FREE WEBINAR: IMMUNOGLOBULIN Heavy/Light Chain

The Binding Site Group Ltd Hevylite® Webinar by Key Opinion Leader and Live Q & A Session ‘The Immunoglobulin Heavy/Light Chain (Hevylite) assay for diagnosis, response evaluation, and evaluation of biological aspects of multiple myeloma’ Presented by University Professor Dr Heinz Ludwig Wilhelminenspital, Vienna, Austria Dr_Heinz_Ludwig_with_Dr_Stephen_Harding Professor Dr Heinz Ludwig with Dr Stephen Harding, Research & Development Director at Binding Site Headquarters Birmingham, UK Monday 10th March 2014 07:00PM - 08:00PM GMT Register Now OR Tuesday 11th March 2014 10:00AM - 11:00AM GMT Register Now What will you learn from this webinar? The Hevylite assay improves detection and measurement of monoclonal proteins that are: Difficult to quantify by electrophoresis At low levels How to improve monitoring of Multiple Myeloma patients with Hevylite The Hevylite ratio lets you: Assess the presence of monoclonal protein production over polyclonal protein production Identify residual disease in some cases that are negative by electrophoresis Detect relapse in some cases where electrophoresis is negative After the webinar, keep listening for a Live Question & Answer Session with Binding Site's Research & Development Director, Dr Stephen Harding, who developed the Hevylite assay. View our Disclaimer. There is no fee to attend this webinar. After registering you will receive a confirmation email containing information about joining the webinar. System Requirements PC-based attendees require: Windows® 8, 7, Vista, XP or 2003 Server Macintosh® based attendees require: Mac OS® X 10.6 or newer Mobile attendees require: iPhone®, iPad®, Android™ phone or tablet Binding Site - Committed to improving patient lives worldwide through education, collaboration & innovation

OLYMPICS: Population ratios makes NATIONAL results absurd.

Mens'Hockey : Canada 3; Sweden 0. Popn Canada 35-million; Sweden 9.5-million Olympics could copy Golf & Polo: introduce Handicaps

ELECTRODIAGNOSIS History @ Toronto General Hospital : Late Dr.John Gilchrist HUMPHREY

ELECTRODIAGNOSIS Dept.at Toronto General Hospital was founded by Assoc.Prof JOHN GILCHRIST HUMPHREY MD(Tor. 1954) FRCPC (1928-1991)Trained at London Institute of Neurology (R.W.Gilliatt & R.G.Willison). Obituary in Globe & Mail. Reason for post. Details not on web.

OLYMPIC FEMALE HOCKEY: Population Health

SWITZERLAND 3rd with female popn 4-million.(All private medical insurance) CANADA 1rst with female popn 17-million (mainly free State insurance, except Quebec which permits Private medicine) USA 2nd with female popn 159-million (Mixed private, and subsidized medicine)

