Ruminations

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

Monday, August 31, 2015

The Deadly Summer of 2015

As temperatures reached up to 49C in Karachi, Pakistan in June, reports circulated that local morgues were running out of space to accommodate the bodies of the dead. "They are piling bodies one on top of the other", Dr. Seemin Jamali a senior official at the city's largest government hospital said at the time. More than two thousand people died that month in Pakistan, most in Karachi. An even deadlier heat wave -- the fifth-deadliest ever -- swept through India in May, claiming more than 2,500 lives and melting asphalt roads. More than one hundred people died from the heat in August in Egypt, while at least 90 deaths were reported in Japan.
Nick Faris/Catherine McIntyre, National Post


This has been a hot summer. Summers do tend to be hot. Particularly around the equator. But this summer was deemed by the U.S. National Oceanic and Atmospheric administration to be one for the history books as the warmest year in recorded history. May, June and July among the five months qualifying as extraordinarily hot, were the warmest ever experienced, while July is considered to have been the hottest month ever across the land and ocean surfaces of the Globe.
  • Ashgabat, Turkmenistan: 47.7C June 30, previous record set in 1891.
  • Walla Walla, Lacrosse and Chief Joseph Dam, Washington: Three towns reached 45C in June, breaking the all-time high of 43.9C in Washington set in July 2006.
  • Urumita Colombia: 42.2C the hottest day ever in Colombia on July 1, besting the 42C record set on June 27.
  • Kitzingen, Germany: 40.3C July 5, hottest day ever in July for Germany, breaking previous record of 40.2C set in 2003 and 1983.
  • Madrid, Spain: 39.9C on July 6, as opposed to 39.5C reached July 1995.
People, desperate to find relief from the stifling heat and humidity have tried remedies both new and old. Wherever water was to be found, people doused themselves. Young and old stayed in the shade and hurried to pools, lakes and rivers. When water shortages loomed in villages across India in May volunteers handed out pouches of buttermilk and raw onions representing an Ayurvedic Hindu medicine practise to hydrate the body.

Pakistani men rest under a bridge during a heat wave in Karachi, on June 29, 2015, Rizwan Tabbasum, AFP/
Getty Images

In Turkey at least a hundred people were reported drowned, attempting to find some relief from the oppressive heat, during a late-July, early-August heat wave. In India, the deadly heat wave destroyed over 17-million chickens leading to a steep rise in poultry prices. In Thailand, severe drought hit the world's biggest rice exporter damaging 80 percent of the country's rice farms, resulting in a 20 percent drop in yield.

Brazil is anticipating its smallest coffee crop since 2009; ten percent lower than the year before, related to two months of record-low rainfalls in the southeast where over 90 percent of Brazilian coffee beans are grown. Tanzanian farmers are uprooting their coffee trees to replace them with hardier vegetables like cabbage and onions. California's agricultural stability was hard hit by persistent hot, dry weather causing it to write off over 500,000 acres of crops.

Climate change is believed to be playing a role in the kind of extreme weather patterns seen around the world, but environmental scientists are also pointing to a brutal El Nino this year, held by many to be the real cause of the 2015 summer year of extreme heat conditions. When dwindling trade winds disrupt the flow of warm water from close to the equator to cooler parts of the ocean, the El Nino climate phenomenon kicks in

A pool of heated water is created in the Pacific, some hundred metres deep and with a wide circumference. That heated water rises into the atmosphere, in the process creating greater extremes of chaotic weather in counties closest to the equator.

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Sunday, August 30, 2015

Medicine's Astonishing New World

"Ultimately, everyone will want everything 3D-printed. It's not a question of what will be 3D-printed, it's a question of what will not be 3D-printed."
"The ability to work with the [3D-printed model, pre-surgery] model gives you an unprecedented level of reassurance and confidence in the procedure."
"For surgeons who have 3D printing, most won't go into the operating room without it for a complicated procedure."
"It allows for incredible customization. This is the ultimate form of personalized medicine."
"There's great value in going to a place where you can direct a group and develop the technology the way you think it should be done."
"Ultimately, you have to show it's financially viable. But really, I think the savings are going to be unbelievable. It will happen."
Dr. Frank Rybicki, chief of medical imaging, The Ottawa Hospital
Dr. Frank Rybicki holds a 3D model of a child's heart. Models help surgeons plan and perform intricate operations. (Darren Brown/Ottawa Citizen)
Dr. Frank Rybicki holds a 3D model of a child’s heart. Models help surgeons plan and perform 
intricate operations. Darren Brown / Ottawa Citizen
The 3D printer that is on the brink of revolutionizing manufacturing, let alone medical technology, was invented in 1983 by an engineer from an American company that used photopolymers to create a plastic veneer on furniture in their manufacturing technology. During the course of his work, Chuck Hull wondered whether the same protocol used in coating furniture with acrylic-based liquids could be used to produce three-dimensional objects comprised of multiple thin layers of acrylic hardened with UV light from a laser beam.

