Sunday House Call #286, October 18, 2009

The Ontario Government’s electronic medical record fiasco spent a billion dollars with little to show for it. At McMaster University, physicians and programmers have developed a comprehensive, secure, web-based and open source electronic health records system that is ready to be rolled out across Canada.

There are several major differences in the way the system was developed. While the government used a top down approach with consultants who do not actually treat patients, the team at McMaster used a ground-up approach based on clinical need and patient-encounter experience.

The McMaster EMR, Oscar, is an open-source program that is continually upgraded through direct clinical use. Physicians, who have programming experience or programmers hired by the clinical staff develop modifications that are submitted to McMaster for quality control and added to the program.

What does this mean for the patient? What can it do for them to assist them in being proactive in their health care management?

Oh yes, one more thing. The McMaster EMR is FREE!

  • Dr. David H Chan, MD, CCFP, MSc, FCFP, Associate Professor in the Department of Family Medicine at McMaster University and a family physician at the Stonechurch Family Health Centre and the developer of OSCAR

There are many branches of stroke research from prevention, emergency treatment, to rehabilitation technologies and therapies. When a person suffers a stroke, it is a race to try to minimize the death of brain cells that follow the initial damage and oxygen deprivation.

Scientists at the Krembil Neuroscience Centre, located at Toronto Western Hospital part of University Health Network, have learned in laboratory-based experiments, how to prevent the death of brain cells which would normally die within a few days after the brain is deprived of oxygen (stroke).

The findings were published in the September 8, 2009 online edition in the journal Nature Neuroscience.

  • Dr. Mike Tymianski, MD PhD FRCSC, Medical Director of the Neurovascular Therapeutics Program at the University Health Network.  Professor in the  Departments of Surgery and Physiology at University of Toronto and Senior Scientist at Toronto Western Hospital Research Institute

Commentary on misrepresentation about H1N1 vaccine and polio heard on The Tony Greco Show on the TEAM 1200 Ottawa on October 17, 2009

0 thoughts on “Sunday House Call #286, October 18, 2009”

  1. Here is some information about Ethyl-mercury on the FDA website. It is important to understand that Ethyl-mercury is still toxic.

    http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/ucm096228.htm

    “Lacking definitive data on the comparative toxicities of ethyl- versus methylmercury, FDA considered ethyl- and methyl-mercury as equivalent in its risk evaluation.”

    “Magos concluded that ethylmercury, the mercury derivative found in thimerosal, is less neurotoxic than methylmercury, the mercury derivative for which the various guidelines are based.”

    “the FDA evaluated the amount of mercury an infant might receive in the form of ethylmercury from vaccines under the U.S. recommended childhood immunization schedule and compared these levels with existing guidelines for exposure to methylmercury, as there are no existing guidelines for ethylmercury, the metabolite of thimerosal.”

  2. Thank you Andrew for your comments.

    Indeed, your assertion of toxicity is correct but it must be taken into context of the dose in the vaccine itself.

    Further, you correctly noted that original assumptions were that ethylmercury found in thimerosal was equivalent in toxicity to methylmercury because there were no direct measurement of the former. On the FDA site you referenced they state the following:

    “The various mercury guidelines are based on epidemiological and laboratory studies of methyl mercury, whereas thimerosal is a derivative of ethyl mercury. Because they are different chemical entities – ethyl- versus methylmercury – different toxicological profiles are expected. There is, therefore, an uncertainty that arises in applying the methylmercury-based guidelines to thimerosal. Lacking definitive data on the comparative toxicities of ethyl- versus methylmercury, FDA considered ethyl- and methyl-mercury as equivalent in its risk evaluation. There are some data and studies bearing directly on thimerosal toxicity and these are summarized in this Section.”

    When reviewing the studies they discovered that ethylmercury is rapidly metabolized and cleared from the body reducing the risk of neurotoxicity; the basis for my comments.

    In the Pichichero study, the FDA article states,

    Blood levels of mercury did not exceed safety guidelines for methyl mercury for all infants in these studies. Further, mercury was cleared from the blood in infants exposed to thimerosal faster than would be predicted for methyl mercury; infants excreted significant amounts of mercury in stool after thimerosal exposure, thus removing mercury from their bodies. These results suggest that there are differences in the way that thimerosal and methyl mercury are distributed, metabolized, and excreted. Thimerosal appears to be removed from the blood and body more rapidly than methyl mercury.

    It was determined later that ethylmercury is cleared from the body and the brain significantly faster than methylmercury, revising the late 1990’s overly conservative estimates of risk. A 2008 study found that the half-life of blood mercury after vaccination averages 3.7 days for newborns and infants, much shorter than the 44 days for methylmercury.

    My point is that toxicity is related to dose and the compound in question. The doses found in the flu vaccine have not been shown to have a deleterious effect on infants and children.

    Thanks again for your comments and taking the time to provide feedback.

    References:

    Toxicology of thiomersal: Clarkson TW (2002). “The three modern faces of mercury”. Environ Health Perspect 110 (S1): 11–23. PMID 11834460. http://www.ehponline.org/members/2002/suppl-1/11-23clarkson/clarkson-full.html.

    Pichichero ME, Gentile A, Giglio N et al. (2008). “Mercury levels in newborns and infants after receipt of thimerosal-containing vaccines”. Pediatrics 121 (2): e208–14. doi:10.1542/peds.2006-3363. PMID 18245396. http://pediatrics.aappublications.org/cgi/content/full/121/2/e208

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