CMAJ • January 17, 2006 • 174(2) | 149

News

and other medical specialists. We arealso committed to developing a plan toget the many workers already in thesystem, but not working at their fullcompetencies, upgraded to higher lev-els, and to increase funding so thatprovinces and territories can act imme-diately to increase their health humanresource capacity.

In the long term we are committedto working to establish a national strat-egy that would address the shortage ofhealth professionals.

Conservative Leader Stephen Harper: AConservative government would workwith the provinces and territories to in-crease the supply of health care profes-sionals in Canada by supporting the ex-pansion of educational programs fordoctors, nurses and other health pro-fessionals.

We have introduced a generouspackage of support for postsecondaryeducation to assist students and theirfamilies with the rising costs of univer-sity and college attendance. The pack-age will include new funding for theCanada Student Loan program and taxrelief for students receiving bursariesand scholarships.

Liberal Leader Paul Martin: The Lib-eral government believes that investingin our health care professionals is criti-cal to maintaining our public healthcare system.

After a meeting with OntarioPrivacy Commissioner AnnCavoukian, Ontario’s pharma-

cists have issued new guidelines andwill no longer routinely collectwomen’s names, addresses and sensi-tive personal information before dis-pensing an emergency contraceptive.

Privacy commissioners in BritishColumbia and in Saskatchewan havealso expressed concern to pharmacycolleges in their provinces about ascreening form and the collection andstorage of sensitive personal informa-tion, a practice the Canadian Pharma-cists Association (CPhA) had been rec-ommending after levonorgestrel (PlanB) became available without a prescrip-tion in April 2005.

The Ontario College of Pharmacistsreleased its new guidelines Dec. 15, 9days after CMAJ posted a news articleabout the screening form and the con-cerns of several privacy commissioners.

The Women’s Health Network andindividual women that CMAJ inter-

In 2005, this Liberal governmentpledged $75 million over 5 years to ac-celerate and expand the assessmentand integration of internationally edu-cated health care professionals, to ad-dress Canadians’ concerns about im-proved and more timely access to care.

This funding will be used for evalu-ating clinical skills, knowledge, lan-guage proficiency and prior learningactivities of internationally educatedhealth care professionals, and increas-ing the number of clinical placementsfor physicians, nurses and other healthcare professionals. — Compiled byLaura Eggertson and Barbara Sibbald,CMAJ

DOI:10.1503/cmaj.051665

viewed have said they are worried that the collection of women’s names, ad-dresses and sensitive personal informa-tion will deter some women from ac-cessing the drug.

Pharmacists do not routinely collectpersonally identifiable informationwhen providing other Schedule IIdrugs, Cavoukian said.

The new Ontario guidelines statethat “Pharmacists should continue toseek information from the patientonly as necessary to clarify the appro-priateness of providing Plan B, keep-ing in mind the patient’s right to re-main anonymous and to declineresponding to personally sensitivequestions.”

“In the case of Plan B, personallyidentifiable information should not berecorded except when requested by thepatient for reimbursement purposes orin those rare instances where it isdeemed important for continuity ofcare of the patient.”

In a news release accompanying theguidelines, Marc Kealey, CEO of theOntario Pharmacists Association, em-phasized that pharmacists should seekinformation from the patient “only asnecessary to clarify the appropriatenessof providing ECP.”

“The release of these guidelinesdemonstrates tremendous leadershipby Ontario pharmacists and the Officeof the IPC,” Kealey stated.

In British Columbia, Privacy Com-missioner David Loukidelis and hiscolleague Bill Trott have been speakingto the College of Pharmacists of BC.They planned to meet again in January,Trott said in an interview.

“We are looking at a series of op-tions. We hope to be able to providesome recommendations to them.”

Saskatchewan Privacy Commis-sioner Gary Dickson has also written tothe Saskatchewan College of Pharma-cists about the screening form and pri-vacy issues.

“We have indicated a number ofconcerns that we have with the pro-gram,” Dickson said in an interview.“There was some concern about thehighly sensitive and prejudicial infor-mation on the forms and what happensto that information.”

Dr. Philip Hall, president of the

Liberal Leader Paul Martin

Ontario pharmacists drop

Plan B screening form

Published at www.cmaj.ca on Dec. 21, 2005.

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CMAJ • January 17, 2006 • 174(2) | 150

News

medical staff at St. Boniface GeneralHospital in Winnipeg, has urged theSociety of Obstetricians and Gynae-cologists of Canada to weigh in on theissue.

“In my view, collection of personalinformation in this context is abhor-rent and reprehensible,” Hall, who isalso a professor at the University ofManitoba, wrote Dec. 13 to the SOGCexecutive.

