mdchc checking origin of form

Hello Maren,

As discussed during our telephone conversation last week, I have taken your concern to our Management Team for discussion. I wanted to determine how the form had been developed and confirm the data collection requirements of CHC's across the province. I hope that you had the opportunity during the week to check out the Association of Ontario Community Health Centres (AOHC) website to find out more about the work of Community Health Centres in Ontario communities. The website is www.aohc.org. While CHC's provide medical services there are
also other broader programs and initiatives provided in the community depending upon community needs.

We are reviewing our forms and checking with colleagues in other CHC's regarding the wording, which had been taken directly from a CHC Program Evaluation User Guide provided to us. While we are required to collect the information, as are all 55 CHC's in the province, we will review the
way the questions have been worded and look at expanding the statement at the bottom of the form explaining the purpose of collecting this information.

Thank you for sharing your concerns with us.

Regards,

Ruth

Ruth Dimopoulos BSC.PT
Health Services Co-ordinator
Registered Physiotherapist
Merrickville District Community Health Centre
Phone: 613-269-3400 x228 Fax: 613-269-4958
Website: www.mdchc.on.ca
Email: ruth@mdchc.on.ca

Open letter to Merrickville's District Clinic Health Centre

Dear Ruth,

thanx for our conversation on the phone last Wednesday (?), I think it was,..
I finally found some time to read up on things I wanted to check before critiquing your questionnaire CLIENT REGISTRATION FORM, where patients are asked to specify their race/ethnic origin, when a second question right afterwards enquires about their "country of origin" which made me think long and hard. I wanted to at least superficially research this complex which I have been able to just tonight.

Sorry for the delay. Unfortunately I haven't found anything on the Health Canada pages, which would explain (guidelines? good practise? not really), why such question was required. And besides, Health Canada is already asking that or the like at the border:

http://www.hc-sc.gc.ca/hl-vs/travel-voyage/
general/inspection/index_e.html

As I haven't been in time yet to try on the phone, I am sending this letter also to the media staff of the health ministry, and some members of the press - I hope a lot of people are going to have a look at or even join in this discussion:

"race"?
I tried to find out where the discussion was at, whether the term "race" is scientifically defined or, at all, describes a scientifically approved concept. I noticed, that nothing much had changed, as I can confirm due to my own work in science as a biologist. This discussion has been going on for longer and I am only referring to one very recent tip of it here:

http://www.iidb.org/vbb/archive/index.php/
t-209684.html

It might serve as a starting point for other interesting sources of information (Richard Dawkins, Jared Diamond etc).

However, we now seem to only share 94 percent of our genes with the Chimpanzee, instead of 98 percent some years ago, according to the latest research.

My summary here:
To know a person's body's constitution helps to diagnose and treat patients better - no doubt here as illustrates the above noted web page:

"Sickle cell anemia, most closely identified in the United States with black Americans, is often found in African and Mediterranean peoples, ...

Conversely, cystic fibrosis is a common genetic disorder in people of northern European descent, but far less so in Africans.

Those are both diseases that are caused by a single mutation, so the genetic link is clear-cut. [sickle cell and cystic fibrosis]

... , African Americans seem to have a higher frequency of one mutation that reduces the liver's ability to break down certain tricyclic antidepressant drugs, ...

Blacks also have a higher frequency of a mutation that increases the speed at which a newer class of antidepressants, such as Prozac, take effect.

About 8 percent of whites carry a mutation that would cause trouble with warfarin, a blood-thinning drug, compared to 2 or 3 percent of blacks.

Last year, the New England Journal of Medicine published a study showing that African Americans with heart failure were less likely than whites to benefit from a type of drug known as an ACE inhibitor."

(end of quote of the above web page)


Taking the risk of crashing open doors I can't but list some points which seem important in this context:

a.
The exterior (phenotype) expression of a "race" - solely out of mid age convenience I'll stick with the criteria in the internet discussion from above, because I am sure that there are plenty of scientist who would dispute these as defining attributes: nose, hair, skin - represent different alleles on the molecular level, varieties of one gene - that all populations - and to 94 percent even the Chimps - share.
b.
The genetic disposition can be much more diversified as the actual "look" of that person. People can carry two different alleles, coming from their parents gene-disposition, even from far gone by ancestry - somebody's "race" might not be so easy for any of us to reveal.
c.
The experts argue long and hard, if the molecular disposition of a person allows for conclusions about geographic details of that same person.

