Look what they've done to my song Ma (Musings on invisible health professionals)

July's blog, another short one, was stimulated by an editorial in the Archives of Pathology; Laboratory Medicine, August 2019: Emerging From the Basement: The Visible Pathologist. (Further Reading)

The editorial reminded me that a hematopathologist I once worked with told me, "Pat, just like medical laboratory technologists/scientists (biomedical scientists in UK, Australia, NZ) feel invisible, at the bottom of the health professional pecking order, so do pathologists of all specialties."

Also on the local scene in Alberta, Canada, a new provincial government just cancelled a needed planned hub lab in Edmonton, with the new government implying they wanted to concentrate on patient care (as if clinical laboratories didn't affect patients) and the centralized superlab/ hub lab was a waste of money best spent elsewhere. The new Premier Jason Kenny argued the changes (new consolidated hub lab) would do nothing to improve patient services.

The blog's title derives by a 1970 song by Melanie Safka.

INTRODUCTION
My take has always been that most folk don't have a clue what medical laboratory technologists/ biomedical scientists do. Suspect they assume we are merely the vampires/blood suckers who draw their blood samples for lab tests. Generally, folks do not realize we are highly educated and trained professionals who play an critical role in assisting physicians to diagnose and treat patients.

PROMOTING THE PROFESSION
Fact is med lab science and clinical labs need to be more visible to the public. In this section I'm going to include tweets of colleagues and former students (my beloved 'kids') who are using Twitter to promote med lab science and make the case for why clinical labs merit respect as playing an as important in patient care.

Tweets and News
Folks you can see tweets without being on Twitter. If you are asked to join, just ignore the dialogue box asking you to join and click on the tweet off the dialogue box. All tweets are short, please read them.

1. Thanks to all who came out to the CSMLS open forum last night

2. AHS Newborn Metabolic Screening program

3. Cancelling superlab undermines foundation of patient care

4. Finally - someone took a look at what's going on

5.  Short-sighted decision to halt ongoing construction of the Edmonton Clinical Lab Hub

6. Yet another example of the importance of lab medicine

7. Pictured here are very passionate medical lab professionals seeking to educate Albertans of the critical role med lab plays in quality patient care 

8. Clinical labs save lives. We have no space & aging equipment. Cancellation of Northern AB Hub Lab leaves us wondering how will this crisis be addressed?

9. Thank you for helping champion the voice of the medical lab profession and its critical role in effective quality patient care.

FOR FUN
I chose this song because I'm disappointed that medical lab technologists (biomedical scientists) still have to fight to be visible to the public, including some politicians, after all these years. I came to the med lab science field by a non-traditional route 55years ago and still we face the same challenges.

• Look what they done to my song Ma (Melanie Safka)

Look what they've done to my song, Ma
Look what they've done to my song
Well, it's the only thing I could do half right
And it's turning out all wrong, Ma
Look what they've done to my song

FURTHER READING
Harrold IM, Bean SM, Williams NC. Emerging from the basement: the visible pathologist. Arch Pathol Lab Med. 2019 Aug;143(8):917-8.

Health Quality Council of Alberta: Provincial Plan for Laboratory Services in Alberta (February 2017)

Leaning into the challenge of medical science (4 June 2019)

The UCP government scrapped Edmonton's 'superlab'. Medical experts say Alberta needs an alternative and fast (24 July 2019)

Medical lab group pushing Alberta government to address gaps after cancelling superlab (24 July 2019)

Alberta government keeps promise to cancel construction of medical superlab (20 June 2019)

Lab Tests Online: For anyone interested in what medical lab professionals do and information on your lab tests results

Nessun dorma (Musings on anti-paid plasma blogs over the years)

Updated: 14 Nov. 2018

Below is a list of the blogs I've written so far on paid plasma: 23 blogs over 6 years as of 14 Nov. 2018. Some blogs focus on it entirely, others touch upon it along with related issues. In total 2004-2018 I've written 174 blogs, and paid plasma constitute about 13% of them. This blog's sequence is different than others. The main content (list of earlier blogs) will come at the end.

INTRODUCTION
The blog's title comes from a famous aria for tenors in Puccini's opera Turandot, which premiered at La Scala in Milan in 1926 after Puccini's death. Like many, I love the classic for many reasons. One is my spouse and I heard Pavarotti sing it in person in Edmonton in 1995. The face of every person on the LRT ride home from the concert radiated with joy.

I chose Nessun Dorma for several reasons. The title and first lines translate as 'None shall sleep' and builds to the final, victorious cry of 'Vincero!' (I will win!). In the battle over paid plasma in Canada, and it is a battle, I'm against paid plasma, as explained in the 23 blogs below. We don't know who will win and what the win will look like.

I hope the eventual winners (Vincero!) will be

• Patients who need plasma derivatives and are prescribed products like intravenous immune globulin (IVIG) for evidence-based reasons, not because Big Pharma promotes it relentlessly to physicians. VERSUS patients being scared into panic by BIG Pharma, which supports their associations financially and is not beyond creating fear the world will end if paid plasma clinics cease to grow exponentially. 
• Blood donors in financial need, who will no longer be exploited at the risk of their health by Big Pharma, which makes $billions off their body tissue. Yes, not all see themselves as being exploited, but many, if not all, are exploited and it's unethical.
• Volunteer blood donor sector, which will recruit and be able to retain young donors, instead of having them slowly siphoned off to paid plasma, from which they are unlikely to return as they age.
• Canada's blood supplier CBS (outside Quebec), which can concentrate on ways to encourage more volunteer young donors, perhaps with token incentives as happens in the USA system, or maybe not. Hope that CBS gets funding to open plasma collection clinics to get Canada closer to meeting its plasma needs.
• Canada's government funders of the blood system, which should fund CBS plasma clinics, encourage voluntary donation, VERSUS now needing to spend megabucks to regulate ('police') the use of IVIG due its ever-increasing usage, as done by the BC PBCO and others, including for primary immunodeficiency. 
• Health Canada should do its duty to regulate blood safety as a win-win strategy for patients and blood donors, VERSUS encouraging Big Pharma to promote endless iffy uses of plasma derivatives by supporting its exploitative paid plasma growth in Canada. 

