Podcasts about ontario health

Rebecca Shields and her team at CMHA York and South Simcoe have strong throughlines in place for their 2025-2028 Strategic Plan. A key driver of this plan is the update of their mission and values, and their new vision which is all about a cure for mental illness. This disruptive and exciting thought stems from CHMA's belief that true recovery is possible when institutions globally work together towards this goal.   What does this vision mean for their organization? “It means that we begin more and more to look at how do we partner in research, how do we ensure that we're adopting promising, evidence-based best practices, how are we adopting better data analytics and decision making,” explains Rebecca. In this episode of Healthcare Change Makers, Rebecca also shares insight into York Region's first Mental Health Community Care Centre. She speaks passionately about how healthcare organizations can work together to move the needle around mental health and addiction issues, and the importance of equity, diversity, inclusion, accessibility and reconciliation strategies. Quotables: “The field of mental illness because of stigma has been left behind, in research, investment, in care; and so bringing people along is helping them believe and turning that belief into action that things can actually improve.” “Mental illness can be treated, people can recover. And that I think we can all get behind.” “And that collective vision is, what do we need to do to ensure that somebody's first mental health crisis is their last.” “I just want to say a huge gratitude to all of our partners, and Ontario Health and the government, for stepping up and supporting this work. This is about system change, and although we're leading it, everybody is committed to a collective vision and we can't do it without going back and believing in the possible.” “All of us have to lean in right now as we see an erosion of, and people trying to dismantle the respect and identity of each and every person and their own personal identities.” “We know that there's a tie between racism, oppression and mental health. It is a stressor. It is morally disruptive, you know absolutely that kind of ongoing trauma of racism, discrimination and oppression actually impacts somebody's wellbeing.” “I've always thought back about Dr. Ian Dawe who used to say, all of us as healthcare providers, we might be able to treat the symptoms and treat mental illness, but mental health is a home, a job, and a friend.” “The value of each person, and the perspective and what they bring actually will be part of what makes communities resilient and allows for the recovery and support of people for all of us, and our kids, our families and our seniors.” “I feel that governance is incredibly important. Good governance really supports an organization to achieve great things.” “We are trying to solve wicked problems together – and good governance and leadership are part of that.” Mentioned in this Episode: ·       CHMA York and South Simcoe ·       CAMH ·       Dr. Ian Dawe ·       Health Common Solutions Lab (Sinai Health Systems) ·       Human Services Planning Board of York Region ·       IABC Communicator of the Year Award ·       Ontario Health Mental Health and Addictions Centre of Excellence ·       Ontario Health ·       Share Scale Repeat: A Podcast by HIROC ·       Southlake Health Access More Interviews with Healthcare Leaders at HIROC.com/podcast Follow us on LinkedIn and Instagram, and listen on Apple Podcasts, Spotify, or wherever you get your favourite podcasts. Email us at Communications@HIROC.com.

Dr. Ko Un “Clara” Park and Dr. Mylin Torres present the latest evidence-based changes to the SLNB in early-stage breast cancer guideline. They discuss the practice-changing trials that led to the updated recommendations and topics such as when SLNB can be omitted, when ALND is indicated, radiation and systemic treatment decisions after SLNB omission, and the role of SLNB in special circumstances. We discuss the importance of shared decision-making and other ongoing and future de-escalation trials that will expand knowledge in this space. Read the full guideline update, “Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer: ASCO Guideline Update” at www.asco.org/breast-cancer-guidelines. TRANSCRIPT This guideline, clinical tools, and resources are available at http://www.asco.org/breast-cancer-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO-25-00099       Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges and advances in oncology. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Ko Un "Clara" Park from Brigham and Women's Hospital, Dana-Farber Cancer Institute, and Dr. Mylin Torres from Glenn Family Breast Center at Winship Cancer Institute of Emory University, co-chairs on “Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer: ASCO Guideline Update.” Thank you for being here today, Dr. Park and Dr. Torres. Dr. Mylin Torres: Thank you, it's a pleasure to be here. Brittany Harvey: And before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Torres and Dr. Park, who have joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. To start us off, Dr. Torres, what is the scope and purpose of this guideline update on the use of sentinel lymph node biopsy in early-stage breast cancer? Dr. Mylin Torres: The update includes recommendations incorporating findings from trials released since our last published guideline in 2017. It includes data from nine randomized trials comparing sentinel lymph node biopsy alone versus sentinel lymph node biopsy with a completion axillary lymph node dissection. And notably, and probably the primary reason for motivating this update, are two trials comparing sentinel lymph node biopsy with no axillary surgery, all of which were published from 2016 to 2024. We believe these latter two trials are practice changing and are important for our community to know about so that it can be implemented and essentially represent a change in treatment paradigms. Brittany Harvey: It's great to hear about these practice changing trials and how that will impact these recommendation updates. So Dr. Park, I'd like to start by reviewing the key recommendations across all of these six overarching clinical questions that the guideline addressed. So first, are there patients where sentinel lymph node biopsy can be omitted? Dr. Ko Un "Clara" Park: Yes. The key change in the current management of early-stage breast cancer is the inclusion of omission of sentinel lymph node biopsy in patients with small, less than 2 cm breast cancer and a negative finding on preoperative axillary ultrasound. The patients who are eligible for omission of sentinel lymph node biopsy according to the SOUND and INSEMA trial are patients with invasive ductal carcinoma that is size smaller than 2 cm, Nottingham grades 1 and 2, hormone receptor-positive, HER2-negative in patients intending to receive adjuvant endocrine therapy, and no suspicious lymph nodes on axillary ultrasound or if they have only one suspicious lymph node, then the biopsy of that lymph node is benign and concordant according to the axillary ultrasound findings. The patients who are eligible for sentinel lymph node biopsy omission according to the SOUND and INSEMA trials were patients who are undergoing lumpectomy followed by whole breast radiation, especially in patients who are younger than 65 years of age. For patients who are 65 years or older, they also qualify for omission of sentinel lymph node biopsy in addition to consideration for radiation therapy omission according to the PRIME II and CALGB 9343 clinical trials. And so in those patients, a more shared decision-making approach with the radiation oncologist is encouraged. Brittany Harvey: Understood. I appreciate you outlining that criteria for when sentinel lymph node biopsy can be omitted and when shared decision making is appropriate as well. So then, Dr. Torres, in those patients where sentinel lymph node biopsy is omitted, how are radiation and systemic treatment decisions impacted? Dr. Mylin Torres: Thank you for that question. I think there will be a lot of consternation brought up as far as sentinel lymph node biopsy and the value it could provide in terms of knowing whether that lymph node is involved or not. But as stated, sentinel lymph node biopsy actually can be safely omitted in patients with low risk disease and therefore the reason we state this is that in both SOUND and INSEMA trial, 85% of patients who had a preoperative axillary ultrasound that did not show any signs of a suspicious lymph node also had no lymph nodes involved at the time of sentinel node biopsy. So 85% of the time the preoperative ultrasound is correct. So given the number of patients where preoperative ultrasound predicts for no sentinel node involvement, we have stated within the guideline that radiation and systemic treatment decisions should not be altered in the select patients with low risk disease where sentinel lymph node biopsy can be omitted. Those are the patients who are postmenopausal and age 50 or older who have negative findings on preoperative ultrasound with grade 1 or 2 disease, small tumors less than or equal to 2 cm, hormone receptor-positive, HER2-negative breast cancer who undergo breast conserving therapy. Now, it's important to note in both the INSEMA and SOUND trials, the vast majority of patients received whole breast radiation. In fact, within the INSEMA trial, partial breast irradiation was not allowed. The SOUND trial did allow partial breast irradiation, but in that study, 80% of patients still received whole breast treatment. Therefore, the preponderance of data does support whole breast irradiation when you go strictly by the way the SOUND and INSEMA trials were conducted. Notably, however, most of the patients in these studies had node-negative disease and had low risk features to their primary tumors and would have been eligible for partial breast irradiation by the ASTRO Guidelines for partial breast treatment. So, given the fact that 85% of patients will have node-negative disease after a preoperative ultrasound, essentially what we're saying is that partial breast irradiation may be offered in these patients where omission of sentinel node biopsy is felt to be safe, which is in these low risk patients. Additionally, regional nodal irradiation is something that is not indicated in the vast majority of patients where omission of sentinel lymph node biopsy is prescribed and recommended, and that is because very few of these patients will actually end up having pathologic N2 disease, which is four or more positive lymph nodes. If you look at the numbers from both the INSEMA and the SOUND trial, the number of patients with pathologic N2 disease who did have their axilla surgically staged, it was less than 1% in both trials. So, in these patients, regional nodal irradiation, there would be no clear indication for that more aggressive and more extensive radiation treatment. The same principles apply to systemic therapy. As the vast majority of these patients are going to have node-negative disease with a low risk primary tumor, we know that postmenopausal women, even if they're found to have one to three positive lymph nodes, a lot of the systemic cytotoxic chemotherapy decisions are driven by genomic assay score which is taken from the primary tumor. And therefore nodal information in patients who have N1 disease may not be gained in patients where omission of sentinel lymph node biopsy is indicated in these low risk patients. 14% of patients have 1 to 3 positive lymph nodes in the SOUND trial and that number is about 15% in the INSEMA trial. Really only the clinically actionable information to be gained is if a patient has four or more lymph nodes or N2 disease in this low risk patient population. So, essentially when that occurs it's less than 1% of the time in these patients with very favorable primary tumors. And therefore we thought it was acceptable to stand by a recommendation of not altering systemic therapy or radiation recommendations based on omission of sentinel nodes because the likelihood of having four more lymph nodes is so low. Dr. Ko Un "Clara" Park: I think one thing to add is the use of CDK4/6 inhibitors to that and when we look at the NATALEE criteria for ribociclib in particular, where node-negative patients were included, the bulk majority of the patients who were actually represented in the NATALEE study were stage III disease. And for stage I disease to upstage into anatomic stage III, that patient would need to have pathologic N2 disease. And as Dr. Torres stated, the rate of having pathologic N2 disease in both SOUND and INSEMA studies were less than 1%. And therefore it would be highly unlikely that these patients would be eligible just based on tumor size and characteristics for ribociclib. So we think that it is still safe to omit sentinel lymph node biopsy and they would not miss out, if you will, on the opportunity for CDK4/6 inhibitors. Brittany Harvey: Absolutely. I appreciate you describing those recommendations and then also the nuances of the evidence that's underpinning those recommendations, I think that's important for listeners. So Dr. Park, the next clinical question addresses patients with clinically node negative early stage breast cancer who have 1 or 2 sentinel lymph node metastases and who will receive breast conserving surgery with whole breast radiation therapy. For these patients, is axillary lymph node dissection needed? Dr. Ko Un "Clara" Park: No. And this is confirmed based on the ACOSOG Z0011 study that demonstrated in patients with 1 to 3 positive sentinel lymph node biopsy when the study compared completion axillary lymph node dissection to no completion axillary lymph node dissection, there was no difference. And actually, the 10-year overall survival as reported out in 2017 and at a median follow up of 9.3 years, the overall survival again for patients treated with sentinel lymph node biopsy alone versus those who were treated with axillary lymph node dissection was no different. It was 86.3% in sentinel lymph node biopsy versus 83.6% and the p-value was non-inferior at 0.02. And so we believe that it is safe for the select patients who are early stage with 1 to 2 positive lymph nodes on sentinel lymph node biopsy, undergoing whole breast radiation therapy to omit completion of axillary lymph node dissection. Brittany Harvey: Great, I appreciate you detailing what's recommended there as well. So then, to continue our discussion of axillary lymph node dissection, Dr. Torres, for patients with nodal metastases who will undergo mastectomy, is axillary lymph node dissection indicated? Dr. Mylin Torres: It's actually not and this is confirmed by two trials, the AMAROS study as well as the SENOMAC trial. And in both studies, they compared a full lymph node dissection versus sentinel lymph node biopsy alone in patients who are found to have 1 to 2 positive lymph nodes and confirmed that there was no difference in axillary recurrence rates, overall survival or disease-free survival. What was shown is that with more aggressive surgery completion axillary lymph node dissection, there were higher rates of morbidity including lymphedema, shoulder pain and paresthesias and arm numbness, decreased functioning of the arm and so there was only downside to doing a full lymph node dissection. Importantly, in both trials, if a full lymph node dissection was not done in the arm that where sentinel lymph node biopsy was done alone, all patients were prescribed post mastectomy radiation and regional nodal treatment and therefore both studies currently support the use of post mastectomy radiation and regional nodal treatment when a full lymph node dissection is not performed in these patients who are found to have N1 disease after a sentinel node biopsy. Brittany Harvey: Thank you. And then Dr. Park, for patients with early-stage breast cancer who do not have nodal metastases, can completion axillary lymph node dissection be omitted? Dr. Ko Un "Clara" Park: Yes, and this is an unchanged recommendation from the earlier ASCO Guidelines from 2017 as well as the 2021 joint guideline with Ontario Health, wherein patients with clinically node-negative early stage breast cancer, the staging of the axilla can be performed through sentinel lymph nodal biopsy and not completion axillary lymph node dissection. Brittany Harvey: Understood. So then, to wrap us up on the clinical questions here, Dr. Park, what is recommended regarding sentinel lymph node biopsy in special circumstances in populations? Dr. Ko Un "Clara" Park: One key highlight of the special populations is the use of sentinel lymph node biopsy for evaluation of the axilla in clinically node negative multicentric tumors. While there are no randomized clinical trials evaluating specifically the role of sentinel lymph nodal biopsy in multicentric tumors, in the guideline, we highlight this as one of the safe options for staging of the axilla and also for pregnant patients, these special circumstances, it is safe to perform sentinel lymph node biopsy in pregnant patients with the use of technetium - blue dye should be avoided in this population. In particular, I want to highlight where sentinel lymph node biopsy should not be used for staging of the axilla and that is in the population with inflammatory breast cancer. There are currently no studies demonstrating that sentinel lymph node biopsy is oncologically safe or accurate in patients with inflammatory breast cancer. And so, unfortunately, in this population, even after neoadjuvant systemic therapy, if they have a great response, the current guideline recommends mastectomy with axillary lymph node dissection. Brittany Harvey: Absolutely. I appreciate your viewing both where sentinel lymph node can be offered in these special circumstances in populations and where it really should not be used. So then, Dr. Torres, you talked at the beginning about how there's been these new practice changing trials that really impacted these recommendations. So in your view, what is the importance of this guideline update and how does it impact both clinicians and patients? Dr. Mylin Torres: Thank you for that question. This update and these trials that inform the update represent a significant shift in the treatment paradigm and standard of care for breast cancer patients with early-stage breast cancer. When you think about it, it seems almost counterintuitive that physicians and patients would not want to know if a lymph node is involved with cancer or not through sentinel lymph node biopsy procedure. But what these studies show is that preoperative axillary ultrasound, 85% of the time when it's negative, will correctly predict whether a sentinel lymph node is involved with cancer or not and will also be negative. So if you have imaging that's negative, your surgery is likely going to be negative. Some people might ask, what's the harm in doing a sentinel lymph node biopsy? It's important to recognize that upwards of 10% of patients, even after sentinel lymph node biopsy will develop lymphedema, chronic arm pain, shoulder immobility and arm immobility. And these can have a profound impact on quality of life. And if there is not a significant benefit to assessing lymph nodes, particularly in someone who has a preoperative axillary ultrasound that's negative, then why put a patient at risk for these morbidities that can impact them lifelong? Ideally, the adoption of omission of sentinel lymph node biopsy will lead to more multidisciplinary discussion and collaboration in the preoperative setting especially with our diagnostic physicians, radiology to assure that these patients are getting an axillary ultrasound and determine how omission of sentinel lymph node biopsy may impact the downstream treatments after surgery, particularly radiation and systemic therapy decisions, and will be adopted in real world patients, and how clinically we can develop a workflow where together we can make the best decisions for our patients in collaboration with them through shared decision making. Brittany Harvey: Absolutely. It's great to have these evidence-based updates for clinicians and patients to review and refer back to. So then finally, Dr. Park, looking to the future, what are the outstanding questions and ongoing trials regarding sentinel lymph node biopsy in early-stage breast cancer? Dr. Ko Un "Clara" Park: I think to toggle on Dr. Torres's comment about shared decision making, the emphasis on that I think will become even more evident in the future as we incorporate different types of de-escalation clinical studies. In particular, because as you saw in the SOUND and INSEMA studies, when we de-escalate one modality of the multimodality therapy, i.e., surgery, the other modalities such as radiation therapy and systemic therapy were “controlled” where we were not de-escalating multiple different modalities. However, as the audience may be familiar with, there are other types of de-escalation studies in particular radiation therapy, partial breast irradiation or omission of radiation therapy, and in those studies, the surgery is now controlled where oftentimes the patients are undergoing surgical axillary staging. And conversely when we're looking at endocrine therapy versus radiation therapy clinical trials, in those studies also the majority of the patients are undergoing surgical axillary staging. And so now as those studies demonstrate the oncologic safety of omission of a particular therapy, we will be in a position of more balancing of the data of trying to select which patients are the safe patients for omission of certain types of modality, and how do we balance whether it's surgery, radiation therapy, systemic therapy, endocrine therapy. And that's where as Dr. Torres stated, the shared decision making will become critically important. I'm a surgeon and so as a surgeon, I get to see the patients oftentimes first, especially when they have early-stage breast cancer. And so I could I guess be “selfish” and just do whatever I think is correct. But whatever the surgeon does, the decision does have consequences in the downstream decision making. And so the field really needs to, as Dr. Torres stated earlier, rethink the workflow of how early-stage breast cancer patients are brought forth and managed as a multidisciplinary team. I also think in future studies the expansion of the data to larger tumors, T3, in particular,reater than 5 cm and also how do we incorporate omission in that population will become more evident as we learn more about the oncologic safety of omitting sentinel lymph node biopsy. Dr. Mylin Torres: In addition, there are other outstanding ongoing clinical trials that are accruing patients right now. They include the BOOG 2013-08 study, SOAPET, NAUTILUS and the VENUS trials, all looking at patients with clinical T1, T2N0 disease and whether omission of sentinel lymph node biopsy is safe with various endpoints including regional recurrence, invasive disease-free survival and distant disease-free survival. I expect in addition to these studies there will be more studies ongoing even looking at the omission of sentinel lymph node biopsy in the post-neoadjuvant chemotherapy setting. And as our imaging improves in the future, there will be more studies improving other imaging modalities, probably in addition to axillary ultrasound in an attempt to accurately characterize whether lymph nodes within axilla contain cancer or not, and in that context whether omission of sentinel lymph node biopsy even in patients with larger tumors post-neoadjuvant chemotherapy may be done safely and could eventually become another shift in our treatment paradigm. Brittany Harvey: Yes. The shared decision making is key as we think about these updates to improve quality of life and we'll await data from these ongoing trials to inform future updates to this guideline. So I want to thank you both so much for your extensive work to update this guideline and thank you for your time today. Dr. Park and Dr. Torres. Dr. Mylin Torres: Thank you. Dr. Ko Un "Clara" Park: Thank you. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/breast-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

Ontario's government recently announced that Jane Philpott will lead a team with the goal of connecting every person in the province to primary health care within the next five years. With around 2.5 million people currently without a family doctor in Ontario, the task is enormous.  So how did a former Liberal health minister get hired on by a conservative government for such an important job? And how exactly does she plan on doing it? Jane Philpott joins Paul to talk about how the job came about, and her vision for getting it done, which involves rethinking the way we deliver primary care.

