dr day: hospitals need to wise up
Your article "Experts duke it out over how to fund our hospitals" (February 15, Vol 3, No 3, page 40) is excellent. Proponents of the status quo will always fight for the status quo. One of the future developments is that "health policy experts," who base their views mostly on Op Eds written by themselves and like-minded colleagues, are likely to be displaced as true evidence-based reforms are introduced. Academic institutions such as the new UBC's Sauder Business School's Centre for Health Care Management, with expertise in basic and practical economic and business theory, will displace health policy groups who promote theories that are largely ideology based. We saw what Robert Evans and colleagues did for medical school enrollment with their theory that too many doctors and nurses were the driver for rising health costs.

It's no coincidence that the report of Senator Michael Kirby, a PhD in mathematics who applied simple logic and basic internal marketing principles, came out solidly in support of patient-based funding (PFF). In late October of 2006, the updated OECD report also came out solidly in support of it. Of course there must be safeguards in place, and it's not a panacea. Smaller rural hospitals can actually outperform large institutions, although the opposite has been claimed. We're very lucky to have the British experiment to learn from.

Dr Brian Day, CMA President-Elect, Vancouver, BC

INTERNATIONAL INCIDENT
Shame! Your article "Metabolic Syndrome wreaks heart havoc" (February 15, Vol 3, No 3, page 10) uses US units! How can a Canadian medical review do this?

It's not rocket science to convert triglycerides, cholesterol and glucose from mg/dL to mmol/L. Divide triglyceride by 88, cholesterol by 38 and glucose by 18. Several programs do this automatically. Why bother with such an article in mg/dL? Amazing US bias — I am appalled.

Dr Mark S Silverman, Ottawa, ON

Editor's response: We're most decidedly Canadian-biased at NRM. Here are the SI units as they should have appeared:

• raised triglyceride level: >/=1.7 mmol/L, or specific treatment for this lipid abnormality
• reduced HDL cholesterol: < 1.03 mmol/L in males and < 1.29 mmol/L in females, or specific treatment for this lipid abnormality
• raised fasting plasma glucose (FPG): >/=5.6 mmol/L, or previously diagnosed type II diabetes

The corrected table is available at this link: www.nationalreviewofmedicine.com/issue/2007/02_15/4_patients_practice01_3.html

GREEN — AND NOT-SO-GREEN
Here's what some of your colleagues had to say about our January 30 poll question, "Would you call the main facility where you practise "environmentally friendly?" for full poll results click here):

• Our facility makes every effort to reuse, recycle and minimize waste or use of materials that are not recyclable. Washable gowns and sheets, sterilizable speculae, etc, help to protect our resources and reduce environmental stress.
• We have both old and new buildings. "Old has mould!"
• I work in a converted dog research lab and with old carpeting on the floor, spotty recycling and terribly poor ventilation, the place is more of a health hazard than anything. I try to do my best to take plastic bags from home to recycle, avidly blue boxing any and all appropriate paper, bringing lunch in washable containers and recycling the endless supply of water bottles that patients forget in my office, but it all feels like an uphill battle. I think that the place ought to be torn down but I bet it's got asbestos in it somewhere!
• Every computer always on, every light always on, doors propped open in the winter to let excess heat out, minimal or no recycling. No doctor would allow his own house to be run like we run our hospitals. This should be a major priority. The damage our hospitals do to the world and its citizens violates "primum non nocere."
• No facility is environmentally friendly unless you want to spend megabucks on that same edifice. With the remuneration we receive, why increase our overhead any more? It would be nice to be enviro-friendly, but that's not very practical.
• Our building does not recycle any recyclable materials. I'm trying to change this.