January 2014 by Doctor's Review

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MEDICINE ON THE MOVE

JANUARY 2014

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HISTORY OF MEDICINE The benefits of eating human flesh

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Introducing NEW Levemir FlexTouch ®

An easy to use, easy to teach, pre-filled insulin pen

Insulin delivery at the touch of a button A pre-filled insulin pen with a light-touch button requiring up to 5X less thumb pressure* 62%–82% lower injection force demonstrated with FlexTouch® than other pre-filled insulin pens*§ (Mean Injection Forces: FlexTouch® 5.1N. At 4, 6 and 8 mm/s respectively; SoloStar® 13.5N, 19.1N and 26.9N, KwikPenTM 14.5N, 20.9N and 28.2N)

Light-touch button does not extend at any dose

End-of-dose click to confirm dose delivery

Indications and clinical use: Levemir® (insulin detemir) is indicated for the treatment of: • adult patients with type 1 or type 2 diabetes mellitus who require a long-acting (basal) insulin for the control of hyperglycemia • pediatric patients with type 1 diabetes mellitus who require a long-acting (basal) insulin for the control of hyperglycemia. The safety and efficacy of Levemir® has not been studied in children below the age of 6 years • type 2 diabetes mellitus in combination with oral anti-diabetic agents (OADs) [metformin or sulfonylureas] in adult patients who are not in adequate metabolic control on OADs alone. For safety reasons, the use of insulin in combination with thiazolidinedione is not indicated • type 2 diabetes mellitus in combination with Victoza® (liraglutide) and metformin when Victoza® and metformin do not achieve adequate glycemic control Levemir® is also recommended in combination with short- or rapid-acting mealtime insulin. Please consult the product monograph at http://novonordisk.ca/PDF_Files/our_products/ Levemir/LevemirPM.pdf for important information on contraindications, warnings and precautions, adverse reactions, drug interactions and dosing. The product monograph is also available by calling us at 1 (800) 465-4334. * Comparative clinical significance has not been established § Injection Force = the force required to press the pushbutton on pens to inject insulin Adapted from Hemmingsen H et al., 2011. This study compared the injection force of FlexTouch® with that of SoloStar® and KwikPenTM. Injection force was measured at 3 constant push-button speeds delivering 80 units with SoloStar® and 60 units with KwikPenTM. FlexTouch® was not tested at 3 speeds because the spring-loaded mechanism has no influence on the rate of insulin delivery. Instead, injection force was measured as the spring activation force at 80 units. The manufacturers’ recommended needles were used; NovoFine® (Novo Nordisk) 32-gauge tip extra thin wall (etw) 6 mm needle for FlexTouch® and BD (Franklin Lakes, NJ) MicroFineTM 31-gauge 5 mm needle for SoloStar® and KwikPenTM. Only one needle of each type was used for all injection force tests to avoid variation in measured injection force caused by the flow stress of different needles. REFERENCES: 1. Levemir® Product Monograph, Novo Nordisk Canada Inc., September 2013. 2. Hemmingsen H, Niemeyer M, Hansen MR, Busher D, Thomsen NB. A prefilled insulin pen with a novel injection mechanism and a lower injection force than other prefilled insulin pens. Diabetes Technol Ther 2011;13(12):1-5. All trademarks owned by Novo Nordisk A/S and used by Novo Nordisk Canada Inc. Novo Nordisk Canada Inc., 300-2680 Skymark Avenue, Mississauga, Ontario L4W 5L6. Tel: (905) 629-4222 or 1-800-465-4334. www.novonordisk.ca

CA/LM/0813/00147-E

When less is more

CHEPKO DANIL VITALEVICH / SHUTTERSTOCK.COM

The turning of the year is always marked with talk of change. A year ago the topic that was top of mind in the media was climate change. Given the erratic weather patterns of the last 12 months all over the globe, the concern was well founded. As the first month of 2014 rolls in the focus has shifted to the growing income gap between the top one percent and the rest of us — a disparity that, again, is a worldwide phenomenon. As a species, we resist change but these are two issues where change is sorely needed. Incomes for the majority of Canadians have declined over the last decade. It’s time to support more fairness in the distribution of wealth here and in the foreign sweatshops that produce most of the clothes we wear and the goods we use. Help me down from my soapbox. Much closer to home you may have noticed a thinning in the number of pages in the medical journals you’ve received over the last six months. This is the result of another change, endorsed by Health Canada, that no longer requires physician-targeted pharmaceutical advertising to be accompanied by “brief prescribing information (BPI).” Those black-and-white pages of fine print that have appeared in the back of medical journals to support claims made in the upfront colour display ads are largely gone already. They will entirely disappear by June of this year. Instead, you’ll find a reference in ads directing you to a website where the information is featured. What that means is that the journals have fewer pages overall, but it doesn’t mean they contain fewer editorial pages. This issue, for example, has 64 pages; 50 of those are devoted to the columns and articles that have made Doctor’s Review so popular with doctors across the country. In the past, an issue that contained 50 pages of editorial would have been about 100 pages long, including advertising. This shift in the “business model” has all publishers of medical journals looking for new ways to continue to provide the reader services they always have. At first blush the move to online prescribing information might seem part of the overall trend from print to digital. This is not the case; far from it, in fact. The readership of print versions of medical journals has increased by 16 percent since 2008 according to the Print Measurement Bureau. Clearly you enjoy your paper copies as much as we enjoy putting them together. We have some terrific content in store for 2014. Your letters and e-mails that keep us on track, keep them coming. All the very best in 2014,

Visit

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JANUARY 2014 • Doctor’s

Review

The speed of 2 or 3 day dosing in Actinic Keratosis is here

Picato® Gel (ingenol mebutate) is indicated for topical treatment of non-hyperkeratotic, non-hypertrophic actinic keratosis (AK) in adults.

Demonstrated efficacy Median % reduction in lesion count at day 57:1 for face and scalp - 87% (study 1) and 83% (study 2)* for trunk and extremities - 75% (study 3) and 69% (study 4)†

Complete clearance at day 57:1 for face and scalp; 47% for Picato® Gel vs. 5% for placebo gel (study 1) and 37% for Picato® Gel vs. 2% for placebo gel (study 2) (p<0.001)* for trunk and extremities; 42% for Picato® Gel vs. 5% for placebo gel (study 3) and 28% for Picato® Gel vs. 5% for placebo gel (study 4) (p<0.001)†

®Registered trademark of LEO Pharma A/S used under license and distributed by LEO Pharma Inc., 123 Commerce Valley Dr. E., Suite 400, Thornhill, Ontario L3T 7W8

NEW

Once daily dosing: 3 days - face & scalp, 2 days - trunk & extremities Relevant Warnings & Precautions • Severe Local Skin Responses (LSRs) including erythema, flaking/scaling, crusting, swelling, vesiculation/pustulation, and erosion/ulceration can occur after topical application • Severe eye disorders, including periorbital edema, eyelid edema, eye edema, eye pain, and eyelid ptosis, occurred more frequently in patients treated with Picato® Gel than vehicle, and may result from spreading of application site edema • Administration of Picato® Gel is not recommended until the skin is healed from treatment with any previous medicinal product or surgical treatment • Contact with skin outside the treatment area should be avoided • Picato® Gel is for topical use only but should not be used near the eyes, on the inside of the nostrils, on the inside of the ears, or on the lips • Picato® Gel must not be ingested • Avoid the use of Picato® Gel during pregnancy • Nursing mothers should avoid physical contact between her newborn/infant and the treated area for 6 hours after application • The efficacy of Picato® Gel in the prevention of squamous cell carcinoma (SCC) associated with actinic keratosis (AK) has not been studied

• Clinical data on re-treatment and treatment of more than one area is not available • Clinical data on treatment in immunocompromised patients is not available For more information Please consult the product monograph at www.leo-pharma.ca/ picato_pm for important information relating to adverse reactions, drug interactions, and dosing information which have not been discussed in this piece. The product monograph is also available by contacting LEO Pharma Medical Information at 1-800-263-4218. 1. Picato® product monograph, January 30 2013. *Two multi-centre, double-blind, randomized, parallel-group, vehicle-controlled, clinical studies of AK patients evaluating the efficacy and safety of Picato® Gel 0.015% applied once daily on the face or scalp to a 25cm2 area of skin for 3 consecutive days in adult patients. Efficacy measurements included complete clearance rate and median percent reduction compared to vehicle control assessed at day 57 in Study 1 (PEP005-025) (Picato® Gel N=142, Placebo Gel N=136) and Study 2 (PEP005-016) (Picato® Gel N=135, Placebo Gel N=134) (8 weeks). †Two multi-centre, double-blind, randomized, parallel-group, vehicle-controlled, clinical studies of AK patients evaluating the efficacy and safety of Picato® Gel 0.05% applied once daily on trunk and extremities to a 25cm2 area of skin for 2 consecutive days in adult patients. Efficacy measurements included complete clearance rate and median percent reduction compared to vehicle control assessed at day 57 in Study 3 (PEP005-028) (Picato® Gel N=100, Placebo Gel N=103) and Study 4 (PEP005-014) (Picato® Gel N=126, Placebo Gel N=129) (8 weeks).

www.leo-pharma.ca

SYMBICORT budesonide/formoterol fumarate dihydrate

Product Monograph is available upon request from AstraZeneca Canada Inc. AstraZeneca Canada Inc., 1004 Middlegate Road, Mississauga, Ontario L4Y 1M4

www.astrazeneca.ca SYMBICORT® and the AstraZeneca logo are registered trademarks of the AstraZeneca group of companies. © AstraZeneca 2013

contents JANUARY 2014

38 COVER: MARTIAPUNTS / SHUTTERSTOCK.COM

features

Orient yourself Dim sum, Bruce Lee — and 50 million tourists a year. Here’s how to make sense of Hong Kong by Camille Chin

regulars

Living in the past Nevis is proud to display its history alongside its white-sand beaches by Josephine Matyas

Hawaii’s hole-in-one

LETTERS A real head-to-head

The volcanic golf courses of Maui are some of the US’s best by Anita Draycott

PRACTICAL TRAVELLER UNESCO embraces tradition, a Parisian boutique without Parisian salespeople, and our map of Asian spring festivals by Camille Chin and Tyson Lowrie

Latin lovers Three flavour-packed recipes from the queen of cocina by Maricel E. Presilla

BUDGET TRAVELLER Banff, New York, Quebec City, the Caribbean and rideshares by Tyson Lowrie

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JANUARY 2014 • Doctor’s

Review

Still suffering from GERD?

Trust TECTA to help relieve the symptoms of GERD.

Indications and clinical use: TECTA® (pantoprazole magnesium) is indicated for the treatment of conditions where a reduction of gastric acid secretion is required, such as symptomatic GERD (such as, acid regurgitation and heartburn). The safety and effectiveness of pantoprazole in children have not yet been established. Contraindications: • Hypersensitivity to benzimidazoles Relevant warnings and precautions: precautions • Possibility of malignancy should be excluded before therapy • Co-administration of atazanavir is not recommended • May slightly increase risk of gastrointestinal infections, such as Salmonella, Campylobacter and Clostridium difficile • Concomitant use with high dose methotrexate (primarily at high dose) may elevate and prolong serum levels of methotrexate and/ or its metabolite • May increase risk of osteoporosis-related fracture of the hip, wrist or spine. Lowest dose and shortest duration of therapy should be used

• Patients >71 years of age may already be at high risk for osteoporosis-related fractures and should be managed carefully according to established treatment guidelines • Not recommended in patients with severe liver disease • Chronic use may lead to hypomagnesaemia. For patients expected to be on prolonged treatment or taking concomitant treatment with digoxin or drugs that may cause hypomagnesaemia, initial and periodic monitoring of magnesium levels may be considered For more information: For important information on conditions of clinical use, contraindications, warnings, precautions, adverse reactions, drug interactions and dosing that have not been discussed in this piece, please consult the product monograph at www. takedacanada.com/ca/tectapm. The product monograph is also available by calling us at 1-866-295-4636. * Gastroesophageal reflux disease

contents JANUARY 2014

regulars

HISTORY OF MEDICINE Two eggs and a slice of Uncle Jim: the stomach-churning story of medical cannibalism by Jackie Rosenhek

Eating air? Alcorexia? Five reasons not to take celebrity food advice by Annarosa Sabbadini

25 26 29

I PRESCRIBE A TRIP TO... BRAZIL A PEI family physician meets friendly caimans and eats piranhas in the Pantanal wetlands by Dr Rachel Kassner

ONE BOTTLE A supple Argentinean beauty by James Nevison

GADGETS Hit the slopes with the latest skis and boards by Annarosa Sabbadini

LIQUID NUTRITION Three MDs dissect 007’s drinking habits by Tyson Lowrie

23 FOOD

NEW! TOP 20 PLUS WHY CHICAGO

PHOTO FINISH A black-and-white world by Dr Dennis Lee

Our new listings of the world’s top medical meetings, with an in-depth look at the Windy City

26 25 JANUARY 2014 • Doctor’s

Review

I M P O RTA N T N O T I C E

Health Canada/PAAB regulation change for prescribing information in journals Dear Doctor, Beginning in July 2013, important changes to regulations governing advertising of prescription, non-prescription, biological and natural health products will come into effect. The Canadian Association of Medical Publishers (CAMP) wants to inform our valued readers of these changes, as they will affect access to prescribing information that is currently published in our journals. The Pharmaceutical Advertising Advisory Board (PAAB), acting on behalf of Health Canada, reviews and approves all promotional materials directed at healthcare professionals in Canada. PAAB recently approved changes to their code of advertising acceptance that will allow advertisers to replace the current prescribing information pages with an electronic link to full product monographs. This link will be displayed prominently in all published print ads (a 1-800 number will also be provided). These changes will be phased in over the next twelve months, during which time you will see a mix of ads using the current print prescribing information and ads utilizing the new format. Medical journals play a vital role in educating physicians. Journal readership continues to grow. An annual national study (Print Measurement Bureau – Medical Media Study July 2012) shows readership of medical journals has risen 16% since 2007. Journals rank second only to live CME as a preferred communication channel. Canada will be breaking new ground with this “ePI” approach. If you have comments or concerns regarding these changes we encourage you to contact PAAB or Health Canada directly: Pharmaceutical Advertising Advisory Board (PAAB) 300-1305 Pickering Parkway Pickering, Ontario L1V 3P2 Canada Contact: Patrick Maasad Telephone: 905-509-2275 Email: Patrickm@paab.ca

Sincerely, Canadian Association of Medical Publishers

Health Canada Alain G. Musende, PhD Manager, Regulatory Advertising Section/ Gestionnaire de la section de la réglementation de la publicité Therapeutic Effectiveness and Policy Bureau/ Bureau de l’efficacité thérapeutique et des politiques Marketed Health Products Directorate/ Direction des produits de santé commercialisés Tel/Tél.: 613-954-6780 Fax/Téléc.: 613-948-7996

LETTERS

EDITOR

Annarosa Sabbadini

MANAGING EDITOR

A real head-to-head

Camille Chin

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Tyson Lowrie

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Katherine Tompkins

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Valmai Howe

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Pierre Marc Pelletier

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None of the contents of this publication may be reproduced, stored in a retrieval system or transmitted in any form by any means, without prior permission of the publishers. ISSN 0821-5758 Canadian Publications Mail Sales Product Agreement No. 40063504 Post-paid at St. Laurent, QC. Return undeliverable Canadian addresses to: Circulation Department, 400 McGill Street, 3rd Floor, Montreal, QC, H2Y 2G1. Subscription rates: One year (12 issues) – $17.95 Two years (24 issues) – $27.95* One year U.S. residents – $48.00 *Quebec residents add PST.