In this episode, host Helen Angus, CEO of AMS Healthcare, speaks with Anna Greenberg. Anna is a highly regarded member of Ontario Health's senior leadership team, serving in a number of roles since the organization's beginning. She served as the inaugural Chief of Strategy and Planning and as Chief Regional Officer, Toronto and East, for over two years. Now, as Executive Vice-President and Chief Operating Officer, Anna serves as a strategic partner with the CEO, the Board and senior leadership counterparts, providing additional leadership support to our corporate services. She works closely with senior government officials and health system leaders to continue to shape and drive Ontario Health's vision, mission and values. Anna is also the Executive Lead, Equity, Inclusion, Diversity and Anti-Racism. She has a track record of success, excelling in each role.   Anna led a number of strategic and corporate initiatives and was instrumental in support of Ontario's Health's system response to the COVID 19 pandemic. Her commitment to actively listening, engaging and educating has helped Ontario Health better recognize and address barriers to equity. A former president of Health Quality Ontario, Anna championed improved performance monitoring, public reporting and clinical standards. Prior to that Anna served in policy and strategic roles in the cancer system and at the Ministry of Health. https://amshealthcare.ca/  

The recent revelation by UnitedHealth Group that the ransomware attack on its subsidiary Change Healthcare exposed the sensitive data of more than 100 million customers is once again bringing scrutiny to how companies manage personal information. In this episode of Privacy Files, we talk to seasoned privacy professional, Saima Fancy. Saima is a Senior Privacy Specialist at Ontario Health in Canada. During the interview, she explains how her approach to "privacy by design" involves working at the intersection of engineering, law and policy, and cybersecurity. Saima says that one of the challenges privacy professionals face worldwide is the fact that 80% of the world's data is unstructured. She also discusses what's involved in conducting a privacy impact assessment. To wrap up the episode, Saima weighs in on smart device technology, AI and digital footprints, and even offers some advice for people considering a career as a privacy professional. This conversation provides valuable insight on what it takes on the corporate side to protect customers' personal data. Links Referenced: https://techcrunch.com/2024/10/24/unitedhealth-change-healthcare-hacked-millions-health-records-ransomware/ OUR SPONSORS: Anonyome Labs - Makers of MySudo and Sudo Platform. Take back control of your personal data. www.anonyome.com MySudo - The world's only all-in-one privacy app. Communicate and transact securely and privately. Talk, text, email, browse, shop and pay, all from one app. Stay private. www.mysudo.com MySudo VPN - No personal information required to sign up. You don't even need a username and password. Finally, a VPN that is actually private. https://mysudo.com/mysudo-vpn/ Sudo Platform - The cloud-based platform companies turn to for seamlessly integrating privacy solutions into their software. Easy-to-use SDKs and APIs for building out your own branded customer apps like password managers, virtual cards, private browsing, identity wallets (decentralized identity), and secure, encrypted communications (e.g., encrypted voice, video, email and messaging). www.sudoplatform.com Reclaim - Whether you're just beginning your privacy journey, or have been working at it for some time, Reclaim is the perfect tool for assessing the size of your digital footprint and then taking action to reduce it. It's an also an excellent way to see if your personal information was exposed in a data breach. https://mysudo.com/reclaim/

The show Part 1: The show Part 2: The full interview (Podcast): Your toddler has a fever that does not seem to break. You are a senior who needs a prescription renewal to treat a chronic condition. Your cold is getting worse, not better. For some in Northumberland, it is a call to your physician […] The post Seeking solutions for people without doctors, Ontario Health Team weighs in appeared first on Consider This. Related posts: Walk-in clinic re-opens following year of challenges to serve patients who don't have a doctor Port Hope mayor gives an update as the walk-in clinic is in the final stages, preparing to open in July Proposed walk-in clinic aiming to open in former Toronto Road location in Port Hope Nov. 1

THE MEDICAL RECORD: WHAT COMES AFTER CANCER TREATMENT? Libby Znaimer is joined by Dr. Fahad Razak, a Canada Research Chair in Healthcare Data and Analytics at the University of Toronto and General Internist at Unity Health Toronto, Dr. Alisa Naiman, a family doctor practicing comprehensive primary care in Toronto, and Dr. Keith Stewart, Vice President, Cancer and Director of Princess Margaret Cancer Program at the UHN. Today: a discussion about what comes next for cancer patients who complete treatment, a new guideline in the U.S. pertaining to mammogram results and, closer to home, Ontario Health is changing its guidelines on how iron deficiency is measured. THE PAINFUL REALITY OF ONLINE TRANSACTIONS Libby Znaimer is joined by Carmi Levy, Technology Analyst and Journalist based in London, Ontario. Why is making a transaction online such a hassle whether we purchase tickets for a concert or sports match or purchase something from a retailer? There's always a tedious process to follow including registration and providing personal details and even credit card info. Why are companies doing this, and what can we do as consumers to make the process less of an inconvenience?   REACTION TO THE TRUMP-HARRIS DEBATE Libby Znaimer is now joined by Brad Polumbo, a Conservative commentator and editor-in-chief  & Co-Founder of BASEDPolitics, Dr. Chris Cooper, Political Science Professor at Western Carolina University, and Lee Strickland, Toronto Chair of Democrats Abroad. Americans and the world got to watch the first ever debate between former U.S. President Donald Trump and Vice President Kamala Harris and it ventured into the absurd at times. Our panel of Americans weighs in on what was said and whether VP Harris or former President Trump won the debate.

Why is male allyship so important especially for female leaders? Join us as we speak with Dr. Anju Virmani who spent many years as Director of Engineering and is passionate about her role as a director for many boards which include Payments Canada, Ontario Power Generation and Ontario Health. She migrated to Canada at the young age of 20 and sadly her education was not recognized. But she knew she had to find a way to build a life and sustain herself in her new country and even after a lot of discouragement, she decided to switch from child education to computer programming, eventually leading her into engineering where her focus was about solving for complexities.  During our conversation, Dr. Virmani shared with us the opportunities and challenges faced when working in male-dominated sectors, and how she is making a difference for both men and women as they navigate the differences in how we lead. She also speaks about the work she has done to encourage and support students (especially women) in those final years of school by helping with scholarships and mentorship. Her influence spreads wide and far with those she leads and is a role model for. The power distribution belongs to men – so how do we get better at empowering more women? And how do you ignore the male influence? This becomes critical to change the narrative. Understanding the role male allies play and how both men and women leaders have a responsibility and power to make this change. She shared a great story when she was invited to join a celebration for Diwali and out of 40 participants, she was the only female in the room. The men were congratulatory and communicative, and yes there were no other women in the room. She was comfortable highlighting this and encouraging everyone to change that in the future. She also talks about the importance of ensuring our boys are raised with equality in mind. We can't make changes unless we are all working toward building a pipeline for a more equitable future. Another wonderful example she shares is when a male ally invited her to a round table discussion with Prime Minister Stephen Harper…to learn what happened and her first experience being on a board, have a listen.Are you ready to better understand how you show up as a leader? Visit www.wilempowered.com and take our free leadership quiz.  Enjoyed this episode of #WILTalk, please leave us a review and share with your friends and other women looking to have an impact. #maleallies #womenonboards #changemakers #womenintech #mentorship #sponsorship #wilempowered 

Greg spoke with Dr. Sohail Gandhi, family physician, Former President of the Ontario Medical Association about no 'diminished supply' of doctors concern in Ontario: Health ministry. Learn more about your ad choices. Visit megaphone.fm/adchoices

Greg spoke with Dr. Sohail Gandhi, family physician, Former President of the Ontario Medical Association about no 'diminished supply' of doctors concern in Ontario: Health ministry. Learn more about your ad choices. Visit megaphone.fm/adchoices

Melissa Chadwick, Lead for Palliative Care Implementation at Ontario Health, joins us to explore the evolving landscape of palliative care within our healthcare system. She challenges stigmas surrounding end-of-life care and provides a deeper understanding of comfort and support for patients, their families, and loved ones. ---The Cancer Assist Podcast and its content represent the opinions of Dr. Bill Evans and the guests of the podcast. Any views and opinions expressed by Dr. Bill Evans and guests are their own and do not represent those of their places of work. The content of The Cancer Assist Podcast is provided for informational, educational and entertainment purposes only and is not intended as professional medical, legal or any other advice or as a substitute or replacement for any such advice. The Cancer Assistance Program, Dr. Bill Evans and guests make no representations or warranties with respect to the accuracy or validity of any information or content offered or provided by The Cancer Assist Podcast. For any medical needs or concerns, please consult a qualified medical professional. No part of The Cancer Assist Podcast or its content is intended to establish a doctor-patient or any other professional relationship. This podcast is owned and produced by the Cancer Assistance Program.

In this episode, Ayesha spoke with Margaret Froh, President of the Métis Nation of Ontario (MNO). Margaret is also a lawyer by training.  The Métis are a distinct Indigenous people recognized in s.35 of Canada's Constitution. Métis communities have their own shared customs, traditions and collective identities that are rooted in kinship, their special aboriginal relationship to the land and a distinctive Indigenous culture and way of life that persists to the present day.  Cancer is a significant concern among Métis people in Ontario and across the Métis Nation Homeland, including women, as they experience higher cancer rates and lower cancer screening uptake than the non-Indigenous population.  Cancer Prevention Action Week, which took place during the third week of February, focuses on supporting and empowering people to make changes to their lifestyle and promoting routine cancer screening to reduce the risk of preventable cancers.  To help uncover and address cancer disparities among the Métis, Margaret has helped lead Métis-specific health research in collaboration with organizations like Ontario Health (formerly Cancer Care Ontario) and the Sunnybrook Research Institute.  Margaret is also a recent breast cancer survivor and by sharing her personal cancer story, is helping raise awareness about the importance of routine cancer screening among the Métis.  Tune into the episode to learn about the disproportionate impact of cancer on Métis communities and how Margaret's leadership at the MNO is helping to drive changes to help improve cancer screening rates and better health outcomes.  For more life science and medical device content, visit the Xtalks Vitals homepage. https://xtalks.com/vitals/  Follow Us on Social MediaTwitter: https://twitter.com/Xtalks Instagram: https://www.instagram.com/xtalks/ Facebook: https://www.facebook.com/Xtalks.Webinars/ LinkedIn: https://www.linkedin.com/company/xtalks-webconferences YouTube: https://www.youtube.com/c/XtalksWebinars/featured

Dr. Jyoti Patel and Dr. Natasha Leighl discuss the latest full update to the stage IV NSCLC without driver alterations living guideline. This guideline addresses first-, second-, and subsequent-line therapy for patients according to their histology (squamous cell and nonsquamous cell carcinomas) and PD-L1 expression. They discuss the streamlined recommendations, incorporation of recent evidence, and the highlights for implementation of these recommendations in the treatment of advanced non-small lung cancer. Dr. Patel and Dr. Leighl also point out ongoing trials that will inform this continuously updated guideline as we look ahead.  Read the full update, “Therapy for Stage IV Non-Small-Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline, Version 2023.3” at www.asco.org/living-guidelines. TRANSCRIPT This guideline, clinical tools, and resources are available at http://www.asco.org/living-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO.23.02746.    Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts  delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all of our shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and today I'm interviewing Dr. Jyoti Patel and Dr. Natasha Leighl, co-chairs on “Therapy for Stage IV Non-Small-Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline, Version 2023.3.” Thank you for being here, Dr. Patel and Dr. Leighl. Before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Patel and Dr. Leighl, who have joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes.  So, to start us off on the content of this episode, Dr. Patel, this living clinical practice guideline for systemic therapy for patients with stage IV non-small cell lung cancer without driver alterations is being updated on a regular basis. Could you provide some background information on the process for these living guidelines? Dr. Jyoti Patel: The ASCO Living Guideline offers continually updated recommendations based on review of systemic randomized controlled trials. We bring a panel of experts together that includes representatives from Ontario Health as well as ASCO patient representatives. We review phase III studies and other published studies between the times from July 2022 and October 2023 for this most updated guideline. We think about the size of the populations that are being tested, what kind of interventions we have, the outcomes. We certainly look at PFS, as well as OS, but also toxicity, and overall response rates. We prioritize randomized trials and really look for studies that have large sample sizes. We exclude studies that were only meeting abstracts and really look at those that are published in peer-reviewed journals.  When we weigh the evidence, we really think about a number of factors. So what is the strength of the evidence, what's the sample size, and how we can make recommendations for our patients based on the totality of the data. Certainly, because this is such a rapidly evolving field, one of the things we are looking at is how to update in real-time these guidelines. So for this coming year, for example, these guidelines are published and we look forward to quarterly updates and, again, incorporate the latest evidence. Brittany Harvey: Great. Thank you for that explanation on the background and how these living guidelines are developed.  So, Dr. Leighl, could you describe what the key changes are from the expert panel? Dr. Natasha Leighl: So what we try to do in the guidelines for this latest publication, was really try and streamline the way we set up a format to make it much easier for people to use. In terms of new recommendations, we made sure to include more recent studies of additional PD-1 or PD-L1 inhibitors, for example, cemiplimab in combination with chemotherapy, or the combination of durvalumab and tremelimumab with chemotherapy, both of these in unselected patients, so with any PD-L1 expression, of course, this continues with pembrolizumab with or without chemotherapy, atezolizumab with chemotherapy combinations, and, of course,  nivolumab and ipilimumab with and without chemotherapy. And so it really is just an update on all of the potential options. In the discussion, we've really tried to go through some of the nuances in the trials just to help when you're discussing with patients or discussing with your oncologists, how to figure out which of these is best for you. Brittany Harvey: Excellent. It's helpful to have all of the recommendations listed out together so that clinicians and patients know all of the available options available to them.  So then, Dr. Patel, what should clinicians know as they implement these changes into their clinical practice? Dr. Jyoti Patel: I think it's important to stress that our decision-making in the treatment of advanced non-small cell lung cancer is really reliant on adequate biomarker testing. And so the way we approach this is our assumption that all appropriate patients undergo molecular testing and have PD-L1 testing to help us get the best therapies. And the other assumption is that patients and physicians are engaging in a dialogue to better assess patient preferences to have a better understanding of performance status, for example, as we think about allocating therapy. One thing that we've been able to do is to take the evidence and break it up by histology as well as PD-L1 expression for patients who don't have driver alterations. Based upon that, think about the toxicity data with, for example, dual immunotherapy versus chemo-immunotherapy for subsets of patients, and so hopefully get some guidance to clinicians as they are going through this process. The other part of the guideline was to, once again, look at second-line and subsequent therapies. So, again, for patients who get immunotherapy alone, the recommendation is that patients get a carboplatin-based doublet in the second-line setting. We still do not know if patients should get immunotherapy after that initial exposure, that is the subject of ongoing randomized studies. We also have stronger evidence than ever that docetaxel is an appropriate second-line agent, but there are other options there, so docetaxel and ramucirumab, as well as other single-agent chemotherapies. Brittany Harvey: Understood. Those are key points for informed and shared decision-making and are helpful for clinicians to know.  So then, Dr. Leighl, in your view, how will these guideline recommendations impact patients with non-small cell lung cancer without driver alterations? Dr. Natasha Leighl: Thanks. So, we're really hoping that with all of the focus in the first-line setting, that more patients will receive immunotherapy with or without chemotherapy in the first-line setting to really bring it forward and really make sure that patients can start benefiting as soon as possible. As Dr. Patel said, one of the challenges, of course, is to understand who might benefit most with a chemotherapy-free approach and have treatments in sequence versus who really needs everything together. And so, we've really tried in the discussion to try and help with that discussion both from a provider and patient perspective. So, we want more people to get immunotherapy to help improve their outcomes and also to potentially get it earlier. I think the other thing, and Dr. Patel has brought this up, but when we looked at what happens after first-line therapy, we really have very limited recommendations. And so it's our real hope that this will spur the community on to do even more studies to help us figure out what's next and how do we really improve outcomes for our patients after all of these great first-line options have stopped working. Brittany Harvey: Absolutely. I appreciate you touching on those key points for improved outcomes for patients with non-small cell lung cancer.   Finally, Dr. Patel, you have mentioned some ongoing randomized clinical trials and so has Dr. Leighl. So, what are the ongoing developments that the living guideline expert panel is monitoring for future updates? Dr. Jyoti Patel: We will continue to update guidelines based on available literature, but certainly, there are a number of trials that we should be reading out in the next year or so, looking at combinations of immunotherapy in the second-line setting. Certainly comparing novel agents to docetaxel in the second-line settings, and things like antibody-drug conjugates. So certaintly that's evidence that we hope to incorporate this evidence within the guideline with the idea that  we can really help clinicians and patients recognize or at least identify the best options for treatment for them.  Brittany Harvey: Definitely. Well, we'll look forward to the expert panel's review and interpretation of this evidence as those trials read out. And appreciate all of your work on this guideline update and we'll hear more as these guidelines are continuously updated. Thank you so much for your time today, Dr. Patel and Dr. Leighl.  Dr. Jyoti Patel: Thank you. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to asco.org/living-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experiences, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    