VACANCY: PRESIDENT PUBLIC HEALTH ONTARIO

On 19 February 2014 11:10, PHO Communications wrote: Public Health Ontario’s President and CEO, Dr. Vivek Goel, will be leaving the organization in May 2014 after six years. The Board of Directors is working closely with PHO’s executive team to manage the transition and a search for a new leader will be launched shortly. (comment MHSc & MSc(Biostatistics) an advantage( In serving as PHO’s founding President and CEO, Dr. Goel oversaw the establishment of the agency, guided the renewal of the public health laboratories and many provincial health protection programs, and assembled unique talent and expertise. His academic and scientific leadership positions Public Health Ontario well for ongoing success. Prior to joining PHO, Goel was vice-president and provost at the University of Toronto. Upon leaving Public Health Ontario, he returns to academe by joining California company Coursera as their Chief Academic Strategist. https://www.coursera.org Vivek Goel MD,CM, MSc, SM, FRCPC Contact Information Email Address: vivek.goel@utoronto.ca Office Phone Number: 647-260-7111 Public Health Ontario 480 University Avenue, 3rd floor Toronto ON M5G 1V2 Website(s): www.oahpp.ca Dr. Vivek Goel is president and chief executive officer of Public Health Ontario, an arm's-length government agency dedicated to protecting and promoting the health of all Ontarians and reducing inequities in health. As a hub organization, PHO links public health practitioners, front-line health workers and researchers to the best scientific intelligence and knowledge from around the world. PHO provides expert scientific and technical support relating to infection prevention and control; surveillance and epidemiology; health promotion, chronic disease and injury prevention; environmental and occupational health; health emergency preparedness; and public health laboratory services to support health providers, the public health system and partner ministries in making informed decisions and taking informed action to improve the health and security of Ontarians. Dr. Goel brings extensive experience in health care evaluation and research to this role. He has been engaged in a broad range of research activities related to public health, particularly focusing on chronic disease prevention and control. These research activities include the economic evaluation of health care interventions, optimization of the use of laboratory tests in the periodic health examination and the development of measures for health status assessment. In addition, Dr. Goel has served on numerous local, provincial and federal committees related to public health as well as being involved in international activities. Prior to joining the PHO in 2008, he served five years as vice-president and provost at the University of Toronto. Dr. Goel joined the University of Toronto as an assistant professor in the Department of Preventive Medicine and Biostatistics in 1991. He was chair of the Department of Health Administration in the Faculty of Medicine from 1999 until 2001 and served in the University’s senior administration as vice-provost, faculty from 2001 to 2004. He was president of the Central East Health Information Partnership, an Ontario Ministry of Health and Long-Term Care funded health intelligence unit. From 1999 to 2002 he was the scientific program leader at the Health Evidence Applications Linkages Network (HEALNet), a federal network of centres of excellence. Dr. Goel is a licensed physician and Fellow of the Royal College of Physicians of Canada, having obtained his medical degree from McGill University. He did his post-graduate medical training in community medicine at the University of Toronto and also obtained a Master’s degree (M.Sc.) in health administration from the University of Toronto and a Master’s degree (S.M.) in biostatistics from Harvard University’s School of Public Health.

Ont PublicService Retiree benefits. (NONE FOR OMA MEMBERS).

News Release Ontario Updates Public Sector Retiree Benefit Plans February 18, 2014 Sharing Cost Of Retiree Benefits Equally With Ontario Public Sector Employees The Ontario government will transition to a cost-sharing model for retiree benefits for employees retiring on or after Jan. 1, 2017. This will bring Ontario Public Service retiree benefits in line with other public sector organizations where retirees are often asked to contribute up to 100 per cent of their benefits premium. Current retirees from the Ontario Public Service will not be affected by these changes. Key features of the new model will: Require employees retiring on or after Jan. 1, 2017 to pay 50 per cent of their benefits premiums (e.g. life, health, dental and vision). Currently the government pays 100 per cent. Change the eligibility period for retiree benefits from 10 to 20 years for employees hired on or after Jan. 1, 2017. Taking a measured and moderate approach to Ontario's finances is part of the government's economic plan that is creating jobs for today and tomorrow. The comprehensive plan and its six priorities focus on Ontario's greatest strengths - its people and strategic partnerships. QUICK FACTS Employees who do not have 10 years pension credit in the pension plans by Jan. 1, 2017 will have to have at least 20 years of pension credits and retire to an immediate unreduced pension in order to qualify for retiree benefits. About 3,000 - 4,000 employees begin to receive a pension and retiree benefits from the Public Service Pension Plan or the OPSEU Pension Plan each year. There are more than 84,000 active members of the Ontario Public Service and other employers enrolled in Ontario Public Service pension plans. Retiree benefits are not a provision of the pension plans nor are they a pension benefit. (COMMENT Ont.MDs do not have similar juicy perks. They are Ont.Govt.CONTRACT WORKERS with FIXED RATES of PAY with the legal fiction of being "self-employed".)

Princess Margaret Cancer Hospital TOWN vs GOWN Patient care vs Research.

