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Who’s rating doctors on RateMDs? The invisible hand of ‘reputation management’

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This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.

Did that doctor pay to hide some bad reviews on RateMDs, the online physician rating system? You wouldn’t know.

Nor would you know if a doctor hired a reputation management service to boost the volume of positive reviews.

Online reputation management is an emerging industry with companies offering a variety of services to professionals who find themselves ranked on rating sites with no ability to opt out and with no control over the anonymous comments that can affect their reputation.

I feel this is akin to  cyberbullying .– Dr. Sukhbir  Singh, gynecologist, The Ottawa Hospital

The fact that those reputation management tools exist came as a shock to Dr. Sukhbir Singh, a gynecologist at The Ottawa Hospital.

Singh was already grappling with a negative review posted on his RateMDs page — a posting he discovered last weekend after an anonymous person claimed he had harmed them with a procedure that he doesn’t do.

He quickly responded on the site, advising the person to speak to the hospital about their concerns,

Then, just as suddenly, the posting vanished.

“This is crazy. None of this makes sense to me,” he said. “I feel this is akin to cyberbullying.”

In the middle of all of that a sales representative from RateMDs contacted him offering “reputation management tools” for a fee. The service includes the ability to keep up to three comments hidden from public view.

“That just made me sick to my stomach,” he said. “It doesn’t seem that in a public health-care system that I should be marketing myself, that I should be protecting my reputation and paying an independent private company to do that work.”

RateMDs offers doctors two special plans to enhance their presence on the site. The “Promoted” package costs $179 US per month and includes banner ads that will appear on competing doctor’s pages.

RateMDs online physician rating site sells advertising packages to doctors which allows them to pay a fee and hide some unfavourable comments. (Daniel Rofusz/CBC News)

And for $359 US per month the doctor can buy the “Promoted plus” option. Both packages allow doctors to hide up to three unfavourable comments — a feature called “Ratings Manager.”

But if a doctor stops paying, those unfavourable ratings will reappear.

“The reviews a provider designates with the Ratings Manager are not permanently removed and their numerical scores remain as part of the calculation of a provider’s overall rating,” said Chris Goodridge, chief investment officer of VerticalScope Inc., the parent company of Toronto-based RateMDs. (Torstar Corp, publisher of the Toronto Star, purchased a 56 per cent ownership in VerticalScope in 2015.)

“If a user unsubscribes from the Promoted or Promoted Plus plans, he or she will no longer receive the benefits associated with that subscription,” Goodridge said via email. 

“You’re held a little bit to ransom because the second you stop paying that $200 per month, those hidden reviews come back online,” said Ryan Forman, who runs a company called GlowingMDs that helps doctors manage their RateMDs profiles.

Reclaiming reputations

Forman’s company advertises its service to doctors with the line: “Reclaim your reputation.”

For a monthly fee of $229 plus HST the company provides a ratings template that doctors offer to patients to complete after an appointment.

“We then take all of those reviews, good or bad, from the doctor, and we then post it to RateMDs in effect on the doctor’s behalf.”

A reputation management company advertises service to physicians to boost positive patient testimonials on RateMDs online doctor rating site. (Daniel Rofusz/CBC News)

“We’re not able to remove any negative reviews but what we can do is post legitimate reviews that come through the doctor and hopefully improve their RateMDs profile,” said Forman.

Over at RateMDs, Goodridge said he knows that companies are selling reputation management services that target the online site.

“We’re certainly aware that there are a number of companies that support health care providers in soliciting patient reviews and in assisting with posting those reviews,” wrote Goodridge, adding that RateMDs has a system to disallow testimonials from suspicious sources.  

“RateMDs.com utilizes a variety of proprietary methods to identify and remove programmatically-generated reviews or reviews originating from suspicious sources.”

Software circumvents filters

But Forman said RateMDs filters have not prevented his company from posting multiple patient testimonials for a single doctor.

“We have had experience where they have picked up where we are putting more than one review for a doctor from the same location but the truth is our software circumvents that,” said Forman, adding he simply tweaks his software to get around the RateMDs filters.

So could anyone get the software and start posting whatever they wanted as many times as they wanted?