MASSIF ATTENTION Mushroom frittata, blackberry-blueberry yogurt, maple-caramel pastry and warm chocolate croissants [A Massif attack, December 2013, page 37]? Is there a breakfast of ham and eggs, camp potatoes, buttered toast, black coffee, etc. for real men? Dr Ian Verryn-Stuart Via DoctorsReview.com

Not sure what oversight the publisher typically has on the front page of Doctor’s Review, but December’s cover was a real booboo, no no, irresponsible photo. Ski helmets save lives. This is beyond debate in 2013-14 as the recent Michael Schumacher tragedy has shown. As a point of information, he was apparently skiing at a slow speed: less than 20 km/h. For a journal targeting physicians and often found in medical waiting rooms to depict on the cover a snowboarder WITHOUT a helmet is surprising and, frankly, negligent. I simply cannot figure out what the person who approved this was thinking. I am not sure as to how this tacit approval of helmetless snowboarding — a

The winner of a $100 Mountain Equipment Co-op gift card is Dr C. Kwiatkowski, an FP from Huntsville, ON.

sport predominantly done by a younger demographic than skiers for whom I also fiercely advocate wearing a helmet, as I have done for 15 years! — can be rectified now that this magazine has been sent to 50,000 physicians. Just passing along my thoughts! Dr Jeff Brock Via email

Thank you for writing. When we were working on the cover, we thought the model in the photo was, in fact, wearing a helmet — albeit under a white toque and black hoodie. The guy has such a big, round head, we didn’t question that it could be anything but a helmet. Also, most skiing and snowboarding shots, like this one, provided by tourist boards do feature helmets. That said, seeing the image as a real cover is certainly a different experience. Next time, we’ll make sure the helmet is over the hoodie.

All prescription drug advertisements appearing in this publication have been precleared by the Pharmaceutical Advertising Advisory Board.

Still suffering from GERD? 6. Roll over to page xx. JANUARY 2014 • Doctor’s CHANGE #

PRODUCTION NOTES

CHANGES BY

TAK TEC 13435 Doctor Review_1.25x3.5.indd 1

APPROVAL

Review SIGNATURE

2013-10-23 4:06 PM

Open up to a new

LAAC option in COPD

IMPROVED PATIENTS’ QUALITY OF LIFE (LS mean change in SGRQ total score vs. placebo, -3.32; p<0.001)1,2†

Now co by the vered and RAODB MQ

NEW ONCE-DAILY

SEEBRI BREEZHALER

DEMONSTRATED 5-MINUTE ONSET AND 24-HOUR BRONCHODILATION FEV1 improvement shown 5 minutes after first dose (0.093 L vs. placebo, p<0.001, serial spirometry)1,3‡

Significantly greater LS mean FEV1 vs. placebo demonstrated at all time points over 24 hours (LS mean FEV1 [L] vs. placebo after first dose, p<0.001; time points were 5 min, 15 min, 30 min, 1 hr, 2 hrs, 3 hrs, 4 hrs, 6 hrs, 8 hrs, 10 hrs, 12 hrs, 23 hrs 15 min, 23 hrs 45 min)4§ Indication & clinical use: SEEBRI* BREEZHALER* (glycopyrronium bromide) is indicated as a long-term once-daily maintenance bronchodilator treatment in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. Not indicated for the relief of an acute deterioration of COPD Can be used at the recommended dose in elderly patients 65 years of age and older Should not be used in patients under 18 years of age Contraindications: Hypersensitivity to glycopyrronium or to any other component of SEEBRI* BREEZHALER* Relevant warnings and precautions: Not indicated for treatment of acute episodes of bronchospasm Not indicated for treatment of acutely deteriorating COPD Caution in patients with narrow-angle glaucoma Caution in patients with urinary retention In severe renal impairment (estimated GFR <30 mL/min/1.73m2), use only if the expected benefit outweighs the potential risk Risk of paradoxical bronchospasm: discontinue immediately

* SEEBRI and BREEZHALER are registered trademarks. Product Monograph available on request. 13SEE029E © Novartis Pharmaceuticals Canada Inc. 2013

For more information: Please consult the Product Monograph at www.novartis.ca/SeebriMonograph for important information relating to adverse events, drug interactions, and dosing information which have not been discussed in this piece. The Product Monograph is also available by calling the Medical Information department at 1-800-363-8883. LAAC: long-acting anticholinergic; COPD: chronic obstructive pulmonary disease; LS: least square; SGRQ: St. George’s Respiratory Questionnaire; measures health-related quality of life in symptoms, activities and impact on daily life;5 FEV1: forced expiratory volume in 1 second. † GLOW2: A 52-week, randomized, double-blind, placebo-controlled parallel-group study of 1,060 patients with COPD. Patients received either SEEBRI* BREEZHALER* (glycopyrronium 50 mcg o.d.; n=525), placebo (n=268), or open-label tiotropium (18 mcg o.d.; n=267) as an active control. Primary endpoint was 24-hour post-dose (trough) FEV1 following 12 weeks of treatment. ‡ GLOW1: A 26-week, randomized, double-blind, placebo-controlled parallel-group study to assess the efficacy, safety and tolerability of once-daily SEEBRI* BREEZHALER* (50 mcg) in patients with COPD (n=550); placebo (n=267). § LS mean FEV1 (L) after first dose; SEEBRI* BREEZHALER* (n=169) vs. placebo (n=83), respectively: 5 min: 1.39 vs. 1.30; 15 min: 1.43 vs. 1.28; 30 min: 1.44 vs. 1.28; 1 hr: 1.47 vs. 1.28; 2 hrs: 1.53 vs. 1.34; 3 hrs: 1.53 vs. 1.35; 4 hrs: 1.52 vs. 1.35; 6 hrs: 1.48 vs. 1.33; 8 hrs: 1.47 vs. 1.33; 10 hrs: 1.47 vs. 1.32; 12 hrs: 1.45 vs. 1.31; 23 hrs 15 min: 1.37 vs. 1.27; 23 hrs 45 min: 1.39 vs. 1.31; p<0.001 for all time points. References: 1. SEEBRI* BREEZHALER* Product Monograph. Novartis Pharmaceuticals Canada Inc., October 12, 2012. 2. Kerwin E, Hébert J, Gallagher N et al. Efficacy and safety of NVA237 versus placebo and tiotropium in patients with COPD: the GLOW2 study. Eur Respir J 2012;40:1106-14. 3. D’Urzo A, Ferguson GT, van Noord JA et al. Efficacy and safety of once-daily NVA237 in patients with moderate-to-severe COPD: the GLOW1 trial. Respir Res 2011;12:156(1-13). 4. Data on file. Novartis Pharmaceuticals Canada Inc. 5. Jones P. St. George’s Respiratory Questionnaire Manual. Available from: www.healthstatus.sgul.ac.uk/SGRQ_download/SGRQ%20 Manual%20June%202009.pdf. Accessed December 5, 2011. 6. Ontario Drug Benefit Formulary, August 29, 2013. 7. RAMQ, June 1, 2013.

P R AC T I C AL T R A V E L L E R

PHOTOS THIS PAGE SHUTTERSTOCK.COM

A Mongol yurt in Central Asia’s Tian Shan range.

UNESCO embraces tradition The use of the Chinese abacus, the making of Turkish coffee, and the annual renewal of a rope suspension bridge in Peru are three of this year’s 25 additions to UNESCO’s Intangible Cultural Heritage list. The list launched in 2008 with 90 traditions; since then about 200 more have been inscribed. Others to make the cut in 2013 include: • The narration of the deeds of Krishna through song (Sankirtana) in India • Petrykivka (folk) painting of flora and fauna in the Ukraine • The preparation of preserved veggies — aka kimchi — in Korea • Craftsmanship of the round, portable Mongol ger or yurt • A nighttime divination ceremony accompanied by drums in Senegal • Jamdani weaving via handloom in Bangladesh • The Mediterranean Diet of Greece, Italy, Morocco, Spain, Portugal etc. • The festivals and rituals celebrating San Pedro the Apostle in Venezuela • Shrimp fishing on horseback in Belgium • Wine making in an egg-shaped earthenware vessel (or qvevri) in Georgia For the complete list: unesco.org/culture/ich/en/lists. [CC]

JANUARY 2014 • Doctor’s

Review

P R AC T I C AL T R A V E L L E R

According to the PR people behind Rotterdam’s Kunsthal museum, “many women long for new shoes as for new love.” We hate to generalize, but we might agree. In fact, we think a few women might even prefer the shoes. One test of this theory might be just how many people visit S.H.O.E.S Head Over Heels, February 1 through May 11, at the newly renoed Netherlands museum. More than 500 shoes will be on display from circa-1900 Victorian boots to the first stilettos invented by Roger Vivier in 1954 to modern-day models by Manolo Blahnik, Jimmy Choo, Christian Louboutin, Versace and Vivian Westwood. Adults €16.20, youth 12 to 18 €9.95, kids 6 to 11 €7.70. kunsthal.nl. [CC]

High style in Rotterdam

LEFT TO RIGHT: André Perugia, 1937. René van den Berg and Karin Janssen, 2012. Vivienne Westwood, 1993. Jimmy Choo, 2007.

Roomer has it

You book a non-refundable room, plans change, and you’re stuck with a hotel reservation you can’t use. In the past this usually resulted in losing your money, mild self-recrimination and a half-hearted promise to buy travel insurance next time. But now a new booking service, Roomer, lets you buy and sell hotel reservations with other travellers. They don’t currently charge any fee or percentage, and they take care of supplying photos for your listing and changing the details with the hotel. Not only could it let you recoup some money, it’s also a good way to get a cheap room. We ran a sample test for a three-star hotel in Miami for January 25 and 26, and came up with the Regency Hotel for US$97 per night. For the same hotel, Orbitz.com wanted US$145, Hotels.com and Expedia.ca both quoted US$168. Not bad for a startup. roomertravel.com. [TL]

Doctor’s Review • JANUARY 2014

The European Union is taking the first step towards undoing the ban on carry-on liquids on airplanes. Beginning January 31, if you transfer at an EU airport from a flight outside the union, you’ll be able to carry on bottles so long as they’re in sealed duty-free bags. It’s what the EU is calling a “small first step” in their plan to get rid of bans on liquid carry-on items entirely by 2016. For now, the US has no plans to follow suit. In Canada all liquids over 100 millilitres are banned, with the exception of duty-free bottles bought at an EU airport for passengers transferring to another destination within Canada. The EU is also expected to announce relaxed restrictions on cell phones and mobile devices in the coming months. [TL]

Unbanning the bottle

Bring Paris to you Buying a souvenir from the City of Paris’ new, online store isn’t the same as buying one when you’re actually in the City of Lights, but it’s the next best thing. The Boutique de la Ville de Paris launched in December with 250 products on its virtual shelves, from books and stationary to mugs and carafes. The site even sells aluminum garden chairs (€59–199) like those found in the Jardin du Luxembourg and at the Place de la République, handcrafted wooden boats (€11–63) like those that cruise Paris park ponds, and loose-leaf teas (€15 for 100 grams) from the 160-year-old Mariage Frères tea house. boutique.paris.fr. [CC] Contributors: Camille Chin and Tyson Lowrie JANUARY 2014 • Doctor’s

Review

P R AC T I C AL T R A V E L L E R

Asia’s springtime celebrations ISAFMEDIA/FLICKR.COM

Tell a Canadian in February or March that it’s spring and he/she might give you a look somewhere between rage and despair. But across Asia these months mean either springtime, the lunar New Year, or both. Whatever it is, it’s cause for celebration.

SHUTTERSTOCK.COM

UZBEKISTAN Celebrating the March 21 Persian New Year (here called Navruz), Uzbekistan celebrates with a game called kupkari, or buzkashi. Uzbekistanis on horseback compete against each other to be the first to collect a goat carcass off the ground, and then carry it across the finish line while the audience cheers them on.

ARIAN ZWEGERS/FLICKR.COM

INDIA & NEPAL They welcome spring in style in northern India and Nepal. Preceded by massive bonfires the night that celebrates the triumph of good over evil, the Holi celebration (March 17) is best-known for massive street melees of coloured powder-throwing.

GOA Every year Carnival is celebrated in Goa, which was a Portuguese colony for 450 years. In the three days leading up to Ash Wednesday (this year March 1-4), the influence shines through in the form of street parties, concerts and other celebrations.

Doctor’s Review • JANUARY 2014

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JAPAN For the Saidai-ji Eyo “naked festival” on February 15, about 9000 loincloth-wearing men gather outside the Saidai-ji Temple in Saidaiji-naka and compete for good luck charms thrown from the window, in what the Japan National Tourism Organization calls “one of the three most eccentric festivals in Japan.” We wonder what the other two could be.

BURMA The Full Moon of Tabaung is two-week festival during the last month of the year on the Burmese lunar calendar which culminates in mid-March. Since 2012, Buddhists have gathered at the Shwedagon Pagoda to chant and recite.

SHUTTERSTOCK.COM

CHINA There’s no bigger celebration than in China, where on January 31 the Year of the Horse will be ushered in with fireworks, paper lanterns, red envelopes and a cacophony of noise. Festivities carry on in one form or another for 15 days. Gung hay fat choy!

BALI Not every New Year’s has to be merriment and noise-making. Predominantly Hindu, Bali will go dead quiet on March 31 for Nyepi, when people stay inside for quiet reflection. The day before, you’ll be able to watch the procession of the ogoh-ogoh, paper effigies of evil spirits, before they are ritually burnt. [TL] JANUARY 2014 • Doctor’s

Review

gs n i t lis cme e c en e: dr r e f Con ss cod e acc

MEDICINE ON THE MOVE

We asked... What

do Canadian MDs do for exercise? Survey says: 36.1%

WORKOUT AT THE GYM

54.1%

WALK

26.9%

RUN

45.8%

BIKE

39.4%

OTHER

Popular “other” responses included skiing and swimming, with one MD writing that he has been swimming daily since 1994. Slightly more creative responses included crossword puzzles, ping pong and sex.

Readers were able to select more than one response.

How often do MDs exercise during the week? 5–7 times a week

31.8%

3–5 times a week 2–3 times a week

8.9% 31.1%

once a week

4.4% 22.8%

only on days off never

Want to exercise your mind too? Enter to win a $100 !ndigo gift card. Go to doctorsreview.com/meetings then register or use access code drcme to get to the contest ballot at the top of the page. Source: Doctor’s Review, January 2009.