Life depends on choice of Cancer Hospital. In State medicine OHIP pays the same to Triple A and House League Cancer docs. The perks of First Class travel to International Conferences as an Invited Speaker comes to those who organise TRIALS. There is an conflict of interest between giving the Best available treatment to the Individual and the value of the person in a Trial. Patients are given papers to sign however Statistics Canada figures find that 46% of Canucks are FUNCTIONALLY ILLITERATE. They can read simple texts but can't fill forms. Immuno-compromized patients need high level of Hospital hygiene. The appearance of Staff does not give confidence. Habd-washing is not evident. Only the use of less-than-effective Ethyl alcohol gel. (ODETTE CANCER CENTRE @ SUNNYBROOK Hosp has higher level of hygiene and patient care. Possibly due to its location near the most wealthy part of Toronto: The Bridle Path)

FIBROSCAN: vibration-controlled transient elastography (VCTE).to estimate Hep.fibrosis & controlled attenuation parameter for Hep steatosis.

wwww.liverscan.ca $100 FEE NOT PAID BY Ont.Govt insurance(OHIP). NO NEED FOR GP REFERRAL. Liver Scan Direct is a medical diagnostics clinic based in Toronto that specializes in the non-invasive assessment of liver health using FibroScan® technology. Our mission is to provide patients who have liver problems rapid access to FibroScan® testing with interpretation of results by an internationally recognized expert (Dr. Robert P. Myers). Why wait months for a referral to a liver or gastroenterology specialist and then wait longer to undergo an invasive liver biopsy? No referral is necessary to be assessed at Liver Scan Direct. Any patient can contact us directly to schedule an appointment. We schedule appointments rapidly and provide results within 1-2 business days. In order to improve access for physicians and their patients with liver disease, Liver Scan Direct now offers FibroScan® clinics in 10 locations in southern Ontario (Toronto, Mississauga, Scarborough, Richmond Hill, Newmarket, Burlington, Waterloo, and Guelph). Dr. Robert P. Myers, MD, MSc, FRCPC Liver Scan Direct's medical consultant - Dr. Robert Myers - is an Associate Professor of Medicine, Hepatologist, and Director of the Viral Hepatitis Clinic at the University of Calgary. He is an internationally-recognized expert on the non-invasive assessment of liver disease, particularly FibroScan technology. Dr. Myers has published over 110 scientific studies, including the 2012 Canadian consensus guidelines for the management of hepatitis C (see below). Dr. Myers frequently lectures on this technology at international scientific meetings. Dr. Myers is an Associate Editor of the American Journal of Gastroenterology, a member of the Editorial Board of Hepatology (the premier journal in the field), past Chair of the Education Committee of the Canadian Association for the Study of the Liver, and a member of the National Education Advisory Committee of the Canadian Liver Foundation. In 2012, Dr. Myers was awarded a Queen Elizabeth II Diamond Jubilee Medal for his contributions to research and patient care in liver disease. Dr Robert Myers Selected FibroScan Publications by Dr. Myers 1. RP Myers, et al. Feasibility and diagnostic performance of the FibroScan XL probe for liver stiffness measurement in overweight and obese patients. Hepatology 2012;55(1):199-208. ​ 2. RP Myers, et al. Feasibility and reliability of the FibroScan S2 (pediatric) probe compared with the M probe for liver stiffness measurement in small adults with chronic liver disease. Ann Hepatol 2013; 12(1):100-7. ​ 3. Myers RP, et al. Controlled Attenuation Parameter (CAP): a noninvasive method for the detection of hepatic steatosis based on transient elastography. Liver Int 2012;32(6):902-10. ​ 4. RP Myers, et al. Transient elastography for the noninvasive assessment of liver fibrosis: a multicentre Canadian study. Can J Gastroenterol 2010;24(11):661-70.  5. RP Myers, et al. An update on the management of hepatitis C: consensus guidelines from the Canadian Association for the Study of the Liver. Can J Gastroenterol 2012;26(6):359-75.

