ASSOCIATION NEWS * DU COTE DE L'AMC
Issues handled by CMA Council on Health Care multiplying Anne Gilmore
"The Council on Health Care shall be concerned with the provision of comprehensive health care in the protection and promotion of the health ofthe individual, the family and the community. Within this framework the Council shall concern itself with the role and scope of activities ofphysicians and other providers ofhealth care." -
Section 12.4.1, CMA Bylaws
T n here are two things the CMA's Council on Health Care has never lacked from the moment it was formed in 1979 - agenda items of concern to practising physicians and members willing to develop forwardlooking guidelines and recommendations. Last year was no different. "It was," says current chairman Dr. Guy Hogan, "one of the council's most challenging
yet." Because of its wide-ranging mandate, the council's 1990-91 agenda covers the gamut of health care issues, from radon emissions to the use of drugs in sports, from bicycle helmets to the environmental impact of disposable medical products. As Dr. Normand Da Sylva, whose retirement as director of the CMA's Department of Health
mer, puts it: "The council covers everything about the practice of medicine except education and economics." (Those areas are covered by the CMA's other councils.) "It is extremely valuable because it allows physicians who are in active clinical practice to research, discuss and deliberate on a whole range of issues," says Hogan, an obstetrician at the Grace General Hospital in St. John's, Nfld., and a 4-year council member. The council, an amalgam of the old councils on medical services and community health, comprises 12 members - one from each division - plus a chairman appointed by the CMA Board of Directors. It reports
directly to General Council. Members are appointed for 1-year terms, but often sit for 3 to 4 years. The council meets three times a year and its annual report to General Council includes recommendations about policies it thinks the CMA should endorse. Because the range of topics is broad, some agenda items are assigned to four standing subcommittees that cover emergency medical services, drugs and pharmacotherapy, obstetrical care, and environmental and occupational health. These meet twice a year and their members are appointed by the council. To ensure coordination, each subcommittee is chaired by a council member. The work of the council and subcommittees is coordinated by
The council covers everything about the practice of medicine except education and economics. -Dr. Normand Da Sylva
Services was announced last sumAnne Gilmore is a freelance writer living in Ottawa. CAN MED ASSOC J 1991; 144 (1)
73
ME
the Department of Health Services. For example, when Da Sylva was director he coordinated the work of the council and two subcommittees, a job now being handled by his replacement, Dr. David Walters. The associate director, Dr. Catherine McCourt, coordinates the other two subcommittees, while two health policy researchers and three administrative staff provide background information and secretariat services. The subcommittees are centres of expertise. For example, the Subcommittee on Emergency Medical Services handles both accident and injury prevention issues and the provision of emergency medical care. In 1990 it addressed issues such as airline medical kits, bicycle and boating safety, revision and updating of the Physicians' Guide to Driver Examination, and the emergency medical equipment needed in physicians' offices. McCourt suggested in an interview that the last issue would raise many legal and ethical concerns within the medical community and she was right - the recommendation presented to General Council was debated vigorously during the CMA's August annual meeting. [It carried, but
The council is extremely important because it serves as a vehicle through which organized medicine can express its collective opinion on health care issues. -
74
Dr. Donald Morgan
CAN MED ASSOC J 1991; 144 (1)
required a rare recorded vote Ed.] The Subcommittee on Drugs and Pharmacotherapy studies both the medical and nonmedical use of drugs. In 1990 it looked into the use of drugs by seniors, laboratory standards for drug testing, the use and abuse of drugs in sport, and the advertising of over-the-counter medicines. In recent years, says Da Sylva, it has started looking at larger issues, such as the relationship between the pharmaceutical industry and drug researchers. In 1990 the Subcommittee on Obstetrical Care focused on cesarean section rates in Canada, obstetrical and perinatal manpower, the effects of litigation on the practice of obstetrics, and the role of midwives. Da Sylva suggests the subcommittee will be working to reverse the flow of physicians from obstetrics. "Physicians should not abandon the field," he maintains. "Both patient and physician benefit enormously from physician involvement in this area." The double-barrelled responsibility of the Subcommittee on Occupational and Environmental Health means it handles many issues. In 1990 these included a study of the environmental im-
McCourt: council helps MDs in their
day-to-day practice pact of disposable medical items, the ongoing study of sustainable development, focusing on the impact of pesticides, and the start of a 2-year examination of the practice of occupational health in the