FOR FUN

• Nessun Dorma - Luciano Pavarotti, 1994 (3:14 mins)

PAST PAID PLASMA BLOGS (n=23)

2018

The sound of silence (More musings on paid plasma pros and cons) 

The Boxer (Musings on HC's Expert Panel Report on immune globulin and paid plasma)

2017

Look what they done to my song (Musings on how paid plasma mirrors Rumpelstiltskin) 

Always on my mind (Musings on lack of transparency in Canada's blood system) 

The Sound of Silence (Musings on Health Canada's Expert Panel on Immune Globulin Product Supply) 

While my guitar gently weeps (Musings on recent transfusion-related news) 

We are the world (Musings on the humanitarianism of selling body tissues) 

The Boxer (Musings on lies & jests in the blood industry)

2016

Simply the best (Musings on paid plasma  and TM colleagues I've know) 

Sweet Dreams (Musings on a recent transfusion-related nightmare) 

Heart of Gold (Musings on donating the gift of life)

2015

Heart of Gold (Musings on sucking $ from body tissues)

2014

Don't worry, be happy (Musings on the safety of our blood supply) 

If you could read my mind (Musings on hard-to-believe TM news) 

C'est si bon (Musings on TM news that is so good and not so good) 

Hey Jude (Musings on why paid plasma makes it worse, not better) 

I heard it through the grapevine (Musings on paid plasma's PR campaign) 

Bridge over troubled water (Musings on what to be thankful for as TM professionals)

2013

Day tripper (Musings on HC's instructions to the jury on paid plasma) 

Heart of Gold (Musings on pimping for paid plasma) 

Stop children, what's that sound (Musings on commercialization of our blood supply) 

We are the world (More musings on commercialization of the blood supply) 

Still my guitar gently weeps (Yet more musings on commercialization of our blood supply)

I will remember you (Musings on all those who died in tainted blood tragedies)

Updated: 5 Nov. 2018 
Canada's blood scandal, Further Reading
Responses to a Comments

Haven't written a blog for awhile and this one will be short. For October I'll  briefly comment on the ongoing attack on national blood suppliers like Canadian Blood Services and many others by gay activists. In Canada the designation is lesbian, gay, bisexual, transgender, queer, and two-spirit (LGBTQ2).

The blog was stimulated by two items at the AABB 2018 and the current UK Infected Blood Inquiry (Further Reading), both featured in TraQ's October newsletter under General and UK, respectively.

Recently, I've seen many attacks on Twitter accusing  CBS of discrimination. Almost all activists claim there never was a reason to ban or defer male homosexuals. When I've defended CBS by reporting the history of transfusion-associated HIV transmission in Canada, the blood supplier's perspective and its ongoing research, I've often been accused of being homophobic. Quite scary for an oldster but it won't ever stop me from voicing my opinions on controversial issues.

My take is that gays have suffered horrific discrimination over the years and many cannot differentiate blood supplier caution from larger societal historical wrongs. And most are too young to appreciate blood supplier's perspective and the need for nation-specific evidence-based policies. Suspect I'm being too generous here but won't elaborate. What the hell, I will. Could be dead wrong but sometimes when you've been unfairly repeatedly victimized, you see oppressors everywhere.

The blog's title derives from a 1995 song by Canadian Sarah McLachlan.

BACKGROUND
Activists worldwide see even a temporary ban of men who have sex with men (MSM) as discriminatory. Over the years in Canada the deferral has gone from permanent deferral to a 5 year deferral without MSM to a one year deferral without MSM and likely will soon become a 3 month deferral without MSM.

Gays see any deferral, no matter how short, as a holdover from an era of panic over AIDS in the early 1980s (Further Reading, NBC):

"They are just the latest chapter in a narrative that casts gay men as untrustworthy, promiscuous vectors of disease. We know scientifically we pose no greater threat than anyone else, but fear is a really powerful thing — especially fear of HIV."

I'll provide only this one news item but also see Google search for "gay blood donation discriminatory" in Further Reading, which yields 5,630,000 hits.

In Canada, Prime Minister Justin Trudeau was foolish to promise a change in CBS's MSM policy because it's not a political decision, it's science-based. Sadly, his error fueled much of the outrage by the gay community against CBS. The last thing our blood system needs is a political-based decision. We've been there, done that at the beginning of Canada's HIV/AIDS 'tainted blood scandal'.

BOTTOM LINE: As lifelong worker in transfusion as front-line medical laboratory technologist/scientist, supervisor-manager, educator, and consultant (54 yrs - Yikes!)  I've experienced the best of times and the worst of times. I firmly believe our blood supplier CBS is right to be cautious and base blood safety policies on evidence gathered in Canada (CBS MSM deferral policies, Further Reading).

As always, comments are most welcome. Please see the 4 comments below and my response to one (added Nov. 1, 2018).

ADDED Nov.1, 2018
Please see comments below. My reply to Shanta is as follows:

About your first point: If my comment that victimized LGBTQ2 see oppressors everywhere is true, it is probably because homophobia IS everywhere and doesn't magically stop at the front door of institutions because they reflect the values of the society that created them.

I'll grant that homophobia still exists everywhere in society, including in Canada as opposed to nations in which homosexuality is criminalised, including some nations where the death penalty applies. Source: Gay relationships are still criminalised in 72 countries, report finds. (The Guardian, 2017)

But I see it as more nuanced. Having worked for its predecessor Canadian Red Cross for 13 years, and for CBS over many years, mainly as a consultant with a brief stint as 'assman' managing CBS Edmonton's patient services laboratory, I do not believe Canadian Blood Services is a homophobic institution. I don't think CBS institutionalized policies of homophobia, including the ever decreasing ban on gay MSM donations. Individuals within any organization may be homophobic but I don't think there's evidence CBS per se is. Reasonable people can disagree on this point and I'll give my reasons below.

Shanta's second point relates to evidence-based policy-making. If the CBS MSM policy is purely based on evidence, we should be able to correlate each change over 30 years -- from permanent to 5-year to 1-year to the now anticipated 3-month deferral without MSM -- to the evidence that triggered each decision. If we can't do that, it's possible to conclude that policy-makers are influenced by more than just the evidence.

My view is that evidence-based policy-making on HIV and MSM is complex and affected by many factors including risk-modelling research, which is way above my pay grade (comprehension). For the record like many countries Canada moved from an indefinite deferral for any MSM to a five-year deferral in 2013, and to a 12-month deferral in 2016. Source: HIV donor testing. I believe the initial permanent deferral was justified and I've been labelled a homophobe on Twitter for it by  gay activists.

To be clear, national blood suppliers need to take into account many variables, including national HIV rates, data accumulated over many years because of the low prevalence of HIV, and the need to be cautious because of the incredible screw-ups that cost thousands of lives in what Canada refers to as the 'tainted blood tragedy,' the biggest PREVENTABLE public health disaster in our history.

CBS recognizes that 'MSM deferral is one of the most controversial deferral policies, and while blood safety remains paramount, issues of social justice and inclusivity highlight the need for its modernization.' See Developing more inclusive deferral policies for blood and plasma donors,

To Shanta's point, it's impossible for CBS to present clear cut evidence for each decision to decrease the deferral without MSM. The variables are too numerous. My view is that, yes, 'policy-makers are influenced by more than just the evidence.' But the elephant in the room is NOT homophobic discrimination, it's CBS's desire to err on the side of safety and caution to prevent a massive catastrophe of the 1980s (HIV) and 1990s (HCV) which resulted in Canada's blood supplier Canadian Red Cross Blood Transfusion Service being axed.

