Ruminations

Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Monday, October 16, 2017

Running Biomedical Trials, Saving Lives

"I was curious."
"This may sound odd, but as a medical student, it's quite interesting to go through the process of being very ill [as a result of taking part in an emerging therapy medical experiment]."
"It does help to create empathy for your [future] patients."
James M. Duggan, medical student, Oxford University

"These are great results."
"And challenge tests are a great way to short-circuit the process of proving it [this type of research] works."
"If we'd done this in the field, we would have had to follow children for three or four years."
Dr. Anita Zaidi, director of diarrheal diseases, Bill & Melinda Gates Foundation

"[I felt] happy to be doing something that could help millions of poor people who haven't got antibiotics."
"[During the worst part of the trial] you feel sorry for yourself and you say 'I;m never doing that again'."
"And then it's like childbirth -- you get amnesia, and you do it again. I've just signed up for a second trial."
Faye Frances, 42, psychiatric nurse
SianRogers.jpg
The student, pictured, says although she may come across as being 'unfazed' by the studies, she feels safe with knowledgeable staff who explain everything thoroughly beforehand / Siân Rogers via The Tab

Typhoid was deadly when it became an unstoppable epidemic in various points of human history relating to the aftermath of natural catastrophes, of wars and of famines, reflecting the time in human history and medicine before antibiotics came on the scene. Invariably during times of great social upheaval, poor sanitation and lack of adequate hygiene results, leading to opportunistic lice carrying the disease, typical of times of social chaos and upheaval.

The bacteria leading to the onset of typhus can remain dormant for years before affecting people and in that stage it is also transmissible to others. Before the advent of antibiotics, which now in use swiftly aids the body to recover from the disease, it is likely that the woman named 'Typhoid Mary', who was a cook in houses of the aristocracy and who also worked in a New York maternity hospital was able to infect people in the years 1900 to 1915, but was never herself ill.

Recently 100 residents of Oxford in England agreed to take part in a trial of a new vaccine for typhoid which can spread in food and water and kills close to 200,000 people annually, many of them African, Asian and Latin American young children. Those who survive may end up with perforated intestines, heart problems and/or other life-complications.

As it happened, the vaccine turned out to be successful, at 87 percent effectiveness, as the only vaccine that is also safe for use with infants. It is already being manufactured inexpensively and is in wide use in India. The trial was run by the Oxford Vaccine Group under the funding auspices of the Bill & Melinda Gates Foundation. There is hope that the vaccine will be endorsed shortly by the World Health Organization.
Salmonella Typhi bacterium (Sanofl Pasteur via Flickr creative commons)
Subjects who had agreed to be part of the trial, were given an experimental vaccine, after which they were deliberately infected with the pathogen to determine whether the vaccine succeeded in protecting them from the disease. This kind of trial can only be undertaken with illnesses such as cholera or malaria that respond rapidly to antibiotics, curing the individual in short order. Even so, those who agreed to participate were informed they would experience being miserably ill with typhoid fever for several days while the antibiotics established their curative function.

This being so, it is interesting that people would decide to take part in the trials, prepared to feel very unpleasant for a short duration while the vaccine performed its mission. Some people were very ill with high fevers, joint pains and headaches. These symptoms which tests clarified were those of typhoid led to the immediate application of antibiotics.

Just as the subjects themselves all reacted in various ways, presenting with a number of symptoms and combinations of symptoms, their reasons for participation varied, as well. Some were simply curious, others wanted to feel they had given of themselves for a good cause, and others yet were motivated by the money they would earn, about $4,000 in cash.