“If the pharmacists don’t need it fora bottle of aspirin, they don’t need it forPlan B either,” he later told CMAJ, re-ferring to the collection of identifyinginformation.

Dr. André Lalonde, SOGC executivevice-president, says the Society justwants to move the issue forward.“We’re not interested in battles, we’rejust interested in getting these drugs towomen as best we can.”

Cavoukian and Loukidelis both saythey are worried about the security ofthe data once pharmacists collect andstore it, and about whether individualpharmacists had policies lettingwomen know what they used the infor-mation for and what would ultimatelyhappen to that data.

Cavoukian has already had a callfrom one woman who had a “distress-ing” experience when she went to ob-tain levonorgestrel from a pharmacistwithin the last 2 weeks, before the newguidelines took effect.

“She was humiliated. She was askedthese very embarrassing questions andshe didn’t understand why,” Cavoukiansaid in an interview.

The woman thanked Cavoukian forher intervention, and Cavoukian in turnsaluted the Ontario pharmacists. “Theywere wonderful and I was delightedwith the cooperation and the spirit withwhich they met us.”

The Canadian Women’s HealthNetwork is also pleased by the On-tario pharmacists decision. ChairAbby Lippman says “We hope phar-macists in other provinces follow suit,and that all other processes that im-pede or delay access to women andgirls will be lifted.” — Laura Eggert-son, CMAJ, with notes from AndréaVentimiglia.

DOI:10.1503/cmaj.051681

HTLV-1 is rare in Canada (see Box1), but the number of cases is notknown because it’s not a reportabledisease in most jurisdictions. CanadianBlood Services has been screening do-nated blood for HTLV-1 since 1990 andreports an average of 10–12 positivetests per 800 000 donations annually(prevalence of 0.0014%). If even 15 peo-ple in Nunavut are infected, among apopulation of 29 000, the prevalence is0.05%.

HTLV-1 can be transmitted sexually,which is cause for concern. “We knowthat there are still high levels of unpro-tected sex occurring because of ourstatic chlamydia rates,” says Dr. Geral-dine Osborne, Nunavut’s associatechief medical officer of health. Chlamy-dia rates have remained fairly stablesince 1991 at 2500 per 100 000 popula-tion, compared to 188 per 100 000 inCanada generally. Gonorrhea rateshave declined from 900 per 100 000 in1991 to 250 today, largely due to “effec-tive treatment and contact tracing,”says Osborne. Rates for other STIs in-cluding syphylis and HIV are very low;less than 20 reported cases each.

HTLV-1 will top the agenda at a sex-ual health symposium at the end of Feb-ruary, says Aideen Reynolds, managerof Sexual Health Policy and Program for

Nunavut health officials reportat least one death related tohuman T-cell lymphotropic

virus type 1 (HTLV-1) and “fewer than20” infected persons.

Nunavut’s Medical Officer of Health,Dr. Issac Sobol, says residents need totake this very seriously, but adds, “It’snot what we consider an outbreak. Infact, it’s been here a number of years.”It can take up to 20 years before symp-toms appear. There is no effective treat-ment to reduce the viral load.

In response to the death and re-ported cases, the Nunavut Departmentof Health and Social Services began offering testing for HTLV-1 to pregnantwomen and the population in general inOctober, “We worried about our capac-ity to handle demand [from the generalpopulation],” says Sobol. As of Dec. 7,only 300 people had been tested.

Sobol would not disclose the precisenumber of people infected or the num-ber of HTLV-1–related deaths. He statedthat such caution is common in sparselypopulated areas where anonymity is dif-ficult. It is important to “ensure thatNunavummiut feel absolutely confidentthat no information will ever be revealedthat could in any way be traced back toeither communities or to individuals.”Even one death in a small communitycould raise suspicions.

Box 1: HTLV-1 revealed

Human T-cell lymphotropic virustype 1 (HTLV-1) is a retrovirusendemic in Japan, West Africa, theCaribbean, South America andMelanesia. It has also been reportedin other areas such as North Americaand Europe, where about 1% of thepopulation are carriers; in Japanbetween 6% and 37% of thepopulation are infected. After a longasymptomatic phase, 2%–5% ofpeople infected with HTLV-1 go onto develop adult T-cell leukemia;a smaller proportion of infections(0.1%–2%) result in HTLV-1associated myelopathy, aprogressive neurological disease.The 2 most common ways of gettingthe virus are through blood contact(e.g., blood products, intravenousdrug use) and mother-to-childtransmission through breast milk.There are about 20 million infectedpeople worldwide.

Custom condom wrappers, communityevents, posters and other strategieshelp prevent the spread of STDs, in-cluding HTLV-1, in Nunavut.

Pauk

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HTLV-1 virus detected in

Nunavut