And let's face it, the emphasis on evidence-based medicine is relatively new.  Example: Choosing Wisely Canada launched on April 2, 2014.

FOR FUN
I chose a song by Canadian Sarah McLachlan to honour all those thousands who died and suffered from infected blood tragedies worldwide. Having lived through it in 1980s and 1990s I can never forget them. In early days of my career, I knew folks with hemophilia who came to blood centre to pick up their cryoprecipitate, then FVIII concentrate that killed so many. Two were Barry and Ed Kubin mentioned in Vic Parsons' book below.

• I will remember you (Sarah McLachlan) 

FURTHER READING
It's still a ban': Gay blood deferrals still discriminatory, LGBTQ advocates say (NBC, 29 Nov. 2017)

Google search: "gay blood donation discriminatory"

AABB 2018

• Compliance and the changing landscape of MSM blood donation (13 Oct. 2018)
• Canada: Progressive reduction in donation deferral period for MSM associated with small increase in donations from eligible MSM (15 Oct. 2018)

CBS on MSM Deferral Policies

• Leach Bennett J, Devine DV. Risk-based decision making in transfusion medicine. (Review) Vox Sang. 2018 Sep 19. [Epub ahead of print]
• Goldman M, W-Y Shih A, O'Brien SF, Devine D. Donor deferral policies for men who have sex with men: past, present and future. Vox Sang. 2018 Feb;113(2):95-103. Epub 2017 Dec 13.
• Goldman M, Lapierre D, Lemay L, Devine D, Sher G. Donor criteria for men who have sex with men: a Canadian perspective. Transfusion. 2014 Jul;54(7):1887-92.
• CBS's Dana Devine on changing permanent MSM deferral to 5 years (~3 mins, Youtube, 2013) | Takes years to get sufficient data to assess MSM policy on blood safety, as incidence of HIV+ donors very low

Canada's Blood Scandal

• Book Review:  Bad Blood: The Tragedy of the Canadian Tainted Blood Scandal by Vic Parsons
• A look back at Canada’s tainted blood scandal (CBC, 4 Oct. 2013) 
• Includes interview with Dr. Don Francis (2:00 video)
• Canadian Red Cross medical director denies link between AIDS & blood products (1984, 2:00 CBC video)
• NS becomes first province to compensate blood victims (2:34 CBC video)
• Must watch: Tragedy of FVIII concentrate (19:14 CBC video, 1994) 
• Krever Inquiry (by André Picard)

UK Infected Blood Inquiry: October 2018 News

Take a chance on me (Musings on PROMs and PCOs)

Updated: 30 Aug. 2018

August's blog derives from a scientific paper by authors in Ottawa, Canada (Further Reading) that I added to TraQ and tweeted about.

Staibano P, Perelman I, Lombardi J, Davis A, Tinmouth A, Carrier M, Stevenson C, Saidenberg E. Patient-centered outcomes in the management of anemia: a scoping review. Transfus Med Rev. 2018 Jul 12. pii: S0887-7963(18)30051-8. [Epub ahead of print]

First, out of curiosity I wondered about the meaning of 'scoping review', something I wasn't familiar with.

Second, patient-reported outcome measures (PROMs) used to evaluate the quality of patient-centered outcomes (PCO) struck home in my personal life. According, I obtained the full article to read. Then, when one of the authors on Twitter asked me for an opinion, I replied as follows.

What follows are the key points I took from the paper according to my own interests and career as a medical laboratory science educator who taught critical analysis of scientific literature for years.

This blog concentrates on only three features of the paper. I didn't include Methods and Results for the sake of brevity and to keep the blog more accessible to readers. Obviously, they are key to the paper.

• Scoping review (What's it all about?) 
• PROMs and PCOs (Research often omits all mention of them)
• Discussion (Great model for authors of research papers)

Don't expect an expert analysis because I'm unqualified to get into the review's nitty-gritty. What I present are generalizations within my personal and professional experience.

The blog's title derives from a 1978 ditty by Sweden's ABBA.

SCOPING REVIEW
After reading several resources (Further Reading) on 'scoping review' I'm not all the wiser but see it as follows:

• Relatively new approach; 
• Purpose is to map the literature on a topic vs a systematic review designed to summarize the best available research on a specific question;
• Scoping is broad, systematic is narrow.

If anyone can enlighten me further, please do so via Comments below.

PROMs and PCOs 
This is where it gets personal. Patient-reported outcome measures (PROMs) are used to evaluate the quality of patient-centered outcomes (PCOs - Further Reading). Both are usually absent in medical research on various treatments.

In this scoping review the most common PROM tools were Functional Assessment of Cancer Therapy (FACT) and Functional Assessment
of Chronic Illness Therapy (FACIT) scales (46.9% of studies).
See examples of PROMs in Further Reading. Headings typically include these types of well-being:

• Physical
• Social/Family
• Emotional
• Functional

The authors explain the concepts as follows:

'Patient-centered outcomes (PCOs) measure the impact of disease and treatment on a patient’s physical, social, and mental well-being.Tools used to measure such outcomes are known as patient-reported outcome measures (PROMs).'

'PROMs are necessary for understanding the holistic burden of various disorders from the patient perspective and for improving patient-physician communication, patient satisfaction, and treatment outcomes'

Five years ago my spouse was diagnosed with an incurable disease, idiopathic pulmonary fibrosis (IPF), with an average life span from diagnosis of  3-4 years, although some patients live much longer. At first the Alberta government did not cover the one drug that supposedly could help (Esbriet or pirfenidone). But later after more CADTH research gave it the okay, Alberta did fund the drug under certain disease conditions (at a cost of ~$43,000/yr). The studies that showed pirfenidone was useful were based on extenuating life, the so-called survival benefit.

In my opinion, pirfenidone's many side effects (See blogs in Further Reading) were downplayed in research articles and manufacturer's literature, saying they could be managed by lessening the dose. Perhaps for many but not in spouse's case, and who knows how many others.

Patient-reported outcome measures used to evaluate the quality of patient-centered outcomes related to the patient's physical, social, emotional, and functional well being were slim and mainly physical side effects. In reporting side effects outcomes were chosen that were mostly clear cut such as rash, sun-sensitivity, nausea, and of course, whether patients survived longer on the drug, the key.

As a result of my spouse's experience, if ever requiring treatment for a life-threatening condition, I hope health professionals will ask me for PROMs. I'm best qualified to assess my overall quality of life and well-being and would want those factors to be considered alongside how much my life and functionality were extended by the treatment.

DISCUSSION
I appreciated the paper's discussion for several reasons, especially how the authors extensively discuss limitations, some of which are presented below. This section could be used as a model for students learning how to evaluate literature. How the authors analysed the review's results follows.