“Yes, I think if they were tech-savvy they probably could,” Forman said.” It’s not software that we developed, it’s software that’s out there on the internet so, yeah, they could definitely do it on their own.”

RateMDs is a free and open forum. That means anyone can say anything about any doctor. Just write a comment, click on each of the four rating stars and hit “Rate this doctor.” The site does not ask for a name, email address or phone number.

The doctor has no control over whether he or she appears on the site and there is no way to remove their page once it’s been posted.

A study published in the Journal of Medical Internet Research found that more than half of Canada’s physicians have been rated on the site.

“Overall, physicians are rated positively,” said study author Dr. Jessica Lui, a clinical investigator at the University of Toronto. “We did find there were differences in the likelihood of receiving a positive rating depending on what type of medicine you practiced.”

Misconduct decisions not visible 

But how useful are those ratings for patients especially if there are ways for doctors to boost their positive ratings?

And right now RateMDs does not post any warnings about physicians who have been disciplined by the medical regulatory colleges.

“If a provider has active or past disciplinary actions on their file they are not visible on their RateMDs.com profiles,” Goodridge wrote.

The remedies do not entirely correspond to the challenge.– Chantal Bernier, privacy and cybersecurity counsel, Dentons Canada LLP

The result? Doctors who have committed professional misconduct including sexual abuse of patients can still have glowing reviews on RateMDs.

“Providing transparency on disciplinary actions is a feature we continue to pursue on behalf of our audience,” wrote Goodridge. “At the moment, the limited availability of this data from the disparate colleges does not make this practical. RateMDs.com hopes to add this information in the near future by partnering with regulatory colleges if they are willing.”

There is also little transparency when it comes to anonymous accusations posted on RateMDs. Several doctors told CBC News about bad experiences including malicious postings from disgruntled employees.

And when patients do post negative reviews, the doctors pointed out that they can’t tell their side of the story without breaking patient confidentiality.

Forman started GlowingMDs after seeing some of those problems emerge in the medical clinics he manages.

“There’s definitely a need for the service,” Forman said. “Their hands are tied in terms of what they can say and do on RateMDs”

Thorny issues

Being rated without your consent can now happen to anyone. Doctors, lawyers, dog walkers — there is nothing preventing a company from setting up an online rating site and publishing anonymous reviews in any field — comments that will circulate on the internet forever.

“There is, I think, a very real issue that has, in a way, run away on us because we do not have the laws that specifically address these situations,” said Chantal Bernier, former federal privacy commissioner, now a privacy and cybersecurity counsel at Dentons Canada LLP.

“The thorny issues it presents is the reconciliation between the right to information, the obligation of accountability on one side and privacy and reputation on the other.”

Bernier said there is a need to examine the legislative tools that will be required to manage those competing ethical issues.

“Right now the remedies do not entirely correspond to the challenge.”



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Natural Whipped Body Butter Recipe

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diy natural body butter recipe homemade gift

I love making natural beauty products as gifts, and homemade body butter is one friends and family always love to receive. It’s a gift that is easy to personalize with custom natural scents (and even can help with sleep if you add a little magnesium!).

Put the finished product in a cute glass jar with ribbon and a tag, and you have a thoughtful and beautiful gift that will make them feel pampered for months.

Even if you aren’t typically the type to make your own gifts, this recipe is easy for DIY beginners and fun to make. Give it a try!

Why Body Butter?

Body butter is thicker than lotion and contains less water. This means it takes longer to penetrate the skin (don’t walk on a floor barefoot after applying body butter to your feet!) but it’s very moisturizing and softens even those tougher, very dry spots like the knees, elbows, and feet.

By whipping body butter, you get the best of both worlds since it is soft and easy to apply but still extra moisturizing.

How to Make Body Butter

This new recipe has similar ingredients to these homemade lotion bars, but removes the beeswax and whips the mixture as it cools to create a cloud-like lotion that is extremely nourishing!

This body butter is great for babies or sensitive skin, and scents can be added to make it a custom gift for anyone (or to keep for yourself!).

My current favorite is a peppermint-scented version for the holidays, but I also like a citrus/lavender combination.

Homemade Whipped Body Butter Recipe

The combination of shea and cocoa butter with two nourishing oils makes a highly moisturizing combination, but whipping the mix helps it go on smoothly without being oily.

