRC comprises 12 practising physicians and six public members. They will audit the patient files of the physician under investigation. They do not investigate medical fraud as these cases are turned over to the Ontario Provincial Police Anti-Rackets Squad by OHIP. They are not commissioned to be a judiciary body. They do not have to listen to evidence, legal arguments or expert opinion.

In 1996 the Government of Ontario enacted changes to the existing regulations to increase the number of audits by the MRC and subsequently, the amount of money collected. Between 1998 and 2001, hundreds of doctors have been audited. They were ordered to repay $16.5 million of allegedly overbilled services. There was no proof of fraud or even overbilling, just the belief that this was so.

Once found “guilty” the physician must pay back OHIP within one year of the MRC’s decision all overbilling with interest and the MRC and OHIP legal costs (about $15,000 to $25,000). It makes no difference if the doctor appeals. He/she must pay now or the physician’s billings are withheld at source.

Should the physician not have sufficient funds to pay the penalty, their assets can be seized. To add insult to injury, the MRC can reaudit the physician for a different billing period for the same perceived infraction.

Although not burned at the stake and physically tortured, physicians seem to be subjected to the same bureaucratic persecution process by the MRC and general manager as were the “witches” of England. Physicians subjected to this process are demoralized, ashamed and depressed; their spirit all but vapourized.

The law firm Tremayne-Lloyd Partners LLP, advocates for health law is trying to bring to light the injustices of this process. There may be some changes to the MRC in the near future as both Ontario Health Minister Tony Clement and Ontario Medical Association President Dr. Elliot Halparin review this travesty of justice.

By all means prosecute those physicians who cheat and commit fraudulent acts. We already have a system to do so. It is called due process and courts of law. The last time I checked physicians have not traded in their stethoscopes for brooms.

Thank you to Dr. Doug Mark, President of the Coalition of Family Physicians for this information.

© Dr. Barry Dworkin 2002

Related articles:

1. Death of caring doctor should concern all Canadians
2. Small study shows reduced recall of negative memories after using cortisol-blocking medication
3. Study reviews the drug interactions between cardiac medications and herbal products

Originally published in The Ottawa Citizen September 24, 2002
Original Title: Copy Capers

A recent Dave Brown column touched upon the thorny issue of patient chart transfer requests. He cited the case of one individual who expressed his irritation with transfer fees that he felt should be free of charge. Copyright law analogy provides the basis for his assertion. His claim is that patient chart notes are paid by the patient through taxation and as such did not belong to the physician. The physician writing the notes does so for the patient who subsequently owns the record.

The crux of the issue is not who owns the charts. It is the expectation that all medical and administrative services should be free. OHIP pays for medical, not extra-administrative services. In some instances considerable secretarial time is spent collating the documents. Odd-sized lab report paper cannot be automatically fed through the photocopier feeder and require manual single sheet copying. The chart notes and lab results are sorted chronologically and if necessary a covering note from the physician is placed at the front. Then it is mailed to the new physician.

This is not about copyright law. The medical records are not being published. The information contained within the chart belongs to the patient. They are entitled to a copy of their records. The physician requires their own original copy to best provide patient care and for medicolegal purposes. Records must be kept for ten years beginning from the date of the last patient visit.

It has been my experience that patients sometimes lose original documentation. Heck, they misplace prescriptions and ask for another an hour after I prescribed it for them! Mistakes happen. If the originals are lost, copied records are a poor substitute for purposes of legibility (multiple copies of copies degrade resolution) and original evidence.

The OMA provides guidelines for third party billing purposes where OHIP fees do not cover these services. It states in the OMA Physicians Guide to Third Party and Other Uninsured Services, Section 1, Para. (e): “Preparation and transfer of an insured person’s health records when this is done because the care of the person is being transferred at the request of the person or person’s representative. In addition to the office overhead, the physician may charge for his or her time in preparing the information for transfer.”