In this episode, host Helen Angus, CEO of AMS Healthcare, speaks with Adil Khalfan.  Adil Khalfan is President and CEO of Kensington Health, a not-for-profit health service organization located in Toronto, Ontario. Adil has a vast background in nursing, public health, international development, and health system strategy in Canada and internationally. His career has crossed many sectors with diverse populations, including community care, public health, acute care, home care, regional care, and specialty health. He has worked extensively in Ontario and the Middle East, and understands the relationship between accountability and strategy, planning, quality, performance measurement, best-practice implementation and change management.  Adil was the founding CEO of Royale Home Health (of Royale Hayat Hospital in Kuwait). Before that, he served as Middle East Executive Regional Director and Operational Lead for University Health Network (UHN) where he led an international cancer centre transformation in the region.  He is a Registered Nurse and holds a BSc Nursing from the University of Western Ontario and a Master of Health Administration from the University of Ottawa. Prior to joining Kensington Health, Adil served as Ontario Health's Senior Vice President, Health System Performance and Support, where his position has required him to oversee Ontario Health's work to advance provincial strategies, funding, accountability agreements, standards and initiatives through information, evidence, and other supports to assess, inform and improve overall health system performance and effectiveness. www.kensingtonhealth.org www.amshealthcare.ca https://linktr.ee/AMSHealthCare

In this episode a stellar panel of privacy engineering experts delve into the evolving world of privacy engineering. Saima Fancy, Senior Privacy Specialist for Ontario Health, Jay Averitt, Privacy Product Manager and Engineer at Microsoft, and Mira Olson, Privacy Architect at Doordash, bring diverse perspectives from their extensive experience in the field. They kick off the discussion with personal introductions, shedding light on their roles and contributions to privacy engineering. Jay helps tackle the fundamental question, "What is a privacy engineer?" sparking a thoughtful debate. Mira builds on this by reflecting on the evolution of the role and emerging trends in privacy engineering. Saima assesses the current maturity of the profession, highlighting areas of progress and those needing improvement. The panel discusses the challenges and opportunities facing privacy engineers, with each guest offering insights from their unique vantage points. They explore the core responsibilities and misconceptions about the role, the need for specialized skills and certifications, and the importance of interdisciplinary collaboration. Ethical considerations and the balance between user privacy and technological innovation are also dissected. The discussion dives into the growing privacy concerns surrounding AI and whether we need specialized regulations. Finally, the panel looks towards the future of privacy engineering over the next decade and what they'd change and impact they'd like to see.

Meet our guestsDon Wood was a caregiver for his late wife Sherry who battled Stage 4 metastatic colon cancer for 3 years. He also lost his only brother Ken to leukemia as a young adult. Don focuses his time now when not golfing or skiing working and volunteering his time primarily in cancer research for several provincial and national health care organizations including the Canadian Cancer Society. He recently co-authored “Co-Creation of a patient engagement strategy in cancer research funding” with the Canadian Cancer Society.Judit Takacs (she/her) is the senior manager for partnerships and engagement in research at the Canadian Cancer Society. She was the staff lead in co-creating the patient engagement in research strategy and works to diversify voices in research and research funding. She holds a PhD from the University of British Columbia and a coffee from the local coffee shop – though the latter is not yet a formal degree.Dr. Michael S. Taccone is the proud Founder and CEO of Childhood Cancer Survivor Canada, Canada's first survivor-led organization which aims to unify and empower the growing childhood cancer survivor community through awareness, education, access to care and peer-support. By training, Michael is a senior resident of neurological surgery at the University of Ottawa and completed his PhD in the Surgeon-Scientist Training Program at the University of Toronto. Himself a survivor of childhood cancer, Michael merges his experiences as a patient advocate, cancer researcher and junior physician to influence policy, research and practice for children and young people living with and beyond cancer in Canada. As a patient partner and co-investigator, Michael contributes to several CIHR-funded AYA and childhood cancer national research programs, is an acting co-chair of the Integrated AfterCare Advisory Council with the Pediatric Oncology Group of Ontario, and informs strategic development and capacity building for patient-engagement initiatives at Sick Kids Hospital, the Canadian Cancer Society and Ontario Health.Suzanne Bays has been the caregiver for her father and husband, both of whom died from metastatic colon cancer. She spent 2019 as a Fellow at Harvard's Advanced Leadership Initiative, where her Capstone Project focused on improving the lives of those with Advanced Cancer. She continues this work with the Canadian Cancer Society as a Patient Advocate, helping create action-oriented strategies to impact the lives of those touched by cancer. She is a co-author of the articles “Co-Creation of a Patient Engagement Strategy in Cancer Research Funding” as well as “Supporting People and their Caregivers Living with Advanced Cancer: From Individual Experience to a National Interdisciplinary Program”. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit asperusual.substack.com

Saima Fancy used to prepare medical illustrations, Now she considers privacy implications. In school, Saima studied applied science, Learn how she combines engineering with privacy compliance.

THE ZOOMER SQUAD: CARP'S REACTION TO A NEW U.S. DRUG POLICY Libby Znaimer is joined by Bill VanGorder, Chief Operating Officer and Chief Policy Officer of CARP, Anthony Quinn, Chief Community Officer of CARP and Peter Muggeridge, Senior Editor of Zoomer Magazine. It's Monday time for our Zoomer Squad and there's  a very worrisome development South of the border: Florida has passed a law allowing the importation of drugs from Canada. The Floridians are thrilled. They say this can save the $150 million a year but what about us? We are already plagued with serious drug shortages. Remember when busloads of Americans drove to a border pharmacy to buy insulin? And what about Americans buying Ozempic here at a third of the US price and exacerbating the shortage? What if anything can be done? JUSTIN BATES OF THE OPA REACTS TO FLORIDA IMPORTING DRUGS FROM CANADA Libby Znaimer is joined by Justin Bates, CEO of the Ontario Pharmacists Association. What are the rules around those possible sales to the US?  Can the wholesalers just sell to whomever they like? Can the government stop them? And these medications are not made here - they are produced by big multinationals. So how does that work? HOW MANY SURGERIES IN ONTARIO FOR AGGRESSIVE CANCERS ARE DONE WITHIN RECOMMENDED TIME FRAME? Libby Znaimer is joined by Dr. Aaron Schimmer, the Director of Research at the Princess Margaret Cancer Centre as well as a staff physician and a senior scientist. Some very disturbing statistics from Ontario Health's annual report: Just over half of cancer surgeries - including those for some of the most aggressive cancers - were completed within the mandated wait time. This is actually a bit of an improvement over the previous year, when the pandemic was more of a factor but it is still not good enough.

It's time for our annual fireside chat with a prominent member of the Guelph community, and since we're run the gamut of local political leaders over the last few years, we turn to the new head of the hospital. It's a massive challenge, but in keeping with the spirit of the season, and the need to help people who can't help themselves, we're going spend Christmas week with the president and CEO of Guelph General Hospital, Mark Walton. Walton hasn't been the head of the Guelph General Hospital for even a year yet, but he had to hit the ground running. He's already appeared at city council twice, once to talk about offload delays at the hospital, and the other to talk about how homelessness and poverty create more work for hospitals as lagging indicators. And then there's the ongoing demand for a new hospital facility, which is complicated, but it's another one of those things that's on Walton's very busy desk. But let's back up for a minute, who is Mark Walton? Before coming to Guelph earlier this year, he served as the Senior Vice-President, COVID-19 Pandemic Response as well as the Regional Lead and CEO of Local Health Integration Networks in the region with Ontario Health. We always associate hospitals with people with stethoscopes, but there are a lot of people with all kinds of experiences and expertise who make hospitals work, and this Christmas, we're going to talk to one of them. So on this holiday edition of the podcast, we sit and chat with Walton about his background, and what brought him to Guelph. We will also talk about where pandemic planning fell short, and the paradox of running a hospital in that you have to make an attractive place that no one wants to visit. He will also talk about the hospital's role in fighting poverty, how fighting the affordability crisis is changing his job, and what the future of Guelph General, and a future Guelph hospital, both look like. So let's spend some quality Christmas time with the head of the hospital on this week's Guelph Politicast! To learn more about Guelph General Hospital, you can go to their website, and you can learn more about fundraising to support the hospital at the website for the Foundation of the Guelph General Hospital. While you're there, you can buy tickets for Black Tie Bingo or take part in some holiday giving. And speaking of which, Merry Christmas to all you listeners. Thanks for tuning in all year and stay tuned as we keep cranking out new episodes over the holidays and on into 2024. The host for the Guelph Politicast is Podbean. Find more episodes of the Politicast here, or download them on your favourite podcast app at Apple, Google, TuneIn and Spotify. Also, when you subscribe to the Guelph Politicast channel and you will also get an episode of Open Sources Guelph every Monday, and an episode of End Credits every Friday.

40% of a clinicians time is currently spent on administrative tasks within Ontario Health. Buy axing the fax though there is a huge opportunity to reduce administrative burden - specially in relation to paperbased workflows - freeing up clinicians to focus on delivering care. Colleen McDuffe shares how the Patients Before Paperwork system is reinvigorating patient-clinician relationships and changing how providers communicate across the health ecosystem.     Colleen McDuffe, VP Customer Experience and Business Integration, Ontario Health   For more great insights head to www.PublicSectorNetwork.co

Ontario Health's Mental Health and Addictions Centre of Excellence is looking to create a more integrated, higher quality, and more accessible mental health and addictions system in Ontario. To that end, they have recruited five Provincial Clinical Leads to champion different areas of focus. Two of those Clinical Leads, Dr. Caitlin Davey and Dr. Randi McCabe join Mind Full to talk about this program and how to improve provincial delivery of mental health supports. Roadmap to wellness: a plan to build Ontario's mental health and addictions system https://www.ontario.ca/page/roadmap-wellness-plan-build-ontarios-mental-health-and-addictions-system Mental Health and Addictions Centre of Excellence https://www.ontariohealth.ca/about-us/our-programs/clinical-quality-programs/mental-health-addictions New Centre of Excellence roles to target key clinical areas in mental health and addictions https://www.ontariohealth.ca/about-us/news/news-release/new-centre-excellence-roles-target-key-clinical-areas-mental-health-and Depression and Anxiety-Related Concerns – Ontario Structured Psychotherapy Program https://www.ontariohealth.ca/getting-health-care/mental-health-addictions/depression-anxiety-ontario-structured-psychotherapy Mental Health Services ~ Mamaway Wiidokdaadwin https://mamaway.ca/mental-health-services/ DART: Diagnostic Assessment Research Tool - PsycNET https://psycnet.apa.org/doiLanding?doi=10.1037%2Ft81500-000 Anxiety | Department of Psychiatry & Behavioural Neurosciences https://healthsci.mcmaster.ca/psychiatry/about-us/divisions/anxiety

It can be pulmonary. It can be neurological. It can set off autoimmune issues. Long Covid can be many things. Should we no longer see it as a single issue? Is this catch-all term now an obstacle to research and finding effective treatments? Is trying to research and treat long covid like trying to research cancer, than than the individual types? The Agenda examines the mystery of long covid and how to help those struggling with lingering symptoms.See omnystudio.com/listener for privacy information.

Mario Hyland, Senior Vice President and Founder of AEGIS, has more than 30 years supporting Information Technology having a variety of roles and responsibilities. Mr. Hyland initially served the Pharmaceutical Industry in the capacity of Product Developer/Manager for a Call Reporting system with more than 120 Pharma companies across Canada and the U.S. Mr. Hyland was instrumental in coordinating and forming a Pharmaceutical (Walsh Marketing) industry collaboration and steering committee. Mr. Hyland served as a member of the Litton Systems Guidance Division, where he participated in Testing that served to address numerous Engineering Change Orders (ECO) associated with the performance and accuracy of the U.S. Cruise Missile System in U.S. Department of Defense (DoD) program. Mr. Hyland has taken this experience of driving better testing practices to a number of industry engagements with AEGIS. Mr. Hyland's duties have included a broad range of Executive Leadership, Board and Advisory services, and Global Operations, including financial, budgeting, and marketing duties. Mr. Hyland has been a board member of industry organizations such as Application Service Providers (ASP) Executive Consortium, the HL7 ARB, and various HIMSS Chapters. Mr. Hyland's focus on testing was spawned by a desire to ensure "PRODUCTION" systems have the highest data quality as possible. By leveraging this Test-First approach, Mr. Hyland has seen AEGIS engage with MCI/WorldCom (FTS2001 - 65,000 concurrent users), US Army AKO (Army Knowledge Online - 2M concurrent users), and the Department of Veterans Affairs (VA) My HealtheVet program. Mr. Hyland's introduction to Health IT standards first began with the VA, and HL7 V2 (MLLP) with VistA. With Dr. Kolodner's (formerly VA Executive Director My HealtheVet) appointment to the Office of the National Coordinator for Health Information Technology (ONC), Mr. Hyland and AEGIS were engaged to support several IHE Profiles, and the NHIN (predecessor to eHEX) National Exchange. While working with the VA, DoD, ONC and other federal partners in support of VLER, Mr. Hyland advanced the concept of Standards based development to align with cloud testing services with the Developers Integration Lab (DIL). Through the DIL, more than 500 Organizations including vendors, implementers, and exchange participants were able to self-service and test conformance 24x7x365 to ensure continuous interoperability. Mr. Hyland led AEGIS efforts on the DIL and leveraged that program level experience to advance the Touchstone project, a cloud platform designed to support FHIR implementations around the globe. Touchstone is a Test-Driven-Development (TDD) environment which engages the community from the early stages of standards development, through early-adopters, and wide-industry adoption. Touchstone currently supports programs like Da Vinci, CARiN Alliance CARiN BB, Ontario Health, Nictiz, and Medcom (to name a few). Mr. Hyland was recently recognized as a Federal Health IT Top 100 Executive for 2022, an award issued in collaboration with HHS, the Department of Defense and the Department of Veterans Affairs. Mr. Hyland continues to speak about the benefits of standards based approaches to Interoperability, including leveraging HL7 Standards such as FHIR and numerous Implementation Guides (IG's). Mr. Hyland's desire to support the HL7 FHIR FAST Accelerators in the role of Steering Committee member will be to leverage his experience with the NHIN and other national exchange and information sharing networks to ensure FHIR continues to offer the community a reliable and robust "Continuously Interoperable" platform “At-Scale” for better Patient Care Coordination by accelerating adoption, reducing burden for implementers, and ensuring the highest level of standards compliance across the Integrated Ecosystem.

The president of the Legion in Chatham has mixed emotions leading up to Remembrance Day this year, a boil water advisory is still in effect for customers in the Wallaceburg area but schools are open again, and a leaked report from Ontario Health confirms what many who have had to go to the hospital are saying.

