Tag Archives: Health Information

Canadian DTCA Charter Challenge Indefinitely Adjourned…and a tree falls in the forest

The News

In the middle of financial turbulence, potential bankruptcy, and a storm of management changes, CanWest Global has decided to seek indefinite adjournment of their court case challenging Canadian restrictions on direct-to-consumer advertising (DTCA) of prescription drugs.  In summary, CanWest was alleging that the ban on certain types of DTCA was infringing on their freedom of expression, especially since they couldn’t make money off that type of ad while media across the border in the US could. The case was seen as a landmark case as it was a challenge to existing law under the Canadian Charter of Rights and Freedoms (a constitutional law case, for non-Canadians reading this), and thus would set new Canadian constitutional precedent.

The adjournment request came right at the 11th hour, since closing arguments were set to be heard June 15-19, which is to say, this past week. While CanWest can request to revive the case, it seems unlikely at this point, when the company is facing billions in debt and is working to secure major restructuring deals. It appears that CanWest may silently agree with opposing lawyer Stuart Shrybman, that the company should have pulled the plug on this “ill-conceived litigation” months ago,” and that the best option at this point is to avoid pouring more money into what is pretty much a lost cause.

So what? In short, this case has cost both CanWest and the government a lot of money since it was filed in December 2005. Current regulations on DTCA in Canada are not well enforced to begin with, and to my knowledge there’s not much indication that this is changing. However, by not opening the floodgates wider, we may be able to avoid even more expense and needless adverse side effects (such as Vioxx related deaths) that appear to be encouraged by DTCA.

Didn’t hear about this?  I’m not surprised. Somehow nobody else has either.

The News (not)  in the News

This story has been weirdly absent from the media.  And by media, I mean practically everybody.  When I heard about CanWest dropping this case, I immediately ran to my web browser and started searching for early news coverage…nothing.   A week later…still nothing in the mainstream news sources.

The medical journals? One article in the faithful CMAJ, which has offered ongoing coverage of this trial and whose parent organization, the Canadian Medical Assoiaition, has an official position statement opposing “Brand-specific direct-to-consumer advertisements, such as those permitted in the United States.”

Okay, well, I figured that perhaps this was an example of the failures of traditional media.  Maybe media companies aren’t nimble enough to catch this story in a timely manner; maybe the industry carries an inherent bias against reporting on what is essentially a failure (of the cut-your-losses type) of a fellow media behemoth.

The bloggers, though – the bloggers will have lots to say about this, right?  The bloggers are the new media, right?  Citizen journalism! Media democracy! They are us! We are on the ground, everywhere, reporting on the real issues in our spare time, without budgets to support travel expenses or copyediting, and hoping our cameras are not confiscated by the police and our tweets are not blocked.

So far I have found one lonely blog post about this, from the magazine marketing industry, which I’m sure has been watching CanWest’s case avidly, as a CanWest win would potentially open up a whole new world of direct-to-consumer drug ads, with accompanying revenue stream, for magazines as well as television channels. That post did link to one other blog, from a magazine marketing magazine.

But basically, this adjournment has been a tree falling in the forest.  Why?  Is it just tough to compete in the health news arena the week the WHO declares a pandemic? Perhaps, but the possibility of federal regulations on trans-fats  is getting press. Do we feel bad for CanWest, and not want to slag them more? I dunno, we seem to have an appetite for the details of the restructuring /fall of the Asper family empire. Is DTCA just a boring topic? Well, discussions of the topic can certainly be acronym-heavy, but there has been plenty of coverage in the media (even in CanWest outlets) about the recent Plos ONE article, “Twelve Years’ Experience with Direct-to-Consumer Advertising of Prescription Drugs in Canada: A Cautionary Tale.”

What’s the deal?  I don’t get it.

My government went to court against the largest media entity in the country, basically won, and no one is in the forest to hear the media giant fall!

For previous posts on direct-to-consumer advertising, see: dtca part 1, and part 2.

Disclosure: I work with authors in the PloS ONE article cited above, including on DTCA-related topics.

ETA – Apparently I (and Google) missed The Tyee’s Hook blog coverage of this on June 12. It’s here, if you’re interested.  Of note in this article is the statement, “a spokesperson for Canwest says the company did not ask for the adjournment and plans to continue the case in the fall” — which is entirely possible but not something I have seen/read elswehere. Anyone reading this have more info on CanWest’s official stance on this?