BUDGET TRAVELLER by

T y s on L ow r i e

great deals: Banff, New York, Quebec City, the Caribbean and rideshares Porto, Portugal.

New York’s winter welcome The Buttermilk Falls Inn & Spa is known for its cozy rooms with fireplaces, large breakfasts and idyllic setting on the Hudson, midway between Albany and NYC. Book a three-night stay through March 31 by January 31, and you only pay for two nights thanks to the Winter Welcome offer. That means three nights at the highly-rated inn, which also includes access to the pool, sauna and steam room, starting at US$500. buttermilkfallsinn.com/promotions.htm.

The cheapest Caribbean destinations The very useful budget travel blog priceoftravel.com has ranked 32 destinations in the Caribbean and Mexico based on cost. Their index uses the cost of flights and a cheap three-star hotel. The cheapest destination was Cancún in Mexico, followed by Punta Cana (Dominican Republic), Negril (Jamaica), San Juan (Puerto Rico), and Ocho Rios (Jamaica). The full list is on their website.

Claudia Masciotra

Banff on a budget

Doctor’s 2014 IfFor you can tear yourselfReview away from your January practice, the Banff High Country Inn is offering a Sunday to Thursday getaway rate per night, including continental breakfast and a Faxfor $891-855-861-0790 free bottle of wine thrown in, to boot. The High Country Inn isn’t a luxury option, but for a simple and cheap Banff base, it ain’t half bad. banffhighcountryinn.com.

JTHETZEL / FLICKR.COM

BOOK NOW!

Cancún, Mexico.

Quebec City during Carnival Staying in Quebec City during Carnival can be expensive, but there are ways around it. You could try staying away from the downtown/Vieux Québec area. For example, the Château Repotel Henri IV is 15 minutes from downtown, and thanks to a third night free offer, you can book it from February 13 to 16 (the Carnival’s closing weekend) for $189.90, coming to $63.30 per night.

Safer, cheap ridesharing Quebec City-based startup Kangaride.com is slowly moving ridesharing into the mainstream. A membership with the site costs $7.50, and each individual ride booking is $5. That money goes towards checking the driving records of its users through an agreement with provincial governments to provide a safer experience than Craigslist ads, while being cheaper than intercity buses. Over 5000 rides are posted per week.

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JANUARY 2014 • Doctor’s

Review

For the treatment of women with postmenopausal osteoporosis at high risk for fracture

TRUST THAT PROLIA DEMONSTRATED FRACTURE RISK REDUCTION WITH A Q6M SC INJECTION * ®

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Fracture risk reduction demonstrated at all sites measured throughout the skeleton: vertebral (primary endpoint), hip and non-vertebral (secondary endpoints) sites, at year 3 of continued treatment vs. placebo1,2* New vertebral fractures

% RRR

p<0.001, ARR

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Hip fractures

RRR

p=0.04, ARR

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RRR

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1.5%

Find out if Prolia is an appropriate choice for your patients - visit Prolia.ca

Denosumab is recommended by Osteoporosis Canada as a 1st-line treatment for postmenopausal osteoporosis The guidelines recommend treatment in women at high risk of fracture.3† Prolia is indicated for the treatment of postmenopausal women with osteoporosis at high risk for fracture, defined as a history of osteoporotic fracture, or multiple risk factors for fracture; or patients who have failed or are intolerant to other available osteoporosis therapy. In postmenopausal women with osteoporosis, Prolia reduces the incidence of vertebral, nonvertebral and hip fractures. Refer to the page in the bottom-right icon for additional safety information and for a web link to the product monograph discussing: • Contraindications in patients with hypocalcemia. • Other relevant warnings and precautions relating to adequate intake of calcium and vitamin D, hypocalcemia (monitor as necessary), not using concurrently with XGEVA®, serious infections, epidermal and dermal adverse events, atypical femoral fractures, osteonecrosis of the jaw, significant suppression of bone remodelling, caution in patients with renal impairment, potential sensitivity in older patients, and latex allergy. • Conditions of clinical use, adverse reactions drug interactions and dosing instructions In addition the page contains the reference list and study parameters relating to this advertisement. © 2013 Amgen Canada Inc. All rights reserved. Prolia®, ProVital® and XGEVA® are registered trademarks of Amgen Inc., used with permission. See prescribing summary on page 62 xx

H I S T O R Y O F M E DI CI N E by

Bite me

The upper class in Tenochtitlan, Mexico believed eating humans was good medicine.

Ja c k i e R os e n he k

Cannibalism is hard to swallow, but honeyed humans were the medicines of yesteryear

Frostbite was a huge issue in conflicts well into the 20th century; here, a Japanese soldier in 1905 is suffering the effects.

hey say the hair of the dog is the best cure for a hangover, but before you crack an egg into that Bloody Mary and call it breakfast, consider the history of the belief: doctors used to pack hair from rabid dogs into the wounds of bite victims. The notion that “like cures like” has no basis in science (sorry, homeopathy!) and yet some people still cling to the hope that it does. Why? Is it because rhino horn really cures impotence thanks to its resemblance to a certain erect male organ? Or because allium species like onions and garlic prevent the watery eyes and runny nose of hay fever and head colds? Far from it. But this logic was behind many centuries of prevailing medical wisdom. Back then it was understandable. The simplicity and even poetry of sympathetic magic appealed to our need to make sense of disease — and none stretched the law of similars to the limit more than medicinal cannibalism.

HONEYED HUMANS Art historians can make a good case that the stable Ming Dynasty (1368-1644) was one of the cultural and artistic peaks in Chinese history. Medical historians might JANUARY 2014 • Doctor’s

Review

Of course, China and Arabia weren’t the only places where medicinal cannibalism existed, though the New World version was decidedly less gentle than sweet corpses steeped in honey. During the early 16th century, Spanish conquistadors observed an obsession in Tenochtitlan, Mexico’s enormous Aztec capital of 200,000, that included human sacrifice. Estimates suggest that as many as 250,000 men, women and children (some willing, some not) ascended the steps of pyramids each year to have their beating hearts and guts ripped from their bodies to offer as sacrifice to the gods, but also to be fed to Tenochtitlan’s wealthy elite, presumably as a form of medicine. As revolted as the conquering Spaniards were by the practice, a similar if less active form of medicinal cannibalism was being practiced closer to home, in England and throughout Europe.

BRAIN FOOD The tumultuous reign of Charles II (1630-1685) saw all manner of drama befall Great Britain, including the Great Plague, the Great Fire of London and the great Restoration. Less great were the “apoplectic fits” Charles II suffered one morning in 1685 at age 54. Medical historians now believe he died of renal failure, but back then the sudden onset and strangeness of his symptoms had most believing he was poisoned. In the four days before he died, the king’s physicians took extraordinary measures to bring him back from the brink, most notably by breaking the bank using high doses of one of the day’s most sought-after cure-alls: “spirit of skull” or King’s Drops. It was pretty much what it sounds like — powdered human skull mixed with alcohol, herbs and other ingredients. Charles paid £6000 for the secret recipe and took a dose daily. It was believed that human skulls absorbed the power of the brains they held after death, so much so that even the moss that grew on skulls was considered a rare and effective cure.

Doctor’s Review • JANUARY 2014

TOP TO BOTTOM: Powdered mummies were touted as a cure for epilepsy, headaches and bruising. It was thought that skulls absorbed the power of the brains they held after death. Medicine jars once contained human fat. King Charles II took a dose of powdered human skull daily to help his seizures. Did Pope Innocent VIII really drink the blood of young boys? Guilty as charged.

BULLENWÄCHTER / WIKIMEDIA.ORG

“...in Arabia there are men 70 to 80 years old who are willing to give their bodies to save others. The subject does not eat food, he only bathes and partakes of honey. After a month he only excretes honey (the urine and feces are entirely honey) and death follows. His fellow men place him in a stone coffin full of honey in which he macerates. The date is put upon the coffin giving the year and month. After a hundred years the seals are removed. A confection is formed which is used for the treatment of broken and wounded limbs. A small amount taken internally will immediately cure the complaint.”

STUDIO37 / SHUTTERSTOCK.COM

say it was the height of medicinal cannibalism, too. In the materia medica text Bencao Gangmu (1578), legendary Chinese physician and pharmacist Li Shizhen (15181593) outlines, among his 1892 entries, the process of creating a “mellified man.” Also known as “human mummy confection,” it was a substance made from a corpse that had been marinated in a coffin full of honey. Shizhen promoted it as a cure for various ailments and also reported on a more powerful form, mellifluous martyrs:

Human mummy confection was a substance made from a corpse that had been marinated in a coffin full of honey So ubiquitous was skull medicine that apothecaries in England displayed skulls in their windows. Only the wealthy were safe from the threat of skull-moss fraud, however, since they could afford to pay the premium for moss with the cranium still attached. King Charles, of course, could afford the very best of both and was a big believer in their powers; the lab he had set up at the Palace of Whitehall allowed him to keep a ready supply at hand. Towards the end, when he was wracked by convulsions, drooling, eye-rolling and the like, the royal doctors assured their tortured monarch that their hair-of-the-dog remedy was the only thing that could save him. Shockingly, even mega-doses weren’t enough, and Charles II succumbed to his seizures at last. Still, this was not the first time Europeans dabbled in the dead to cure what ailed the living. The Romans had their own cannibalistic cures and the flesh of Gladiators was prized above all else. Their dried and ground-up livers, and brave blood, were considered an especially potent medicine for epilepsy — and a nice way of using what was left behind on the floor of the Colosseum and other arenas across the country.

MARMALADE, MUMMIES AND MORE By the 16th and 17th centuries, body parts appeared within the pharmacopoeia of the day quite frequently. The monks of one Franciscan monastery used the blood of corpses to make a marmalade, as per a 1679 recipe. Pastes, poultices, drams and draughts made of flesh, fat and bone were employed across the board. The preferred flesh, of course, came from the executed, since the vitality which their parts would hopefully confer had not been marred by disease or old age. Creative potions were described in the literature, often to ridiculously specific degrees. One 17th-century German recipe laid out by pharmacologist Johann Schröder (1600-1664) called for soaking in aloe, wine and myrrh the dried flesh of the cadaver of a reddish man... of around 24 years old... dead of a violent death, but not an illness. Bandages soaked in rendered human fat were a favourite German cure for gout. Sometimes, doctors got a little overzealous sourcing body parts, especially when the patient was of particular importance. One example occurred in 1492, when desperate doctors did their best to cure the dying Pope Innocent VIII. They sent for a trio of young boys, bled them until they died and had the Pope drink their blood after transfusions failed. Not so innocent after all....

But the most sought-after cure in Europe — for well over 200 years — was a mixture made from mummies. It started during the Renaissance, when fascination with ancient civilizations began. Could it be that Pharaohs held the secret to immortal life? It was worth a shot and so doctors began doling out doses of powdered, cloth-wrapped, bitumen-soaked corpses stolen from sacred ground and smuggled into Europe. It was touted as a cure for epilepsy, headaches, bleeding and bruising. The King of France, Francis I (1494-1547), never left home without a dose of mummy medicine. Prior to the 18th century, in fact, the word “mummy” was synonymous with “drug.” But the black market couldn’t keep up with demand. When the mummy well ran dry, suppliers turned to the unclaimed corpses of beggars and lepers, but the consistency was too new. The public appetite for flesh soon turned into a boon for grave-robbers and industrious sorts with shovels set about supplying Europe with the desiccated parts they needed. In France in 1694, the royal pharmacist noted that those looking for a little human fat to cure their arthritis were bypassing pharmacists and going straight to the public executioner, who was selling it for cheaper. As more frauds were exposed, the bloom was off the proverbial skull moss, and mummy medicine became increasingly ridiculed as unscientific and superstitious. By the end of the 18th century, corpse medicine was all but dead... or was it?

MODERN-DAY MONSTERS This past October, two Chinese students were arrested for buying and reselling 3000 pills online. Touted as cure-alls, revitalizers and weight-loss aids, the pills tested 100-percent positive for human flesh. Since 2011, South Korean officials have been stemming a tide of Chinese capsules being smuggled into the country through the mail and in luggage for resale internally and, presumably, to the rest of the world. The pills, believed to originate from Northeast China, contain the powdered remains of fetuses, placenta and newborn babies. The potential health implications are considerable, the moral ones far worse. Leonardo da Vinci explained the living’s appetite for human flesh as medicine as follows: “We preserve our life with the death of others. In a dead thing insensate life remains which, when it is reunited with the stomachs of the living, regains sensitive and intellectual life.” As horrendous as it sounds, the demand for cannibalistic cures remains. Now, as then, it’s all just hair of the dog... with plenty of bark and no bite. JANUARY 2014 • Doctor’s

Review

gs n i t lis cme e c en e: dr r e f Con ss cod e acc

MEDICINE ON THE MOVE

We asked... How

many times a week do MDs eat breakfast? Survey says: 83.4% 5 –7 times a week 6.4% 3–5 times a week 4.5% 2–3 times a week 1.6% once a week 2.6% only on days off 1.5% never

What’s your favourite breakfast? 40.5% cereal 6.6% fruit 14.3% eggs 0.8% meat

Yogurt, toast and oatmeal were popular “other” responses. More than one doc confessed to eating leftover lunch or supper.

2.7% smoothies 16.7% coffee or tea and a pastry, muffin or bagel 18.4% other

Do you eat up books? Enter to win a $100 !ndigo gift card. Go to doctorsreview.com/meetings then register or use access code drcme to get to the contest ballot at the top of the page. Source: Doctor’s Review, January 2009.

F OOD by

An n a r os a S a b b a d i n i

(In)famous food advice A diet low in food but rich in alcohol? How about one in which you fill up on substantial portions of air and sunlight? These are just two of the weight-loss diets that made the British Dietetic Association’s annual list of the Top 5 Worst Celebrity Diets to Avoid. Here the BDA’s full list for 2014: 1. The Breatharian Diet This is similar to the French L’Air Fooding diet, popularized in a 2010 issue of French Grazia. The magazine interpreted a Dolce & Gabbana ad campaign featuring Madonna being all domestic — washing dishes, chopping veggies, holding up spaghetti but not eating it — as an endorsement of what the mag called the new It diet. Breatharians believe they get all the nutrients they need from air and/or sunlight alone. Michelle Pfeiffer claims she was once influenced by a Breatharian cult. The Grazia spread came with a sidebar recipe for soupe à l’eau or water soup — literally water and salt. 2. Biotyping This one looms large on the Internet, and is dangerous if you’re easily swayed by pseudoscience. The diet aims for site-specific body fat reduction. It begins with a test, called the biosignature modulation, which checks your hormonal balance, body fat, genetics, deficiencies and toxicity. Spot reduction is achieved by choosing only certain foods, not eating others, with a training regimen and supplements. Boy George swears by it. 3. The Gluten-Free Diet The BDA takes issue with celebrity diet experts like Gwyneth Paltrow who allegedly advocate a gluten-free diet for all — not just for those with celiac disease or gluten sensitivity.

