Ruminations

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

Friday, July 21, 2017

Living With Blacklegged Ticks

"There are a lot of ticks now that carry the bacteria that cause Lyme disease so we have to be able to provide some answers on how to better prevent infection and treat the disease."
"There are pockets of excellence in Canada on Lyme disease research but we want to bring them together to have more impact."
Dr. Mark Ouellette, scientific director, Institute of Infection and Immunity, Canadian Institutes of Health Research

"It's a complicated disease that is quite difficult to understand -- and it's turning out to be more complex than people originally thought."
Dr. Tara Moriarty, infectious disease researcher, University of Toronto
Lyme Disease
This is the two-year life cycle of ticks. (Centers for Disease Control and Prevention)

Awareness of Lyme disease spread through infected deer ticks has been an issue for decades. Less of an issue in Canada than it has been in the United States, until the blacklegged ticks, aka deer ticks, began spreading into Canada. And now that they have, and continue to spread more widely it is not only Canadians visiting deer-tick-vulnerable places in the United States that contract Lyme disease, but those being exposed to the ticks increasingly right in Canada.

It isn't of course, only humans that are susceptible to Lyme disease, but animals as well. And just as people are cautioned to be aware when they are in wooded areas, of the presence of deer ticks, and to check for ticks clinging to clothing or to human skin, veterinarians warn dog owners of the risks to animals, and that anyone spending time in forested areas would do well to check their dogs for ticks as well. For dogs there is an oral medication to protect against ticks.

For humans, avoidance is the key for the present time. Which is to be alert to the presence of these tiny ticks and if they are found, to remove them as expeditiously as possible, within a 24-hour window representing the time it takes for bacterial transmission once the tick has latched on to human skin. Those troublesome ticks can appear anywhere in an outdoor environment, but mostly in forests and tall grasses.

They don't fly, and depend on animals or people passing by so that when they brush past where the ticks are perched with their front legs outstretched on grasses or leaves, they find their victims. Insect repellent is recommended, containing DEET, as is wearing long sleeves and long pants whenever in wooded areas. If a companion animal picks up an infected tick (not all deer ticks are infected with the Lyme bacteria) it can be easily transferable to a human.
Tick bite
Health authorities have found an increase in cases of Lyme disease and blacklegged ticks. A tick bite can leave a bull's-eye-shaped rash on the skin. (CBC)

And nor do all people who have been bitten by an infected tick suffer Lyme symptoms. It is a small minority of people who develop the hard-to-treat and painful form of the disease. Scientists do not yet know whether Lyme disease leaves biomarkers in the bloodstream representing an opportunity for doctors to diagnose Lyme while yet in its earliest, treatable stages. There is more not known about Lyme disease and its threatening effects than is yet known.

And it is precisely the need to know what it is about the bacteria Borellia burgdorferi that makes people so ill when it spreads within the human body. Dr. Moriarty's laboratory has discovered that in laboratory test mice, obesity and diabetes cause greater susceptibility to the bacteria and it can be the cause of bone loss as well, in mice.

The federal government has just announced a new initiative to spur Lyme disease research to create a network  to establish a nation-wide cohort of patients for the purpose of studying and tracking their experiences with Lyme disease to better understand how the disease manifests itself in those it infects, how to best diagnose and treat it, and how it persists even in people who have received treatment.

Lyme disease cases in Canada saw 144 diagnoses in 2009. An increase in prevalence and diagnoses raised that number to 917 in 2015, and growing nationwide. Estimates by public-health researchers now posit that 80 percent of Eastern Canada's population will live in areas where the ticks have established themselves by 2020, as opposed to the 18 percent represented in 2010 living in areas at risk of Lyme disease exposure.

Authorities caution people that ticks should be removed with tweezers grasping the head, to ensure that the entire tick, a member of the arachnid family, is removed. Discovered in its early stages, the illness the disease creates with flu-like symptoms generally is successfully treated with antibiotics. Untreated, arthritis can ensue, along with numbness, paralysis, heart disorders and neurological problems.

