Open Government leads to more transparency?
Canada’s Open Government strategy provides Health Canada with an opportunity to embark on transformational change focused on improving transparency. See Editorial, page 641
Ending life and end of life
Before Canada can legalize assisted suicide, it must ensure equitable access to palliative care for those who need it. Shariff uses a human rights framework to argue that people nearing the end of their life may be short changed by a move to legalize assisted suicide and euthanasia. See Commentary, page 643
Triage of patients with a charted history of depression
Patients with acute myocardial infarction who also have a charted history of depression are more likely to be given lower priority for treatment in the emergency department. This is the finding of an analysis of the hospital charts of 6784 patients discharged from hospital after acute myocardial infarction. Emergency department staff need to be made aware that heart disease is more common — not less common — in people with depression, and they need to differentiate between anxiety and depression, say the authors. See Research, page 663
Biased economic analyses
Economic analyses with industry involvement made assumptions that favoured their new tests over the standard Papanicolaou (Pap) test. Polyzos and colleagues reviewed cost-effectiveness analysis studies and examined their assumptions of the sensitivity and specificity of the Pap test, while comparing the degree of industry involvement as reported in the studies. The authors suggest adherence to guidelines for reporting economic analyses and more funding from public or private foundations without industry ties. See Research, page E337
Optimal body mass index for Chinese people
The association between body mass index (BMI) and mortality is U-shaped among adult Chinese people, with the lowest risk of death occurring among those with a BMI between 24 and 26. This finding is based on a 10-year cohort study involving more than 100 000 Taiwanese adults who attended national health screening centres, where basic health information was collected. On the basis of these findings, there is no need to suggest lower BMI cutoff values for obesity and overweight for Chinese adults, say the authors. See Research, page E329
This study suggests a U-shaped association between BMI and all-cause mortality among adult Chinese people as opposed to the generally observed J-shaped association. The findings suggest a higher BMI than the currently recommended cutoff for defining overweight and obesity in Asian populations. See Commentary, page 645
Alternatives to the drug patent system
Aspects of the current drug patent system impede the development of first-in-class drugs, while rewarding the development of “me too” drugs, report Paul Grootendorst and colleagues. The authors propose promising alternatives, including public subsidies of basic research and phase III clinical trials, as well as impact-based and royalty-based rewards for new drugs. See Analysis, page 681
Bowel obstruction and pelvic mass
A 42-year-old woman presented with symptoms consistent with bowel obstruction. On examination, she was found to have left adnexal fullness, and computed tomography confirmed a large bowel obstruction secondary to a 7-cm rectosigmoid mass. What is the next step? See Practice, page 686
HIV transmission from mother to child
A 29-year-old woman with a positive prenatal HIV test was prescribed highly active antiretroviral therapy and followed closely during pregnancy, delivery and postpartum. At 13 months of age, her baby tested positive for the same HIV subtype as the mother’s. What went wrong? See Practice, page 690