"This new vaccine could be a real game changer in tackling a disease that disproportionately affects both poor people and children."
"For the first time, we will be able to offer protection to children under two years of age, which will enable us to stem the tide of the disease in the countries where it claims the most lives."
"If we are going to make serious headway in tackling typhoid, we need to dramatically reduce the number of people suffering from and carrying the disease globally, which will in turn lead to fewer people being at risk of encountering the infection."
"This is a disease that only affects humans, and I believe that it will be possible for us to eradicate [it] one day. However, we’re currently losing ground as overuse of antibiotics is leading to the emergence of new resistant strains, which are spreading rapidly."
Professor Andrew Pollard, professor of Paediatric Infection and Immunity, University of Oxford -- Director of the Oxford Vaccine Group

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Sunday, October 15, 2017

Avoiding Islamophobia

"We're still waiting for a march against honour killings, child marriages, polygamy, sex slavery or female genital mutilation."
Ayaan Hirsi Ali and Asra Q. Nomania (Muslim Reform Movement)

"If one finds white male sexism intolerable, then one should find all male sexism just as intolerable. Excusing men of colour, Muslims, immigrants or men living in non-Western societies for bad behaviour toward women is an expression of the bigotry of low expectations."
"The result of this mindset is that Christianity is criticized for every misstep against women but Islam is protected from the glare of scrutiny."
Ayaan Hirsi Ali, ex-Muslim Somalian, writer, activist

"What I describe as a 'faux feminism' has arisen in the last 30 years, a postmodern and post-colonial feminism that passionately condemns Christianity and Judaism but dares not critique religiously supremacist Islam for this same reason."
"[Today's Western feminists] are too nervous about being called Islamophobes, racists or colonialists] to dedicate themselves to rescue of victims of rape from Islamic communities]."
"In recent years, I fear that the 'peace and love' crowd in the West has refused to understand how Islamism endangers Western values and lives, beginning with our commitment to women's rights and human rights. The Islamists who are beheading civilians, stoning Muslim women to death, jailing Muslim dissidents, and bombing civilians on every continent are now moving among us both in the East and in the West. While some feminist leaders and groups have come to publicize the atrocities against women in the Islamic world, they have not tied it to any feminist foreign policy. Women's studies programs should have been the first to sound the alarm. They do not. More than four decades after I was a virtual prisoner in Afghanistan, I realize how far the Western feminist movement has to go."
Phyllis Chesler, American feminist
Women wearing the Chador.
Women wearing the Chador. Getty Images

The campaign by women fed up with their secondary, unentitled place in society engaged in a protracted campaign to shame society with the understanding that in institutionalizing a social contract that diminished the stature and the intelligence and opportunities of women, not only were women and their children suffering great harm, but society itself, like those it targeted, would never reach its full aspirational potential. Equal-pay legislation, marital rights, equal access to education, opening up politics and the professions to women has enabled Western societies to move forward and grow.

All of which have been a tremendous benefit to the societies which finally accepted equality for both genders in every aspect of social, political, and working life. Yet, since those victories were established, with feminists forever cautious that nothing occur to set back the advances that took so many years to accomplish, it is women in the West who have benefited, not women universally. There were overtures to some societies to improve the lives of women virtually held in bondage to patriarchal societies who were condemned for the strictures they placed on women's lives.

But the issue of women living under Shariah law in Islamic countries where it is traditional and a vital part of the culture to assert female inferiority to the place of men has been consistently and deliberately overlooked. Women who ascribe great value in the feminist ideal and the men who support them have hesitated to criticize those cultural practices that dominate and repress women. Ayaan Hirsi Ali, a fierce critic of Islam and Asra Q. Nomania, co-founder of the Muslim Reform Movement recently called upon western feminists to re-adjust their focus.

Noting the women's march across the United States decrying the ascension of a crude sex predator to the presidency of the United States, they declared their dissatisfaction, yet while bringing attention to a man whose exploits as a braggart and a bully has brought infamy to the office of the president, pay no attention whatever to the plight of women and girls living in Islamic societies, both abroad and within Western countries where the cultural and religious traditions that have kept women as disadvantage chattels were brought as baggage to be practised in the West.

Feminists, so swift to denounce Western men for not recognizing women as equals and respecting them for the same traits and capabilities that men gain respect for, have chosen to overlook the attitudes and behaviours of Muslim men. Are they regarded as underdogs and therefore to be pitied should they be deprived of "their last source of pride: their domination over their women"? For this is what Islam views as a man's 'honour', that complete control of a woman be exerted. Any Muslim woman's father, brother, uncle, husband, son or brother-in-law has explicit control over her, dominating her life as seen fit lest family honour be shamed.