CMAJ: LACRIMAL GLAND CALCULI

Lacrimal Gland Duct Stones Misdiagnosed as Chalazion This report is of three patients with lacrimal gland duct stones that were misdiagnosed as chalazion at a local clinic between 2010 and 2012. A review of clinical, imaging, and histopathologic manifestations are discussed. Clinical manifestations of lacrimal gland duct stones included conjunctival injection, lid swelling, tenderness, and ocular discharge, which are similar to chalazion symptoms. Computed tomography revealed a relatively well-defined, high-density mass near the lacrimal gland. Histopathologic examination of excised material revealed calcified amorphous stones. Intractable chalazion-like lesions at the lateral canthal area near the lacrimal gland should be carefully examined; imaging studies are required to confirm the presence of lacrimal gland duct stones, which require surgical removal. SOURCE: Kim SC, Lee K, Lee SU. Lacrimal gland duct stones: misdiagnosed as chalazion in 3 cases. Can J Ophthalmol. 2014;49(1):102–5.

HAEM CANCERS: MINIMAL RESIDUAL DISEASE MONITORING: SWISS MED.WEEKLY www.smw.ch

Review article | Published 22 January 2014, doi:10.4414/smw.2014.13907 Cite this as: Swiss Med Wkly. 2014;144:w13907 Minimal residual disease monitoring: the new standard for treatment evaluation of haematological malignancies? Mathieu Hauwel, Thomas Matthes Swiss Flow Cytometry School, Haematology Service and Clinical Pathology Service, Geneva University Hospital, Switzerland Summary Abbreviations ALL acute lymphoblastic leukaemia AML acute myeloid leukaemia ASO-PCR allele-specific oligonucleotide-PCR BCR B-cell receptor CLL chronic lymphocytic lymphoma CML chronic myeloid leukaemia CR complete remission cytoCR flow cytometry CR DNA deoxyribonucleic acid FISH fluorescent in-situ hybridisation FL follicular lymphoma iCR immunofixation CR IgH immunoglobulin heavy chain LAIP leukaemia-associated immunophenotype LSCs leukaemic stem cells MCFC multicolour flow cytometry MRD minimal residual disease mRNA messenger RNA NGS new generation sequencing NMR nuclear magnetic resonance PCR polymerase chain-reaction PET positron emission tomography PFS progression-free survival Ph Philadelphia chromosome RNA ribonucleic acid RT-PCR reverse transcriptase-PCR sCR serum free light chain ratio CR TCR T-cell receptor Minimal residual disease (MRD) refers to the small number of malignant cells that remain after therapy when the patient is in remission and shows no symptoms or overt signs of disease. Current treatment protocols for haematological malignancies allow most patients to obtain some form of MRD state, but cure seldom follows and in most cases fatal relapses occur sooner or later, leaving a bitter impression of having won a battle yet lost the war. MRD detection and quantification are used for evaluation of treatment efficiency, patient risk stratification and long-term outcome prediction. Whereas multicolour flow cytometry (MCFC) and polymerase chain reaction (PCR) based methods constitute the two most commonly used techniques for MRD detection, next generation sequencing will certainly be widely employed in the future. As MRD reflects the nature of the malignant disease itself, including its sensitivity to the drug regimens applied, it constitutes the ideal method for surveillance and patient follow-up. The morphological examination of peripheral blood or bone marrow smears, although still an indispensable part of routine laboratory testing, is clearly insufficient for patient management, and clinicians should not ask themselves whether to look for MRD or not, but how and when. Key words: minimal residual disease; flow cytometry, next generation sequencing; PCR; acute lymphoblastic leukaemia; acute myeloid leukaemia; chronic myeloid leukaemia; multiple myeloma, lymphoid neoplasm

Feb 8-11 Royal.York Hotel Can Digestive Diseases & Can.Assn.for Liver Study.: FAECAL CALPROTECTIN

No press room = No media present-including CMAJ & Ont.Med. Review) Impressive exhibition (50+) but few visitors. Norwegian-developed SWISS ALPCO system offers OFFICE & LAB test for FAECAL CALPROTECTIN. Diff.Diag.of Abdom.pain,cramping,diarrhoea. INFLAMMATORY Bowel Disease (IBD) vs. Irritable Bowel Syndrome(IBS) Using Buhlmann Calprotectin assay HIGH LEVELS = IBD (CROHN & ULCERATIVE COLITIS)LOW LEVELS = IBS (suspect FOOD INTOLERANCE & COELIAC DISEASE) Used in Teaching Hospitals: Hamilton, London, Toronto . Stool collected using EasySampler kit @ $8. Extraction using $300 Vortex. "Schebo Quick Prep" for Solid stool "Smart-prep" for solid/liquid stool OFFICE CALchek Blue @ $25/test; LAB/OFFICE: QUANTUM blue using $2500 small casette Quantitative tester.LABORATORY HIGH VOLUME: CALPROTECTIN ELISA. www.alpco.com Values below 50 microgram/gram Unlikely to be inflammation Values above 50 to 100 = mild inflammatory disease: aet NSAID; diverticulae; IBD in remission. Values above 100= ACTIVE ORGANIC DISEASE. GP referral to Specialist imperative. url http://www.alpco.com/content/products/Calprotectin_Assay.aspx