Where I part company with the guideline’s fee is thus: their recommended rate is $27.96 for pages 1-5 and $1.12 for each page thereafter. I know that the physician writes the notes but it is hardly worth the price of a thick novel. In our practice we charge $15 for pages 1-5 and ten cents per page thereafter. The average cost is about $20. For whole families, the $15 is waived for each additional family member. I believe this is a reasonable compromise.

There has to be a reasonable accounting for services and value provided for the fee. Our health care system has influenced the public’s expectation that all requests for services are free and therefore have no inherent value. This is especially true for sick notes or for telephone or fax prescription renewal requests. I do not agree that I or any physician should work for nothing. You would not expect the same from any other professional service that provides reports and information requested by an individual. If I request a transfer of my business accounting records from my accountant, I would receive a bill for the service.

OHIP pays the physician for the services outlined in the General Preamble of The Schedule of Benefits (physician billing code book), not the patient. The purpose of OHIP is to remove the barriers between doctor and patient by having a third party pay for the medical services. The physician does not have to worry about payment and the patient need not be hindered by lack of funds in seeking medical care. The doctor-patient relationship is protected by this arrangement.

The notion that the public pays my salary is not quite correct. OHIP is an insurance organization. Other insurance companies collect premiums from their clients. If the client has an accident or requires medical attention, the insurance company will pay the professional fees. Would one say then that all the clients pay the salary of that professional? Or is it the insurance company that oversees these funds and negotiates the best value for their dollar? Where does the circle of funding end?

Let us look at government contracting out service requests from independent businesses or third party individuals. Do we assume that these people are beholden to the taxpayer? Are they not independent businesses on contract to government? Is it not the government who is responsible for how the money is spent in-trust for the taxpayer? Where is the public outrage about the recent disclosures of misappropriation of federal monies?

The circuitous logic of where the money trail begins and ends and who owns the money is flawed. Frankly the basis for the whole issue centres once again on the insinuation that doctors are greedy and are looking for any angle to justify the extra fees. It is an issue that is demeaning to me and my profession.

I do not condone exorbitant fees for chart transfers. I do not withhold the chart if the patient does not pay. I rely on good faith and reputation as the carrot. There is no stick. I do not subscribe to the notion that because I am paid through OHIP, I am beholden to the whims and rages of the taxpayer. At some point the refrain “I pay your salary”, denoting control, loses its charm.

© Dr. Barry Dworkin 2002

Related articles:

1. Doctors must factor in free will of the patient
2. Patient Safety in Ontario Acute Care Hospitals
3. Patient Safety in Canada 2007

Originally published in The Ottawa Citizen August 21, 2002
Original Title: Who Wants to Save a Million Dollars?

Despite the problems in our health-care system, there are some roses worth our attention. One such rose is the Riverside Acute Care Medical Centre. Unfortunately, if the Ottawa Hospital administration has its way, the rose will whither at the end of September this year.

The Health Restructuring Commission, in its final report, stated that the Ottawa Hospital provide both community-based and teaching-based hospital services. To that end the Riverside has done an admirable job as a community-based facility. In fact, the Riverside Hospital was rated outstanding during its accreditation process four years ago. It was the second most cost effective hospital in the province.

Servicing an older population as well as families from all over Ottawa, the Riverside Acute Care Medical Center (RACMC) not only provides acute care but virtually all of the emergency services that are found at Ottawa Civic (OCH) and General (OGH) and Queensway-Carleton (QCH) hospitals. The primary difference between the ACMC and an emergency room is that the Riverside does not accept ambulances; you have to be able to walk in. A tour of the Centre revealed a spacious, bright and well-organized emergency room.

There are four electronically monitored cardiac beds. The staff is prepared to treat heart attacks, irregular heart beats, respiratory distress and other life threatening conditions if they walk in. They will administer clot-busting drugs to treat heart attacks. For patients that do not require in-hospital cardiac admission, a cardiology clinic nearby will receive patients from the ER after the assessment.

