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But many medical tourists are returning home with potentially catastrophic complications, including anastomotic leakages, where intestinal contents leak through surgical staples into the abdominal cavity, increasing the risk of life-threatening sepsis. "It's almost like your stomach ruptures," says Dr. Shahzeer Karmali, an associate professor of surgery at the University of Alberta and one of the authors of the newly published paper.

Complications can be a nightmare to manage and repair "because we don't really know what they've had done," Karmali says. "There's no real operative report; we don't know exactly what happened elsewhere. It's hard for us to figure out what was done, and how to fix it." One woman in her 20s who underwent surgery in Mexico had to have her "essentially her entire stomach," as well as part of her esophagus, removed, he says. She will need to be fed through a feeding tube for the rest of her life. Despite increased funding in Ontario and other jurisdictions, wait lists average five years across Canada. Only one per cent of eligible patients are offered access to surgery. "Consequently,

many patients turn to medical tourism despite potentially severe complications," the Alberta researchers write in the Canadian Journal of Surgery. Earlier work by the same group estimated a complication rate of 42 to 56 per cent for out-of-country weight loss surgery. In Canada, unplanned readmission to hospital within 30 days of bariatric surgery was 6.3 per cent in 2012-2013, according to the Canadian Institute for Health Information. Karmali says Canadians living with obesity are being shortchanged because of lingering stigma and bias. "The stigma is that these people just eat too much and don't exercise enough and they can fix themselves," he said.

"The reality is, it's a significant problem and when people become severely obese it is very hard to 'fix.'" Surgery not only improves weight and overall life expectancy, it helps reduce the drain on the health-care system and economy. A Senate committee report released this month pegged the cost of obesity at upwards of $7.1 billion a year in health care and lost productivity. The committee made 21 recommendations to combat obesity, from overhauling Canada's food guide to banning food advertising to children. But it was silent on reducing wait times for bariatric surgery. Karmali and colleagues surveyed Alberta general surgeons to estimate the cost of revision surgery, ICU stays and other interventions to treat complications in "BMTs" - bariatric medical tourists.

In all, 25 doctors responded to the survey. Together they treated 59 out-of-country surgery patients in 2012-13. Complications included slipped bands, leaking, abscesses and blood clots. The estimated average cost per medical tourist was just under $10,000 - an "extremely conservative estimate" that doesn't include total hospital stay, blood work, nursing care and other costs. By comparison, the average cost of bariatric surgery performed in Alberta public hospitals was just under $14,000. "Alberta does not seem to save much money by limiting the annual volume of bariatric surgeries," the authors write. Studies suggest bariatric surgery accounts for a growing proportion of Canadian medical tourism, with Mexico one of the most popular destinations. According to Statistics Canada, one in four adults in Canada - more than six million people - are obese. skirkey@postmedia.com

While the Canadian notion has no resonance in the United States, and is downright silly, the fact is that nativism is alive and well south of the border, and means that Canada could one day be side-swiped in other ways that are very damaging unless we manage the relationship well. So whoever's in Ottawa must be more American-savvy than ever before, and yet the opposition parties don't bring up the U.S. relationship at all. Canada's newest political entries pander to the status quo, and merely offer the electorate a roster of competing shopping lists: Tom Mulcair with his extravagant universal day care and Justin Trudeau with his infrastructure spending spree. This is housekeeping, not nationbuilding. Canada faces existential challenges that should be addressed. In the spirit of politically incorrect Donald, here a few major ones, not necessarily in order of importance:

.. What does Canada do for a living after most of the auto jobs have gone to Kentucky and Mexico or Silicon Valley in 15 years or so? ..What does Canada do for a living after fossil fuels are replaced by solar and other renewables after 2030? ..Should Canada become economically joined with the United States, given its technological dominance and wealth, so it's not left behind? ..How does Canada mitigate the ongoing Canadian brain drain and close its lengthening productivity and innovation gaps? (In the 20th century, the equivalent of the entire 1900 population of Canada emigrated to the United States and now roughly the population of Quebec City emigrates permanently every decade. Currently, roughly three million more have become U.S. citizens, are living there on visas, are illegally there or are snowbirds. Roughly 400,000 work daily in Manhattan, 250,000 in Hollywood and 300,000 in Silicon Valley.) ..Why can't Canada capitalize on its superior health-care system and allow the creation of a massive industry of health-care tourism serving Americans and the world?

