SPread Sheet IN THIS ISSUE FEATURES ARTICLES

Standardized Patient Program Newsletter
educating, informing, entertaining, inspiring
SPread Sheet
IN THIS ISSUE
PAY GOES UP
FEATURES
SYMPTOMS . . . Bruits—
Carotid, Thyroid, & Renal 2
SESSIONS PENDING
3
SPIN AND AROUND
3
HUMERUS
5
PROSE
ARTICLES
SPOTLIGHT ON . . .
Gloria de Paz-Hrynuik 2
SEVERITY IN H1N1
PATIENTS
DISEASE
ODDS OF
PROBLEM
HIV RESISTANT
4
GAMBLING 6
6
PEOPLE
TRANSFORMATIVE REPORT
7
FACULTY OFNURSING MAY OPEN
8
PH.D. PROGRAM
IMPROVED MEDIA ACCESS TO
HEALTH
POLICY RESEARCH
9
FINDINGS
SOMETIMES THE BEST MEDICINE
MIGHT BE A
PLACEBO
Volume 2, Issue 6, March 2010
11
Based on the results of the “meals vs. pay” survey last fall, the
Department of Medical Education is initiating a 2.3% pay raise to
take effect April 1, 2010 for all payment Levels.
SPs are paid at Level 1 if they are:
• Serving as a back-up on site (if utilized, pay is adjusted to
correspond to duties)
• Participating in a training session
• Participating in a teaching session wherein they play a role
and give little or no feedback about students’ performances
• Participating in an exam as a model, giving no feedback
SPs are paid at Level 2 if they are:
• Participating in a teaching session wherein they play a role
and provide considerable feedback about students’ performances
• Participating in an exam as a model and giving basic feedback
such as completion of a short check list
SPs are paid at Level 3 if they are:
• Participating in an examination in which they provide extensive feedback that is part of the evaluation of the student
SPs are paid at Level 4 if they are:
• Participating as an SP where an invasive procedure is practiced – only the CTA and MURTA programs pay out at this
level.
SPs are hired for a minimum of three (3) hours - unless they are
working as back-ups or in training where the minimum is one (1)
hour.
If you have any further questions regarding payroll or the exact
hourly rates, please contact an SPC directly.
SUBMISSIONS,
PLEASE
The SPread Sheet is your newsletter; if you have any articles, photos, opinions, thoughts,
trivia, anecdotes, pictures, or jokes to contribute for the next issue, please do so by May 31,
2010. Contact information is provided in the sidebar on page two. We reserve the right to
edit any and all submissions for length and content in collaboration with the contributor.
Submissions that are not included in one issue may be included in subsequent issues.
Questions or comments? Call 480-1307
Page 2
SPread Sheet Volume 2, Issue 6, March 2010
Contact the SPread Sheet:
Office B, Clinical Learning
& Simulation Facility
Level 000, Brodie Centre
727 McDermot Avenue
Winnipeg, MB, Canada
R3E 3P5
Phone:
(204) 480-1307
Fax:
(204) 977-5682
E-mail:
[email protected]
Home Page:
http://www.umanitoba.ca/
faculties/medicine/
education/ed_dev/
spp.html
NEWSLETTER EDITOR
Tim Webster
SP
SPOTLIGHT
ON
...
Gloria de Paz-Hryniuk will be a familiar face to
any SPs who have been to the Clinical Learning &
Simulation Facility (CLSF) in the past year. She is
the full-time receptionist for the CLSF, with an adjusted work schedule to enable her to provide support for Saturday sessions.
Gloria’s other duties in the CLSF include booking
the rooms and equipment for any and all sessions,
as well as providing support to the Medical Director, Dr. Robert
Brown, and the Research Director, Dr. Bertram Unger. She’s thrilled
to be part of the learning development of CLSF users who will go on
to become successful medical professionals: “Being part of the latest
technology in medicine – simulation – is fascinating.”
Born in Suriago City in the province of Surigao del Norte as the
youngest five children, Gloria comes to the CLSF almost directly
from the Philippines. She graduated from the Philippine Christian
University in 1981 with a B.S. in Agriculture, and worked her way to
Resort Manager at Club Paradise on the island province of Palawan
in just five years. Her move to Winnipeg was at the behest of love,
when she met and married Harold Hryniuk in 2006.