The Wikipedia entry on the term offers orientation, too:

"Some argue that although "race" is a valid taxonomic (note of the editor: = classifying) concept in other species, it cannot be applied to humans.[3] Many scientists have argued that race definitions are imprecise, arbitrary, derived from custom, have many exceptions, have many gradations, and that the numbers of races delineated vary according to the culture making the racial distinctions; thus they reject the notion that any definition of race pertaining to humans can have taxonomic rigour and validity.[4] Today most scientists study human genotypic and phenotypic variation using concepts such as "population" and "clinal gradation". Many anthropologists contend that while the features on which racial categorizations are made may be based on genetic factors, the idea of race itself, and actual divisions of persons into groups based on selected hereditary features, are social constructs."


It takes considerate writers to find the matching word. We have just tangentially touched the scientific discussion, and it's already clear, that this is one of the hot spots of social life science and why the term "race" is very disputed and may seem offensive - why not avoid it altogether?

I think there are better ways of accessing that information that is so crucial to provide the right services to your community. On the same note I'd like to express my appreciation for the service that I received when I attended the pap-clinic - everybody was very friendly and helpful. I know the mdchc is trying hard to improve people's health.

Therefore the following suggestions with my best wishes as a worshipper of appropriate wording and expression, and a scientist:

The second and third paragraph of the questionnaire need to be modified. In order to screen on any infectious potential the question

Where have you been travelling within the last two years?

seems much better suited.

Would that point out a certain increased risk, you could try to obtain details in the one-on-one (have you been exposed to farms, chickens, touched a bird, noticed a strange sting or bite on your skin), as usual.

To screen for potential diseases more common amongst people who share a certain phenotype - well, that poses challenge, and I know that the mdchc has an interest in what is politically correct. Should that really be required here, why don't you ask your patients what they know about themselves instead of something that is so hard to describe, even for scientists (s.a.):

Please check boxes to indicate (cultural or family) ties with the following regions (multiple possible):

Central America, North America, South America, Middle East, India, Africa, South East Asia, China, Australia, Russia, Europe, Caribbeans, Pacific etc.

Upon registration - is the new patient at least seen by a nurse? The details need a private setting, which can be easily established with the nurse or office manager.

A far as I remember you on the phone as well as the staff lady who was at the counter when I started to try to find out more about the intention of question 2 and 3, explained to me upon my enquiry, that the mdchc was trying to provide an appropriate frame of care according to the conviction or any other personal choices of the individual patient. This can easily be addressed with this question:

Do you prefer a male/female family doctor?

Also here, a one-on-one will reveal necessary details ("Is there anything else we need to know in order to treat you appropriately?").




Come on, guys!


What in the world could be the reason for using such a dirty and leached out looser of a word as

"race?"

NUCLEAR SMOKE AND MIRRORS FROM ALBERTA TO AUSTRALIA

Jim Harding is a retired professor of environmental and justice studies and author of the just released Canada’s Deadly Secret: Saskatchewan Uranium and the Global Nuclear System (Fernwood, 2007).


The AECL’s Advanced Candu and Bush’s Global Nuclear Partnership

By Jim Harding

A few weeks before Stephen Harper went to the APEC meeting in Australia, ready to discuss George Bush’s Global Nuclear Energy Partnership (GNEP), the Energy Alberta Corporation (EAC) in consort with AECL announced its plan to build two Advanced Candu Reactors (ACRs) near Peace River, Alberta. Harper, EAC’s Wayne Henuset and AECL’s mandarins won’t want the public to connect the dots too quickly. Harper’s minority government might not weather a heated controversy over Canada importing nuclear wastes while having a huge unsolved nuclear waste problem of its own. That controversy erupted in the Australian election campaign after the Howard government indicated it would consider buying into Bush’s plan to have supplier countries take back and reprocess spent fuel.

The Seaborn Panel, the 9-year federal review of Canada’s nuclear wastes, never investigated Canada importing nuclear wastes, and reprocessing these wasn’t even on its radar screen. Rather, it concluded that deep geologic disposal of irradiated nuclear fuel is not acceptable to the Canadian public and recommended that the management of irradiated fuel be addressed by a body at arms length from the both the nuclear industry and government. Instead, the Chretien government mandated the industry-owned agency, the Nuclear Waste Management Organization (NWMO), to deal with the issue. Under the NWMO’s announced plan, irradiated fuel is to be stored at existing reactor sites for at least a generation, i.e. 30 years, before being moved to a centralized location and possibly being reprocessed before the high-level radioactive residues are buried in a deep geologic repository. Such reprocessing would create a highly radioactive corrosive liquid even more dangerous than the solid spent fuel rods, and the extracted plutonium will remain extraordinarily toxic for over 800 generations.

