CMAJ: Who should hold the keys to your DNA?

Editor’s note: Third of a multipart series on genetic testing.
Part 1: Separating hype from reality in the era of the affordable genome (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4143).
Part 2: Popping the genetics bubble (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4142).
Next: Race and genetics in the doctor’s office



CMAJ: Who should hold the keys to your DNA?

"Opinion is divided over whether doctors or patients should be receiving the results of direct-to-consumer genetic tests........."

"“I think there is a need to think this through and to have some balance. On the one hand, we should respect consumers’ preferences and freedom to choose,” says Peter Neumann, director of the Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston, Massachusetts and lead author on the paper. “We should also inform them about the risks and benefits.”
In some countries, governments have stepped in to ensure that doctors are the ones who must inform consumers about risks and benefits. Laws in France, Germany, Portugal and Switzerland stipulate that genetic tests only be administered by physicians. There are no regulations in Canada and few in the United States, though the US Food and Drug Administration has indicated that it will be stepping up efforts in the area...." 

CMAJ: Letter in response to Canadian Breast Cancer Guidelines/link to guidelinesBreast cancer guidelines

• Letters

Breast cancer guidelines

Ian Grant-Whyte, MA MD, Retired physician

There is often no rhyme or reason as to who gets breast cancer. Mammograms have detected many malignancies in women in their 40s who have many years of life ahead of them: wives, mothers, daughters, coworkers and friends.

Given that mammography is a cornerstone in our ability to save women’s lives from breast cancer, which is a leading cause of death among women between the ages of 40 and 49, the Canadian Task Force on Preventive Health Care’s guidelines that appear in the Nov. 22, 2011, issue of CMAJ1 are absolutely unconscionable.

The guidelines1 could result in fewer women getting screened and a return to the days when we caught cancers only when they were big enough to feel. Without mammography, many women would not be candidates for treatment. You cannot treat a tumour until you find it.

Have you any idea how breast cancers can metastasize in two or three years? Have you ever visited a loved one in a hospice? This is not the time to turn back the clock. Finding a tumour late often leads to a poor prognosis.

Mammography has a proven track record, and we as doctors “must do no harm.” By jettisoning this life-saving tool, we are indeed harming the patient.

Reference

1. ↵
   1. Tonelli M,
   2. Gorber SC,
   3. Joffres M

   ; The Canadian Task Force on Preventive Health Care. Recommendations on screening for breast cancer in average-risk women aged 40–74 years. CMAJ 2011;183: 1991–2001.

   FREE Full Text

The Elephant in the Canadian Health Care System | thepatientfactor.com

CMAJ:Ontario doctors to get break in liability fees + other news

"Average charges for doctors in Quebec will rise 11.1% to $4332, while charges for doctors in the rest of Canada will rise 11% to $2670."

"The CMPA’s annual report indicates that of 891 civil legal actions commenced in 2009, 101 went to trial but only 19 of those saw an outcome favouring a plaintiff. Some 319 actions were settled, while 522 were dismissed, discontinued or abandoned."

“Last year as a nation, we spent $183 billion on our health care. And what did that get us? It got us ranked second-lowest among advanced countries in terms of value for money in health care.”

CMAJ - Patient charters: the provincial experience (1st part of 3) CMAJ

CMAJ Editor’s note: 
First in a series on patient charters
Tomorrow: Patients advocates say charters are an unnecessary distraction
Thursday: The international experience

Value of medical practice guidelines questioned - Canadian Medical Association Journal