PROGRAM STAFF
Lezlie Brooks,
SP Coordinator
SPs who attended 2009’s Annual Holiday Party last December
may also remember Gloria for her singing voice, and her lovely rendition of Whitney Houston’s I Have Nothing. With her warm demeanor, friendly smile, and active lifestyle, she certainly models her
personal motto: “Life is beautiful – have fun!”
Holly Harris,
SP Coordinator
SYMPTOMS . . . Bruits—Carotid, Thyroid, & Renal
Tim Webster,
SP Coordinator
Cathy MacDonald,
Office Assistant
Copyright © 2010
University of Manitoba
Permission to reproduce
and/or distribute any of
the material contained
herein must be obtained
from the Standardized
Patient Program.
ISSN 1715-5452
Bruits (“broo-ees”) are rushing or blowing sounds produced by
blood flowing in arteries and heard with a stethoscope. Successful
simulation of a bruit relies on the distraction of the examiner, who
should be concentrating on listening through the stethoscope—bruits
are often difficult to hear.
The SP must be aware of his or her own pulse so that the simulated bruit is synchronous with the pulse. The simplest
method is for the SP to locate the pulse in the wrist artery just below the base of the thumb, where a nurse or
physician usually takes a pulse (Fig. 1). This done best
Figure 1
with the opposite hand, so the SP should have his or her
hands hidden by a sheet or gown, or casually folded in the lap.
Another method is to become aware of one’s own pulse in the
head, neck or fingers; this is difficult, but can be achieved with
practice. Regardless, the action of monitoring one’s own pulse
(continued on page 4)
Questions or comments? Call 480-1307
Page 3
SPread Sheet Volume 2, Issue 6, March 2010
SESSIONS
PENDING
UGME / CPAs
March 31, 2010
April 9, 14, 23 & 28, 2010
PAEP Session
April 16, 2010
FPA
April 17, 2010
Pharmacy 2100
April 1, 2010
UGME / Med III OSCE
April 17 & 18, 2010
UGME / CS140
April 1, 6, 13 & 16, 2010
PAEP Session
April 23, 2010
UGME / CS266
April 1, 8 & 15, 2010
CAPE
May 15, 2010
UGME / Med I Mini-OSCE
April 10 & 11, 2010
Neonatal OSCE
April 15, 2010
PAEP / MURTA Session June 11, 2010
CAPE
June 16, 2010
CAPE PREP
June 17, 2010
NB: This listing is for informational purposes only; some of the sessions listed are
already in progress. If you are required for a role, you will be contacted directly by
an SP Coordinator. If there is a discrepancy between the information provided here
and a confirmation form you have received, please regard the information from
your SPC as correct.
SPIN
AND AROUND
•
“Farewell!” to SP Sarah Severloh who is
pursuing other opportunities while abroad. •
•
“Welcome!” to new SPs:
Brenda Borzykowski
Shannon Cameron
Erin Garner
Chelsea Hermus
Eden Katz
Char Kenemy
Megan Krohn
Colleen Michalkow
Felicia Perron
George Scott
Rachel Seenie
Tara-Lynn Strickland
Wendy White
Monica Whiteway
Mark Yuill
•
•
Please be sure to provide our Office Assistant, Cathy MacDonald, with any changes
in your personal or contact information as
they occur. You can reach her at [email protected] or at 480-1308.
We are still compiling a catalogue of photos
of all the SPs and Applicants in the program. The Coordinators don’t know what
each and every SP and Applicant looks like,
and a catalogue will help us to fill roles
more easily. If you haven’t already, please
forward an 8” x 10” picture of yourself –
preferably in black and white – to the SP
office. You can send your pictures electronically to: [email protected]
. . . or mail them by regular post:
The phone number for the Standardized
Patient Program Training Room, 203 Brodie Centre, is 272-3164. Please use this
number if an SPC is expecting you for a
training session but for some reason you
aren’t on time.
Attn: Tim Webster, SPC
Office B, CLSF
Level 000, Brodie Centre
727 McDermot Avenue
Winnipeg, MB R3E 3P5
Questions or comments? Call 480-1307
Page 4
SPread Sheet Volume 2, Issue 6, March 2010
SYMPTOMS . . . Bruits—Carotid, Thyroid, & Renal
cannot be seen by the examiner so that the
examiner remains unaware of the simulation.