How to avoid tick bites

The best way to prevent Lyme disease is to prevent tick bites by:
  • covering up
  • using insect repellent
  • double-checking yourself
  • washing and drying thoroughly
  • checking your pets

Cover up

Your clothing gives you an important layer of protection. Make sure to wear:
  • light-coloured clothing so you can spot ticks and remove them before they bite
  • a long-sleeved shirt or jacket tucked into long pants
    • tuck the pants into your socks for extra protection
  • socks and closed footwear

Use insect repellent

Use an insect repellent, or bug spray, containing DEET or Icaridin on clothes and exposed skin. Always read the label for directions on how to use it.

Double-check yourself

When you go to an area where blacklegged ticks live, check – and recheck – yourself by:
  • paying close attention to areas such as your scalp, ankles, armpits, groin, naval and behind your ears and knees
  • using a mirror to check the back of your body or having someone else check for you
When you’ve double-checked yourself, don’t forget to do the same for children in your care.

How to remove a tick

Removing a tick is the same for humans and animals. Follow these steps to remove ticks:
  1. If the tick is attached to you, use fine-tipped tweezers or tick removal tool to grasp the tick as close to your skin as possible. Do not use your fingers.
  2. Pull the tick straight out, gently but firmly making sure to remove the entire tick (including the head). Don't squeeze it – avoid crushing the tick’s body.
  3. After removing the tick, place it in a secure container, such as a screw-top bottle used for medication.
  4. Give the tick to your health care professional or local health unit.
  5. Thoroughly clean the bite site with rubbing alcohol and/or soap and water.

Lyme disease symptoms

Common symptoms include:
  • fever
  • headache
  • muscle and joint pain
  • spasms, numbness or tingling
  • facial paralysis
  • fatigue
  • swollen glands
  • expanding skin rash
People with Lyme disease often see symptoms within 1-2 weeks. But symptoms can appear as early as 3 to 30 days after a bite from an infected blacklegged tick.
Province of Ontario website

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Thursday, July 20, 2017

Child Sunscreen Concerns

"It [reaction to sunscreen] could be an allergy to a part of the sunscreen that's not a UV absorber. It could be to a fragrance or a preservative or some other compound used in making up a lotion or a cream."
"[Risk of skin damage from the sun] is worse than the risk of sunscreen use."
Dr. Cheryl Rosen, dermatologist, Toronto Western Hospital
Complaints about the sunscreen include an allegation that it caused 14-month-old Kyla Cannon in Botwood, N.L., to develop a facial burn and blisters.
Complaints about the sunscreen include an allegation that it caused 14-month-old Kyla Cannon in Botwood, N.L., to develop a facial burn and blisters. (Rebecca Cannon/Facebook)

The issue is that some sunscreens have been linked to reactions in children. Sunscreen use is widely recommended by health professionals to ensure that children responding to their freedom to be out playing in the summer sun, do not sustain damage to their skin through burns from penetrating rays hitting their tender, vulnerable skin. The concern goes quite beyond sustaining painful sunburns, and on toward the potential of subsequent long-lasting DNA damage.

"Overall, sunscreens are very safe" assures Dr. Jennifer Beecker, national chairwoman for the Canadian Dermatology Association's program for sun awareness. She stresses the requirement that parents be aware their sun-exposed children need a sunscreen coverage of SPF 30 or greater, but that sunscreen needs to be used discreetly, alongside other measures to protect from sun exposure. That children should be taught to use shade if available, and to be aware that the sun's rays are at their most piercing during the hours of 11:00 a.m. to 3:00 p.m., daily.

The merits of wearing clothing ensuring the least exposure to the sun's rays, when applicable, are not to be overlooked, nor is the use of a head covering and eye protection; hat and sunglasses. All of the above apply to infants under six months of age, with the exception of sunscreens for which research has never been undertaken relating to the safety of sunscreens for the very young. Parents of children who had experienced burns and blisters with the application of Banana Boat products alerted Health Canada to problems they had experienced.