The centre has nine decently-sized cubicles, a Gynecology room, Ear, Nose and Throat (ENT) assessment room, and an eye station for ocular emergencies. Two orthopedic surgeons provide follow-up for fractures seen at the ACMC. A large casting room houses all the equipment. Complex fractures or open fractures (bone protruding through the skin) that require immediate treatment are referred to the tertiary centres like the General or Civic.

There are two well-stocked and equipped suture rooms to handle most skin trauma.

The Centre has an Intravenous Room for patients requiring antibiotic treatment. Patients no longer remain in hospital for this simple procedure. They come in at designated times for about 30 to 60 minutes and then go about their daily business. Everyone supports this cost-effective alternative. Ten ER physicians provide medical services from 11 AM to 10 PM every day. The Centre used to open at 7 AM but the Ottawa Hospital administration cut the hours back last October because they felt it competed with the local family doctors; a non-issue since many of the doctors refer their patients to the Centre when on vacation or for further medical assessment and treatment.

Approximately 80 to 120 patients are seen daily or about 40,000 per year. Three physicians staff the ER every day. If patients come to the ACMC simply because they are unable to find a family doctor they are treated and are given a list of family doctors accepting new patients when they leave.

Patients come from all parts of Ottawa including Barrhaven, Kanata and Stittsville for simple reasons. They get first-class medical treatment within a reasonable time frame. Waiting times at the QCH are about four to five hours, the OCH, five hours and the OGH six to seven hours. The Riverside average wait is one to two hours. There is also ample parking in front of the Centre.

This is a win-win Centre for the ER system, staff and patients. Patients love the service, family doctors have a means to provide quick ER assessment for their patients and ER physicians and nurses have first-rate facilities. It also saves the system money because it is more expensive to evaluate patients in a tertiary centre.

The tertiary centres can focus on their mandate to handle the complex injuries and intensive care services. Indeed, the Riverside relieves the tertiary centres of the less complicated patient emergencies thereby relieving the pressure off these centres. They also stabilize the more critically ill patients prior to transferring them to the tertiary hospital.

The Ottawa Hospital administration plans to close the Riverside Acute Care Centre this September 28th. The administration wishes to cut costs to the global hospital budget. The projected saving is one million dollars per year. The provincial government has not been involved in this decision. Indeed this decision seems to contravene the Health Restructuring Commission’s recommendation to maintain community-based services.

The staff and patients are baffled by this decision. It is difficult to understand how money will be saved. All the nursing staff will be transferred to other departments within the Ottawa Hospital System. Their salaries will not change. The bricks and mortar of the ER will remain and will have to be maintained. The physicians will move on and see patients elsewhere for the same OHIP payments. Forty thousand patients per year will flood the remaining ERs increasing waiting times and straining service provision. It will cost more to treat them.

Patients stand to lose money from lost wages because of longer waiting times. Imagine waiting six to eight hours to have a simple wound sewn up.

The General plans to provide a fast-track triage and treatment centre for many of these patients. If this is the case, how much of that million dollar saving will be spent to re-invent the wheel? The Riverside already fulfills this fast-track concept.

This seems to be a monetary shell game by an administration under pressure to show it is cutting services to save money. The Riverside physicians looked into privatizing the Centre to keep it afloat but the OHIP remuneration for patient services, when overhead was deducted, was insufficient to attract enough physicians to maintain the service.

This is a situation where the funding of community emergency health-care services should be borne by the public system. I urge everyone to let the Ottawa Hospital administration know what they think about this decision. Everyone loses if it closes.