A carotid bruit can be heard
over the large artery in the neck
(Fig. 2) and can be simulated by a
soft rushing sound as the SP exhales gently in synchrony with the
pulse: “unh unh unh” or “ehh ehh
Figure 2
ehh” - not as words, but sounds
produced by the breath forced softly through
the throat.
A thyroid bruit is produced similarly, the only difference being that
the examiner is listening over the
thyroid gland above and around the
Adam’s apple (Fig. 3).
(continued from page 2)
stenosis can be heard with a
stethoscope over the side of
the abdomen where the affected kidney lies (Fig. 4).
Figure 4
To simulate the sound of a
renal artery stenosis, the SP puts his or her
hand just under the lower back on the side of
the affected kidney and scratches the skin
with the thumbnail in time with the pulse.
The exact sound and volume of these
bruits should be fine-tuned in concert with a
physician / clinician who has heard them before.
Adapted from Training Standardized Patients
Figure 3
to Have Physical Findings, by Howard S.
Barrows, M.D., Southern Illinois University,
A renal artery stenosis is the partial blockSchool of Medicine, Springfield Illinois,
age of the artery which supplies blood to the
1999, pp. 6 & 26
kidneys. The sound made by a renal artery
DISEASE
SEVERITY
IN H1N1
PATIENTS
A new study published in CMAJ (Canadian Medical Association Journal)
http://www.cmaj.ca/cgi/doi/10.1503/cmaj.091884 concerning the severity of H1N1 influenza has found that admissions to an intensive care unit
(ICU) were associated with a longer interval between symptom onset and
treatment with antivirals and with presence of an underlying medical condition. People of First Nations ethnicity were also found to be at higher risk of
severe H1N1 infection compared to people of other ethnic origins.
“Predicting disease and mitigating hazard in at-risk populations is an important aim of
public health epidemiology, and in preparation for future waves of H1N1, determining the
correlates of disease severity is incredibly important,” write Dr. Ryan Zarychanski, Assistant
Professor, Sections of Haematology/Medical Oncology and Critical Care, Faculty of Medicine,
University of Manitoba and coauthors from the departments of Internal Medicine, Medical Microbiology and Community Health Sciences in the Faculty of Medicine, University of Manitoba;
National Microbiology Laboratory, Public Health Agency of Canada; Manitoba Health; and the
Ottawa Hospital Research Institute.
“This is the first viral study to demonstrate the importance of paying attention to symptoms of H1N1 and seeking earlier treatment, such as anti-virals, that could prevent a more
serious illness,” adds Dr. Zarychanski, lead researcher.
The highest incidence of severe H1N1 occurred in Manitoba, where 45 residents of the
province were admitted to an ICU. As of September 5, 2009, there had been 795 laboratory
confirmed cases of H1N1 in the province where location of treatment (continued on next page)
Questions or comments? Call 480-1307
SPread Sheet Volume 2, Issue 6, March 2010
DISEASE
SEVERITY
IN H1N1
PATIENTS
Page 5
(continued from previous page)
could be determined. Seventy-two percent (569) of patients remained in the community,
23% (181) were admitted to hospital but not the ICU and 6% (45) were admitted to the ICU.
The mean age of people with H1N1 was 25.3 years old.
In this study, which included all confirmed H1N1 cases in Manitoba, the authors found that
longer intervals from symptom onset to eventual treatment with antivirals (Tamiflu) were
strongly associated with more severe disease necessitating admission to an intensive care
unit. Those who had untreated symptoms the longest required more life support, compared
to people who were treated within 48 hours.
“Of course not everyone with H1N1 symptoms requires treatment, but this finding underscores the importance of prompt medical therapy for those experiencing serious symptoms,
such as shortness of breath, in patients with underlying medical conditions, and among First
Nations people,” states lead researcher Dr. Zarychanski.
In the study, Dr. Zarychanski and colleagues also found that First Nations ethnicity was
associated with severe H1N1 disease requiring ICU admission. The proportion of First Nations people increased as the severity of disease increased; 28% of confirmed H1N1 cases in
the community occurred in First Nations people, compared with 54% of hospital admissions
and 60% of admissions to the ICU. Similar trends have been observed in Aboriginal communities in Australia and New Zealand. This is “consistent with historical records from the 1918
Spanish influenza pandemic, during which mortality in Aboriginal communities was far higher
than in non-Aboriginal communities,” write the authors.
