Methinks the Gentleman Doth Protest Too Much

As usual I am way behind the news cycle but I had to get this one off my chest.

We have in Canada what is called the Conservative Party governing us. They are basically the Republican Party without the funny southern accents.

Recently they tried to pass one of those internet snooping laws. This would allow the police to make your internet provider give them a list of all the sites you had browsed without a warrant. This would also include your private email address and any financial transactions which would of course give them your banking and credit card information. It would require the providers to install expensive equipment to monitor this. Of course you know who would really be paying for this, as if we don't pay enough for the internet in Canada. As my mother told me, if you don't have anything to hide, you don't need privacy (my mother also doesn't own a computer). If I really thought that this was going to help the police get bad guys off the street any quicker or more efficiently, I might even agree except we all know that is not going to happen, in 90% of cases it will be used to harass people.

The point man for the government was their family values Minister of Public Safety Victor Toews. Early on in the debate, Mr. Toews framed his position as," you can support the bill or you can be with the child pornographers.". This naturally pissed off people who were against the bill and really didn't support child pornography either.

Quickly up came the Twitter account Vikileaks. This is a play on Wikileaks and our minister's first name. I would show you the site but unfortunately it came down. It seems Mr. Toews has a few skeletons in his closet.

• Like he was recently divorced, in a fairly messy divorce.
  
• Like he got divorced because he was boinking his babysitter.
  
• Like he has a four year son from his mistress, the same babysitter.
  
• Like said mistress is now on the government payroll working for a Senator.
  

These are all in the public record as part of his divorce proceedings. Now in the States or Britain, the press would have been all over about that as soon as it came out. In Canada our press respects the privacy of politicians (especially when two of the national news chains support, maybe support is too weak a word, the Conservatives).

I am always happy to rejoice whenever a politician I don't support gets caught with his pants down. I even posted a link to Vikileaks on Facebook.

Mr. Toews was able to turn what should have been a humiliation and resignation into a bit of a triumph. Press stories covering Vikileaks called the tweets, "unsubstantiated". press instead of trying to flesh out more of the story about Mr. Toews' marital woes, by consulting public records, went after Vikileaks. Eventually it was found that the Twitter account came from within the House of Commons and after some time a poor Liberal staffer fessed up. The Leader of the Liberals had to make a groveling apology, the staffer was fired and the case is closed.

Quite frankly I think he doth protest too much. The only thing I can fault the poor staffer on was being too stupid to use an account from outside the HofC; one that would have been harder to trace. Mr. Toews entire political career has been about being a family values politician including opposing gay marriage. He always campaigned with his wife and family front and centre. In fact according to Vikileaks when they were separated before divorcing, he forced her to campaign with him for appearances sake.

A lot of politicians have wives and families and most of them don't use them as campaign props. You may see them on the podium on election night but that is about it. They deserve their privacy. In the 1970s our Prime Minister Pierre Trudeau campaigned with his beautiful young wife Margaret. When his marriage went off the rails it was all over the news. Some mainstream commentators stated that his choice of a flaky wife (she was later diagnosed with bi-polar illness) was a reflection of his lack judgement and fitness to lead the country. The press had a field day with the fact that while he was losing the 1979 election, she was dancing at Studio 54. And he had no right to complain, he had sacrificed his right to privacy.

Meanwhile the group Anonymous has posted videos disclosing the name of Mr. Toews' mistress on You-Tube. He is naturally not amused by this.

Drug Shortages

We take the drugs we find in our cart and in the evil Pyxis machine for granted.

When I go to Ecuador every year, I have to figure out exactly how much of each drug we use, add a fudge figure and buy them all in advance (except the controlled ones which we buy there). That was a little stressful the first time, I have since learned that we can buy most of the drugs we need there anyway.

Now as we recently learned almost all the generic injectable drugs in Canada are produced at a single factory in Lennoxville Quebec, owned by Sandoz which is itself owned by a European company. Some time ago this factory was visited by representatives of the FDA who found safety flaws in their manufacturing process and told them to fix it, essentially shutting down the plant or at least severely curtailing its production while it fixes itself. This happened a few months ago but the shit has only now hit the fan.

Affected are drugs like morphine, fentanyl, rocuronium, glycopyrrolate, ketamine, ondansatron, norepinephrine and protamine (actually it would be shorter to just list what's not affected). Ondansatron is more or less gone once we run out of what is on hand. The rest are currently being rationed. Alternate drugs have been proposed but many of them are also produced by Sandoz. Surgeries have already been canceled in Canada, mostly due to protamine shortages.

The government is acting sluggishly to license drugs from other countries to be imported to Canada and of course companies that could have made these drugs but that have historically been shut out of our market are in no hurry to accomodate us.

A number of observations:

1. How come free market USA has higher standards for drug production than Soviet Canuckistan?
2. Who was the genius who decided that all or most of Canada would buy its drugs from a single source?

Of course this crisis is generating about 500 emails a day for me and numerous meetings (we all know meetings are the best way to solve any problem). As someone whose connection with anaesthesiology goes back to 1986 when I started my residency, the responses of some of my colleagues are quite amusing. A number of people have for example stated that there is absolutely no way they can practise without ondansatron. Suggestions that maybe we should use Pancuronium for longer cases are met with horror. Faced with a potential shortage of glycopyrrolate, last week, I put a note on the white board asking people to consider using atropine when they felt they could, to preserve our supplies. Somebody wrote "Are you nuts?". (I am analyzing the handwriting). Atropine is also made by Sandoz.

The other thing that has become apparent is the amount of wastage. Our recovery room nurses for example when they give a small bolus of morphine, will draw this from a 10 mg ampoule, give two or three mg and waste 7-8 mg, repeating the process over and over on the same patient. This of course comes from pharmacy and nursing who don't want syringes of morphine lying around and of course when morphine was cheap this was not necessarily rational but supportable. Likewise many of my department will not use a multi-dose vial opened by someone else. I suggested that maybe they should, a small number have refused, believing apparently that we have a pyschopath in our department who goes around adulterating other people's vials.

We are also switching to oral medications to spare the IV meds we use. It only took a couple of days to get Pharmacy to supply us with acetaminophen, ibuprofen, dexamethasone and ondansatron which we now give to patients with a sip of water in the holding area. These are supplied in the evil Pyxis machine. Unfortunately they cannot store enough to last all day and the head of Pharmacy was astounded when I told him, we do about 60 cases a day in our OR. I suggested that if there wasn't room in the Pyxis, why didn't he just leave a large bottle of the drugs around in the holding area. I haven't heard back.

Bureaucracy is still slow to respond. I suggested that the oral drugs above might better be given on the ward and suggested a reasonable protocol. I was told firmly that standing orders and protocols must be vetted by a appropriate committees. Not holding my breath on that one.

Shortages are of course going to become more and more frequent. It is much more profitable for a company to make Lipitor than the mostly generic drugs we use. We have already lost Pentothal; I have heard of propofol shortages in Canada. A year ago we were short of ephedrine (also made by Sandoz which may have been a harbinger of things to come). Many people say we should just let the market sort this out (they have after all done such a great job already) and there is very little appetite in our current government to interfere with the natural order of things.