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Filed under government, Health, media democracy, privatization

Chief Public Health Officer offers CHN postmortem

Okay, who has seen this? (Non-OA)

Butler-Jones D. (2008). Streamlining How We Deliver Public Health Information Online: From CHN to PHAC. The Serials Librarian, 55 (4): 625-627. DOI: 10.1080/03615260802282559

It came to me via the CANMEDLIB listserv, so I’m sure some of you who have access to to journal have also linked into it and taken a peek.

In the article, Dr. David Butler-Jones, first (and thus far only) Chief Public Health Officer of Canada, assures librarians that the closing of the Canadian Health Network (CHN) is not a loss, but

“rather, a change that consolidates resources and information into one website, that of the Public Health Agency of Canada.”

According to Butler-Jones, the primary reason for termination of the CHN was that

“The decision was made to incorporate some CHN materials into the Public Health Agency’s website to better reach both that professional audience [“teachers, health care providers, public health professionals and more”] as well as the general public.” (emphasis mine)

This, naturally, brings up the question of usage stats.  My understanding is that 40% of the CHN users were health professionals, although I’m not sure who all that includes and who the other 60% were. Is it teachers who were not using the CHN, but rather the PHAC?  The general public?  Some specific groups of health care providers?

I’d love to know who the users of PHAC are and who they were a year ago as well. It’s unclear from the Serials Librarian article which audience is considered to have been affiliated with which site, and whether those groups/individuals formerly using the CHN are thought to have actually migrated their use to the PHAC now. (I know I’m sure not; I have become reliant on the NLM’s MedlinePlus for most searches that would previously have been done first on the CHN. You?)

The secondary reason was that the PHAC website is “better equipped” than the CHN to take advantage of today’s online information searches, which use “advanced search engines.”

What do you think this one means?  Does PHAC have better metadata on its webpages than the CHN did? (The PHAC webpages I checked out do have rather sexy metadata, I must say.)  Are the webpages more accessible? More bandwidth to handle higher hit counts? A deal with Google to up pagerank? I’d love to know what this means, personally, so I can think about whether I think it’s a good reason to scrap rather than reform a website.

A third reason Butler-Jones lists as “[a]nother reality at play” was the necessity of making cuts to departmental budgets within government.

Ah, well, this is the one that has been discussed from the beginning.  In fact, this is the only reason we were getting back when things were actually going down. I still have not heard any official answer as to where the funds to launch the new (and relatively vapid) Healthy Canadians website came from, right when the CHN was being axed…have you?

We know the search mechanisms/indexing on the PHAC, Healthy Canadians, and Health Canada websites are inferior to that on the old CHN for consumer health research, and this is likely to be especially so for certain “hot” (controversial) topics. (Go ahead – try it!  And do let me know what you searched for and how the search went on the various sites.) We don’t know whether there is any interest in this matter on the part of the government, or any planning to address this on the PHAC site.

I am curious to know how much of the CHN content has now or will eventually be rolled into the PHAC website.  I know some of it has been appearing, but I believe there is also some that will not migrate. Anyone know more about this transition plan?

Butler-Jones asserts that the CHN and PHAC websites had the same goal and it was financially irresponsible to continue to maintain both sites. He alludes to better systems “in the end” without mentioning when that end will come or what the plan is for getting us there. And he thanks all of those who helped build the CHN, stating that he hopes

“the Public Health Agency of Canada can count of your continued involvement and support.”

Because, um, why wouldn’t health librarians want to pour time and effort into a new website when the one they’d spent the past decade nurturing into a success was just slashed?

As Andre Picard stated last December,

“The [CHN] affiliates don’t need hollow praise, they need cold hard cash to keep the much-needed service up and running.”

And now? Health librarians and information specialists still don’t need hollow praise. They need to be actively and seriously consulted and listened to when national health information infrastructure is being developed. I know sometimes hard questions about resources and budget cuts must be made; however I’m probably not alone in my appreciation of transparency, honesty, and consultation.

Are any of you library/info types out there who use to work on the CHN now working on the PHAC? If so, what are you doing and how is it going?  Is it same thing/different URL, or are there differences in the type of information you are providing now?  What library & information specialists is the PHAC consulting in order to provide accessible information and improve usability? I’m curious!