Recently Health Canada had received 139 complaints concerning lotions produced by U.S.-based Edgewell Personal Care. A whopping 133 of those complains were conveyed to Health Canada since May 11, leading a spokesperson for the agency to note it had undertaken a review of the company's laboratory documents confirming a product meets specifications, called certificates of analysis. Their tests to date have identified no issues of concern with the products.

Which has led Health Canada to conduct screening of its own of Banana Boat samples to be able to identify "all drugs present, whether they appear on the label or not". All active ingredients in the products are also being analyzed, so a thorough investigation is being carried out. In its defense, Banana Boat Canada claims its products reflect a neutral pH range and thus cannot be the cause of chemical burns. They do posit that some people may be sensitive to a particular ingredient possibly triggered by sun exposure.
Rebecca Cannon Banada Boat sunscreen
Health Canada says at least 14 of the complaints it received involve claims that using the sunscreen resulted in burned or blistered skin. (Charlene Fudge/Facebook)

Best practice, according to dermatologists, is to place sunscreen on a discrete portion of skin to determine whether it is tolerated, after which more can be tested on a larger area of the skin to clear the product of any possible doubts over whether a reaction would ensue with its use. Dr. Beecker also recommends that parents look for sunscreens that are free of fragrance, with fewer preservatives. One preservative in particular she advises avoiding is methylchloroisothiazolinone, known "to have a very high rate of allergy".

Which then naturally begs the question: if so, they why is it commonly used? A combination of vitamin E and acetic acid -- tocopheryl acetate -- is frequently contained by many cosmetic creams, which also has the potential to become a skin irritant for some people. As for "natural" ingredients such as aloe, chamomile and feverfew, these too are known to potentially be problematical when they act as "photo sensitizers", where their use for some people translates to being more susceptible to the sun's rays.

The risk of damage from prolonged, direct exposure to the sun's rays cannot be overstated. Skin damage has the potential to lead to skin cancer, including deadly melanoma, the seventh most commonly diagnosed type of cancer in Canada, a diagnosis that has risen over the past several decades.

Ryan Truman Banana Boat sunscreen
Ryan Truman's parents say their 3-year-old son developed red skin and his face swelled up after using Banana Boat sunscreen. (Rory and Monika Truman)

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Wednesday, July 19, 2017

The Case Against Artificial Sweeteners as Sugar Substitutes

"I think a lot of people consuming them kind of assume they’re harmless because they contain zero calories. But what the evidence is suggesting is maybe there’s more to the story than that."
"The message is there isn’t strong evidence for a benefit from these products – and there’s potential evidence for harm."
"I’m going to say that you should drink water."
"The results [of the new review] showed a statistically significant association between consumption of artificial sweeteners and higher risks of diabetes, heart disease and increased weight gain."
"Given the widespread and increasing use of artificial sweeteners, and the current epidemic of obesity and related diseases, more research is needed to determine the long-term risks and benefits of these products." 
Dr.Meghan Azad, assistant professor of pediatrics and child health, University of Manitoba

A new study published in the Canadian Medical Association Journal carried out by University of Manitoba researchers reviewing the effects of sugar substitutes in an effort to avoid using sugars in diet-conscious consumers' food choices has concluded that these artificial sweeteners may be responsible for making people gain weight, and increasing as well the onset risks inherent in high blood pressure, diabetes and cardiovascular events such as heart attack and stroke.

While hard-and-fast evidence is as yet elusive, and the study's lead author calls for ongoing research, a leading theory is that the use of sweeteners changes the body's metabolic processes, leading to functional anomalies which confuse the brain and the body's capacity to respond to, and process sugar.

Artificial sweeteners like aspartame represent the most widely used food additives globally. They're found in over six thousand products worldwide as substitutes for sugar in "no sugar added" foods such as ice cream, yogurt and granola bars.

The presence of artificial sweeteners in foods is so ubiquitous that when urine and blood samples are taken from people who state they never use such additives, trace amounts nonetheless show up. "People are consuming them without knowing it", stated Dr. Azad, study lead author.
 