.Why can't Canada create an Australian-style system of fast-track verification involving First Nations claims to stop the country's resource and pipeline quagmire, and to finance First Nations development? ..Why can't Canada scrap its costly farm supply management systems (poultry and dairy) and create worldclass, competitive agribusinesses like New Zealand has done instead of coddling and subsidizing these farms? ..Why doesn't Canada simply admit the Arctic is not properly monitored, protected or developed and create a U.S.-Canada navy in the face of Russia's aggressiveness?

.Why can't Canada scrap the Senate or replace it (if it must) with a legitimate, elected body? ..Why can't Canada merge the four Atlantic Provinces into one super province? These are just a few questions hanging over the country that are ignored because they are politically incorrect. Instead, the country drifts, thanks to politicians whose "vision" is restricted to taxing and spending initiatives. dfrancis@nationalpost.com

Canada ranks lowest for number of hospital beds, with Mexico and Chile

Only Mexico and Chile have fewer hospital beds per resident in the developed world.

£7 an hour, receives an extra £1 an hour for a night shift and £2 an hour for weekends.

"The NHS encourages you to have these NVQs, all this training, improve your knowledge, and then they [private care companies] come along and it all comes to nothing.

Care UK expects to make a profit "of under 6%" by the end of the three-year contract

£700,000 operating profit in the six months between September last year and March this year,

In 1993 the private sector provided 5% of the state-funded services given to people in their homes, known as domiciliary care. By 2012 this had risen to 89% – largely driven by the local authorities' need for cheaper ways to deliver services and the private sector's assurance that they could provide the answer. More than £2.7bn is spent by the state on this type of care every year. Private providers have targeted wages as a way to slice out profits, de-skilling the sector in the process.

1.4 million care workers in England are unregulated by any professional body and less than 50% have completed a basic NVQ2 level qualification, with 30% apparently not even completing basic induction trainin

Today 8% of care homes are supplied by private equity-owned firms – and the number is growing. The same is true of 10% of services run for those with learning disabilities

William Laing

report on private equity in July 2012

"It makes pots of money.

Those profits – which are made before debt payments and overheads – don't appear on the bottom line of the health firms' company accounts, and because of that corporation tax isn't paid on them.

Some of that was in payments on loans issued in Guernsey, meaning tax could not be charged. Its sister company, Silver Sea, responsible for funding the construction of Care UK care homes, is domiciled in the tax haven of Luxembourg

Bridgepoint

.voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_1 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_1 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_1 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_1 .ob_clear{clear:both;} .AR_1 .ob_amelia, .AR_1 .ob_logo, .AR_1 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_1 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_1 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_1 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_1:hover .ob_amelia, .AR_1:hover .ob_logo, .AR_1:hover .ob_text_logo{background-position:center bottom;} .AR_1 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } More from the guardian Rogeting: why 'sinister buttocks' are creeping into students' essays 08 Aug 2014 Theatre's decision to ban Jewish film festival is 'thin end of wedge' 09 Aug 2014 Sir Paul Nurse: 'I looked at my birth certificate. That was not my mother's name' 09 Aug 2014 Adventures in contraception: eight women discuss their choices 10 Aug 2014 Child prison deaths 08 Aug 2014 [?] .voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_2 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_2 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_2 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_2 .ob_clear{clear:both;} .AR_2 .ob_amelia, .AR_2 .ob_logo, .AR_2 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_2 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_2 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_2 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_2:hover .ob_amelia, .AR_2:hover .ob_logo, .AR_2:hover .ob_text_logo{background-position:center bottom;} .AR_2 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } /* updated via mysql on 2014-04-08 */ .AR_2 .ob_what { display: block; } /* added via mysql on 2014-06-20 */ .OUTBRAIN:hover .ob_what a { text-decoration: underline; } .ob_box_cont.AR_2 { padding-bottom: 5px; } /* end mysql add */ /* added via mysql on 2014-07-14 */ .AR_2 .ob_org_header span { color: #999; font-family: arial; font-size: 11px; font-weight: normal; display: block; } /* end 2014-07-14 */ More from around the webPromoted content by Outbrain http://paid.outbrain.com/network/redir?p=0iZOm4XuGW6R5uuT6ZFciNevzJlIfmxs0SRwpiMrH7gWrMXoPie4vIA9PlhaEW%2BXNi57pCgl9j8yOE3HuJT75pwCLNj4n18v3EKQDEV0YFQjOBxc46mOs