Generalizability
Because the review analysed PCOs and anemia in mainly adult oncology patients (less than one-tenth evaluated pediatric or older adult
populations), authors note the limited generalizability of findings to those patients.

Bias
Although more than half of the included studies were RCTs,approximately 45% of these were open-label* and susceptible to patient allocation biases and biases related to the inherent subjectivity of PROMs (self-reported patient replies to survey questions).

*Open label clinical trials do not attempt to disguise the drug/treatment, meaning that no standard treatment or placebo is utilized. This can lead to bias, as both patients and physicians are aware of which groups are receiving which treatment. 

Transfusion
More than 75% of included studies investigated PCOs in anemic patients treated with erythropoiesis-stimulating agents (ESAs), whereas only 3.8% evaluated PCOs in studies of transfusions to treat anemia. The authors write,

 'As blood transfusions are one of the most common medical procedures in hospitals, are known to carry risk, and also use a limited resource, the lack of studies assessing how transfusion affects patient quality of life remains a troubling discrepancy.' 

I'm tempted to say, "It's the transfusions, stupid" as in the 1992 USA presidential race, where strategist James Carville ('the ragin' cajun') used  'It’s the economy, stupid' to focus the minds of Clinton's campaign workers.

Study Outcomes
Published studies evaluating ESAs to treat anemia, regardless of etiology, have nearly all had change in hemoglobin levels as the primary study outcome. Those related to the appropriate threshold at which to administer transfusion nearly always have mortality as the primary outcome.

To assess treatments for anemia or any condition, having a standardized set of core outcomes would help.

Bottom Line
My view: Using patient centered outcomes in research of any treatment for a specific condition faces many challenges. But they are essential if patient-centered care is to go beyond the cliché it often is today. Developing validated PROMs and requiring consistent and full reporting are key. Lots of work is needed to make this a reality.

FOR FUN
Could not resist choosing this ABBA song. I see it as asking medical researchers to take a chance on me and all patients. We patients should have a say in what the full outcomes of our treatment are. Plus ABBA songs are fun.

• Take chance on me (ABBA, 1978)

As always comments are most welcome.

FURTHER READING
Staibano P, Perelman I, Lombardi J, Davis A, Tinmouth A, Carrier M, Stevenson C, Saidenberg E. Patient-centered outcomes in the management of anemia: a scoping review. Transfus Med Rev. 2018 Jul 12. pii: S0887-7963(18)30051-8. [Epub ahead of print]

What is a scoping review?

Pham MT,et al. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Res Synth Methods. 2014 Dec; 5(4): 371-85. EPub 2014 Jul 24.

Patient-centered outcomes research from PCORI

PROMs (from Canada's CIHI)

PROM Examples
   All FACIT questionnaires
   FACT-L: For patients with lung cancer [Download pdf]

Personal Blogs
To be or not to be (Musings on IPF and Esbriet) Mar. 2016

IPF and Esbriet (Musings on extended life vs quality of life) Sept. 2016

Everything I do, I do it for you (Musings on the UK's Bawa-Garba case)

In July's blog I offer brief comments on an item in TraQ's July newsletter. The title derives from Canadian Bryan Adams' 1991 song.

UK's Bawa-Garba case, dating to 2011 and still unresolved, has gained attention of health professionals worldwide (right click, open in new tab,for clearer graphic).

Source: What impact will the Bawa-Garba case have on community pharmacy? (Further Reading)

Pictorial representation of timeline 

Source: The Bawa-Garba case, BMJ (Further Reading)

The case gives rise to so many points of discussion, including

• Racial bigotry;
• Culture of blame vs encouraging health professionals to report errors honestly without fear of reprisal;
• Responsibilities of senior staff supervising junior staff;
• Consequences of one serious error by an otherwise competent practitioner;
• Stifling the recording of written reflections about mistakes made (tool for personal learning) because they may be used in court;
• Facility responsibility for errors made by overworked staff in understaffed health facilities;
• Should public perceptions trump justice and dictate harsh sentences so faith in the safety of the health care system won't be lost.

As an ex-med lab science (transfusion) educator, I'm especially interested because I was involved in case where a student error hastened a patient's death:

• TraQ's Case A8: Severe Hemolytic Transfusion Reaction Involving a Student (Further Reading)

Also, earlier as an experienced medical technologist in a stand-alone central transfusion service separate from hospitals, and working alone on a Saturday night, I once crossmatched a pre-op patient who surprisingly typed as group AB when records showed she was group O. The SOP of always checking prior records saved that patient as another sample was drawn at the hospital, which correlated with the historical group.

But what if I had been distracted or swamped by an emergency and somehow did not do the required patient history check? A disaster (serious hemolytic transfusion reaction) might have occurred, perhaps leading to patient death, and it would be due to my error for not following standard operating procedures. Perhaps I would have been charged with gross negligence manslaughter due to not doing what a reasonably competent technologist would do?

The Bawa-Garba case offers food for thought for all health professionals.

FOR FUN
My lifetime experience is that health professionals put patient safety above all else and often sacrifice much to perform health care duties in an exemplary manner. That includes long years of study as students and, once registered, investing much personal time to keep up-to-date with the latest advances and best practices.

Could not resist using Bryan Adams' 1991 ditty, the third best selling Canadian single of all time:

• (Everything I do) I do it for you (Bryan Adams, Wembley Stadium, 1996)

FURTHER READING

What impact will the Bawa-Garba case have on community pharmacy?

The Bawa-Garba case, BMJ

Bawa-Garba news items (TraQ's 2018 July newsletter)

TraQ's Case A8: Severe Hemolytic Transfusion Reaction Involving a Student 

As always, comments are most welcome.

The sound of silence (More musings on paid plasma pros & cons)

Updated: 13 August 2022 (Fixed one link)

Wrote first version of this blog a few days ago then pulled it. Why? I wrote it when angry, never a good idea. What got me mad was the following reality:

If there's one thing that gets my goat (or, in the vernacular, pisses me off), it's a campaign that's clearly orchestrated and perhaps indirectly funded by the likes of USA's far-right Koch brothers (Further Reading). I say indirectly because Koch biz is well known as a hidden maze of covert operations. Tracing funding is impossible. Like crime investigators, I don't believe in coincidence as outlined below.

The reality is the many letters to the editors, and so-called opinion pieces/commentary, that support paid plasma have 'coincidentally' flooded many Canadian papers as Health Canada's Expert Panel on Immune Globulin Product Supply and Related Impacts in Canada considered the issue. Interestingly, several op-eds 'coincidentally' cite the same letter written to the Panel by Peter Jaworski (co-author of 'Markets without Limits:  - Further Reading) and 32 ethicists and economists, including two Nobel Prize winners and a recipient of the Order of Canada, as we are ever reminded. Walks, talks, and quacks like coordinated to me. 