Colorectal cancer is the fourth most common cancer in Canada, but if caught early, many people have a good chance of surviving. But screening for it is key. Dr. Jill Tinmouth, lead scientist at the colorectal cancer screening program at Ontario Health and gastroenterologist at Sunnybrook Health Sciences Centre, speaks with guest host Dr. Peter Lin about colorectal cancer screening.

A leaked document from Ontario Health shows how serious the emergency room crisis is. The Canadian Association of Emergency Physicians president will be here to discuss why we are seeing record wait times and what can be done about it. Why did Peterborough's mayor declare a homeless emergency ? What does that mean to the worsening crisis and how the city responds to it? We spoke with Peterborough's Mayor Diane Therrien.

Libby Znaimer is joined by Karen Stintz, CEO of Variety Village, Lauren O'Neil, Senior News Editor of BlogTO and Councillor Joe Mihevc of Spadina Fort-York. Today: one of the central themes we are focused on is the reality that basic city services are not functioning properly (or at all). We're heading into the winter season soon and we're hearing stories about wards where it took months for some neighbourhood streets to get plowed, we've got overflowing litter bins, and it's not hard to look elsewhere where things are just not getting done. Also, this Thursday, CARP is hosting one of only two Toronto Mayoral debates at the Zoomer Hall which will also be broadcasted live on Fight Back at noon. We ask each of our panelists what they think the top question should be for the candidates. ---- ONTARIO HEALTH REPORT: THE CRISIS IN ONTARIO HOSPITAL ERs Libby Znaimer is joined by Dr. Stephen Flindall, an emergency doctor in the GTA. A new report by Ontario Health reveals the severity of the crisis in ERs at hospitals. For example, the report found that hospital stays in emergency departments increased by 15.8 per cent in August compared to the year before Our guest reacts to the latest. ---- TECH COMPANIES MADE THEIR OWN ARRIVECAN APP PROVING THAT OTTAWA SPENT WAY TOO MUCH MONEY ON THE ORIGINAL Libby Znaimer is now joined by Sheetal Jaitly, Founder and CEO of TribalScale. TribalScale is one of two tech companies that produced their own version of Ottawa's ArriveCAN over the Thanksgiving weekend and it proved that the federal government did not have to spend a whopping $54 million on the mobile app. Sheetal explains. Listen live, weekdays from noon to 1, on Zoomer Radio!

Author Sandie Lynn Fletcher shares her experiences writing her memoir "Feelings from Within Me" about her escape from living on the streets in Toronto..Ward 9 City Councillor candidate Shaker Jamal wants bus only lanes to fix Toronto's transit woes..Ontario's Minister of Health Sylvia Jones announced a $400 per day fee for seniors in acute care beds, we get your response.

Canadian Medical Association President Katharine Smart on the current crisis in Canada's health care system. Plus, the Washington Post's Aaron Blake and Semafor's Kadia Goba preview the Jan. 6 committee prime-time hearing. And the Power Panel on a third official Conservative Party leadership debate that Pierre Poilievre says he won't attend.

An interview with Dr. Ishmael Jaiyesimi from Beaumont Health Royal Oak and Oakland University William Beaumont School of Medicine in Royal Oak, MI, and Dr. Andrew Robinson from Kingston General Hospital, Queen's University in Ontario, Canada, authors on "Therapy for Stage IV Non-Small Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline." Dr. Jaiyesimi and Dr. Robinson review the latest recommendation updates for first-, second-, and third-line therapy in patients with stage IV NSCLC without driver alterations. Read the full guideline at www.asco.org/thoracic-cancer-guidelines.   TRANSCRIPT Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast series, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows including this one at asco.org/podcasts.  My name is Brittany Harvey, and today I'm interviewing Dr. Ishmael Jaiyesimi from Beaumont Health Royal Oak and Oakland University William Beaumont School of Medicine in Royal Oak, Michigan, and Dr. Andrew Robinson from Kingston General Hospital, Queen's University in Ontario, Canada, authors on 'Therapy for Stage IV Non-Small Cell Lung Cancer Without Driver Alterations: ASCO Guideline Update'. Thank you for being here, Dr. Jaiyesimi and Dr. Robinson.  Dr. Ishmael Jaiyesimi: Thank you for inviting me.  Brittany Harvey: First, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline.  The full conflict of interest information for this guideline panel is available online with the publication of the guideline in the Journal of Clinical Oncology.  Dr. Jaiyesimi, do you have any relevant disclosures that are directly related to this guideline topic?  Dr. Ishmael Jaiyesimi: I do not have any financial disclosures. Thank you.  Brittany Harvey: Thank you. And Dr. Robinson, do you have any relevant disclosures that are directly related to this guideline topic?  Dr: Andrew Robinson: Yes, I do. I have had funding of less than $5,000 from BMS, Merck, and AstraZeneca in the past two years.  Brittany Harvey: Okay. Thank you for those disclosures. So, then let's talk about the content of this guideline update. So, Dr. Jaiyesimi, what prompted this guideline update, and what is the scope of the update?  Dr. Ishmael Jaiyesimi: The purpose of this guideline update is to update the ASCO and Ontario Health guidelines on the systemic treatment of patients with non-driver alteration stage IV non-small cell lung cancer last published in January of 2020.  The update is the result of potentially practice-changing evidence published since the last update. ASCO published the last full clinical practice guideline updates on systemic therapy for patients with stage IV non-small cell lung cancer that included those whose cancer did not have driver alterations in January of 2020.  The scope of evidence for the update guideline is made of ongoing or completed randomized controlled trials for non-driver alterations from 2018 to 2021. These updated algorithms provide recommendations from the ASCO expert panel and emphasized rapid changes in the management of patients with advanced non-small cell lung cancer and the importance of clinical research.  Brittany Harvey: Thank you for that overview, Dr. Jaiyesimi. So, then talking about those changes you just mentioned, I'd like to review the new or changed recommendations for this guideline. So, let's start with for patients with stage IV non-small cell lung cancer without driver alterations, and with high PD-L1 expression and non-squamous cell carcinoma, what are the updated recommendations for first-line therapy?  Dr. Ishmael Jaiyesimi: In addition to 2020 options for patients with high PD-L1, 50% or more expression, non-squamous cell carcinoma, and performance status of zero to one, and absence of targetable oncogenic driver alterations, clinicians may offer a single agent atezolizumab alone, or single agent cemiplimab alone, or a combination of nivolumab and ipilimumab without chemotherapy, or a combination of nivolumab and ipilimumab with two cycles of platinum-based chemotherapy. The number of acceptable options has increased. And each of the recommendations carries a strength of recommendation and quality of evidence with it.  Brittany Harvey: I appreciate you reviewing those options. So, then Dr. Robinson, moving on to the next category of patients addressed in this guideline, for patients with stage IV non-small cell lung cancer without driver alterations and with negative or low positive PD-L1 expression and non-squamous cell carcinoma, what are the updated recommendations for first-line therapy?  Dr. Andrew Robinson: Thank you for that question. So, in addition to the 2020 options for patients with negative, 0%, and low positive PD-L1 expression, with a TPS score of 1 to 49% and I'd add, unknown PD-L1, non-squamous, non-small cell lung cancer and a good performance status, clinicians may offer combination nivolumab and ipilimumab or combination nivolumab and ipilimumab with two cycles of platinum-based chemotherapy.  These are the additional recommendations and this gives an increased number of acceptable options, particularly for patients who cannot or choose not to take cytotoxic chemotherapy.  Brittany Harvey: Understood. Thank you for reviewing those options. So. then the next category of patients this guideline addresses, for patients with stage IV non-small cell lung cancer without driver alterations and with high PD-L1 expression and squamous cell carcinoma, what are those updated recommendations for first-line therapy?  Dr. Andrew Robinson: So, similar to the patients with non-squamous cell carcinoma for patients with stage IV non-small cell lung cancer that is squamous cell and a good performance status of zero to one, clinicians may also offer single agent atezolizumab alone or single agent cemiplimab or combination nivolumab and ipilimumab or combination nivolumab and ipilimumab with two cycles of platinum-based chemotherapy followed by ongoing nivolumab and ipilimumab. So, these are additional recommendations in this group as acceptable options for treatment.  Brittany Harvey: Great thank you for reviewing those options. So, then Dr. Jaiyesimi, what is recommended for patients with stage four non-small cell lung cancer without driver alterations and with negative or low positive PD-L1 expression and squamous cell carcinoma for first-line therapy?  Dr. Ishmael Jaiyesimi: In addition to 2020 recommendations, for patients with negative, TPS 0%, and low positive, with TPS 1% to 49%, PD-L1 expression, squamous cell carcinoma, and performance status of zero to one, clinicians may offer a combination of nivolumab and ipilimumab alone or a combination nivolumab and ipilimumab with two cycles of platinum-based chemotherapy.  Brittany Harvey: Great! So, then we've just reviewed the updates and changes to the first-line therapy recommendations. So, Dr. Jaiyesimi, were there any updates to second- or third-line therapy recommendations for patients with stage IV NSCLC without driver alterations?  Dr. Ishmael Jaiyesimi: For patients with non-squamous cell carcinoma who receive an immune checkpoint inhibitor and chemotherapy as first-line therapy, the clinician may offer paclitaxel plus bevacizumab in the second-line setting.  For the majority of patients with non-squamous cell carcinoma who received chemotherapy with or without bevacizumab and immune checkpoint inhibitor therapy, in either sequence, clinicians should offer the option of single-agent pemetrexed (non squamous cell carcinoma, non-small cell lung cancer), or docetaxel (all histologic types), or weekly paclitaxel plus bevacizumab, (non-squamous cell carcinoma, non-small cell lung cancer) in the third-line setting.  For patients in whom the initial treatment was not a chemoimmunotherapy combination should receive the treatment not given earlier that is platinum doublet chemotherapy (if the initial treatment was monotherapy with an immune checkpoint inhibitor, or dual immune checkpoint inhibitor therapy) and immunotherapy with an approved PD-1 or PD-L1 inhibitor in the second line setting (if the initial treatment was platinum doublet chemotherapy).  Brittany Harvey: Okay, thank you for reviewing those recommendations as well. So, then Dr. Robinson, what is the importance of these recommendation updates for practicing clinicians?  Dr. Andrew Robinson: These updates give an increasing menu of choices for patients and physicians, particularly in the first-line setting. The increased list of acceptable first-line options may help us physicians may run into situations where their preferred first-line option isn't available, or for other reasons shouldn't be given.  Now we recognize that given the increasing variety of options in the first line, it would be really nice if we could have guidelines, that say in this certain patient treatment with nivolumab and ipilimumab is recommended and in that certain patient chemotherapy plus pembrolizumab is recommended, and divide things up that way so that the right patient gets the right treatment.  However, the guideline committee did not feel that this was appropriate at that time as the only comparative data with these different strategies is insufficient, either population-based data or cross trial and network comparisons, that, however well done, do not have a defense against confounders and bias that a randomized study has.  So, the advances in drug development and research in non-small cell lung cancer in the past decade have made available multiple treatment options, particularly for first-line therapy for patients, and to some extent, this has also made the process of decision making in this context challenging for practicing clinicians, especially in the community and for patients and caregivers.  Clinicians need to understand patients' comorbidities as well as other variables that can potentially influence treatment decisions prior to making final therapeutic recommendations for any given patient, and also become comfortable handling a few of these regimens. Each of these are somewhat complex regimens with sometimes subtle and sometimes not-so-subtle differences that require expertise and appropriate treatment and monitoring.  So, with so many options available, it's important that clinicians get familiar with a few of them at least given that all of these regimens are now considered as appropriate standard of care regimens suitable for first-line therapy, it may also help justify physicians, researchers and ethics boards who are participating, designing and overseeing simple clinical trials that pragmatically ask the questions as to what should be used when.  So, physicians should simultaneously become familiar with these guidelines, familiar with different therapies, have expertise in a few of these therapies, and continue to stress cancer clinical trials that may improve outcomes, and also may help us determine which treatment for which patient at which time.  Brittany Harvey: Definitely, that makes sense. Thanks for reviewing these recommendations and also the limitations of the evidence around them. So, finally, Dr. Robinson, how will these guideline recommendations affect patients with stage 4 non-small cell lung cancer without driver alterations?  Dr. Andrew Robinson: Well, there are more options available which should be good but we wish what we meant when we say there are more options for patients, what we meant is that if one option doesn't work that other options are then available.  However, in this case, we mean that there are more options for patients for their initial therapy, particularly including more non-chemotherapy or reduced chemotherapy options.  It's difficult to imagine that many patients and clinicians will now discuss, say 8 options with patients with high PD-L1 lung cancer. Pembrolizumab, cemiplimab, atezolizumab, pembrolizumab with platinum doublet, nivolumab, ipilimumab, nivolumab and ipilimumab chemotherapy, and the majority of patients with high PD-L1 will likely continue to have single-agent PD-1 or PD-L1 inhibitors.  For patients with low PD-L1 lung cancer, the inclusion of nivolumab and ipilimumab without chemotherapy as a potential option may allow some patients to avoid chemotherapy toxicity and trade for other toxicities and choose a different therapy.  Patients who enroll on clinical trials where the comparator arm is any one of these therapies should be comfortable knowing that they are considered acceptable standards. The advancement in non-small cell lung cancer diagnosis and treatment would allow patients with stage IV non-small cell lung cancer without driver mutations who are eligible for immunotherapies with or without chemotherapy, a chance of living longer and the opportunity to participate in ongoing research to further move the ball down the field.  Brittany Harvey: Definitely. And, thank you for reviewing that as well. So, I want to thank you both for all of your work to review the rapid changes in evidence in this field and provide these guideline updates. I want to thank you again for your time today, Dr. Robinson and Dr. Jaiyesimi.  Dr. Ishmael Jaiyesimi: Thank you for having me.  Dr. Andrew Robinson: Thank you. It was a pleasure to be here.  Brittany Harvey: And thank you to all of our listeners for tuning into the ASCO Guidelines podcast series. To read the full guideline, go to www.asco.org/thoracic-cancer-guidelines. There's a companion guideline update on therapy for stage IV non-small cell lung cancer with driver alterations available there and on the JCO.  You can also find many of our guidelines and interactive resources in the free ASCO guidelines app available on iTunes or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.    The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.     