4. The Alcorexia/Drunkorexia Diet This diet, alledgedly favoured by some supermodels, advocates eating very few calories during the week and saving up in order to binge-drink. You’re supposed to “bank” about 1500 calories a day, leaving you with 10,500 extra for the week — all for drinking. The 10,500 banked calories amount to: 131 glasses of red wine, or 26 bottles; 45 pints of lager beer; or 201 shots of spirits. That’s one long hangover!

Advocates of the L’Air Fooding diet, aka the Virtual Eating Diet, took this ad as an endorsement for simply not eating — ever!

5. The Dukan Diet This one, created by former French MD Pierre Dukan, banned from general practice in 2013, has appeared on the BDA’s list since 2010. Reported followers include Jennifer Lopez and Carole Middleton. The Dukan is a high-protein, no/low carb, four-phase diet that promotes rapid weight loss. Basically one restricts entire food groups. Side effects include lack of energy, constipation, the need for supplements and bad breath.

JANUARY 2014 • Doctor’s

Review

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Adam van Koeverden,

Olympic medalist Father is a colon cancer survivor

Colon Cancer Canada Weâ&#x20AC;&#x2122;re behind your behind

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L I QU I D N U T R I T I ON by

T y s on L ow r i e

Shaking, not sober In the Christmas 2013 issue of the British Medical Journal, Drs Graham Johnson, Indra Neil Guha and Patrick Davies conducted an extensive literature review in order to answer a pressing question: was James Bond a lush? The results for the fictional spy aren’t encouraging. Counting every drink Bond took in the original book series written by Sir Ian Fleming, the authors concluded that Bond drank on average 92 units a week — one unit is equivalent to 10 millilitres of pure ethanol, or a 25 millilitre serving of spirits — which is over four times the recommended British maximum, and about 3.5 times the recommended Canadian amount. In retrospect, the signs of overconsumption were evident. It seems Bond’s requests for his martinis to be “shaken, not stirred” had less to do with having a classic catchphrase than with his suffering from alcoholic tremors. In Casino Royale, before we find Commander Bond crashing his car during a high-speed chase, he had suspiciously drunk 39 units of alcohol. At risk of liver cirrhosis, hypertension and more, Bond’s life expectancy was 56 — the age at which Fleming, himself no saint, died. The authors drafted the study to point out that though Bond is admired for his physical, sexual and mental prowess, in reality his boozing would have had him underperforming in all aspects of his life. To any young male admirers of the legendary Cold Warrior, the authors have an additional warning: Bond was at “high risk of suffering from sexual dysfunction, which would considerably affect his womanising.” Full article at: bmj.com/content/347/ bmj.f7255

JANUARY 2014 • Doctor’s

Review

GA D GE T S by

An n a r os a S a b b a d i n i

Snow business Rocky Mountain-tested Looking for skis where even the topsheet has your name written all over it? Snoday, based in small-town Cochrane, AB, tailor-designs and hand-builds all their skis and snowboards. Order one and you’ll also be involved in selecting the amount of flex, camber and rocker. Once the technical stuff is out of the way, you’ll just have to choose a graphic. Ever wanted to look down at your pooch, kitty or significant other while you ski? Here’s your chance. The company stands behind its work with a limited two-year warranty. Skis start at $895; boards at $750. snoday.ca. Glide and grip Looking to spend more of your crosscountry time exploring woods, parks or snow-covered waters, well away from groomed trails? The new Rossignol Evo OT (as in off-trail) is a refined version of the company’s already popular Evo Tour. Wider dimensions, partial metal edges and smaller sizing give you all the stability you need to manoeuvre through a variety of snow conditions. $275. rossignol.com. Easy operators The Line Soulmate 90 give intermediate skiers more flex and stability on both familiar and tougher runs. Good value for what these skis offer. US$550. lineskis.com. A backcountry luxury vehicle Limited edition 4FRNT, from online retailer Backcountry.com’s Renegade line, give you the flex, full-rocker camber profile, and power usually reserved for professional models. Handmade in Salt Lake City, UT. US$800. The two-trick Pony The Burton Family Tree Trick Pony is a great beginner-friendly board that also allows experienced riders to do just about anything in most any terrain and condition. You can trust any board from this now-veteran company. Burton has been making them for both pros and amateurs since the 1970s. US$500. burton.com. Refined riding Custom-made skis and snowboards are made to your dream shape, length, sidecut, flex and composition in Prior’s factory at the base of Whistler. Each order takes about three weeks; if you can’t wait, Prior has some in stock. Skis start at $849; boards at $699. priorsnow.com. Walking the winter trail The limited-edition Blitzen snowshoes, made by Redfeather, are a stylish and affordable way to successfully cover most ground, be it ice or deep snow. US$100. redfeather.com.

Doctor’s Review • JANUARY 2014

1. Personalize every aspect of your new skis — right down to their look — when you buy a pair from Snoday. 2. The Rossignol Evo OTs are smaller and come with partial metal edges for better maneuverability. 3. The Line Soulmate 90 will satisfy intermediate and advanced skiers looking for all-purpose do-just-about-anything skis. 4. Backcountry skiers wanting to treat themselves should look to the limited-edition, handmade 4FRNT. 5. Any snowboard from Burton, like the Family Tree Trick Pony for beginners, is sure to be reliable. 6. Whistler’s Prior has been handcrafting skis and snowboards since 1990. 7. Designed for ice and deep snow, the limitededition Blitzen snowshoes are also an affordable way to look snazzy. 6.

JANUARY 2014 • Doctor’s

Review

• Easy to use • Accurate and durable • Designed to fit patients’ unique needs and personalities

PEOPLE ARE UNIQUE. THEIR PENS SHOULD BE TOO. HumaPen® is a registered trademark of Eli Lilly and Company, used under license. SAVVIO™ is a trademark of Eli Lilly and Company; used under license. © 2013, Eli Lilly and Company. All rights reserved.

doctorsreview.com/meetings access code: drcme

the top 20 medical meetings Canada Banff, AB June 3-6

Halifax, NS June 4-7 2014 Annual Meeting and Exhibition of the Canadian Ophthalmological Society

Montreal, QC June 12-14 23rd Montreal Live Symposium: Interventional Cardiology

June 25-28 91st Annual Conference of the Canadian Paediatric Society

MICHAL BEDNAREK / SHUTTERSTOCK.COM

49th Congress of the Canadian Neurological Sciences Federation

The Old Town in Warsaw, Poland.

Niagara Falls, ON June 10-13

St. John’s, NL June 5-7

70th Annual Clinical and Scientific Conference of the Society of Obstetricians and Gynaecologists of Canada

2014 Annual Meeting of the Canadian Nutrition Society

Quebec City, QC June 18-21

OTMPC

XXXIII FIMS World Congress of Sports Medicine

Clifton Hill in Niagara Falls, ON.

For contact info on these and 2500+ more conferences, visit doctorsreview.com/meetings

June 28-July 1 69th Annual Meeting of the Canadian Urological Association

Toronto, ON June 19-22 14th Annual Meeting of the International Association of Forensic Mental Health Services

June 25-28 89th Annual Conference of the Canadian Dermatology Association

Amsterdam, Brasilia, Florence, Hamburg, Honolulu, Istanbul, Madrid, Milan, Paris, Quebec City, San Diego, Seoul, Shanghai, Sydney, Toronto

Go to doctorsreview.com/meetings for a reason to visit these cities... and many more! JANUARY 2014 • Doctor’s

Review

Why Chicago?

by Tyson Lowrie

ABADONMI01 / FLICKR.COM

While the doctor-friendly Chicago location of the National Museum of Health and Medicine won’t open until 2015, the Field Museum’s The Machine Inside: Biomechanics explores “living, breathing machines that walk the Earth” like fish that can project their jaws out to half their body lengths to capture prey. Using real-life skeletons as well as realistic models, it looks essential for any MD (or veterinarian).

Museum meanderer

Ever asked yourself where you could see a WW2 German U-Boat and a working coal-mine elevator in the same place? Of course you haven’t. But you should still visit the Museum of Science and Industry. The Shedd Aquarium is one of Chicago’s bestloved institutions. Visit the Caribbean Reef, Waters of the World and Amazon Rising exhibits for just US$8 for adults, with the other exhibits extra. The 90-year-old aquarium houses over 30,000 animals.

Architecture aficionado

CESAR RUSS PHOTOGRAPHY

My father hates guided tours. He went on the First Lady Architecture Tour and loved it, as do countless other tourists. The 90-minute boat cruise has become a must-do for visitors. Book ahead. Liked what you saw? Keep your eye open in boutique shops or head to StudioChris.com for local artist Chris Gorz’s beautifully screenprinted posters of iconic Chicago landmarks. Probably the best souvenir of the city. US$35.

Blues lover

Take in Chicago’s grimier side, and architecture of a different sort with the Historic Chicago Bar Tour, which also takes in history and local lore. Runs about US$50 when you factor in the 2.5 servings of alcohol of your choice. Book ahead.

16th International Congress of Endocrinology TRIPP / FLICKR.COM

June 25-28 2014 Annual Meeting of the Federation of Clinical Immunology Societies

For contact info on these and 2500+ more conferences, visit doctorsreview.com/meetings

Doctor’s Review • JANUARY 2014

ALBERTO CABELLO MAYERO / FLICKR.COM

June 21-24

COMPUJERAMEY / FLICKR.COM

NOONCH / FLICKR.COM

DIRECTORY

Movie nut

Art Institute of Chicago 111 South Michigan Avenue tel: 312-443-3600 artic.edu Buddy Guy’s Legends 700 South Wabash Avenue tel: 312-427-1190 buddyguy.com

Fans of the silver screen will find parts of Chicago uncannily familiar. The bank Heath Ledger’s Joker robs in the opening of 2008’s Dark Knight? That’s the Old Chicago Post Office, which also played a starring role in the flashy-yet-forgettable Transformers 3.

Burnham Park tel: 312-742-5369 chicagoparkdistrict.com/parks/ burnham-park

Kevin Costner shooting about 15 bad guys, a stroller rolling down a flight of stairs in slo-mo, and the famous “you got him?” moment — it all happened in The Untouchables, on the steps of Union Station.

Field Museum 1400 South Lake Shore Drive tel: 312-922-9410 fieldmuseum.org adults US$15, kids 3 to 11 US$10

The director of Ferris Bueller’s Day Off called it his “love letter to the city.” No spot is more prominent than the Art Institute, where young Ferris walks by the iconic lion statue out front and is spellbound by the paintings inside.

First Lady Architecture Tour tel: 847-358-1330 cruisechicago.com US$38 Historic Chicago Bar Tour tel: 312-350-1131 chicagodetours.com

Urban outdoorsman

Do as the Chicagoans do and hit the 42 kilometres of lakefront beaches; they’re clean, there’s no admission fee, and plenty have beach volleyball courts and even free Wi-Fi. cpdbeaches.com. Suggesting a park in Chicago is like suggesting the perfect cookie in an Oreos factory. Still, even among much competition the Osaka Garden at Jackson Park stands out. If you are more into wildlife viewing than relaxing on the beach or in a garden, try the McCormick Bird Sanctuary in Burnham Park. It’s conveniently-located near McCormick Place and lets you spy warblers, woodpeckers and more.

Jackson Park 6401 South Stony Island Avenue tel: 773-256-0903 chicagoparkdistrict.com/parks/ jackson-park Lee’s Unleaded Blues 7401 South Chicago Avenue tel: 773-493-3477 Museum of Science and Industry 5700 South Lake Shore Drive tel: 773-684-1414 adults from US$27, kids 3 to 11 from US$18 Old Chicago Post Office 433 West Van Buren Rosa’s Lounge 3420 Armitage Avenue tel: 773-342-0452

Chicago is ground zero for the American blues scene, and you’d be stone-crazy to pass up Buddy Guy’s Legends bar, which regularly hosts top-quality acts. The man himself (pictured left) drops in and plays a few licks now and again. The Cajun cuisine is said to be pretty good, too.

Shedd Aquarium 1200 South Lake Shore Drive tel: 312-939-2438 sheddaquarium.org adults from US$8, kids 3 to 11 from US$6 Union Station 225 South Canal Street

Lee’s Unleaded Blues is less-celebrated than Mr. Guy’s, but locals will tell you it’s the most authentic blues joint in town. Sparse decor, local talent, no cover, two-drink minimum — what’s not to love? The New York Times called Rosa’s Lounge the best blues bar in the Windy City. The marquee shows cost around US$25. JANUARY 2014 • Doctor’s

Review

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I P R E S C R I B E A T R I P T O... BRAZIL

One with the caimans An FP from PEI finds peace deep in the world’s largest wetland area

The Pantanal, the world’s largest wetland area, teems with wildlife like monkeys and surprisingly friendly caimans.

M Dr Rachel Kassner is a family physician in Charlottetown and travels extensively. She is the former Head of the Department of Family Medicine at the Queen Elizabeth Hospital, and Dr Bowins posing in front of the is past president and current chopper and mountains that made chair the board of directors his experience soof memorable. of the Medical Society of PEI.

Doctor’s Review • JANUARY 2014

y husband Joel, our 15-year-old son Kass and I just returned from a fabulous trip to Brazil. We and nine others travelled with Doctors-on-Tour

(tel: 855-362-8687; doctorsontour.ca), a Toronto-based company that specializes in continuing medical education (CME) programs in wonderful locations. For the past several years, I have led tours for the company. Though we visited Salvador, Bahia, the historic former centre of the slave trade, and took a boat ride under the incredible Iguazú Falls, in addition to stops in Rio de Janeiro and the colonial town of Paraty, the true highlight of our trip was the Pantanal. The Pantanal is part of the Amazon Basin, and is designated a World Biosphere Reserve by UNESCO. It is the world’s largest wetland area at just un-

der 200,000 square kilometres. It has an immense population of birds, butterflies, fish and other species. We stayed at the Pousada Rio Mutum (Barão de Melgaço, Mato Grosso; pousadamutum.com.br), which is a beautiful eco-resort on the Mutum River nestled in one of the lushest regions of the Pantanal. The staff is wonderful, the 22 air-conditioned apartments are clean and more than comfortable; the food is buffet-style, varied and absolutely delicious. But you don’t come here for creature comforts. You come for the flora and fauna, and for the joy and peace of being immersed in nature.

ALL PHOTOS COURTESY RACHEL KASSNER

by Dr Rachel Kassner

Dr Kassner (right), with her husband Joel and son Kass in Rio de Janeiro, which they visited before the Pantanal.