I've since cooled off and developed a second thesis for the blog. Advocates on both sides of the paid plasma issue are talking past each other, both sides being certain they are right. Like current USA politics, polarization is extreme and we're all partisans, endlessly pounding home the same points to those who agree with us and to convince the larger public via endless op-ed pieces.

Disappointed that CBS and Health Canada are not more transparent about where Canada is headed on paid plasma. Both HC's Expert Panel (bit of a joke) and CBS have been less than transparent on the issue. CBS's position is understandable, Health Canada's not so much. This is the origin of the blog's title, The Sound of Silence.

So the blog's aim is to outline what I find wrong and weak about both anti-paid plasma and pro-paid plasma advocacy. Yes, my position is clear and I've said similar before over many years. One more time....

ANTI-PAID PLASMA
My view is that anti-paid plasma advocates (I'm one) who sound alarm about safety issues that are iffy at best do not do the cause any good. Yes, some risk exists since zero risk is impossible. Although paid plasma is as safe as volunteer plasma, largely due to the processes that fractionated products like intravenous immune globulin go through, plasma fractionation destroys KNOWN 'deadly' risks (HBV,HCV,HIV) but not necessarily future unknown transfusion-transmitted infectious organisms. But to focus on safety is non-productive. Why?

Because focusing on safety undermines two main legitimate arguments:
1. Paying for body tissues is unethical because it preys on the poor;
2. Culture of paid blood donation will undermine volunteer donations over time.

For more on unethical, see Further Reading (Musings on how paid plasma mirrors Rumpelstiltskin).

FACT: Valid statistics about decreased voluntary donations are hard to come by since no one knows what they would be if (1) paid plasma didn't exist and (2) national blood suppliers like CBS had made concerted efforts over the years to encourage and facilitate plasma donation.

PRO- PAID PLASMA
The pro-side argues as follows, exemplified by Jawarski in 'Markets without Limits':  'If you may do it for free, you may do it for money' meaning selling body tissues and organs is moral because you can do it for free (voluntarily donate). And selling tissues / organs saves lives so must be good, conveniently ignoring or minimizing that it preys on the poor (Further Reading).

Another position pro-plasma advocates pound away at is that anti-paid plasma advocates in Canada and elsewhere are hypocrites. Let's face it, we are all hypocrites in some ways. I'm a vegetarian who wears leather shoes, believes in transitioning to renewable energy yet has flown a lot around the world and taken cruises, which contribute significantly to greenhouse gas missions. 

To me, not wanting to make Canada a paid-plasma haven like the USA, sucking the blood from the needy, is a legitimate ethical view. More legitimate than fear mongering that patients will die if we don't pay for plasma that can be fractionated into life-saving derivatives. Fear mongering conveniently serves the needs of Big Plasma and its billions in annual profits, And means nil will change, we'll be forever captive to the plasma industry, instead of promoting voluntary donation and developing innovative alternative treatments, and reining in off-label uses of products like IVIg. 

Another pro-paid plasma position is that anti-paid plasma advocates are all about unions wanting to save their members' jobs. Seems a knee-jerk reaction to public service unions supporting voluntary donations, often citing the iffy safety rationale. But please answer this: Under what scenario would unionized CBS workers lose their jobs to paid plasma private clinic workers, who presumably would not be unionized and paid much less to maximize profits to shareholders, as well as having poorer working conditions? Beats me.

WHO'S BEHIND PRO PAID PLASMA PROPAGANDA?
In the latest propaganda piece ('Why we should pay Canadian donors for their blood plasma donations,' 13 June 2018), the authors feel compelled to write:

'Neither of us is in any sense funded by 'big plasma' or any other commercial interest. We are professors at universities (one at a Canadian public institution, and one at a private American one). We have no financial stake in this issue. We are merely doing our jobs as philosophers and ethics professors: namely, putting forward what we believe to be the very best argument on a matter of substantial public importance.'

Reminds me of 'the lady doth protest too much, methinks' (Hamlet). Note that Jaworski co-founded the Institute for Liberal Studies (Further Reading) and is an adjunct scholar at the libertarian Cato Institute (Further Reading - Behind the Cato Myth), created by the Charles Koch Foundation. Cato is anti-minimum wage, anti-union, anti-universal healthcare. You get the picture. And it's fair to judge folks by the company they keep, isn't it?

Not all Cato Institute positions are obnoxious to progressives like me, but among other policy positions, Cato is pro-tobacco, pro-private schools, pro-private prisons, in other words, pro-private anything like pro-paid plasma. And, of course, Cato thinks man-made climate change is exaggerated.

All these philosophers writing to papers and volunteering to author op-eds may be sincere advocates that paid plasma is the way to go, and are prepared to put patient needs above the poor who subsidize patient treatment risking their own health. Kinda reminds me of Trump's 'Amerika First'. My needs trump yours.

And pro-paid plasma advocates ignore that Big Plasma makes billions off the blood of the needy because markets rule (Further Reading). Instead they focus on the needs of patients, a legitimate concern, but have closed minds that voluntary plasma donation can significantly help. Until recently, plasma donation has never been promoted by CBS. Volunteers may not be able to supply all the plasma needed but why not try instead of letting paid plasma become the norm?

• Once paid plasma is part of the culture, why would anyone donate plasma voluntarily?

Just a coincidence that pro-paid plasma philosophers, who seem to know each other via various networks, flood newspapers with pro-paid plasma pieces, just because they're doing their jobs?

Perhaps but clearly a coordinated effort. They may be sincere but do not support a heart of gold. Instead they support Big Biz, earning gold on the backs of the poor. As befits anyone who's part of the Koch-Cato right wing propaganda initiative.

As always comments are most welcome.

FOR FUN
Again I use Simon and Garfunkel's ditty:

• The Sound of Silence (Free benefit concert in Central Park, NYC, 1981 before 500,000)

FURTHER READING
Over the years I've written many blogs on paid plasma, the last previous to this one on Dec. 29, 2017:

Look what they done to my song (Musings on how paid plasma mirrors Rumpelstiltskin) Note relevant links in Further Reading:

• Twisted business of donating plasma for money (The Atlantic, 28May 2014)
• WHO: The state of the international organ trade: a provisional picture based on integration of available information
• Meeting an organ trafficker who preys on Syrian refugees (BBC, 25 Apr. 2017)
• The body trade - Reuters series ('The chop shop')
• Search on Google for organ trafficking(1.3 million hits, 29 Dec. 2017)

A rare look inside the Koch brothers political empire

Those ubiquitous libertarians (2014) - Discusses influence of the Koch Brothers in academia (much of it hidden); wonders about funding of Jaworski's Institute for Liberal Studies (ILS)

Multi-millionaire quietly funds network of right-wing groups active in fight to dismantle Canada’s public healthcare system (2017); Including funding ILS

Behind the Cato Myth (2012)

Why we should pay Canadian donors for their blood plasma donations (13 June 2018)

'Markets without Limits: Moral Virtues and Commercial Interests' (positive review)

BIG PLASMA MAKES BILLIONS

• Australia: 'Beautiful blood': How CSL became a global success story (1 June 2018) | In 2017 CSL made $US 6.92 billion up 15%; net profit after tax $US1.4 billion
• Plasma fractionation market forecast to exceed US$ 26 billion by 2022 (12 June 2018)

Revolution (Musings on how e-mail destroys work lives)

Updated: 4 July 2017

June 29, 2007, Steve Jobs introduced a revolutionary gadget 

June's blog had a long gestation. Perhaps it's a baby elephant as it's been in the womb for more than a year and a half.  Why so long? Likely because I've hesitated to 'give birth to a child' who may be unwelcome. But I'm hoping readers can accept the latest baby-blog in the spirit in which it was created.