Body Butter Ingredients

Optional: Cocoa butter, shea butter, and mango butter are all interchangeable in this recipe. If you only have one or two on hand, feel free to substitute or play with different proportions.

Body Butter Instructions

  1. In a double boiler or glass bowl, combine all ingredients except essential oils.
  2. Bring to medium heat and stir constantly until all ingredients are melted.
  3. Remove from heat and let cool slightly. Add essential oils if using.
  4. Move to fridge and let cool another hour or until starting to harden around the edges but still somewhat soft.
  5. Use a hand mixer to whip for 10 minutes until fluffy.
  6. Return to the fridge for 10-15 minutes to set.
  7. Store in a glass jar with a lid and use as you would regular lotion or body butter. If your home stays above 75 degrees, it may soften and need to be kept at the fridge, but it will stay whipped at a temperature lower than that.
  8. Keep for yourself, or give away! Enjoy!

Body Butter FAQ

This recipe has been around for a while, so here are some of the questions you’ve asked the most:

Will it be greasy?

Body butter is definitely more emollient and has a heavier texture than lotion does, but after a few minutes it will penetrate the skin and lose any greasy feel.

How long will it last?

Stored away from moisture and light this homemade body butter should last 6-8 months. Using a spoon or spatula to dip rather than your fingers will extend the life of the body butter.

Why is mine not white like yours?

Shea butter especially can vary in texture and color depending on the brand. Not to worry, it will still work just as well!

Will this clog my pores?

Nope! This body butter actually did wonders on my cystic acne back in the day.

Other Body Butter Variations

Mastered the recipe? Try mixing up your own combinations! Here are some ideas to get you started:

Ever made your own body butter? Want to try this recipe? Share below!

How to make simple and luxurious whipped body butter with shea butter and natural oil



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Canada’s first successful heart transplant was 50 years ago this week. Here’s how it happened

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In mid-November 1968, a team of cardiologists at St. Michael’s Hospital received a call they had been waiting on for months.

An 18-year-old man had been badly injured in an accident, they learned. He was ruled brain dead, but his heart was still beating.

It was a tragedy that set into motion the first successful heart transplant in Canadian history, which marks its 50th anniversary on Saturday.

“We never had any hesitation,” said Dr. John K. Wilson, now 93. “We were ready. The team was ready.”

A year earlier, in 1967, Wilson had identified a potential recipient for a heart transplant, Charles Perrin Johnston, who had been suffering from heart failure and appeared headed toward an early death.

“I told him at the time, almost facetiously, ‘Hey, maybe we can give you a new heart in a year’s time,'” Wilson remembers telling Perrin Johnston.

Charles Perrin Johnston lived for six years after receiving a new heart in 1968. At the time of his death, no transplant recipient had lived longer. (St. Michael’s Hospital)

The golden age of cardiology

In December 1967, the South African doctor Christiaan Barnard performed the world’s first human-to-human heart transplant — an earlier transplant had been attempted using a chimpanzee heart — though the recipient lived for just 18 days after the surgery.

In Canada, several hospitals were jockeying to become the first to replicate the operation, though early attempts were met with fast deaths or incapacitated patients.

In May of 1968, Albert Murphy became the first Canadian to receive a new heart, though he died within hours of the operation, performed at the Montreal Heart Institute.

In the following months, Toronto General and Toronto Western hospitals also attempted heart transplants, though none of the patients recovered.

In the wake of multiple failures and amidst a growing media frenzy around the race between the three Toronto hospitals, the team at St. Michael’s took their shot at the potentially life-saving operation on Nov. 17, 1968.

The transplant was to be performed by Dr. Clare Baker, with Wilson providing support during Perrin Johnston’s recovery.

Dr. Clare Baker was the surgeon who carried out the operation. Baker died in 2010. (St. Michael’s Hospital)

“We had to have confidence. And if anybody gave the image of being a confident performer, a confident surgeon, a capable surgeon, it was Dr. Clare Baker,” Wilson remembered about his colleague, who died in 2010.

That confidence and preparation ultimately translated into a successful surgery.

“He left the operating room like any other patient, with a beating heart,” Wilson said.

Perrin Johnston went on to live six years with his new heart. At the time of his death, he was the longest lived male heart transplant recipient in the world.

