Drastic development needed in heart attack care for Aboriginal people: Canada must improve its prevention and treatment of heart attacks and heart disease among Aboriginal people, according to a new report from the Canadian Institute for Health Information (CIHI). Residents of communities with high concentrations of Aboriginal people are more likely to have heart attacks and conditions that complicate heart disease, such as diabetes, than people living in communities with a small Aboriginal population. Despite this higher need for treatment, people living in communities with high concentrations of Aboriginal people are less likely to undergo specific cardiac procedures. CIHI reviewed seven years of data for the study, Hospital Care for Heart Attacks Among First Nations, Inuit and Métis (https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2048). — Adam Miller, CMAJ
Obesity court: A doctor has been found negligent by an Australian court for failing to send a patient now dying of liver cancer to an obesity clinic or a bariatric surgeon. The morbidly obese patient, Luis Almario, has been awarded A$350 000 from his physician. The court decided that Dr. Emmanuel Varipatis was legally responsible for Almario’s health problems progressing from liver disease to cirrhosis to liver failure to liver cancer. The physician has appealed the decision. Some medical experts have called this a legal landmark that could place enormous pressure on physicians to order numerous unnecessary tests and interventions to avoid litigation. Almario, who weighed 140 kg while under Dr. Varipatis’ care, has been given 40 weeks to live. — Roger Collier, CMAJ
Breast cancer priorities: The US government is not investing enough money in research on the environmental causes of breast cancer and how best to prevent the disease, according to a report from a 23-member committee established by US Congress. Environmental influences on breast cancer include alcohol consumption and exposure to chemicals or radiation. Research often focuses on extending the lives of women with breast cancer, but tends to neglect preventive strategies such as reducing exposure to harmful environmental factors, stated committee members. It is also important to examine the degree of influence these factors have on a person through different stages of life, from childhood to puberty to pregnancy and beyond, according to the report, Breast Cancer and the Environment — Prioritizing Prevention (www.niehs.nih.gov/about/assets/docs/ibcercc_full.pdf). — Roger Collier, CMAJ
Deadly cola addiction: A coroner in New Zealand has linked the death of a 30-year-old mother of eight to the massive quantities of Coca Cola she consumed each day. The woman, Natasha Harris, died from cardiac arrest in 2010, though the coroner’s report was only recently released. Harris drank up to 10 litres of cola a day. That works out to about a kilogram of sugar each day and twice the recommended daily intake of caffeine. The coroner, Dr. David Crerar, suggested it was unlikely Harris would have died when and how she did if not for her cola addiction. The Coca Cola Company has expressed disappointment with the finding, suggesting that the coroner could not be certain of the cause of Harris’ death. — Roger Collier, CMAJ
Storage struggles: A changing illegal drug market in Canada has led to new complications, such as leakages and explosive reactions, in the storage and disposal of seized narcotics and drug production equipment, suggests a recently released report from Health Canada. Canadians are manufacturing more illegal drugs domestically, leaving RCMP and other police forces with the difficult task of determining how to manage and dispose of controlled substances and manufacturing equipment. The December 2011 report by Cheminfo Services Inc. was made public by Health Canada in early February. Initial data indicated that it cost Canadian tax payers at least $25 million in 2010 to manage and dispose of drugs and equipment. Recommendations included disposing of low-value hydroponics, precursor chemicals and other equipment immediately upon or shortly after seizure. Most controlled substances are destroyed within a year, according to the report, but some drug manufacturing equipment is now stored for up to eight years. — Adam Miller, CMAJ
Ice cream budget: It appears that Israeli Prime Minister Benjamin Netanyahu may be eliminating a large number of calories from his diet. He has canceled his US$2700-a-year contract with a gourmet ice cream parlor located near his official residence. Netanyahu received heaps of negative publicity when his ice cream budget made the news in Israel, which has been reining in government spending. The ice cream shop, Metudela, reported that Netanyahu would place an order about twice a month, requesting up to four kilograms at a time if he was entertaining guests. Netanyahu favours pistachio ice cream, the parlor reported. His wife prefers French vanilla. — Roger Collier, CMAJ
Cigarette packaging: New Zealand has revealed plans to become the second country to mandate that all cigarettes be sold in plain, unbranded packaging with health warnings. Associate Health Minister Tariana Turia announced that policy work would begin immediately but implementation might be at least 18 months away. Australia became the first country to institute a plain-packaging law last year and is facing legal challenges from the World Trade Organization and the tobacco company Philip Morris. Turia acknowledged that legal disputes were likely in New Zealand’s future as well, but suggested that the country could still meet its trade obligations under the proposed packaging change. — Roger Collier, CMAJ
