Briefly
=======

* Brittany Hinds
* Roger Collier
* Wayne Kondro

**No conflict**: Accusations that the World Health Organization’s policies regarding pandemic (H1N1) 2009 were influenced by the pharmaceutical industry were entirely unjustified, Dr. Keiji Fukuda, pandemic influeza adviser to WHO told a Council of Europe hearing. “The influenza pandemic policies and responses recommended and taken by WHO were not improperly influenced by the pharmaceutical industry,” Fukuda said in his statement ([www.who.int/csr/disease/swineflu/coe_hearing/en/index.html](http://www.who.int/csr/disease/swineflu/coe_hearing/en/index.html)). “WHO recognizes that global cooperation with a range of partners, including the private sector, is essential for optimally addressing the public health challenges of today and tomorrow. Numerous safeguards are in place to manage conflicts of interest or perceived conflicts of interest among members of WHO advisory groups and expert committees. Expert advisers provide a signed declaration of interests to WHO detailing any professional or financial matters that could affect the impartiality of their advice. WHO takes allegations of conflicts of interest seriously and is confident of the integrity and scientific validity of its decision-making during this influenza pandemic.”

**Weight loss surgery for teens**: A new program in Toronto, Ontario, is the first in Canada to offer laparoscopic band surgery to obese teenagers. The Hospital for Sick Children launched the program on Feb. 5 to help patients dealing with obesity caused by complex medical conditions. Through the program, a variety of health care professionals work with patients to develop healthy eating habits, exercise routines and coping techniques to manage their weight and associated health problems. The bariatric surgery is also available to those who meet specific criteria. Laparoscopic band surgery is a minimally invasive surgery that involves inserting a band around the top portion of the stomach, making the patient feel fuller so they eat smaller portion sizes. The program targets patients aged 12–17 with complex, severe obesity, indicating a body mass index greater than the 95th percentile.

**Calculating risk**: The American College of Surgeons is expanding its development of risk calculators so patients can be more aware of possible dangers as a result of surgery. Risk calculators evaluate a patient’s chances of dying or developing complications by factoring in variables such as age, weight and existing medical conditions. The calculations are based on data from patient records collected by the National Surgery Quality Improvement Program. Heart surgeons have been using them for years, the college says, but now the devices are being designed for other surgical specialties. In 2009, the college produced calculators for surgeries of the colon and pancreas. Now it is creating calculators for at least 15 other procedures, including gastric bypass, small bowel obstruction, hysterectomy, knee replacement, hip replacement and prostatectomy.

**Federal appeal**: Justice Minister and Attorney General Rob Nicholson says the federal government will appeal the British Columbia Court of Appeal’s decision that supervision of the Vancouver-based Insite safe injection site falls within provincial jurisdiction ([www.courts.gov.bc.ca/jdb-txt/CA/10/00/2010BCCA0015.htm](http://www.courts.gov.bc.ca/jdb-txt/CA/10/00/2010BCCA0015.htm)). “This case raises important questions regarding the doctrine of interjurisdictional immunity and the division of powers between the federal and provincial governments. There was a dissenting opinion in the BC Court of Appeal, and the Government of Canada believes it is important that the Supreme Court of Canada be asked to rule on this matter,” Nicholson said in a statement ([www.justice.gc.ca/eng/news-nouv/nr-cp/2010/doc_32475.html](http://www.justice.gc.ca/eng/news-nouv/nr-cp/2010/doc_32475.html)).

**Weight monitoring**: A group of Canadian health associations are urging all primary health care and clinical practitioners in Canada to monitor children’s growth according to standards established by the World Health Organization (WHO). In a collaborative statement released Feb. 8, the group says that WHO growth charts are based on populations around the world, making them ideal for Canada’s multi-ethnic society, and are a good tool for identifying children at risk for obesity ([www.dietitians.ca/growthcharts](http://www.dietitians.ca/growthcharts)). Standardized tools to monitor children’s growth help health care providers to earlier identify problems with nutrition and health, according to the statement’s contributors. The group — Dietitians of Canada, Canadian Paediatric Society, the College of Family Physicians of Canada and Community Health Nurses of Canada — recommends that children be weighed and measures soon after birth, at 2, 4, 6, 9, 12, 18 and 24 months, and once a year thereafter.