Islamic dress code survey results

Phyllis Chesler's feminism dates back to the 1960s and 70s, when she campaigned with the National Organization for Women and allied organizations with the understanding that they were meant to support women everywhere. That has changed. In lock-step with the emergence of Islam as a factor and a growing one by leaps and bounds in the world of the West thanks to rampant immigration and migration. Now, Western societies are aware of child marriages, of female genital mutilation, of social forces that ghettoize Muslim women, of honour killings taking place within Muslim communities.

The heart of Islam beats hard for the misogyny they feel is the correct social order of relations between the sexes; women are not to be trusted, and must be firmly held in place under the heavy fist of a man, and if she requires physical punishment to emphasize her obligations, that is readily arranged. At one time feminists organized rape-crisis counselling centres and helped to bring in new rape laws; even in India which has a long tradition of violence against women has brought in new rape laws though violence has scarcely abated, so engrained is it in the culture of male entitlement.

Now, Phyllis Chesler hopes to influence feminists of their moral duty to advance human rights to aid girls and women "who are being beaten, stalked and threatened with death by their own families because they refuse to veil or to marry their first cousin". She feels there is an obligation to erect shelters as havens from honour-based violence, all the cultural 'norms' of Islamic society imported with immigration to the West. To each thing there is a season and a time for everything....

Muslim women wearing various style of veils
Muslim women in Amsterdam, wearing different styles of veils

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Saturday, October 14, 2017

Politically Correct : Chiefly in Magnitudes of Utter Stupidity

A plan has been put forward to have the York Region District School Board remove this totem pole from in front of Summitview Public School in Whitchurch-Stouffville. The totem has stood there since 1974. - Mike Barrett/Metroland
"While initially constructed with positive intentions, our understanding of how cultural appropriation affects our leaning environments has developed significantly."
"The totem pole was created without consultation or involvement of members of Indigenous Nations, including members of the Indigenous Nations of the West Coast for which the totem pole is unique."
York Region District School Board

"At that time, there was less awareness to what appropriation was."
"The First Nation felt it was probably not done with any ill-intent. That's why we're not jumping up and down with our arms in the air."
"Everybody's just trying to do the right thing here."
Lauri Hoeg, Chippewas of Georgina Island, Band councillor

"Listen, I think we've engaged in some significant learning since the totem pole went up."
"The one big thing for me is around the spaces that we're creating in our schools."
"We're looking to engage in some learning, as a starting point."
Drew McNaughton, Summitview Public School Superintendent, Stouffville, Ontario
TDSB

"It may not have originated as an Indigenous word, but the fact is that it [the word "chief"] is used as a slur in some cases, or in a negative way to describe Indigenous people."
"With that in mind, as it has become a slur in some cases, that's the decision the administration has made to be proactive on that [to henceforth disallow the use of the word chief in any context]."
Ryan Bird, spokesman, Toronto District School Board

"If that usage is going to genuinely hurt a group of people, then I would say yes, by all means, let's see if we can find an alternative."
"On the other hand, the word originated outside of the context of First Nations cultures ... and the First Nations associations that it has, I don't think are negative."
Mark Morton, University of Waterloo's Centre for Teaching Excellence
We are canting at a galloping pace toward the very last gap in touchy-feelly empathy and rejection of anything that might possibly be construed as cultural appropriation -- heaven forfend -- or (gasp!) perceptions of bigoted expressions aimed at Indigenous people or their culture. An elementary school in Ontario has decided in a righteous fit of sanctimony that a totem pole erected decades ago as an exercise in children understanding and respecting historical culture, was to be summarily removed from its place adjacent the school's front entrance.