You don’t come here for creature comforts. You come for the flora and fauna, and for the joy and peace of being immersed in nature We arrived at the end of the rainy season, which meant that we usually experienced a downpour every day. We didn’t see a lot of the larger wildlife like cats, since most of these animals retreat to find higher and drier ground and return in the dry season, but we were able to spot three different varieties of monkeys jumping from tree to tree. The variety and profusion of birds and butterflies left us in a constant state of amazement. We all became “spotters” and the photographers’ shutters were constantly clicking. Helder, our guide, certainly helped. He has a degree in botany and vast knowledge of the surrounding flora and fauna. He was able to recognize 62 different birds just by their call — and he’s learning more. One day, half of us went fishing for piranhas while the remainder took a horseback ride through the rainforest to meet us. And then we switched. Our group mounted up. It was my husband’s first time on a horse. Quite the thrilling experience! It was to be a two-hour trip through the rainforest back to the lodge. No sooner had we started out than the skies opened up. We ended up navigating

paths covered by a foot or two of water, but the horses were undeterred. We all got soaked despite our rain ponchos. Meanwhile, the rest of our group who hoped to fish got equally drenched and had to immediately head back to the lodge. At home, this experience could have felt upsetting, but at Mutum it was just part of the magic. Amidst all this, there was still time for an informative CME component.

Smile! The group caught piranhas using hooks baited with raw meat, and used the fish to make a local specialty — piranha soup.

There were presentations on various topics from members of our group and a presentation on health care by a physician in Salvador who married local traditional healing concepts with modern medicine. In addition, there were visits to the Charitable Works Foundation of Sister Dulce in Salvador, which is a public hospital — Sister Dulce is to Brazil as Mother Teresa is to India. We also visited a hospital in Iguazu, and the family health centre in the Pantanal. It was a real educational experience. On another afternoon, our guide took a few of us out to try fishing for piranhas again. There was no sophisticated gear: just a bamboo pole with a string and a hook. Helder baited the hook with raw meat and then very carefully removed it from the razortoothed piranhas that we caught. Our son became the piranha catching champ — with 10! As we returned to the lodge our guide literally called to the resident caimans. They immediately appeared on shore eagerly anticipating what they knew was to come: lunch! As they crawled towards our dock (a couple metres safely above them), our guide held up his hands and shouted a command. Believe it or not, the caimans immediately stopped and dropped to their bellies to await the feeding. We took turns throwing the smaller fish to them, and the caimans scrambled and fought to gulp them down. The larger fish went to the kitchen for our evening piranha soup, one of our regular evening appetizers: unique but absolutely delicious. Some of our group happily chose to remain at the lodge rather than do some of the excursions. There was a pool to laze about, horses roaming freely around and varied birds, stunning in their plumage. There were dozens of capybara grazing around the property. Capybaras are the world’s largest rodents, about the size of a small hog. They look like Disney creations. Lounging at the lodge was a photographer’s paradise. You didn’t have to move; you just sat quietly and waited to be amazed by the birds, butterflies and all that surrounded you. JANUARY 2014 • Doctor’s

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Kowloon’s Night Market is a bit kitschy, but you’ll buy into it every time.

yourself

Conquering Hong Kong isn’t an option, but a game plan will ensure you don’t lose your way by

Camille Chin

T “ ALL PHOTOS HONG KONG TOURISM BOARD UNLESS OTHERWISE NOTED

he thing about Hong Kong is that there’s so much choice,” my friend said one sweltering September afternoon. We were slogging our way through the courtyards of the Bird Market then past the open-fronted shops of the nearby Flower Market before heading to the 100-plus stalls of the Ladies’ Market. “Do you think Hong Kongers are ever overwhelmed?” she asked. It was 35°C without the humidity that day and my clothes were damp with sweat. I was too beaten down by the heat to consider the states of mind of seven million locals, so I ignored her. The question came up again. “When they’re shopping for shoes,” she persisted a few days later while we were doing just that in the open-‘til-midnight APM Mall. “How do they decide on a pair and not wonder if there are nicer ones in the hundreds of other stores?” Her concern for the mental health of Hong Kongers was interesting — and maybe warranted. One of China’s two Special Administrative Regions (or SARs; Macau being the second), the Cantonesespeaking region is the fourth most densely populated “country” in the world. There are 16,000 shops, and 11,000 restaurants for all those people, but that kind of bounty does beg the question, can too much choice make it hard to choose? And what if you’re one of the 50 million visitors who bustle through Hong Kong every year? How will you choose where to shop or eat or even stay? Here, we look at some options. It won’t help you conquer Hong Kong, but it might stop the compact, already-too-vertical, ever-expanding region from overwhelming you.

S . TAY

I can’t predict the future, but I know what your first question will be when planning your inaugural trip to Hong Kong: “which side is better? Kowloon or Hong Kong Island?” For now, the Kowloon Peninsula is still grittier than Hong Kong Island with more crowded, open-air stalls for tchotchkes you never knew you wanted than the Island’s bright, glass-and-steel malls and tai tais, or ladies who lunch. Hong Kong higher uppers might agree. In 2011, they announced plans to transform Kowloon East into a second Central Business District, CBD number one being in the Central neighbourhood on the Island. But Kowloon also has Tsim Sha Tsui and Nathan Road aka the “Golden Mile of Shopping,” and the 118-storey International Commerce Centre, the tallest skyscraper in the SAR that’s also Guinness World Record-recognized for its twice nightly light-andmusic shows; Hong Kong Island has the oldest colonial building in the region and the double-decker trams that have been ding dinging since 1904. Old and new is everywhere. The SAR’s 85-station subway system doesn’t make it easier to choose a side. Trains run every two to JANUARY 2014 • Doctor’s

Review

CAMILLE CHIN

Chef Mak Kwai Pui’s Michelin-star meals cost $10 per person.

Surprisingly, men still “walk” their caged birds at the Bird Market.

Lung King Heen was awarded three Michelin stars after Red Book inspectors made 12 anonymous visits five minutes with a 99.9 percent on-time rate despite carrying 5.1 million commuters on work days. The world’s 10th-busiest subway system might be the best run — going from peninsula to island is as easy, say, as finding a fake Jimmy Choo handbag. MDs long hauling it to the SAR for a working vacation might decide where to stay by considering how they want to commute each morning. The Hong Kong Convention and Exhibition Centre (HKCEC) is on Victoria Harbour in the Wan Chai neighbourhood on Hong Kong Island. Crashing in Kowloon would mean taking the metro or the Star Ferry, which has been dutifully crossing the Harbour since 1888. The cruise is an easy 10-minute ride with Wan Chai’s Star Ferry Pier next to the HKCEC. Prefer to walk to work? Hong Kong Island it is.

E . AT

Of the 11,000 restaurants in the SAR, I wouldn’t be surprised if 10,999 of them serve dim sum. I ate so many steamed dumplings during my stay, if you poked my belly, I too would’ve “hoo-hooed” like the Pillsbury Doughboy. Dim sum roughly translates to “touch your heart” and I, being part Chinese, have indeed loved the brunch since I was little. Also eaten for lunch, there

Doctor’s Review • JANUARY 2014

can be as many as 150 snack-size items on a menu with up to 2000 in its entire range. The steamed, baked and fried items are always served with tea, which is why the experience, said to originate in the ancient Silk Road teahouses that comforted boned-tired travellers, is also called yum cha or “to drink tea.” The best dim sum in town is arguably at Lung King Heen (8 Finance Street, Central, Hong Kong Island; fourseasons.com/hongkong) and Tim Ho Wan (five locations; search openrice.com/english/restaurant/ index.htm for details). Lung King Heen was the first Chinese restaurant ever to be awarded three Michelin stars. Kowloonborn-chef Chan Yan Tak, who admits only to being “50-something,” was honoured in 2008 after Red Book inspectors made 12 anonymous visits. Also focused on seafood, the Cantonese restaurant has upheld the honour for six years. Lung King Heen or “View of the Dragon” is inside the swanky Four Seasons Hotel. Its floor-to-ceiling windows frame Victoria Harbour and Kowloon or “Nine Dragons” so named for the eight mountains to its north plus the Song Dynasty emperor who named them. The restaurant’s xiao long bao will also catch your eye — and burn the inside of your mouth if you

Harbour City on Canton Road is three malls in one and it oozes luxury.

Hong Kong Park is an eight-hectare oasis in the busy Central neighbourhood.

The free class at the LockCha Tea House demos the traditional way to make a cuppa.

LEATHER 1/1

Take a workshop at Leather 1/1 and hand stitch your own Doctor’s Bag.

don’t know how to eat it. The steamed, Shanghainese pork dumplings with crab meat contain a hot broth. I learned to first pick the slippery sucker up with my chopsticks, place it onto my Chinese soup spoon, then poke a hole in it with one stick to let the steam out. The spoon caught any liquid that spilled out. I then drizzled the dumpling with some kind of vinegar and voilà. No ER doc needed. Dim sum costs about $60 per person. Tim Ho Wan is the cheapest (one) Michelin-star restaurant in the world. It costs about $10 per person to eat there. It can take up to two hours to get a table at any of the five, no-reservations locations, even the one on Fuk Wing Street in Sham Shui Po, the area for cheap electronics. About 1500 people pass through the humble, 110-seat joint a day — including travellers on their way home. When I visited, there was luggage at the door. Owner Mak Kwai Pui, a former Four Seasons chef, worries about not being able to keep up with appetites. He employs two dim sum masters and 22 cooks at the Sham Shui Po location alone; they start at 5am each morning and open their door at 8:30am. The most popular item on the menu is the baked barbecue-pork bun (about $2.50 for three). It was the best BBQ pork bun I’ve ever had (and I’ve had a lot): crispy on the outside, light and soft on the inside, sweet and yet savoury too.

A panoramic bay view is on the menu at the Crowne Plaza’s Cielo restaurant.

THE ABC’S OF HK

CROWNE PLAZA

Cathay Pacific (tel: 800-268-6868; cathaypacific. com) flies direct to Hong Kong from Vancouver twice daily and direct from Toronto 10 times a week. The new Crowne Plaza (crowneplaza.com/ kowlooneast) in Kowloon East has 359 elegant rooms that start at $255 a night, Wi-Fi not included. The new Hotel Indigo (hotelindigo.com/hongkong) in Wan Chai on Hong Kong Island is a 20-minute walk to the Convention Centre. Its 138 rooms are chic and compact, and start at $275, Wi-Fi included. The metro system (mtr.com.hk) is clean and reliable; the fare depends on the distance you’re travelling. The Star Ferry (starferry.com.hk) costs about $0.35 for adults on weekdays; $0.50 on weekends. The Hong Kong Tourism Board (discoverhong kong.com/ca) has new five- and eight-day prepaid tourist smartphone SIM cards for local mobile data usage, and local and international voice calls. The cards start at $9.50 and are available at newsstands and convenience stores.

Doctor’s Review • JANUARY 2014

P . LAY

After you’ve chewed over forking out Michelin-star money or Michelin-star time, dig into Hong Kong’s past. Completed in 1846, the Flagstaff House is the oldest colonial structure in the SAR. Formerly the home of the commanders of the British Forces in Hong Kong through 1978, the Greek Revival property in Hong Kong Park is now the Museum of Tea Ware (10 Cotton Tree Drive, Central, Hong Kong Island; hk.art.museum; free). Its collection includes 600 pieces: 300 that are porcelain, the rest unadorned Yixing clay, which is unglazed to better capture the colour and fragrance of tea. The Hong Kong Tourism Board’s free Tea Appreciation Class takes place Mondays, Wednesdays and Fridays between 4 and 5pm next door at the beautiful LockCha Tea House (lockcha.com). In addition to single-harvest, estate tea, it sells lovely cups, pots — and vegetarian dim sum. I had even more tea at Leather 1/1 (2D1, 2/F, Yip Win Factory, 10 Tsun Yip Lane, Kwun Tong, Kowloon; leather1of1.com), a factory space-turned-workshop in Kowloon’s Kwun Tong neighbourhood, which is fast becoming the future. Kwun Tong was an important manufacturing sector before businesses moved to (cheaper) mainland China. Galleries and other creative spaces have embraced the empty warehouses because of the low rent. Angus and Manho didn’t serve their tea in beautiful glassware like they did at LockCha, but the two twenty-somethings in leather brogues, cropped pants and button-down shirts sweetly set out paper cups before teaching a group of us how to hand stitch — read: no sewing machines — a rainbow of little leather pouches. Mine was the colour of eggplant. Turns out I should stick to my day job. The price of each workshop depends on the piece you’re stitching: key chains take three hours and cost $35; messenger bags take 18 hours and cost $250. Fees include the leather. Their English is limited, but their instructions easy to follow. Call or email to sign up, or just visit to buy a memento like a one-ofa-kind, leather guitar strap. Or experience old and new together at the Hong Kong Heritage Museum (1 Man Lam Road, Sha Tin, New Territories; www.heritagemuseum.gov.hk; adults $1.50). I tiptoed around glossy ceramics, solid bronze statues and people-sized stonework in its permanent T.T. Tsui Gallery, but felt like wailing out war cries and giving some nunchuks a whirl at Bruce Lee: Kung Fu, Art, Life. Not wanting to get woman-handled by the small, Chinese security guard on the lookout for cameras, I quietly browsed the 600 items instead. On now through July 20, 2018, the massive exhibit features hundreds of photos, handwritten letters and notes, and equipment and clothing, including Bruce Lee’s protective headgear, black leather boots and the traditional tang suit that he wore while training.

I tiptoed around glossy ceramics and peoplesized stonework, but felt like wailing out war cries at the Bruce Lee exhibit I spent an hour studying his reports cards — he was good in bible history and moral science; bad in arithmetic and geometry — manuscripts that detailed the primary freedom of Jeet Kune Do — “the wheel revolves when it is not tightly attached to the axil” — and his letters to Linda. In one from 1971 that he wrote while filming The Big Boss in Thailand, he asked for pictures of her and their two children. As I walked out of the museum, I overheard a woman saying that she loved the Cantonese Opera Hall. I didn’t even know that was yet another gallery in the same museum. I should have known. In Hong Kong, there are always more options.

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JANUARY 2014 • Doctor’s

Review

The Nevisian Heritage Village displays many phases of the island’s history, including replica slave quarters and the ruins of the plantation’s boiling house.

Living in the past

Nevis isn’t just beautiful — it’s one of the most authentic Caribbean islands you’ll ever visit by

Josephine Matyas

VIRGIN ISLANDS (U.K.)

PUERTO RICO

VIRGIN ISLANDS (U.S.)

ATLANTIC OCEAN ANGUILLA SAINT-MARTIN

SINT MAARTEN

SAINT-BATHÉLEMY BARBUDA

SINT EUSTATIUS ST. KITTS

ANTIGUA

NEVIS

CARIBBEAN SEA MONTSERRAT

GUADELOUPE

DOMINICA

MARTINIQUE

hey say the two islands of St. Kitts and Nevis are sisters. I see St. Kitts as the older one with a closet full of splashy outfits: casinos, sprawling resort properties, a cruise port and acres of duty-free shopping.

