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.