In 1973 former teacher Bernadine Mumford began a project as part of a focus on Canadian history, in the process enthusing her grade 6 students and the project was begun, everyone happily contributing to the carving and erection of a distinct and complimentary facsimile of a traditional West Coast totem pole, in sympathetic recognition of the "great harm" done in the past to Indigenous peoples. "It bothered me that there was an implication it was racist", she latterly said, to a local newspaper.

However, the spectral reality of victimhood, real or perceived, raised its accusing head. She was informed that a complaint had been broached to the school board about the structure, that the York Region District School Board identified as "community-based concerns"; one individual lodging an impassioned complaint to demonstrate her/his commitment to upholding the human rights and dignity of First Nations by taking the initiative to demand the removal of a disrespectful object mocking tradition is all it would take.

People in positions of authority have raised their antennae over such complaints of purported racism and no one wants to defend themselves by pleading not guilty and in so doing proving to the skeptical ultra-sensitive that no harm was intended, rather a project was meant to convey empathy and recognition of past wrongs. The merest whiff of controversy serves to light a firecracker under the seat of anyone held to be publicly accountable, and they move with righteous indignation blazing firmly in their culpable breasts.

When the board consulted with representatives from the Chippewas of Georgina Island, a local First Nation, though the totem pole does not reflect their own traditions, the Chippewas gravely agreed: the totem pole must be removed as an affront to First Nation dignity. In the matter of removing the offensive word "chief" from usage in any context whatever to assuage the perception that it is a word recognized as an epithet-arrow aimed at aboriginal hearts, there is nothing to discuss; the deed is done.

What is most harrowing about all of this is the simple fact that these intellectual simpletons have the last word on the kind of education Canadian children are exposed to, manipulating and avoiding any measure of discomfort through controversy that might be experienced when totally absurd notions arise implicating normal interactions of language and intention for fear that something, somewhere will be certain to offend someone at some time.

Summit View Public School letter
This letter was sent home to parents of students at Summit View Public School in Whitchurch-Stouffville Sept. 29. - YRDSB letter

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Friday, October 13, 2017

Be Advised :  Rough Road Ahead

"It will be essential for those tasked with [educating youth about Cannabinoid Hyperemesis Syndrome -- CHS] this massive undertaking to figure out what to say by engaging stakeholders, including the Canadian Association of Emergency Physicians, in order to shed some light on CHS."
"We need to find out how to say it and who should say it so youth will listen."
"And, this all needs to be done starting now; we are on a tight time frame, after all. July 1 [2018, when Marijuana possession becomes lawful in Canada] is coming up fast, and we aren't ready."
Dr. Jessica Ross, emergency physician, Ontario
Marijuana
In this Feb. 17, 2016 photo, plants grow at the home of Jeremy Nickle, in his backyard in Honolulu, Hawaii. (AP / Marina Riker)

Abdominal pain, nausea and intractable vomiting resulting from chronic, regular cannabis use is a condition with a name: Cannabinoid Hypermesis Syndrome. Some doctors are familiar with the symptoms to enable them to make an accurate diagnosis and proceed with appropriate treatment, which of necessity includes persuading teens that it is not in their best interests to smoke pot. And some physicians have never heard of CHS, much less are knowledgeable about its symptoms; ergo, no diagnosis will be made in identifying an ill teen accompanied by a worried parent.

Dr. Ross, on the other hand -- in her capacity as an emergency physician, once she had ascertained that the very sick young man who had been admitted to her hospital in the company of his frantic mother had no fever, no diarrhea, and hadn't recently been on a trip to the tropics -- was able to identify the symptoms and link it to the cause. Her questioning of the 14-year-old boy and his mother elicited few clues, but the light slowly began to dawn when Dr. Ross suggested that the boy's mother briefly withdraw. And then it was that the boy admitted that he is a casual imbiber of alcohol and a daily pot smoker.

At the ripe old age of 14, the tow-haired boy said he was actually a veteran pot user, had been smoking it daily for a full two years. Making Dr. Ross quite confident in diagnosing his symptoms. She ran a few tests and then informed her patient and his mother that his vomiting was a result "of all the pot you've been smoking". Dr. Ross is becoming fairly confident and comfortable about such diagnoses, even while she is fairly perturbed and definitely uncomfortable that the syndrome is on the increase.