© Dr. Barry Dworkin 2002

Related articles:

1. The Maplesoft Centre opens in Ottawa
2. Recommendations to ease emergency room overcrowding
3. Travelling gallstones warrant emergency care

Originally published in The Ottawa Citizen July 9, 2002
Original Title: Who Wants to be a Millionaire

How much are doctors paid? It varies depending on the medical specialty. Certainly some specialties provide a greater income for its practitioners but on average most physicians are not pulling in the big bucks as perceived by the public. In March 2000, the Coalition of Family Physicians representing 3000 Ontario family doctors commissioned a survey by Northstar Partners asking Ontarians how much they thought their family doctors were paid for different services. People provided estimates that were as much as 300% more than the actual fees.

After three years for a bachelor’s degree and four years for a medical degree, the new physician enters residency. Depending on the specialty, residency can last from two to seven years. It takes nine years of university to become a family doctor, ten to 15 for other specialties. As usual the public, always ahead of our elected officials, have clearly stated through the Northstar survey that family doctors are not remunerated at the rate they expect.

The four most common fees or billing codes used by family Physicians (FPs) are the Minor, Intermediate, General Assessment (GA) and Counseling/Psychotherapy.

The Minor involves the evaluation of one body system. A sore toe, simple blood pressure check or suspicious mole would qualify for this code.

An intermediate assessment evaluates two body systems. These include visits for colds, abdominal or chest pain, headaches, rectal bleeding or HIV amongst others.

The GA or Annual Exam includes a complete history and physical examination which can take 30 to 45 minutes to complete.

Ontarians estimated that family doctors are paid an average of $106.60 for an intermediate exam and $153 for an annual examination. Two thirds of respondents said that FPs are paid for specialist referrals and receive about $68.70 for this service.

The actual fees are $17.30 (Minor), $27.30 (Intermediate), $54.10 (GA) and psychotherapy/counseling is $50.45 per half hour. Doctors are not paid for specialist referrals, telephone consultations and telephone prescription renewals. The average office overhead expenses consume between 40 to 50% of these gross billings.

What about that Pap test or IUD that was replaced? A Pap test is $4.35; an IUD insertion is $20.80. A well baby check up including vaccination is $31.05. Deliver a baby, $338.95. If delivered after midnight, $567.74.

OHIP pays for 90 minutes of counseling per topic per year. There are no such restrictions for psychotherapy. Many illnesses require more than 90 minutes a year to answer patients’ questions, address their concerns and provide adequate information. This is especially true for adolescent patients. Well-informed patients are more likely to accept their physician’s recommendations and follow their treatment plan.

The ministry believes that rationing this aspect of care will save money. In fact the less informed, the more non-complaint the patient. Costs increase due to unused medications, deteriorating medical conditions and increased hospital admissions.

One of my colleagues provided a breakdown of his yearly salary for 2000:

• Gross income: $162,123.21. (The figure oft quoted by governments)
• Office overhead: $63,799.77.
• Medical dues and licensure: $4446.00.
• RRSP contributions: $13,500.
• Taxable income: $77,539

He works an average 50 hours per week including weekends. This translates into an hourly wage of $39.30 based on net income. He does not have a pension plan, vacation pay, disability benefits, EI, dental plan and sick days. These all have to be paid out of his after tax income.

I paid $65 per hour to have my car repaired. There are television actors that portray doctors who are paid more per season than what a physician will earn in their lifetime. Despite the public perception that doctors “make lots of money”, most doctors earn a comfortable middle class income.

Office overhead is the crux of the problem. Costs increase by three to four percent per year. Our office staff works diligently to provide the best service to our patients. It becomes difficult to reward this good work when we cannot keep pace with the cost of inflation. The latest agreement with the government provided a two percent increase in fees the last two years with the latest increase being one percent this past April.

Our society idolizes celebrities and sports personalities and willingly contributes to their lucrative salaries. How much are nine to 15 years of university training plus the years of practice experience worth? The markets usually decide these things. But our system is centrally controlled. We all live with it because of the choices we make. I do not think you will encounter many physicians who will complain about their salaries. I write this column to counter the common media mantras that we are fat cats earning gazillions of dollars.