“Our data was presented to the federal government and was one of the considerations
used to inform policies to include Aboriginal populations in the at-risk groups and conduct
universal vaccinations for First Nations, Metis and Inuit Canadians,” Dr. Zarychanski noted.
While the authors note that a genetic predisposition hypothesis is interesting, Aboriginal
peoples in Canada, Australia and the Torres Strait do not share common ancestry. “What
they do have in common is a history of colonization, combined with historic and continuing
social inequities that have led to significant health disparities,” write the authors. They also
suggest the increased risk for First Nations peoples may be because of substandard living
conditions, low income, diet, additional health issues or lack of access to health care.
These findings may have implications for public, and health care provider education, as
well as for future public health planning and community outreach programs in the face of the
current, or future outbreaks.
Source: U of M / Faculty of Medicine webpage
http://myuminfo.umanitoba.ca/index.asp?sec=36&too=100&dat=1/21/2010&sta=3&wee=4&eve=8&npa=21489
HUMERUS
PROSE
The Winnipeg Parking Authority has installed new meters all around the Health Sciences
Centre, where there use to be free two-hour and one-hour parking during the day. Now
when SPs arrive for training or simulation session before 4:30PM – no matter what their case
notes may indicate - they all suffer from parking zones disease.
Inspired by: http://www.punoftheday.com/cgi-bin/disppuns.pl?ord=S&cat=6&sub=0606&page=2
Questions or comments? Call 480-1307
Page 6
SPread Sheet Volume 2, Issue 6, March 2010
ODDS OF
PROBLEM
GAMBLING
Researchers in the departments of Community
Health Sciences and Psychiatry in the Faculty of
Medicine at the University
of Manitoba have found
that gambling by playing
video lottery terminals
Tracie Afifi, Ph.D.
(VLTs) in bars and restaurants was associated with the highest odds of
problem gambling among women in Canada.
A study published this week in the Canadian Journal of Psychiatry noted that VLTs in
communities and in casinos are the number
one and two modes of gambling associated
with problem gambling among Canadian
women aged 15 years and older.
“The best way to reduce problem gambling
is to reduce the availability and accessibility of
VLTs,” concludes Tracie Afifi, lead researcher
of the study. “Regulators may be reluctant to
do so because VLTs generate the largest profits, compared with other types of gambling.”
Within provinces, Crown corporations manage legal gambling operations that put them
in contrasting roles of maximizing profits and
protecting and promoting public health.
The researchers recommend a public
health perspective that recognizes “the
health, social and economic costs and benefits
of gambling for people, families and communities.”
Their study used the most current, national
-level gambling data and is the first to use a
population health model to understand the relation between types and frequency of gambling activities and problem gambling among
Canadian women.
Their recommendations include:
• Develop a plan to remove and prohibit all VLTs from bars, restaurants,
lounges and Legions.
• Reduce the hours of operation of
VLTs regardless of the hours of operation of the establishment.
• Create awareness campaigns specifically addressing problem gambling
among women.
• Develop prevention programs and
help women self-manage their gambling behaviour.
Source:
U of M / Faculty of Medicine webpage
http://myuminfo.umanitoba.ca/
index.asp?
sec=36&too=100&dat=1/21/2010&sta=
3&wee=4&eve=8&npa=21462
HIV RESISTANT PEOPLE
The discovery was huge: a group of women in Kenya, all of them sex-trade
workers, were somehow evading HIV infection despite repeated exposure to the
deadly virus.
It was Keith Fowke’s job as a graduate student in the late 1980s, guided by
lead investigator Frank Plummer, to go to the AIDS-ravaged East African country
and collect data to determine whether or not these women had some sort of natu- Keith Fowke
ral immunity. If so, it would be a major breakthrough in the global pursuit of a
vaccine.