Diet Coke is poured on a Big Gulp cup at a 7-Eleven store     Joe Raedle / Getty Images
A study published in the journal Nature two years earlier had discovered that sugar substitutes act on gut bacteria. Mice fed saccharin for 11 weeks showed alterations in their gut microbiome, and became pre-diabetic, leading Dr. Azad to wonder whether evidence could be found for similar effects in people. This led her and her colleagues to perform a systematic review and meta-analysis (study of earlier studies) to assess the effects of long-term, regular consumption of sweeteners on cardio-metabolic health conditions.

Of 37 studies reviewed which reflected the involvement of over 400,000 people, seven of the studies represented randomized controlled trials involving approximately a thousand people followed for an average of six months. The studies concluded that sweeteners did not demonstrate a consistent effect of weight loss.

Another thirty longer and larger observational studies which had people responding with information relating to their use of artificial sweeteners and who were then followed for an average of ten years, showed a 14 percent rise in diabetes in "high" consumers (people having a diet soft drink at least once or more daily).
 
splenda-rf-getty.jpg
Artificial sweeteners are synthetic food additives that provide a sweet taste to mimic sugar, while containing significantly fewer calories. / Mario Tama/Getty Images
Compared to those reporting never or rarely consuming sugar substitutes, a 32 percent increased risk of coronary heart disease, heart failure and other cardiovascular problems assailed the artificial sweetener users who also evidenced a 31 percent increase in risk of metabolic syndrome, representing a group of conditions which include hypertension and abnormal cholesterol raising the risk of heart disease and stroke.

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Tuesday, July 18, 2017

Controlling Society's Troublesome Children

"[Increase in weight and BMI in children irrespective of the type of SGA treatment] remains of great concern given that childhood obesity can adversely affect nearly every organ system."
University of Montreal research study

"Some kids need these medications to function and to go to school and do well. I don't want people to stop their children's medication if they need it."
"But there are things parents can do to [ensure their children] live healthy lives and [to] prevent some of these side effects. They just need to ask."
"Often these kids will stay on these medications for years, and not be reviewed. We've had kids on them for over seven years."
Dr. Dina Panagiotopoulos, pediatric endocrinologist, B.C. Children's Hospital, Vancouver

"[Weight gains of] this enormous magnitude [can set children up for a future with diabetes and cardiovascular disease] This is a terrifying study."
"[Antipsychotics are being] wildly and recklessly overused, very often by primary care doctors with little expertise or time, under the influence of drug company aggressive marketing."
"It's a form of social control. It's medicalizing problems that are social problems."
"[In instances where extreme behaviour cannot be controlled by other means] that medication may be worth it, despite all the risks. But this should be a very last resort, not a first reflex."
Dr. Allen Frances, professor emeritus, Duke University, Durham, North Carolina
Potent antipsychotics given to children as young as two can lead to significant weight gain, according to new Canadian research into a class of drugs that one prominent American psychiatrist says are being used as tools of "social control."  Getty Creative Images

Researchers from the University of Montreal initiated a study in concern over side effects, whether one drug alone was prescribed, or switched or combined with other antipsychotics prescribed as treatment for children diagnosed with attention deficit hyperactivity disorder (ADHD), aggression and behaviour problems. They took samples of children's height, weight and blood, searching for side effects. And they discovered that after 24 months of antipsychotic treatment, the mean weight of those children increased by 28 pounds (12.8 kilograms).

Of the young people being followed, twenty-three percent became overweight or obese, with close to ten percent developing impaired fasting glucose, a precursor to developing diabetes. The frequency with which children diagnosed with "disruptive behaviour disorder" in ADHD were prescribed antipsychotic medications was found to go beyond mood disorders or actual psychotic conditions, even though national guidelines recommend that these drugs not be used for behaviour problems in children.

Yet children as young as two years of age are being prescribed these powerful drugs meant to be prescribed to adults with serious psychotic issues. Second-generation antipsychotics (SGAs) use for children with ADHD has undergone an exponential growth, prescriptions seeing an 18-fold increase in British Columbia alone in the years 1996 to 2011. Right across Canada in the time frame 2005 to 2009 there was a 114 percent increase in recommendations for children in the use of psychotic drugs to manage their disruptive behaviour.