One year after Dr. Parks’s letter was leaked, the government claims the ER wait times issue is under control.

Should we believe the hype?

In October 2010, local media published a leaked letter from the province’s chief emergency room doctor to Health & Wellness Minister Gene Zwozdesky and other government officials warning of “catastrophic collapse” if immediate action wasn’t taken. The letter was written by Dr. Paul Parks, president of the Alberta Medical Association Section of Emergency Medicine

Dr. Parks started to collect examples of substandard care and “adverse events” caused by overcrowding in the ER

When the letters and reports were eventually leaked to the media in 2010, they launched a firestorm.

It’s common to have five-plus EMS units and their medics tied up for hours while they wait for an ER stretcher to be freed up so that they can download their patient and get back on the streets

The situation has gotten so out of hand that we now have patients calling 9-1-1 from the ER

ER was overcrowded because hospitals were overcrowded

A study in the British Medical Journal found that patients whose ER wait times were six hours or longer were more likely to suffer an “adverse event,” such as the need for hospital admission, or even death.

Dr. Parks estimates that Alberta’s large-volume hospitals are still hovering at around 30 per cent of beds occupied by patients waiting to be admitted—meaning that those hospitals are still operating at well over capacity.

Dr. Parks, ER doctors were clear from the beginning of this crisis that the issue of overcrowding in emergency was due to downstream capacity problems, mostly a lack of long-term-care beds in nursing homes.

despite our vast wealth, Alberta has fewer hospital beds than the Canadian average.

The same situation exists for long-term care, where Alberta’s number of beds per capita falls below the national average. But don’t think the province makes up for this by supporting those folks in their homes. Alberta also sits close to the bottom of provinces for home-care spending.

the government opened 360 new hospital beds in Edmonton and Calgary in 2011. It announced plans to open 5,300 new long-term care beds by 2015 (1,174 of them were ready by April 2011), to make additional investments in home care (800 new clients in Edmonton and Calgary) and to improve patient discharge planning. It also announced a five-year plan that includes a primary-care focus

But there’s no plan to increase full long-term care, nursing homes and auxiliary hospitals. This is the category of care that is most needed to take pressure off our hospitals

He also says that even if beds are created, they may not match the needs of hospitalized patients, because of the lower levels of nursing support and the high personal cost for the patient and his family. “Indications are that the private, for-profit care model may actually create barriers to moving patients out of hospital beds,” he says.

Ontario has the fewest hospital beds per capita of any jurisdiction almost in the world

According to the Organization for Economic Development and Co-operation, Ontario has two hospital beds for every 1,000 residents. Only Mexico has fewer. Canada-wide, there are three hospital beds per 1,000 residents, an amount also considered relatively low.

“There is strong evidence of an association between high bed occupancy and (the superbug C. difficile),” researchers wrote recently in the journal Infection Control and Hospital ­Epidemiology.

Ontario has 2.4 hospital beds for every 1,000 residents, less than half the European average. Of 39 countries compared by the Organization for Economic Co-operation and Development, only three had fewer hospital beds than Ontario: Mexico, India and Indonesia.

Precisely how bad the bed crunch is now in Ontario isn’t clear. Last summer, a period when demand for hospitals typically drops, the average occupancy was 92%. Health Ministry bureaucrats were unable this week to provide more current data.