BACKGROUND
Bear with me as I explain the experiences that caused me to write the blog before getting to the nitty-gritty content.

In brief, I've been a user of personal computers from the get-go. My first PC was the PC Jr using command-driven MS-DOS software (Aargh!). 

Also was an early adopter of the Internet when it came to Canada, mainly because of the exciting potential to communicate with colleagues around the globe. In those prehistoric times terms like archie, ftp, html, telnet, usenet groups, and veronica ruled. Indeed, to create my first website, I learned how to code html from a textbook. Then...DRUM ROLL....

• 1984: Steve Jobs introduced the first Macintosh with GASP! a graphical user interface (GUI) and mouse;
• 1986: Eric Thomas invented listserv software for mailing lists and commercialized it as LSOFT in 1994;
• 1989: Tim Berners-Lee invented the World Wide Web;
• 1995: Bill Gates' Microsoft introduced its GUI OS, Windows 95. 

And, all of a sudden, the Internet was off and rolling, Bigly (as US President Trump might say). A revolution in communication whose evolution is far from over. 

Pricing tidbits: After using computers run on MS DOS, I became a 'Macaholic' for years, although Macs were truly expensive in the early years. For example, in 1988 bought a Mac SE with basic software for $5595, 4 MB memory upgrade in 1990 for $660, and 40 MB hard drive in 1989 for $1300. In 1991 got a MaC LC with basic software for a whopping $8111, on a line of credit. Yikes! 

Of course, once Windows 95 appeared due to consulting contracts, I ultimately was forced back to the MS dark side.

Over decades of observing how folks communicate on the Internet including running mailing lists for med lab professionals, writing blogs, and corresponding with colleagues around the globe, I'd like to say a few things about e-mail. The blog is not strictly a transfusion-related blog, but I hope transfusion professionals everywhere will be able to relate to its musings on communication.

Executive version: The blog's content offers tidbits for how to communicate more effectively via e-mail, but I'm under no illusion that readers will take them to heart. Perhaps agree in principle to the ideas but, without executing them, ideas are worth nothing. And old habits are hard to break.

The blog may (or may not) be the first in a series of tips involving other communication such as presentations and scientific writing. I'll play it by ear.

Much has been written on e-mail and many valuable resources exist. Hence, I do not intend to re-invent the wheel or to be all inclusive. What follows are just a few musings on things that bug me most.

The blog's title comes from a 1968 Beatles ditty.

IS E-MAIL THE BEST CHOICE OR EVEN NECESSARY?
Most professionals with job-related e-mail accounts know that it's over-used and abused and a major consumer of valuable work time. Indeed, much e-mail is a total waste of time (Further Reading).

Seems obvious, but for each message sent, do you first decide whether e-mail is the most effective way to communicate whatever it is you want to communicate. Before sending a message or responding to one, do you ask if it's truly necessary and the best way to achieve its purpose? Likely not. Today e-mail is an automatic response to communicating.

Yes, e-mail is the easiest way to communicate but may be a poor, even horrid, way for a given objective. Plus e-mail has the dreadful disadvantage of being easy to misinterpret. For one thing we cannot see the sender's facial expression, the smile and twinkle in the eyes. Words said even warmly can come across as blunt and harsh.

FACT: E-mail has run wild with little to no purpose for a long time So many e-mails about so little clog staff in-boxes and take away precious time from the real work of providing patient care, ensuring safe transfusion.

Bet you all know a TM professional (lab technologist, nurse, or physician) whose in-box bulges with 100s of e-mails read once but not yet dealt with. Or on return from vacation, even more in-box clutter? 

Abuse like that forces staff to read work e-mail when on holidays, destroying the entire aim of getting away from work pressure.  Executives and managers abuse staff this way and get away with it. Ultimately the buck stops with employers who do nothing to stop the practice and may even encourage it.

And you know what? I bet that, if the 100s of e-mails were never read, the universe would still unfold as it should.

TIDBITS: HOW TO WRITE E-MAILS
In this section I concentrate on a few things that bug me most about writing e-mail messages. From experience, I believe that many lab professionals, regardless of age (including those who have known e-mail, social media, the Internet all their lives) do not know how to write and respond to e-mails effectively.

1. ABOVE THE FOLD
Why keep the purpose of an e-mail message a secret, as so many do? For most job-related e-mail and correspondence with colleagues, it's critical to convey the purpose and any action required 'above the fold' (newspaper parlance).

Nothing is worse than wading through an e-mail to find the key bit at the end. It's abusive of the reader's time and reminds me of the typical telemarketing call:

• You answer, hear nothing but background noise. 
• After a few seconds that seem an eternity, someone asks you something like, 'How are you today?' 
• My response, sometimes said aloud, is 'What the hell do you want? I'm busy.' 
• Or what a pal typically says forcefully but more politely: 'What do you want?'

Learning point: When writing e-mails, specify the purpose and say what you want recipients to do up front, above the fold. Don't keep it a frigging SECRET.

FACT: Today most professionals are so overwhelmed with  e-mail that they typically scan messages with almost none of it being processed in their brains. This makes it critical to get their attention immediately. Also, using all-caps headings can help to focus the mind.

Examples of what to write above the fold include

• No response required, for information only. Read now (it's time-sensitive) and file;
• Your immediate response  to a question is required below. Please do NOT 'reply to all';
• Please confirm receipt. It's FYI only but important enough that I need to know that you received the message. Replying 'Got it' suffices. 

2. SUBJECT LINES
Vague Subject Lines that tell the receiver next to nil about the e-mail's content are another gripe.

First, to have any value, Subject Lines of messages to individuals and to mailing lists must be precise and descriptive. As a long time manager of mailing lists, most subscribers have learned to draft useful Subject lines. But I'm always surprised that some continue to use Subject Lines such as 'Question'. Not very informative to readers and makes list archives useless if not revised by the list moderator.