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Filed under government, Health, technology

Further thoughts on the POPLINE debacle: what went right?

Rachel Walden’s follow-up post on POPLINE has given me a kick in the pants to get moving on my own follow-up post. (Yes, the one that I alluded to months ago…)

I’ve been thinking about the POPLINE debacle. While Rachel rightly points out that all is not perfectly resolved, and we await more answers, in general I’ve been wondering about what went so darned right.

Yes,I know I’ve been one of many ranting about what went wrong – i.e. USAID anti-abortion policies interfering with access to information – but what went right is a different question all together. Considering the positive is something I don’t get to ponder a lot on this blog, so indulge me here.

To recap, for anyone not following along in April: A librarian noticed that abortion was no longer a searchable term in the database and sent out an email about it. The email was passed along on various health librarian and feminist listservs and public outcry was raised. Who-knows-how-many of us emailed the POPLINE admins and blogged it with outrage, and within two days the dean of the Johns Hopkins Bloomberg School of Public Health issued a public statement assuring the world that this would be rectified and investigated.


So…as I asked before, what went right here? Why were we successful in calling attention to this issue, and getting it addressed so swiftly? Why did this work fairly well, when in comparison the Canadian Health Network was shut down after months of protest by health librarians, a petition, multiple high-profile newspaper articles, and various other media attention? I’ve been pondering this, trying to figure out what we can do in the future to make our information resources more like POPLINE and less like the CHN, and these are the elements that I’ve come up with thus far:

  • US vs. Canada: The US is generally more political & inflammatory, and Canadian librarians will jump on a US database issue, while 99% of the US generally forget that Canada exists or is within the scope of the ALA
  • POPLINE is housed at/maintained by a single institution with important people who could be embarrassed at the top of the chain of command vs. the CHN, which was, as I understand it, purposively built on a distributed model
  • Specific interest vs. general resource: It’s hard to argue than another resource could easily replace POPLINE, as there aren’t really other reproductive health focused databases like it (are there?), and – however their scope or quality (attirbutes understood by librarians but not everyone) may vary – there are other websites that aim to be broad consumer health resources. It may also be significant that POPLINE is not really for everyday use of the general public, but more for scholars and health professionals.
  • The scope of POPLINE, while specifically focused, had broad interdisciplinary appeal (while reproductive rights info access was damaged by CHN removal, as shown in my previous “ABC” post, POPLINE is obviously related to reproductive rights, and thus feminists signed on the campaign en masse: POPLINE was discussed on WMST-L, while the CHN never was)

I know there are more differences that may have been important in determining how things went down. Feel free to tell me what I am missing. My mind is now spinning on how future projects can be built in a way that helps a threat play out in a POPLINE manner, not a CHN one.


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Filed under censorship, gender, Health, The Profession

CHN Closure Part IV: Americanization or obfuscation?

In my non-librarian alter-ego, I teach women’s/gender studies at a college. The class of my heart (don’t most teachers have these – the one or two courses they just love the most?) is a women’s health course. I love it for multiple reasons. I find it fascinating to explore the intersection between two concepts – “women” and “health” – that both have strong roots both in biology and social construction. I love that everyone finds something personally relevant in the material we cover. I love that the material is always evolving and the class content will never be exactly the same twice. And I love that, even if some students don’t master all the feminist theory we cover, all students can still leave the class with an enhanced ability to understand health information and navigate health systems.

I was recently talking with one student about as assignment she’s working on. She is very interested in learning more about abortion in Canada, and the health issues surrounding abortion. Like many people, she has been exposed to a lot of propaganda/myths about alleged negative health impacts of abortions. Part of my job as her teacher (strikingly similar to my job in my other role as a a librarian) is to help her develop the ability to navigate all the information (and misinformation) out there on such a topic, in order to assess what is reliable and “true” to the best of our scientific knowledge, and to use her critical analytical skills to try to figure out what is going on when there is such apparent disagreement about the scientific “truth.”

