Prevention & Recovery

The future of Canadian health care

Photography by John Hryniuk Author: Canadian Living Credits: Photography by John Hryniuk

Prevention & Recovery

The future of Canadian health care

Canadian Living: What are the most common medical issues you're seeing in patients?

Dr. Danielle Martin: There are two major trends. One is the re-emergence of vaccine-preventable illnesses. Across Canada, we're seeing more cases of whooping cough and mumps, both of which can be prevented with vaccines.

There are a few reasons for this emerging trend. First, some families are choosing not to immunize their children, which is a public health concern. Second, we are learning that some of these illnesses require booster shots. Those of us who were immunized 30, 40 or 50 years ago may actually need a top-up. Once in their lifetimes, for example, adults should have a booster against the whooping cough virus and some may require a booster of the measles, mumps and rubella (MMR) vaccine. This is particularly important to women of reproductive age prior to having children. If you are wondering whether you need a booster, ask your primary care provider.

The second trend is the rise in chronic illness. According to Statistics Canada, nearly three-quarters of Canadians over 65 have at least one chronic condition, such as high blood pressure, diabetes, arthritis or depression, and nearly 25 percent have three or more chronic illnesses. We've done such a good job of treating the things that used to kill people, like infectious 
illnesses and acute illnesses, that Canadians are living for a long time with chronic illnesses.

Furthermore, as we all know, many of us are living lifestyles that predispose us to chronic illnesses. A health-care system centred around hospitals is not as well-positioned to respond to that 
reality as the health-care system we are trying to move towards, which is one that is much more centred around primary care, community-based care and 
ambulatory care.

CL: What surprising treatment have you been prescribing?
 
DM: We used to think that you needed to exercise for 45 minutes at a time, four to five times per week to get the maximum cardiac benefits, but evidence has emerged about interval-based exercise approaches. There's also emerging evidence about the role of exercise in the treatment of a whole lot of diseases. We know that, in some cases, exercise can perform as well as or better than medicine for a whole range of health problems, like depression, diabetes, heart disease, arthritis and fibromyalgia. And there is evidence that if a doctor prescribes exercise to a patient, the patient is more likely to follow up on the recommendation. So I am 
prescribing exercise!

CL: What are you most excited about in the medical world?

DM:
The emergence of personalized medicine and genomic research is very interesting. How soon will it be before people start routinely getting their entire genome sequenced, so they know what they are at risk developing over the course of their lifetimes? It's a bit of a Pandora's box. How does it change your insurability? How does it change the lifestyle choices that you make? What kind of information do we want access to?

This has been topical because of Angelina Jolie, who got her genes tested and found out she had a lifetime risk of developing breast cancer, which prompted her to get a prophylactic double mastectomy. That gene, called BRCAII, was discovered by a team of international researchers, including Dr. Steven Narod right here at Women's College Hospital in Toronto. In the case of that gene, we know the risk is very substantial and we have a preventative treatment to offer women, which is highly invasive but does work. Unfortunately, we can't say the same for being at high risk for major depression. Genomics and personalized medicine have the potential to pave the way for new treatments that could advance medicine in very significant ways.

We have more health advice from Dr. Martin, including how to create a mind-body connection.
 
This content is vetted by medical experts

                   
This story was originally titled "The Doctor is In..." in the January 2014 issue.
           
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Prevention & Recovery

The future of Canadian health care

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