It also said the department had not yet figured out what measures were needed to address the potential for conflicts of interest in its reviews of drug submissions. “Health Canada has not adequately fulfilled its key responsibilities for monitoring the safety of marketed drugs,” the report said. There are about 13,000 prescription and nonprescription drugs on a Canadian market that was worth around C$28 billion ($26.9 billion) in 2008.

“The department does not take timely action in its regulatory activities … in particular, (it) is slow to assess potential safety issues. It can take more than two years to complete an assessment of potential safety issues,” the report said. Wiersema said Health Canada had also not acted on a long-standing commitment to disclose more information about the clinical trials it has authorized.

“This increases the risk that Canadians may be unaware of new treatment options or may unknowingly participate in an unauthorized trial,” he said. Health Minister Leona Aglukkaq said “it is important to note that the report did not question the safety or effectiveness of drugs authorized by Health Canada.” In a statement, she added: “During the audit period and since that time, we have taken important steps to improve performance.”

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“Dietary supplementation with vitamin E significantly increased the risk of prostate cancer among healthy men,” said the study in the Journal of the American Medical Association. Selenium, a trace mineral found in foods like Brazil nuts, tuna and beef, is often deficient in areas such as China and Russia where it is lacking in the soil.

The study was launched based on previous research that had suggested that selenium or vitamin E might reduce the risk of developing prostate cancer. The latest data emerged three years after a preliminary study of the findings, published in 2008, showed a slightly higher but statistically insignificant risk of prostate cancer among those taking vitamin E.

However, since the risk was approaching statistical significance, a safety committee called for a halt to the randomized Selenium and Vitamin E Cancer Prevention Trial (SELECT) in the United States, Canada and Puerto Rico in 2008. A longer-term follow up, concluded in July of this year, has revealed the higher cancer incidence in men assigned to the vitamin E portion of the trial.

“Based on these results and the results of large cardiovascular studies using vitamin E, there is no reason for men in the general population to take the dose of vitamin E used in SELECT as the supplements have shown no benefit and some very real risks,” said Eric Klein, a study co-chair for SELECT, and a physician at the Cleveland Clinic. “For now, men who were part of SELECT should continue to see their primary care physician or urologist and bring these results to their attention for further consideration.”

The study began in 2001 and broke participants into four groups: one would receive selenium, another would get 400 international units of daily vitamin E, another group would take both, and the fourth was prescribed a placebo. A total of 620 men in the vitamin E group developed prostate cancer, as did 555 in the combined selenium and vitamin E group.

Those taking selenium only saw 575 develop prostate cancer, compared to 529 on the sugar pill. “The observed 17 percent increase in prostate cancer incidence demonstrates the potential for seemingly innocuous yet biologically active substances such as vitamins to cause harm,” said the study.

Men entering the trial had no signs of prostate cancer and were considered to exhibit average risk of developing the disease, which is the second most common cancer among US men, after skin cancer. According to the American Cancer Society, 240,890 new cases of prostate cancer will be diagnosed in 2011 and 33,720 men will die of prostate cancer in the United States.

The study found no biological explanation for why vitamin E was driving the risk higher, but warned that the effects of the pills may continue even after the patient stops taking them. “The fact that the increased risk of prostate cancer in the vitamin E group of participants in SELECT was only apparent after extended follow-up… suggests that health effects from these agents may continue even after the intervention is stopped,” it said.

The findings also “underscore the need for consumers to be skeptical of health claims for unregulated over-the-counter products in the absence of strong evidence of benefit demonstrated in clinical trials,” it said. The trial was funded by the National Cancer Institute, the National Center for Complementary and Alternative Medicine, the National Heart, Lung, and Blood Institute, the National Institute of Aging and the National Eye Institute.