1990s. The Council on Health Care has its own yearly agenda, which includes collaboration with numerous government and nongovernment organizations on issues such as native health, domestic violence and child health. McCourt, for example, represents the CMA on an interdisciplinary project on domestic violence. "The aim is to raise the profile of the issue and to promote better
cooperation among professionals such as physicians, lawyers and teachers," she explains. Many issues arrive directly from CMA members, so as the concerns and problems facing Canadian doctors have changed, so have the issues brought before the council. "It's quite clear that over the 19 years that I've been with the CMA the issues have become both more global and more concerned with the environment," Da Sylva observes. For instance, the council is currently studying medicine's environmental impact. "This is an issue that arose from the floor of General Council last
-1
and reflects the growing societal concern about the effects of disposable products." This change in perspective is clear in the work of the Subcommittee on Occupational and Environmental Health. Dr. Donald Morgan, its chairman, believes that "the interest in the environment has obviously made the work of this subcommittee more important. It's a group whose work has now come of age, and we hope we had some small part to play in that." Morgan points to the role the subcommittee played, along with other groups, in the successful drive to remove lead from gasoline. The subcommittee is looking forward to working with the Canadian Standards Association to develop a code of practice for the management of wastes from health care institutions, and with Environment Canada to develop guidelines for the handling of wastes from physicians' offices. Morgan admits that the subcommittee's agenda is as ambitious as it is long. "There's no question that the number of agenda items is large, and that it is not possible to do an in-depth study of some issues. But, rather than taking a general esoteric approach, we always try to relate a particular issue directly to the health of our patients." This patient-centred focus is apparent in the subcommittee's recent study on the effects of nuclear war. When asked to prepare a paper, it chose to, analyse the issue using a conflict-resolution approach that emphasized the use of peaceful, not military, means. "We tried to relate the threat of a nuclear war directly to the effect it had on our patients, on the children and their parents," says Mor-
year
gan.
The council and its subcommittees demand a lot from members. "We are very fortunate to have such committed and expert members on our subcommittees,"
says Hogan. He points to Dr. THERAPEUTIC INDEX Victor Goldbloom, a former enviINDEX THERAPEUTIQUE ronment minister in Quebec and member of the Subcommittee on Occupational and Environmental Angiotensin converting enzyme inhibitor Health, as an example. "He brings Prinivil 16 A,B,C,D,E,F,G,H, 17, 18, 19 both a political and a medical agent perspective to the subcommittee's Antianginal Transderm-Nitro 6, 85 work," says Hogan. Morgan thinks the council's Anti-inflammatory agent SR 2, 79 work fulfils one of the public's Naprosyn Voltaren SR 84, Outside Back Cover expectations of doctors. "I believe the public expects physicians to Asthma prophylaxis make statements on the issues Becloforte 70, 71, 76 that concern health. To my mind, Bronchodilator the council is extremely important Volmax 10,11, 77 because it serves as a vehicle through which organized medi- Bronchial anti-inflammatory agent cine can express its collective Tilade 56 A,B,C,D opinion on health care issues. Cholesterol-lowering agent This is a pretty important aspect Mevacor 62, 63, 80, 81 Zocor 82, 83, Inside Front Cover of our professional life." McCourt thinks the council Oral contraceptive has another equally important Synphasic 14, 15, 78 role because it "helps physicians cessation aid in their day-to-day practice by Smoking Nicorette 4, 79 providing them with information and by helping them to communicate with and educate their patients." She says revision of the Physicians' Guide to Driver Examination and the council's ongoing safety campaign concerning recreational vehicles are examples of the day-to-day clinical support it provides. CANADA'S INTERNATIONAL IMMUNIZATION PROGRAM Reaching consensus on the mUunizing the world's complex issues discussed and children by 1990evaluated by the council can be Canada is proudly par"The difficult, says Hogan. counticipating in this extraordinary cil reflects the range of opinion undertaking to control the six within the Canadian medical leading communicable childhood community. Sometimes, there are diseases that kill or permanently disable seven million children in diametrically opposed opinions the developing world every year. on certain topics, but nevertheless For more information, contact: the members come up with a posiCanadian Public Health Association tion to which everyone can sub1565 Carling Avenue, Suite 400
A Miradle in the Makfing
scribe. This sometimes takes a lot of soul-searching, but I find that there is always a vision toward the future. That's why the council is so important." In its next issue CMAJ will interview Dr. David Walters, the physician now responsible for coordinating the council's ac-
O[TAWA, Canada K1Z 8Ri Telephone: (613) 725-3769 Telefax: (613) 725-9826 Funded by the Govemment of Canada. Managed
by the Canadian Public Health Association.