Asked about overcrowding, Health Minister Deb Matthews wouldn’t say if more beds are needed. Just because infection rates rise when wards get crowded doesn’t mean the latter causes the former, she said.

But data collected by her ministry tells another tale: While beds were freed up from 2008-11, progress has stalled for a year or two, experts say.

Sinha isn’t convinced the jam in all hospitals is the result of too few beds — some hospitals have been slow to adopt best practices to free up beds faster, he said.

But hospitals that operate at or above 100% capacity do so at the risk of patients, he said. “Everyone agrees that’s not a safe level to run,” he said.

Some hospitals may need more beds, said Dr. Michael Schull, president of at the Institute for Clinical Evaluative Sciences, which independently analyses Ontario health care.

"The current health system is reaching its limit," Judit Rius, manager of Médecins Sans Frontières/Doctors Without Borders Access Campaign in the United States, told IPS. "It is failing patients with rare diseases, for example." "That's why the TPP could be a tool for promoting health and improving innovation and access, instead of fostering failed, costly systems based on monopolistic patents," she added.

The TPP free trade accord went into force between Brunei, Chile, New Zealand and Singapore in January 2006. Eight other countries are now negotiating their incorporation: Australia, Canada, Japan, Malaysia, Mexico, Peru, the United States and Vietnam.

Valeant CEO Michael Pearson says the latest results demonstrate the company's ability to grow without acquisitions by boosting its guidance for 2015 after reporting their fourth consecutive quarter of greater than 15 per cent organic growth. "Our M&A strategy will always be a question of tuck-ins or bolt-ons, and opportunistically larger acquisitions. One can never predict the timing of a larger acquisition so when those happen, those happen," said Valeant CEO Michael Pearson on a conference call Thursday. "We don't put them on a timeline."

Valeant released its second-quarter results on Thursday, increasing its 2015 revenue outlook from a range of $10.4-billion to $10.6 billion up to a range of $10.7-billion to $11.1 billion. In the latest quarter, Valeant said organic growth was up 19 per cent on a same-store sales basis, driven by its dermatology, gastrointestinal, contact lenses and dental businesses. Pearson has said he is certain organic growth will continue in the doubledigits at least until the end of 2016. "I think they will continue to see a higher organic growth than they have in the past, but can they sustain that 19 per cent? That's probably one of the high marks," said Stephanie Price, an analyst at CIBC World Markets.

The company reported a total revenue of $2.7 billion in the quarter, an increase of 34 per cent over last year and $200 million over the first quarter outlook. Pearson said the results were driven by strong performances in the U.S. market, as well as sales in Asia, Australia, Canada, Mexico, the Middle East and North Africa. Valeant did take a $173-million hit from the negative impact of foreign exchange in the second quarter. The company completed its $11.1-billion acquisition of Salix Pharmaceuticals Ltd. earlier this year, which contributed $313 million in revenue. The U.S. Food and Drug Administration approved Salix's irritable bowel syndrome drug, Xifaxan, in May. Prior to the acquisition, Salix had issues with an inventory pileup, though Pearson says levels have been reduced from four to five months, to three months to 3.5 months. The company laid off 258 Salix employees in April as part of a $500-million cost-savings plan which Pearson said will reach $530 million by the end of the year.

Valeant has made cuts to sales staff following previous acquisitions, though this is not the case with Salix where the team remains largely intact as the company awaits regulatory approval for its direct-to-customer advertising campaign. A serial acquisitor, last week Valeant said it will buy Amoun, a major Egyptian pharmaceutical company, for about US$800 million as a platform for further expansion in the Middle East and North Africa.