An interview with Dr. Ishmael Jaiyesimi from Beaumont Health Royal Oak and Oakland University William Beaumont School of Medicine in Royal Oak, MI, and Dr. Andrew Robinson from Kingston General Hospital, Queen's University in Ontario, Canada, authors on "Therapy for Stage IV Non-Small Cell Lung Cancer With Driver Alterations: ASCO Living Guideline." Dr. Jaiyesimi and Dr. Robinson review the latest recommendation updates for therapeutic options for patients with stage IV NSCLC with ALK rearrangement or RET rearrangement. They also discuss new agents on the horizon. Read the full guideline at www.asco.org/thoracic-cancer-guidelines.   TRANSCRIPT Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast series, brought to you by the ASCO Podcast Network, a collection of nine programs, covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Ishmael Jaiyesimi from Beaumont Health Royal Oak and Oakland University William Beaumont School of Medicine in Royal Oak, Michigan, and Dr. Andrew Robinson from Kingston General Hospital at Queen's University in Ontario, Canada, authors on 'Therapy for Stage IV Non-small Cell Lung Cancer with Driver Alterations: ASCO Guideline Update'. Thank you for being here, Dr. Jaiyesimi and Dr. Robinson. Dr. Ishmael Jaiyesimi: Thank you. Dr. Andrew Robinson: It's a pleasure to be here. Brittany Harvey: Great! First, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guideline in the Journal of Clinical Oncology. Dr. Jaiyesimi, do you have any relevant disclosures that are directly related to this guideline? Dr. Ishmael Jaiyesimi: None. Brittany Harvey: Thank you. And, Dr. Robinson, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Andrew Robinson: Yes, I have received funding less than $5,000 from AstraZeneca, Merck, and BMS over the past two years. Brittany Harvey: I appreciate those disclosures. So, then Dr. Jaiyesimi, let's talk about the purpose of this guideline. So, what is the purpose of this guideline update, and what clinical scenarios does this guideline address? Dr. Ishmael Jaiyesimi: The purpose of therapy for stage IV non-small cell lung cancer with driver alterations, is to rapidly update the ASCO and Ontario Health guideline on the systemic treatment of patients with stage IV non-small cell lung cancer, last published in February of 2021. The update is a result of potentially practice-changing evidence published since the last publication in February 2021. The update is based on two clinical trials from 2020 to 2021. The clinical scenario this guideline covers are stage IV non-small cell lung cancer with driver alteration with an ALK gene rearrangement and RET gene rearrangements. Brittany Harvey: Great. So, then let's review those two clinical scenarios that you just mentioned. So, there are a few new recommendations regarding ALK rearrangement. So, what are the recommended first-line options for patients with stage 4 non-small cell lung cancer in an ALK rearrangement? Dr. Ishmael Jaiyesimi: In the previous guideline alectinib or brigatinib were recommended as first-line therapy with a strong recommendation and level of evidence in patients with ALK gene rearrangement, and a performance status of zero to two. In the current update, lorlatinib was cited as the first-line ALK inhibitor that may be offered as an alternative first-line therapy. If alectinib, brigatinib, or lorlatinib are not available, ceritinib or crizotinib should be offered. This is based on the CROWN study that showed alectinib was superior to crizotinib in the first-line setting. Unfortunately, we don't have head-to-head comparative data with alectinib or brigatinib, so we cannot conclude that any one treatment is more effective than the other, and decisions should be made on experience, toxicity, and on. Brittany Harvey: Okay, thank you for describing how a clinician should select between those treatments as well. So, then the second clinical scenario that Dr. Jaiyesimi just mentioned, Dr. Robinson, what is recommended for both first-line and second-line treatment for patients with stage IV non-small cell lung cancer and a RET rearrangement. Dr. Andrew Robinson: Thank you. So, for patients with a RET rearrangement and a good performance status of zero to two and previously untreated non-small cell lung cancer, clinicians may offer selpercatinib or pralsetinib as first-line therapy. Selpercatinib was recommended in the 2020 guidelines and pralsetinib has been added to that. As with other driver mutation recommendations for scenarios where randomized studies against standard non-driver mutation treatments have not been done or completed, these recommendations are with a lower level of evidence and somewhat weaker recommendations, an alternative approach of first-line standard non-driver mutation treatment may also be offered. As a guideline group, we listed this approach of non-driver treatment behind the targeted therapies, because there's a belief that the targeted approach may be superior upfront. But we should also continue to, of course, encourage participation in ongoing trials comparing selpercatinib or pralsetinib to standard first-line non-driver mutation treatment to determine whether our assumptions are correct. For patients with a RET rearrangement who've had previous RET targeted therapy, clinicians may offer treatment as per the non-driver mutation guidelines. And for patients with a RET rearrangement who have had previous chemotherapy, chemoimmunotherapy, clinicians may offer selpercatinib or pralsetinib for them. Brittany Harvey: Okay. And then you've just mentioned some ongoing trials as well. So, that leads to my next question of what ongoing trials and new agents is the panel monitoring for the next guideline iteration? Dr. Andrew Robinson: It's really an exciting time with new agents on trials and I think we can divide it into more driver mutations, more lines of therapy, and more certainty with what we're doing. In terms of driver mutations, there are several phase II and III trials with agents such as sotorasib and adagrasib in KRAS-G12C mutated non-small cell lung cancer, trastuzumab deruxtecan in the DESTINY trials in HER-2 mutated lung cancer, mobicertinib and amivantamab in EGFR, exon 20 insertion lung cancer or HER-2 exon 20 insertion lung cancer, etc. So, looking at more driver mutations is all of those agents plus a number of others that will be coming out over the next couple of years at ASCO. We're also interested in more lines of therapy. So, for patients who progress after standard first-line, say osimertinib with EGFR or after progression on ALK therapies such as lorlatinib. So, we're looking forward to studies such as the CHRYSALIS studies of amivantamab and lazertinib in EGFR mutation-positive patients who have progressed after osimertinib, and other studies that are looking at the increasing treatment options for second-line treatment and third-line treatment. And then we're looking at interest to phase three studies that are comparing targeted agents to docetaxel in the second-line setting such as the sotorasib studies in KRAS-G12C patients and capmatinib and MET exon 14 patients, particularly as many of these patients may do well with non-driver mutated guided first-line treatment. There are phase three trials comparing RET inhibitors to standard first-line chemoimmunotherapy which will also be keenly awaited to see if our, and when I say our, I mean, the ASCO guideline panel and also the thoracic oncology community writ large, our assumption that targeted therapy will be superior to first-line therapy is actually borne out with clinical trial evidence. So, there's plenty of evidence that we're excited to keep our eye on and update as soon as possible, which is more driver mutations, more lines of therapy for patients who have established driver mutations, and more certainty, hopefully, regarding the timing of these various interventions. Brittany Harvey: Definitely, there's a lot going on in this space. So, we'll look forward to the results from these ongoing trials and the panel's review of that evidence, and eventually updated recommendations. So, then Dr. Jaiyesimi, in your view, why is this guideline update important and how will it impact practice? Dr. Ishmael Jaiyesimi: This guideline is important because it emphasizes rapid development in the research and treatment in advanced non-small cell lung cancer and that non-small cell lung cancer are heterogeneous. Clinicians need to identify biomarkers of the molecular pathways, including targetable driver mutations, example: epidermal growth factor receptors, the BRAF, the MET, the KRAS, and etcetera, and fusion rearrangement, example: anaplastic lymphoma kinase, c-ROS oncogene 1, RET, and on that drive malignancy in patients with non-small cell lung cancer, especially in those patients with adenocarcinoma histology and a little or never smoking history regardless of histology. Because of the availability of effective targeted agent for many of these cancers, at minimum, determination of epidermal growth factor receptor mutation status and anaplastic lymphoma kinase rearrangement status before initiating therapy because rapid and sensitive tests are available. An initiation of immunotherapy could increase the toxicity of tyrosine kinase inhibitors later in the patient's course. All this, in my opinion, will impact clinical practice. Furthermore, an opportunity for patients with driver mutation to enrolled in ongoing clinical trials targeting the driver mutations. Brittany Harvey: Yes. You've just mentioned that this is not a one size fits all approach for patients. And so, in your view, Dr. Jaiyesimi, how do these guideline recommendations affect patients living with stage IV non-small cell lung cancer with driver alterations? Dr. Ishmael Jaeysimi: I believe along with my associates the improvement in the treatment of stage IV non-small cell lung cancer brings hope to the patient with driver alteration for a possibility to use targeted therapy and no chemotherapy or immunotherapy upfront to some patients and this may enhance their lives, increase longevity with some tolerable side effects, and better quality of life, and a truly wide range of opportunities for patients to participate in clinical trials. Brittany Harvey: Great! Yes, it seems like the data has come fast, and a lot of new results of recent trials have driven these updated recommendations and we're also looking forward to many of the results from upcoming clinical trials that you both mentioned. So, I want to thank you so much for your work on these guideline updates, and thank you for taking the time to speak with me today, Dr. Jaiyesimi and Dr. Robinson. Dr. Ishmael Jaiyesimi: Thank you, Brittany. Dr. Andrew Robsinson: It was a pleasure to be here and I hope that this was educational. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. To read the full guideline go to www.asco.org/thoracic-cancer-guidelines. There's a companion guideline update on therapy for stage IV non-small cell lung cancer without driver alterations available there and on the JCO. You can also find many of our guidelines and interactive resources in the free ASCO guidelines app available on iTunes or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO the mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.  

A study of more than 3000 health care leaders in Canada found that while gender parity was present, racialized executives were substantially under-represented. Diversity among health care leaders in Canada: a cross-sectional study of perceived gender and race was published in CMAJ. It found that at the ministry level fewer than 7 percent of health care leaders were racialized. The representation gap between racialized executives in healthcare and the racial demographics of the population it serves ranged from a low of 7.3% for Prince Edward Island to a high of 27.5% for Manitoba. The gap was highest in geographic locations with a greater percentage of racialized residents. On this episode, Drs. Omole and Bigham speak with the lead author of the study Anjali Sergeant, a final year medical student at McMaster University.  She describes how researchers determined race, compares results in different parts of the country and discusses how closely the results of the study reflect what she is seeing in her medical school cohort.Drs Omole and Bigham also speak with Anna Greenberg, the Chief Regional Officer, Toronto and East for Ontario Health. Ms. Greenberg is also the agency's Executive Lead for Equity, Inclusion, Diversity, and Anti-Racism. She discusses the efforts her agency is making to address this disparity. She also explains why it is important for healthcare leaders to ask themselves, “Why does this matter?”

The show: The full interview with bonus material: Wait times. How many times have you had to wait to get medical care? How long have you waited in the emergency room? How about a doctor's office? To get home care? To access mental health services? There are many examples. Lots of people complain about this […] The post Ontario Health Team Northumberland wants to know what you think about local healthcare appeared first on Consider This. Related posts: Members of the new Ontario Health Team explain impact on health care in Northumberland New rural outreach clinic marks collaborative efforts by municipality and health team to increase access New seniors program aims to help elderly navigate local healthcare system and other supports

An interview with Dr. Andrea Eisen from Sunnybrook Odette Cancer Centre and Ontario Health in Toronto, Ontario, co-chair on “Use of Adjuvant Bisphosphonates and Other Bone-Modifying Agents in Breast Cancer: ASCO-OH (CCO) Guideline Update.” This guideline updates recommendations for which patients with primary breast cancer should be treated with bone-modifying agents, and which bisphosphonates are optimal. Read the full guideline at www.asco.org/breast-cancer-guidelines.

Accessibility reporter Meagan Gillmore describes the barriers to access when renewing Ontario health cards. From the February 8, 2022 episode.

Matt Anderson (BA'92) and Chris Simpson (BSc'90) took very different routes to get to top leadership positions in healthcare in Canada. Matt graduated with an arts degree and began his career in data analytics and IT. He went on to earn a master's degree in Healthcare Administration and Management from the University of Toronto and is now CEO of Ontario Health. Chris Simpson graduated from science and went on to Dalhousie University to graduate with an MD in medicine, subsequently completing internal medicine and cardiology training at Queen's University. Currently, he's Executive VP (Medical) and Chief Medical Officer at Ontario Health. They discuss leading healthcare through a pandemic, addressing current and future challenges and adapting to change.   In this episode:  The very different paths to healthcare leadership and knowing vs. not knowing what you want as a student  COVID-19 as a change agent that forced change quickly in healthcare  Using data and evidence to guide decisions and create the most benefit   The health human resources problem and burnout of healthcare workers  Managing stress and avoiding burnout  Advice for building a successful career – and defining what success really means    Links and resources:  Ontario Health: https://www.ontariohealth.ca/our-team/senior-leadership-team  Chris Simpson Twitter: https://twitter.com/Dr_ChrisSimpson  Think Like a Monk book   Thanks to:  Our alumni host, Shauna Cole: https://www.unb.ca/alumni/alumni-news/unb-alumni-podcast-hosts.html  Music by alumni artist, Beats of Burden: https://music.apple.com/ca/artist/beats-of-burden/1451387846  Our alumni Affinity Partners, TD Insurance, Manulife, and MBNA Mastercard: https://www.unb.ca/alumni/benefitsandservices/index.html 

The Empire Club of Canada Presents: Transforming Health Care Beyond the Pandemic Canadians take a great deal of pride in their health care system. But the COVID-19 pandemic exacerbated many long standing challenges in care, particularly for seniors, under-served populations and those in need of mental health and addictions services. Matthew Anderson, President and CEO of Ontario Health discusses lessons learned during the pandemic and how system recovery can serve as a catalyst for innovation and transformation in order to better connect, coordinate and improve health care for all, in discussion with André Picard, Health Columnist and Author, The Globe and Mail. Speakers: André Picard, Health Columnist and Author, The Globe and Mail Matthew Anderson, President and CEO, Ontario Health *The content presented is free of charge but please note that the Empire Club of Canada retains copyright. Neither the speeches themselves nor any part of their content may be used for any purpose other than personal interest or research without the explicit permission of the Empire Club of Canada.* *Views and Opinions Expressed Disclaimer: The views and opinions expressed by the speakers or panelists are those of the speakers or panelists and do not necessarily reflect or represent the official views and opinions, policy or position held by The Empire Club of Canada.*

Ontario's health care system has been battered by COVID-19, medical staff have been pushed to their limits, and there's a massive backlog of diagnostic and surgical procedures built up due to shutdowns. Has the time come for private health care to help fill the gaps? We ask: Alistair McGuire, head of the department of Health Policy at the London School of Economics; Colleen Flood, professor at the University of Ottawa and a University Research Chair in Health Law & Policy; and Sara Allin, assistant professor at the University of Toronto's Dalla Lana School of Public Health and the Institute of Health Policy, Management and Evaluation. See omnystudio.com/listener for privacy information.

Artificial intelligence (AI) and machine learning (ML) have transformed our lives. The adoption of AI in medicine has perhaps lagged its adoption in other areas, and machine learning in healthcare has had mixed results. In this episode, Drs. Muhammad Mamdani and Amol Verma discuss a series of three CMAJ articles on the development, use, misuse, and evaluation of machine-learned models in medicine. Dr. Muhammad Mamdani is vice-president of data science and advanced analytics at Unity Health Toronto, director of the Temerty Center for Artificial Intelligence Education and Research in Medicine, and professor at the University of Toronto. Dr. Amol Verma is a physician and scientist at St. Michael's Hospital and the University of Toronto, an AMS healthcare fellow in compassion and artificial intelligence and a provincial clinical lead in health quality improvement with Ontario Health. They are both two of the authors of the articles series published in CMAJ: Implementing machine learning in medicine https://www.cmaj.ca/lookup/doi/10.1503/cmaj.202434 Problems in the deployment of machine-learned models in health care https://www.cmaj.ca/lookup/doi/10.1503/cmaj.202066 Evaluation of machine learning solutions in medicine https://www.cmaj.ca/lookup/doi/10.1503/cmaj.210036 Podcast transcript: https://www.cmaj.ca/transcript-202434 ----------------------------------- This podcast episode is brought to you by Audi Canada. The Canadian Medical Association has partnered with Audi Canada to offer CMA members a preferred incentive on select vehicle models. Purchase any new qualifying Audi model and receive an additional cash incentive based on the purchase type. Details of the incentive program can be found at https://www.audiprofessional.ca. ----------------------------------- This podcast episode is brought to you by Dr. Bill. Dr. Bill makes billing on the go easy and pain free. Start your 45-day free trial today: https://www.drbill.app/cmaj ----------------------------------- This podcast episode is brought to you by Shingrix. Learn more at: https://www.shingrix.ca/en-ca/index.html ----------------------------------- Subscribe to CMAJ Podcasts on Apple Podcasts or your favourite podcast app. You can also follow us directly on our SoundCloud page or you can visit https://www.cmaj.ca/page/multimedia/podcasts.

Last week's report from the Financial Accountability Office of Ontario outlined a multibillion-dollar gap between what the provincial government intends to spend on health care, and what it hopes to achieve. Add to that a surgical backlog that will take years to clear, and it leaves many questions. Financial Accountability Officer Peter Weltman provides some answers. See omnystudio.com/listener for privacy information.

Critical care space is starting to get tight at the hospital in Chatham, concerns about blood clots have led Ontario Health to put a pause on using the AstraZeneca vaccine, and Chatham-Kent police are seizing an increasing amount of drugs and guns.

Ontario Health Coalition raised the alarm in 2016, using Canadian and Global Data from as far back as 2010, they demonstrated the pending collapse of Ontario's socialist Health Care System/Hospitals. They succinctly illustrated that the misappropriation of tax payer dollars within our healthcare system was the root cause. Ontario Beds per 1000 is the worst in Canada and amongst the worst in the entire world. Only Chile and Mexico have a healthcare system less prepared and capable of providing healthcare then Ontario. Something tells me Ontario and Canadian tax payers pay significantly more money and taxes towards healthcare then Chile or Mexico. Ask me again why socialism always leads to tyranny.As I have been warning teachers like Wendy Anes Hirshegger, Jen Galinciski and many many others over the years, their greed was going to come back and haunt them. CP24 this past week raised the alarm that the Government of Ontario is looking to significantly cut education budgets and are pushing for the implementation of permanent remote learning. Its ironic that the teachers union leveraged a public health “emergency” as a collective bargaining strategy to receive everything they wanted in their pre-pandemic strike. I once again remind Ontario Teachers that you are extremely well paid and compensated civil servants. You have zero right to strike against the tax paying public and zero right to refuse to work, let alone at the expense of our children. What exactly did you think was going to happen if the government spends into deficit each and every year, while you demand more and more funding and resources. Instead of turning around and asking your corrupt union the hard questions, you chose to act like self righteous state funded thugs and facilitated the bankruptcy of the Canadian tax paying citizens – you know, your employers – under the guise of public health and safety. I tried to warn you. You were being used by corrupt bureaucrats as the useful idiots you allowed yourselves to be. They were absolutely going to come for your guaranteed salaries and benefits next - and now they are. Ask me again how socialism always leads to tyranny.Finally Doctors and Medical Professionals are realizing that there is a serious problem here and are starting to speak out. The Declaration of Canadian physicians for science and truth has been released as an open letter/petition and is accruing 1000's of signatures from all across Canada. Silencing Doctors and Medical Professionals is not science, it is by every definition of the word – tyranny. Consider taking the time to review their open letter, their references to Nazi Germany and the Nuremberg Code. The nonsensical fear mongering and fake pseudo “science” our corrupt self serving media and public health officials have been ramming down our throats for over a year now has been laughable. Flagrant lies and propaganda. I've been screaming, begging and pleading for over a year now. Its about time Canadian Doctors have entered the fray. Better late then never folks. Happy to have you onboard. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit andrewrouchotas.substack.com

Mike Stafford hosts 640 Toronto's Morning Show   GUEST: Dr. Janet Papadakos, provincial head of patient education at Ontario Health, and an assistant professor at the University of Toronto's Dalla Lana School of Public Health See omnystudio.com/listener for privacy information.