His first, modest design has long since been improved upon; 3D printers are capable of using all manner of materials to produce the desired object; materials like metals, ceramics, sugar, rubber, plastic, chemicals, wax -- and, amazingly, living cells. The leap from concept and design to the finalized product is amazingly swift. These printers are now indispensable to researchers, to manufacturers, and even to ordinary people wanting to experiment themselves, at home.

As the printers' speed of production has been stepped up, along with their versatility, their cost has diminished, so that even home inventors can acquire these incredible devices. A home desktop version is available from Home Depot for $1,699, and the DaVinci Junior 3D printer is available from Amazon.com for $339.

Medical researchers are now planning to engineer implantable livers, kidneys and other body parts, with 3D printers. New limb joints made from a patient's own tissue and implantable skin for burn victims are being produced by Canadian scientists with the use of 3D bioprinters. Those 3D printers don't, however, come cheap, clocking in at $150,000.

This technology is transforming applications of medical surgeries in ways that could never before be imagined. Doctors in Britain used 3D-printed models, surgical templates and titanium implants to repair facial injuries sustained by a 29-year-old man in a motorcycle accident. A 3D-printed titanium plate solved a hole created by cancer surgery, which caused the patient's eye to sink into the hole when the diseased part of the orbital bone was removed.

Last year in Beijing, surgeons implanted 3D-printed vertebrae in a 12-year-old boy with a malignant tumour in his spinal cord. Doctors in Ann Arbor, Michigan saved a critically ill child by designing and implanting a 3D-printed splint to hold his collapsing windpipe open. Customized body parts, surgical tools, pharmaceutical drugs, and living tissues are now being designed on computers and produced with 3D printers building, layer by layer, three-dimensional objects.

In recent years, 3D printers have succeeded in producing bones, ears, exoskeletons, windpipes, jawbones, cell cultures, stem cells, blood vessels, vascular networks, and organ tissue, according to an article recently published in the medical journal Pharmacy and Therapeutics. Custom-made skull plates, knee implants, hip joints, hearing aids and dentures are now more commonly produced with the aid of 3D printers.

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Saturday, August 29, 2015

Trusting the Professional Skills of the Rest-Deprived

"Overall, the risks of adverse outcomes of elective daytime procedures were similar whether or not the physician had provided medical services the previous night."
"Attending physicians have greater experience than trainees, which may compensate for decrements in performance so that clinical outcomes are not affected."
"More important, attending physicians may exercise professional judgement and self-regulate their practise the next day by cancelling surgeries or arranging for coverage by colleagues if they feel too fatigued to perform surgery safely."
"However, the effect of profound sleep loss may warrant further study, and it remains important for physicians to critically assess the effects of all sources of fatigue on their individual ability to treat patients and self-regulate their practices appropriately."
Study: Institute for Clinical Evaluative Sciences, Toronto
Jean-Sebastien Evrard/AFP/Getty Images

It would appear that the performance of medical trainees, famously sleep-deprived throughout their medical internships have been the focus of most such studies to evaluate performance levels of sleep-deprived professionals undertaken in the past. Those studies concluded that mood, cognition and "psychomotor function" stood to be impacted through sleep deprivation on the part of medical interns or trainees. This led, logically, to North American residency training programs instituting reasonable duty-hour restrictions.

Now, a new study out of Ontario and published in the New England Journal of Medicine -- where about 39,000 patients who had undergone a dozen surgical procedures, ranging from bypass and spinal surgery to hip and knee replacements at 147 Ontario hospitals between 2007 and 2011, which examined practised surgeons' performances when sleep deprived -- concludes that concern is misplaced when it is skilled practitioners who are involved, not trainees.