Pearson says so far the company has signed eight tuck-in deals this year and says Valeant is looking for opportunities to grow in Latin America. "I think there are a lot of smaller guys out there they can continue to consolidate, so we're not worried about a lack of targets," said Price. "At the high end there is a limit to the number of large acquisitions out there, but I don't think we're anywhere near that limit right now." Financial Post, with files from Bloomberg News DvanderLinde@nationalpost.com

It is hard to estimate the economic cost - lost productivity, costly treatments if illnesses are allowed to get worse, or even premature death - of such a high level of non-compliance. But studies show the highest compliance rates are for drugs for erectile dysfunction, contraception, and pain relief that have nothing do with saving lives. But if these drag down the average non-compliance rate, then prescriptions for other ailments, including serious ones, must be dragging it back up. A third reason to consider universal Pharmacare is a more easier-to-measure economic loss. Green leader Elizabeth May's plan sounded too good to be true as she outlined it - annual cost of $300 million a year for the feds to set up a national Pharmacare agency in return for savings to the health-care system of up to $11 billion a year.

But these estimated savings aren't something dreamed up in the party's backrooms - they are drawn from a recent scholarly analysis by UBC health economist Steven Morgan, a leading researcher in the field. The issue, Morgan told me in an interview, is that the whole system is fundamentally flawed and inefficient. Despite recent agreements by the provinces to co-operate on drug purchases - an approach Morgan thinks is worthwhile, but not nearly enough - neither the governments nor the dozens of private insurers have enough clout with drug companies to negotiate best prices. Not to mention the millions of uninsured who have no negotiating power at all.

As well, governments spend $3 billion a year on employees' health insurance premiums, Morgan said, and businesses pay several times that - money that would be saved if we had universal Pharmacare. May didn't pitch her plan simply as something a Green government would implement if her party is elected - a long-shot by any measure. Rather, she called on other parties to work together on this. This isn't likely to happen in the toxic partisan environment of federal politics, especially during an election. But given the Angus Reid poll's finding that 39 per cent of Canadians strongly support and 48 per cent moderately support adding prescription drugs to the universal medicare program (B.C.'s numbers are 44 per cent and 47 per cent), it's an issue other parties ignore at their peril.

Fifteen years later, the “movement of movements” has another opportunity to strike a dramatic blow to neoliberalism — this time by stopping the Trans-Pacific Partnership (TPP). The TPP is a deal the United States is negotiating with 11 countries in the Asia-Pacific region (Australia, Brunei Darussalam, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, and Vietnam) allegedly to boost “free trade.”

access to medicines

But labor and environmental standards are just the tip of the iceberg. The GAO studies don’t even touch upon the rules found in modern “trade” pacts’ chapters on financial services, food safety, public procurement, medicine patents, investment, and so-on, all of which the TPP would expand to an estimated 40 percent of the global economy — with a built-in mechanism to cover more countries still.

Given the smaller number of negotiators at the TPP table than at the WTO — and the fact that so many seem willing to sell out their nations’ public health programs, family farms, financial stability measures, and just plain sovereignty in order to cut a deal with the United States — it’s unlikely that protests in the United States are going to appeal to their sense of morality. Thus, the anti-Fast Track strategy is not only more feasible than centralized mass protest; it’s probably more effective.

TPP supporters and opponents alike both know that, with the U.S. presidential elections gearing up in the latter half of 2015, the window of opportunity for concluding the TPP is fast closing. Neither political party in the United States wants an unpopular trade debate on its hands while it’s trying to take the White House.

Trade in Services Agreement (TISA) This agreement is being negotiated on the sidelines of the World Trade Organization by a group of 23 governments representing 50 countries, including Canada, the United States, the European Union, Australia, Mexico and South Korea.

reforms to national public health systems to promote 'offshoring' of health care services. .

Trans Pacific Partnership (TPP) This free trade zone of twelve countries including Canada, the United States and Japan, would encompass about 40 per cent of the world's economy. It is believed that the negotiations for this deal could be concluded as early as next month.

medicines in both the United States and abroad.

Transatlantic Trade and Investment Partnership (TTIP) The United States and the European Union have just completed their eighth round of talks for this agreement.

intellectual property rights that would prolong monopolies on pharmaceuticals and reduce access to affordable and lifesaving generic medicines.

As flashy weight-loss ads for medical surgeries continue to draw Albertans to Mexico and abroad, a new study says the costs of fixing some of the bungled procedures costs Alberta's health system more than half a million dollars each year.