Fowke, now a medical microbiology professor, remembers well the evening the results became clear. Perched on the balcony of his tiny 600-square-foot flat
(continued on next page)
Questions or comments? Call 480-1307
Page 7
SPread Sheet Volume 2, Issue 6, March 2010
HIV RESISTANT PEOPLE
(continued from previous page)
in a Nairobi suburb, a cold beer nearby, a full
moon above, he did the calculations from lab
data collected earlier that day. In a test tube,
he had combined HIV cells with blood samples
from exposed but uninfected women and
noted whether or not – and to what extent –
the women’s blood cells would go after the virus. HIV cells under attack released a radioactive compound. Fowke did the same comparison for infected women.
wide in HIV vaccination research. They continue to try to figure out which part of the virus is being targeted by the immune systems
of HIV-resistant individuals in order to stop
the virus from taking hold. But recent findings have steered them in a new direction as
well, suggesting a calm immune system may
play a role.
“This is a brand new area,” Fowke says.
The hope is to create a vaccine that siAn analysis of the numbers (which measured radioactivity levels) showed the healthy lences the cells first exposed to HIV and renwomen’s cells were killing the HIV virus “very der them a poor target for the virus.
aggressively,” Fowke says, suggesting they
The research team is also taking a closer
were in fact “naturally vaccinated.”
look at AIDS on the Canadian prairies. “The
“That was an amazing moment. I remem- epidemic in Manitoba and Saskatchewan is
really exploding, especially among young
ber calling Dr. Plummer and saying this is
what the result is and he said, ‘Are you sure? women,” says Fowke.
Did you double-check?’” Fowke recalls. “He
said, ‘Wow, I think it’s real.’ We were both
excited about that.”
Source: U of M e-memo, March 24, 2010
http://myuminfo.umanitoba.ca/
index.asp?
Three decades later, Plummer, Fowke, and sec=2&too=100&eve=8&dat=3/16/2010
their University of Manitoba colleagues Blake
&npa=21997
Ball and Ma Luo are leading the way worldTRANSFORMATIVE REPORT
On January 28th, 2010, the Association of Faculties of Medicine released
its report titled: The Future of Medical Education in Canada (FMEC): A Collective Vision for MD Education.
2010 marks the hundred-year anniversary of the Flexner Report – a
study of medical education in the United States and Canada. Since that
time, there have been countless changes in medical practice, Canada’s
healthcare system and population, and the availability of medical and
pedagogical technologies. Yet there has been no comprehensive study of
the Canadian system of medical education in 100 years . . . until now.
The report is the culmination of a 30-month project funded by Health Canada which examines medical education in the country. The report contains ten recommendations and 5 enabling recommendations which, once implemented across the country, will fundamentally
strengthen medical education in Canada and ultimately, the health status of all Canadians.
Strengthening the future of medical education is important to everyone, said Joy Smith,
Member of Parliament for Kildonan-St. Paul, Manitoba.
(continued on next page)
Questions or comments? Call 480-1307
Page 8
SPread Sheet Volume 2, Issue 6, March 2010
TRANSFORMATIVE REPORT (continued from previous page)
has received the unanimous approval of our
faculties of medicine. For the first time in a
hundred years, our system of medical education has been examined through multiple
lenses, and what has emerged is a series of
recommendations that are consensus-based
and firmly grounded in the evidence” said Dr.
“This is a watershed moment for medical
James Rourke, Dean of the Faculty of Medieducation in Canada. The recommendations
cine at Memorial University of Newfoundland
contained in this report are forward-thinking, and Labrador, and Chair of the Board of Direcambitious, and broad-based; their implemen- tors of AFMC.
tation on a national scale will have a definite
A full copy of the report, in both official
impact on how physicians are trained and how
care is delivered in this country” said Dr. Nick languages, as well as a downloadable version
Busing, President and CEO of the Association of the FMEC launch video can be downloaded
of Faculties of Medicine of Canada. “We look at: www.afmc.ca/fmec/
forward to working closely with our members
Source: U of M / Faculty of Medicine webpage
as they implement these recommendations
and embark on this exciting transformation.”
http://myuminfo.umanitoba.ca/
“I have no doubt that this report will ensure that physicians are well equipped to
meet the changing health needs of Canadians.” said the MP, who represented the Honourable Leona Aglukkaq, Minister of Health, at
the launch of the report.
“The recommendations contained in this
report will fundamentally strengthen medical
education in Canada. Moreover, the report
index.asp?
sec=36&too=100&dat=1/28/2010&sta=
3&wee=5&eve=8&npa=21547
FACULTY OF NURSING MAY OPEN PH.D. PROGRAM by Sarah Petz
In hopes of keeping graduates in the province, the U of M faculty
of Nursing has put forth a statement of intent to develop a PhD
program.