Canada loses top childhood development researcher : Dr. Clyde Hertzman passed away Feb. 10 at age 59 while working in the United Kingdom. Known internationally for his work, Hertzman held a Canada Research Chair in Population Health and Human Development, and was a professor in the School of Population and Public Health at the University of British Columbia (UBC) in Vancouver. He also received an Order of Canada and was named researcher of the year in 2010 by the Canadian Institutes of Health Research. Hertzman devoted his career to understanding how early life experiences affect a child’s brain and body development. His most recent work, “The Promise of the Early Years: How Long Should Children Wait?” will be published posthumously in the Feb. 22 edition of the Journal of the Canadian Academy of Child and Adolescent Psychiatry. His friend and UBC colleague Ziba Vaghri told the Vancouver Sun that Hertzman had been looking forward to his medical school reunion and turning 60 next month. Hertzman is survived by his partner, Marcy; his three children Eric, Emily and Amos; and his mother, Eileen. — Sarah Spitz, CMAJ
Costly readmission: A new study in the Journal of the American Medical Association finds little correlation between readmission and mortality rates for Medicare patients. Between 2005 and 2008, the study found no relationship between readmissions and mortality rates for patients with heart attacks or pneumonia (JAMA 2013;309:587–93). For heart failure patients, there was a “modest” inverse relationship, and hospitals with lower death rates had somewhat higher readmission rates. The study is new fuel for critics of the Centers for Medicaid and Medicare Services’ Readmissions Reduction Program, who say pressure to reduce readmissions is unreasonable, as low rates don’t necessarily mean better care. According to a paper in the British Medical Journal, pressure to reduce readmissions could force hospitals to strain emergency departments by holding patients there for days, skirting costly readmission status (BMJ 2013; 346:f1043). This year, more than 2000 hospitals in the United States will lose up to 1% of their payments from Medicare for exceeding baseline readmission rates (about US$300 million in total) The penalty will rise to 3% of Medicare payments by 2015. — Sarah Spitz, CMAJ
Mutant receptors: Mutations of ryanodine receptors, intracellular calcium channels that control muscle contractions, change their structure and are more disruptive than previously thought, according to new research. “We found that many disease mutations cause much larger structural changes than anticipated,” says Filip van Petegem, associate professor of biochemistry and molecular biology at the University of British Columbia in Vancouver. Petegem is one of the authors of a paper that analyzed eight mutations using 3D models (www.nature.com/ncomms/journal/v4/n2/pdf/ncomms2501.pdf). Ryanodine receptors control the contraction of muscles, including the heart, by allowing calcium ions to flow through them. Mutations make it easier for calcium to flow through, which can cause heart arrhythmia. Other mutations destabilize the structure and raise body temperature enough to compromise proteins, says van Petegem, which can lead to health problems and even death. The researchers built 3D models of the protein using high-powered X-ray imaging. This is the only study to map mutations of ryanodine receptors when they are both open and closed, revealing how certain mutations are activated in different states. — Juanita Bawagan, CMAJ
Putin out cigarettes: Russian President Vladmir Putin has signed a law banning smoking in public places. Starting June 1, smoking will be illegal in workplaces, playgrounds and public transportation entrances, with more restrictions coming next year. But some wonder if people will obey the law, as Russia has notoriously high rates of smoking. It is estimated that an incredible 70% of men in Russia smoke. The life expectancy of males is only 60.1 years, more than a decade less than females, at 73.2 years. The smoking rate among women is estimated at 26%. About 400 000 deaths are attributed to smoking-related diseases each year. — Roger Collier, CMAJ
Out of retirement, into rural China: The government of China is trying to get more doctors to come out of retirement and provide medical services in poorer rural areas that struggle to provide adequate health care. The effort is being made to reduce the large health care disparity between cities and the countryside. Public hospitals require male doctors to retire at age 60 and female doctors to retire at age 55. China has also announced plans to build more hospitals and primary care facilities in rural areas. — Roger Collier, CMAJ
Tanning warning: Tanning beds will soon come with a strong warning label, according to a Feb. 24 announcement from National Minister of Health Leona Aglukkaq and conservative MP James Bezan. Much like on cigarette packaging, health warnings will soon detail the associated risks of bronzing under a tanning lamp. The new measure is the next step for Bezan, who has tabled several bills pushing for stronger regulations and labelling on tanning equipment. According to the World Health Organization, the relative risk of developing melanoma increases by 75% when people start using tanning beds before age 35. Some provinces have already imposed age restrictions. The proposed signs will read “DANGER: Tanning equipment can cause cancer.”