JOSEPHINE MATYAS

Little sister Nevis is the Cinderella of the duo: modest and hard-working, pretty with plenty of substance. It’s not that there is anything wrong with St. Kitts; it’s just that Nevis has… a better personality. There. I’ve put my bias up front. It’s only three kilometres across the channel from St. Kitts to Nevis. And for most people the water crossing is the best way to get there. To those who can’t face a twisty drive around a mountain and a pedal-to-the-metal boat ride across a (sometimes) choppy sea after a long flight, I have this to say: no problem; you can have your ultra-convenient, onthe-beaten-path stay. Leave perfect little Nevis to the rest of us. Certainly, Nevis may not be the first place that comes to mind when you think of a family vacation — in our case not sisters like the islands, but mother and twenty-something son. It was a test for me — when Eric was small, as parents we’d explained the world to him through travel: the elasticity of people, cultures, landscapes and politics. How much of it sank in? For him, I assumed Nevis was five days in the Caribbean sun and a break from the anchor of a grey

JANUARY 2014 • Doctor’s

Review

JOSEPHINE MATYAS

The Nisbet Plantation features 36 lemon-hued cottages with traditional Nevisian white pyramid roofs.

The author’s son, Eric, poses in front of the remains of a windmill tower, which was used to grind down sugarcane.

JOSEPHINE MATYAS

NISBET PLANTATION

Four of Nevis’s eight hotels, like the award-winning Nisbet Plantation, are housed in former colonial plantation complexes.

Eric eyed Nevis Peak, salivating at the chance to tackle the 985-metre summit Canadian winter. For me, it was a chance to reconnect and to see how many of those childhood lessons had infiltrated. In any case, we found ourselves in a speedboat, bouncing along the surface of the water: St. Kitts in the rear view mirror, Nevis straight ahead.

ince I discovered Nevis a decade ago, I’ve been returning as often as I can. Unfortunately — or fortunately, depending on how you look at it — the itch does not go away. Perfectly round, with a verdant, dormant volcano smack in the middle, Nevis is like the Little Island That Could, chugging along in pace with the ups and downs of the global economy. Uphill — like every other Caribbean island when the world’s finances take a shellacking — and on cruise control when times are good. On Nevis they know what they have and, like the modest Cinderella, they have resisted becoming too enamoured of their own success. There are just eight resorts on the island, including four built at the remains of the island’s once-thriving colonial-era plantations. They stay abreast of the times, but their sweet and gentle character remains unchanged. And Nevis doesn’t make you wait long for a perfect tropical vista. For starters, there is a landscape that is the envy of the Caribbean — picture-perfect beaches lined with coconut palms and a lush and green rainforest-draped mountain — but at the heart of the island are its people. Nevis has a solid British history (save for one year when the French planted a flag in 1782 before the Brits got it back the following year) and it comes with all the modern-day customs — drive on the left, afternoon tea, basic politeness and continental-style dining etiquette. In the morning we set out for a hike along a nature trail above the hillside plantation inn of Golden Rock (Charlestown; goldenrocknevis.com; doubles from $191). I’d asked for a gentle route, with moderate elevation change. Youthful and fit, Eric eyed Nevis Peak, salivating at the chance to tackle the 985-metre summit, intrigued by the way the low hanging clouds suddenly shrouded the peak, and then just as quickly floated away leaving a crystal clear view of the top. Age ruled. Gentle nature walk it was. He acquiesced, intrigued by the larger-than-life rainforest vegetation and the tales of the island history reeled off by our hiking guide, Lynnell Liburd. “They think this volcano is about 1.2 million years old,” said Lynnell, whose ancestors were brought to Nevis in the 1600s aboard slave ships from West Africa. “The land was settled by the Arawak, the Carib,

the Europeans and then the African slaves brought to work the plantations.” In the thick undergrowth of shrubs and vines are the remains of walls and terraces, each stone placed by hand to create a larger — and more productive — area for growing the plantation crops. Lynnell pointed out how, in the era of large plantations, even the hillsides were cleared of natural vegetation to use every possible inch to grow sugarcane, the once lucrative crop known as white gold. “Sugar was grown from the coast to 500 metres up the slopes — that’s halfway up the mountain. At the time, Nevis was so rich that the highest paid British official in the region was based here. The money, however, came from the backs of slave labour,” he said. “In the 1700s the economy of West Indian colonies like Nevis was larger than the 13 American colonies put together. That’s how it came to be known as the ‘Queen of the Caribees.’”

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JANUARY 2014 • Doctor’s

Review

There are plenty of hiking and walking opportunities on the island, from the strenuous sallies to the simple strolls.

JOSEPHINE MATYAS

Nisbet Beach is one of the island’s best for snorkeling, swimming and shelling.

JOSEPHINE MATYAS

NISBET PLANTATION

If relaxing in a hammock isn’t your thing, you could always decide to tackle the 985-metre Nevis Peak, which dominates the island’s skyline.

On Nevis they know what they have and, like the modest Cinderella, they have resisted becoming too enamoured of their own success

istory is never far from the surface on Nevis and it was hard to dodge the harsh reality of the colonial plantation economy. As difficult as it is, it’s important to Nevisians to tell the story of their history, whether on a hike or at stops like the Nevisian Heritage Village or the Bath Springs, a steaming hot vein of water sourced deep inside the volcano. It’s a favourite spot for locals and visitors to meet at the end of the working day. To both mother and son, this gave the island an authentic feel: people sharing their lives and their heritage rather than creating an artificial amusement park atmosphere carved out to satiate North American demands. “They ground sugar cane here,” said Pat Thompson as she explained the workings of the Heritage Village, where they preserve history through model homes of slaves quarters, rum shacks and the ruins of the massive stone boiling house. The village is set on the remains of Fothergills Estate, at one time a working sugarcane plantation. “This village is a vision for the future. Without this, our children would not know where they are coming from.” Okay. Visions for the future, children learning from their family history. This was something I could connect with. These daytime experiences opened the door for us the next evening, when I talked to Eric about the difficult history of his immigrant grandparents leaving their homeland and coming to Canada. It was a long conversation that we’d never had before. Now we talked, asked and answered questions, adult to adult, mother to son. The setting was the casual Thursday night beachside barbecue at the historic Nisbet Plantation Beach Club (St. James Parish; nisbetplantation.com; doubles from US$560 including breakfast, afternoon tea and dinner). Beach barbecue night at Nisbet is about steel-pan bands, digging into a platter of seafood with the sand in your toes and the breeze off the ocean. For us, it was also about learning family history. The resort property is the ancestral home of Fanny Nisbet, the wife of British naval hero Admiral Horatio Nelson. The history books tell how Nelson arrived on Nevis, fell in love with Fanny Nisbet and the two were married under a large fig tree up the mountain. The resort — once a coconut plantation — has been

turned into an intimate, award-winning property. It’s the island’s only beachfront plantation — where guests break for traditional English afternoon tea served with small sandwiches and biscuits on the patio at the stone Great House. The next day we were off again, skimming across the water between the sister islands. This time, Nevis was at our backs, heading home to Canada. For Eric it was “the most authentic place” he’d ever been. For his mother it was more than Caribbean sun. It was a chance to connect and to learn together. I have no doubt that he will be itching to return to Nevis — just as I did. That will be a part of his future. I’m glad we saw it together now.

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JANUARY 2014 • Doctor’s

Review

Hawaii’s hole-inWith Maui’s world-class golf and stunning scenery, you get everything in one stroke by

Anita Draycott

Hawaii’s volcanic topography is on full view at Wailea Golf Club.

-one

y favourite time on Maui is just before sunset, when the sky turns tangerine and magenta, the birds go into a chirping frenzy in the trees, tropical flowers perfume the air and the traditional tiki torch-lighting ceremony ushers in the evening. Despite ongoing traffic jams and new tourist developments on Hawaii’s second-largest island, the land and sea are still more powerful than “progress.” Repeatedly voted “Best Island in the World” by readers of Condé Nast Traveler and Travel & Leisure magazines, Maui lives up to its stellar reputation. Fuchsia sunsets, crashing surf, powdery beaches and a cool flower lei around your neck —it’s got all of the above, and some of the best golf anywhere in the US. Here are three resort communities with great options for hitting the links.

KAPALUA

ARTIN AHMADI

Kapalua (kapalua.com) on the northwest coast is home to two world-class courses. The Bay Course rolls to the edge of the Pacific; during the winter you might be distracted by the antics of humpback whales frolicking offshore. Palm trees, ironwoods and stately Cook pines line the fairways. This is your ideal warm-up round before tackling the challenging Plantation Course where the likes of Tiger Woods and Bubba Watson have competed in the annual PGA Tour Hyundai Tournament of Champions held every January. Designed by Ben Crenshaw and Bill Coore, the Plantation features massive bunkers, sweeping slopes and dramatic contours. Of the numerous ocean holes, most notable is the grand finale 18th, a downhill 663-yard par five. And if you’re feeling beat up by the Plantation, the state-of-the art Kapalua Golf Academy, designed with PGA tour pro, Hale Irwin, will provide the required swing doctoring. Get to the Plantation in time to enjoy one of the best breakfasts and views on the island. Try the Maui Gold pineapple served with a cinnamon cream sauce and French toast smothered with bananas. You’ll be spoiled for choice when deciding where to stay at Kapalua, from the Ritz Carlton to The Residences at Kapalua Bay to the spacious Kapalua

JANUARY 2014 • Doctor’s

Review

Villas. And if you’d like to belt out a few tunes, head over to Sansei (sanseihawaii.com) on Thursday and Friday nights for late-night sushi and karaoke.

Noodle (286 Kupuohi Street; tel: 808-667-5400; starnoodle. com) has a casual vibe but the Asian food is seriously delicious. Try the garlic noodles or pad thai.

KA’ANAPALI

WAILEA

It’s home to several world-class hotels, condominiums and vacation club resorts, a beachfront shopping complex, the historic Sugar Cane Train (sugarcane train.com; roundtrip tickets adults US$23, kids US$16), 36 holes of championship golf and one of the best beaches in the US. Suffice it to say there’s probably something to suit every one at Ka’anapali (kaanapali resort.com). Once the playground of Hawaiian royalty, Ka’anapali was the first planned resort community in Hawaii. They got a lot of things right. You can stroll along a beach path from one property to another and over to Whaler’s Village for plenty of shopping and fine dining choices. For over a decade Ka’anapali beamed Hawaiian golf and a backdrop of gorgeous tropical scenery into the homes of TV viewers of the Senior PGA Tour’s Ka’anapali Classic, making them want to grab their clubs and fly to paradise. Before you play the 6700-yard, par-71 Royal Ka’anapali Course, you might want to head to Ka’anapali Beach the day before to watch the sunset. Not only is it memorable, but it might just improve your score. The greens on the Royal are notorious for their strong grain; a useful factoid to remember is that the ball will break toward the setting sun. You should also be prepared to play in a stiff wind. Course architect Robert Trent Jones Sr. took advantage of the rolling terrain to create undulating fairways. The result is that flat lies are few and far between. Arnold Palmer commented that the par-four finishing hole is one of the most challenging he’d ever played. Arthur Jack Snyder, architect for Ka’anapali’s Kai Course, believes that golf should be fun. The good times begin on the par-five number one that oozes with birdie potential. This par-70, 6400-yard course is very user-friendly but it’s no waltz in the park. The fairways are relatively tight and those prevailing trade winds need to be factored into your course strategy. After your round, dine at Roy’s Maui (2290 Ka’anapali Parkway; tel: 808-669-6999; royshawaii.com) in the golf clubhouse. Japanese-born chef Roy Yamaguchi serves what he calls Hawaiian Fusion Cuisine. I recommend his signature dish, the Dim Sum Canoe for Two — crispy and seared shrimp, crab gyoza, baby back ribs and ahi tuna poke presented in a mini dugout canoe. Ka’anapali also provides shuttle service between properties and into Lahaina, an old whaling town where there are no golf courses but several reasons to visit. Just up the hill from the Cannery Mall, Star

Doctor’s Review • JANUARY 2014

Further south on Maui’s west coast, the Wailea Golf Club (waileagolf.com) encompasses two clubhouses, a 12-acre training facility and three 18-hole layouts — the Blue, Emerald and Gold Courses. Both Golf Digest and Golf Magazine named Wailea one of the US’s finest golf resorts, recognizing not only the quality of the courses but also the destination. The Blue is your quintessential Hawaiian layout with wide, manicured fairways that flow with the natural topography of the volcanic foothills, interrupted here and there by coral sand bunkers, lakes, fountains and fragrant plumeria trees. “Humpback at 10 o’clock,” said the starter. I was taking my practice swing on the elevated tees of the first fairway of Wailea’s Gold Course when a majestic whale suddenly leapt into the air in front of the Molokini Crater. The ocean vistas, exotic birds and rivers of lava all vie for your concentration. Scoring well here is not so much about pounding your Titleist as far as you can, but more about accuracy and finesse. Brains over brawn triumph on the superb 7078-yard design by Robert Trent Jones II, who describes it as the “24-carat option.” The Gold blends classic design with rugged natural landscapes, including 200-foot elevation changes with lava rock walls, tall native grasses and 93 bunkers to add to the awe factor. Not to be outdone by the Gold, the Emerald Course is where the same designer has created what he calls feminine characteristics, referring to the course’s softer visual appeal. There are fewer forced carries and more genial landing areas. Here you’ll get an occasional whiff of an exquisite plumeria and plenty of ocean vistas. The 6825-yard Emerald has often been applauded for its female-friendly design, but there’s plenty of challenge for both sexes. One of Maui’s top chefs, Bev Gannon, opened Gannon’s (gannonsrestaurant.com) in the Wailea clubhouse with a spectacular view of the first fairway of the Emerald Course. Beware: she makes her own addictive potato chips. Try her barbequed ribs, or golfer’s top dog smothered with chili, onions and cheese. Another dining option is just across the road from the Wailea courses. The Fairmont Kea Lani’s poolside restaurant, Ko (4100 Wailea Alanui Drive; tel: 866-540-4456; korestaurant.com) won “Restaurant of the Year” at the Maui No Ka ‘Oi magazine’s 2013 ‘Aipono Restaurant Awards. Not to be missed on the appetizer (pupus) menu is Ahi On the Rock. The sashimi-grade tuna comes to the table with a hot stone so you can sear it to your liking and then dip it in orange-ginger-miso sauce.

KA’ANAPALI BEACH RESORT ASSOCIATION

Kapalua’s Plantation Course ends in style, at the dramatic 663-yard 18th hole.

ANITA DRAYCOTT

AIDAN BRADLEY

On a lucky day, you might spot humpback whales surfacing near Kapalua’s fairways — if you can see through the Cook pines and palm trees.

Ka’anapali was the first planned resort community in Hawaii, but the compact layout, proximity to beach and great golf still make it a winner.

Ka’anapali is on the historic Sugar Cane Train line, which connects the resort to nearby Lahaina and Puukolii.

WAILEA GOLD CLUB

At the Fairmont’s Ko restaurant, you can order raw tuna, served with a hot stone to sear it on and orange-ginger-miso sauce.

The Wailea’s Gold course last hole’s surroundings are easy on the eyes, and made even more impressive by the setting sun.