With a potential roll out date of 2011, the program hopes to develop skilled leaders and researchers in academic and health care
settings.
According to Dauna Crooks, dean of Nursing, there is still another year of meetings before
the program can be developed.
“We’re actually in the proposal at this point, so the statement of intent is sort of a basic
document that lets the university and the ministry know what we’re doing,” explained Crooks.
There are currently no universities in Manitoba that offer a doctoral program in Nursing.
“In Winnipeg alone we have about 150-200 Masters-prepared nurses with nowhere to go,”
said Crooks.
Instead, Crooks said graduates interested in obtaining a PhD in Nursing would have to go
either to the University of North Dakota, Minnesota or another Canadian university. Another
reason for proposing the PhD program is the need for faculty renewal, said Crooks. “You can’t
renew an academic program without having doctorate-prepared staff,” said Crooks. She said
that in the majority of cases, in order to obtain a faculty position at (continued on next page)
Questions or comments? Call 480-1307
Page 9
SPread Sheet Volume 2, Issue 6, March 2010
FACULTY OF NURSING MAY OPEN PH.D. PROGRAM (continued from previous page)
an academic institution those applying would
require a PhD.
with 4-5 students being admitted.
offer a doctoral program in Nursing, including
the University of British Columbia, University
of Alberta, and University of Ottawa.
“If the opportunity is available here, that’s
great; that opens so many doors for Winnipeg
and for Manitoba in Nursing.
While some of the PhD students have
“If we ha[d] a PhD program, we would be started the program directly after completing
able to essentially home grow our own junior their Masters of Science in Nursing, over half
have been working and decided to return to
faculty members,” said Jay Doering, dean of
school. “Their backgrounds are extremely vargraduate studies at the University of Maniied, ranging from management, policy positoba. According to the statement of intent,
the program will encourage the study of vul- tions to acute care,” said Kirsten Woodend,
director and associate dean of Nursing at the
nerable populations and health disparities
where assessment, relevant and effective care University of Ottawa.
and social support are required.
Upon graduating, the students can become
directors of research or clinical scientists at
“PhD students in this program would be
larger institutions, with a number of hospitals
able to [ . . . ] research topics that would be
related to [issues affecting] Manitoba, Canada in Ottawa hiring PhD-prepared nurses for
these positions. Others seek government poand the world”, said Doering.
sitions involved in policy development or obThe program would also add to the variety tain a faculty position at an academic instituof the graduate studies at the U of M, said Do- tion.
ering. “When it comes to graduate programs,
“I know a lot of people who have done
most of the units on campus have both a Mastheir masters or undergraduate degrees and
ters and PhD program,” said Doering.
are going to try the practice for a couple of
“This PhD program would have a much
years but fully intend on coming back to do
broader appeal, and would certainly be com- their masters and teach here, or maybe go on
petitive with other PhD university programs in to a PhD program,” said (Brittany Weber),
Canada.”
UMSU representative of the Nursing Students
Many universities across Canada currently Association Council,.
The University of Ottawa, which has a simi- Source: The Manitoban, September 14, 2009
lar program to the one now being proposed at
http://www.themanitoban.com/
the U of M, has accepted students to their
articles/20000
program since 2004. Since that time, between
5 and 15 applicants have applied each year,
Reprinted with permission
IMPROVED MEDIA ACCESS TO HEALTH
POLICY
RESEARCH FINDINGS
Journalists communicate to the public about a wide range of health policy issues, yet it can
be challenging for them to find reliable, evidence-based information.
A new University of Manitoba project called the Best Evidence Network will link journalists
with the academics who research and publish reports on these issues. The network will create
an accessible, credible, evidence-based resource for members of the
(continued on next page)
Questions or comments? Call 480-1307
Page 10
SPread Sheet Volume 2, Issue 6, March 2010
IMPROVED MEDIA ACCESS TO HEALTH
POLICY RESEARCH FINDINGS
(continued from previous page)
media covering topics in health policy, includ- sues like wait times, user fees, immunization
and the sustainability of Medicare.
ing those that are the most controversial.
The 3-year project will receive $370,800
from the Canadian Institutes of Health Research’s (CIHR) Partnerships for Health System Improvement and $97,000 from the
Manitoba Health Research Council as their
partner contribution.