At Hotel-Dieu de Levis hospital in Quebec 147 children between the ages of ten to sixteen were treated in the years 2005 and 2013, part of a program meant to track the metabolic effects of second-generation antipsychotics on being treated for the first time with these mood-altering drugs that were at one time reserved to treat schizophrenia in adults, and now being prescribed "off-label" for an unapproved age range to adolescent boys and girls and even younger children, for aggression and behavioral problems.

The SGA drugs marketed in Canada include clozapine, risperidone and quetiapine, none of which are authorized for use under age 18 other than aripiprazole, approved for the treatment of schizophrenia in 15 to 17-year-olds. The Montreal study marking the weight increase, published by the Canadian Journey of Psychiatry, warns of serious complications that include high blood pressure, fatty liver disease and increased risk of heart disease and stroke "from childhood onward".

Dr. Panagiotopoulos at B.C. Children's Hospital studied a theory that these drugs affect brain chemicals that function to control hunger and satiety, disrupting normalcy. Her research team found that the actual caloric intake is not seen to sufficiently account for the weight increase, leading to the suspicion that the drugs may affect a child's resting energy expenditure, so that they burn fewer calories. Her research confirms that antipsychotic drugs are now being prescribed to preschool children.

It is vital, she states, that children be monitored every three months during the first treatment year, and thereafter at least once annually. Dr. Frances at Duke University points out that in his experience the reckless overuse of these drugs often targets poor children and children in foster care, as a form of social control.

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Monday, July 17, 2017

"Ego-Driven" Yoga Injuries

Getty Images

"Poses associated with pain first noticed during class appeared to be typical of standard yoga participation."
"Participants may overexert themselves, take a class that is too advanced or try to attain a position they are not prepared for."
"The risks for traumatic, acute injuries may be small, but participants should participate conscientiously to improve or avoid musculo-skeletal pain. Those with existing pain should be even more careful."
"Indeed, 20.9 percent of participants in the current sample reported existing pain that was exacerbated by yoga participation."
Hidden Risks of Yoga study, published in the Journal of Bodywork and Movement Therapies
yoga injury

Studies exist that document yoga's functionality in diminishing back, neck and joint pain. Many yoga practitioners styling themselves as practised yoga instructors boast that they have the knowledge to help people attain improved posture, strength, flexibility and balance. Among these yogis may be some whose knowledge fails to match their enthusiasm, let alone their promises of no-pain guidance in yoga.

Millions of people don't hesitate to place their trust in the healing and restorative powers of yoga, unfailingly attending their local yoga studies, trusting that the training and experience of the instructor who leads their classes does truly reflect what the public relations and advertising boasts claim from among the many and varied yoga practises and certification programs.

But the fact is that people do sustain injuries during their yoga classes, and so the authors of this new study, coming from Boston, New York and Sydney, Australia, collaborated in reviewing published literature studying the issue. Through their reviews they discovered yoga-related injuries reported to range from 2.4 percent annually ranging up to 21.3 percent representing lifetime injuries.

They decided to use questionnaires, sending them out to several thousand participants from among whom they sought volunteers willing to report their yoga habits and any pain that might be associated with them. Another questionnaire followed up a year after, to the 354 recreational yoga practitioners who had agreed to take part in the study.

Respondents, mostly female, had an average age of 45.7 with about ten years of yoga experience which they practised three hours weekly, on average. And of that number the majority (86.7 percent) faithfully reported experiencing pain in at least one area of the body, along with many (65.8 percent) feeling that practising yoga improved their discomfort.

