BUPA Worldwide insurance (since 1947) now covers CANADA

British United Provident Association now offers Canadian coverage. Multiple options.(in USA$) For World Hospital treatment (except USA) 29y-$1584 year; 39y- $2595; 49y- $3417. (Private General Hospitals now exist Montreal ROCKLAND MD; Ontario has one:Homewood Psychiatric in Guelph) RocklandMD MEDICAL CLINIC DOWNTOWN MONTREAL 1538 Sherbrooke ouest, Office 500, Montreal (Quebec) H3A 1L5 Guy-Concordia Metro Opening hours Monday to Friday from 8:00 am. to 4:00 pm Phone 514-667-3383 option 1 Toll Free 1-866-677-3383 Fax : 514-667-3834 EMAIL : info@rocklandmd.com ROCKLANDMD MEDICAL CLINIC VILLE MOUNT-ROYAL 100 Rockland road, suite 110, Ville Mont-Royal (Québec) H3P 2V9 Acadie metro Opening hours Monday to Friday 7:00 am to 6:00 pm Saturday from 8:00 am to 4:00 pm Phone 514-667-3383 option 1 Toll Free 1-866-677-3383 Fax : 514-667-3834 EMAIL : info@rocklandmd.com ROCKLANDMD SURGERY CENTER VILLE MOUNT-ROYAL 100 Rockland road, 115A, Ville Mount-Royal (Quebec) H3P 2V9 Acadie metro Opening hours Monday to Friday from 7:30 am to 18:00 pm Phone 514-667-3383 option 2 Toll Free 1-866-677-3383 Fax : 514-667-3834 EMAIL : info@rocklandmd.com

ONTARIO CHAPTER American College Physicians Anglo-Canadian Nephrologist Prof A.R. MORTON.

Meet Our Governor-elect Designee Ontario Chapter Congratulations to the Ontario Chapter Governor-Elect Designee, Alexander Ross Morton, MD, FACP. Our new Governor-elect Designee will do a year of training as a Governor-elect and then will start his four-year term as Governor in the Spring of 2015. As Governor, Dr. Morton will serve as the official representative of the College for the Ontario Chapter, providing a link between members at the local level and leadership at the national level. In the meantime, Dr. Morton will be working closely with Dr. Feldman (the current Governor) and College staff to learn about the College and his duties as Governor. To learn more about Dr. Morton, feel free to read his bio below. Alexander Ross Morton, MD, FACP Dr. Morton EDUCATION: University of Saint Andrews, University of Manchester POST DOCTORAL TRAINING: University of Manchester, University of Toronto; CERTIFICATION: BSc (Saint Andrews) MB ChB (Manchester) MD (Manchester); FRCP (London) FRCPC (Canada) FACP PRESENT POSITION: Professor of Medicine, Queen’s University, Kingston, Ontario, Canada ACP ACTIVITIES: FACP October 2008 CHAPTER INVOLVEMENT/LEADERSHIP ACTIVITIES: Member of the Governor’s Advisory Council. Queen’s University representative. Frequent Speaker at Chapter Annual Meeting HOSPITAL/COMMUNITY SERVICE: Kingston General Hospital OTHER APPOINTMENTS: Chair, Division of Nephrology AREAS OF PROFESSIONAL INTEREST/EXPERTISE: General Internal Medicine, Nephrology, Mineral Metabolism Vision Statement The Ontario Chapter of the American College of Physicians has forged strong links with the Canadian Society of Internal Medicine this year. These links needs to be maintained and strengthened to include other Chapters across the country. With the President of the Canadian Medical Association due to be appointed from Ontario in the summer of 2014, this is an ideal opportunity to increase dialogue between the two major national organizations using Ontario as a base. The link between the Ontario University and Community Physicians is ripe for strengthening as Social Media communications increases. Issues relevant to the membership can be brought to the attention of the Chapter quickly and dealt with in a timely manner, enhancing the relevance of the ACP to the Ontario membership. Furthermore using such rapid communication techniques, Medical Student and Trainee interest can be engaged, and educational opportunities increased.

ProMed:ZIKA VIRUS- FIRST in EUROPE A SEXUALLY TRANSMITTED DISEASE

PRO/EDR> Zika virus - Germany ex Thailand Inbox x promed@promedmail.org 20:24 (12 hours ago) to promed-post, promed-edr-post ZIKA VIRUS - GERMANY ex THAILAND ******************************** A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases Date: Fri 27 Dec 2013 From: Jonas Schmidt-Chanasit [edited] A previously healthy 53-year-old man consulted at the Saarland University Medical Center on 22 Nov 2013 after returning from travel to Thailand. During his 3-week round trip (31 Oct-20 Nov 2013), including visits to Phuket, Krabi, Ko Jum, and Ko Lanta, he developed joint pain and swelling on his left ankle and foot on 12 Nov 2013 after several mosquito bites, followed by a maculopapular rash on his rear and front trunk that spread to the face and the upper as well as lower extremities over the next 4 days before fading. Accompanying symptoms were malaise, fever, and shivering, of which the latter 2 appeared only for one day. He and his travel partner, who never had any comparable symptoms, were using insect repellent during travel. Upon presenting in Germany, which was intended as a check for tropical diseases and included taking blood samples, no clinical signs could be found, and the only subjective complaint was continuing tiredness. Initially, the 1st serum sample collected 10 days after disease onset gave a positive result in the dengue IgM antibody tests (IFA and rapid test), although tests for dengue IgG antibody (IFA and rapid test) and dengue NS 1 antigen (ELISA and rapid test) were negative. However, the isolated positive result for dengue IgM antibodies prompted us to investigate a probable flavivirus etiology through a serological approach. Serological tests for Japanese encephalitis virus, West Nile virus, yellow fever virus, tick-borne encephalitis virus, and Zika virus were performed by the WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research (WHOCC), Hamburg, Germany. IFAs gave positive results for Zika virus IgG and IgM antibodies, demonstrating an acute or recent Zika virus [ZIKV] infection of the patient. In contrast, IFAs gave negative results for the other flaviviruses tested as well as for chikungunya virus. Real-Time RT-PCR for ZIKV RNA (in-house) was negative. The presence of ZIKV-specific neutralizing antibodies was confirmed by a virus neutralization assay, and an IgM titer decrease in IFA was demonstrated in the 2nd serum sample collected 31 days after disease onset. This is the 1st laboratory confirmed case of ZIKV reported in Germany and Europe and the 2nd case reported from Thailand. Thus, differential diagnosis in febrile returning travelers from the south of Thailand (Phuket, Krabi, Ko Jum, and Ko Lanta) should include Zika virus infection. -- Jonas Schmidt-Chanasit, Petra Emmerich, Dennis Tappe, Martin Gabriel, Stephan Gunther: Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, National Reference Centre for Tropical Infectious Diseases, Hamburg, Germany. Jorgen Rissland, Gerhard Held, Sigrun Smola: Saarland University Medical Center, Homburg/Saar, Germany [ProMED thanks Jonas Schmidt-Chanasit and colleagues for sending in this interesting, firsthand report. This is the 2nd ProMED-mail report of a Zika virus infection originating in Thailand. The virus was 1st isolated in 1947 from sentinel rhesus monkey serum in Uganda. Fortunately, the probability of ongoing transmission from this case in Germany is nil. This is another example of long-distance international travel involving an individual who acquired a tropical arbovirus disease who was seen in a temperate zone clinic halfway around the world. The above case is an excellent example of a thorough laboratory approach to establishing a diagnosis of a disease exotic to Germany. It also underscores the importance of taking a good travel history for these types of cases. It also indicates that Zika virus transmission is active in Thailand and could be confused easily with a dengue virus infection without comprehensive laboratory testing. This report along with the earlier one this year [2013] make one wonder how many Zika virus infections in Thailand and other Southeast Asian countries are mistakenly diagnosed as dengue virus infections.

CME: Can.Soc.CLINICAL HYPNOSIS

CANADIAN SOCIETY OF CLINICAL HYPNOSIS (ONTARIO DIVISION) announces registration opening for: The Fundamentals of Hypnosis a two-day Introductory workshop - March 28th and 29th $575 until Feb 17th, then $625 Non-members can pay online to reserve their spot, but you still need to mail your registration form to establish eligibility. www.HypnosisOntario.com Book soon, attendance may be limited. Full details are in the attached brochure in Adobe PDF format

GILEAD: SOVALDI (Sofosbuvir) for Chr.HEP.C.

Health Canada Issues Notice of Compliance for Sovaldi™ (Sofosbuvir) for the Treatment of Chronic Hepatitis C – Sovaldi Receives Marketing Authorization for Patients with Genotypes 1, 2, 3 or 4 HCV – – High Cure Rates (SVR 12) and Therapy Shortened to Just 12 Weeks for Many Patients – FOSTER CITY, Calif.--(BUSINESS WIRE)--Dec. 16, 2013-- Gilead Sciences, Inc. (Nasdaq: GILD) today announced that Health Canada has issued a Notice of Compliance for Sovaldi™ (sofosbuvir) 400 mg tablets, a once-daily oral nucleotide analog polymerase inhibitor for the treatment of chronic hepatitis C (CHC) infection. Sovaldi is indicated for use in adult patients with compensated liver disease, including cirrhosis, for the treatment of genotype 1 or 4 CHC in combination with pegylated interferon and ribavirin, and for the treatment of genotype 2 or 3 CHC in combination with ribavirin. The recommended dose and treatment duration for Sovaldi combination therapy is as follows: Treatment Duration Treatment-naïve patients with genotype 1 or 4 CHC Sovaldi + peginterferon alfa + ribavirin 12 weeks Patients with genotype 2 CHC Sovaldi + ribavirin 12 weeks Patients with genotype 3 CHC Sovaldi + ribavirin 16 weeks* * Consideration should be given to extending the duration of therapy beyond 16 weeks and up to 24 weeks guided by an assessment of the potential benefits and risks for the individual patient (these factors may include cirrhosis status and treatment history). Treatment regimen, duration and response to Sovaldi are dependent on viral genotype and patient population, and associated baseline factors. Sovaldi must not be administered as monotherapy. The Canadian Product Monograph is available at www.Gilead.ca. Gilead submitted the marketing application for Sovaldi in Canada on May 17, 2013 and was granted Priority Review by Health Canada. Gilead is awaiting federal and provincial reimbursement review for Sovaldi under the Canadian Common Drug Review process. Gilead anticipates that Sovaldi will be available to patients in Canada early next year. Sovaldi was approved in the United States on December 6, 2013 and applications are pending in the European Union, Australia and New Zealand, Switzerland and Turkey. “I believe sofosbuvir has the potential to transform HCV treatment in Canada as it addresses many unmet patient needs,” said Jordan Feld, MD, MPH, Staff Hepatologist, Toronto Western Hospital, Department of Medicine, Division of Gastroenterology. “The high cure rates, shortened treatment duration, and potential to eliminate or reduce interferon injections give us our best opportunity to successfully treat Canadians with hepatitis C.” An estimated 250,000 Canadians are living with chronic hepatitis C virus (HCV), but because the disease can progress for many years without causing noticeable symptoms, about 35 percent of these individuals do not know they are infected. HCV disproportionately impacts “baby boomers,” individuals born between 1945 and 1965, and the Canadian Liver Foundation now recommends that all Canadian baby boomers be tested for the virus. The current standard of care for HCV in Canada involves up to 48 weeks of therapy with a pegylated interferon (peg-IFN)/ribavirin (RBV)-containing regimen, which may not be suitable for certain types of patients. The marketing authorization is supported primarily by data from four Phase 3 studies, NEUTRINO, FISSION, POSITRON and FUSION, which evaluated 12 or 16 weeks of treatment with Sovaldi combined with either RBV or RBV plus peg-IFN. Three of these studies evaluated Sovaldi plus RBV in genotype 2 or 3 patients who were either treatment-naïve (FISSION), treatment-experienced (FUSION) or peg-IFN intolerant, ineligible or unwilling (POSITRON). NEUTRINO evaluated Sovaldi in combination with peg-IFN/RBV in treatment naïve patients with genotypes 1, 4, 5 or 6. Patients who achieve SVR12 are considered cured of HCV. Trial participants taking Sovaldi-based therapy achieved SVR12 rates of 50-90 percent. For full study details, see the Clinical Studies section of the Product Monograph. Sovaldi combination therapy was well tolerated in clinical studies. Adverse events were generally mild and there were few treatment discontinuations due to adverse events. The most common adverse reaction occurring in at least 5 percent of patients receiving Sovaldi in combination with ribavirin was fatigue. Among patients receiving Sovaldi in combination with RBV and peg-IFN, the most common adverse reactions occurring in at least 5 percent of patients were fatigue, anemia, neutropenia, insomnia, headache and nausea. See below for Important Safety Information regarding contraindications, warnings and precautions, adverse reactions and drug interactions. Patient Assistance Program in Canada As part of its commitment to ensuring that people with hepatitis C can access Sovaldi, Gilead Sciences Canada has developed the Momentum Support Program™, which will launch on January 6, 2014. The program is designed to provide an integrated offering of support services for patients and healthcare providers, including: Access to dedicated case managers to help patients and their providers with insurance-related needs, including identifying alternative coverage options such as federal and provincially-insured programs. The Sovaldi Co-pay assistance program, which will provide financial assistance for eligible patients who need help paying for out-of-pocket medication costs. For more information regarding Sovaldi or the Momentum Program in Canada, please call the Gilead Sciences Canada medical information line at 1-866-207-4267. About Sovaldi Sovaldi is an oral nucleotide analog inhibitor of the HCV NS5B polymerase enzyme, which plays an essential role in HCV replication. Sovaldi is a direct-acting agent, meaning that it interferes directly with the HCV life cycle by suppressing viral replication. Treatment regimen and duration for Sovaldi are dependent on both viral genotype and patient population. Treatment response varies based on baseline host and viral factors. Sovaldi must not be administered as monotherapy. - See more at: http://www.gilead.com/news/press-releases/2013/12/health-canada-issues-notice-of-compliance-for-sovaldi-sofosbuvir-for-the-treatment-of-chronic-hepatitis-c#sthash.wY1SdSIb.dpuf