That being so, she is more than slightly concerned at the impending legalization of recreational marijuana. All the more so that cannabis use in the youth of Canada is taken as a casual reality, with more young people using the drug than most parents are prepared to credit. Young people feel relaxed about their cannabis use -- after all, 'everybody does it' and whatever is popular is a must for youth who are otherwise engaged in proving how 'different' they are from everyone else.

Young people in grades 7 through to 12 in responding to surveys affirm that one in five have tried cannabis, with over one in ten using it in the past month, while the average age of initiation into the ritual use of pot appears to be 15 years of age. In the United States, Colorado legalized marijuana use and if a dependable example is sought, they can qualify as a model for avoidance given they experienced close to a doubling of CHS cases following liberalization.

Hazards such as dangerous dehydration can result from CHS, which also contributes to absenteeism from school and from the workplace, even if setting aside the effect it has on an already overburdened health care system with emergency departments seeing the same sufferer on multiple occasions. And diagnosis is often elusive, leading to needless and expensive tests and prescribed treatments after consultation, which bypass correct diagnosis until an accurate diagnosis finally occurs.

Despite which the belief persists among young people that marijuana use is pretty safe. Education for parents, their children and health-care practitioners must be dependably in place to inform all parties. Health Canada has made it a priority to educate about the health effects of  cannabis, particularly among the young, while the Canadian Pediatric Society and the Canadian Psychiatric Association have produced positions statements giving warning of  cannabis harms to youth.

Risks such as impaired brain development, increased prevalence of mental illness and diminished school performance as well as lifetime under-achievement are real potentials and people need to understand this to be fact, not fiction, as they would prefer to believe. All to the good; Dr. Ross applauds their efforts, yet on the other hand, wonders why mention of CHS in these documents is completely absent.
Cannabis use has become one of the most commonly abused drugs in the world. It is estimated that each year 2.6 million individuals in the USA become new users and most are younger than 19 years of age. Reports describe marijuana use as high as 40–50% in male Cyclic Vomiting Syndrome patients. It is this interest in cannabis in the World, coupled with recognition of a cyclic vomiting illness associated with its chronic use that beckons a review of the most current articles, as well as a contribution from our own experiences in this area. The similarities we have demonstrated for both cannibinoid hyperemesis syndrome and cyclic vomiting make the case that cannibinoid hyperemesis syndrome is a subset of patients who have the diagnoses of cyclic vomiting syndrome and the role of marijuana should always be considered in the diagnosis of CVS, particularly in males.
Mithun B. Pattathan, Reza A. Hejazi, and Richard W. McCallum  U.S.National Library of Medicine: National Institutes of Health: Published online 2012 Jun 29.

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Thursday, October 12, 2017

The Health Benefits of Exposure to Greenery

"We found that those who have more trees and vegetation around where they lived had an eight to 12 per cent reduced risk of dying compared to those who didn’t."
 "Holding all that constant [ambient pollution, population density, socio-economic conditions], if you live in a greener area, compared to a less greener area, there’s about a 10-per-cent reduced risk of dying."
"One thing that was kind of striking is that we found that those who were in the highest income bracket and those who had the highest levels of education were benefiting more from the exposure to greenness."
"If you take two people and everything else is more or less the same … their age, sex and city they live in and they both have the same amount of greenness around where they live, someone who is more affluent is getting a big boost to their risk of dying whereas people in the lowest income group were getting almost no benefit at all."
"Parks are important but I think this shows that it’s just as important to have trees on medians and along streets and sidewalks where people are going to have contact on a regular basis."
"If it's a really nice green area, it's sort of a pleasant spot, people are more inclined to go walking, even just walking their dog, not necessarily getting … intense physical exercise."
"Water is completely different from green space, but living on the water can be very relaxing and stress reducing."
Dr. Dan Crouse, Epidemiologist, Research Associate in Sociology, University of New Brunswick 
Saint John's Rockwood Park is one of Canada's largest urban parks at 890 hectares.
Saint John's Rockwood Park is one of Canada's largest urban parks at 890 hectares. (YouTube)
A new study just published in the latest issue of The Lancet Planetary Health, is intriguing for its findings, but it shouldn't surprise people who gravitate to the out-of-doors in their leisure time for the distinct purpose of immersing themselves in natural surroundings such as city parks or urban forests. Ten researchers from Canada and one based in the United States formed a team led by Dr. Crouse do determine the health effects of being surrounded by trees and other types of natural greenery.