SERUM FREE LIGHT CHAIN ANALYSIS (NOT PAID BY OHIP if orded by GPs & General Medical Clinics)

"BINDING SITE FREELIGHT" serum free light chain analysis Now available PRIVATELY by Gamma Dynacare laboratories. Provided free by OHIP at selected Oncology clinics. Freelite™ Serum Free Light Chain Assays (UK) Freelite™ is a major breakthrough for the detection and monitoring of Multiple MyelomaFreelite Logo (MM) and other B-cell dyscrasia. Freelite™ assays were developed by Binding Site to measure free lambda and free kappa immunoglobulin light chains. Our expertise in the manufacture of antibodies has enabled us to provide a quantifiable, highly specific, automatable free light chain assay for serum. Significant clinical evidence indicates the benefit of Freelite™ serum free light chain assays in initial screening for monoclonal gammopathies. Other benefits include the identification of AL amyloidosis and Nonsecretory MM patients missed by conventional electrophoretic methods, use as a prognostic indicator for progression in myeloma, for risk stratification of MGUS patients, and rapid evaluation of treatment efficacy. Freelite™ is a sensitive, specific marker of kappa and lambda free light chains (FLC) in serum and provides quantitative measurement of: Free kappa in serum Free lambda in serum The serum free kappa/free lambda ratio (κ/λ) The serum free light chain ratio is a strong indicator of monoclonality and is valuable for distinguishing monoclonal from polyclonal diseases.

CONN SYNDROME:10% of resistant hypertension.

SPIRONOLACTONE & EPLERENONE in PRIMARY ALDOSTERONISM (CONN SYNDROME) Integr Blood Press Control. 2013 Oct 4;6:129-138. eCollection 2013. Mineralocorticoid receptor antagonists: emerging roles in cardiovascular medicine. AUSTRALIA: Melbourne. PROF J.W.FUNDER Spironolactone was first developed over 50 years ago as a potent mineralocorticoid receptor (MR) antagonist with undesirable side effects; it was followed a decade ago by eplerenone, which is less potent but much more MR-specific. From a marginal role as a potassium-sparing diuretic, spironolactone was shown to be an extraordinarily effective adjunctive agent in the treatment of progressive heart failure, as was eplerenone in subsequent heart failure trials. Neither acts as an aldosterone antagonist in the heart as the cardiac MR are occupied by cortisol, which becomes an aldosterone mimic in conditions of tissue damage. The accepted term "MR antagonist", (as opposed to "aldosterone antagonist" or, worse, "aldosterone blocker"), should be retained, despite the demonstration that they act not to deny agonist access but as inverse agonists. The prevalence of primary aldosteronism is now recognized as accounting for about 10% of hypertension, with recent evidence suggesting that this figure may be considerably higher: in over two thirds of cases of primary aldosteronism therapy including MR antagonists is standard of care. MR antagonists are safe and vasoprotective in uncomplicated essential hypertension, even in diabetics, and at low doses they also specifically lower blood pressure in patients with so-called resistant hypertension. Nowhere are more than 1% of patients with primary aldosteronism ever diagnosed and specifically treated. Given the higher risk profile in patients with primary aldosteronism than that of age, sex, and blood pressure matched essential hypertension, on public health grounds alone the guidelines for first-line treatment of all hypertension should mandate inclusion of a low-dose MR antagonist. KEYWORDS: eplerenone, inverse agonists, primary aldosteronism, public health, spironolactone PMID: 24133375 [PubMed - as supplied by publisher] PMCID: PMC3796852 Free PMC Article