BMJ: COITUS PORTALIS

Like a virgin (mother): analysis of data from a longitudinal, US population representative sample survey BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f7102 (Published 17 December 2013) Cite this as: BMJ 2013;347:f7102 Amy H Herring, professor12, Samantha M Attard, PhD candidate23, Penny Gordon-Larsen, professor23, William H Joyner, the reverend4, Carolyn T Halpern, professor25 Author Affiliations Correspondence to: A H Herring amy_herring@unc.edu Abstract Objective To estimate the incidence of self report of pregnancy without sexual intercourse (virgin pregnancy) and factors related to such reporting, in a population representative group of US adolescents and young adults. Design Longitudinal, population representative sample survey. Setting Nationally representative, multiethnic National Longitudinal Study of Adolescent Health, United States. Participants 7870 women enrolled at wave I (1995) and completing the most recent wave of data collection (wave IV; 2008-09). Main outcome measures Self reports of pregnancy and birth without sexual intercourse. Results 45 women (0.5%) reported at least one virgin pregnancy unrelated to the use of assisted reproductive technology. Although it was rare for dates of sexual initiation and pregnancy consistent with virgin pregnancy to be reported, it was more common among women who signed chastity pledges or whose parents indicated lower levels of communication with their children about sex and birth control. Conclusions Around 0.5% of women consistently affirmed their status as virgins and did not use assisted reproductive technology, yet reported virgin births. Even with numerous enhancements and safeguards to optimize reporting accuracy, researchers may still face challenges in the collection and analysis of self reported data on potentially sensitive topics.

OMA PRESIDENT Stoney Creek (Hamilton) GP Scott Douglas WOODER

Dr.S.D.WOODER MD (U.Toronto 1985) High School:Scarborough CEDERBRAE COLLEGIATE INSTITUTE. Married: McMaster U.Professor Lori WHITEHEAD MD(Tor.1985) FRCPC(Internal Medicine & Respirology) Daughter:Hamilton Realtor Jess WOODER BA (McMaster U.,Sociology) STONEY CREEK HEALTH SCIENCE BUILDING Dr. C. Ambis Family Physician Dr. B. Babic Pediatrician Dr. M. C. De Benedetti Family Physician Dr. F.D. Fraser Family Physician Dr. K. Hallett Pediatrician Dr. J. Jones Family Physician Dr. T. Kwok Family Physician Dr. A. Lozinski Dermatology & Cosmetic Surgery Dr. J. Profetto Family Physician Dr. S. Wooder Family Physician

Mycobacteriun leprae incidence in INDIA

LEPROSY - INDIA (05): (ANDHRA PRADESH) INCREASED INCIDENCE ********************************************************** A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases Date: Sat 21 Dec 2013 Source: The Times of India Times News Network (TNN) [edited] Leprosy is increasing alarmingly in Andhra Pradesh with the government doing little to check the bacterial infection from spreading, experts said as a staggering 8285 cases were reported in the state during 2012-13. As many as 239 new cases were detected in Hyderabad in the same period. Health department officials said Andhra Pradesh now figures among the top 12 states with the highest caseloads of leprosy in the country. The proportion of new paediatric cases in the state was also among the highest in the country, experts said. Data from the National Leprosy Eradication Programme shows that out of the total new cases, a substantial 911 cases (11.34 per cent) are of children, officials said. Experts said the numbers have gone up particularly in the last 2 years. During 2011-12, 7820 cases were detected, they pointed out and attributed the situation to the state government's apathy towards the health issue, so much so that it is now regaining ground. "We could not identify these cases well in time," said Dr Michael Sukumar, a WHO consultant who is working with the state leprosy cell [in Hyderabad], underscoring a situation when agencies are sometimes helpless when local governments fail to read health warnings.

UK DAILY MAIL:: ERROR in "NIL BY MOUTH" at ROYAL BOURNEMOUTH HOSPITAL

Elderly patient starved because a 'nil by mouth' sign meant for the previous occupant of her bed had not been removed Royal Bournemouth Hospital in Dorset under attack from hospital inspector Care Quality Commission inspection found alarming care of elderly patients One was left naked on top of a soiled sheet and other forced to wet the bed Another left on the verge of malnutrition because they couldn't reach food By Anna Hodgekiss PUBLISHED: 11:49 GMT, 19 December 2013 | UPDATED: 11:53 GMT, 19 December 2013 An elderly patient starved because a ‘nil by mouth’ sign meant for the previous occupant of her bed had not been removed. A damning report into care at the Royal Bournemouth Hospital also found that another elderly patient was left completely naked on top of a soiled sheet, while others were forced to wet the bed after their repeated calls for assistance went unanswered. A dementia patient was also left on the verge of malnutition because they were unable to reach food or drink left for them. The Royal Bournemouth Hospital in Dorset has received a damning hospital inspection report. Patients were found to have had fluids and food restricted by mistake while others were left lying in soiled or wet beds The Royal Bournemouth Hospital in Dorset has received a damning hospital inspection report. Patients were found to have had fluids and food restricted by mistake while others were left lying in soiled or wet beds The terrible treatment came to light after the Care Quality Commission, which inspects hospitals, visited in October. The two-day inspection singled out wards three and 26 for being particularly bad and understaffed. The report states the family of an elderly woman were surprised to find the ‘nil by mouth’ sign on her bed and were shocked when it was realised it wasn’t meant for her. Yet it took another five hours for the patient to be given water, such was the lack of staff on the ward. The report states: 'One person on ward 3 told us they had come to visit their relative and had been surprised to find they had a sign above their bed saying "nil by mouth", which told staff not to offer this patient food or fluids orally. More... How was NHS surgeon allowed to carry out controversial breast cancer surgery even AFTER colleagues raised concerns? Report published today as victims sue 'Bully' chief of cancer scandal hospital quits: £165,000-a-year executive accused of fiddling cancer waiting times 'The relative had questioned this with a nurse, who told them that their relative was due to undergo an investigation, which meant that they couldn’t eat or drink. 'They then asked the nurse to find out what this investigation was. When the nurse returned they said that the patient was not in fact meant to be ‘nil by mouth’ but that the sign had been left on the bed from a previous patient. 'This meant that the patient had missed breakfast and lunch, and had not received fluids since their admission to the ward. 'The concerned relative went on to say that although this mistake was discovered at 2pm, when they returned to the ward at 7pm their relative had still not been given water to drink.' The report also highlights the case of a dementia patient who lost a significant amount of weight because they were unable to reach their food just inches away. Professor Sir Mike Richards, the Chief Inspector of Hospitals Royal Bournemouth Chief Executive Tony Spotswood Despite the scathing report from the chief inspector of hospitals, Professor Sir Mike Richards (left), Bournemouth chief executive Tony Spotswood (right) said there was no reason for him to resign It reads: 'Despite them being able to eat independently, food and drinks had been left out of their reach and left to go cold. 'As a result, their relative had lost a significant amount of weight on the ward. 'When they asked about the weight loss they were told that staff had weighed their relative that morning and they had weighed 90 kilograms. 'As they felt that this did not seem correct, they asked staff to weigh them again. On that occasion they weighed 69 kilograms. 'They said that the ward had given their relative a Malnutrition Universal Screening Tool (MUST) score of zero after the first weight was recorded, which needed to be changed to a three after the second weight was recorded. Dorothy Simpson, 84, telephoned her family from the hospital because she could not breathe, and died 20 minutes later Dorothy Simpson, 84, telephoned her family from the hospital because she could not breathe, and died 20 minutes later 'This score of three showed that their relative was at risk of malnutrition.' The Royal Bournemouth was one of the first to be inspected by the CQC in the wake of the Mid Stafforshire scandal, following complaints about the level of care there. The inspection found that nurses on ward three accepted staffing levels were ‘horrendous’. The chief inspector, Sir Mike Richards, concluded: 'The trust did not employ enough staff, even though it was fully aware that nearly all its beds were occupied all the time. Professor Sir Mike Richards, the Chief Inspector of Hospitals, said: 'Whenever we inspect we will always ask the following five questions of every service: Is it safe? Is it effective? Is it caring? Is it responsive to people's needs? Is it well-led? 'At Royal Bournemouth Hospital, we were told about basic nursing care which was not being given to patients on two medical care wards. We heard from five patients who told us they had been left to wet or soil their beds. 'The hospital had a high occupancy rate and there had been ongoing use of escalation beds when a ward or unit was full - even though these beds could not meet patients' needs properly. The 64-page document also said that stroke victims were 'not always given the urgent care they needed'. Surgical services and outpatient departments also came under the microscope at the hospital managed by The Royal Bournemouth and Christchurch Hospitals NHS Trust, which serves 550,000 people. 'A number of services were not always safe, effective, responsive, caring or well-led,' stated the CQC report. 'In particular we found that medical care (including care older people's care) was inadequate. 'There were widespread and significant negative views from patients and staff.' The outpatients' department was found to have infection control risks. The main outpatient reception, the floor sinks and the waste bins in the female toilets were not clean. The sluice room - a specially designed cleaning room - was cluttered with 'obsolete equipment' and stacked with used clinical dressing packs. The Royal Bournemouth was one of the first to be inspected by the CQC in the wake of the Mid Stafforshire (pictured) scandal, following complaints about the level of care there The Royal Bournemouth was one of the first to be inspected by the CQC in the wake of the Mid Stafforshire (pictured) scandal, following complaints about the level of care there The report said: 'Staff entered the sluice with dirty packs, adding to the pile, and left without washing their hands.' Despite the report beign scathing of the leadership of the hospital, chief executive Tony Spotswood said there was no reason for him to resign. He added: 'We accept the broad findings of the report and would like to apologise to those patients who received poor care. 'Clearly it is unacceptable but many of these issues have now been set right. 'We have put in place a number of changes in relation to staffing and care of the elderly and we have already seen a number of improvements within the last six weeks. Paula Shobbrook, director of nursing at the Royal Bournemouth, added: 'I don’t want patients to be frightened about coming to hospital. 'We have recruited more nurses; 57 newly qualified nurses are now working on our wards and we have new ward sisters who are committed to raising standards.' Read more: http://www.dailymail.co.uk/health/article-2526334/Patients-left-soiled-sheets-locums-poor-nursing-Hospital-chief-inspector-slams-two-leading-hospitals-unsafe.html#ixzz2nvdpTWcw Follow us: @MailOnline on Twitter | DailyMail on Facebook

Switzerland: PRESERVATIVE-FREE EYE DROPS.

Consider using preservative-free topical medication in patients with ocular surface disease Publishing date: December 2013 The Science behind the Tip Many glaucoma drops contain a preservative agent to minimise the risk of microbial contamination. Benzalconium chloride, a cationic surfactant, is the most widely used preservative, but even in doses of 0.002% to 0.004% can result in toxic effects on the surface of the eye and ocular inflammation. (1) Symptoms and signs of ocular surface disease (OSD) are found in 48-60% of patients on topical glaucoma medication (2) (3). This is a multifactorial condition which leads to adverse local reactions, reduced visual acuity, reduced quality of life and reduced compliance with prescribed therapy. (1). Risk factors associated with OSD include the number of preserved drops used and duration of therapy. (4) An improvement of symptoms is found if these patients are switched to preservative-free topical medication. (1) Contributor: Frances Meier-Gibbons, Switzerland References 1. Baudouin C, Labbé A, Liang H et al Preservatives in eyedrops: the good, the bad and the ugly. Prog Retin Eye Res 2010; 29 (4) 312-334. 2. Leung EW, Medeiros FA, Weinreb RN. Prevalance of ocular surface disease in glaucoma patients. J Glaucoma 2008; 17 (5) 350-355. 3. Fechtner RD, Godfrey DG, Budenz D et al. Prevalence of ocular surface complaints in patients with glaucoma using topical intraocular pressure lowering medications. Cornea 2010;? 29: 618-621. 4. Rossi GC, Pasinetti GM, Scudeller L et al. Risk factors to develop ocular surface disease in treated glaucoma or ocular hypertension patients. Eur J Ophthalmol 2013; 23 (3) 296-302. Tip Editors: John Salmon and John Thygesen Reviewers: Roger Hitchings and Anders Heijl

OMA TORONTO STREET ADS

ASTRAL TTC STOP ADS. $3787 (inc 13% tax) per face for 4 weeks (central core area).

UK PRIVATE MED.SCHOOL: University of BUCKINGHAM

Accredited by UK Gen Med.Council www.buckingham.ac.uk/medicine Tuition:$70,000/year for 4.5 years (short vacations) NO SCHOLARSHIPS Living expenses: circa $30,000/yr Entry: Int.Baccalaureate(36+)for Canadian students.

Dr.GERHARD MANN PHARMA, Berlin ( a Bausch & Lomb company ) CARBOMER, MYRITOL 318 "LIPOSIC" eye drops.