The large nuclear reactors (ACR-1000) that EAC wants to build in Alberta are justified as an environmentally-friendly alternative to the natural gas that is currently used to heat the tar sands. The fact that the tar sands are the dirtiest of all fossil fuels discredits the nuclear industry’s PR about being the clean, magic bullet for averting global warming. That’s bad enough. If it became widely known there was a hidden agenda about an international nuclear waste dump in Canada, then all the hype about clean nuclear energy providing economic development might begin to fall on deaf ears. Besides, the ACR-1000 reactor is only a design on paper and hasn’t been reality tested. Without the $200 million granted to AECL from the Harper government for design work, adding to the $17 billion dollars of subsidies since 1952, there’d be no chance at all of this project ever seeing the light of day. (Such large handouts of federal taxpayer’s money could become a contentious issue, given Alberta’s populist ideology of self-reliance.) Serious design flaws have already been noted by the 2004 Safety Assessment done for the U.S.’s Nuclear Reactor Regulation (NRR); most notably the risk of a Loss of Coolant Accident (LOCA) and core meltdown after a power surge resulting from a large or multiple pipe breakage.

AECL’s 180 degree About-Turn
The original Candu designers prided themselves on using heavy water (the “d” in Candu) as a moderator and coolant, so that natural uranium (the “u” in Candu) can be used as fuel. No enrichment of uranium is required. But the new ACRs will use light water as a coolant, and for that reason they will require slightly-enriched uranium (SEU) as a fuel. Why the flip-flop?

The basic motivation is to reduce costs, but there is a darker side to what AECL calls the ACR’s “fuel adaptability”. AECL’s Technical Summary for the ARC-1000 says it is “ideally suited to burn other fuels such as mixed oxides (MOX) and thorium.” MOX is a code word for a blend of uranium and plutonium. But “other fuels” can also be used and these include irradiated fuel elements from Light Water Reactors (LWR) such as used in the U.S., France, Japan and elsewhere. According to Gordon Edwards of the Canadian Coalition for Nuclear Responsibility, the ARC-1000 would be able “to make use of the “DUPIC” process, whereby spent LWR nuclear fuel is repackaged and used to fuel a Candu reactor.” The reason for this, he says, is that “the amount of fissile material (U-235 plus plutonium) in spent LWR fuel is more than enough to match” the requirements for SEU.

AECL is trying to put a responsible spin on this. It’s scientistic handlers used to assert that due to international safeguards there was no chance of uranium exported for nuclear power being diverted for weapons. Now they’ve created a new argument to market their “peaceful atom.” An AECL paper by nuclear engineer Jeremy Whitlock argues that the new Candu design will provide “unique synergism with LWR technology”, that it “can be used to disposition ex-weapons plutonium”, and, furthermore, that all this will be a “positive contribution to world peace.” The U.S.-based Union of Concerned Scientists (UCS) disagrees, saying in its January 2006 statement on Bush’s GNEP, that “all reprocessing technologies are more proliferation-prone than direct disposal” of nuclear wastes.

AECL’s Unparalleled History of Botched Designs
The only advantage of the new Candu would be to the fledgling AECL. But don’t hold your breath waiting for the ARC-1000 to be up and running, for the list of botched AECL designs is lengthy. There was the Organic Cooled Reactor in Manitoba, which was an expensive dead end. There was the Candu Boiling Light Water Reactor in Quebec, which (without even including design costs) was a $126 million disaster. Then there was the Slowpoke Energy System, for which design work cost $45 million, which didn’t work properly. Next came the Candu-3, for which design work cost $75 million, which no one wanted. And the Candu-9, with design costs still secret, which was a no-go in South Korea. More recently AECL built the Maple Reactor at Chalk River, which threatens to become another technological and financial fiasco since the Canadian Nuclear Safety Commission (CNSC) is refusing to even license it for operation.