**DSM draft**: The American Psychiatric Association has released proposed changes to the *Diagnostic and Statistical Manual of Mental Disorders (DSM).* The next edition of the manual *, DSM-V*, is scheduled for release in May 2013. Some of the proposed changes are already generating debate, including placing the diagnosis of Asperger syndrome into a broader category called autism spectrum disorder. Another recommendation sure to stir controversy is the addition of temper dysregulation disorder with dysphoria, which has been added to reduce the number of children being misdiagnosed with bipolar disorder and given antipsychotic drugs. Two other new disorders proposed are binge eating disorder, defined as quickly eating food to the point of discomfort (accompanied by guilt and mood changes) at least once a week for three months, and hypersexuality, which a person might have if he or she is often consumed by sexual fantasies and urges. The proposed diagnostic criteria were posted Feb. 9 for public comment until April 20 ([www.dsm5.org](http://www.dsm5.org)).

**Heart care savings**: Canada could save about $5 billion a year if the risk factors for cardiovascular disease were reduced, according to a Conference Board of Canada report released Feb. 15 ([www.conferenceboard.ca/documents.aspx?DID=3447](http://www.conferenceboard.ca/documents.aspx?DID=3447)). The report, *The Canadian Heart Health Strategy: Risk Factors and Future Cost Implication*, states the savings could be achieved by meeting risk factor targets set by the Canadian Heart Health Strategy and Action Plan in its February 2009 report *Building a Heart Healthy Canada* ([www.chhs-scsc.ca/web/wp-content/uploads/60408strategyeng.pdf](http://www.chhs-scsc.ca/web/wp-content/uploads/60408strategyeng.pdf)). The risk factors considered in the analysis are lack of physical activity, smoking, obesity, hypertension and consumption of fruit and vegetables.

**Reducing unnecessary radiation**: The United States Food and Drug Administration has unveiled an initiative aimed at reducing unnecessary radiation exposure from computed tomography (CT), nuclear medicine examinations and fluoroscopy. The initiative introduces “targeted requirements for manufacturers” of CT and fluoroscopic devices, while urging the establishment of a national dose registry ([www.fda.gov/Radiation-EmittingProducts/RadiationSafety/RadiationDoseReduction/ucm199904.htm](http://www.fda.gov/Radiation-EmittingProducts/RadiationSafety/RadiationDoseReduction/ucm199904.htm)). Although details are being finalized, imaging devices may be required to display and record equipment settings and radiation doses, as well as an alert if the dose exceeds the diagnostic reference level. The FDA is also pushing for development of diagnostic radiation reference levels, as well as patient medical imaging history cards. Ideally, medical imaging devices will transmit radiation dose information to patient medical records and to the national registry.

**Add swine flu to seasonal vaccine**: The World Health Organization recommended on Feb. 18 that a dominant strain of pandemic (H1N1) 2009 be added to seasonal vaccines during the next flu season in the northern hemisphere ([www.who.int/csr/disease/influenza/201002_Recommendation.pdf](http://www.who.int/csr/disease/influenza/201002_Recommendation.pdf)). “In essence, what the scientists said was that in the past year, the overwhelming number of influenza viruses isolated around the world were the pandemic H1N1 virus,” Dr. Keiji Fukuda, pandemic influenza advisor to the WHO, said in a press release. “The experts believe, based on this information, that these viruses will continue to be one of the dominant viruses in the coming fall and winter season in the northern hemisphere.”

## Footnotes

*   Published at [www.cmaj.ca](http://www.cmaj.ca) from Feb. 8 to Feb. 19