OMA had an EYE CME @ WESTIN PRINCE HOTEL. BAUSCH & LOMB presented LIPOSIC combination of Ophthalmic drops & night use Liposic gel for xerophthalmia.

TORONTO: MEDICAL ADVICE FOR VISITORS

FROM PHYSICIAN CONTRIBUTOR. AVOID LOCAL ER. WAITING TIME 4-6 hrs. ADVISE LIMO RIDE ($400) 1.5 - 2 hr. to Mount St.Mary Hospital,Lewiston, NY. Quick access to Specialists, MRI etc. For general medical advice CLEVELAND CLINIC CANADA, (30,000 sq.ft.)@ BROOKFIELD PLACE, 181 BAY ST. (also entrance YONGE ST.) 416-507-6600 Same building as Hockey Hall of Fame & MARCHE Swiss Restaurant. Connected to USA Cleveland clinics. (Near Fairmont ROYAL YORK Hotel.) MEDCAN Private clinic 150 YORK St.(@ Adelaide)416-350-5900 (Mid-Town location)Near to HILTON & SHERATON Hotels.) No Private Hospitals in Ontario (Quebec has Private Medicine)

50y. anniversary of development of Measles vaccine by Duke Univ. Emeritus Prof S.L. KATZ

Press Release Embargoed until: Thursday, December 5, 2013 at 12:00 noon ET Contact: Media Relations (404) 639-3286 Measles Still Threatens Health Security On 50th Anniversary of Measles Vaccine, Spike in Imported Measles Cases Fifty years after the approval of an extremely effective vaccine against measles, one of the world’s most contagious diseases, the virus still poses a threat to domestic and global health security. On an average day, 430 children – 18 every hour – die of measles worldwide. In 2011, there were an estimated 158,000 measles deaths. In an article published on December 5 by JAMA Pediatrics, CDC’s Mark J. Papania, M.D., M.P.H., and colleagues report that United States measles elimination, announced in 2000, has been sustained through 2011. Elimination is defined as absence of continuous disease transmission for greater than 12 months. Dr. Papania and colleagues warn, however, that international importation continues, and that American doctors should suspect measles in children with high fever and rash, “especially when associated with international travel or international visitors,” and should report suspected cases to the local health department. Before the U.S. vaccination program started in 1963, measles was a year-round threat in this country. Nearly every child became infected; each year 450 to 500 people died each year, 48,000 were hospitalized, 7,000 had seizures, and about 1,000 suffered permanent brain damage or deafness. People infected abroad continue to spark outbreaks among pockets of unvaccinated people, including infants and young children. It is still a serious illness: 1 in 5 children with measles is hospitalized. Usually there are about 60 cases per year, but 2013 saw a spike in American communities – some 175 cases and counting – virtually all linked to people who brought the infection home after foreign travel. “A measles outbreak anywhere is a risk everywhere,” said CDC Director Tom Frieden, M.D., M.P.H. “The steady arrival of measles in the United States is a constant reminder that deadly diseases are testing our health security every day. Someday, it won’t be only measles at the international arrival gate; so, detecting diseases before they arrive is a wise investment in U.S. health security. Eliminating measles worldwide has benefits beyond the lives saved each year. Actions taken to stop measles can also help us stop other diseases in their tracks. CDC and its partners are building a global health security infrastructure that can be scaled up to deal with multiple emerging health threats. Currently, only 1 in 5 countries can rapidly detect, respond to, or prevent global health threats caused by emerging infections. Improvements overseas, such as strengthening surveillance and lab systems, training disease detectives, and building facilities to investigate disease outbreaks make the world -- and the United States -- more secure. “There may be a misconception that infectious diseases are over in the industrialized world. But in fact, infectious diseases continue to be, and will always be, with us. Global health and protecting our country go hand in hand,” Dr. Frieden said. Today’s health security threats come from at least five sources: The emergence and spread of new microbes The globalization of travel and food supply The rise of drug-resistant pathogens The acceleration of biological science capabilities and the risk that these capabilities may cause the inadvertent or intentional release of pathogens Continued concerns about terrorist acquisition, development, and use of biological agents. “With patterns of global travel and trade, disease can spread nearly anywhere within 24 hours,” Dr. Frieden said. “That’s why the ability to detect, fight, and prevent these diseases must be developed and strengthened overseas, and not just here in the United States.” The threat from measles would be far greater were it not for the vaccine and the man who played a major role in creating it, Samuel L. Katz, M.D., emeritus professor of medicine at Duke University. Today, CDC is honoring Dr. Katz 50 years after his historic achievement. During the ceremony, global leaders in public health are highlighting the domestic importance of global health security, how far we have come in reducing the burden of measles, and the prospects for eliminating the disease worldwide. Measles, like smallpox, can be eliminated. However, measles is so contagious that the vast majority of a population must be vaccinated to prevent sustained outbreaks. Major strides already have been made. Since 2001, a global partnership that includes the CDC has vaccinated 1.1 billion children. Over the last decade, these vaccinations averted 10 million deaths – one fifth of all deaths prevented by modern medicine. “The challenge is not whether we shall see a world without measles, but when,” Dr. Katz said. “No vaccine is the work of a single person, but no single person had more to do with the creation of the measles vaccine than Dr. Katz,” said Alan Hinman, M.D., M.P.H., Director for Programs, Center for Vaccine Equity, Task Force for Global Health. “Although the measles virus had been isolated by others, it was Dr. Katz’s painstaking work passing the virus from one culture to another that finally resulted in a safe form of the virus that could be used as a vaccine.”

PHILADELPHIA:WILLS EYE INSTITUTE FREE CMEs

Wills Eye Knowledge Portal www.willseyeonline.org Wills Eye Knowledge Portal Free Registration. Free CME. Sign Up Here! Experience Wills Eye education online at www.willseyeonline.org Learn from top doctors at Wills Eye Institute. Experience web-based medical education. Earn CME credits from world-renowned experts. ---------------------------------- CME Courses Strabismus Disorders 0.5 AMA PRA Credit Strabismus is a common condition in children, occurring in about 4% of children in the United States. If untreated, strabismus can lead to untreatable visual compromise once the child is grown. The treatments for strabismus have evolved with scientific studies. Given the potential to minimize a lifetime of sub-optimal vision, physicians should be aware and up-to-date on this topic as significant practice gaps exist in awareness of strabismus disorders. ------------------------------------ ALL CME COURSES ON THE WILLS EYE KNOWLEDGE PORTAL ARE FREE! ------------------------------------ Wills Eye 39th Annual Ophthalmology Review Course March 1-5, 2014 A comprehensive review of the basic principles and recent advances in ophthalmology for Residents and Fellows. Information: (215) 440-3169 Wills Eye 65th Annual Conference March 6-8, 2014 Philadelphia, PA willsconference.org This is a three day conference designed for comprehensive ophthalmologists, specialists, and allied health personnel. The conference will review clinical, diagnostic and therapeutic approaches to eye problems related to all ophthalmic sub-specialties. Follow us on Twitter Like us on Facebook View our videos on YouTube December 2013 Corneal Trauma, Abrasions, Chemical Burns, Perforating Trauma Presenter: Kristin Hammersmith, MD Dr. Hammersmith is an assistant surgeon on the Cornea Service and Director of the Cornea Fellowship Program at Wills Eye Hospital. She is also an instructor at the Jefferson Medical College of Thomas Jefferson University. Dr. Hammersmith interests include severe ocular surface diseases such as dry eye, blepharitis, ocular cicatricial pemphigoid, chemical burns, and the potential of limbal cell transplantation to help patients with these conditions. Central Retinal Venous Obstruction Presenter: Joseph I. Maguire, MD Dr. Maguire is an attending surgeon on the Retina Service at Wills Eye Hospital and an associate professor of ophthalmology at Thomas Jefferson University. He is a past Retina Service President and Scientific Director of the Eye Reseach Institute (ERI). He is currently a principal investigator in the VEGF-trap clinical trial and the National Institutes of Health sponsored AREDS 2, and has been clinical co-investigator in several completed and ongoing clinical trials evaluating novel treatments for diabetic retinopathy and AMD. Low Vision 101: Custom Refractions, Prisms, and Optics; and Low Vision 201: Rehabilitation Presenter: Scott Edmonds, OD Dr. Edmonds is Co-Director of the Low Vision and Contact Lens Service at Wills Eye Hospital. He has written and lectured extensively on clinical topics of post operative care, low vision, contact lenses, and ocular diseases as well as management topics of managed care and medicare. Dr. Edmonds has been recognized as Optometrist of the year by the Philadelphia Optometric Society, the Chester-Delaware Optometric Society, and Pennsylvania Optometric Association. IOP Variation: Should It Affect Our Management of Glaucoma? Presenter: L. Jay Katz, MD, FACS Dr. Katz is the director of the glaucoma service at the Wills Eye Hospital and professor of ophthalmology at Thomas Jefferson University. He has published more than 160 articles in peer reviewed journals and has authored, coauthored, or edited more than 30 books and book chapters. He has received numerous awards including the Physicians Recognition Award from the American Medical Association and an Honor award from the American Academy of Ophthalmology. Dr. Katz has been an investigator in several landmark multicenter trials. Additional Highlights: Importance of Adherence and Quality of Life in People Under Glaucoma Treatment George L. Spaeth, MD Introduction to Ocular Pathology Ralph C. Eagle, MD Biopsy Techniques Edward H. Bedrossian, MD Contemporary Management of Retinal Detachment Repair Gaurav K. Shah, MD Herpetic Disease of the Anterior Segment Brad Feldman, MD Visiting Professor Lectures and Cases Joshua R. Ehrlich, MD; Timothy V. Johnson, MD; Jared D. Peterson, MD Chiefs' Rounds Anthony W. Farah, MD; Nina Ni, MD; Michael S. Ehrlich, MD; Kristin M. DiDomenico, MD; Blair K. Armstrong, MD

OMA Toronto Sheraton Centre Hotel 4 hour course by GLENN TECKER of TECKER INT.LLC.

www.tecker.com Approx 300 OMA members recorded opinions on responsibilities of OMA Board; Council; CEO; Assemblies - Diagnostic, Medical,Primary practice, Surgical; Sections; Districts and Branch societies. Electronic voting was by table, not individual. ONTARIO 2013 (Stats Can.) Primary physicians: 12,933 Specialists: 10,475

TORONTO: North York (community) hospital anaesthetist guilty of 21 sexual acts..

CBC News A Toronto court has found Indo-Scot Anaesthetist Dr.George Doodnaught, MBChB (Glasgow 1974)FRCPC(anaes.1981), guilty of sexually assaulting 21 women while they were under conscious sedation in a hospital.

ONTARIO HEALTH INNOVATION COUNCIL -14 members

ontario.ca/innovation-news 9-male;5-female. Technical experts include: Pres & CEO MaRS INNOVATION Dr. R.HOFSTEIN BSc(Phys/Chem. Hebrew Univ.) MSc & PhD(Chem.Weizmann Instit.) Pres.,MEDTRONIC(Can.)N.FRASER.B.Applied Sc.(Chem engineering U.B.C.)P.Eng., MBA(Ivey) Pres & CEO Boehringer Ingelheim(Can.)Prof.Dr.T.WITEK MPH(Yale) Doctor Public Health(Columbia) MBA (Henley,UK)

OMA ad in TORONTO STAR: $34,000

Whole page ad in Toronto star Nov 16 p. A 18 at $34,000 "Ontario's doctors are making health care better. Doctors diagnose,treat,and cure. They're leaders in prevention. But it's their unique understanding of health care that helps them transform the system so that you and your family get the exceptional care you need. Find out how they're doing it at OntariosDoctors.com OMA Ontario Medical Association"

LANCET: Antibiotic resistance

http://www.reactgroup.org/uploads/news/Comments-on-The-Lancet-Infectious-Diseases-Commission-on-Antibiotic-Resistance-Nov2013.pdf COMMENT: OMA could force CPSO to reject time-wasting, expensive complaints against MDs for NOT prescribing antibiotics on demand by patients.

ProMED: FREE ebook from GIDEON on Infectious diseases of the Philippines.

A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases Date: Sat 16 Nov 2013 From: Uri Blackman [edited] A massive effort is underway to supply medical assistance to the Philippines. ProMED has arranged to supply a free copy of Infectious Diseases of the Philippines, 2013, to all subscribers. This e-book (411 pages, 88 graphs, 1869 references) is the only comprehensive source for background information on the status of every individual infectious disease in the Philippines. To obtain Infectious Diseases of the Philippines, 2013: 1. click on the following link: 2. click on "add to cart" 3. click on "add a coupon" and enter ProMED 4. click on "update" 5. fill in identification and mailing information where indicated You will receive a link for the e-book by e-mail, which you can open on your computer or mobile device. Infectious Diseases of the Philippines, 2013, is one in a series of 419 e-books (105 000 pages), with one title dedicated to every disease and every country in the world. All books are updated yearly. The publisher has agreed to offer a 50 percent discount on all titles to ProMED subscribers. To obtain any of these books at a discount: 1. click on the desired title(s) listed at and 2. follow instructions as for Infectious Diseases of the Philippines, 2013 3. at the stage of "add a coupon" enter 50promed13 -- Uri Blackman [We expect that the conditions in the typhoon-affected areas of the Philippines may well result in emerging disease outbreaks and increases in endemic diseases. ProMED appreciates this offer from our friends at GIDEON. - Mod.LM]

CANADA : PROVINCIAL MEDICINE VARIES.