The Candu industry has been a sinkhole for the Canadian taxpayer. Each Candu reactor built so far has required refurbishing costs equal to the original construction costs after only half of its projected operating life. And after 50 years in business, AECL has only sold 12 reactors abroad. In 1996, to try to justify its huge taxpayer subsidies, it set a goal of 10 sales by 2006. But only 3 sales occurred, including the Romanian Cernavada plant from a 1980 deal, which required another $328 million Canadian guarantee; and two plants at Qunshin in China that received $1.5 billion in Canadian Account financing. During this decade AECL lost sales to Turkey, Australia and South Korea. With this dismal record, AECL has done a design flip-flop, turning its back on natural uranium fuel to try to cash in on the worldwide nuclear waste crisis. But we must be on guard. While AECL is opportunistically promoting ACR’s which can use irradiated nuclear fuel from other countries, after 60 years they still haven’t cleaned up their radioactive mess at the Manitoba Whiteshell Lab, and their plan for cleaning up their contaminated Chalk River Lab, costing millions more for the taxpayer, remains obscure.

Enter George Bush and his GNEP
Beholding to huge federal subsidies, AECL is also beholding to U.S. President George Bush with his $405 million brainchild, the GNEP. The only thing “global” about this plan is the U.S. pretence to world hegemony, which seems delusional after the Iraq debacle. And the only partners to this proposed “global” plan would be countries already in the nuclear weapons club, along with their uranium suppliers. The agreement would make it mandatory for uranium suppliers to take back spent fuel from reactors abroad. The bargaining chip would be allowing enrichment facilities and nuclear power plants that use spent fuel in these countries. Some chip. We’d get to throw more public money down the nuclear drain, create and store even more dangerous nuclear waste, and have less capital to create truly sustainable, renewable energy systems to avert even more catastrophic climate change.

Bush’s plan would be unworkable without the major uranium exporting countries – Canada and Australia - involved. Luckily for Bush, both countries are governed by neo-conservative parties that also oppose Kyoto. Bush is presenting the GNEP as a means to control nuclear proliferation, while making nuclear power available globally, by not allowing enrichment facilities, or spent fuel to remain, that could be used to produce weapons. (This finally admits that the Non-Proliferation Treaty is not an effective guarantee against proliferation from nuclear power plants.) The converse of this is that GNEP members would preserve a near monopoly on nuclear technology and weapons. No wonder, in the context of discussing billions living in inhuman conditions, climate change and the potential for nuclear holocaust, the head of the International Atomic Energy Agency, Dr. ElBaradei, in a Sept 03/07 interview with Der Spiegel, said “we are moving rapidly towards an abyss”. With a real sense of urgency, he said that, “in order to seem credible to the nuclear wannabe states we must demand steps towards nuclear disarmament from those who have nuclear weapons - an obligation that is stipulated in the non-proliferation treaty but is not complied with.” He goes on to deplore what he calls “this two-faced approach” since “If practically all nuclear powers are modernizing instead of reducing their arsenals, how can we argue with the non-nuclear states?”

More pragmatically, the GNEP would provide “a way out” for the nuclear powers, none of which has any fundamental solution to their own mounting nuclear waste problem. As the world’s major supplier of uranium, Canada, under the GNEP, could be required to take nuclear wastes back from the largest users of nuclear power – the U.S., France and Japan. The elements therefore exist for a dangerous nuclear expansion strategy in Canada. First, a Candu redesign requiring some uranium enrichment that can be used as a justification for importing nuclear wastes to reprocess as fuel, and then the tar sands as a justification for building this new generation of nuclear plants. And, finally, lest we forget, we have the huge Saskatchewan uranium industry supplying the raw material to the nuclear powers, which, under the GNEP, would require that nuclear wastes be brought back to Canada.

Nuclear and Kyoto: The Big Disconnect
The first I heard of Canada “repatriating” spent fuel was when AECL and Saskatchewan’s uranium multinational, Cameco, advocated this in the early 1990s. At the time they were both working towards an integrated uranium-nuclear industry. Now Cameco operates the Bruce Candu plants and a uranium refinery in Ontario, and, with a sympathetic Prime Minister from Alberta, AECL is trying to base itself in its north. It seems the AECL and Cameco were flying this trial balloon of us taking back nuclear wastes long before George Bush or Stephen Harper were elected. Could the tail be wagging the dog?

It’s no accident that the GNEP is spearheaded in countries refusing to support the Kyoto Accord. Kyoto sets targets for reducing greenhouse gases (GHGs), which mostly come from fossil fuels. However, business and government interests in oil-dependent countries (including countries like Canada, i.e. Alberta, dependent on exporting oil) don’t want anything to slow down their profit and royalty-gushing ventures. Meanwhile efficiency, geothermal, wind and solar electricity are proving to be the most cost-effective ways to quickly lower GHGs, which doesn’t sit well with the nuclear industry’s comeback strategy of stressing itself as the clean alternative to fossil fuels. Furthermore, the 2001 Climate Change Conference in Bonn rejected nuclear as a solution to climate change partly because nuclear will steal capital from the cheaper, less risky, more effective renewable alternatives. So the nuclear industry is primarily looking to the countries outside Kyoto for support. It helped when George Bush’s 2005 Energy Bill gave another $13 billion subsidies to the industry, and a privatized electrical market allowed U.S. nuclear plants to displace “stranded costs” on to the consumer. And it certainly helped AECL when the Harper government, continuing the Liberal practice of bailing out the nuclear industry, provided millions to design the ARC.