One suggestion I have made to her, of course, is to always be aware of the source – and funding – of the information you are reading. That, in the case of, for example, the alleged link between breast cancer and abortion, political abortion websites (pro or anti choice) are not as good a choice for unbiased information as a reliable cancer information website would be. Thus for accurate and current consumer information on whether there is a link between breast cancer and abortion, one would have better results going to, say, the Canadian Cancer Society or the US National Cancer Institute, than following “Dr. Google” to the atrociously misleading and inaccurate top hit of “The Coalition on Abortion/Breast Cancer.” (the search was [“breast cancer” abortion])

I also talked with her about the challenges of looking at medical research as someone who is not an expert or even a health professional of any sort. Sometimes students will find A study on a topic and take its findings for truth, not fully understanding that one individual study is not usually as reliable as a set of studies, that small studies are usually less useful than very large ones, and not having the skills to critically assess the methods used in the study.

So where should she go for such information, particularly if she’s not someone who has the familiarity with the topic to know that there even *is* a Canadian Cancer Society? Good question.

In the past, my first answer for her would have been simple: try the Canadian Health Network. And this would have been a good answer, as a search there for [“breast cancer” abortion] gives one result:

Abortion and breast cancer
Provides the Canadian Cancer Society’s perspective on rumours that suggest having an abortion or miscarriage will increase the risk of breast cancer.
Source: Canadian Cancer Society (CCS)
Amazing! That link is exactly what I first thought of to recommend. Or not so amazing, as that link was put there by some health librarian or similar, who has the same values I do of promoting clear, easy access to accurate, impartial consumer health information.
However, the CHN homepage now has a “Thank You” notice on it:

A notice to Canadian Health Network users

The Canadian Health Network would like to thank its visitors for using this Web site as a health information resource since 1999.

Beginning April 1, 2008, Canadians will be able to access timely, trusted and credible public health information through a single source – the Public Health Agency of Canada’s Web site at www.publichealth.gc.ca. Accessed by over 10 million visitors a year, we invite you to bookmark this Web site as a valuable and unique source for information on healthy living, disease and injury prevention.

Since my class is possibly the only consumer health training my students will ever have, and the CHN is still slated to go *poof* in three weeks, I didn’t recommend it to my student who was researching breast cancer and abortion, even though it would be an ideal starting point for any similar searches she wanted to do in the future.

Seeing as the CHN website refers users to PHAC, the Public Health Agency of Canada, as a replacement resource, I decided to head over there and try the same search on the PHAC site. Rather than a link to one resource to answer the question, we got ten hits, beginning with:

· 1. CYAC 2006E.vp

unopposed estrogen Breast cancer Uterine cancer Ovarian Endometrial cancerSarcoma Early age at menarche or irregular menses ?*36 ? *187, 128, 183, 63, 140 URL:http://www.phac-aspc.gc.ca/publicat/cyac-cjac06/pdf/cyac-cjac-2006_e.pdf
2006-09-12 | Size:1456.4K |Language:English

and continuing down a list of references that are, for the most part, equally unintelligible to the average consumer health information seeker. None of the ten citations listed look promising for answering our question.

This is where I started to get angry.

It’s one thing to take away a really great consumer health resource.

It’s another to take it away and leave a pointer referring people to an other resource that is virtually useless for the same type of information seeking!

Okay, I thought. I’ll try Health Canada, then. They do everything; they must have the info there. Well, as we all know, having everything is not what makes a useful library for most regular patrons. Looking for info on abortion and breast cancer at Health Canada is like looking for Harriet the Spy at the Library of Congress by only using a keyword search in the catalogue. There have got to be a lot of books about adolescent girls and journals out there, ya know? Similarly, at Health Canada, our [“breast cancer” abortion] search returns us 76 pages of results, several of which have the same ambiguous title/description:

1. Canada-U.S.A. Women’s Health Forum Commissioned Papers
Canada-U.S.A. Women’s Health Forum Commissioned Papers…

This is not what my student needs.

Just for kicks, I hop across the virtual border and conduct the same search in MedlinePlus. Here, I got 32 hits, with the top one being:

Can Having an Abortion Cause or Contribute to Breast Cancer? Abortion and breast cancer are both topics that can an Abortion Cause or Contribute to Breast Cancer? Abortion and breast cancer are both topics that can bring out strong&# … http://www.cancer.org/…abortion_cause_or_contribute_to_breast_cancer.asp?sitearea=cri

This is the U.S.American version of what the CHN gave us from the Canadian Cancer Society. The results that followed were all reasonably closely related as well, being decent consumer health webpages about either breast cancer or abortion. For this topic, the U.S. and Canadian information is basically the same, so from an information standpoint there should be little qualitative difference (the Canadian Cancer Society might differ in opinion, though, now that they will no longer be getting the web traffic from CHN). However, for, say, breast cancer treatment, the U.S. information would definitely not be the same, or even equivalent to the Canadian, due to different drug approval systems and healthcare delivery systems.

