Philip Jong

Last month the American Medical Association (AMA) rejected a controversial proposal to classify video game addition as a mental disorder. As both an avid gamer and a health professional myself, I applaud the decision by the AMA to instead recommend that more rigorous scientific research be done to study this phenomena (or epiphenomena). I make no claim to have any medical knowledge on addiction; still, I find it troublesome to label the overuse of video gaming as an addiction akin to alcohol or drug addiction. This is because the mere overuse or overindulgence of an activity, such as video gaming, cannot by itself define it to be an addiction. Not only such an act wrongly promotes a societal stereotype (of a video game “junkie"), the act of labeling (someone to have a disease when there is none) may even be medically harmful. It may lead to a misdiagnosis of an underlying illness (mental or physical) for which so-called video game addiction is simply an epiphenomena or a mere sign of an undiagnosed disease. Undoubtedly, there are rare cases of individuals (particularly adolescents) reported by the mainstream media in whom playing video games has led to addiction-like behaviors. In these cases, however, it is more (or equally) likely that these individuals are suffering from some other legitimate mental disorders for which playing video games has simply become a platform for the underlying disease to manifest. In other words, until science can validate such claims, diagnosing video addiction today may be akin to diagnosing “female hysteria” centuries ago, a practice that once led to the ludicrous use of pelvic massage to treat a phantom disease.

Earlier this month the city of Toronto saw the opening of the Medicor Cancer Centre, a for-profit private clinic that provides cancer patients with medical services in return for a charged fee. Proponents claim that the clinic acts primarily as an advocate for cancer patients and its services rendered do not infringe the laws of the Canada Health Act. Opponents argue that the establishment of such a clinic merely creates a two-tier health care system that violates the spirit of universal healthcare in Canada. The center includes a team of medical physicians, naturopathic doctors, counselors, dieticians, physiotherapists, massage therapists, and other ancillary healthcare providers. To the clinic’s credit, while many (if not all) of these services are readily available to cancer patients free of charge via other means (such as through the Canadian Breast Cancer Foundation), the convenience of one-stop “shopping” and the perceived continuity of care (including 24-hour access to a physician from the center) offered by the clinic may be appealing to cancer patients who can afford such care and who do not want to be burdened by the need to arrange similar services for themselves while battling their disease. However, the autonomy of an individual to choose private over public care must be carefully balanced by the potential abuse of these alternative care pathways that may undermine the equality and rights of all Canadians to receive appropriate and timely health care. It should also be noted that the clinic does not offer essential cancer services such as chemotherapy, radiation, and surgery. As such, the public must be made aware that the care provided by this clinic is not meant as sole substitute for traditional medical care delivered to cancer patients by public healthcare. Regardless of the ethical dilemma that is raised, this is a clear demonstration that health and wealth are inescapably intertwined.

For some individuals who are at risk of heart disease, the Christmas holiday season can be a dangerous time for their health. Past epidemiological studies had founder higher incidences of heart attack and heart failure during the winter season as compared with the summer season. Today, Canada’s national newspaper The Globe and Mail published a story on the syndrome that was dubbed the “Merry Christmas coronary” and the “Happy New Year heart attack.” In it, the column cited studies from the US and France but also data from our own research group in Canada to which I belong. The phenomenon is of great public health interest because it remains unclear what preventable measures can be taken by the population to reduce the risks of cardiac morbidity or mortality during the winter season. While the colder outdoor temperature is an obvious potential culprit responsible for the holiday “woes” of the heart, many other environmental factors as well as the behaviours of the population are also likely to be at play. Moreover, I had suggested that it might be the response of the population to the changing environment that is more of a determinant of risk than the actual environment where the population is currently inhabited. For example, the story cited our data showing that the increase in heart attack and heart failure rates is paradoxically higher in Southern than Northern Canada, despite the fact the climate in the north is colder than the south. Future studies should help to discover the underlying causes of this winter danger and derive appropriate public health measures. In the meantime, the public should heed to the advice of the Heart and Stroke Foundation of Canada and use common sense to minimize risky behaviors that may increase the risks of having heart attack or heart failure.

The adoption of Canada Health Act in 1984 establishes the provision of universal healthcare in providing essential medical services to all Canadians without economic or access barriers. It forbids health professionals and institutions from rendering priority medical care to individuals in return for financial compensation. For the past two decades, our universal healthcare system remains to be a pinnacle achievement by Canada in attempt to deliver efficient and cost-effective medicine. Still, the merit of public versus private healthcare has been an ongoing debate between proponents and opponents of our current system.

More recently, co-operative medicare has been promoted to be the ultimate savoir of our degenerating healthcare system, where public medical care coexists with limited priority medical care that are available to individuals who are willing to pay for “extra” service. Proponents argue that the establishment of such two-tiered system will jeopardize neither quality nor equity of medical care for Canadians. Yet, it is unclear at present how such protection can be guaranteed. In the US, variations in quality of medical care have been linked to the coexisting delivery of managed care and public care. Last month, Canadians witnessed the opening of Canada’s first private primary care centre in Vancouver, British Columbia. The Copeman Healthcare Centre offers services to primary care physicians and in-house specialists for an initial enrolment fee and an annual service charge. Last week, Vancouver’s Cambie Surgical Centre announced plans to open a for-profit surgical hospital in Ontario. As a healthcare professional myself, I believe the prima facie proof must always be the delivery of timely quality medical care to “all” people who seek such service, regardless of what healthcare system or systems may ultimately be employed. If co-operative medicare is to be instituted, the ethical ramification and resource repercussion must be thoroughly explored by all key stakeholders (not just those who may benefit) before it should be made available to Canadians.

On September 25, an outbreak of respiratory illness began in a nursing home in Toronto, Canada. When neither the source nor the etiology of the outbreak could initially be identified by public health officials, media and public attention quickly grew on the developing outbreak. News agencies in the US and worldwide began to compare the virulent outbreak to that of SARS in 2003, despite no medical evidence existed to suggest the pathogen was that causing SARS. As the death toll from this outbreak rose, public fear was further heightened by the suggestion that a new or mutated virus might be the cause. A disconnect began to grow between the “real” truth and the “perceived” truth of the outbreak.

When the cause was finally identified to be due to Legionnaires’ disease, a known and not uncommon respiratory illness, the gap between these two versions of truth had grown so large that many of the public could no longer tell apart the factual and frictional elements of the outbreak. Proper delivery of public health must involve more than the prevention and treatment of diseases, but the education of the public (and the media) so that unjustified speculation and fear will not run rampant as they had during this public health crisis.

These days I see many infomercials and ads on television selling “miracle” pills that promise to cure a wide variety of ailments. Among the common health miracles made by these advertisements are promises such as weight loss, hair growth, and pain relief. These pills are sold as nutritional or dietary supplements in order to avoid the strict regulations existed in many countries that forbid false health claims and advertisements of pharmaceutics to the public. While government agencies had been successful in prosecuting many unscrupulous vendors and removing these offended products, the legal process was often slow and could not protect the public from the next “false” drug or “miracle” cure. Moreover, special interest groups in many countries had successfully lobbied their governments against the need for these supplements to provide the same level of scientific proofs to support their health claims as traditional pharmaceutics.

As a health professional myself, I see little difference between traditional drugs and so-called supplements. Any substance that is given outside of its natural form or concentration or extracted for the purpose of consumption for a health problem is a pharmaceutic, regardless of the origin and nature of the active ingredient. Even water can be toxic to the body in non-physiologic amount. In other words, there should only be one dividing line for all health products—ones that work and ones that do not work. Any other divide serves little to protect the public’s health.