When doctors later asked him how they did it, “maybe we said more prayers at St. Michael’s Hospital,” Wilson would say with a laugh.

Surgery inspired future doctors

Shortly after Perrin Johnston’s transplant, Dr. Robert Chisholm arrived at St. Michael’s as a medical student. He says the experience of watching Dr. Wilson and Dr. Baker during their breakthrough years altered the course of his career.

“That two month experienced changed my life,” said Chisholm, who started his tenure at St. Mike’s without a medical specialty. He has now worked as a cardiologist at the hospital since the 1970s.

“It was a very exciting time because the world was kind of watching us,” he added. “We had pretty good success in those early days.”

Dr. Robert Chisholm worked with Dr. John K. Wilson and Dr. Clare Baker as a student in the late 1960s. The experience inspired him to pursue a speciality in cardiology. (Martin Trainor/CBC)

While the techniques used in cardiology have advanced considerably since the 1960s, Chisholm says the approach taken by Wilson and Baker should serve as a powerful lesson to their modern contemporaries.

“The key to their success, I think, was judgment,” he said. “And that still applies today.”

Failed surgeries following breakthrough

Following Perrin Johnston’s surgery, Baker, Wilson and the St. Michael’s cardiology team travelled around the world, sharing their findings at medical conferences filled with doctors still struggling to perform the operation.

In total, Wilson and the team carried out five heart transplants at St. Michael’s, though the last two were unsuccessful.

They stopped performing transplants after those failures, due to advancements in other areas of cardiology and a need for anti-rejection medications that were not yet developed.

Still, Wilson looks back fondly on his years at the cutting edge of the specialty, knowing that his team’s success informed the work of doctors around the world, and elevated the profile of his hospital as a result.

“We were pretty proud that we were able to present a successful transplant,” he said. “We showed that it can be done.”

According to the latest figures from the Canadian Institute for Health Information, 170 Canadian received heart transplants in 2015.



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Trying to bridge the ‘genomic divide’: Lack of Indigenous data a challenge for researchers

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A prominent U.S. senator turned to genetic testing last month to try to prove her claim that she had Indigenous ancestry.

But in assessing Elizabeth Warren’s DNA, the geneticists were forced to use samples from Mexico, Peru and Colombia because there were no samples from American Indigenous peoples in the reference databases. 

Because the data is missing, Indigenous geneticists Krystal Tsosie of Vanderbilt University and Matthew Anderson of Ohio State University argue that Warren’s test results, which showed Native American ancestry six to 10 generations ago, are a reach.

Many more researchers have joined the discussion regarding Warren’s DNA test results, weighing in on the problems inherent in using genetic databases to unearth Indigenous ancestry.

Indigenous data is missing because “Native American groups within the U.S. have not chosen to participate in recent population genetic studies,” wrote Carlos Bustamante, the geneticist studying Warren’s DNA. That information gap for Indigenous groups exists around the world, including Canada. 

“The Warren news was a distraction from the real work,” said Laura Arbour, one of the lead scientists for the Silent Genome project recently funded by Genome Canada and Genome British Columbia. 

Arbour and her colleagues are trying to develop strategies to better engage Indigenous communities in genomic research.

She describes a growing “genomic divide” that reflects the apparently insatiable appetite among people with a European background to give their DNA to large databases in return for predictions regarding future health and well-being.

Precision medicine

Bridging this “genomic divide” will allow Indigenous people to benefit from a future with precision medicine, says Arbour.

The term precision medicine refers to the use of genomic data to predict which drug will work best for each person.

But precision medicine cannot serve Indigenous people if their reference data is missing.

The lack of representation of Indigenous genomes in large databases reflects a general wariness in that group caused in part by historical cases of genetic research gone wrong. 

One study considered by leading geneticists including Roderick McInnes, former institute director in the Canadian Institutes of Health Research, as a game changer involved the Nuu-chah-nulth First Nations on Vancouver Island.

The Nuu-chah-nulth have a high frequency of rheumatoid arthritis. The research team collected DNA samples from approximately half of the First Nations members to study the genetic basis for the disorder.