So where does this leave my undergraduate researcher/young woman trying to find out some health info? Really, she has three main choices now, if she is savvy enough to question the verisimilitude of the abortion-breast cancer propaganda in the first place:

  1. Ask a professional (teacher, librarian, doctor…)
  2. Use non-Canadian sources (if US sources, often similar to Canadian info, but sometimes quite different)
  3. Give up: either be confused by the seeming garbledygook on Health Canada/PHAC, or accept the “facts” according to the top hits on an internet search.

I guess I still just don’t understand the idea behind closing the CHN. Is it merely to obfuscate, or is the intent to Americanize?


See previous posts on the CHN here, here and here.


Filed under gender, Health, Uncategorized

Book challenges, media independence, and profits, oh my

Tara over at We Read Banned Books blogged about a conversation she & I had about media interests in publicizing book censorship here. I wanted to expand on a few points back here.

This summer, I had a reference question about anaesthesia awareness. The question came from a very well educated woman who had recently been scheduled for surgery. And she was terrified that she would be awake during the procedure, feeling pain and unable to communicate. Terrified to the point she was considering not going through with the surgery, even though it would probably improve her quality of life to a great degree. She wanted to know what I could find for her on waking during surgery.

I did a nice little lit search for her, hitting the usual suspects among consumer health websites and medical databases, and came out with some statistical information on risks of anaesthesia awareness, along with information on what exactly anaesthesia awareness means (hint: it doesn’t necessarily mean you are actually awake and feeling pain). When we next talked, she expressed that she knew she *should* feel reassured by the information and statistics, but still felt this semi-irrational, disabling fear about waking during surgery.

So I did another search for her. This time, on the open web. Just to see what was going on in the non-specialist world related to anaesthesia awareness. To my surprise (considering the relative rarity of the phenomenon), I found a number of recent news articles about anaesthesia awareness. Then I found this: Awake, a thriller released Friday and distributed in North America by MGM. Hmm…

According to MGM’s website, the 6 strategic partners who comprise their ownership include Sony and Comcast. And, according to Film Industry News last year, “MGM has ownership interests in international TV channels reaching nearly 110 countries.” Not to mention the other media outlets related to MGM through owners such as Comcast.

But the point of this story is not to laboriously connect all the dots from MGM to Canadian news outlets. It’s to help our patron who feels anxious about her upcoming surgery, is it not? Why are we mucking about on media corporation websites, rather than scouring for clinical guidelines to minimize anaesthesia awareness?

Why? Because no matter how educated we are, we are all influenced by our popular culture surroundings. That is why even those of us who think we are so hip and independent all like the same baby names at the same time. That is why doctors who are trained clinical experts still prescribe advertised drugs more frequently than others.

When I was able to let this woman know that the media actively *wants* her to be terrified of anaesthesia awareness this year, that such terror on the part of the population could mean big bucks this year, it added a sense of perspective. When we could have a decent, respectful conversation about the actual risks versus the sudden media hype about anaesthesia awareness, she was able to temper her fear with acknowledgement that the high profile of the phenomenon likely had more to do with media connections than frequency of occurrence, the fear took on a different shade. Thinking of her risks along evidence-based lines rather than media-encouraged fear became an active stance for her to take.

Health information is not just about clinical information. It is also about information about your information. Very meta, I know, but in this age of ubiquitous advertising, it is as important to let our patrons know what we can find out *about* the information as it is to convey the content.

And you know I’m not just talking about health.

When I talked Pullman over coffee with Tara the other day, I had this reference question in mind. I have no way of knowing whether media outlets are getting explicit orders to cover controversy surrounding banned books that are being made into movies by related media companies, or whether the increased media hype over the movie just makes the book banning seem a more interesting and attractive topic for coverage. But I do know that excitement, taboo, and intrigue surrounding The Golden Compass can only improve box office revenues for the movie. I adore the His Dark Materials trilogy and personally hope they outgross Harry Potter bigtime. But that doesn’t mean I shut down the part of my mind that critically questions they way the media covers each story.