The result of the study was that a surgical procedure is perfectly safe and the result predictably so despite being performed by a physician who had not slept between midnight and 7:00 a.m., going on to perform daytime operations following all-night work. Patients are no more likely to die, to suffer complications, or to be readmitted to hospital, than those who experienced their surgery done by a fully-rested doctor, the research held.

The study examined the work-and-sleep-deficits of 1,448 different doctors. Half of the patients had been treated by doctors who had delivered overnight medical care to patients, and then prepared to do the same with daytime patients. An equal number of patients received similar elective procedures from the same number of adequately-rested physicians. The analysis held that the rate of death, readmission or complication was identical between the two groups.

Taken into account was the physicians' age or the type of medical procedure involved, when evaluating the outcomes. On the other hand, a "small but significant" increase in complications was noted among those patients whose doctors had performed two or more procedures the previous night. The differential, however, was considered not sufficient to justify concerns over surgical outcomes performed by sleep-deprived doctors.

While agreeing that sleep deprivation and fatigue could have the potential to affect physician performance, the conclusion seemed to be that adjustments in policy shifts relating to duty hours and the practices of attending surgeons "may not be necessary at this time", according to the researchers. Which does seem strange, when taking into account that "small but significant" increase in complications noted.

And the equivocating statement on the ability of physicians to themselves recognize whether they have been sleep-impaired and accordingly call on others to fill in for them, and the importance placed in physicians critically assessing fatigue effects on their capacity to function professionally. There are so many variables at play here; professional pride, stubbornness of character, failure to recognize just how spent their energy is, that it would simply seem to be common sense to assume that lack of rest equals potential impairment.

Bearing in mind that the patient is at the merciful skill of the surgeon, without being aware that the health professional's skills may have been compromised by lack of adequate rest prior to operating. In full fairness to the patient, there should be hospital rules and regulations pertaining to the dependability of the physician attending to the condition of the patient before surgery is embarked upon.

Much depends upon the professional acuity and capability of the doctor whom the patient trusts is operating under ideal circumstances.

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Friday, August 28, 2015

Zimbabwean Natural Resources

"Quinn bore the full brunt of the charge and, unable to fire his rifle due to the speed of the attack, literally stopped the attack of the lion on his group by placing himself directly in harm's way."
"Having been thrown to the ground, bitten in the shoulder and neck Quinn sadly died at the scene, the shouting of his guests driving the lion away from his body and allowing, ultimately unsuccessfully emergency first aid to be performed."
Camp Hwange, Zimbabwe

"It's a safe experience [wildlife walking tours through Hwange National Park] and a great experience too. It's not as if these attacks happen daily."
"It was an accident and we are still recording huge interest from tourists. It's popular and will remain so."
Trevor Lane, Safari Operators Association of Zimbabwe
So 40-year-old Quinn Swales, a walking tour guide who works for Camp Hwange at Zimbabwe's Hwange National Park, was the victim this time in a human/wild beast interchange; quite unlike the stalking of a favourite celebrity lion from the same park that aroused so much indignation by outraged animal lovers when a wealthy American dentist arranged with a local hunting guide to tempt the lion away from the preserve so he could shoot it with a bow and arrow.

On that occasion, a month ago, Cecil the lion was illegally killed. The arrow shot by Walter Palmer, a trophy hunter from Bloomington, Minnesota only wounded Cecil and he lived in agony for another day before he was finally tracked and shot, putting him out of his misery, and setting the law and public outrage against his killers. For his prideful pains, Dr. Palmer will now live in infamy, and the Zimbabwean hunter who aided his vanity will serve time in prison.

Cecil the Lion
Star: Cecil was a major tourist attraction at the Hwange National Park

In the most recent exchange between man and beast, Mr. Swales was leading a tourism wild-animal-sighting party when they happened upon a pride of lions. Which was the point of the exercise. As an adult male began closing in on the group, their guide cautioned everyone to line up behind him and be perfectly physically still, as they shouted loudly in hopes the racket would deter the lion from continuing its approach.

It did not, and the attacking lion, whose name is Nxaha, killed the guide, but finally turned away from the others. It will be up to Zimbabwe's National Parks & Wildlife Management Authority to determine what will be done with Nxaha, a satellite collar-wearing animal resident in the national park. Zimbabwe, infamously, is a country whose dictatorial megalomaniac president-for-life, Robert Mugabe's policies has destroyed the country's economy.