CANADA approves POMALYST one year after USA

Pomalyst (Pomalidomide) Approved By FDA For Relapsed And Refractory Multiple Myeloma The Myeloma Beacon Staff Published: Feb 8, 2013 The United States Food and Drug Administration (FDA) has approved pomalidomide, which will be marketed under the brand name Pomalyst, for the treatment of relapsed and refractory multiple myeloma. Specifically, Pomalyst has been approved for use in patients with multiple myeloma who have received at least two prior therapies including Rev­limid (lenalido­mide) and Velcade (bortezomib) and have demon­strat­ed disease progression on or within 60 days of completion of the last therapy. Celgene (NASDAQ:CELG), the company that will market Pomalyst, has told The Beacon that the drug will be available in U.S. pharmacies in about two weeks. Pomalyst is the second drug, following Kyprolis (carfilzomib), that the FDA has approved for the treatment of multiple myeloma over the past year. Prior to Kyprolis, the last FDA approval of a novel myeloma therapy was in June 2006, when the agency approved Revlimid as a treatment for myeloma. Pomalyst also is being reviewed by the European Medicines Agency for approval in Europe. Celgene submitted the European marketing authorization application for the drug in June of last year. In recent discussions with financial analysts, the company has said that it expects a decision on this application by the second half of this year. Pomalyst is chemically similar to Revlimid and thalidomide. All three drugs are administered orally as a capsule or tablet, and the three drugs together make up the class of myeloma therapies known as immunomodulatory agents. Celgene, which developed Pomalyst and will sell it in the U.S., also markets Revlimid and thalidomide in the U.S. and internationally. The FDA’s decision regarding Pomalyst’s new drug application is likely to be its last approval of a new myeloma therapy for at least a year. There are a number of potential new myeloma therapies in the later stages of development, including elotuzumab, panobinostat, and perifosine. However, many analysts believe it may not be until 2015, and possibly even later, until one of these drugs becomes the next novel anti-myeloma therapy to gain FDA approval. Celgene has not yet said publicly what the price of Pomalyst will be. However, it has confirmed with The Beacon published reports that Pomalyst will cost about $10,500 per 28-day cycle, based on a 21-out-of-28-day dosing regimen. At that price, Pomalyst will be the most expensive treatment for multiple myeloma. In comparison, Revlimid costs $8,400 per 28-day period at the FDA-approved 21-out-of-28-day dosing; Velcade costs between $4,100 and $8,200 per 28-day period, depending on the frequency of dosing; and Kyprolis costs $10,000 per 28-day cycle at the recommended dose for a patient of average size. Pomalyst’s FDA approval is based on data from the Phase 2 “MM-002” clinical trial of Pomalyst plus dexamethasone in relapsed and refractory myeloma patients. Updated results from this study were presented at the American Society of Hematology (ASH) meeting in December (see related Beacon news). They showed that the combination of Pomalyst and dexamethasone had an overall response rate of 34 percent in myeloma patients with a median of five previous lines of therapy. Median progression-free survival in these patients was 4.6 months and median overall survival was 16.5 months. Also presented at the ASH meeting were initial results of the Phase 3 “MM-003” clinical trial comparing Pomalyst plus low-dose dexamethasone to only high-dose dexamethasone, also in heavily pretreated myeloma patients. These results showed that the combination of Pomalyst and dexamethasone had a statistically significant overall survival advantage compared to treatment with with dexamethasone alone (see related Beacon news). In Pomalyst’s clinical trials, the most frequent serious side effects were low red blood cell, white blood cell, and platelet counts, as well as infections such as pneumonia.

PRIVATE Catastrophic illness insurance.

As OHIP guidelines control doctors' actions, more Ontarians buying Catastrophic illness insurance (usually a $250,000 payout )which allows world-wide freedom of choice of Hospital and Doctors. Ontario is the least generous when supplying expensive medication. Quebec and Alberta are best.