COMMENT: For non-Canadian readers, the practice of Canadian medicine varies according to Provincial political decisions. Private Hospitals legally exist in QUEBEC. Payment for expensive medication varies according to Provincial political policy. QUEBEC and ALBERTA are the most generous, (allowing MDs to make independent clinical decisions). Ont.Med Review Nov. 2013. The Ont.Govt has reduced all fees by 0.5% about $1000 a year for a GP. New political controls for Optical Coherent Tomography, colonoscopy and cervical cancer screening. Patients can get "private medicine" ,which is officially not permitted by the Canada Health Act (except in Quebec), by subscribing about $3000/year to "Wellness Clinics" which use a legal device providing non-Gov.-paid advice from Dietitians, Physiotherapists et al. Examples in Toronto are Cleveland clinic Canada, MedCan, MediSys, together with GPs with Executive clients. MDs are not permitted to practice in Provinces where they are not licenced. Lawyers can practice in another Province for 100 days a year. An Ontario MD in Ottawa cannot practice across the river in Hull,Quebec.

Toronto Univ..SUNNYBROOK HOSP. :Paroxysmal Nocturnal Haematuria.

Paid by OHIP: approx $250,000 a year. Soliris® (eculizumab), is a first-in-class terminal complement inhibitor discovered, developed and commercialized by ALEXION pharmaceuticals,Inc.. Soliris is approved for the treatment of patients with paroxysmal nocturnal hemoglobinuria (PNH)1, a progressive and life-threatening disease characterized by the excessive destruction of red blood cells (hemolysis).1,2,3 Soliris is the first and only therapy approved for the treatment of PNH to reduce hemolysis. In the United States and European Union, Soliris is also approved for the treatment of patients with atypical hemolytic uremic syndrome (aHUS), an ultra-rare, life-threatening, genetic disease that can progressively damage vital organs, leading to stroke, heart attack, kidney failure and death.4,5 Soliris is the first and only therapy approved for the treatment of aHUS. Specifically, Soliris is indicated for the treatment of patients with aHUS to inhibit complement-mediated thrombotic microangiopathy, or TMA. The effectiveness of Soliris in aHUS is based on the effects on TMA and renal function. Prospective clinical trials in additional patients are ongoing to confirm the benefit of Soliris in patients with aHUS. Soliris is not indicated for the treatment of patients with Shiga toxin E coli-related hemolytic uremic syndrome (STEC-HUS). Soliris works by selectively targeting and blocking the complement cascade—a normal part of the immune system that, when activated inappropriately, plays a role in serious diseases like PNH and aHUS. Soliris has earned some of the pharmaceutical industry’s highest honors for innovation, including the 2008 Prix Galien USA Award for Best Biotechnology Product with broad implications for future biomedical research and the 2009 Prix Galien France Award in the category of Drugs for Rare Diseases. To learn more about Soliris, visit www.Soliris.net. Sunnybrook Haematology Dept: Prof. Richard A.WELLS MD(Newfoundland 1985) D.Phil(Oxon) FRCPC (Int.Med & Haematology).

LESLIE DAN SCHOOL of PHARMACY Prof C. GIULIVI

CPIN DISTINGUISHED LECTURE – November 1, 2013 Speaker | Dr. Cecilia Giulivi, Professor of Biochemistry, Department of Molecular Biosciences, University of California at Davis, CA Title | Role of environmental exposures in mitochondrial dysfunction and autism Date | Friday, November 1, 2013 Time | 9:30 am Location | Room PB150, Pharmacy Building, 144 College St., Leslie Dan Faculty of Pharmacy Host | Dr. David R. Hampson, Professor, Department of Pharmaceutical Sciences Co-Sponsor | Department of Pharmaceutical Sciences

GAIRDNER AWARDEE Dr. H.J.ALTER

TORONTO GAIRDNER AWARDS ($100,000) : USA NIH Dr.Harvey J. ALTER co-discoverer of AUSTRALIA ANTIGEN Lectured on Hepatitis C at the Sir Ka-shing LI GBM,KBE building of St.Michael's Teachimg hospital. Advised testing 48-68 age group. (Many used IV drugs between 1945 - 1965) 50% carriers not identified. 1-3% Worldwide infection. 60-70% show slow disease progress over 30 years 20- 30% develop cirrhosis in 15-40 years <5% develop cirrhosis in 5-10 years. Increased prevalence of Liver cancer due to Hep.C.

2013 James Arthur GAIRDNER AWARDS

Stockbroker JAMES ARTHUR GAIRDNER, LLD 1893-1971 Bequeathed his house to the town of Oakville as an art gallery. While he had always had an interest in medicine, it was the onset of severe arthritis in his early 50s that led Gairdner to become involved with the newly created Canadian Arthritis and Rheumatism Society. In 1957 he donated $500,000 to establish a foundation to recognize major research contributions in the conquest of disease and human suffering. Gairdner’s decision to create awards ($100,000)that recognize outstanding discoveries by the world’s top scientists was, and continues to be, an act of extraordinary vision. Much of his original instruction regarding the process of selection and awarding of the prizes remains in place today, contributing to the current stature of the Canada Gairdner Awards. - See more at: http://www.gairdner.org/content/james-arthur-gairdner-lld-1893-1971#sthash.J9YVdn07.dpuf

WSIB INSURANCE for MEDICAL OFFICES

Although NOT MANDATORY, Ontario MDs can insure themselves and staff for Occupational injury, illnesses, and death cheaply by WSIB at the rate of 73 cents per every $100 of OHIP income and staff salary. For $200,000, yearly premium would be $1460,(about $28 a week) Correspondence with the Late WSIB Chmn Hon.Lincoln Alexander QC will show that provided contact with communicable illness is noted in an office diary, the MD and Staff would be covered by WSIB if infected. Estate of SARS-killed GP Nestor YANGA received nothing from the Ont Govt as he`was "self-employed". Had he been covered by WSIB his Estate wiould have received approx $100,000.

MEDICO-LEGAL SOC TORONTO NOV. 6 Wed.

MLST Dinner Program: Brian Cuthbertson et al. v. Hassan Rasouli Wednesday, November 6, 2013 5:30 p.m. Reception, 6:00 p.m. Dinner 7:00 p.m. Presentations Metropolitan Hotel (Soon to be Doubletree by Hilton - 108 Chestnut Street, Toronto) On Friday October 18th, the Supreme Court of Canada released its decision in Brian Cuthbertson, et al. v. Hassan Rasouli by his Litigation Guardian and Substitute decision-maker, Parichehr Salasel (Ont) (34362). A 5-2 majority of the Supreme Court in Rasouli dismissed the appeal. The majority found that withdrawal of life support requires consent because the act of withdrawing life support is treatment, as it serves a “health-related purpose” by preventing suffering and indignity at the end of life, is closely associated with palliative care, and entails physical interference. The Court held that the withdrawal of life support “impacts patient autonomy in the most fundamental way.” The Supreme Court drew a distinction between the withdrawal of life-sustaining treatments and that of other medical services. The MLST has convened a panel of physicians and lawyers with intimate knowledge of the case to comment on the future implications of the decision for physicians, hospitals and lawyers. Be prepared to attend what promises to be a very lively and informative event -with perspectives on the case that only The Medico-Legal Society of Toronto can present. Program Chair: Daphne Jarvis, Borden Ladner Gervais LLP and First Vice-President, MLST Other Commentators: Andrew Faith, Polley Faith, LLP and Member of Council, MLST Dr. Andrew Baker, Chief of Critical Care Medicine, St. Michael's Hospital and Member of Council, MLST

CMAJ: Canadian Medical Inferiority Complex.

CMAJ Oct.15 printed one page PRACTICE advice on "MGUS". Authors were from Antwerp & Sydney. In Continental Europe UTRECHT is the main centre for study of "MGUS" & Plasma cell cancer. MGUS converts to PCC at 1% a year after diagnosis. Toronto has a World famous Plasma Cell cancer (aka "Multiple Myeloma") centre under the direction of Prof Donna REECE. MD(Baylor 1978) FRCPC No mention of on-line info and literature for MDs & patients from the INTERNATIONAL MYELOMA FOUNDATION.12650 Riverside Drive,Suite 206,North Hollywood,CA.91607-3421 Also omitted: "Serum Free Light Chain Analysis" (6th. Ed.) The Binding Site Group ltd.. Author: UK Univ.Birmingham Prof A.R. BRADWELL (wikilite.com) ISBN: 9780704427969 USA$75 350pp with many multi-colour graphs & illustrations.

Toronto Barrister Gary HODDER wins Supreme court verdict

Sunnybrook Hosp.doctors cannot stop life support of patient in coma for past three years at cost of $2000 a day.

CMAJ OBIT Internist & Psychiatrist J.R. BINGHAM d. Aug.5.2013 aet 98.

Died Lindsay,Ont. MD(Man.1940)RCN WW2. University Gastroenterologist At 55y studied Psychiatry @ CLARKE INSTITUTE (COMMENT: LOWER OVERHEADS. Less physically taxing)

Organisation for Economic co-operation & Development: World Literacy and Numeracy

www.oecd.org/canada Stats Can: 48% Canadians are FUNCTIONALLY ILLITERATE (difficulty in filling forms). GPs often forced by patients to fill forms ( time not paid by OHIP) If GP refuses, threat of complaint to CPSO. OECD STATS: LITERACY Canada 15th place below Slovakia. NUMERACY Canada 16th place below Poland.

UK DAILY MAIL: WORLD LITERACY

at the same level, whereas countries like Korea are showing huge improvement between generations Picture of Britain: This graph shows how the UK compared to other industrial nations when it came to numeracy Interesting: Countries like Japan, Netherlands and Sweden were the top performing in terms of literacy, even though children start school often years later than British youngsters Read more: http://www.dailymail.co.uk/news/article-2449481/Education-crisis-Up-8-5MILLION-numeracy-level-10-year-old.html#ixzz2hBd5fqRR

COMSOC: ONLY ODB DRUGS TO BE PAID for patients on Welfare (aka "Ontario Works")

Prescription Drug Coverage Under Ontario Works Discretionary Benefits Policy (COMMENT "Ontario Works" = WELFARE) The Ministry of Community and Social Services has informed the OMA of a change to the Ontario Works discretionary benefits policy that will impact patients who receive social assistance. Effective September 1, 2013, prescription drugs not listed on the Ontario Drug Benefit (ODB) Formulary will no longer be covered by Ontario Works as a discretionary benefit. This change will impact both Ontario Works and Ontario Disability Support Program recipients. In order to transition existing clients who receive coverage under this benefit, administrators will have the discretion to continue to fund prescription drugs not listed on the ODB Formulary under exceptional circumstances for a period of up to six months, until February 28, 2014. The transitional period will allow these clients time to speak with their physicians to arrange alternative approaches to their treatment. It is anticipated that some social assistance recipients who are currently being prescribed medication that is not listed on the ODB Formulary may be approaching their physicians in the coming weeks and months to arrange alternative approaches to their treatment. Ontario Works and Ontario Disability Support Program recipients will continue to have access to prescription medication through the Ontario Drug Benefit Formulary as a mandatory benefit. The Honourable Ted McMeekin Minister of Community and Social Services Ted McMeekin was re-elected into the riding of Ancaster-Dundas-Flamborough-Westdale in 2011 for a fourth consecutive term. He was appointed Minister of Community and Social Services in February 2013. Previously, he served as Minister of Agriculture, Food and Rural Affairs and Minister of Consumer and Business Services. Ted has a long history of community service. He served as Mayor of Flamborough from 1994-2000 and Hamilton City Councillor from 1977-1981. As MPP for the riding of Ancaster-Dundas-Flamborough-Westdale, Ted has been a powerful advocate for seniors, children with special needs, farm risk-management programs, strategic infrastructure investment and our local environment. Ted is a driven volunteer. He has worked to make a difference with many local organizations including the Hamilton Mental Health Association, Wesley Urban Ministries, the Five Oaks Christian Workers Centre, the Circle of Friends and Operation Lifeline. Ted served as President of both the Hamilton and Burlington YMCA and the Hamilton-Wentworth Lung Association. He has acted as an overseas volunteer, a church youth group leader and a baseball and soccer coach.

UK Royal Soc.Medicine: FUTURE of GP

New call for GPs to relinquish independent contractor status General practitioners should give up their independent contractor status and become NHS employees. This is the most radical alternative method of primary care funding considered by Professor Azeem Majeed, Head of the Department of Primary Care & Public Health at Imperial College London, in an editorial published today in the Journal of the Royal Society of Medicine. Professor Majeed, who also works as a part-time GP in South London, suggests that the funding of primary care should also be modified in favour of methods that link workload more closely to funding. In the last few years GPs have seen a dramatic transformation in their circumstances with reduced funding and higher clinical and administrative workload. Professor Majeed says:“Under the current capitation-based funding method, GPs face unrestricted demands for their services and on their time while having to operate on a fixed budget.” “When GPs are unable to cope with their workload, ” he says, “pressure will increase on other parts of the NHS – such as emergency departments – as well as impacting on access to primary care services and on how well GPs can manage patients with complex health needs.” If GPs gave up their independent contractor status, they could become NHS employees under similar employment terms to doctors working in acute, community and mental health trusts. This could, says Professor Majeed, allow GPs and their staff to be employed on national NHS terms of service and overcome the divide between self-employed GP principals and salaried GPs. Other options considered by Professor Majeed include the incorporation of tariff-based methods of funding in place of or in addition to capitation payments; The establishment of ‘super-partnerships’ involving the merger of general practices to allow the formation of larger primary care organisations; Or greater collaboration between general practices via the formation of general practice networks or federations. ENDS Notes for editors General practice in the United Kingdom: Meeting the challenges of the early 21st century (DOI: 10.1177/0141076813504326), by Azeem Majeed is published by the Journal of the Royal Society of Medicine today Friday 20 September 2013.