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ONE BOTTL E by

James Nevison

Argentina dreaming Life is all about balance. And perspective. While we may be confronting the dead of winter in the Northern Hemisphere, the Southern Hemisphere is enjoying the height of summer. At least this is what I remind myself when the cold seeps through and I need an image to warm my thoughts. Then daydreaming about a trip to Argentina ensues. As grand as it would be to take in the tango in San Telmo right now, the harsh reality is this will likely remain a mere vision dancing in my head. Nonetheless, even if we can’t jet to Argentina to enjoy the warmth firsthand, we can uncork a bottle of bold Argentine Malbec to warm the cockles. Not just any Malbec mind you. While Malbec really is a modern wine success story — the wineries of Argentina deserve credit for making it a global superstar in less than a decade — the truth is that the cultivar’s accelerated rise has led to some mediocre Malbec hitting shelves. Not to say that one style is superior. Indeed like all wines, Malbec comes in a myriad of styles, from elegant and floral to rustic and meaty. As always, the key to quality is balance: the intermingling of fruit and acidity complemented by integrated oak (as Malbec is typically barrel aged) and the absence of bitterness from overbearing tannins or overt alcohol. With more than 100 years experience, family-owned and run Mendoza winery Luigi Bosca knows a thing or two about making wine in Argentina. Made from grapes grown and handharvested in the family’s Finca La Linda vineyard in the Luján de Cuyo subregion of Mendoza Province, their Reserva Malbec is the definition of supple. It’s flush with plum and vanilla, backed by a nice assimilated kiss of wood thanks to 12 months aging in French oak barrels, while a languid finish rounds things out in this pliant yet elegant Malbec. It’s the type of wine that commands one to crank on the fire and load up the slow cooker; a bottle that will certainly help ward off the winter chills, though unlikely to stop the warm destination daydreaming.

Where to find it

James is an award-winning wine writer and educator based in Vancouver. The 2014 edition of his bestselling wine guide, Had a Glass: The top 100 wines under $20, is currently available through all major booksellers. Visit www.hadaglass.com to learn more.

Available across Canada, priced from $17.95–21.50

JANUARY 2014 • Doctor’s

Review

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3/13/09 3:08:08 PM

Soupy rice and chicken.

Latin lovers

Big-on-flavour recipes that are easy to fall for recipes by

Maricel E. Presilla

uban-born Maricel E. Presilla is an authority on Latin American food. She’s travelled to every Spanish- and Portuguese-speaking country in the Americas, is the chef and co-owner of two New Jersey restaurants

and was named Best Chef of the Mid-Atlantic in 2012 by the James Beard Foundation. Add to that a cookbook, or rather a 900-page tome, that was the 2013 James Beard Foundation Cookbook of the Year, and Presilla might in fact be the authority on all things edible from Mexico to Argentina’s Patagonia. Gran Cocina Latina: The Food of Latin America,

published by W. W. Norton & Company, features 500 recipes that’ll heat up your kitchen. The soupy rice and chicken included here is from Presilla’s own Cuba and is just the one-pot meal you’ll want to come home to when the February weather is frightful. And the flan that she describes as “seductive?” That’s for Valentine’s Day, of course. JANUARY 2014 • Doctor’s

Review

ARGENTINEAN BEEF EMPANADAS These panzudas (big-bellied) empanadas are a delight when fresh from the oven, begging to be eaten with tangy chimichurri. The best are made with hand-chopped beef, but if you use ground, buy ground top sirloin or chuck. If you’d rather not make the dough, use 12 store-bought empanada disks. The La Salteña brand comes in two styles: a flaky, buttery kind and a drier, less flaky type labelled criollas para horno, which are the ones you want here. For the dough 6 c. (1.5 L) extra-fine flour (preferably Argentinean Blanca Rosa 000) or cake flour 2 tsp. (10 ml) salt 2 tsp. (10 ml) sugar 1 c. (250 ml) homemade or storebought suet or lard 2 extra-large eggs 1¼ c. (310 ml) cold water or as needed For the filling 1 lb. (500 g) lean beef, such as boneless shin or top sirloin, or ground sirloin or chuck ¼ c. (60 ml) extra-virgin olive oil 3 large garlic cloves, finely chopped 2 large yellow onions, finely chopped (about 4 c./1 L) 4 scallions, finely chopped (white and 3 in./7.5 cm of green parts) 1 medium red bell pepper, cored, seeded, deveined and finely chopped (about 1 c./250 ml) 1 tbsp. (15 ml) salt or to taste 2 tsp. (10 ml) freshly ground black pepper 1 tsp. (5 ml) ground Argentinean hot red pepper (ají molido) or ground cayenne 1 tsp. (5 ml) hot Spanish smoked paprika (pimentón) 2 tsp. (10 ml) ground cumin 2 tsp. (10 ml) dried oregano 3 hard-boiled eggs, coarsely chopped 24 Manzanilla olives, pitted and quartered (about 1 c./250 ml) 2 large eggs, beaten with 2 tbsp. (30 ml) cold water, for glaze

Place the flour, salt and sugar in a large Argentinean beef empanadas.

bowl. Make a well in the centre, place the suet or lard in the middle, and work it into the dry ingredients with your fingertips or a pastry blender. In a small bowl, whisk together the eggs and water. Add the liquid to the flour a little at a time, mixing to form a dough. If the dough feels too dry to hold together, add more water one tablespoon (15 ml) at a time. Transfer to a work surface and knead vigorously for 5 minutes or until smooth. Divide in half. Roll each half into a 12-inch- (30-cm-) long log. Wrap in plastic wrap and refrigerate for at least 1 hour, preferably up to 24 hours. Unless you’re using ground meat, cut the beef into ¼-inch- (0.5-cm-) thick slices, then into ¼-inch- (0.5-cm-) wide strips and chop into ⅛-inch (0.25-cm) dice. Set aside. Heat the oil in a 12-inch (30-cm) skillet over medium heat. Add the garlic and sauté until golden, 40 seconds. Stir in the onions, scallions, bell pepper and spices, and cook until the onions are soft, 7 minutes. Add the meat and cook, stirring to break it up, for 4 to 5 minutes, until cooked, but still juicy. Transfer to a container 12 inches (30 cm) square and 2 inches (5 cm) high. Smooth the surface with a spatula and let cool. Spread the chopped eggs and olives evenly over the meat so when you scoop out a portion, it’ll have equal amounts of both. Cover with plastic wrap and refrigerate until chilled. Preheat the oven to 375°F (190°C). Unwrap the dough and cut each log into twelve 1-inch (1.25-cm) sections. Keeping the unused dough covered with a kitchen towel, knead one section briefly with the heel of your hand. With a rolling pin, roll out a round ⅛-inch (0.25-cm) thick. Using a large round cookie cutter, cut the dough into a 5-inch (10-cm) circle. (If using defrosted frozen empanada disks, trim them into 5-inch/ 10-cm circles.) Holding the disk in the palm of one hand, place 2 generous tablespoons (30 ml) of filling in the centre, then fold the two edges together, as if you were making a taco. Pinch the middle together, then seal the empanada by making a triangular pleat at one end then continuing to make triangular pleats all the way around the edge (a decorative border

called repulgo). Place on a baking sheet. Fill and seal the remaining empanadas. Brush lightly with the egg wash. Bake for 25 to 30 minutes, until the crusts are golden and the empanadas sound hollow when tapped on the bottom. Let cool slightly, and serve warm with a bowl of chimichurri. Makes 24 empanadas.

SOUPY RICE AND CHICKEN There were two main versions of arroz con pollo in Cuba in the 1950s. One was a fluffy, dry dish made with long-grain rice, the other a soupy one made with short-grain rice. In both, the rice and chicken were cooked together, and garnished with canned asparagus, peas and pimientos. This is Maricel E. Presilla’s own version. 6 whole chicken legs (thighs and drumsticks), skin removed For the seasoning 6 large garlic cloves 1 tsp. (5 ml) ground cumin ¼ tsp. (1.25 ml) dried oregano ¼ tsp. (1.25 ml) ground allspice ¼ c. (60 ml) juice of 1 bitter orange or 2 tbsp. (30 ml) fresh lime juice 1 tsp. (5 ml) salt For the dish 1½ c. (375 ml) Valencia-style medium grain rice (preferably Bomba or Montsia Extra) ¼ c. (60 ml) achiote-infused extravirgin olive oil 3 oz. (90 g) slab bacon or Virginia ham, diced (about ½ c./125 ml) 8 large garlic cloves, finely chopped 1 medium yellow onion, finely chopped (about 1½ c./375 ml) 1 medium green bell pepper, cored, seeded, deveined and finely chopped (about q c./160 ml) 2 tsp. (10 ml) ground cumin 1 tsp. (5 ml) dried oregano 1 bay leaf ¼ tsp. (1.25 ml) freshly ground black pepper or to taste 1 c. (250 ml) homemade light tomato sauce or canned tomato sauce

1 c. (250 ml) lager beer 4 c. (1 L) homemade or store-bought chicken broth 1 c. (250 ml) green olives, such as Manzanilla (about 35), pitted ¼ c. (60 ml) capers, drained ½ c. (125 ml) water 2½ tsp. (12.5 ml) salt or to taste 6 white or green asparagus spears, trimmed, peeled, halved crosswise on the bias and blanched or 6 canned spears, halved crosswise on the bias ½ c. (125 ml) fresh or thawed frozen peas 1 8-oz. (250 g) can pimientos or 1 large red bell pepper, roasted, peeled, cored, seeded and cut into ¼-inch- (0.5-cm-) wide strips

Rinse the chicken legs and pat dry with paper towels. Put the legs in a large bowl. Using a mortar and pestle or a food processor, grind or process the garlic, cumin, oregano, allspice, orange juice and salt to a paste. Rub the legs with the paste. Let sit for 2 hours or for up to 24 hours in the refrigerator, tightly covered with plastic wrap. Wash the rice in a medium bowl and drain well in a sieve or strainer. Heat the oil in a heavy 5-quart (5-L) pot over medium heat. Add the bacon or ham and sauté until lightly golden, 3 minutes. Scrape the seasoning paste from the chicken legs and reserve. Working in batches, add the legs to the pot and sauté until golden, turning occasionally, 5 minutes on each side. Remove to a platter. Leave the bacon or ham in the pot. Add the garlic to the pot and sauté until golden, 20 seconds. Add the onion and sauté until light golden, 6 minutes. Add the bell pepper, cumin, oregano, bay leaf and black pepper and cook, stirring, for 5 minutes. Stir in the tomato sauce and reserved seasoning paste, and simmer for 8 minutes. Add the rice and cook, stirring to coat well, for 2 minutes. Add the beer and continue simmering for 2 minutes. Add the chicken broth, olives and capers and let simmer in the sauce to absorb flavours for 5 minutes. Pour in the water and salt, and mix well. Bring to a boil over medium heat, then lower to medium-low and simmer, covered, JANUARY 2014 • Doctor’s

Review

Valencia orange and cheese flan.

for 15 to 20 minutes. The liquid will not be fully absorbed. Stir gently with a kitchen fork to fluff the rice and mix all the ingredients. Reduce the heat as low as possible and cook, tightly covered, for 15 minutes. If using fresh asparagus, place on top of the rice before covering. If using canned, add to heat through at the end of cooking, 1 to 2 minutes. Add the peas and the pimientos or roasted peppers and fluff the rice with a fork. Let rest for 5 to 10 minutes before serving. The texture of the rice should be creamy yet with grains that still have some bite. Remove from the heat and spoon onto a platter. Garnish with the asparagus and pimiento. Serves 6 to 8.

VALENCIA ORANGE AND CHEESE FLAN This is a seductive flan with the texture of a creamy cheesecake and the aroma of fresh oranges. The key flavouring is Venezuelan Santa Teresa Rhum Orange, an orange rum liqueur. You can use Cointreau or Grand Marnier, but try adding a tablespoon or two of a good aged rum as well. It does wonders to the flavour. 2 c. (500 ml) sugar ¼ c. (60 ml) water 3 c. (90 ml) whole milk 2 12-oz. (375-g) cans evaporated milk 1 vanilla bean or 1 tsp. (5 ml) vanilla extract 3 Ceylon cinnamon sticks (canela) 6 star anise pods peel of ½ orange, cut into long strips 8 oz. (250 g) cream cheese, preferably Philadelphia brand, softened 6 large egg yolks

2 whole eggs 1 14-oz. (435 g) can sweetened condensed milk ½ c. (125 ml) orange-flavored liqueur, preferably Santa Teresa Rhum Orange or Cointreau 1 tbsp. (15 ml) orange blossom water 4 c. (1 L) fresh orange juice (from 12-14 medium oranges) peel of ½ orange, cut into thin slivers orange slices, for garnish

Have a baking pan ready that’s at least 3 inches (7.5 cm) deep that’s large enough to hold the flan mold comfortably. Place 1 cup (250 ml) of sugar and the water in a small heavy saucepan, bring to a boil over medium heat and cook until the liquid turns a light caramel colour. To avoid crystallization, do not stir, and brush the sides frequently with a pastry brush dipped in ice water. Pour into a mold, either a 9-x-2-inch (22-x-5-cm) round cake pan or an 8-x-4-inch (20-x-10-cm) loaf pan, and swirl at once to coat the bottom and sides. Let cool. Place the whole and evaporated milk in a medium saucepan. Split the vanilla bean in half lengthwise, scrape the black seeds into the milk and add the bean; or add the vanilla extract. Add the cinnamon, star anise and orange peel, and bring the milk barely to a boil over medium-high heat. Lower and simmer gently for 2 to 3 minutes, then remove from the heat and let cool. Strain and discard the solids. Preheat the oven to 350°F (180°C). Place the cream cheese, egg yolks and eggs in a large mixing bowl, and beat with a wooden spoon while adding the condensed milk until smooth and well integrated. Add the cooled steeped milk, ¼ cup (60 ml) liqueur and the orange blossom water, and stir

gently until well incorporated. Strain through a fine-mesh sieve into the caramelized mold. Place the baking pan on the middle oven rack. Put the mold in the pan and pour in enough hot water to come halfway up the sides. Bake until just until set, 1 hour to 1 hour and 10 minutes. Remove from the oven and let cool to room temperature. While the flan is cooling, place the orange juice, the remaining 1 cup (250 ml) sugar and the slivered orange peel in a medium saucepan, and bring to a boil over medium heat. Lower the heat and simmer, uncovered, until the mixture is reduced almost by half. Stir in the remaining ¼ cup (60 ml) liqueur and continue simmering for 10 to 15 minutes, until the sauce coats the back of a spoon. Remove from the heat and let cool to room temperature on a wire rack. Refrigerate until ready to use. Chill the flan in the refrigerator, in the pan, for at least 3 hours before serving. Unmold onto a decorative platter and garnish with orange slices. Pour the sauce into a bowl to serve with the flan. Serves 8.