Governor Rick Snyder said physicians will now be asked to include information on the so-called body mass index of patients under 18 years of age to the Michigan Care Improvement Registry, a database set up in 1998 to track the immunization records of state residents. BMI is basically a height-to-weight ratio that doctors use to measure obesity, a condition that raises the risk of heart disease, stroke, diabetes, various cancers and hypertension, among other things.

Obesity is fast replacing tobacco as the single most important preventable cause of chronic non-communicable diseases, according to recent study by the Mailman School of Public Health at Columbia University. It is expected to add an extra 7.8 million cases of diabetes, 6.8 million cases of heart disease and stroke, and 539,000 cases of cancer in the United States by 2030, the study said.

Snyder outlined his health-related push, including a proposal to ban tobacco at all the state’s beaches, in a special message to the state legislature. He said that 67 percent of Michigan adults were overweight or obese — and that the problem was taking its toll on the state’s finances. The Columbia study estimated that, unchecked, obesity would add an additional $66 billion to U.S. healthcare costs annually. Christine Ferguson, the director of the STOP Obesity Alliance at George Washington University and a former commissioner for public health in Massachusetts, called Snyder’s proposal “a great idea.”

“Registries are a really useful way of aggregating data on a population and really drilling down into it and finding out where the big problem areas are,” she said. Meagan Dorsch, a spokeswoman at the National Conference of State Legislatures, said efforts to gather information on obesity at the state level were “not without precedent.” But she said she was not sure if any other state had made it a required part of a doctor’s visit and then placed the information on the state’s immunization database.

The exchanges are envisioned as open marketplaces for competing insurance plans where uninsured people and small businesses can band together to negotiate cheaper rates. “State agencies have a very bad habit of chasing any money that comes to them … pursuing the money instead of pursuing their visions and their goals,” said Tony Keck, who heads South Carolina’s Health and Human Services Department.

“We’re not planning on taking any further money for the exchanges,” he told Reuters. “We are worried that the federal government seems to be saying that states should become the back office managers for the private insurance market and we’re not sure that’s a good use for the state resources.”

States face a January 1, 2013, deadline to submit detailed plans for the exchanges or the U.S. Health and Human Services Department will come in and build them itself. Whether run by states, HHS or a combination of the two, the exchanges have to be up and running by 2014, according to the law passed last year.

With deadlines looming there is concern about a smooth and timely roll-out of the healthcare reform, especially as many Republican governors want to block the new law supported largely by Democratic lawmakers. The HHS has awarded states $1 million planning grants to research exchange options and the administration is now sending out applications for establishment grants, which South Carolina plans to skip.

Seven states received much larger amounts of federal funding to establish prototype exchanges other governments could use as a model. Two of those states, Oklahoma and Kansas, have since returned the money. But even though Republican Governor Nikki Haley “remains an equal opportunity opponent of ObamaCare,” according to her spokesman, South Carolina officials say it is too soon to tell what the state will do about the exchange plan. But like other states whose executive branches adamantly oppose Obama’s reforms, the work on an exchange quietly continues in South Carolina

The state has created a planning committee that is holding a meeting on Thursday and, using the $1 million federal grant, will continue to analyze various structures South Carolina can adopt before or after 2014. The committee is getting background briefings from industry consultants and is working on a final report to be sent to Haley and state lawmakers by the end of October, said Gary Thibault, program manager for the exchange planning grant.

Among the options being weighed by South Carolina is a plan to seek help from the private sector to create a separate — and perhaps cheaper — exchange that would satisfy the state’s public health goals.

“Our question is … why does the federal government have to bankroll all of this, especially when there are private solutions … that are already out there running millions of employees’ insurance in exchanges?” Keck said. He says the state is taking a “wait-and-see approach” and is eager for more details from HHS on how the government expects the exchanges to work.

“The (federal) dollars really bother me,” Keck said. “It comes with strings attached and then, all of a sudden, their agenda is your agenda.” Local newspaper The State first reported Governor Haley’s plan to refuse more federal funding. Neither Haley’s office nor the state’s health department have issued any official statements on the decision.