On the other hand, 10.7 percent claimed that it was yoga itself that caused their pain, with a third claiming the pain they suffered mitigated against their practising yoga for as long as three months at a time. Roughly 50 percent of those injured stated they sustained their injuries during a yoga class, with another 21 percent adding that yoga worsened existing pain.
Photo: Heidi Kristoffer

Practising yoga was most likely to relieve pain and discomfort in the back and neck for practitioners, while the most common injury sites turned out to be the wrists and hands. The study authors specifically mentioned other studies that named headstands, shoulder stands, the lotus position, half lotus position, forward bends, backward bends and handstands to have been noted for their propensity to increase risk of injury.

In interviews with yoga instructors, issues such as excess effort, poor techniques and inadequate instruction were cited as additional sources of injury, to which was added "ego-driven" performance. It seems logical enough to reach the conclusion that the widespread belief in yoga as being a remedy for what ails, convinces people to feel they are safe in making efforts to go beyond their physical limits.

Even so, injury rates sustained in the practise of yoga are seen to compare with those sustained through other forms of exercise.

A University of Sydney study found yoga caused musculoskeletal pain – mostly in the arms – in more than 10% of participants. Photograph: Bartlomiej Zborowski/EPA

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Sunday, July 16, 2017

Society's Killers-by-Default?

Bottles of painkillers
Photo: The Atlantic
Big Pharma is being introduced through the courts to the power of public concern over their products. The drugs, OxyContin, Percocet, Opana and a generic version of oxycodone are not illegal, they have a place in responsible use by medical professionals when the attributes they are capable of are called upon to ease peoples' suffering and pain. But their manufacturers deliberately and with the prospect of enriching themselves, launched public relations blitzes convincing prescribing doctors that these opiates are 'less addictive' than others which have been a bane to society, not a boon.

Public authorities are alarmed throughout North America at the carnage that the drugs' dependencies are wreaking through drug overdose deaths. The general public has been made aware that they live in a time where the "culture of drug dependence, dysfunction and death" has affected the larger society, not only drug addicts dealing with mental instability, crime and profit, feeding addictions, but ordinary, middle-class and upper-middle class professionals who have lost their way, becoming hopelessly in the thrall of death-delivering medications.
"[The opioid epidemic was produced by a] fraudulent scheme [engineered by Purdue Pharma, Mallinckrodt Pharmaceuticals and Endo Pharmaceuticals] to mislead doctors and the public about the need for, and addictive nature of opioid drugs."
"They put millions of dollars into advertising. They put lots of sales forces out there. And they supported legislation that made this stuff far more available than it was before. And it's not enough to say, 'Well, people misused it'."
"When you put way too many drugs, for way too many bad reasons, into way too many people's hands, prescribed by way too many people, you get what we have in our area, which is an epidemic."
Barry Staubus, District Attorney, Sullivan County, northeast Tennessee
Photo: The Atlantic

The entire world knows about the legal battles undertaken by various governmental bodies to punish tobacco manufacturing giants in 1998 when they were accused on the evidence which revealed they were in the business of deceiving the public trust about tobacco addiction. They were ordered to pay out over $200-billion in fines to aid government in cost outlays associated with providing health care to smokers whose lung cancer was directly attributable to scientifically validated and acknowledged carcinogens present in cigarettes.

A new battle  has been mounted by public authorities whose areas have been hit with the still-emergent epidemic of drug overdoses. Attorneys general of Ohio, Missouri, Mississippi and Oklahoma, along with counties in California and New York among others, have launched lawsuits against the offending pharmaceutical giants. This is just the beginning. There will be an increasing number of lawsuits. And, as with the battle against tobacco manufacturers when those suits have been settled, individual civil suits will be launched.

In 2015, opioid overdoses caused the deaths of 33,000 people in the United States. This is fast becoming a crisis of intense and untenable proportions, no little of the sense of urgency to do something to ameliorate the situation and name and punish the perpetrator, that white-middle-class suburbanite communities with political influence, has persuaded politicians of all stripes to become involved, as the issue keeps gaining momentum.

There is no disagreement among public health experts to the obvious; that legal painkillers are the cause of a crisis where prescription opioids steadily gained prominence through wide prescription practices, habituating users to search out ever more powerful drugs, leading them on to heroin. OxyContin maker Purdue was persuaded to plead guilty in 2007 to a criminal felony, admitting to fraudulent practices, inaccurately promoting its product as less likely to be abused than other drugs, leading to a $600-million settlement.