The genetic determinants of rheumatoid arthritis weren’t found, but that wasn’t the big problem. Researchers sent the DNA samples to external facilities for genetic ancestry studies without the knowledge or consent of the participants.

That action created concern around privacy and possible exploitation through the use of the genetic data for commercial gain, Tsosie and Anderson wrote in a piece posted on The Conversation.

Positive relationships

On the other hand, there are examples of positive relationships between Indigenous groups and non-Indigenous genetic researchers. 

Members of the Gitxsan nation in British Columbia, for instance, told Arbour and her colleagues about the high prevalence of sudden cardiac death in their community.

The Gitxsan not only initiated the research into the genetic cause for this disease but also helped supervise the work through advisory and governance committees.

When geneticists were assessing U.S. Senator Elizabeth Warren’s DNA, they had to use samples from Mexico, Peru and Colombia because there were no samples from American Indigenous peoples in the reference databases. (Charles Krupa/Associated Press)

With that co-operative relationship, the research team found the genetic basis for the prevalence of Long QT syndrome, which can cause sudden cardiac death, in the Gitxsan. A gene mutation was found to be responsible for disrupting normal cardiac rhythm. The Gitxsan could then be effectively treated for Long QT syndrome after that discovery.  

Arbour also sees a need to customize the practices for DNA collection in Indigenous communities so that they maintain control.

One little-known aspect about most genetic testing projects, such as the 1000 Genomes Project or 23andMe, is that they, not the donor, retain ownership of the sample.

Indigenous leaders don’t want this to happen in studies of their people.

DNA obtained from an Indigenous individual should be considered “on loan” to the researcher just for the purpose of the specific research project, says Arbour. Ownership of the sample should be retained by the individual with the future potential to be stored in a “tribal-controlled DNA bank,” she says.

Calls for Indigenous leadership

Indigenous leaders have long recognized the need for Indigenous scientists to take ownership of the research conducted with their DNA.

Writing in the Hill Times last month, Natan Obed, president of the Inuit Tapiriit Kanatami, a national, non-profiit organization representing 60,000 Inuit, said that “Inuit are the most researched people in the world — yet with colonial approaches to research … our role is imagined as marginal and of little value.”

He also recently renewed his call for Inuit leadership in the three major Canadian research agencies: the Canadian Institutes of Health Research, the Natural Sciences and Engineering Research Council of Canada and the Social Sciences and Humanities Research Council of Canada.  

Laura Arbour, one of the lead scientists for the Silent Genome project recently funded by Genome Canada and Genome British Columbia, and her colleagues are trying to develop strategies to better engage Indigenous communities in genomic research. (Brad Lyle, Genome BC)    

Building capacity for Indigenous leadership in genomic research takes time. 

But real change could come through the work of programs like SING, which stands for the Summer Internship for Indigenous Peoples in Genomics.

This educational program initiated at the University of Illinois Urbana-Champaign in 2011 and sponsored by multiple agencies including the National Institutes of Health was geared primarily for Indigenous students in a university undergraduate or graduate degree program in the U.S. but has since spread to Canada and New Zealand. 

The SING workshops aim to give Indigenous students interested in genetic science additional skills and knowledge that would help them move into advisory and leadership roles within genetic research. The workshops of approximately 20 participants have been held annually at multiple U.S. university venues, most recently in Seattle earlier this year.

Katrina Claw, a former SING participant and now a leader of the program in the U.S., says there have been participants from 44 First Nations, including mostly students who are interested in genomic, social and political sciences. 

The SING training workshops include basic scientific methods in DNA sequencing and analysis along with tutorials on the principles of informed consent and ethics relating to DNA data sharing. 

Faculty positions

The Indigenous leader of SING Canada, Kim TallBear, an associate professor in the Faculty of Native Studies at the University of Alberta, says that genomics research must also be taught with the view of correcting the history of disciplinary mistakes made by scientists.

A significant proportion of SING participants enter the program with a background in genomic science or the social and political sciences and with the intention of learning about Indigenous genomics from a “bioethical and decolonizational perspective,” said TallBear.

The goal of the SING workshops is starting to be realized. According to TallBear, Anderson is another great example of someone of Indigenous descent who started with SING as a graduate student, came up through the ranks to become an assistant professor and is already leading discussions around genomic research in Indigenous communities.



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