Harper’s government has tried to low-key its involvement with Bush’s GNEP, but we know from a Canadian Press Access to Information request that his government has been seriously involved in discussions about this since at least March 2006. While his aides, seemingly aware that this issue is politically explosive, tried to downplay the “secret agenda” item at the APEC forum, Natural Resources Minister Lund has been more candid. In reference to reprocessing spent fuel for new Candus, in the September 5, 2007 Globe and Mail, Lund is quoted as saying: “as the technology evolves, it’s something we’ll see”. The next day this was “corrected” and it reported that the Canadian government hadn’t yet decided on supporting such reprocessing. At the end of the APEC meeting, Harper’s Foreign Minister Bernier said that the Canadian government had just about decided about the GNEP. This is more smoke and mirrors, as Harper had already funded the ARC, which AECL promotes as being able to use reprocessed spent fuel, and his government has enthusiastically supported the ARC being built in the tar sands. All this from the man who so righteously attacked the Liberals for being unaccountable for far less consequential and less expensive matters.

Meanwhile the Canadian Nuclear Association (CNA) is forthright about its support for enriching uranium and importing nuclear wastes. CNA President Murray Elston even uses the high price of raw uranium as a reason to support nuclear waste as the fuel of future choice. He continues the practice of the CNA providing disinformation to the public, saying in the Sept. 5, 2007 Globe and Mail that, “nuclear military powers have been reprocessing and transporting nuclear waste for years, and have proven it can be done safely.” Plutonium contamination at the U.S. Rocky Flats plant, France’s nuclear conglomerate Areva contaminating the North Sea, radioactive contamination of the Irish Sea along with detectable levels of plutonium in children’s teeth emitted from England’s Windscale/Sellafield reprocessing plant, and various weapons countries losing nuclear weapons grade uranium is apparently “safe” to the CNA.

Lessons from AECL’s Saskatchewan Shenanigans
We saw a similar process as what is now happening in Alberta in my home province from 1989-91, when AECL had another private company front the proposed building of a Candu-3 in our North. (AECL also tried but failed to sell its Slowpoke 3 to the University of Saskatchewan at the time.) AECL used every manipulative trick in the book, including inflating energy growth to make us fear we’d freeze in the dark without nuclear power. (They forecast a shortfall of electricity in Saskatchewan by 2000 unless a Candu reactor was built.) They wined and dined local politicians and businessmen on trips to Ontario’s Candus, as they are now doing with Albertans. And they tried to bribe us – during a slump in the economy - with the economic opportunities of a Candu-3 export industry based in our province. And they made no mention of the huge taxpayers subsidies that made it possible for them to float such grandiose schemes.

Under Grant Devine’s Tories, who privatized the uranium crown Cameco, AECL got the public utility Sask Power on side for a while, though their figures never jibed. At one point, as many jobs were promised from constructing one Candu-3 as came in total from the massive Ontario Darlington 8-reactor complex. There was lots of nuclear hype that got favourable coverage by the well-oiled and parochial provincial media. But, as with so many other AECL projects, the Candu-3 was never built, anywhere, as Saskatchewan people and third world countries alike rejected the contrived plan. And we are doing fine in 2007, with no black outs and no nuclear plants; though the Tory-like Sask Party and its Premier-in-waiting Brad Wall seem to think we should have one even if its not needed. We have a few wind farms, and, yes, uranium exports remain the bulk of primary energy production and export. The NDP government which spearheaded uranium expansion in the 1970s publicly opposes nuclear power without wanting to admit that they have been willing and essential pawns in the nuclear expansion strategy, which we now see taking shape with Bush’s GNEP and Harper’s compliance.

Saskatchewan and Alberta people are now interlocked in this geo-political drama. We will have to be vigilant about creating a future based on sustainable, renewable energy while phasing out the uranium-nuclear industry; or see both our provinces become the dangerous playground of a nuclear industry that expands by economic bribery and political bailout.