"The drug companies are not utterly defenceless. There are issues they can raise and they're pretty good at it", observed University of Kentucky law professor, Richard Ausness. All they have to do is point out that prescription opioids have a distinct purpose, aiding patients in coping with pain issues, as long as they are used responsibly, and therefore they have a place for good health reasons in the prescription pharmacopoeia.
Prescription and illegal opioids are commonly abused because they are so addictive. <br /><br />Opioid medications bind to the areas of the brain that control pain and emotions, driving up levels of the feel-good hormone dopamine in the brain's reward areas and producing an intense feeling of euphoria.<br /><br />As the brain becomes used to the feelings, it often takes more and more of the drug to produce the same levels of pain relief and well-being, leading to dependence and, later, addiction.
Prescription and illegal opioids are commonly abused because they are so addictive, binding to areas of the brain that control pain and emotions. Photo CNN

They were given a scientifically-approved clean bill of  health when government health regulators themselves studied, then endorsed prescription opioids, releasing them for wide use. In any event, it is medical professionals themselves who stand between the manufacturers and the patients. "Unlike tobacco companies, our products are medicines approved by the FDA, prescribed by doctors, and dispensed by pharmacists, as treatments for patients suffering pain. [The company] vigorously [denies allegations, and is] committed to working collaboratively to find solutions [to the crisis]", Purdue huffed righteously.

The maker of Percocet and Opana, Endo Pharmaceuticals, chooses to side-step any awkward acknowledgement of impending litigation: "Our top priorities include patient safety and ensuring that patients with chronic pain have access to safe and effective therapeutic options". How can any one argue with that selfless, public-service-focused statement, of a totally innocent manufacturer whose only interest in producing drugs is to serve the public?

Ohio Attorney General Mike DeWine announced Wednesday the state is suing five pharmaceutical companies, claiming the companies knowingly understated the addiction risks of prescription opioid medication.
Ohio Attorney General Mike DeWine announced Wednesday the state is suing five pharmaceutical companies, claiming the companies knowingly understated the addiction risks of prescription opioid medication.(Jackie Borchardt, cleveland.com)

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Saturday, July 15, 2017

Medical Priorities

"It's quite obvious that we could be utilizing those operating rooms for a longer period of time for performing medically necessary surgeries."
"All you have to do is look at the waiting list for surgeries."
Dr. Mitchell Brown, Canadian Society of Plastic Surgeons

"I can see how in certain segments of society [aesthetic surgery in public facilities] would raise eyebrows."
"I can also see this is a means for hospitals to raise revenue."
"Hospitals are pretty much all working in the red, and this is a source of revenue for them."
Dr. Brian Bottenberg, otolaryngologist/ear, nose and threat specialist, London, Ontario
In crunching the numbers of 1,109 patients with documented reasons for delayed surgery, the researchers found that almost a third of cases were delayed because of a lack of personnel. Trevor Lush / Post Media.  Patients whose emergency surgery is delayed are at a higher risk of dying, stay longer in hospital and cost the system more money, says a groundbreaking study at The Ottawa Hospital.
Are hospitals in Canada underfunded? The estimated health expenses in Canada are representative of 11.1% of the country's GDP, at $228.1 billion for a population of 36 million people, and a steadily growing cohort of the elderly.  Of that total expenditure, the majority is spent on hospitals, at 29.5%, while drugs take up another 16% and doctors' fees 15.3%, according to the Canadian Institute for Health Information in their latest, 2016 update.

Though health care spending is varied across the country, on average each of the provinces spends about 38% of their total budgets on health care. Per capita that comes out to $6,299 for all of Canada in figures representing the situation in 2016. The variances range from $5,822 in Quebec to a much higher $7,256 in Newfoundland and Labrador, according to the Canadian Institute for Health Information. 