When it comes to YA fantasy novels, speculation around media hype connections is interesting and intellectually useful. When it comes to health information – life or death, or even “just” quality of life issues – it is critical.


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Filed under censorship, media democracy

CHN Part II – Replacement Resources?

What resources will fill in for the CHN when it no longer exists?

Let’s consider our options…

  • The US NIH, via MedlinePlus (not Canadian, necessarily US-biased…which makes little difference in some areas and a whole lot in others, like pharmaceuticals)
  • Provincial Health Portals/Guides (Typically not in-depth and underutilised)
  • There is that new Canadian government consumer health website, Healthy Canadians (unfortunately, it only covers the 6 topics the current government wants you to be thinking about)
  • Hospital or Clinic websites (How many of these are still non-profit and impartial, particularly if they are US institutions?)
  • For-profit medical websites such as WebMD and WrongDiagnosis.com (Supported by advertising…need I say more?)

The CHN is big, well-used, and non-commercial. These are non-trivial attributes in an information source.

Interestingly, at the same time as the primary, premier source for Canadian consumer health information is being defunded, another source of health “information” is proliferating – one that I wager will ultimately cost Canadians far more than the piddly price of a few librarians, nurses, and IT folk who appear to make the CHN happen. This flourishing source is, of course, pharmaceutical industry advertisements.

Is it merely coincidence that there are more public “reminder ads” (the kind that are legal here in Canada – you can get away with much more in this arena in the USA and NZ) around my city this fall than I’ve seen since moving here? Bus shelters encourage us to have warm fuzzies about Celebrex (a Vioxx-like drug), subway ads ask us if we’ve had a HPV vaccine, among others.

There is currently a battle going on in this country over how far drug advertising should be allowed to go, and the pro-ad argument tends to fall back upon the unproven notion that pharmaceutical advertising is somehow educational to patients in a way that can improve health outcomes, not just teach then to ask for drugs. While I like a good conspiracy theory as much as the next lefty, I’m not suggesting that the rise in drug advertising has been deviously crafted to fill the void we will feel when we no longer have a national health website on which to look up arthritis or human papilloma virus. I am however, quite concerned over the trend here.

When a pro-privatization government cuts national funding to social infrastructure and, at the same time, turns a blind (or at least feeble) eye to corporate challenges to public health and social policy regulations…well, I guess that’s where all that information literacy training we librarians are always pushing comes in. Because health information with a profit-motive is clearly not in the public interest. But without a not-for-profit health education, will we recognize it when we see it?

Resource list inspired by:
Evans, M. (2007, November 13). Searching for sound medial advice online. Globe and Mail. Retrieved November 19, 2007 from: http://www.theglobeandmail.com/servlet/story/RTGAM.20071113.wevans13/BNStory/specialScienceandHealth/home.



Filed under Health

The Canadian Health Network: Part I – Pulling the Plug on a Success Story

As a health librarian, I suppose it’s only fitting for me to start us off here with a health information issue. So here we go. That said, this is not really “just” a health information issue – it’s an issue of social infrastructure, government priorities, and the current Conservative* government.

The Canadian Health Network is being shut down at the end of March.

What is the Canadian Health Network? The CHN is a bilingual website that, for the past 8 years, has provided neutral/balanced, quality-assessed information pages and links to information for Canadian health. Use of the CHN has exploded, growing each year since inception, and increasing 70% in the past year alone.

The CHN provides in-depth information on 25 “key health topics” and links to over 20,000 appraised information sources on other topics. Health professionals, librarians, and the public go to CHN for info on diabetes, domestic violence, bird flu, or what to do when someone dies.

The CHN is maintained by cooperative efforts among libraries, government entities, and academic health centers, and trains users in health literacy skills while delivering health information. There is no resource quite like the CHN in the world.

In short, the CHN is a huge Canadian success story, part of the national commitment to health care as a human right.

The federal government, along with many of the provinces, is running a fiscal surplus.

Which begs the question: Why is the government, particularly in times of plenty, pulling the plug on the CHN?

For coverage of the defunding, see also:

Goar, C. (2007, November 16). Conservatives axe health network. Toronto Star. Retrieved November 19, 2007 from: http://www.thestar.com/comment/article/276891 .

*N.B. for the USAmericans in the crowd: In Canada the 2 largest political parties are the Liberals and the Conservatives, roughly analogous to the Democrats and Republicans.



Filed under Health