They undertook an extended study of data encompassing 1.3 million people over an eleven-year time span in cities around Canada, in an effort to understand and determine how people benefit from being in green environments. What they discovered was what they might have expected, except that the rate of benefit far outdistanced their expectation.

Constant, direct exposure to a green environment, they concluded, had the effect of reducing mortality caused by cardiovascular and respiratory diseases by between 8 and 12 percent.


It's no mystery that when you're immersed in an atmosphere of green, growing flora it has a calming effect. That kind of exposure is pleasurable and mellow, tending to a feeling of peacefulness. At risk of appearing maudlin: "at one with the world". But the mechanical properties of plant life represent an invaluable attribute; they cleanse the air we breathe by taking in carbon dioxide and exuding oxygen.

Moreover, when we venture into natural settings, in a park, on a forest trail, we walk or bicycle, exercising ourselves.

Most people acknowledge that having a canine companion results in the feeling of responsibility to get that dog, large or small, out for its daily exercise, a requirement to ensure the dog remains healthy. What works for dogs works for people, and in the very same way; exercise benefits a dog's cardiovascular and respiratory system just as it does for humans. We feel better about ourselves walking among trees and shrubs, and our vital organs, our muscles and our brains benefit.


Statistics Canada's many yearly collections and outputs of data carefully gathered and computed into useful form provide statistics used by many lines of research enquiries as well as for businesses. In this instance, their statistics from 2001 also aided this study which used the long-form census to compare it to mortality data within Canada for the following 11 years; extracting that information helped the researchers gain their end result.

Taking into account, moreover, the aggregate number of trees, plants, shrubs and allied vegetation in a 250-metre proximity to peoples' homes enabled the research team to conclude estimates of daily exposure to living greenery and that exposure's impact on longevity. Interviews resulted in anecdotal accounts of the stress-relieving capacity in green exposure on peoples' minds.

Economics enters the picture when it was judged that those in lower-income brackets may have less leisure time, and less opportunity to immerse themselves in green surroundings.The element of continuous exposure to local parks or trees growing on a boulevard close to one's home which can be passed daily has its benefits, as opposed to once-weekly visiting a treed park.

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Wednesday, October 11, 2017

Drug Trafficking Consequences

"We're trying to show that when we have the information, we're going to pursue the people providing this because it's causing death in our communities."
"We think it's a fairly well known fact that the ingestion of fentanyl can cause death. They are supplying something they know could cause death to the person purchasing it. That's where manslaughter comes in."
Det.Sgt.Brad Reynolds, South Simcoe Police Force

"My son didn't deserve to die, he didn't deserve for these people to sell him this sh-- and for me to wake up in the morning to find him dead."
"Shawny may have held a gun to his own head, but the people that sold it to him are the ones that pulled the trigger."
"He was going to work the next day, he had two little boys to live for. He was on the right path. My son turned to the wrong people and he's no longer here."
Denise Lane, Innisfil, Ontario

"The law is clear that you do incur a liability for death resulting from your distribution of a drug."
"That's because the mental state fault requirement for manslaughter is very low -- the objective foreseeability of bodily harm, not even death."
Alan Young, law professor, York University, Toronto

"Given that it's pretty notorious what fentanyl does to people, it seems to me like a logical progression [police laying manslaughter charges on drug traffickers]."
Kent Roach, law professor, University of Toronto
fentanyl
Fentanyl .. torontosun

A new, and perhaps predictable issue has raised its head; with the public now so well aware of the dangers inherent in the use of powerful opiates like fentanyl and carfentanil, more than proven by the seemingly unstoppable incidences of drug overdoses throughout North America caused by other drugs being doctored with the cheaper fentanyl and the introduction of both these potentially lethal drugs to the street trade, no one peddling the drugs can claim ignorance of its deadly effects.