Canadim Pbl Heak AS80dadn
Casub
_m#dzakinWr
tivities.CAN MED ASSOC J 1991; 144 (1)
75
Issues handled by CMA Council on Health Care multiplying Anne Gilmore
"The Council on Health Care shall be concerned with the provision of comprehensive health care in the protection and promotion of the health ofthe individual, the family and the community. Within this framework the Council shall concern itself with the role and scope of activities ofphysicians and other providers ofhealth care." -
Section 12.4.1, CMA Bylaws
T n here are two things the CMA's Council on Health Care has never lacked from the moment it was formed in 1979 - agenda items of concern to practising physicians and members willing to develop forwardlooking guidelines and recommendations. Last year was no different. "It was," says current chairman Dr. Guy Hogan, "one of the council's most challenging
yet." Because of its wide-ranging mandate, the council's 1990-91 agenda covers the gamut of health care issues, from radon emissions to the use of drugs in sports, from bicycle helmets to the environmental impact of disposable medical products. As Dr. Normand Da Sylva, whose retirement as director of the CMA's Department of Health
mer, puts it: "The council covers everything about the practice of medicine except education and economics." (Those areas are covered by the CMA's other councils.) "It is extremely valuable because it allows physicians who are in active clinical practice to research, discuss and deliberate on a whole range of issues," says Hogan, an obstetrician at the Grace General Hospital in St. John's, Nfld., and a 4-year council member. The council, an amalgam of the old councils on medical services and community health, comprises 12 members - one from each division - plus a chairman appointed by the CMA Board of Directors. It reports
directly to General Council. Members are appointed for 1-year terms, but often sit for 3 to 4 years. The council meets three times a year and its annual report to General Council includes recommendations about policies it thinks the CMA should endorse. Because the range of topics is broad, some agenda items are assigned to four standing subcommittees that cover emergency medical services, drugs and pharmacotherapy, obstetrical care, and environmental and occupational health. These meet twice a year and their members are appointed by the council. To ensure coordination, each subcommittee is chaired by a council member. The work of the council and subcommittees is coordinated by
The council covers everything about the practice of medicine except education and economics. -Dr. Normand Da Sylva
Services was announced last sumAnne Gilmore is a freelance writer living in Ottawa. CAN MED ASSOC J 1991; 144 (1)
73
ME
the Department of Health Services. For example, when Da Sylva was director he coordinated the work of the council and two subcommittees, a job now being handled by his replacement, Dr. David Walters. The associate director, Dr. Catherine McCourt, coordinates the other two subcommittees, while two health policy researchers and three administrative staff provide background information and secretariat services. The subcommittees are centres of expertise. For example, the Subcommittee on Emergency Medical Services handles both accident and injury prevention issues and the provision of emergency medical care. In 1990 it addressed issues such as airline medical kits, bicycle and boating safety, revision and updating of the Physicians' Guide to Driver Examination, and the emergency medical equipment needed in physicians' offices. McCourt suggested in an interview that the last issue would raise many legal and ethical concerns within the medical community and she was right - the recommendation presented to General Council was debated vigorously during the CMA's August annual meeting. [It carried, but
The council is extremely important because it serves as a vehicle through which organized medicine can express its collective opinion on health care issues. -
74
Dr. Donald Morgan
CAN MED ASSOC J 1991; 144 (1)
required a rare recorded vote Ed.] The Subcommittee on Drugs and Pharmacotherapy studies both the medical and nonmedical use of drugs. In 1990 it looked into the use of drugs by seniors, laboratory standards for drug testing, the use and abuse of drugs in sport, and the advertising of over-the-counter medicines. In recent years, says Da Sylva, it has started looking at larger issues, such as the relationship between the pharmaceutical industry and drug researchers. In 1990 the Subcommittee on Obstetrical Care focused on cesarean section rates in Canada, obstetrical and perinatal manpower, the effects of litigation on the practice of obstetrics, and the role of midwives. Da Sylva suggests the subcommittee will be working to reverse the flow of physicians from obstetrics. "Physicians should not abandon the field," he maintains. "Both patient and physician benefit enormously from physician involvement in this area." The double-barrelled responsibility of the Subcommittee on Occupational and Environmental Health means it handles many issues. In 1990 these included a study of the environmental im-
McCourt: council helps MDs in their
day-to-day practice pact of disposable medical items, the ongoing study of sustainable development, focusing on the impact of pesticides, and the start of a 2-year examination of the practice of occupational health in the
