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BCMJ -#51Vol6-July-09-July.Qxp personal view limiting consumption of albacore 2 Letters for Personal View are welcomed. tuna. HealthLink BC and Health They should be double-spaced and few er Canada have set different serving than 300 words. The BCMJ reserves the limits and age categories in their fish right to edit letters for clarity and length. consumption recommendations. The Letters may be e-mailed (journal@bcma recommendations also differ some- .bc.ca), faxed (604 638-2917), or sent what from those of the State of through the post. Washington and the US FDA/EPA.3 One of my associates, Dr Laurie Chan, chair of Aboriginal environ- mental health at UNBC, has told me Flu protection for the accompanying document for “In - that cheaper light tuna tends to have fection Control Guidelines in Acute an Hg level 5 times lower than that physicians Care Facilities,” www.phac-aspc.gc found in albacore tuna.4 have recently moved from Ontario .ca/alert-alerte/swine-porcine/ I would sincerely like to know the to BC in rural family practice. I guidance-orientation-ipc-eng.php. background, rationale, and references Iwork in the clinic and hospital The BC Ministry of Health Ser- used by the Ministry of Health and the full-time in Invermere, BC. vices is not planning at this time to CDC to make this recommendation. I In Ontario every doctor’s office follow the Ontario decision to supply remember listening to Ray Copes in a was supplied with a stock of protective physicians’ private offices with pro- meeting one day, and he mentioned masks, gowns, etc., after the deaths of tective equipment as the ministry Continued on page 240 doctors, nurses, and paramedics in the believes it is properly the responsibil- SARS outbreak in Ontario. ity of the physician to ensure that What are the BCMA and the Min- infection control practices are in place istry of Health doing to protect front- in these offices. Liquid Nitrogen line health care workers from the next At the request of Canada’s minis- for Medical Use pandemic outbreak? ters of health, a national advisory Westgen has been providing Liquid Nitrogen Will we be supplied with protec- group reviewed the issue of providing to doctors for the past 10 years. We have tive equipment since we are asked to antivirals as prophylaxis during a pan- established a reputation for prompt, quality deal with these patients in our offices? demic and recommended that govern- service at a reasonable price. Will we be supplied with prophylactic ments not do this. Rather, they empha- We also offer MVE Cryogenic Refrigera- tors in 10 and 20 litre sizes. These can be antivirals for exposed heath care sized that government’s antiviral acquired on a one year LEASE TO OWN workers? stockpiles, with few exceptions, option, a system that allows you to own your —Stephen Arif, MD should be reserved for early treatment tank after a year of low monthly payments Invermere of infection during a pandemic. This which includes free liquid nitrogen for the report and its annexes can also be lease period. The Provincial Health accessed at the Public Health Agency MVE Cryogenic of Canada web site. Refrigerators Officer replies —Perry Kendall, MD • No Stop Charge n response to Dr Arif’s enquiry, I Provincial Health Officer • No Cartage Fees • No Dangerous would refer all BC physicians to Goods Handling Ithe recently posted documents on Charges the Public Health Agency of Canada Why differences in • Lease to own web site, “Interim Guidance—Infec- tuna limits? option Service provided to practitioners on Vancouver tion Prevention and Control Measures ith respect to canned tuna Island, Lower Mainland and Okanagan area. for Health Care Workers in Ambula- in Canada, HealthLink BC For more information contact Westgen at: tory Care Facilities for Human cases W Files recommend that Bri - 1-800-563-5603 Ext. 150 or 778-549-2761 of Swine Influenza A H1N1,” www tish Columbians limit consumption of .phac-aspc.gc.ca/alert-alerte/swine- all types of canned tuna1 whereas porcine/hp-ps-info_amb-eng.php and Health Canada currently recommends www.bcmj.org VOL. 51 NO. 6, JULY/AUGUST 2009 BC MEDICAL JOURNAL 239 personal view Continued from page 239 4. Burger J, Gochfeld M. Mercury in canned regarding mercury risk do not apply that he had come across a case of Hg tuna: white versus light and temporal well in the BC context. For British poisoning in a boy that was related to variation. Environmental Research 96 Columbians, information on local pat- some higher-than-normal Hg levels in 2004:239-249. terns of fish consumption, local levels some canned tuna. Is the recommen- of mercury in different fish species, dation based on this incident? I would and local risk factors for elevated blood also like to know which government COHP replies mercury were carefully considered. agency should be looked to for conta- he recommendations