UK ROYAL SOCIETY of MEDICINE FREE on-line LECTURES

UK London Roy.Soc.Med @ 1 Wimpole St. provides many free lectures. http://www.rsmvideos.com/cat/free Other lectures cost GBP 5 to non-members.

OMA: Pharm & Vet. associations pay for OMA Mental care.

OMA receives yearly $250,000 from combined Pharm. + Vet associations to receive help from OMA 20 staff of "Physician Health Program".

U.TORONTO FREE LECTURES

PHYSIOLOGY SEMINAR – Thursday, October 3, 2013 Speaker | Dean Buonomano, PhD Institution | Departments of Neurobiology and Psychology, University of California, L.A. Title | “The role of short-term synaptic plasticity and neural dynamics in timing and neural computations” Date | Thursday, October 3, 2013 Time | 4:00 pm Location | Medical Sciences Building, Room 2172, Faculty of Medicine, University of Toronto Sponsors | Department of Physiology Seminar Series, CIHR Team Research and Training Program: Sleep & Biological Rhythms Toronto, CPIN – Collaborative Program in Neuroscience CPIN CORTEX CLUB – Thursday, October 3, 2013 Brain features and flaws: can the brain understand itself? Prof. Dean Buonomano Depts. of Neurobiology & Psychology, UCLA 5:30PM, Thurs. Oct 3rd Upstairs at the GSU Pub (16 Bancroft Avenue) CPIN DISTINGUISHED LECTURE – Friday, October 4, 2013 buonomanoSpeaker | Dean Buonomano, PhD, Departments of Neurobiology and Psychology, University of California, Los Angeles Title | Time and the Brain Date | Friday, October 4, 2013 Time | 4:00 pm Location | Room 108, Koffler House (569 Spadina Crescent) Host | Sheena Josselyn, PhD Co-Sponsor | Psychology Brian & Behaviour Seminar Series -- For more information, see the CPIN Website: http://www.neuroscience.utoronto.ca/ CPIN Distinguished Lectureship Series: http://www.neuroscience.utoronto.ca/events/lectureship.htm CPIN Cortex Club: http://www.neuroscience.utoronto.ca/events/cortexclub.htm CPIN Upcoming Neuroscience Seminars: http://www.neuroscience.utoronto.ca/events/seminar.htm

CATASTROPHIC INSURANCE TO 75

http://illnessprotection.com/critical-illness-insurance.php $75,000 of Critical Illness Insurance Guaranteed Issue - No Medical Required - Most people buy life insurance to protect their family but never consider the possibility of what happens if you get sick. There is a five times greater likelihood of getting sick before age 65 versus dying. 1 out of every 3 Canadians will suffer from a critical illness which means that if you have life insurance and no critical illness coverage, you are not really protected During your recovery you may also have to pay for healthcare services, special drugs, supplements and homecare expenses not covered by your government health insurance plan or your group plan. You might have to travel to get the medical attention you need. The financial consequences of surviving a serious illness add up very quickly and without critical illness insurance protection you may never recover financially. With Lifecheque® Basic critical illness insurance, you will have the security of knowing that 30 days following a diagnosis of cancer, heart attack, stroke, coronary bypass, or aortic surgery, you will receive a one-time, lump sum benefit – paid directly to you. With critical illness insurance in place you will have fewer financial worries. Choose Your Coverage Level Recognizing everyone’s insurance needs are different, the Lifecheque® Basic critical illness plan offers three different benefit amounts – $25,000, $50,000 and $75,000 – so you choose the level of coverage that suits your needs and your budget. Have You Been Declined or Rated in the Past? This product is perfect for you because there is no medical required. With the Lifecheque® Basic critical illness plan, you don’t have to complete a medical examination; all that’s needed is a declaration of your good health. Once covered, you can keep Lifecheque® Basic up to age 75, regardless of any changes in your health or occupation. Even if your health declines, your coverage cannot be cancelled as long as you pay your premiums. Of course, you can choose to cancel this protection at any time. Get Back All Your Premiums Just For Staying Healthy It is comforting to know that when you reach your 75th birthday and you have not made a claim, Manulife Financial will reimburse ALL the premia you paid. Please note that this option is only available at the time of initial application.

CPSO: Lawyer Brenda DOIG leaves for TD BANK.

Brenda Doig Senior Lawyer at TD (after returning from Maternity leave some time ago) Toronto, 79 WELLINGTON ST. M5J 2Z9 Previous College of Physicians and Surgeons of Ontario, Torys LLP Education University of Toronto Doctors are warned about dealing with the Toronto-Dominion Bank as their Senior Lawyer is the less than ethical Brenda DOIG The new 2014 Revised Rules of Professional Conduct should help control her excessive zeal).

SAS Institute Inc & MEDICAL RECORDS

"SAS (pronounced "sass") once stood for "statistical analysis system," and began at North Carolina State University as a project to analyze agricultural research. As demand for such software grew, SAS was founded in 1976 to help all sorts of customers - from pharmaceutical companies and banks to academic and governmental entities. SAS – both the software and company – thrived throughout the next few decades. Development of the software attained new heights in the industry by being able to run across all platforms, using the multivendor architecture for which it is known today. While the scope of the company spread across the globe, the encouraging and innovative corporate culture remained the same. In 1988, SAS opened its physical operation in Canada. SAS (Canada) has many long-standing customer relationships and recently celebrated 25th anniversaries with RBC, Bell Canada, CIBC and BMO. SAS (Canada) employs both technical and vertical industry experts to ensure that our predictive and business intelligence solutions align and solve our customers’ business problems. Headquartered in Toronto, SAS (Canada ) employs more than 300 people across the country at its Calgary, Montreal, Ottawa, and Toronto offices. The SAS Canada headquarters at 280 King Street East" http://www.sas.com/offices/NA/canada/en/corporate/sas_canada.html OMA Economics Dept (Dr.B.KRALJ PhD + 9 staff) subscribe to SAS) Cost to provide SAS Statistical analysis system to all OMA members would be approx $300,000 then $100,000 yearly.(according to SAS). (Comment: this would give extra visual information value to OMA members' medical records and be a defence against the ease of CPSO-appointed OMA-member "PEER ASSESSORS" charging their colleagues with professional incompetence for so-called "poor record keeping". CPSO makes money forcing accused doctors to take Record Keeping Courses in Toronto at about$700 + travelling costs. (BTW the CPSO-appointed doctor who gave the lectures was recently charged by CPSO for improper Narcotic prescribing.)

McGILL UNIVERSITY: FREE CONFERENCE REPORTS

http://www.mednet.ca/en/credits.html Accredited Conference Report Series (See program description at the bottom of the page) Latest Reports 8th World Congress of Melanoma - New Advances in the Treatment of Basal Cell Carcinoma: Targeting the Hedgehog Signaling Pathway XXIV Congress of the International Society on Thrombosis and Haemostasis (ISTH)/ 59th Annual Scientific and Standardization Committee (SSC) Meeting - Potential for Advances in the Treatment of Hemophilia A 73rd Scientific Sessions of the American Diabetes Association (ADA) - New Antidiabetic Medications Yield Flatter PK, More Predictable Blood Glucose Levels than Standards 73rd Scientific Sessions of the American Diabetes Association (ADA) - Clarity Grows on the Role of SGLT2 Inhibitors in Routine Control of Type 2 Diabetes SLEEP 2013 - 27th Annual Meeting of the Associated Professional Sleep Societies - Sleep-Wake Systems Intersected: A New Dawn in the Treatment of Sleep Disorders Digestive Diseases Week 2013 - Progress in Control of Constipation: Highly Specific Agents Change Treatment Algorithm International Conference of the American Thoracic Society - Updates in the Treatment of Chronic Thromboembolic Pulmonary and Pulmonary Arterial Hypertension Primary Care Today 2013 - Update on Benign Prostatic Hyperplasia in Primary Care 23rd European Congress on Clinical Microbiology and Infectious Diseases - Serum Antifungal Concentrations Are Fundamental to Cure of Invasive Aspergillosis 8th Congress of the European Crohn’s and Colitis Organisation - The Potential of IV Iron Treatment in IBD Patients with Iron Deficiency Anemia 54th Annual Meeting of the American Society of Hematology - Emerging Concepts in the Management of Iron Deficiency Anemia 54th Annual Meeting of the American Society of Hematology - Seeking Better Outcomes for Indolent Lymphomas 10th Canadian Immunization Conference - Invasive Meningococcal Disease: Focus on the New Serogroup B Disease Vaccine 10th Canadian Immunization Conference - Improving Influenza Protection in Seniors with Adjuvanted Vaccines 10th Canadian Immunization Conference - Nasopharyngeal colonization and disease transmission: Eradication of Vaccine-Specific Organisms Dramatically Reduces Disease Incidence in Recipients/Non-Recipients Alike 4th European Multidisciplinary Meeting on Urological Cancers (EMUC 2012) - Targeting the Androgen Receptor in Castrate-resistant Prostate Cancer: A Step Forward 63rd McGill Annual Refresher Course for Family Physicians - Update on Family Medicine: Oral Anticoagulants, Stroke Management, Ovarian Cancer 76th Annual Meeting of the American College of Rheumatology (ACR) - Protection Against Radiologic Progression in Rheumatoid Arthritis with JAK Inhibition Appears Similar to IV Biologics 65th Annual Meeting of the Canadian Cardiovascular Society - Effective Event Reduction in the Era of New Oral Anticoagulants: Pursuing Options 2012 Canadian Hypertension Congress - A Template for Improved Blood Pressure Control and Better Adherence: Integrating Third Generation b-blockers and Single-pill Multiple Mechanism Combinations 2012 Kidney Week of the American Society of Nephrology (ASN) - Options for Iron Correction and Erythropoiesis Stimulation: Better Benefit:Risk Through Individualized Therapy 21st Congress of the European Academy of Dermatology and Venereology (EADV) - Progress in Advanced Basal-cell Carcinoma: Exploring Hedgehog Pathway Inhibition 37th European Society of Medical Oncology Congress (ESMO) - Exploring Benefits of Multitargeted Therapy for Metastatic Colorectal Cancer and Gastrointestinal Stromal Tumours 89th Annual Meeting of the Canadian Paediatric Society - Prevention and Minimization of Potential Complications from Infection and Disorders in Infancy 2012 Annual European Congress of Rheumatology (EULAR) - Progress in Oral Biologics for Rheumatoid Arthritis 28th CINP World Congress of Neuropsychopharmacology - Resetting the Internal Master Clock: A Novel Approach to the Treatment of Depression 48th Annual Meeting of the American Society of Clinical Oncology - Hormone Activity Suppression in Castration-resistant Prostate Cancer 10th Annual Primary Care Today Conference - Preventing Allergies in Infants: Focus on Atopic Dermatitis 15th International Congress of Endocrinology and 14th European Congress of Endocrinology (ICE-ECE) - Hyponatremia: Optimizing Clinical Approaches 22nd European Congress on Clinical Microbiology and Infectious Diseases (ECCMID) - Primary Treatment of Invasive Aspergillosis in Hematology Patients

OMA JOBS

Sr. Policy Analyst, Emerging Issues - September 2013 The Senior Policy Analyst is responsible for undertaking research, analysis and evaluation of emerging issues in the health care system... Sr. Policy Analyst, Hospital Issues (12 Mth Contract) September 2013 The Ontario Medical Association is recruiting for a Senior Policy Analyst to focus on hospital issues... Staff Technologist, Ontario Laboratory Accreditation (OLA) - September 2013 The Quality Management Program—Laboratory Services (QMP–LS) is a department of the Ontario Medical Association (OMA) operating under agreement between the OMA and the Ministry of Health... Sr. Policy Analyst - Health Policy The OMA is seeking to hire a Senior Policy Analyst (Research) in its Health Policy department, which identifies and responds to emerging and on-going issues in the health care system as they affect physicians and patient care. Administrator, Business Development & Partnerships - Engagement & Program Delivery The Administrator, Business Development & Partnerships, is accountable to the Director, Business Development & Partnerships for providing administrative support to the department. Coordinator, Business Development & Partnerships - Engagement & Program Delivery The Coordinator, Business Development & Partnerships, is accountable for the coordination and monitoring of established business relationships that support members professional and personal business needs. Business Analyst, Customer Experience - Insurance Services August 2013 The Business Analyst, Customer Experience is accountable for providing business analysis, member and client insights with a view to improving the customer experience, Net Promoter Score and perception of OMA Insurance's value proposition. Director, Public Affairs - Public Affairs & Communications August 2013 The Director, Public Affairs, is accountable to the Executive Director, and is responsible for developing, managing, executing and evaluating media and government relations initiatives and programs that support the short and long term goals of the OMA. Team Leader - Service and Operations Insurance Services June 2013 The Team Leader is accountable to the Director, Insurance Service & Operations. The Team Leader is responsible for supervising the activities of the Insurance Service & Operations team including; project planning... Previous Page T