Second, with a series of e-mails on the same topic between even two persons, keeping the original Subject Line for multiple messages in a conversation is not helpful. Multiple messages with identical Subject lines don't give a clue as to which ones contain the specific info people may want to refer to later.

Learning point: Make Subject Lines as useful as possible to the receiver. Think about the TV shows you want to view. Would Sports Contest, Police Drama, or Reality TV be useful listings on your cable TV guide?

3. SHORT PARAGRAPHS
Short paragraphs in e-mails are as important as they are on web pages or in any writing (annual reports, even novels).

But to write in paragraphs, you need to know what they are. Are such basics even taught anymore in the age of texting? (Further Reading)

Learning point: With e-mails I recommend that writers break information into short paragraphs even if they deal with an over-arching theme, but have a discernible sub-topic. When reading long paragraphs, eyes invariably glaze over.

4.  PRIVACY
Some colleagues. and administrative assistants in university faculties and hospitals include everyone in the visible Cc field as opposed to the blind carbon copy (Bcc) field.

An easy alternative is to use your address (sender's address) in the To: field and put recipients in the Bcc field. That way privacy is protected, including if any recipient decides to forward the message to others beyond the intended recipients.

Added benefits of the Bcc field: 

• If someone goofs and replies by hitting 'reply to all', the message will not go to those in the Bcc field; 
• It's an anti-spam device. Should someone's computer be infected with a virus that harvests e-mail addresses, addresses in the Bcc field are protected. 

Learning points: Many people do not want their e-mail address to be distributed to people they do not know. And what folks write to you is for your eyes only. How else can they be honest?

5. HANDLING INFO OVERLOAD
Most experts say to limit reading e-mails to set times of the day, perhaps once in the morning and once in the afternoon. But I know of few who have the insight and guts to do it. There's always the fear that you may miss something, a silly fear because most e-mail is an unimportant waste of time.

Research shows that when you interrupt your work with a distraction such as e-mail, it takes much time to recover and re-focus on important tasks at hand. Yet folks do it constantly throughout the work day. E-mail gobbles up so much staff time it borders on the criminal, meaning it does real harm to an organization's productivity.

Learning point: Why not try being the boss of e-mail versus being its poodle? Breaking free not only involves reading e-mail perhaps twice a day but also dealing with messages at the time of first reading. Reading messages and keeping them so that you need to read them again at a later date is an insane waste of time.

It's similar to quitting smoking. You're the boss - you can choose NOT to smoke. I made the choice 30 years ago after being a nicotine-addicted chain smoker. You can choose to be the boss of your e-mail. It's within your power, albeit not easy. New life-changing habits take much effort.

6. ETIQUETTE
Tips on e-mail and mailing list etiquette are all over the Internet. Many years ago I wrote guidelines for MEDLAB-L (Further Reading). For this blog I'll only offer a few tidbits:

 1) As a general rule do not share personal e-mails without the sender's permission. While it's true that once anyone sends an e-mail, they never know where it will end up, But respect the sender's privacy as you would want yours to be respected. Do not share without permission, unless there's a compelling reason to do so, such as you think you are being abused and need to discuss it with others.

2) Never send an e-mail in anger or with a flippant response and especially not after midnight. Give it a day or two to reflect upon.

3) When you e-mail a colleague for help or advice on any topic, once they reply, have the courtesy to say thanks. That way they know you received the reply and, more importantly, appreciated them taking the time and effort to help. I can't count the times I've spent hours assisting folks with a request (some I know but many who are strangers) to never hear from them again. Some experts say to axe the thanks (just more in box clutter) but to me it's common human courtesy and let's folks know you got the reply.

4) Because e-mail is such an impersonal medium and open to misinterpretation, take the time to personalize messages as if you were talking to the recipient in person. Again, some experts recommend cutting the niceties because they're superfluous time wasters. But to me, the personal touch is essential.

5) Keep e-mails short and, as noted earlier, consider using headers to focus the recipient's attention. Involves editing original for brevity (as you would with Twitter's 140 characters), but more importantly, deciding what is fluff that adds nil to the e-mail's key message.

However, do not sacrifice the personal touch for brevity. Connect with colleagues and encourage them to see you as a real person with shared experiences they can relate to.

6) Proofread e-mails as you would scientific papers submitted for publication. E-mail messages reflect on you.

Learning point: See e-mail as a communication medium with an etiquette similar to talking face-to-face. The key point is to respect colleagues as you would want them to respect you.

FOR FUN
The Internet is a revolution that changed everything, which is why I chose Revolution for the blog's title. So many good outcomes and some not so good. On balance, to me life before e-mail was better than life after. Why? Because today time for professionals to reflect is limited. Yep, we can communicate worldwide but at what cost?

Professionals are now slaves to mostly useless e-mail. With multi-tasking 24 hrs a day, no one has time to reflect. It's hours of mindless skimming of e-mail messages that did not exist before. Non-productive, non-efficient wasted time at workplaces, abuses staff time at home and on holidays, and contributes nil to patient safety. 

• Revolution (The Beatles)

As always, comments are most welcome whether you disagree with me or would like to add more pet e-mail peeves. You can do so anonymously, and include your name or not. 

FURTHER READING

Tim Berners-Lee - Inventor of WWW

Eric Thomas - Inventor of Listserv

On paragraphs

Is text messaging infecting or liberating the English language? Judge for yourself, as we rewrite classic texts in txt. (BBC, 2003)

MEDLAB-L Guidelines 

The iPhone turns 10 (Just a kid and who knows what it will be when it grows up or if it becomes landfill like so much technology)

E-MAIL WASTES TIME

• 40% of staff time is wasted on reading internal emails (The Guardian, 2012)
• Email overload is costing you billions (Forbes, 2014)
• How many hours of your life have you wasted on work email? (Washington Post, 2016)

Little boxes (Musings on when established clinical labs become passé)

Updated: 3 Nov. 2015

October's blog focuses on three news items from The Dark Daily/Dark Report about clinical laboratories in the USA and Canada.
If you're not lab or not in North America, the blog has tidbits about health care fraud that could be coming to a lab near you, and demographic trends that affect your health profession and country. My musings will expand the scope slightly to include the role of innovation in upsetting existing apple carts.

The blog's title derives from an anti-establishment ditty written by Malvina Reynolds that became a hit for her pal Pete Seeger in 1963. Be forewarned - you either love it or hate it. It was written about USA in the 1950s when most readers were not yet born.
For links to news items below, please see Further Reading.
NEWS ITEMS
1. USA: Biggest case of Medicare fraud and abuse in history of clinical laboratory business.