1990s. The Council on Health Care has its own yearly agenda, which includes collaboration with numerous government and nongovernment organizations on issues such as native health, domestic violence and child health. McCourt, for example, represents the CMA on an interdisciplinary project on domestic violence. "The aim is to raise the profile of the issue and to promote better
cooperation among professionals such as physicians, lawyers and teachers," she explains. Many issues arrive directly from CMA members, so as the concerns and problems facing Canadian doctors have changed, so have the issues brought before the council. "It's quite clear that over the 19 years that I've been with the CMA the issues have become both more global and more concerned with the environment," Da Sylva observes. For instance, the council is currently studying medicine's environmental impact. "This is an issue that arose from the floor of General Council last
-1
and reflects the growing societal concern about the effects of disposable products." This change in perspective is clear in the work of the Subcommittee on Occupational and Environmental Health. Dr. Donald Morgan, its chairman, believes that "the interest in the environment has obviously made the work of this subcommittee more important. It's a group whose work has now come of age, and we hope we had some small part to play in that." Morgan points to the role the subcommittee played, along with other groups, in the successful drive to remove lead from gasoline. The subcommittee is looking forward to working with the Canadian Standards Association to develop a code of practice for the management of wastes from health care institutions, and with Environment Canada to develop guidelines for the handling of wastes from physicians' offices. Morgan admits that the subcommittee's agenda is as ambitious as it is long. "There's no question that the number of agenda items is large, and that it is not possible to do an in-depth study of some issues. But, rather than taking a general esoteric approach, we always try to relate a particular issue directly to the health of our patients." This patient-centred focus is apparent in the subcommittee's recent study on the effects of nuclear war. When asked to prepare a paper, it chose to, analyse the issue using a conflict-resolution approach that emphasized the use of peaceful, not military, means. "We tried to relate the threat of a nuclear war directly to the effect it had on our patients, on the children and their parents," says Mor-
year
gan.
The council and its subcommittees demand a lot from members. "We are very fortunate to have such committed and expert members on our subcommittees,"
says Hogan. He points to Dr. THERAPEUTIC INDEX Victor Goldbloom, a former enviINDEX THERAPEUTIQUE ronment minister in Quebec and member of the Subcommittee on Occupational and Environmental Angiotensin converting enzyme inhibitor Health, as an example. "He brings Prinivil 16 A,B,C,D,E,F,G,H, 17, 18, 19 both a political and a medical agent perspective to the subcommittee's Antianginal Transderm-Nitro 6, 85 work," says Hogan. Morgan thinks the council's Anti-inflammatory agent SR 2, 79 work fulfils one of the public's Naprosyn Voltaren SR 84, Outside Back Cover expectations of doctors. "I believe the public expects physicians to Asthma prophylaxis make statements on the issues Becloforte 70, 71, 76 that concern health. To my mind, Bronchodilator the council is extremely important Volmax 10,11, 77 because it serves as a vehicle through which organized medi- Bronchial anti-inflammatory agent cine can express its collective Tilade 56 A,B,C,D opinion on health care issues. Cholesterol-lowering agent This is a pretty important aspect Mevacor 62, 63, 80, 81 Zocor 82, 83, Inside Front Cover of our professional life." McCourt thinks the council Oral contraceptive has another equally important Synphasic 14, 15, 78 role because it "helps physicians cessation aid in their day-to-day practice by Smoking Nicorette 4, 79 providing them with information and by helping them to communicate with and educate their patients." She says revision of the Physicians' Guide to Driver Examination and the council's ongoing safety campaign concerning recreational vehicles are examples of the day-to-day clinical support it provides. CANADA'S INTERNATIONAL IMMUNIZATION PROGRAM Reaching consensus on the mUunizing the world's complex issues discussed and children by 1990evaluated by the council can be Canada is proudly par"The difficult, says Hogan. counticipating in this extraordinary cil reflects the range of opinion undertaking to control the six within the Canadian medical leading communicable childhood community. Sometimes, there are diseases that kill or permanently disable seven million children in diametrically opposed opinions the developing world every year. on certain topics, but nevertheless For more information, contact: the members come up with a posiCanadian Public Health Association tion to which everyone can sub1565 Carling Avenue, Suite 400
A Miradle in the Makfing
scribe. This sometimes takes a lot of soul-searching, but I find that there is always a vision toward the future. That's why the council is so important." In its next issue CMAJ will interview Dr. David Walters, the physician now responsible for coordinating the council's ac-
O[TAWA, Canada K1Z 8Ri Telephone: (613) 725-3769 Telefax: (613) 725-9826 Funded by the Govemment of Canada. Managed
by the Canadian Public Health Association.
Canadim Pbl Heak AS80dadn
Casub
_m#dzakinWr
tivities.CAN MED ASSOC J 1991; 144 (1)
75