In choosing to continue selling these drugs to people addicted to opiates, drug pushers are fairly directly responsible for the deaths that ultimately ensue. If and when they can be identified and linked to particular instances of drug overdose leading to death they can now expect that local police forces will be arresting and charging them with homicide. This is not a particularly shocking new revelation, after all.

The notorious case of actor John Belushi who died of a drug overdose appears to have been the breaking point when Cathy Smith was convicted of involuntary manslaughter in a plea deal when she was prosecuted for second-degree murder for injecting Belushi with heroin and cocaine that killed him.

The Supreme Court of Canada in 1993 upheld a manslaughter conviction against a man who provided and injected cocaine into a woman's arm with her consent, after which she went into cardiac arrest and choked to death on her vomit.

Two charges against fentanyl traffickers have been laid by Ontario Provincial Police, while an additional three other traffickers are under investigation for the same offence. According to an OPP spokesperson, it can be expected that such charges will be increasingly used as a deterrent and punishment for those who traffic the drugs in lock-step with the growing death rate due to overdoses.

Two fentanyl suppliers in two separate cases have had manslaughter charges brought against them in the past year in Edmonton, Alberta. In Brantford, Ontario, police charged a man with manslaughter for selling powdered fentanyl and cocaine in early September to a man who died of an overdose. While RCMP in that same month reacted after a man died from an overdose of carfentanil, by charging the man who provided the drug, with manslaughter.

However, in Vancouver where a full-flood fentanyl crisis continues to unfold, no manslaughter charges have been laid by police against fentanyl dealers. "This is a complex issue that our investigators have considered at length. I believe charges and convictions in this area are fairly rare, and are usually only successful when a unique set of circumstances and evidence exist for that particular case", explained Const.Jason Doucette.

This could reflect a police culture at variance with those in other parts of the country. And it could conceivably reflect that this is a less efficient police force, incapable of investigating the source of an ongoing proliferation of deadly drugs, linking specific dealers to deadly events in the aftermath of yet another tragedy.

Fentanyl patches. (Postmedia Network)
Fentanyl patches. (Postmedia Network)

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Tuesday, October 10, 2017

"Three-Parent Babies"

"[The DNA blending technique represents a] novel, promising intervention [allowing women to avoid the potential of children inheriting fatal diseases, and as such should not be forbidden by law resulting from] misplaced apprehension [of interfering with the human genome."
"[Canadians] have the right to benefit from scientific advances [under the Universal Declaration of Human Rights]."
"[The procedure, mitochondrial replacement therapy: MRT], is often the only possible intervention to enable the birth of a healthy, genetically related child for women who carry [mitochondrial mutations]."
"The desire -- and social pressure -- to conceive biological children have been subjects of rich theoretical and health policy inquiry. [The media's reporting of assisted-baby-making techniques] has played no small part in contemporary social constructions of assisted reproduction as being antithetical to 'natural' processes of conception and parenting."
Journal of Obstetrics and Gynaecology Canada commentary

"Were not advocating that anybody can do anything. We're advocating that this should be allowed to go forward."
"Because right now it's impossible because of criminal law -- if you do this, there are jail times and fines, period."
"We can set up an ethical framework and protect Canadians from the sorts of cowboys like Zhang."
"People might say we don't know what the impact of the change is on the children born. What we're saying is, this is one of many discoveries and techniques that are coming, and we don't have a framework whereby we can say whether we should or shouldn't do it."
Dr. Arthur Leader, Ottawa fertility specialist
It's a (controversial 3-parent baby technique) boy!
Controversial 3-parent baby technique: image media

The "Zhang" referenced was to Manhattan-based Dr. John Zhang who has set up his own commercial enterprise providing a form of MRT, promising to guide women in their 40s toward carrying their very own biological babies. Their DNA undergoes a technique whereby it is inserted into younger, fresher eggs provided by younger women at his New Hope Fertility Center. The facility Dr. Zhang opened operates with a stable of fertility doctors able, at a substantial cost, to 'give hope' to women past their normal child-bearing years.