SWISS HAEMATOLOGY Soc. : HAEMATOLOGY NOTES 265 pages

http://ssh.bio-med.ch/media/shared/uploaded/Files/9/9/6.pdf

PROMED: SYPHILIS in FLORIDA

x promed@promedmail.org 11:00 (43 minutes ago) to promed, promed-edr SYPHILIS - USA (05): (FLORIDA), HIGHER INCIDENCE ************************************************ A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases Date: Fri 20 Sep 2013 Source: Fort Mills Times [edited] Since 2000, Broward County has seen a 400 percent increase in reported syphilis cases. Early last week, 22 000 Broward County residents received an informational mailer from the AIDS Healthcare Foundation (AHF), the largest AIDS organization in the United States, regarding the shocking rates of syphilis within the south Florida county. The postal distribution resulted in a dramatic increase in patients seeking free testing and treatment at AHF's new local STD clinic, as well as a letter issued by the local Health Department to providers about how to help combat the spread of the sexually-transmitted disease. "While Broward County has the highest rate of syphilis in the state of Florida, the good news is that syphilis is a curable disease, one best caught and treated early," said Albert Ruiz, Director, Public Health Division for AHF and who oversees AHF's Wellness Programs. "We encourage any sexually active individual who feels that they may be at risk to come in and get tested, and if necessary, treated." The Florida Department of Health in Broward County's notice to providers highlighted the need for a stepped-up response by declaring 613 new cases of syphilis reported to the department's Broward County office in 2012, 15 of which were congenital syphilis infections passed from mother to child. This information is in line with the concerning statistics presented in the AHF mailer, which include the fact that syphilis cases reported in Broward County have increased by 400 percent since 2000. Within the 1st 10 days of the mailer's receipt, 6 new clients went to the newly opened AHF Broward Wellness Center seeking syphilis screenings and, if needed, treatment. The new Broward Wellness Center opened for free testing and treatment for HIV, syphilis, Chlamydia, and gonorrhea on 3 Sep 2013. -- Communicated by: ProMED-mail from HealthMap Alerts [Broward County is located in the U.S. state of Florida. As of 2010, the population was 1 748 066, making it the 2nd most populated county in the state (). Its county seat is Fort Lauderdale. Broward County is located on Florida's east coast between Palm Beach County to the north and Miami-Dade County to the south. In 2000, the number of cases and the incidence rate of primary and secondary syphilis (P&S), the contagious stages of syphilis, was 5979 and 2.1, respectively, the lowest since reporting began in 1941 (Table 1, ). The number of cases and incidence rate of P&S then increased almost yearly to 13 970 and 4.5 per 100 000 in 2011 (Table 1, ). The southern region of the U.S. accounted for 44.1 percent of P&S cases in 2011 (Table 26, ). Florida had the 5th highest incidence rate for P&S of 6.7 per 100 000 among all the states in 2011 (Table 5, ) and accounted for 9.0 percent of P&S in 2011 (table 26, ). Among counties and independent cities of the U.S. ranked by number of cases reported in 2011, Broward County ranked 10th highest with 235 cases of P&S and an incidence rate of 13.4 cases per 100 000; Miami-Dade ranked 6th highest with 330 cases and a rate of 13.2 per 100 000; Palm Beach County ranked 47th with 65 cases and a rate of 4.9 (Table 32 ). In recent years, young men who have sex with men (MSM) have accounted for an increasing number of syphilis cases in the United States; 72 percent of P&S syphilis cases are among MSM (). In Florida in 2011, men accounted for 89 percent of P&S cases, the same percentage as the country as a whole.

COURSERA

About Coursera® We believe in connecting people to a great education so that anyone around the world can learn without limits. Coursera is an education company that partners with the top universities and organizations in the world to offer courses online for anyone to take, for free. Our technology enables our partners to teach millions of students rather than hundreds. We envision a future where everyone has access to a world-class education that has so far been available to a select few. We aim to empower people with education that will improve their lives, the lives of their families, and the communities they live in.

NURSE PRACTITIONER CLINIC replaces MDs.

(ONT. GOVT.release)New Nurse Practitioner-Led Clinic Improving Health Care in Scarborough Hong Fook Nurse Practitioner-Led Clinic Now Open ( A new nurse practitioner-led clinic is offering family health care services closer to home for (Asian) residents in Scarborough. The new Hong Fook Connecting Health Nurse Practitioner-Led Clinic will focus on immigrant health to support Scarborough's Asian community. At full capacity the clinic is expected to provide care to over 3,200 people in Scarborough who currently do not have access to a family health care provider. Ontario's nurse practitioner-led clinics are the first of their kind in North America and offer important health services such as comprehensive primary care, illness prevention and health promotion, diagnosis and treatment of episodic and chronic illness, health assessments and primary mental health care. Supporting nurse practitioner-led clinics is part of the Ontario government's Action Plan for Health Care and its commitment to provide the right care, at the right time, in the right place. QUICK FACTS Nurse practitioners in these clinics work collaboratively with an inter-professional team of health care providers and support staff, which may include registered nurses, registered practical nurses, registered dietitians, pharmacists and social workers. When all 25 nurse practitioner-led clinics are at full capacity, they are expected to serve more than 40,000 patients across Ontario.

TRILLIUM Hospital: Chief of Medical Staff DANTE MORRA MD(Tor.2000) FRCPC MBA

Trillium Hosp Chief of Medical staff Dr.Dante MORRA (approx.38y)has to deal with Radiology diagnosis scandal involving elderly radiologist (approx 70y) IVO SLEZIC MD(Zagreb 1968) FRCPC(1978) OHIP does not have a retirement age. In UK NHS provides a retirement pension after compulsory retirement from NHS at 65y.

CPSO "records expert":Dr.HOWARD WU found to be "incompetent"

Dr. Howard Wu, Markham. On April 29, 2013, the Discipline Committee found that Dr. Wu is incompetent and committed acts of professional misconduct in that, he failed to maintain the standard of practice of the profession and he engaged in disgraceful, dishonourable or unprofessional conduct. Dr. Wu is a family physician practising in Markham. As a result of five investigations into his practice, allegations were referred to the Discipline Committee on July 6, 2011 and September 5, 2012. On July 27, 2011, Dr. Wu signed an Undertaking not to prescribe narcotics or other controlled substances, subject to the engagement of a College-approved clinical supervisor. Following an investigation into Dr. Wu's compliance with the Undertaking, an additional allegation of disgraceful, dishonourable or unprofessional conduct by breaching his Undertaking was referred to the Discipline Committee on April 4, 2013. Dr. Wu admitted that he: failed to maintain the standard of practice and is incompetent in his chronic pain practice in relation to patient charts as detailed in the reports of the medical assessors. failed to maintain the standard of practice in his family practice in relation to patient charts, as detailed in the report of a medical assessor. failed to maintain the standard of practice and engaged in disgraceful, dishonourable or unprofessional conduct with respect to his delegation of controlled acts in relation to patient charts as detailed in the report of a medical assessor. engaged in disgraceful, dishonourable or unprofessional conduct by breaching his Undertaking as follows: a) by issuing a prescription for Testosterone on August 10, 2011, before engaging a clinical supervisor acceptable to the College; b) between June 2012 until October/November 2012, by failing to ensure his clinical supervisor co-signed patient charts to indicate he approved of the prescription for each and every restricted substance prescription issued by Dr. Wu; c) by failing to ensure the charts co-signed by his clinical supervisor for two patients on December 4, 2012, accurately reflected the prescriptions issued to the patients; and d) by failing to include required information in his log pertaining to prescriptions for restricted substances in relation to five patients. The Discipline Committee ordered a public reprimand and a six-month suspension of Dr. Wu's certificate of registration commencing June 1, 2013. The Committee also ordered that the following restrictions be imposed on his certificate of registration: i. Dr. Wu shall not issue new prescriptions or renew existing prescriptions for Narcotic Drugs; Narcotic Preparations; Controlled Drugs; and Benzodiazepines/Other Targeted Substances. ii. Dr. Wu shall post a clearly visible sign in his waiting room that shall state as follows: "Dr. Wu cannot prescribe Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances." A sign reflecting this restriction will also be posted in Chinese. iii. Dr. Wu shall not delegate to any other person any controlled act as that term is defined in the Regulated Health Professions Act, 1991. iv. Approximately one month after the completion of the suspension of Dr. Wu’s certificate of registration, he shall undergo an assessment of his family practice by College-appointed assessor(s) at his expense. The assessor(s) shall report the results of the assessment to the College. Dr. Wu shall abide by any recommendations of the assessor(s). v. Dr. Wu shall consent to the sharing of information between the assessor(s) and the College as any of them deem necessary or desirable in order to fulfill their respective obligations. vi. Dr. Wu shall cooperate with unannounced inspections of his office practice and patient charts by the College for the purpose of monitoring and enforcing his compliance with the terms of this Order and will make his OHIP billings accessible to the College for this purpose. Dr. Wu was further ordered to pay the College costs in the amount of $3,650.

From MEDICAL POST:: CPSO "records teacher" Toronto GP Howard WU suspended for 6 months on 1 June 2013 for illegal drug prescribing.

See CPSO suspension of licence of CPSO “teacher” Howard WU on 1 June 2013. http://www.cpso.on.ca/publicregister/details.aspx?view=4&id=%2067746

TORONTO: Canadian Cancer Research Alliance conference

The Canadian Cancer Research Alliance is proud to host the second Canadian Cancer Research Conference, taking place from Sunday November 3 to Wednesday November 6, 2013 at the Sheraton Centre Toronto Hotel in Toronto, Ontario. The conference will: Showcase the breadth and excellence of Canadian cancer research to both the research community and the public; Provide a single venue for researchers from across the cancer research spectrum and cancer sites; Expose researchers to new areas of cancer research, new techniques and infrastructures and facilities to support research; Allow for cross-fertilization between research disciplines; and Provide networking opportunities for researchers at all levels of their careers. The conference is targeted to all involved in cancer research from the lab to clinic to policy and will also incorporate special sessions for trainees and new principal investigators. We look forward to seeing you in November 2013! The conference will be conducted in English, which has become the international language of science.

UK: PRIVATE(charitable) BUCKINGHAM UNIVERSITY MEDICAL SCHOOL

http://www.buckingham.ac.uk/medicine/undergrad/mbchb MBChB after 4.5 years. 2 pre-med + 2.5 clinical. No limit to Overseas (non-EU) students. Oxbridge-style tutorials.

USA: Nat.Preparedness Month

Emergencies can occur with no warning. Do you have a supplies kit and a plan of action? September is National Preparedness Month. Visit Ready.gov for guidance on what to before, during, and after different kinds of natural disasters and other emergencies. Another action you can take is to join the National Preparedness Community. It's free and open to all. As a member, you'll have access to special preparedness resources and can collaborate with others in your community.

DAILY MAIL: NHS to pay for ZOSTAVAX for those 70-79y

Monday, Sep 02 2013 NHS to offer shingles jab for patients in their 70s: Programme aims to protect those who are most vulnerable Government advisers ruled that vaccinating people in their 80s is not cost-effective An estimated 800,000 people will be eligible for the vaccine in the first year Read more: http://www.dailymail.co.uk/news/article-2408633/NHS-offer-shingles-jab-patients-70s-Programme-aims-protect-vulnerable.html#ixzz2dhZk1TZ9

VALEANT Pharmaceuticals Inc.(Laval West,QUEBEC): Magnetic AMSLER GRID.

VALEANT includes a magnetic AMSLER GRID in a VISUDYNE (verteporfin)package which also includes a Body Surface Area and Dosage calculator.

Toronto ASRS:OCTOVUE " iVUE SD-OCT " (PORTABLE)

Optovue, Inc 2800 Bayview Dr Fremont, CA 94538 Phone: 1-510-623-8868 1-510-743-0988 Toll Free : 1-866-344-8948 Fax Number: 1-510-623-8668 iVue-the-world-OCT $40,000 The World OCT… The next wave of the revolution is here! The first advanced OCT for every clinical practice. The iVue is the next generation in advanced OCT product design and the first true World OCT. Optovue brings the diagnostic power of high-speed, high-resolution OCT technology to clinicians everywhere.

TORONTO : ASRS Exhibits

PICTOR portable ophthalmic imager $8,000 + optional attachments for CORNEA, EAR CANAL, SKIN @ $1000 each. Handset, connected with anterior module for external eye imaging Dermatoscopic module for examination of the entire skin surface Otoscopic module to view the entire auditory canal and tympanic membrane Retinal module for non-mydriatic fundus examination Volk Pictor is a truly portable digital imaging device that provides a variety of imaging capabilities with interchangeable modules. This versatile hand held device is available with the option of four key imaging modules for examination: ophthalmic - posterior and anterior segment, dermatoscopic and otoscopic. VOLK OPTICAL In Optovue, Inc 2800 Bayview Dr Fremont, CA 94538 Phone: 1-510-623-8868 1-510-743-0988 Toll Free : 1-866-344-8948 Fax Number: 1-510-623-8668 iVue-the-world-OCT The World OCT… The first advanced OCT for every clinical practice. The iVue is the next generation in advanced OCT product design and the first true World OCT. Optovue brings the diagnostic power of high-speed, high-resolution OCT technology to clinicians everywhere. www.optovue.com

TORONTO SHERATON CENTRE HOTEL: American Society RETINA SPECIALISTS Aug 24-28.