The single most inefficient index of health care performance in Canada is long wait times for surgery. Some Canadians with health conditions requiring urgent amelioration wait months for medically necessary surgeries. Yet public hospitals country-wide are now revealed to be providing operating room space routinely for cosmetic, privately paid operations.
Are cosmetic surgeries done in public hospital operating rooms?
  • Health Sciences Centre, St. John’s — Yes
  • McGill University Health Centre, Montreal — Yes, very few
  • Jewish General Hospital, Montreal — No
  • Ottawa Hospital — No
  • Scarborough and Rouge Hospital, Ontario — Yes
  • Southlake Regional Health Centre, Ontario — Yes, 120 last year
  • London Health Sciences Centre, Ontario — Yes, 74 last year
  • Trillium Health, Ontario — Yes, less than 16 a year
  • William Osler Health Centre, Ontario — Yes, 150 a year
  • Sunnybrook Health Sciences Centre, Toronto — No
  • University Health Network, Toronto — No
  • North York General Hospital, Toronto — Yes, 168 last year
  • Winnipeg Health Sciences Centre — Yes, 10 a year
  • Saskatoon Health region — Yes, very few
  • Calgary health region — Yes, 110 a year
  • Vancouver Coastal Health — No
  • St. John Regional Hospital — No response
  • QE2 Health Sciences Centre, Halifax — No response
  • Mackenzie Health, York region, Ontario — No response

These would include breast enhancements, nose jobs, and a range of additional aesthetic, non-essential procedures carried out through daytime hours where the same facilities and support staff employed for heart bypasses or liver transplants are all deployed. In seven provinces 15 hospitals or health regions responded to investigative queries, to confirm that they permit some cosmetic surgery cases to take place in public hospitals.

What is revealed is that despite the immense and steadily increasing funding to hospitals through government support, that funding has proven insufficient to enable operating room hours to be expanded. The typical hours of surgical use for operating theatres is from 8 a.m. to 3:30 p.m. to enable medically necessary surgeries to take place, according to responses from these facilities.

The entire day is not, despite the crush of patients awaiting surgery of urgent dimensions, given over to public tax-paid operating room costs. Hospitals permit non-urgent, purely aesthetic, patient-paid surgeries to take place in those off hours, citing the fact that they do not affect wait lists, and help the hospitals' bottom line. Over 20 percent of "priority" treatments such as hip replacements see 20 percent of patients waiting longer than the recommended six months after seeing an orthopedic surgeon.

And while most hospitals charge patients having cosmetic surgery conducted in their operating rooms, the fees are evidently less than what private clinics with more limited facilities charge. The hospitals run the gamut from only a handful performed annually in certain hospitals to hundreds of non-essential aesthetic procedures taking place in hospitals that permit them. "NYGH (North York General Hospital) was not funded to run the operating rooms for the times that the (non-medicare) procedures took place, which allows us to make those ORs available" stated Nadia Daniel-Colarossi defensively where 168 aesthetic procedures took place in 2016.

She took care to stress that a total of 16,000 surgeries took place in 2016 at her hospital, placing the 168 cosmetic surgeries in some perspective. On the other hand, if the public funding were available to open up those ORs during unbooked times, that would represent 168 patients awaiting surgeries of an urgent dimension, having their necessary operations take place.

"These procedures are performed in otherwise unused blocks of operating room time", spokesperson Matt Haggerty of Southlake Regional Health Centre in Newmarket, Ontario, emphasized where 120 patient-paid cosmetic surgeries a year take place, representing close to one percent of the total surgeries undertaken there. And these numbers are reflected across the country in various public hospitals and other tax-paid institutions.

It seems clear enough that though hospitals claim the charges they levy help them cover general operating costs, they do not really reflect patients undergoing breast-lifts or stomach-tucks in such taxpayer-funded facilities compensating the public adequately, taking into account patients are attended by larger medical staffs and have access to more sophisticated equipment, in comparison to private clinics.

Even as Canadians still wait months for many medically necessary operations, public hospitals provide OR space for private, cosmetic surgery, the National Post found. Getty Images

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