The province is reporting 4,041 COVID-19 cases of COVID-19 and 15 deaths. Meanwhile, according to data from ICES, a research institute that covers health issues pertaining to Ontario, five neighbourhoods that are designated as hot spots actually have COVID-19 cases, hospitalizations and deaths that fall below the provincial averages. Meanwhile, a CMAJ study makes the case for pivoting away from a rollout strategy that prioritizes those with health conditions as well as the older demographic. Our Zoomer Squad weighs in on the latest. AND Starting today, Ontario hospitals will be putting a pause down on elective and non-emergency surgery appointments in an effort to ease the burden on ICUs and other units amid the third wave. The directive comes from Ontario Health. For now, hospitals in the northern part of the province don't have to follow this but are being asked to be prepared for this reality in future. The official opposition NDP is calling on the Ford government to do something to confront the delays and backlogs. Meanwhile, members of the medical community are expressing concern over delays in cancer screening appointments.Finally, Dr. Bell details what is happening on the ground at Mount Sinai.

Dr. Chris Simpson, Executive Vice-President, OF Medical, Ontario Health talks about Ontario hospitals to stop elective surgeries as they become overwhelmed by Covid. See omnystudio.com/listener for privacy information.

"Careers are not linear" - Aroma Akhund About Aroma Akhund Aroma is an Analyst at Ontario Health in the patient and public partnering program. She is passionate about helping people and wants to do this through the avenue of healthcare. Her background in life sciences and experience in patient care, research, project and program management have equipped her to make a solid contribution to healthcare. Currently enrolled in the MBA program at Ted Rogers School of Management, she hopes to further develop her skills and lead pivotal changes to improve Ontario's healthcare system. Her current hobbies include trying out the latest tiktok cooking trends, going for long walks around the city, and playing with her pet kitten Winston. She tries not to let the COVID blues keep her from getting exercise, although sometimes they get the best of her. Connect with Aroma LinkedIn: www.linkedin.com/in/aromaakhund Charity of The Month Y&D donates all of its revenue to charity. This month's featured charity is hEr VOLUTION. The organization creates opportunities for the next generation of women in STEM connecting them with leaders in the industry for career support. The org listens to the needs of the community and that of the STEM industry to better help the next generation of underserved youth, with a focus on young women to enter STEM. You can make your donation here: https://www.hervolution.org/donate/ Connect With The Yonge and Dundas Team Y&D takes questions and feedback from our listeners. You can contact Roshan via: Email: roshansahu@protonmail.com LinkedIn: https://www.linkedin.com/in/roshandsahu/ Copyright Roshan Dev Sahu 2021. All Rights Reserved. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

In this podcast, Dr. Andreas Laupacis, editor-in-chief of CMAJ, interviews two authors of a research article published in CMAJ. The research looked at SARS-CoV-2 infection among patients undergoing long-term dialysis in Ontario during the first wave of the pandemic. Rebecca Cooper is the director of clinical programs at the Ontario Renal Network, and Peter Blake is a nephrologist and the provincial medical director of the Ontario Renal Network, which is part of Ontario Health. To read the research published in CMAJ: www.cmaj.ca/lookup/doi/10.1503/cmaj.202601 ----------------------------------- This podcast episode is brought to you by Shingrix. Learn more at: www.shingrix.ca/en-ca/index.html ----------------------------------- Subscribe to CMAJ Podcasts on Apple Podcasts, iTunes, Google Play, Stitcher, Overcast, Instacast, or your favourite aggregator. You can also follow us directly on our SoundCloud page or you can visit www.cmaj.ca/page/multimedia/podcasts.

News at the Top – Trudeau Raising Taxes (Again) The taxpayer takeaway for 2021: you’re going to be paying more, not less. Federal Director Aaron Wudrick tells Alberta Director Franco Terrazano about the incoming tax hikes on alcohol, Netflix, paycheques, and of course, the carbon tax. SIGN THE PETITION: https://www.taxpayer.com/petitions/scrap-the-federal-carbon-tax Deep Dive – Canada Fails on Transparency Our Quebec Director Renaud Brossard explains to Ontario Director Jasmine Moulton how Canada fell behind Russia, Pakistan, and South Sudan in the rankings for best transparency laws. Links: https://www.taxpayer.com/newsroom/trudeau-is-failing-to-meet-his-own-government-transparency-standards?id=18808 https://ca.news.yahoo.com/liberals-trying-balance-transparency-pm-154000384.html https://www.rti-rating.org/ SIGN THE PETITION: Waste Watch – Ontario Health Executives Get Big Payouts Jasmine Moulton, stays on for a crazy story about Ontario health bureaucrats who travelled while we’re all told to stay at home and now they’re in line for seven-figure severance payouts from taxpayers. Link: https://www.taxpayer.com/newsroom/taxpayers-federation-slams-1-million-severance-payout-to-former-hospital-ceo?id=18854 Like this show? Subscribe and give us 5-stars! This podcast is brought to you by the Canadian Taxpayers Federation, Canada’s premier grassroots advocacy group pushing for lower taxes, less waste and accountable governments. Sign-up as a Canadian Taxpayers Federation supporter at no-charge TODAY: https://www.taxpayer.com/join.

Show Opening... But first (0:33); Trump impeached a second time - but Trumpism will live on (21:08); Stay at home order now in effect but will all stopped by authorities be treated equal? (44:14); Why 'free speech' needs a new definition in the age of the internet and Trump tweets (1:04:46); Ontario Health tells hospitals to be ready to accept COVID-19 patients from hardest-hit regions (1:27:20); Laurier student Kristin Cobbett accepted into elite scientist-astronaut program (1:47:58)

Dr. Chris Simpson, Vice-Dean (Clinical), School of Medicine at Queen’s University, Medical Director of the Southeastern Ontario Academic Medical Association and cardiologist at Kingston Health Sciences Centre has been appointed as Ontario Health’s Executive Vice-President, Medical, effective February 1, 2021. Dr. Simpson, who will overtake his new position on February 1st 2021 while still maintaining […]

Dr. Chris Simpson, Ontario Health; Jagmeet Singh, NDP Leader; David Saint-Jacques, Canadian Space Agency Astronaut; Pam Palmater, Ryerson University; Jenni Byrne, Jenni Byrne + Associates; Stephanie Levitz, The Canadian Press; Robert Benzie, Toronto Star. 

Jane Brown is joined by Dr. Chris Simpson, incoming Executive Vice-President, Medical for Ontario Health. And after that interview Marit Stiles joined Jane to give a reaction from the NDP.

Hospitals across Ontario have been ordered to brace for a spike in COVID-19 patients. A memo from Ontario Health obtained by CBC News tells hospitals to prepare to activate emergency plans immediately. For hospitals in the province's grey lockdown and red control zones that means clearing up to 15 per cent of their beds for COVID-19 patients GUEST: Dr. Michael. Warner, Head of ICU at Michael Garron Hospital See omnystudio.com/listener for privacy information.

An announcement promoting electric vehicle production in Canada The Ontario Liberal leader calling for ‘modified stage 2’ in COVID-19 hotspots  AND… The Ontario Health Coalition calling for a Day of Action regarding long-term care workers’ concerns See omnystudio.com/listener for privacy information.

Natalie Mehra, Executive Director, Ontario Health Coalition talks about Ontario resuming elective surgeries but new data shows many might not see the operating room soon. Delays of up to a year possible  See omnystudio.com/listener for privacy information.