ONTARIO MEMBERS: Narendra Armogan, MD, FRCS(C) (905) 212-9482 - Mississauga, ON Alan R. Berger, MD, FRCS(C), B. Sc. (416) 867-3663 - Toronto, ON Michael H. Brent, MD, FRCS(C) (416) 603-5444 - Toronto, ON William Alan Britton Jr., MD (613) 722-1517 - Ottawa, ON Varun Chaudhary, MD (905) 220-5418 - Ancaster, ON David R. Chow, MD, FRCS(C) (416) 867-7447 - Toronto, ON Gilles Desroches, MD, FRCS(C) (613) 236-1907 - Ottawa, ON Robert G. Devenyi, MD, MBA, FRCS(C) (416) 417-7993 - Toronto, ON Kenneth T. Eng, MD, FRCS(C) (416) 480-4688 - Toronto, ON Peter J. Kertes, MD, FRCS(C) (416) 480-5280 - Toronto, ON Wai-Ching Lam, MD, FRCS(C) (416) 603-5376 - Toronto, ON Brian C. Leonard, MD (613) 737-8574 - Ottawa, ON James A. Martin, MD (905) 522-3611 - Hamilton, ON Jason Noble, MD, FRCS(C) (647) 346-5222 - Toronto, ON Alejandro Oliver, MD,FRCS(C),MS (705) 267-1744 - Timmins, ON Sanjay Sharma, MD, FRCS(C),MSc.,MBA 61354434002227 - Kingston, ON Tom Sheidow, MD, FRCS(C) (519) 685-8133 - London, ON Sohel Somani, MD, FRCS(C) (905) 761-7002 - Concord, ON Mario R. Ventresca, MD, FRCS(C) (905) 834-5611 - Port Colborne, ON David T.W. Wong, MD, FRCS(C) (416) 867-3670 - Toronto, ON Pradeepa Yoganathan, MD, FRCS(C)

ONTARIO:PRE-PAID SOLICITOR SERVICES

MID-OCEAN PARTNERS ($460-million/year:founded 2003) CEO 50y Christian PURSLOW MA(Cantab.) MBA(Harvard) owners of LEGALSHIELD (1972) which offers pre-paid solicitor services. Pre-Paid Legal Services founded in ADA,Oklahoma,(pop.17,000),by Harland STONECIPHER, lying in a hospital bed after a car`accident. Now 800+ full-time employees. In 1999 bought by Private`Equity Mid-Ocean. 1.4 million families insured. LEGALSHIELD contracts with local Legal firms. In TORONTO firm of MILLS & MILLS (1884)31 members @ 2 St.Clair Av West.#700 Basic cost about $400/yr inc spouse and dependent children. Ontario & Toronto agents MacKenzie Family : father (ex-police), mother and son. richard.w.mackenzie@gmail.com 905.334.1763 & 905.901.3152 (COMMENT CMPA & OMA do not cover legal costs for Court Appeals to CPSO Tribunal decisions. LEGALSHIELD subscribers receive a 25% discount for Litigation by LEGALSHIELD Barristers.)

PARIS: SILMO OPHTHALMIC EXHIBITION

http://www.silmoparis.com/extension/comexposiumsites/design/silmo_2013/images/pdf/Anglais.pdf SEPT 26-28,2013

LIBRARY SERVICES

BC College Phys. & Surgeons has FULL library services Ontario CPSO has no library services. OMA has minimal library service in a locked floor. No longer employes a librarian.

51 years after Lord Brain's paper on dangers of Neck Manipulation & trauma to Vertebral arteries.

UK DAILY MAIL My chiropractor gave me locked-in syndrome, but I survived': Astonishing recovery of woman, 46, who beat the odds to walk and talk again Sandy Nette, 46, had her neck manipulated which ripped two arteries and caused multiple strokes which left her totally paralysed and unable to talk Doctors didn't believe she would survive but since 2007 she has made a steady recovery thanks to rehabilitation, surgery and determination She said: 'No matter how bad things seem, it is important never to give up' Chiropractor was given a three-month suspension and the Canadian Chiropractic Protection Association will no longer insure him EXCLUSIVE By Rachel Reilly PUBLISHED: 13:17 GMT, 18 August 2013 | UPDATED: 13:30 GMT, 18 August 2013 A woman, with the help of her husband, has spoken out about the incredible recovery she has made after she developed locked-in syndrome. Sandy Nette, 46, who lives in Alberta, Canada, suffered a series of massive strokes after her chiropractor manipulated her neck and ripped two arteries. Doctors did not believe she would survive and said that if she did, she would probably never regain the ability to walk and talk or even breathe unaided. But they were wrong. Read more: http://www.dailymail.co.uk/health/article-2383727/My-chiropractor-gave-locked-syndrome-I-survived-Astonishing-recovery-woman-46-beat-odds-walk-talk-again.html#ixzz2cLOynL8u Follow us: @MailOnline on Twitter | DailyMail on Facebook

MAXWELL'S (1961) Hong Kong tailors in Totonto

COMMENT: Maxwell's visiting Toronto SHERATON ,123 Queen St.West SEPT. 9-13 for other Ontario cities: www.maxwellsclothiers.com e.g. 3 bespoke shirts with monogram $165.

UK DAILY MAIL: SALMONELLA from eggs.

MPs banned from eating scrambled eggs because risk of salmonella is 'too dangerous'... unless they are made from pasteurised liquid from Holland By Brendan Carlin PUBLISHED: 21:11 GMT, 17 August 2013 | UPDATED: 21:11 GMT, 17 August 2013 MPs were at the centre of a new food scare last night after the Commons banned traditional scrambled eggs and omelettes – because they are ‘too dangerous’. Chefs at the House of Commons are now forbidden to make two of the most popular light meals in Britain with fresh eggs on the grounds that they could be contaminated with salmonella or other bugs. MPs at Westminster can still order scrambled egg or omelette, but they will be made with liquid pasteurised egg from Holland instead. Read more: http://www.dailymail.co.uk/news/article-2396237/MPs-banned-eating-dangerous-scrambled-eggs.html#ixzz2cKE5So65

Ontario Lawyers with Certificate in Health Law

City Name Business Name Oakville Valerie Wise Valerie Wise Ottawa Judie Leach Bennett Canadian Blood Services Toronto Neil Abramson Torkin Manes LLP Toronto Lisa Sheryl Braverman Steinecke Maciura LeBlanc Toronto W D T Carter Borden Ladner Gervais LLP Toronto Irwin W Fefergrad Royal College of Dental Surgeons Of Ontario Toronto Ayanna Ferdinand Bridgepoint Health Toronto Bernard C LeBlanc Steinecke Maciura LeBlanc Toronto Julie Maciura Steinecke Maciura LeBlanc Toronto John J Morris Borden Ladner Gervais LLP Toronto Lonny Rosen Rosen Sunshine LLP Toronto Jane Speakman City of Toronto Legal Department Toronto Marc Spector Steinecke Maciura LeBlanc Toronto Pamela C Spencer Cancer Care Ontario Toronto Paula Trattner Osler, Hoskin & Harcourt LLP Toronto Tracey Tremayne-Lloyd Gardiner Roberts LLP

OMA JOBS

https://www.oma.org/About/Pages/Careers.aspx Current Opportunities Regional Manager (SW Ontario) Engagement and Program Delivery - August 2013 The Regional Manager is accountable to the Director, Physician and Stakeholder Engagement, and is the primary OMA regional contact with members and local stakeholders Manager Advisor Team The Manager, Advisor Team is accountable to the Senior Director for overseeing the daily operations of the Advisor Team of the insurance department, as well as providing assistance to the Senior Director on various projects. Team Leader - Service and Operations Insurance Services June 2013 The Team Leader is accountable to the Director, Insurance Service & Operations. The Team Leader is responsible for supervising the activities of the Insurance Service & Operations team including; project planning... Physician Payment Review Board The OMA is looking for 2 Physician Members (1 Anesthesiologist and 1 General Surgeon) to fill the composition on the Physician Payment Review Board.

BENCE JONES SOCIETY ( Measurement in Medicine)

NEUTROPHIL graphing shows earliest change from MGUS("static" plasma cell cancer) to proliferative plasma cell cancer. Confirmed by IgG, M protein & total WBC. Test cheap, widely available, & office test. Free Light Chain best best but expensive. Comments invited.

Leslie DAN School of Pharmacy Dean Dr. Jake THIESSEN MSc(Man.) PhD (U.Calif.: San Fran.) reports on faulty chemotherapy.

Hamilton Pharm MARCHESE charged $6 instead of $20 from BAXTER Int. Ont MOH bought cheaper product. Hamilton Charles JURAVINSKI Cancer Centre did not use the Marchese mixture. 1200 patients affected. Minister Health Dr.D.MATTHEWS PhD(Sociology U.West.Ont.) says sorry.

5% of hypertensives have CONN SYNDROME

Quoted in UK DAILY MAIL Somatic mutations in ATP1A1 and CACNA1D underlie a common subtype of adrenal hypertension Elena A B Azizan, Hanne Poulsen, Petronel Tuluc, Junhua Zhou, Michael V Clausen, Andreas Lieb, Carmela Maniero, Sumedha Garg, Elena G Bochukova, Wanfeng Zhao, Lalarukh Haris Shaikh, Cheryl A Brighton, Ada E D Teo, Anthony P Davenport, Tanja Dekkers, Bas Tops, Benno Küsters, Jiri Ceral, Giles S H Yeo, Sudeshna Guha Neogi, Ian McFarlane, Nitzan Rosenfeld, Francesco Marass, James Hadfield, Wojciech Margas et al. Affiliations Contributions Corresponding authors Nature Genetics (2013) doi:10.1038/ng.2716 Received 04 March 2013 Accepted 03 July 2013 Published online 04 August 2013 At least 5% of individuals with hypertension have adrenal aldosterone-producing adenomas (APAs). Gain-of-function mutations in KCNJ5 and apparent loss-of-function mutations in ATP1A1 and ATP2A3 were reported to occur in APAs1, 2. We find that KCNJ5 mutations are common in APAs resembling cortisol-secreting cells of the adrenal zona fasciculata but are absent in a subset of APAs resembling the aldosterone-secreting cells of the adrenal zona glomerulosa3. We performed exome sequencing of ten zona glomerulosa–like APAs and identified nine with somatic mutations in either ATP1A1, encoding the Na+/K+ ATPase α1 subunit, or CACNA1D, encoding Cav1.3. The ATP1A1 mutations all caused inward leak currents under physiological conditions, and the CACNA1D mutations induced a shift of voltage-dependent gating to more negative voltages, suppressed inactivation or increased currents. Many APAs with these mutations were <1 cm in diameter and had been overlooked on conventional adrenal imaging. Recognition of the distinct genotype and phenotype for this subset of APAs could facilitate diagnosis

UK PHYSICIAN MINISTER of HEALTH D.POULTER LLB (Bristol) MBBS(Lond.) AKC (King's)

Daniel Leonard James Poulter[2][3] (born 30 October 1978) is a British Conservative Party politician, who was elected at the 2010 general election as the Member of Parliament (MP) for Central Suffolk and North Ipswich. Poulter is a qualified medical doctor and has served as a Parliamentary Under Secretary of State in the Department of Health since September 2012.[1][4] Poulter was born in Beckenham in Kent.[2] He attended the University of Bristol, graduating with a Law degree, before qualifying as a medical doctor by gaining an MB BS at the University of London and an AKC (Theology,Ethics)from King's College London.[2] Poulter worked as a junior doctor specialising in obstetrics and gynaecological medicine and has published articles in the area of women's health.[2]

FREE CONFERENCE POSTERS

www.posterdocuments.com

UK DAILY MAIL: TARIFF @ LINDO WING

PRICES AT THE LINDO WING Antenatal care Day case accommodation Up to one hour: £75 Up to three hours, £200 More than three hours: £400 Antenatal care overnight: £900 Parent education (five classes): £350 Consultant-led care packages (Cost of additional night – per room) First 24hrs normal delivery package: £4,965 (Cost of extra night: £900 for superior package; £1,050 for deluxe) First 24hrs instrumental delivery: £5,500 (Cost of extra night: £900 for superior package; £1,050 for deluxe package) First 24hrs caesarean section:(emergency or planned): £6,420 (Cost of extra night: £900 for superior package; £1,050 for deluxe package) Suite prices and information available on request and subject to availability Read more: http://www.dailymail.co.uk/news/article-2344441/Royal-baby-Inside-10k-hospital-suite-Kate-Middleton-birth.html#ixzz2Zml63mig Follow us: @MailOnline on Twitter | DailyMail on Facebook