GP Muhammad Shafiq QAADRI MD(Tor.'88) MPP

Minister to Make Public Transit Announcement February 7, 2014 Glen Murray, Minister of Transportation and Minister of Infrastructure, and (Muhammad) Shafiq Qaadri, MPP for Etobicoke North, will make an announcement about improving GO Transit. Date: Monday, Feb. 10, 2014 Time: 10 a.m. Location: Etobicoke North GO Station 1949 Kipling Avenue Toronto Dr.M S QAADRI graduate of (Toronto) Upper Canada College. Son of Ob/Gyn Mussarat Khurshid QAADRI MD(Nishtar,Pakistan '59) FRCSC: now Chair OMA Section of Clinical Hypnosis.

PROFESSIONAL FEES: OHIP vs LEGAL FEES

2012 Canadian Lawyer Legal Fee Survey reports that the average hourly rates for Ontario lawyers range from $243 for new graduates to $365 for lawyers practising for 10 years. OHIP pays same fee for rookie and`experienced MD. No promotion & no bonuses. Approx 50% of hourly rate for new LLB. OHIP = pro bono work with high risk of WORLD-WIDE patient & family complaints at no expense to complainant even if frivolous. Govt FIXED PRICE CONTRACT work with no WSIB coverage and NO GOVT.BENEFITS. Same rate for practice in high rent area and low rent rural areas. COMMENT: only few grads of Toronto Upper Canada College enter Med.School in Canada.

AIRD & BERLIS: "Canada's Anti-Spam Legislation ("CASL") will govern the delivery of CEMs (Commercial electronic message)

Potential individual fine $1,000,000 Awaiting OMA Legal Dept. advice. "CASL comes into force on July 1, 2014"

DIRECT ACCESS TO SPECIALISTS in TORONTO

COMMENT: Socialist State insurance OHIP requires a referral from a GP to have a specialist OHIP-paid consultation. GPs' choice of Specialist may be influenced by working in a specific Hospital GP service or working in a clinic which includes specialists. They may not know the best specialist for the problem. Another danger is the front office computer programmed for a default "NON-URGENT": potentially fatal. Upper-middle class Ontarians bypass the GP by visiting the Specialist PRIVATELY: telling the receptionist that they have a residence in the USA: very often true as many have condos in Florida. The Ont.Med.Assn tariff is double that of the State insurance.(State payment has fallen 50% during 40 years of Socialist Govt.control.)

USA MEDICINE preferred by the Ontario Upper-Middle class

COMMENTS invited about pay & benefits in USA HMOs. Does MAYO still pay a salary? Cleveland Clinic Canada (30,000 sq ft) & M.D Anderson Cancer have offices in Toronto. Ontarians with means or private insurance go to Capitalist USA for treatment. Avoiding the restrictive Socialist "Guidelines" of OHIP medicine. Princess Margaret Cancer Hosp may do good research but patient care far from top USA standard. NO MAGNET HOSPITALS in ONTARIO

QUEBEC & ALBERTA Best Provinces for expensive Cancer drugs

QUEBEC ("New France" until Treaty of Paris 1790)and ALBERTA are the most generous of the Canadian Provinces. In Canada Medical care is in the Power of the Prov. Govts. The Canada Health Act (CHA) (1984) officially prohibits charging for " medically necessary" services,( never defined in 30 years), in all Provinces except QUEBEC after the judgement in (Dr.)CHAOULLI v QUEBEC(Attorney General) 2005 SCR 791 2005 SCC 35. A 3 months residence in "La belle province" required for membership in the "Regie de l'assurance maladie du Quebec. COMMENT: In Ontario the legal way of avoiding the restriction of the CHA is to call Private Clinics WELLNESS CENTRES. The do not bill OHIP for medical visits , charging about $3,500 a year. Pathology & Imaging can be billed to OHIP. Examples Cleveland Clinic Canada, Medcan, Medisys Inc. and GP "Boutique" clinics providing a Dietition +/- Physio.,Podiatry etc. There are still no private General Hospitals; Homewood Mental Hosp & Shouldice Hernia Hosp are allowed to be privately owned. Some hospitals have single rooms at an extra charge of about $300/day. Difficult to find as many used as isolation rooms for MRSA & AIDS.