in the In addition, the BCCDC and the minant consumption advice. HealthLink BC files have been MOHS categorized the mercury level —Karen Fediuk, RD Tdeveloped based on BC and in different fish species into low (<0.1 Canadian evidence and data indicat- ppm), moderate (between 0.1 ppm and References ing safe and at-risk human body mer- 0.5 ppm), and high (>0.5 ppm) mak- 1. HealthLink BC Health Files. Healthy Eat- cury levels and consumption levels. ing them easier to understand. Health ing: Choose Fish Low in Mercury. The BC Centre for Disease Control Canada has one regulatory cut point www.healthlinkbc.ca/healthfiles/hfile68 (BCCDC) and the Ministry of Health of 0.5 ppm of mercury and has recom - m.stm (accessed 19 February 2009). Services (MOHS) agree with Health mended consumption limits for fresh 2. Health Canada. Mercury in Fish. Con- Canada’s review of mercury toxicity and frozen tuna and canned albacore. sumption Advice: Making Informed levels and the guidelines limiting mer- Health Canada states that canned alba- Choices about Fish. www.hc-sc.gc.ca/ cury to below 1.0 ppm and 0.5 ppm core tuna has higher mercury levels fn-an/securit/chem-chim/environ/ for most fish and shellfish species than other types of canned tuna and mercur/cons-adv-etud-eng.php sold in Canada. But because BC fish therefore does not recommend limits (accessed 19 February 2009). consumption patterns are unique in for consuming other types of tuna. The 3. Washington State Department of Health. Canada and there is regional variation BCCDC and MOHS support group- Fish Facts for Healthy Nutrition. www in mercury levels in the fish available ing all canned tuna, including alba- .doh.wa.gov/ehp/oehas/fish/fishadvisori to consumers across Canada, Health core, into the moderate category. es.htm (accessed 19 February 2009). Canada’s fish consumption guidelines Continued on page 243 The Software BC Specialists Prefer POWERFUL,INTUITIVE,FLEXIBILE x WEBAccess x WaitLists 7%ofGeneralSurgeons x SpecialistForms/ x Inbox 7%ofInternists Templates x Billing 8%ofDermatologists iUserͲdefinable x MedHx Accuro Mobile 8%ofNeurosurgeons Shareable library Tracking i x iPhone 8%ofOtolaryngologists with 1800+ forms Forms x x 9%ofNeurologists x LetterGeneration x Tasks/Mail x Blackberry 13%ofSurgicalSpecialists x Labs/Imaging x Scheduling x Smartphone 13%ofUrologists x DataConversion x RX 13%ofOphthalmologists x ChronicDisease x Reporting 14% of Obstetricians and Management x Charting Gynecologists 16%ofOrthopaedicSurgeons ForaProduct 19%ofEndocrinologists Demonstration hasconsistently 21%ofThoracicSurgeons shown Accuro EMR as the site’s 29%ofPlasticSurgeons 1Ͳ866Ͳ454Ͳ4681 #1HighestRankedEMRin2008/2009. [email protected] 35%ofGastroenterologists www.CanadianEMR.ca www.OptimedSoftware.com 40%ofNephrologists 240 BC MEDICAL JOURNAL VOL. 51 NO. 6, JULY/AUGUST 2009 www.bcmj.org bcmd2b personal view to ensure that the rural clerkship Continued from page 240 ical school with no reference back to remains a sustainable program, we The types of recommendations existing resources (i.e., UBC) makes encourage you to find out more can be confusing, especially between little sense from a time or resource about the initiative and get involved the different canned tuna, and fresh point of view. Our peak need for in any way you can. and frozen. Since the BCCDC and the physicians will hit between 2010 and The rural medicine clerkship is MOHS have focused on local fish and 2030 as the baby boom makes a tran- a valuable program that will help local risk factors, their recommenda- sition from age 65 to 85. After that, to increase the number of physi- tions may be more appropriate. the load on the health care system cians choosing to practise in rural —Shefali Raja, BSc, RD decreases. UBC is currently on track and northern BC. Nevertheless, in Nutrition Committee, to local and distant expansion across order for this important initiative Council on Health Promotion the province. It is accredited and offers to succeed, the students need the programs both through a traditional support of the medical communi- model and an apprenticeship-type ty. With this support, we can work Re: BC needs another model at sites in the Lower Main land, together to ensure that the future of medical school Vancouver Island, Prince George, presently underserved communi- hile I agree with Dr Mur- Chilli wack, and, coming very soon, ties is improved. ray’s basic assertion that Terrace, Kelowna, Kamloops, and W BC could be graduating Fort St. John. References more MDs (“BC needs another med- You would have to build a massive 1. Stewart MA, Bass MJ. Recruiting ical school,” BCMJ 2009;51[4]:150), infrastructure, both in terms of physi- and retaining physicians in northern I would first suggest a recheck of cal buildings and people, become Canada. Can Fam Physician 1982; the statistics.
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