Adam van Koeverden,

Olympic medalist Father is a colon cancer survivor

For more information or to donate visit coloncancercanada.ca P18541_CCC_BANNER_10.5x2.8125_AVKoeverden _FA.indd 1

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JANUARY 2014 • Doctor’s

Review

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Indications and clinical use: Prolia is indicated for the treatment of postmenopausal women with osteoporosis at high risk for fracture, defined as a history of osteoporotic fracture, or multiple risk factors for fracture; or patients who have failed or are intolerant to other available osteoporosis therapy. In postmenopausal women with osteoporosis, Prolia reduces the incidence of vertebral, nonvertebral and hip fractures. Prolia is not recommended for women who could become pregnant or who are nursing. Contraindications: • Hypocalcemia • Hypersensitivity to the drug or any component of the product (anaphylactic reactions have been reported) Relevant warnings and precautions: • Adequate intake of calcium and vitamin D is important in all patients • Hypocalcemia (monitor as necessary) • Do not use concurrently with XGEVA® • Serious infections • Epidermal and dermal adverse events • Atypical femoral fractures • Osteonecrosis of the Jaw • Significant suppression of bone remodelling • Caution in severe renal impairment • Potential greater sensitivity in older patients • Latex allergy For more information: Please consult the Product Monograph at www.amgen.ca/ Prolia_PM.pdf for important information relating to adverse reactions, drug interactions and dosing information which have not been discussed in this piece. The Product Monograph is also available on request by calling Amgen Canada Medical Information at 1-866-502-6436. ARR=absolute risk reduction; RRR=relative risk reduction; SC=subcutaneous * A randomized, double-blind, placebocontrolled study in postmenopausal patients with osteoporosis receiving 60 mg Prolia (n=3,902) or placebo (n=3,906) subcutaneously once every 6 months for 3 years. Subjects were between the ages of 60 and 90 years and had bone mineral density (BMD) T-scores <-2.5 and ≥-4.0. All women received at least 1000 mg calcium and at least 400 IU vitamin D supplementation per day.1,2 † High risk is defined as a 10-year fracture risk >20% or prior fragility fracture of hip or spine or >1 fragility fracture. Please see guidelines for complete recommendations.1 References: 1. Prolia Product Monograph. Amgen Canada Inc., April 18, 2013. 2. Cummings SR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 2009;361:756-65. 3. Papaioannou A, et al. 2010 Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 2010;182:1864-73. © 2013 Amgen Canada Inc. All rights reserved. Prolia®, ProVital® and XGEVA® are registered trademarks of Amgen Inc., used with permission.

Doctor’s Review • JANUARY 2014

JAMDMA 14302E PRE-BC1-DOC-ePI S01.indd 1 SV

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August 13, 2 CH

Prescribing Summary Safety Information Administration Prescribing Summary Patient Selection Criteria Safety Information INDICATIONS AND CLINICAL USE NICORETTE® (medicinal ingredient: nicotine) is a smoking cessation aid that relieves References withdrawalStudy symptoms and nicotine cravings. Administration NICORETTE® Lozenge can help patients stop smoking by reducing withdrawal symptoms, including nicotine craving, by delivering nicotine to the body. It is designed to temporarily relieve cravings and nicotine withdrawal symptoms, while also helping to Patient Selection Criteria relieve other associated symptoms like: irritability and nervousness. Unlike cigarettes, the lozenge delivers a lower, steady level of nicotine to the bloodstream. When used as directed, the lozenge helps regulate, control, and gradually reduce the body’s craving for nicotine – without the medical risks of tar or carbon monoxide. Recommended References duration ofStudy use: 6 months. NICORETTE® Gum can help patients stop smoking by reducing withdrawal symptoms and nicotine cravings. Sucrose-free chewing pieces provide a lower level of nicotine to the blood than cigarettes, to slowly decrease the body’s need for nicotine. The gum is a temporary aid that can help patients quit by reducing nicotine withdrawal symptoms: irritability, frustration, anxiety, difficulty in concentration and restlessness. NICORETTE® QUICKMIST® is an instant release mouth spray that gets to work on cravings in 60 seconds for fast craving relief. The new mouth spray format is the first of its kind and exclusive to NICORETTE®. It is the fastest form of nicotine replacement therapy for patients when they crave a cigarette or require relief from nicotine withdrawal symptoms. Nothing beats cravings faster than NICORETTE® QUICKMIST®. Patients should not smoke while using NICORETTE®. Recommended duration of use: 6 months. ® NICORETTE Prescribing Inhaler maySummary be used as a temporary aid to help reduce cravings and satisfy the hand to mouth ritual of the smoker.

Safety Information WARNINGS AND PRECAUTIONS General Administration Do not use if patients: are under 18 years of age; are an occasional smoker; have never smoked; are pregnant or nursing; have generalized skin disorders (e.g. eczema, rash) or are allergic to nicotine, menthol or any of the ingredients in the product. Ask your patient before use to find out if they have/had: Patient Selection Criteriaheart disease, a heart attack or stroke, chest/heart pain (unstable angina) or resting angina, a heart condition, irregular heartbeat (arrhythmias), untreated high blood pressure, circulation or stomach problems/ulcers, circulation disorders of the brain, asthma or chronic lung conditions, References overactive Study thyroid gland, severe or moderate kidney or liver disease, diabetes, an adrenal gland tumour, jaw disorder, throat or mouth problems. Talk to your patient to see if they are taking any other prescription or non-prescription medicines, of special importance are: insulin (all products): for QUICKMIST®: theophylline (asthma), clozapine (schizophrenia), ropinirole (Parkinson’s disease). When using QUICKMIST® advise patient to discontinue spray and see you if they experience: irregular heartbeat, chest pain, severe persistent indigestion or heartburn. NICORETTE® should be kept out of reach of children and pets. Always direct the patient to read the label. CONTRAINDICATIONS Nicorette Lozenges should not be used if patient: continues to smoke, chews tobacco, uses snuff or any other nicotine replacement as they risk overdosing on nicotine. ADVERSE REACTIONS Adverse Prescribing Drug Reaction Overview Summary Gum and Lozenge, QUICKMIST®: Can occasionally cause mouth or throat irritation, jaw ache, headaches, nausea, hiccups, upset stomach or dizziness. QUICKMIST®: Local effects of the spray are: tingling, burning sensations, Safety inflammation, pain inInformation the mouth or lips, changes in taste perception, dryness of the mouth or throat, increased amounts of saliva and dyspepsia.

Administration DOSAGE AND ADMINISTRATION Always instruct patientSelection to read User Guide. Patient Criteria NICORETTE® Lozenge Patient should slowly dissolve 1 lozenge in mouth, not more than 15 lozenges daily. Should not be chewed or swallowed. Nicotine 2 mg lozenge should be used if first cigarette isStudy smoked References more than 30 minutes after waking, within 30 minutes of waking, 4 mg lozenge should be used. NICORETTE® Gum Chew 1 gum, 10-20 times per day. Patient should chew slowly and intermittently for 30 minutes whenever they get the desire to smoke.

NICORETTE® QUICKMIST® (18 years and older), Step 1 (Weeks 1-6): Patients should use 1 or 2 sprays when they would normally smoke a cigarette or have cravings to smoke. If, after the first spray, their cravings do not disappear within a few minutes, use second spray. If 2 sprays are required, future doses may be delivered as 2 consecutive sprays. For most smokers this means about 1 or 2 sprays every 30 minutes to 1 hour. If an average of 15 cigarettes is smoked per day, 1 or 2 sprays should be used at least 15 times daily. The maximum dose: 2 sprays at a time, 4 sprays per hour and 64 sprays per day. Step 2 (Weeks 7-9): Patient should start reducing the number of sprays per day. By the end of week 9 they should be using HALF the average number of sprays per day that they used in Step 1. Step 3 (Weeks 10-12): Patients should continue reducing the number of sprays per day so that they are not using more than 2-4 sprays per day during week 12. At the end of week 12, they should stop using QUICKMIST®. NICORETTE® Inhaler Patients should use as needed up to a maximum of 12 cartridges per day. Cartridge should be inserted into mouthpiece and inhaled deeply into the back of the throat or puff in short breaths. Each cartridge lasts for approximately 20 minutes of frequent continuous puffing. Inhaler should be used when cravings are strongest – different inhalation schedules should be tried. Puffing on the inhaler for 5 minutes will give Prescribing patient enough nicotine for Summary 4 uses. Puffing on the inhaler for 10 minutes will give patient enough nicotine for 2 uses.

Safety Information Administration Prescribing Summary PatientInformation Selection Criteria Safety INDICATIONS AND CLINICAL USE THERAPEUTIC CLASSIFICATION Study References ® Administration NICODERM (medicinal ingredient: nicotine) is a smoking cessation aid that reduces withdrawal symptoms and nicotine cravings. Always direct patient to read the label /complete instructions before use. NICODERM® can help patients stop smoking by reducing withdrawal symptoms, Patient Selection Criteria ® and nicotine cravings. The NICODERM 21 mg/24 h patch prequit plan gradually reduces the number of cigarettes smoked over 2 weeks leading up to quit date. After completing quit date, patients can use patch for up to 10 weeks. To increase chances of quitting,Study recommend use with a stop-smoking program in User Guide. References Pediatrics (< 18 years of age): Prescribing Summary ® NICODERM should not be used in patients under 18 years of age.

Safety Information WARNINGS AND PRECAUTIONS General Administration ® NICODERM should not be used in: patients under 18 years of age, occasional or non-smokers; pregnant or nursing women, or patients with generalized skin disorders Prescribing (e.g. eczema, rash). Not indicated in patients who: smoke less than Summary 15 cigarettes daily, weigh less than 45 kg (100 pounds) or have heart disease. Patient Selection Criteria Ask your patient before use to find out if they: have/had heart, thyroid, circulation or stomach problems, stroke or high blood pressure, and if they take: insulin or any other prescriptions. NICODERM® should be kept out of reach of children and pets. Safety Information Always direct the patient to read the label or User Guide. Study References

Administration DOSAGE AND ADMINISTRATION Always instruct patient to read User Guide. Patient Selection ® NICODERM 21 mg/24 h PatchCriteria (18 years and older): 1 patch per day. Patients can ease into quitting by using 2-week NICODERM 21 mg/24 h patch prequit plan to gradually reduce and stop cigarette intake. Smokers > 15 cigarettes or more per day (cpd), may use NICODERM Studyusing References 21 mg/24 h patch when preparing to quit, during a two-week pre-cessation period while continuing to smoke. On quit day, patient should start the NICODERM Patch 10- week step-down program, to gradually off of nicotine. The patch delivers nicotine to reduce cigarette cravings, helping patients quit successfully. Patch should be applied once every 24 hours to a non-hairy clean, dry area of front or back above the waist or the upper outer area of arm. Patch must be removed before applying new patch. A fresh skin site should be used each day. McNeil Consumer Healthcare, division of Johnson & Johnson Inc. Markham, Canada L3R 5L2 © Johnson & Johnson Inc. 2013 JANUARY 2014 • Doctor’s

Review

PHOTO FINISH by

Dr Dennis Lee

A black-and-white world

We were in Singapore, between cruises. It was a rainy day, and we went to visit the Singapore Zoo, one of the world’s best. We were impressed by the variety of the wildlife on display (arranged geographically) and the spaciousness of the exhibits, which still allowed close access to the animals. These zebras were within 30 metres of us when I took their picture. This photo was taken with a Nikon D7000. Picture info: 1/500 sec, f/5.6, ISO 1600, focal length 200mm.

MDs, submit a photo! If it’s printed, you’ll receive $50. Please send photos (black and white only) along with a 150- to 300-word article to: Doctor’s Review, Photo Finish, 400 McGill Street, 4th Floor, Montreal, QC H2Y 2G1.

editors@doctorsreview.com

Got a colour pic you want to showcase? Go to doctorsreview.com to Share your Photos. 64

Doctor’s Review • JANUARY 2014

“But I’m concerned I might fail.” “But it’s not the right time.” “But what if my willpower isn’t enough.”

Help your patients get to their last But.

Customize your patients’ quit. Recommend NICORETTE® or

NICODERM® Patch

NICODERM ® for your patients

NICORETTE® Mini Lozenge

NICORETTE® Inhaler

NICORETTE® Gum

Gets to work on cravings in

60 seconds.

NICORETTE® QUICKMIST ® mouth spray. – an innovative way to help quit smoking

NICORETTE® QUICKMIST® is an instant-release mouth spray, that gets to work on cravings in 60 seconds. Patients should not smoke, while using NICORETTE® QUICKMIST®. Do not use NICORETTE® QUICKMIST® if: allergic (hypersensitive) to any of the ingredients in the mouth spray; under 18 years of age, have never smoked; are an occasional smoker; pregnant or nursing. Before use determine if patient has had: heart attack or stroke; chest pain (unstable angina) or resting angina; a heart condition that affects heart rate or rhythm; untreated high blood pressure that is not being controlled by medicines; severe or moderate liver disease; severe kidney disease; diabetes; overactive thyroid gland; pheochromocytoma, or stomach ulcer. Using other medicines: determine if patient is currently taking or has taken any other medicines, with or without a prescription. This is especially important in medication containing: theophylline to treat asthma, clozapine for schizophrenia or ropinirole for Parkinson’s disease. NICODERM® is indicated as an aid to smoking cessation by reducing nicotine withdrawal symptoms and cravings. See the Cautions and Warnings, and Directions of Use sections of the Product Licenses for information to assist in benefit-risk assessment. Always direct the patient to read the label. To increase your patients’ chances of quitting, nicotine replacement therapy products are to be used with willpower as part of a stop-smoking support program. NICORETTE® Gum can help patients stop smoking by reducing withdrawal symptoms and nicotine cravings. NICORETTE® Inhaler is indicated as a temporary aid to help smokers who strongly desire to end their smoking habit. The NICORETTE® Inhaler may be used to reduce cravings and satisfy the hand to mouth ritual of the smoker. NICORETTE® Lozenge can help patients stop smoking by reducing withdrawal symptoms, including cravings associated with smoking cessation. Reference: 1. NICORETTE® QUICKMIST®, Health Canada Natural License, January 18, 2013. 2. NICODERM® Patch 7 mg, 14 mg, 21 mg Health Canada Natural Product Licenses, March 1, 2008. 3. NICORETTE® Gum 2 mg, 4 mg Health Canada Natural Product Licenses, August 11, 2011. 4. NICORETTE® Inhaler Health Canada Natural Product Licenses, March 25, 2011. 5. NICORETTE® Lozenge 2 mg, 4 mg Health Canada Natural Product Licenses, August 11, 2011.

nicorette

McNeil Consumer Healthcare, division of Johnson & Johnson Inc., Markham, Canada L3R 5L2 © Johnson & Johnson Inc. 2013 See prescribing summary on page 63

The plumage of Ploceidae males is typically brightly coloured, usually red or yellow and black. Some species show colour variation only during the mating season.

Find out more from your Boehringer Ingelheim/Eli Lilly Alliance representative. TRAJENTA is a trademark of Boehringer Ingelheim International GmbH. Jentaduetoâ&#x201E;˘ is a trademark used under license by Boehringer Ingelheim (Canada) Ltd.