Apparently clinical lab companies and their executives were paid $500 million in 2010-14 from lab test claims submitted to the USA's Medicare (health insurance for Americans aged 65 and older who have worked and paid into the system and for younger people with disabilities) and Tricare (health benefits for military personnel, retirees, and their families), perhaps $1.2 billion if amount taken from private insurers is added.
US federal attorneys allege the fraud involved: 

• Payments to physicians for shipping and handling lab specimens;
• False processing fees;
• Kickbacks to physicians;
• Illegal sales agreement in which sales staff were paid a monthly fee plus 19.8% of lab revenue;
• Payments to induce doctors to order large multi-assay panels, including many medically unnecessary lab tests.

At its core, it seems that several private clinical labs and their executives fleeced the U.S. government for more than $1 billion.

2. Canada

• Medical laboratories face squeeze from retiring labor force, and more.
• Canada's innovative medical and pathology laboratories share their successes at Toronto Executive Edge Conference. 

In Canada, as elsewhere, a major challenge is how to deal with an ever increasing number of lab specimens when governments continue to decrease lab funding. Labs are asked to do more with less, an old story dating to at least the 1990s in my bailiwick, Alberta, Canada.
According to reports on the Executive Edge Conference in Toronto:

• Labs will need to cut costs without compromising quality, thereby creating a demand for lab professionals skilled in Lean, Six Sigma, and process improvement (Further Reading: 'Can health care learn from assembly lines?')
• To support the growing demand for personalized medicine, labs must upgrade their information technology systems (See earlier blog for my take on personalized medicine)
• Training programs for med lab technologists/scientists struggle to find labs willing to provide practical clinical training required for students to be certified (Old story. Cost constraints in health care have a huge negative impact on educating health professionals)
• The number of trained healthcare professionals is fewer than needed (True for nurses and physicians and long true for med lab scientists/technologists but unsure it holds true today for Canadian lab technologists) 
• No mass retirement by baby boomers, at least not yet (Tsunami of golden oldies retiring hasn't happened yet)

3. Smartphone 'Dongle'achieves capabilities of big clinical laboratory analyzers: Diagnoses three diseases at once from single drop of blood.
The innovative smartphone device  - mobile and inexpensive, making it ideal for use in developing nations - diagnoses HIV and syphilis with a finger prick of blood and displays results on a smartphone screen within 15 minutes.

The device performs an enzyme-linked immunosorbent assay (ELISA) without requiring stored energy because power is drawn from the smartphone. Plus it performs a triplexed immunoassay not currently available in a single test format: HIV antibody, treponemal-specific antibody for syphilis, and non-treponemal antibody for active syphilis infection.

The question is, Could such technology eventually find a place in medical laboratories in developed nations? And how would established labs push back? As with POCT, by citing the legitimate safety needs for quality control and lab oversight or ?

MUSINGS
So there you have it. 

• Private clinical labs in USA bribe physicians to order unnecessary lab tests and promote other unethical practices. 
• Clinical labs in Canada and elsewhere struggle with under-funding and are told to adopt Japanese assembly line solutions to save themselves, i.e., to cut costs without sacrificing quality.
• In Canada private clinical labs exist in parallel with public labs and are paid by provincial governments. No case of fraud has ever been raised against private Canadian labs that I'm aware of. Could it happen in future? Who knows. 
• Innovative start-ups threaten established clinical labs who push back, big-time, sometimes with valid concerns, sometimes without. As an example 
• Theranos' CEO Elizabeth Holmes claims that established US mega-labs like Quest and Laboratory Corporation of America seed the media with negative stories about Theranos.

Personally, on the private vs public lab issue, I'm glad that Alberta cancelled the RFP on a $3-billion contract under the previous government to Sonic Healthcare of Australia. Rightly or wrongly, I have more confidence in private labs with a history in Alberta. And even more confidence in Alberta's publicly owned and operated laboratories.
Regardless, US experience with private labs defrauding government is disturbing. Like Big Pharma's many lapses, does the profit motive trump ethics?

As to the Executive Edge Conference in Toronto, I've focused on issues that interest me. Lean and Six Sigma are trends that mostly give consultants mega-bucks and naturally claim big benefits to justify the fees. On staffing shortages, unsurprisingly, the tsunami of retirements hasn't yet occurred for 'boomer' health professionals. Suspect it'll occur in the next five years.  
 
The smart phone dongle is one of many innovations yet to be validated and will no doubt be challenged as has Theranos's technology, which uses a few drops of blood via a finger-prick rather than the usual tube of blood via venipuncture (Further Reading).

Such innovations, similar to point-of-care testing (POCT),are often administered by nurses. For patient safety, lab professionals have the expertise to see what can go wrong and know that nurses may not, especially when it comes to a sound understanding of quality control of lab instruments.

POCT is now standard practice in most health facilities in the developed world, and often overseen by the clinical laboratory. (Nice guidance from UK's IBMS on the role of the laboratory in POCT)

Ultimately, innovative lab devices may make any debate on public vs private laboratories passé. They may increase the likelihood of fraud by private labs as they struggle for relevance. Because if innovative miniature lab devices succeed, we won't need the ticky-tacky big box labs we grew up with and know as clinical laboratories. 

FOR FUN
'Little boxes' is an anti-establishment song from more than 50 years ago that challenged the conformity of 1950s America. Somehow I suspect it still resonates today because all around I see transfusion folks who pretty much agree with the orthodoxy of the day and question nil. For example:

• Personalized, precision medicine is the best thing since sliced bread. If you're not red cell genotyped to match with blood donors, you're second class, dude.
• Lean and Six Sigma is where it's at. Let's get rid of all the waste. Yes, Lean has done 'good things' but it's curious that waste seldom happens at management/executive levels (see Further Reading)

As noted earlier, you'll either hate Little Boxes or love it.

• Little boxes (By Malvina Reynolds, sung by Pete Seeger)

As always, comments are most welcome.
FURTHER READING
USA: Biggest case of Medicare fraud and abuse in history of clinical laboratory business 

Canada: Medical laboratories face squeeze from retiring labor force, and more (Dark Daily, 25 Aug. 2015)
Canada's innovative medical and pathology laboratories shared successes at Toronto conference (Dark Daily, 14 Oct. 2015)

Smartphone 'Dongle' achieves capabilities of big clinical laboratory analyzers: Diagnoses three diseases at once from single drop of blood
Smartphone, finger prick, 15 Minutes, diagnosis done!

LEAN

• Lean/Six Sigma: Can health care learn from assembly lines? Yes and No.
• Lean design in the medical lab (Presentation by Lean consultant at BC Soc of Lab Sci | Great pictures/diagrams)
• A collaborative approach to Lean laboratory workstation design reduces wasted technologist travel [Cleveland Clinic study done with 67 lab staff: 61 technologists, 4 technicians, 2 assistants]

THERANOS

• U.S. regulators push Theranos to scale back testing
• Hot startup Theranos dials back lab tests at FDA's behest
• Theranos' Elizabeth Holmes needs to stop complaining and answer questions