Sign up today: http://betterhelp.com/solvinghealthcareand use Discount code “solvinghealthcare"Critical Levels:http://www.criticallevels.ca Resource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w   Transcript:Kwadwo : 00:00 Yo, y'all wanted more of André Picard. We are delivering. We're talking cannabis. We're talking PharmaCare. We're talking medical assistance in dying. We're talking privatization of healthcare. Episode 14 with André Picard. Let's go.Kwadwo: 00:18 Welcome to Solving Healthcare. I'm Dr. Kwadwo Kyeremanteng. I'm an ICU and Palliative Care physician here in Ottawa and the founder of Resource Optimization Network. We are on a mission to transform healthcare in Canada. I'm going to talk with physicians, nurses, administrators, patients and their families, because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a better health care system that's more cost effective, dignified and just for everyone involved.Kwadwo : 00:53 Thanks for tuning in everybody. We are super excited about this episode with André Picard. We cover a lot. We cover some of the questions that we saw on social media, on Twitter and on Facebook, but what I want you guys to really take away from this episode is how a lack of clear objectives and goals within our healthcare system really can impair care, and impair resource utilization. I think that was a huge eye-opening point that André and I get to talk about here in this episode amongst the other things, but it's a real eye-opener. Every other area within business, healthcare, your own health, your career goals, you, all of us have clear goals and objectives, but what are our goals in healthcare? Is it to reduce infant mortality? Is it to improve on mental health services? What are our objectives? These are the real questions we should be asking ourselves.Kwadwo : 01:56 Okay. Before getting into the show, I want to tell you about our sponsors, Betterhelp.com As I said, I love these guys. They are online counseling service that provides accessible, affordable, and convenient counseling services that are readily available by a video chat, via telephone, via text messaging, and they cater to your needs, whether it's teen counseling, whether it's marriage counseling, whether it's health care providers, addressing compassion fatigue. They're fantastic. So if you guys are looking to sign up, use promo code Solving Healthcare, and you'll get a 10% discount on their services. Our other sponsor today is The Podcast Critical Levels. This is hosted by my boy Zach Cantor and this show's awesome. It's about paramedicine and the issues around paramedicine, but they also dive into issues that involve us all. Specifically, he had a great episode with Dr. Zemek about childhood concussions, which as a father of three boys that are involved in hockey, I was completely engaged in. It was a great conversation.Kwadwo : 03:08 This guy's going to be a star, so you guys are game, listen to him on iTunes, Spotify, or Stitcher, anywhere you could listen to podcasts and, it's a guaranteed gamer man. Good job Zach. Lastly, I want to give a shout out to the Department of Medicine at the Ottawa Hospital. These guys have supported this show tremendously. I want to give a shout out to Abhilash, Sandra, D D, Tracy, you guys are amazing. They've assisted with marketing, on updated website on the Department of Medicine page. I'll leave links to that on the show notes. It is proper, but yeah, love you guys for all the support and uh, appreciate it. All right, let's dive into it. André Picard, the author of "Matters of Life and Death." And you heard him on Episode 13. Amazing journalist, 40 years of experience and he really delivers on this episode. We talk about it all and I can't wait for you guys to listen to it. So we're just going to dive into it. Enjoy Episode 14.Kwadwo : 04:14 So I touched a bit on universal healthcare and in how, I'm not sure in Canada we can truly say that we have universal healthcare. I'm wondering if you had any thoughts in terms of privatization. You know this is coming up a lot in terms of ways of making healthcare more sustainable, dealing with wait times and so forth. What are your thoughts in terms of privatization?André Picard: 04:40 Well let me start with the universality part of the puzzle. So we have, in Canada we have this notion that we have a universal system, but we have the least universal universal healthcare system in the world. I think once you put it in those terms, you go, "Oh hold on. Is that true?" Because we cover hospitals and we cover physicians a 100%, we cover very little of everything else. We cover about 45% of drugs publicly. Well, 30% of home care, uh, 30- 35% of long-term care, 6% of dental care. We're all over the map and it's irrational. So we don't have a universal healthcare system. So that's the first part of the puzzle. I always said, I like to use the analogy of a basket. So we have this Medicare basket of services. Right now we have a basket that's very narrow and very deep. It's hospitals and physicians.André Picard: 05:29 We pay for all of it, even though some of it probably shouldn't be paid for. And then the other stuff we don't cover near enough. So I think we need to make this basket a lot wider and a bit shallower. So we cover a lot more, but we give some people some responsibility for the rest. So that brings us to the, the second part of the privatization talk. And I think a lot of the talk about privatization in Canada, the way to shut down any discussion about healthcare is to say, "Oh, you're going to privatize, we're going to be like the U. S." Well, I think that's it. I think that's nonsense. I think it's a false dichotomy. I think the reality is every, no health system can cover 100% of everything for everyone all the time. So we're going to have some private healthcare,. We have to realize that from the outset.André Picard: 06:18 So the question is not will we have private healthcare? The question is where do we have it, how do we regulate it, and how do we make sure that everyone gets the essential care that they need at an affordable price? So that's, you have to have these philosophical parameters and then how we deliver the care. To me, it doesn't really matter. I don't care if it's delivered by a privately, publicly a mixture. What matters is that people get the care and that it's accessible and that it's affordable. So that that's my philosophy. I get some grief for that, but I think that's how we have to have the discussion about privatization. It's not black and white. It's about how do we regulate it, how do we ensure that it's delivered fairly and comprehensively, et cetera. I think in Canada, the problem we have is we have a badly administered public health care and badly regulated private health care. So we kind of have the worst of both worlds. A lot European countries have a lot of private health care, but it's very strictly regulated. It's not a free for all the way it is here. So there's different ways to, to have get that balanced right. And again, you've got me on my pet topic.Kwadwo : 07:27 That's part of my game. It's interesting because actually I've never heard it framed that way is that we're the, how'd you put it, in terms of universal healthcare, we're the...André Picard: 07:36 ...the least universal in healthcare.Kwadwo : 07:39 Yeah, I like that. And I mean cause it's often people forget that they're like, oh we don't have any private health care in Canada. But you know, if I go see a physiotherapist I'm paying out of pocket. And it's true. It's like where do we want to put our private resources? I mean, well some of the topics that come up or worries I hear people mention is like resource drain where like some of the best surgeons or physicians or whatever, allied health professionals, would just strictly go into the private sector. But it's kind of like you mentioned if you regular, if you're like anything that you're going to do that's semi new or complicated will take some nuance. And so yeah, you know, maybe you need to restrict how much time physicians could spend in the private sector. Maybe that's a solution, but certainly to think that we can't have any element of private healthcare in 2020 or beyond I think is a bit ignorant at this point.André Picard: 08:41 Well, you're right. It's about setting parameters. So if you look at a country like France, a many doctors practice in the public system and the private system, but there's strict regulations. So if you want to work in the private for every hour you give to the private system, you have to give an hour to the public system. So that's, that's a way of getting some balance there. It's not a, you know, it's not an either or. In Canada you can opt in many provinces, not all, but in many provinces you can opt out of the public system and then you can charge whatever you want. There's no limit. I'm not sure that's a good system. Now very few doctors do because our Medicare system is actually very generous for doctors and it's a good system, very little bureaucracy compared to systems like the U. S. So there's the greatest beneficiaries of Medicare have been physicians. We shouldn't forget that.Kwadwo : 09:27 Yeah. I feel like it's so taboo, but we need to go there and I, I don't know what, will make us go there. What I'm getting at is what is our breaking point? Because baby boomers, are getting to prime time, health care, utilization, age, you know, we keep saying that we can't keep this up in terms of healthcare delivery and spending. So what's next? Like what do you see? What's going to happen in Canada in your, in your humble opinion?André Picard: 10:00 Well, you know, I think that we have to realize that healthcare is really important to us. Uh, we have to find a way of delivering it. And as I said before, we obsess a lot too much about the cost. Do we spend too much on healthcare? I am often asked that question and I always give the same glib response.André Picard: 10:16 I always say, I have no idea because I don't know what we're trying to achieve. So we just spend, you know, we spend the way we spend, we don't have any set public health goals in Canada. So unless you have goals, it's hard to save for we're getting, achieving what we're trying to do. So I think that's, we have to do some basic stuff.Kwadwo : 10:34 What kind of goals would you have us, would you have in mind?André Picard: 10:38 Yeah. So I look to many countries do this. So you look to a country like Sweden. So Sweden publicly publishes every year a list of its public health goals. So for example, I take one in Canada and Canada, we have an abysmally the high rate of child mortality compared to most of the world. So I would say in Canada, we want to bring our rate of child mortality from three per thousand to two per thousand.André Picard: 11:05 That would be a public health goal for me. And then we find out a way to do that and we spend the money that's necessary to do it. So that that's how you have, goals and then you work to achieve them. People often get uncomfortable when I say, "You know, we have to treat it more like a business." And that's what a business does. A business says, here's the goals for the year. Often those goals are related to profit, but we don't have, that doesn't have to be the goal in healthcare. The target, the goal can be, you know, we're going to ensure that our child poverty rate falls by X percentage points or that, the cesarean delivery is going to be less disparate from one end of the country to the other. So there's all kinds of goals you can set once you have goals. It's easier, I think, to, to figure out how to spend appropriately.Kwadwo : 11:48 You know where you're trying to go. You have purpose.Kwadwo : 11:53 Yeah. It's funny cause you always hear on a lot of whatever endeavors that you, you, you go on that, you know, you need to set goals and, and write them down or discuss them, be clear on what your objectives are. And it's funny if you asked me what, you know, what are the goals are Canadian healthcare system, that's not an easy question. Yeah. To make Canadians healthier or whatever. But is that really specific enough? Is that like, what does that actually mean? You know? Yeah. No, that's a, that's a great point.André Picard: 12:25 When I, when I do talk to, I often ask the audience, I say, what, what is the statement of purpose of Canadian Medicare? So we spend a quarter of a trillion dollars every year or $256 billion on healthcare. What is its purpose? So I often ask that to audiences and the question, the answer is always silence. So I tell them, you're right, we don't have any, you're all right. You don't just answer nothing. And when you put it in those terms, I think people go, "Wow, we spend all this money and we don't, what's the purpose of it?"Kwadwo : 12:54 Yeah, wow.Kwadwo : 12:56 I'm actually speechless because yeah, what really is our goals, you know? Yeah. I mean it's, even if you think about it in, in specific niches, like you know, when I'm in ICU, I know my goals are clear. When I'm in the Palliative Care, my goals are clear. You know, when they, when we look at a system level, it's not clear at all. You know, we might have a bunch of issues but we're not prioritizing them. We're just blanketly throwing money in and dealing with fires. Wow.André Picard: 13:29 And Palliative Care is a really good example. You know, you have very specific goals once the patient is there, but whatever. What are our goals as society to ensure that the right patients get there? In Canada between 17 and 35% of people who should have palliative care get it. We do a terrible job of ensuring people are treated well at end of life. And you know, I can't, it's hard to imagine something that's more important than alleviating people's pain at the end of life to not see them die a horrible death. And we just haven't, we don't have goals. We don't have, we haven't made that a priority. You know, again, it's the Canadian classic thing. Once you're in power, you know, you're in palliative care, we have fabulous Palliative Care. So many people are denied access to that, that it's criminal.Kwadwo : 14:16 Yeah, and the thing that people may or may not realize is even when it studied the benefits of early Palliative Care, like there's a study out, it's almost 10 years old now that it was stage four cancer patients got either early Palliative Care or just standard care up to the discretion of their team. And the patients that got early Palliative Care, not only were their symptoms improved, but they actually lived longer, ironically. And so, yeah, I mean you're definitely preaching to the choir in terms of Palliative Care resources. I mean, you know, when you, when you look at trying to improve the experience for the family, for the patient, making sure that the, you know, they're not suffering and you know, even from a resource point of view like the patients are less likely to occupy acute care beds as a result. It's just a, it is a bit mind boggling that this is not emphasized more.André Picard: 15:12 Yeah. And it's a reminder. What you're saying is reminder. I don't, I don't think we lack money. I don't think there's any lack of money in our system, we're one of the biggest healthcare spenders in the world. But I think it's how the money is allocated, is the problem. We don't spend smartly. We don't get value for money.Kwadwo : 15:27 This is, this is my, I mean, this is like my mission, Andre. It's like I see it day in, day out us putting in money into interventions that have no benefit. Even, there's a simple, this is a very simple example, but you know, I think it clarifies things you could have if someone comes into the ICU when they're, they need to be resuscitated with IV fluids. There's normal saline that you've, we've all seen that costs maybe a $1 .30 and then there's some more sophisticated fluids that cost about $50 to $60 for the same amount of volume.Kwadwo : 16:03 So 60 times a price with no, like if you could study it through the union, there was no additional benefit for you getting that fluid. You know, and we, we spent thousands on it and if there's no reason for it. You could have an oral antibiotic that's just as effective as an IV antibiotic, but people will still order the IV one because it makes it feel better. Throwing away money just cause, you know, for lack of understanding or just because of a lack of lack of a will to change, it's just, it's all over the place. And then instead we could be putting it into places that matter. That's a, this is, I don't know if this is what drives me nuts. You know, I see my physio-therapist position gets cut , I see my social worker position get cut, things that actually are going to make a difference into the patient experience and improving care.Kwadwo : 16:56 I'm going to have to cut these positions. Yeah. It's crazy to me.André Picard: 17:00 Yeah. And you remind me of, I remember visiting a unit for girls with eating disorders at a hospital and they had cut the psychological care so they were no longer getting psychological care. So what was the result is they ended up spending many more months in hospital. I had great, a tremendous cost, way more money than it costs to fund a psychologist. A different budget, et cetera. It's just a lot of irrational stuff like that happens and it just, it actually costs more money, not less. I know people, 90 year olds with dementia and cancer are getting a hip transplant. What's the good of that?Kwadwo : 17:36 Absolutely. It's and stuff that has been studied and we know are unlikely to benefit and we still offer it. And you know, I mean when you give that example of arguably who might be the most valuable person in an eating disorder ward, I would think it would be the psychologist. Wow.Kwadwo : 17:56 That reminds me, we did get a bunch of questions on Twitter when we were doing this show and, and one of them, you're a popular man. One question that like really stuck with me and, and I don't think there's an easy answer to this, is how do we break the cycle of these four year,Kwadwo : 18:18 cycles where governments are in power. And so they, the budgets are reflective of that. So there's so much sort short, shortsighted, you know, budget, budget, intervention cuts because we got to balance the budgets despite the fact that some of these cuts are gonna make things worse in the long run. Is there a solution to this problem?André Picard: 18:38 Well, again, yeah, I think there is a solution and again, we can learn from looking at other jurisdictions. I think one of the things that distinguishes Canada is the level of political micromanagement. So there's way too much interference from that. The Health Minister's office reacts to what's on the front page of a newspaper. That's how our system runs. It's like I always call our health ministers, firefighters instead of fire prevention officers, that's what they should be doing. They should be setting the philosophical goals, as I talked about before. These are the goals that we want to achieve and we should have professional administrators running the system so that, that's what I see when I go to countries in Europe, like the Netherlands and France, they're professionally managed. They're run like a business. And the government essentially keeps their nose out of it, and the public doesn't want their noses in it. So I think it's really to let the managers manage.Kwadwo : 19:30 Mmm.André Picard: 19:30 One of the worst jobs in Canada has to be a healthcare administrator because you have all this responsibility and you have no power and you're constantly second guessed by politicians. It's a terrible position to be in. So what do they do? They just cover their butts. They try and not make waves and we just go along, you know, try and keep quiet and nobody wants to catch the attention of the Ministry of Health because it's always going to be bad news. So I think it's this professionalization, that we have to aim for. And it's weird cause we don't do it in any other part of our government. You know, the Transport Minister doesn't call and tell the airport what flight should be going out. And that's, that's how it works in healthcare. It's absurd. So I think that problem is easily solvable, but it's going to take some, some political guts for people to say, listen, hands off, I'm going to let the, you know, Ontario Health. So, you know, say take Ontario Health, this new system, theoretically you should be able to do that. That should be an independent entity. Government gives them their allocation of money, go for it, run it that it should be run that that's how a system works in most countries and that's how it should work here.Kwadwo : 20:42 Have you seen a province, the healthcare system that works better than others?André Picard: 20:47 That's when I traveled around the country. I always know that's going to be the first question when I do a talk. I'm obsessed in Canada. Are we the worst or are we just sort of in the middle? That's everybody wants to be in a major of Canadians. So I think, I think the answer to it is we don't know cause we don't measure things very well. I think anecdotally we know that every province does some stuff really well. So we all have areas of excellence. I often describe Canadian Medicare as "islands of excellence in a sea of mediocrity". We have a lot of mediocrity. We have that but have a lot of great stuff. So New Brunswick has tremendous paramedicine. Manitoba has really good homecare. Quebec has really good primary care with CLSC's.BC has a really good handle on its drug program. So there's all of these provinces that do things well.André Picard: 21:37 And the frustrating things for me is we don't learn from each other and copy each other. We do quite the opposite. We always try to reinvent the wheel. But to get back to your initial question, who does it best overall? I'll just go with my gut feeling cause again, there's no measures, but I think these days, I think it varies. I think Alberta used to have by far the best health system, sort of a pioneered the regionalization model, and it does it really well. It allowed the regions to, to run in the way we talked about, you know, you're the boss and you run it and the government keeps its hands out and until the government started meddling again, that worked really, really well. So I think Alberta was a leader for a long time. I think now probably Saskatchewan. Saskatchewan is a really good size, but a million really good size too to run a system.André Picard: 22:26 Ontario is kind of a dog's breakfast. They're trying to fix this with a reorganization, but it's really the most disorganized system as a result. I think one of the ones with the, with the worst outcomes, unfortunately. I don't think there's a best and I don't think there's a worst, but there's a lot of good and there's a lot of bad overall. Unfortunately.Kwadwo : 22:45 No, I can appreciate your answer. I'm originally from Alberta and one of the things that was taking place before I left was single electronic medical health record. You know, they had this, I'm forgetting the name off the top of my head, but you know, taking the bull by the horns and saying, you know, this is ridiculous. We should all be under one system and oh it should, all hospital charts should be able to speak to each other to a certain extent.Kwadwo : 23:15 And this was, I mean this was in 2005 when I left, so yeah, I do. I could, I could see where you're coming from. And yeah, at the time they still had the like a health authorities is what they would call them. Like which pretty much had as you described, a free reign. Relatively speaking to, to work in the way that was most effective for their community. It's a really good point you bring up though. It's, you know, a little bit more independence for some of these administrators to, you know, to try and do the right thing for their, for the community and to be able to get to their needs. Yeah, I mean that's a, that's a fair point and that you don't hear about every day, but yeah, certainly in Ontario this is what we're attempting. All right. I'm going to ask you a bit of a controversial one too.Kwadwo : 24:02 Is there a party that you feel like since you've been doing this for 40 plus years, it seems to do a better job of this than others?André Picard: 24:11 Well, you know, the, I think one of the biggest problems in Canadian politics is that there's very little difference between the parties, violent agreement on, you know, essentially the status quo. And that's, to me, it's always frustrating to me during election campaigns, there's very little discussion of healthcare because there's no disagreement. Everybody sort of has this, well, Medicare is great and we don't want to talk about it attitude. NDP, Conservative, Liberal, all the same approach. And I think a lot of it goes back to there's a famous quote to attributed to Joey Smallwood, who is the premier of Newfoundland, one of the Fathers of Confederation. He once said that, "I've never had a discussion about healthcare that didn't lose me votes." To this day, politicians feel like that...André Picard: 24:56 You start talking about healthcare and it becomes a losing proposition because you can never satisfy everyone. So the parties kind of agreed to to say nothing. We have these little discussions around the edges occasionally because there's never any serious talk of performing healthcare regardless of the party. So short answer, no, there's not one that's better than the other. What we do know is that the lesser a party's chances of being elected, the more bold their promises are for healthcare. So that, that's the sad reality.Kwadwo : 25:24 Fair enough. Okay. I'm going to touch on a few more questions that some of the our friends were, were asking. So in terms of new cannabis legislation, what's your, your overall opinion on our approach?André Picard: 25:43 Yeah, so I've been long a proponent of, I, don't believe that, you know, drugs should be regulated the way they are now.André Picard: 25:51 I'm a big believer in, legalization of all drugs because I believe people are going to use them and we have to make it safe for them to use, and educate them, et cetera. So that's my premise that I operate from. Lots of people don't like that view, but I have a very libertarian view about drugs and I think it's viewed from a public health perspective, that that's the most rational approach. Now when we take cannabis, I think that legalization of cannabis was long overdue. We started discussing this in the 1970s with the Lyddane Report and finally two years ago we got around to legalization. Now what's happened since then? I think it's been kind of a bust in a bust economically, socially, medically because we've replaced this criminalization with a whole bunch of stupid regulations. There's way more laws about cannabis use now than there were before it was legalized.André Picard: 26:45 So it's kind of a, we've undermined what we were trying to do. From the business perspective, that's the story that gets the most attention in Canada is our cannabis companies are all going bust, because they're, the sales are not what they expected. We could have built an industry here that export it, its knowledge around the world, but, there's so much red tape and regulation that we've denied ourselves that, right. So, and I think we've kind of messed up this good idea. We've get it done it very, very badly unfortunately. So the reality is what the reality is, a lot of people still buy on the black market. The government stores have a product, but they have long wait lines. You know, there's the Canadian way. We wait for everything. We even wait for in line outside to buy our pot. So I think it's kind of been a huge disappointment, unfortunately.Kwadwo : 27:35 Yeah. It's, um, I do hear you about the, from a like a public help perspective on legalization cause certainly, you know, putting somebody in jail or putting them in a spot where they can't have a job based on a substance that people are going to use anyway. It seems, you know, um, not right. But my concern personally is the use, especially amongst the youth. Like I think there's some detrimental affects that maybe we're not appreciating. Like I know we see a little bit more psychosis in lead adolescence, early adult age. I just kind of wish it was studied a bit more before we're like, hey, you know, let's just throw it out to the world, but you know, I, do hear from the public health side for sure.André Picard: 28:27 You know the youth, the youth issue, whether it's cannabis, whether it's vaping, whether it's tobacco, that's a particularly challenging one.André Picard: 28:34 And those things are all illegal. It's always been illegal for young people. Probably always will be. And that's not the issue. That's not the way we're going to deal with that demographic. We have to, we have to teach them. Uh, we have to recognize that they're young people, so they're going to be risk taking. They're going to be experimenting and we have to deal with that reality instead of being moralistic about it and saying, "Oh, we've got to ban, vaping, we've got to ban cannabis." They're going to use it. So let's make sure that when they do they do it safely, uh, they do it rationally as much as possible for a teenager to do anything rationally. I think we just have to be much more pragmatic about this stuff. I think that's, to me, that's the big lesson I've learned about writing about public health for a long time is. ..André Picard: 29:15 You really have to put your opinions aside and be very pragmatic about this stuff and realize it's going to happen. So how do we make it as safe as possible? How do we reduce harm? Harm reduction has to be the driving force of our, our public policies. And the worst thing for harm reduction is, is prohibition. Prohibition is always failed regardless of the substance.Kwadwo : 29:37 Yeah. Fair enough. I guess it's always the question, which I guess we don't know. It's just, you know, what is that safe level? What is a, what is the amount or the approach that, you know, is truly reducing harm. But yeah, a lot of questions in terms of, you know, the approach. How about, another question that came up was regarding PharmaCare. I think you've, you've written a bit about PharmaCare and Canada. Oh, any thoughts on that?André Picard: 30:07 Yeah, so an issue we've written a lot about because it, it actually did get debated politically.André Picard: 30:12 Again, I think PharmaCare is necessary. We need to, you know, we're the only developed country aside from the U.S. that doesn't include drug coverage and our, and our universal health plan. So that's something that's needed to be fixed for 50 years. So we have to do that. So we've done it to a certain extent, but we've done it in a very haphazard way. So we have 102 public drug programs in Canada. We have to make some sense of that. We need some, some more centralization, more logic. But I think the really important thing that's lost in the PharmaCare debate is we have to define what we mean by PharmaCare. So we have a lot of people talking about, you know, we need this single universal system. Sure. That's one way of doing it to be, it's not necessarily that way, but the most important thing is what are we going to cover for who and why?André Picard: 31:02 So how are we going to get value for money, uh, for our drugs? And I think the way to do it is not to copy what we've done with, with the physicians and hospitals, we've covered those 100% and it doesn't work. We've had a lot of waste. We have a lot of, stuff that's not done because we spend too much in those areas. I think we have to be careful not to repeat the mistakes we've made earlier. I think we have to be a little smarter to decide what we're going to cover and that, that to me is the essence of the debate. There's no question that we should cover. Drugs are really important. If we're going to have universal healthcare, but universality doesn't mean covering every product for every person all the time. Ensuring that everyone has the essentials in an affordable way and those are different things .Kwadwo : 31:49 That certainly was one of the few healthcare related topics that came up during this past election.Kwadwo : 31:57 And that was a, it's funny, those are my exact thoughts when it came up, I'm like, what is, what does that actually, what does formal care actually mean? Like what are we actually debating here?André Picard: 32:09 Yeah, there was no, there was no real debate. There were a bunch of platitudes that were uttered, but that wasn't debate because they, the parties never defined what they meant. You know, they said, we're going to bring in, in this program, but what exactly is the program going to be? And then, the fact that the Federal parties were debating this, neglecting the fact that ultimately it's up to the provinces, that that was a big problem as well.Kwadwo : 32:32 Excellent. Excellent. So, okay, André, what are your thoughts on medical assistance in dying?André Picard: 32:38 Yeah. So another issue that we took a long time to deal with. So I started covering that issue in the early eighties.André Picard: 32:45 Then it got a lot of steam with the, in the early nineties with Sue Rodriguez kind of died off for awhile and then came back. So that again, we finally brought in this legislation to give people more choice at the end of life to minimize their suffering. So I think that was a really big important piece of legislation. Now the problem was that the legislation was, was flawed and it was inadequate and we, we've got to fix it. So we're at that point now. In fact, a new public consultations have just started about expanding the MAID legislation. So that's going to happen. The court has ordered it, but it's always frustrating with these issues, how slowly we go, how cautious the politicians are. Thank God we have an activist court in Canada. Or we, we'd have much worse health care. Of course, it forced us to do stuff that we know we should do, but politicians are too, too wimpy to do on their own.André Picard: 33:37 So I read the important issue. I think we have to recognize it. Very few people are ever going to get an assisted death. That's going to be one, 2% very tiny percentage. But I think it's a really important philosophical point, a theoretical point that people have choice that end of life. I think that's what's most important about this debate is giving patients more control. And I think that we're going to see that now we're going to see the really tough ones. Does that apply to people with dementia? Does it apply to people with mental illness? Does it apply to children? There's some really, really tough debates coming. But again, I, I stay in my bubble about being pragmatic. I think we have to give people options and then we have to ensure at the same time that there are protections. So that these things aren't abused.Kwadwo : 34:22 So basically what I'm hearing is we can't use this slippery slope argument as a reason not to implement this. People deserve to have that choice in terms of, how they want to end their life.André Picard: 34:37 I don't know how many times I've said in my columns that not every slope is slippery, but I think we actually remember that, that that's kind of a banal argument. Not every slope is slippery there is, we have to have buffers in place to ensure there aren't abuses, but that doesn't mean denying people rights to want them. No one should be forced to take, to have an assisted death when they don't want to. No one should be choosing assisted death for lack of alternatives like lack of Palliative Care, lack of long-term care. That's unacceptable. Not no one should be denied and assisted death who wants it?André Picard: 35:11 Who's making a rational choice? We can do all those three things at once. They are not mutually exclusive.Kwadwo : 35:19 Exactly. In your book "Matters of Life and Death" you touch on transgender issues. Where do you see some of these issues in 2020?André Picard: 35:30 Well, I think it's just an example of what we talked about at the outset, it's an evolution. You know, it's a new patient group, a new demographic that's standing up and being heard, and that the health system has to adjust. This notion of treating gay men was unthinkable in the 70s and 80s, no, they're a bunch of perverts, and we hear a lot of that same when you're around a long time, you start to hear these echoes and we hear that now about transgender, Oh, we can't possibly do that. We can't use different pronouns. Oh, the language has always been the same, but the things evolve.André Picard: 36:03 Language evolves. Medicine has to evolve and I think this is these developments are good. They challenge us, they force us to think differently. Unfortunately, there are abuses or wrongs that happen along the way that forces us to deal with this, but I think it's, it's a very positive development that we're talking about. Like gender fluidity, that the gender is a social construct. I think these are really important things for physicians and few for future physicians to think about and to talk about. And how do they treat their patients well regardless of their gender or how they identify.Kwadwo : 36:38 Super important topic and definitely one for a future episode. André, what about the wait times we're seeing overall whether in emerge or if you're waiting for a hip. Do you see any solutions in the near future?André Picard: 36:55 Yes. So again, I think wait times is the systemic issue.André Picard: 36:58 So it's about creating more flow in the system. It's about breaking the bottlenecks. You know, as we talked about earlier, at the long rates in our emergency rooms have very little to do with emergency care, right? They're all about bottlenecks. It's about inability to admit people, inability to, to get people out of hospital. We have this perversity in Canada called the ALC patients, (alternate level of care) patients who live in hospitals. I've done stories about this. I met a patient who's been living in a hospital for 10 years because there's no alternative for them. This makes no sense. It makes no sense from a business perspective and makes no sense from a patient care perspective. Ethically, all these things are wrong and we have to fix them. But you know, in some provinces, one third of all hospital beds, are ALC patients. They are people who have been discharged but have nowhere to go.André Picard: 37:51 So these are, this is how you deal with wait times is you deal with things across the spectrum. No easy solution. It can't be overnight, but we have to correct the errors we've made of of bad planning. You know, we all, we hear often and over and over again, Oh well,it's the aging boomers. You know, that's what's overwhelming our system. We've known about the boomers for 60 years. No surprise here. It's just a bad planning, lack of foresight. And we have to fix it.Kwadwo: 38:20 Agreed. But what can we do now? Like if I'm, you know, the Minister of Health or I'm a lead for a health authority and I got these tons of ALC patients, what can we do?André Picard: 38:33 Well, I think, again, if look at it and say from a business perspective, what do you do in a business if you have this problem? You have a mixture of carrots and sticks.André Picard: 38:42 So you start punishing hospitals that have ALC patients. Why did patients, you know, that perversity is that hospitals actually like having ALC patients because they require less nursing care. They're understaffed on nursing. They get paid the same amount of money, require less care. So it's actually a good thing for them, which is wrong. It shouldn't be a good thing. So you have to punish them financially. And that will solve the problem pretty quickly. They'll get them elsewhere. We have to incentivize people to have more long-term care homes. Most of our long-term care homes are private businesses and we have to ask ourselves why people don't go into this business. That's because the rates suck , it's because there's way too much regulations. We have to make it easier for people to provide spaces for people who need it. And then we have to deal with the other pieces of the puzzle, which is home care.André Picard: 39:30 I think we've, put far too many resources into people getting home care just to get them out of hospital quicker from short-term surgery and we haven't invested enough in the chronic part of the puzzle. So again, from a business point of view, way cheaper to care for those ALC patients in their homes costs a fraction of the cost. So take that money and use it differently. And if you don't do that, then you're going to be punished. So the carrot and stick approach, all this stuff is solvable. And I know it's solvable because I see, I don't see these problems in other countries around the world.Kwadwo: 40:05 Interesting. We kind of talked a bit about how to create change in healthcare and you do bring up the carrot and the stick. And I mean money talks. One of my main incentives to do research around costs is because that's the language that that's a change language.Kwadwo : 40:24 That's the language of administrators, of politicians. So if you could show a financial benefit for any intervention, like that's when things actually start to move. And so withholding funds so that change can occur. You know, I think it can go a long way, but certainly just sticking with the status quo is not good enough.André Picard: 40:48 But I would add the proviso that if you're going to have carrots and you're going to have sticks. People have to have accountability and they also have to have power. So you can't punish a hospital for having ALC patients, but not giving them the power to resolve it. I think, again, when you have a regionalization is supposed to be the solution to this, right? So the way a regionalization is supposed to work is that they should say, here's our overall budget. We're not spending it well by having these people living in hospitals, we should spend it on home care or we should spend it on long-term care facilities. So you have to have the power to move that money around and that that's how the issue will get resolved. Ultimately give people, accountability and power to fix things.Kwadwo: 41:29 I love it. You know, trusting in the people that you've invested into, trying to make the healthcare system better.André Picard: 41:36 We pay healthcare administrators a lot of money, let them administer.Kwadwo : 41:40 Mmm, no, that's, that's a great point, André. One thing I like to do is always end on a positive note and allow our guests to talk about a story or a time where they've felt that your job has had a big impact in general. And you did give this story earlierKwadwo : 42:00 about, um, you know, the AIDS patient in Toronto, but is there an any other time where you felt that you covering health care and being as engaged as you have been, that you've really made a difference?André Picard: 42:16 I think there's all those little stories like we talked about, you know, the one patient who, who got better care because of your story, little policy changes. Those are always moving. But to me there, to me, there are two big things in my career that stand out. I wrote for a long time about the tainted blood tragedy. So this came out of my coverage of AIDS. I started covering, you know, there were four groups who were infected with AIDS and one of them was always forgotten. This little group of hemophiliac and transfusion patients. So we started focusing on them and this became, this became a huge story. It became an exposure of one of the worst, probably the worst public health scandal in Canadian history. About 30,000 people were infected with HIV and hepatitis, not because of mismanagement of the blood system, because of lying to people because et cetera.André Picard: 43:06 I have a whole book length version of this rant, but, that issue that the tainted blood issue I think is one of my proudest moments because it really did bring relief to a lot of people. There was more than $5 billion in compensation paid out. Ultimately, our drug regulation system changed profoundly as a result of that. And I'm not taking credit for that solely, but we did get the ball rolling. So I think that's really important story in my, my legacy, if I could put it that way. And there's another one very similar, but on a smaller scale that a very touching one was a work that I did with my colleague on the, thalidomide survivors. So there's a group of five people who are affected by thalidomide in the 1950s, sixties, left with, you know, missing limbs, et cetera.André Picard: 43:54 Those folks live the long time suffering in poverty. And we came back to that a few years ago and wrote about these forgotten survivors. And again, the result was a quite a large compensation package. People getting their lives back, people who are forgotten, you know, we got to tell their story. And there's a lot of, a lot of touching, touching stories as a journalist to hear from that and when you actually change people's lives. So those are two of the biggies for me. But all the little ones day to day, you know, they, they keep you going.Kwadwo : 44:27 Yeah, no, I got to tell you, André, it's truly is a privilege to be able to have this conversation with you. And I could truly echo the amazing, inspiring work that you've done over the years that has impacted Canadians and people worldwide and given people a voice, increasing awareness on many health care related issues. And I got to tell you, I learned a ton today. You know, I got no political, no policy, game. I'm not educated from that front, but the things we talked about today was super eye-opening, especially like the silo stuff and the regionalization aspect of, of things like the way you framed it. And it's just, I don't know, there's a lot to digest and a lot to think about, but, you know, I'm hoping my listeners are feeling similar to me and feeling pretty inspired and I'm truly grateful that you took some time to do this and I hope to have you on again.André Picard: 45:30 A pleasure. And you know, I always remind people, you know, I, my job is to sort of summarize and to translate all this. I meet all these brilliant people and my job is sort of steal their ideas and make them pithy and accessible to the public. So I can't forget that I know nothing. I learned all this stuff from other people and I think my only skill is really being able to boil stuff down and simplify it and hopefully communicate it in a way that people can understand and act on.Kwadwo : 45:55 Yeah. Well I'll tell you it's working. Awesome. André, thank you so much. There's going to be links to all your books, your Twitter handle, everything in the show notes and, thanks again for doing this.André Picard: 46:07 Thank you. I look forward to it.Kwadwo: 46:09 Thank you. Thank you so much for listening to Episode 14 with André Picard. I hope you all enjoyed it. If you guys want to follow him on Twitter, it's @picardonhealth. If you want to follow or support this show on Facebook, on Twitter, on Instagram at Kwadcast, you could send comments to Kwadcast99@gmail.com and please let us know how we're doing. We were looking to always improve on the show, the five star rating on iTunes. If you're up for it, leave a review. Thanks again guys. We'll talk soon.  Please send your comments/feedback to kwadcast99@gmail.com