We are indeed privileged to have the opportunity to practice medicine. All of us want to just get on with what we do best. If we are to have others determine our fees, all we ask is to be treated fairly like anyone else.

By the way, the surgeon’s fee for a hip replacement: $675.60, a heart transplant: $1400.75. My last car tune up: $800. And no one had to worry about the life of the car.

© Dr. Barry Dworkin 2002

Related articles:

1. Doctors Should Discuss Obesity With Patients
2. Doctors must factor in free will of the patient
3. Report states doctors prescribing too much, in fact, they are doing too much of everything

Originally published in The Ottawa Citizen April 30, 2002

Nudge, nudge, wink, wink, say no more! – Eric Idle – Monty Python’s Flying Circus

Recent reports in the National Post and Ottawa Citizen about Health Canada’s failure to disclose to Canadians in the mid 90′s the lead risk in Turkish raisins is another example of political correctness intruding into scientific inquiry. Despite the fact the United State’s Food and Drug Administration (FDA) banned these raisins, Health Canada traveled to Turkey to convince the grape growers not to use a fungicide contaminated with lead.

The growers ignored the request and continued to use the pesticide. Yet Health Canada’s response over a three year period was to inform foreign health organizations but not Canadians. Given the grower’s refusal to cooperate, Health Canada should have banned the raisins until the growers acquiesced to the request. Instead the raisins kept on coming landing up in the hands of children.

Minister of Health Anne McLellan told the House of Commons, “The conclusion of the risk assessment was that there was no unreasonable risk to health. That is why no consumer alert was issued. There have been no raisins imported into this country since November, 1995, that exceeded that established level.”

Indeed, if Health Canada’s determination “that there was no unreasonable risk to health”, why bother informing other countries of the problem. Further, why travel to Turkey to dissuade pesticide use if there was no appreciable health risk?

It seems the United States and United Kingdom concluded otherwise. Advisories were released to the public. The FDA’s acceptable limit for lead in raisins is 250 parts per billion (250 ppb), Health Canada’s, 500 ppb. In fact, the FDA measured lead levels approaching 1000 ppb in early 1996. Other sample screenings of shipments from Turkey found levels in the range of 830 to 980 ppb. These levels far exceeded the 500 ppb Canadian limit. Despite the contention that shipments to Canada ceased in late 1995, it is not unreasonable to assume the lead limit in these raisins did indeed exceeded 500 ppb.

What does lead do to children? It can damage the brain by interfering with the chemicals (neurotransmitters) the brain’s nerve cells use to communicate with each other. This can lead to long-term cognitive and behaviour disorders, reduced IQ levels and decreased fine and gross motor (movement) skills. It can cause heart arrhythmias (irregular heart beat), kidney damage, anemia and hypertension. It accumulates in bone acting as a reservoir for lead.

Children absorb about 50% of ingested lead compared to about ten to 20% in adults. It is for this reason that lead exposure in children is so hazardous. Parents need full disclosure of products that have the potential to harm their children. Only then do they have the opportunity to choose how to protect their children.

What would be the reaction if a doctor did not fully disclose potentially important medical information to their patient? Failure to do so would compromise the patient’s right to make an informed treatment decision. It is also malpractice. The patient has recourse to ensure the physician is accountable for their actions. In some cases the physician has to provide financial recompense. They can also lose their license to practice medicine.

The same rules of conduct do not seem to apply to our politicians and bureaucrats. The complexity of the bureaucracy seems structured so that accountability never sticks to any individual. The Federal Health Minister is ultimately responsible for Health Canada’s public health decisions. Yet why is it so difficult to admit that a mistake may have been made? By defending the status quo at Health Canada, public confidence in the government’s ability to ensure public safety suffers. In fact, admitting fallibility and taking action to rectify the problem increases confidence.

Instead we get a Monty Python skit. Minister of Silly Walks anyone?

© Dr. Barry Dworkin 2002

No related posts.