The project is among 19 new health services research projects announced today by
the Honourable Keith Ashfield, Minister of National Revenue, Minister of the Atlantic Canada Opportunities Agency, and Minister for
the Atlantic Gateway, on behalf of the Honourable Leona Aglukkaq, Minister of Health.
“All Canadians will benefit from the outcomes of this project,” says Digvir Jayas, vice
-president (research) and Distinguished Professor at the University of Manitoba. “I applaud this group’s efforts to provide Canadians with real evidence. This is so important
given that health policy issues affect each one
of us.”
The network involves working with journalists to determine the type and format of information that would be useful to them when reporting on health policy issues; building a research database and a network of researchers
prepared to work with the media; creating a
“CIHR is increasing its focus on solutionmedia-friendly website to allow updates and
based research and knowledge translation –
easy access to the latest reliable health policy
that is, making users aware of new knowledge evidence and commentary; monitoring the
or innovations and facilitating their use,” said media and engaging the researcher network
Dr. Alain Beaudet, President of CIHR.
to respond to breaking news stories across
“Knowledge translation programs like PHSI
the country where health policy evidence is
have a huge potential to pay Canadians a
relevant; and becoming the go-to source for
dividend on their investment in health reevidence on challenging and sometimes consearch.”
troversial health policy topics.
“Canada does not have an effective forum
for communicating health policy research to
journalists who are expected to translate it for
the public,” says lead investigator Noralou
Roos, professor in the Faculty of Medicine’s
Manitoba Centre for Health Policy. “This project seeks to improve the Canadian healthcare
system and ultimately the health of Canadians
by ensuring that our best health policy research evidence is easily accessible to journalists and accurately communicated to Canadians and policy makers via the media.”
Researchers are partnering with journalists
and media experts, and calling on third-party
brokers of research evidence such as the Canadian Health Services Research Foundation,
Media Doctor, and the Health Council of Canada. Together, they will find ways to better
disseminate the best evidence available on is-
The Canadian Institutes of Health Research
(CIHR) is the Government of Canada's agency
for health research. CIHR's mission is to create new scientific knowledge and to catalyze
its translation into improved health, more effective health services and products, and a
strengthened Canadian health-care system.
Composed of 13 Institutes, CIHR provides
leadership and support to more than 13,000
health researchers and trainees across Canada. www.cihr-irsc.gc.ca
Source: U of M e-memo, March 10, 2010
http://myuminfo.umanitoba.ca/
index.asp?
sec=2&too=100&eve=8&dat=3/4/2010
&npa=21839
Questions or comments? Call 480-1307
Page 11
SPread Sheet Volume 2, Issue 6, March 2010
SOMETIMES THE BEST MEDICINE MIGHT BE A
PLACEBO
by Jen Robinson
Mr. Wright was dying of cancer. Confined to his hospital
bed, large tumors invaded much of his body. His prognosis
was bleak — to say the least — yet he had not given up hope.
Despite his doctor’s cautious reservation, Mr. Wright was convinced that a new drug called Krebiozen would be the key to
his recovery. To everyone’s amazement, after receiving a
mere 13 days of treatment with the new drug, the tumors had
shrunk by an astonishing amount and he was happily discharged from the hospital shortly thereafter.
Two months later, Mr. Wright was back in the hospital with
tumors fully regrown, after learning of media reports that questioned the effectiveness of
Krebiozen. This time, his doctors decided to give him a “placebo” (or sham treatment) and
convinced him that he was receiving a new and improved version of the drug which was sure
to work. His tumors shrunk rapidly and he was discharged once again.
Another two months went by before Mr. Wright learned of the recent studies which proved
Krebiozen to be completely worthless and ineffective. He died several days later.
Now, it may seem that the case of Mr. Wright (reported in Dr. Bruno Klopfer’s
“Psychological variables in Human Cancer” in 1957) is an extreme example of the power of
the placebo. Though this might be true, the case should at least cause us to consider that
the mind’s effects on the body are potentially a lot more impressive than we previously
thought.
The healing effects of placebo treatments (which include sugar pills, saline injections and
even sham surgeries) have been demonstrated in a wide range of medical ailments, from
chronic pain and allergies to Parkinson’s disease and cancer.