Natalie Mehra executive director, Ontario Health Coalition talks about the province ignored repeated warnings and evidence leading to Declaration of “State of Emergency” in Brampton hospital,similar issues apply across Ontario   

Massive changes are coming to Ontario healthcare. Bill 74, The People’s Health Care Act, will merge Ontario's 14 LHINs and other prominent health organizations under a single umbrella known as Ontario Health. Will this be Ford's great move to end hallway medicine? Intro song written by Shaan Singh. Intermission music: Takin' You For a Ride by Pandrezz and Birthday Girl by Blue Wednesday End music: Takin' You For a Ride by Pandrezz, more music at: http://chillhop.com/listen

Libby Znaimer is joined by Ontario Deputy Premier and Minister of Health, Christine Elliott. This morning, Health Minister Christine Elliott announced that Mississauga Health is the first to establish an integrated health team as part of the province's broader plan to fix the healthcare system. Listen live, weekdays from noon to 1, on Zoomer Radio!

SEX! Now that I have your attention, here comes Episode 10 of Poutine Politics! When the Progressive Conservatives were elected in Ontario in June 2018, one of the items they ran on was to reform the health & physical education curriculum (including sexual education, which is basically the only part anyone focused on...) for the public school system. After a repeal process that left many people feeling bitter and a consultation process that left many people confused, the new curriculum has been introduced, leaving the rest of the people frustrated. But is it really all that bad? Are the changes being overblown, just like many things in the media? Mike and Adam delve into the "sex-ed" curriculum and give you their thoughts!

Today the Ford government made a cabinet shuffle. This move comes just after a year since the Ontario Progressive Conservative party won the election with a majority government. The shuffle comes as Premier Ford falls in the polls. Jane Brown is filling in for Libby Znaimer. She speaks with Bob Richardson, Senior Counsel to National Public Relations; John Mykytyshyn, Conservative Activist and Political Consultant; and with NDP critic, Marit Stiles, to comment on layoffs across Ontario Health agencies being initiated by the Ford government.

John Humphrey speaks with Devorah Goldberg from the Ontario Health Coalition about the current threats to our public healthcare system under the Ford government.

Peter Weltman, Financial Accountability Officer of Ontario talks about Ontario Health Sector: 2019 and an Updated Assessment of Ontario Health Spending

Alex is joined by Francesca Grosso, Co-author of Navigating Canada's Healthcare - A User Guide to Getting the Care You Need, to discuss the Ford government's plan to consolidate Ontario's local and provincial health networks, in order to create a central agency as part of a system overhaul. Legislation introduced Tuesday would create a new agency, called Ontario Health, to consolidate the 14 local health integration networks, Cancer Care Ontario, eHealth Ontario and several other agencies.

Ontario's Health Minister Christine Elliott has announced that local and provincial health networks will be merged into one super agency as part of the government's plan to overhaul the health care system.

We learned today what health care will look like as Doug Ford's Tory government unveiled sweeping changes to the province's health care system. Multiple government sources had earlier confirmed that Health and Long Term Care Minister Christine Elliott was to reveal details of the creation of a healthcare super agency with plans to dissolve the province's 14 Local Health Integration Network's (LHINs). The LHINs currently manage funds for hospitals, long-term care homes, and community health centres. Early in February, the NDP leaked a government draft bill which first revealed the super agency plan. At the time, Elliott said the bill was "just a draft" and that the NDP were "fear mongering" when it came to concerns they raised about potential privatization of services. In the days that followed, it was revealed that cabinet had already approved various actions as part of the new healthcare plan. Today the plan was announced. Libby spoke with Francesca Grosso, Principal, Grosso McCarthy Strategy; Peter Tabuns MPP (NDP Toronto

Think back to your first sexual education experience. What did you learn? Who taught you? How has your understanding of sex, sexuality, and gender changed as you got older? In this episode of Raw Talk, we explored these questions and more. Toronto District School Board teacher, Laura Brown, shared her thoughts on changes to the Ontario Health and Physical Education Curriculum. AIDS Committee Toronto worker, Alex Urquhart discusses PrEP as a revolutionary medication in the gay community. We also had some fun with Dr. Jessica Maxwell chatting about her PhD and current postdoctoral work on relationships and how to boost sexual well-being and satisfaction. Finally, we brought back Dr.Gillian Einstein, who walks us through the biology and neuroscience behind sexual differentiation, and what science says about both sex and sexuality existing on spectrums. Written by: Melissa Galati Links and Resources: Episode 31: Sex, Gender, and the Brain University of Toronto Sexual Education Centre Walt Disney - The Story of Menstruation (1946) Ontario Health and Physical Education Curriculum (2015) Ontario Health and Physical Education Curriculum (1998) Testosterone Rex by Cordelia Fine Closer by Sarah Barmak AIDS Committee Toronto The lived experiences of female genital cutting (FGC) in Somali-Canadian women's daily lives (article) Sex beyond genitalia: the human brain mosaic (article) Male or Female? Brains are intersex (article)  

Think back to your first sexual education experience. What did you learn? Who taught you? How has your understanding of sex, sexuality, and gender changed as you got older? In this episode of Raw Talk, we explored these questions and more. Toronto District School Board teacher, Laura Brown, shared her thoughts on changes to the Ontario Health and Physical Education Curriculum. AIDS Committee Toronto worker, Alex Urquhart discusses PrEP as a revolutionary medication in the gay community. We also had some fun with Dr. Jessica Maxwell chatting about her PhD and current postdoctoral work on relationships and how to boost sexual well-being and satisfaction. Finally, we brought back Dr.Gillian Einstein, who walks us through the biology and neuroscience behind sexual differentiation, and what science says about both sex and sexuality existing on spectrums. Written by: Melissa Galati Links and Resources: Episode 31: Sex, Gender, and the Brain University of Toronto Sexual Education Centre Walt Disney - The Story of Menstruation (1946) Ontario Health and Physical Education Curriculum (2015) Ontario Health and Physical Education Curriculum (1998) Testosterone Rex by Cordelia Fine Closer by Sarah Barmak AIDS Committee Toronto The lived experiences of female genital cutting (FGC) in Somali-Canadian women's daily lives (article) Sex beyond genitalia: the human brain mosaic (article) Male or Female? Brains are intersex (article)  

Natalie Mehra, executive director Ontario Health Coalition talks about health care chaos  

Sara Labelle, Board Member and spokesperson Ontario Health Coalition talks about an NDP leaked draft on health care legislation

#metoo has been changing how we see and react to harassment for some time now -- but what is the definition of harassment? Let's take a look at the Ontario Health & Safety Act with Workplace Law instructor Colleen Dempsey.

Healthcare is one of the hot button issues for this upcoming provincial election. The Ontario Health Coalition is in Hamilton today to discuss these issues. Guest: Natalie Mehra, Ontario Helath Coalition.

Alex Pierson speaks with radiologist and Coalition of Ontario Doctors co-founder Dr. David Jacobs about the report from the Financial Accountability Office saying that even with an additional $6.9 billion of planned health spending over the next three years, Ontario is not keeping up.

Long term medical and non medical care for those who can no longer live independently.

Long term medical and non medical care for those who can no longer live independently.

A collaborative health care approach to deliver primary care for complex care needs.

A collaborative health care approach to deliver primary care for complex care needs.

A new approach to health care working with patients and doctors to streamline the process and makes it easier and more efficient to get health care they need.

A new approach to health care working with patients and doctors to streamline the process and makes it easier and more efficient to get health care they need.