FUTURE MEDICINE: Prof.S.SCHEY on Multiple Myeloma

International Journal of Hematologic Oncology April 2013, Vol. 2, No. 2, Pages 109-112 , DOI 10.2217/ijh.13.7 (doi:10.2217/ijh.13.7) Interview: A lifetime of working to improve outcomes in multiple myeloma Steve Schey* Steve Schey speaks to Roshaine Gunawardana, Managing Commissioning Editor: Professor Stephen Schey is Consultant Haematologist and Honorary Senior Lecturer at King’s College Hospital and King’s College School of Medicine, King’s College London (London, UK). Schey qualified at St George’s Hospital (London, UK) in 1974, and later travelled to Australia where he worked at the Institute of Clinical Pathology and Medical Research in Sydney as Clinical Lecturer in Haematology. Subsequently, he returned to London to work at the Royal Free Hospital as Transplant Co-ordinator before working at the Royal Marsden (London, UK) and later the Middlesex Hospital (London, UK). Schey took up a Senior Lecturer post in 1985 and subsequently served as Director of Clinical Haematology for the Guy’s and St Thomas’ National Health Service (NHS) Foundation Trust from 1993 to 2004. Schey has contributed his services to a number of national and international professional bodies. He was chair of the UK Myeloma Forum from 2003 to 2009, following two terms as the Secretary from 1997. This was a productive period during which Schey managed the development of guidelines, clinical trials and advocacy for the UK Myeloma Forum patients and healthcare professionals. He has been Clinical Research Lead for the South East London Cancer Network since 2005. He also served on the National Cancer Research Institute (NCRI) Haemoncology Cancer Steering Group between 2002 and 2010, the NCRI Industry Adoption Panel and was Chairman of the NCRI Myeloma Clinical Trials Committee until 2010. Schey was a member of the American Society for Hematology (ASH) Scientific Committee for Immunosecretory Disorders. He is currently the Professor of Plasma Cell Dyscrasias at King’s College London. Q What led to your initial interest in hematology and how did this evolve into a more specific interest in hemoncology? I fell into hematology fortuitously when I took time out in the late 1970s and early 1980s to travel around the world. I initially had a job as a lecturer in medicine at Princess Alexandra Hospital (Brisbane, Australia) and was offered a post in the Institute of Pathology and Medical Research (Sydney, Australia) as a clinical lecturer in hematology at the Institute of Clinical Pathology and Medical Research in Westmead Hospital (Sydney, Australia) by the Director at that time, Dr Wilbur Hughes. He was a superb teacher and I was fortunate enough to become involved in establishing the Bone Marrow Transplant Unit at Westmead and to then be offered a job back in the UK at the Royal Free Hospital in London (London, UK) as Transplant Coordinator by Professor Grant Prentice. My training and exposure to such leaders in the field of this exciting, newly emerging therapeutic area of hemopoeitic stem cell transplantation, here and subsequently at the Middlesex Hospital (London, UK), resulted in me developing an interest in malignant hematology. When I obtained my first consultant job at Guy’s Hospital (London, UK) in 1985, I realized that myeloma was a field where progress had not been made in the previous 25 years, unlike many other hematological tumors, and I resolved to focus my efforts on investigating this malignancy to improve outcomes. Q Some of your research interests include multiple myeloma and the bone marrow microenvironment. Can you briefly describe your latest research in these areas? Previous sectionNext section The crosstalk between multiple myeloma (MM) cells and the cells in the bone marrow (BM) microenvironment, such as osteoblasts, osteoclasts, stromal cells and endothelial cells, are mediated by both soluble factors, as well as by cell–cell contact-dependent mechanisms, such as cellular adhesion molecules and interactions with extracellular matrix proteins. Such interactions result in antiapoptotic signaling and drug resistance, and myeloma cell survival, proliferation and apoptosis can therefore be modulated by both interacting directly with the myeloma cell itself and indirectly through influencing the cellular milieu of the BM. The myeloma group at King’s College London (London, UK) has been studying: ▪ The coordination between integrin-mediated adhesions and actin dynamics leading to cell polarity, directional migration and tissue invasion; ▪ The reciprocal communication between the cytoplasm and the nucleus through the organization of adhesion/cytoskeletal complexes leading to changes in protein levels that regulate the migratory/adhesive properties and tumor-initiating potential of cancer cells. We are currently studying the dynamics of adhesion and cytoskeletal remodeling in myeloma- and tumor-associated myeloid cells (macrophages, dendritic cells and osteoclasts) within the BM microenvironment. We believe these interactions are crucial for the proliferative potential of myeloma cells, their adhesion-dependent drug resistance and tissue invasion. They are also critical for specific features of myeloma, such as hyperactivation of osteoclasts leading to bone lytic lesions and fractures in patients. Currently under investigation is the myeloma cell podia. We are the first group to have identified and characterize podia as the structures that myeloma cells form to interact with BM stromal cells leading to cell adhesion-mediated drug resistance [1]. We combine our basic science with translational research to identify new anticancer therapies by performing functional studies to determine whether specific signaling pathways that are associated with cell adhesion in the tumor microenvironment can be used as therapeutic targets. In order to validate the identified targets we have developed a fluorescence-based experimental model based on fluorimetry, flow cytometry and image analysis that employs mCherry-labeled stromal cells (e.g., BM fibroblastic stromal cells) cocultured in direct contact with enhanced GFP-labeled tumor cell lines for accurate assessment of proliferation and viability in both cell compartments and adhesion of tumor cells. In addition, we use fluorescent-based image analysis to determine morphological changes that predict cell function (e.g., morphology of the actin cytoskeleton and nuclearity of osteoclasts to predict their bone resorption activity). Using this platform we have revealed that dexamethasone induces HS5 fibroblast proliferation and contact with MM cells via a process involving Src/c-Abl kinases. Osteoclasts also inhibited dexamethasone-induced apoptosis in myeloma cells while retaining their normal morphology and functionality in bone resorption. Myeloma resistance to dexamethasone supported by HS5 cells and osteoclasts was reversed by treatment with the Src/c-Abl inhibitor dasatinib but not with bortezomib. This model is scalable to high-throughput application and can be used for more accurate screening of drug efficacy in MM [2]. Effective candidates identified in vitro are then tested in vivo using a myeloma mouse model that we use for basic in vivo studies on adhesion and migration, and use this information to identify combinations that will lead to clinical trials. This new experimental platform provides a more focused model for screening of new therapeutics for improved efficacy of tumor cell killing within the BM microenvironment. Q Your expertise also extends to hemopoeitic stem cell transplantation. How have you seen this technique and its application develop in recent years? Previous sectionNext section The year before I qualified in 1968 the first successful hemopoeitic cell transplant was performed on three patients with severe combined immunodeficiency disease in The Netherlands and the USA. Over the last 40 years there has been an explosion in our knowledge of hemopoiesis and immune biology that has seen better tissue typing and an expanding source of hemopoietic stem cells that has made this approach safer and available to a much increased number of patients. While autologous and allogeneic stem cell transplantation are set to play a role in patient management in the future, current research is looking at identifying which patients are most likely to benefit and, equally as important, who is not likely to benefit from transplantation and at what point in the pathway it should be applied. Biological and genetic engineering of the graft in the future may also be utilized to capitalize on the graft-versus-tumor effect to eradicate tumor stem cells. Q In your experience, what are the main challenges associated with the treatment of MM patients? Previous sectionNext section The massive increase in our understanding of the biology as well as the molecular and cytogenetic anomalies that underlie myeloma has resulted in an appreciation of the fact that myeloma is a heterogeneous disease. This knowledge has, in turn, led to the development of a large number of different classes of novel therapeutic agents and the concept of targeted therapy. Unfortunately, cytogenetic mutations are rarely single abnormalities, may vary in different parts of the tumor, and evolve and change over time, maybe even being driven by treatment. Hence, if one molecular pathway is therapeutically blocked the tumor can overcome this by utilizing a previously redundant pathway for progression or survival. For this reason no single drug is likely to be effective in all patients at all stages of the disease and this is the rationale that has led to combination treatment. Given the large and increasing number of new drugs that are in development, the challenge is to select and optimize appropriate drug combinations and to design and conduct clinical trials to identify the most effective combinations going forward. Although responses utilizing triple agents are approaching 100%, virtually all patients will relapse and die of their disease. We know that the microenvironmental tumor niche is able to protect the myeloma progenitor/stem cell from the effects of antitumor drugs, therefore, we need to devise ways of attacking the tumor precursors in their BM niche if we are to prevent relapse and cure the disease. The challenge is to develop strategies utilizing agents that will either attack the tumor cell in the BM niches or render them susceptible to currently available treatments. Q You have been the chief investigator and coinvestigator for several clinical trials. Why does drug-development research appeal to you? Previous sectionNext section The exciting thing about hematology is that when you see a patient you have the opportunity to follow them through all stages of the diagnostic and therapeutic pathway, first by assessing them clinically and then by performing and analyzing the laboratory investigations in order to come to a diagnosis. Patient-orientated clinical research offers the opportunity to then treat patients in novel ways to improve outcomes while investigating mechanisms of action. Q Could you outline the aims of the recent Phase III trial (MM-003) investigating pomalidomide in combination with low-dose dexamethasone? Previous sectionNext section The recent Phase III (MM-003) pomalidomide trial was a multicenter, randomized, open-label study comparing the efficacy and safety of pomalidomide in combination with low-dose dexamethasone versus high-dose dexamethasone in subjects with refractory, or relapsed and refractory MM [3]. Patients were eligible if they progressed on treatment or relapsed within 60 days of discontinuing their last antimyeloma treatment, which had to have included bortezomib and lenalidomide, either alone or in combination. Treatment was continued until disease progression or unacceptable toxicity occured. The primary end point was progression-free survival. Secondary end points were overall survival, overall response rate, time to progression and safety. Recent retrospective data published by a multicenter international myeloma working group [4] showed that in 286 myeloma patients who relapsed and/or were refractory to bortezomib, and relapsed or refractory to or ineligible to receive an immunomodulatory drug, the median overall survival and event-free survival were 9 and 5 months, respectively. This demonstrates an unmet need for patients who are no longer eligible or are unresponsive to current treatment options. Q How does pomalidomide differ from other available drugs, such as lenalidomide, and what were the main outcomes of the trial? Previous sectionNext section Pomalidomide is a new third-generation immunomodulatory agent originally known as CC-4047 that demonstrates in vitro anti-MM activity, and when compared with thalidomide and lenalidomide (Actimid™), has enhanced immunomodulatory activity through multiple mechanisms, including a direct apoptotic activity via caspase-8, inhibition of NF-κB activation and angiogenesis, and reduction of secretion of stromal cell stimulatory cytokines. Our first-in-man Phase I study of pomalidomide as a single agent in patients with relapsed/refractory MM established the maximum tolerated dose as 2 mg daily on days 1–28 of a 28-day cycle, and a subsequent study of 5 mg on alternate days was shown to be equally efficacious. The drug was well tolerated, the main side effect being myelosuppression, particularly neutropenia, but with a low rate of febrile neutropenia. Subsequently, it has been shown that when given in combination with dexamethasone in the relapsed/refractory setting it can induce partial responses in up to 67% of patients and very good partial responses or better in 33% of patients with median progression-free survivals of up to 12 months. Pomalidomide also shows activity in patients who are refractory to lenalidomide. More recently, the Mayo Group have shown refractoriness to both lenaolidomide and bortezomib using two different doses of pomalidomide in patients, with rates of minimal response in the 4- and 2-mg cohorts of 49 and 43%, respectively, including very good partial remission and partial response rates of 28.5 and 26%, respectively [5]. Furthermore, the responses occur rapidly within 2 months of initiating therapy and the median duration of response was not reached in the 2-mg dose study. Follow-up was only for 6 months but overall survival rates were 67 and 78% in the 4- and 2-mg cohorts. The average previous number of therapies in this current trial was five and 72% of patient entered were refractory to prior use of both lenalidomide and bortezomib. After a median follow-up of 18 months a significant increase in progression-free survival of 15.7 weeks in the combination of pomalidomide with low-dose steroid versus 8 weeks in the high-dose steroid arm (hazard ratio: 0.45; p < 0.001) was reported. Median overall survival was not reached in the combination arm, compared with a median of 35 weeks in the comparator arm (hazard ratio: 0.53; p < 0.001). An independent review by the study’s Data Safety Monitoring Board recommended that all patients in the high-dose steroid arm be switched over to treatment with pomalidomide and low-dose steroid, leading to a discontinuation of the comparator arm. The combination was well tolerated, although neutropenia (reported in 42% of patients on the combination and 15% in the comparator arm), thrombocytopenia (21 vs 24%, respectively) and fever (7 vs 0%, respectively) were reported in both arms. The primary reason for discontinuation was progressive disease (in 35 vs 49 patients, respectively). A total of 25% of patients died in both arms during the study, primarily from progressive disease and infections. Q Celgene (NJ, USA) anticipates a decision by the European regulatory authorities in the second half of 2013. Given the results of the trial, are you confident of a positive decision? Previous sectionNext section As we have become more successful with improved progression-free and overall survival in patients with myeloma, there is an increasing unmet need for agents and strategies to treat patients who have become resistant or refractory to currently available agents. Pomalidomide and the newer third-generation proteasome inhibitors are active in a significant proportion of these patients and have an excellent toxicity profile. I think that the improved survival and quality of life reported in those patients responding to treatment will result in a positive outcome from the regulatory authorities. Q If approved, how do you see pomalidomide impacting the MM patient population? Previous sectionNext section Given the plethora of active agents that are now available, we expect the vast majority of patients to respond to first-line therapy. However, the disease remains incurable with currently available treatments but patients are living 5–8 years longer than previously with a median overall survival of 7–10 years from diagnosis, with an excellent quality of life. I see pomalidomide being used in the intermediate future for patients who relapse or are refractory to our standard first-line agents, such as bortezomib and lenalidomide, and owing to its excellent tolerability and potent immunomodulatory activity I suspect this agent will have a role in long-term maintenance going forward. Q How would you like to see research in this field developing over the next 5–10 years? Previous sectionNext section I believe that the immune system will prove to be important in controlling myeloma progression and pomalidomide will be a valuable tool to explore this avenue of research. In clinical practice I believe pomalidomide will be used to maintain responses post-stem cell transplantation and possibly in preventing progression in high-risk monoclonal gammopathy. The excellent toxicity profile of pomalidomide makes it an ideal drug for long-term use as maintenance or to enhance immune strategies utilizing cellular and antibody therapy. Disclaimer The opinions expressed in this interview are those of the interviewee and do not necessarily reflect the views of Future Medicine Ltd. Financial & competing interests disclosure S Schey has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.