For instance, if you were a 1950s angina sufferer, your doctor might have recommended a
new and highly effective surgical treatment to relieve the severe and potentially debilitating
chest pain associated with this condition. Over 10,000 patients underwent surgery to tie off
the internal mammary artery, and over 90 per cent reported significant improvement and reduction of painful symptoms immediately afterwards. However, some doctors remained
skeptical. They decided to do “sham surgery” on angina patients and look at the effects. The
sham surgery followed all of the usual procedures and preparations of real surgery (scrubbing
in, preparing the area with iodine, anesthetizing the patient, etc), except that surgeons simply cut open the chest and then sewed it back up again. As reported in the New England
Journal of Medicine in 1959, the sham surgery patients reported just as much pain relief as
the real surgery patients. It was the placebo effect all along.
Similar sham surgeries have given patients effective relief from the pain associated with
severe osteoarthritis of the knee, as well as from some of the symptoms of Parkinson’s disease, both with long-lasting effects.
These findings raise some questions as to what it is that makes medical procedures effective. How much of medical science’s current success should we credit to the placebo effect?
While we know that the placebo is a genuine and robust effect, less is known about how it ac(continued on next page)
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Page 12
SPread Sheet Volume 2, Issue 6, March 2010
SOMETIMES THE BEST MEDICINE MIGHT BE A
PLACEBO
(continued from previous page)
tually, physically, works. Scientists are work- which work to decrease pain — may operate
ing hard on this question, and have come up via the brain’s prefrontal cortex, which is an
with a few preliminary ideas.
area associated with conscious attention. A
study conducted at the University of Michigan
First of all, it is generally accepted that
by Dr. Tor Wager gave experimental particisubconscious cues may be at play. For inpants a painful electric shock (as scientists
stance, psychologists believe that treatments seem to love to do). First, however, the readministered by doctors in white lab coats are searchers applied a “pain reducing” cream
more effective than those administered by
(really a placebo) to some participants but not
plain-clothed doctors. A review of the litera- to others. Not only did the placebo group exture published in the British Medical Journal in perience less pain than the other group, but
1996 reported that blue pills are more effec- they also showed increased activation of the
tive than red pills if they are supposed to inprefrontal cortex.
duce sleep, but the opposite is true if they are
supposed to increase stimulation (as with anti
The trouble with this research is the appar-depressants). More expensive, brand name ent lack of any practical implications. Since
drugs also tend to be more effective for a va- deception is necessary for the placebo to work
riety of ailments than cheaper generic drugs. (ie., patients can’t be told they are receiving a
placebo but must believe they are receiving
In at least some cases, the placebo effect bona fide treatment), the patient’s right to
may be the result of simple conditioning. For medical information has to be subverted.
example, if receiving prescription medication While it is unlikely that we’ll give up the right
has often been associated with feeling better, to informed consent in order to undergo sham
then that same scenario (watching the doctor treatments, the research on the placebo effect
in their white coat write out the prescription, will probably not be limited to helping decide
going to the pharmacy to get it filled, actually what color we should dye our medications.
taking the pills, etc.) can result in feeling better, even if you’ve just been prescribed a
Knowledge of the placebo effect gives us
sugar pill. This, of course, does little to exan important understanding of the astonishing
plain cases of improvement following sham
effects that the mind can have on the body.
surgery, and does not describe the specifics of This knowledge is already being put to practihow the effect happens in the body.
cal use, as when cognitive therapies that
teach clients how to alter thought patterns are
A study published in the Journal of Neuro- used to treat physical ailments such as irritascience last year indicated that genetic factors ble bowel syndrome and chronic pain. Knowmay be responsible for determining suscepti- ing how the mind can affect our physical wellbility to the placebo effect. In the study, pla- being provides one more avenue through
cebo treatments for social phobia were only
which we can achieve physical health, and for
effective for individuals with specific genetic
conditions such as chronic pain that consismarkers. This study also found that in both
tently stymie traditional medical treatments,
the treatment and placebo group, anxiety re- this is very significant indeed
duction was associated with decreased activity
Source: The Manitoban, September 22, 2009
in an area of the brain known as the amygdala, meaning that both placebo and real
http://www.themanitoban.com/
treatments acted on the brain in the same
articles/20240
way.
Other types of placebos — namely, those
Reprinted with permission
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