In fact, Dr. Zhang and his clinic have been issued a warning by the U.S. Food and Drug Administration that the technique has not been formally approved for use, and he must cease and desist from promoting and providing his controversial "spindle nuclear transfer" technique. The vast majority of a cell's genetic material (DNA) resides within its nucleus, with an amount less than 1% found in the mitochondria, which in its intact state is passed from mother to child through her egg.

With this technique, less than 0.1% of DNA comes from the donor egg, with the balance of 99.9% contributed by the mother whose DNA the child inherits, while the potential for inheriting a mutation is removed through the process. The ethics involved in this technique is the concern that the process will be used for cosmetic reasons, not reasons linked to avoiding dangerous mutations. And that eventually with the loosening of standards, the technique will ultimately be used to 'design' babies with special attributes of a purely aesthetic nature.

So it is little wonder that this technique, essentially involving two women and a male to conceive a baby, is viewed with concern, the result of which has been that the technique has failed to impress regulators and this is reflected in the law, where it is a criminal offence to knowingly create embryos with DNA from more than two people. The medical specialists who wrote the commentary in the Journal of Obstetrics and Gynaecology Canada have embarked on a mission to overturn the 13-year-old law.
It is a crime in Canada to knowingly create embryos that have DNA from more than two people.  Getty Images
Mutations in mitochondria have the potential to cause fatal metabolic disorders in babies. Babies who inherit mitochondria that may carry mutations can inherit genetic diseases that will affect the neurons and nervous system. It makes sense that women would like to have some guarantee that their babies are not afflicted with any of these potentials. The technique of mitochondrial replacement therapy extracts the nucleus from the egg of a woman whose mitochondria are diseased, injecting it into an "enucleated" donor egg with normal mitochondria.

This is where the dual 'mother' DNA comes in. Used to enable older women to become pregnant and in the process avoiding passing on mutant genes is one thing, using the technique to endow a child with preferred height, colour of hair, of eyes and other features not inheritable from its mother, the primary provider of the DNA, enters a realm of science fiction where replicants and cloning fascinate the human mind and the experimentation of rogue scientists.

The authors of the commentary stress that the techniques around MRT remain in "still-experimental benefits" stages. Their argument is that regulatory and criminal restrictions have the capacity to enhance and promote the phenomenon of reproductive medical tourism, and do great favours to medical outliers like Dr. Zhang who charges $50,000 at his "Darwin Life" clinic to "reverse the effects of age" on human eggs. Both UNESCO and the Council of Europe prohibit the technique.

According to Canada's Assisted Human Reproduction Act, no person shall knowingly "alter the genome of a cell of a human being or in vitro embryo such that the alteration is capable of being transmitted to descendants", for no one knows what such inheritance in later generations can result in.

As for the country's fertility specialists, they strongly urge that the ban on paying donors and surrogates should be overturned; their argument being such that the law drives an underground market, forcing people to import eggs and sperm from the U.S.
"At the present time, there is no such consensus [on how to proceed]."
"We're not really talking about saving lives that exist already. We're talking about creating new lives that are free of disease, and there are other ways we can achieve that objective where we're not prioritizing strong genetic relationships [like using a surrogate or egg donor]."
Bioethicists Francoise Baylis and Alana Cappatan
Scientists use a pipette to remove the nucleus from an egg. OHSU Center for Embryonic Cell and Gene Therapy via AP

What are mitochondria?
Mitochondria are small structures found in our cells that generate the cellular energy used to power every part of our bodies.
Mitochondria have their own DNA, which controls only mitochondrial function and energy production.
This is separate from our "nuclear DNA," which makes us who we are and determines appearance and personality.
Source: Wellcome Trust Centre for Mitochondrial Research

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