A country that was once a regional breadbasket, capable of exporting its agricultural products abroad for gain, while still feeding its own population, now must import food, suffers high unemployment, staggers under an impossible-to-manage inflation rate, has a destroyed currency, and high crime rates. But President Mugabe has resorted to using his country's natural endowments to help keep its economy afloat, despite the monumental adversities he is responsible for.

Tourism is still a draw in Zimbabwe. Apart from which another initiative has been implemented, the sale of hundreds of the country's natural resources, its elephant population. Hundreds of baby elephants are being sold to interests abroad, most going to China. The deal is controversial on the international scene, far less so internally, since dissent is not known to be encouraged in a dictatorship.

Not only are elephants mercilessly hunted for their ivory, much in demand in China, but now hundreds of the beasts will be shipped off to China to be placed in a Guangdong Province Safari Park, in an agreement worth tens of millions to Zimbabwe, or perhaps Mugabe's personal bank account and those of his cronies.

Elephants roam freely near the railway track that Cecil the lion crossed when he was lured onto a farm to his death in Zimbabwe, Aug. 6, 2015. The cash-strapped Zimbabwean government has a controversial deal to sell elephants to China.
AP Photo/Tsvangirayi Mukwazhi   Elephants roam freely near the railway track that Cecil the lion crossed when he was lured onto a farm to his death in Zimbabwe, Aug. 6, 2015. The cash-strapped Zimbabwean government has a controversial deal to sell elephants to China.

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Thursday, August 27, 2015

Immunization As A Social-Medical Priority

"[Fewer than five to ten percent of parents have strong, anti-vaccination views, yet] many more parents have doubts and concerns."
"[A declaration of immunization] coupled with a requirement to meet with public health if it's not up to date, provides the opportunity to understand why the parent hasn't fully vaccinated the child."
"[Such a meeting between parent and public health representatives would present an opportunity] to fully inform those [parents] who may be hesitant." 
"Physicians have a critical role to play in vaccination. It’s an important issue to me because it’s difficult … to understand why a demographic is ignoring medical advice."
Dr. Chris Simpson, past president, Canadian Medical Association

"We're looking to have a very reasoned, rational conversation with our patients, and not have a situation where someone is telling them what to do."
Dr. Cindy Forbes, president, Canadian Medical Association

"While immunization is an area that impacts the practice of a majority of CMA members, both family practitioners and specialists, the medical community has not been very vocal in the current conversations."
"This is a vacuum that CMA could fill by playing a major role in bringing together the expertise to support its members, work(ing) to improve immunization rates and ultimately improve population health."
Canadian Medical Association background paper on immunization uptake

In Canada, the provinces consistently fall below national targets for vaccine coverage for six preventable diseases: invasive meningococcal disease, invasive pneumococcal disease, varicella, pertussis, influenza and rubella. The goal is to ensure that sufficient numbers of children entering school and throughout their school years receive regular vaccinations to ensure herd immunity. Parents, on registering their children for school attendance, are required to fill out a record of their child's immunization history.

Ontario and New Brunswick are the two provinces where childhood vaccination is mandatory, and even they are falling behind national vaccine coverage targets. Increasingly, parents are balking at having their children vaccinated. They have fallen prey to false and misleading claims that vaccines harm children, that inoculations have the capacity to cause other illnesses like autism, or convey not immunity but actually infect their children with the very same active disease-causing properties immunization is supposed to evade.

At the Canadian Medical Association's annual general council meeting, while voting members rejected a proposal for a national compensation program to affect those in the public who may suffer from injuries effected through immunization -- rare though the occasions may be -- there was a more general agreement that governments be encouraged to authorize a firm requirement that parents be expected to proffer proof of vaccination before their children will be admitted to school.
Video thumbnail for Why vaccinate: a Montreal doctor's explanation
When the goal of herd immunity is not achieved through vaccine uptake -- a larger percentage of children immunized to ensure that the much smaller minority that are not are unlikely to become infected and start a flood of disease outbreaks, the system breaks down. The current and growing phenomenon driving down immunization rates for avoidable diseases is leading to a collapse of herd immunity. The resolution that passed targets parents whose children have been "inadequately vaccinated", without calling on mandatory immunization.

Over a third of Canadian parents now appear to believe that vaccines actually cause outbreaks of the diseases they are formulated to protect against or prevent. Outbreaks of measles in the United States and parts of Canada sharpened the focus on the issue. Measles infection is concerning since it is a hugely infectious disease capable of causing blindness, brain swelling and severe respiratory disease, including death in severe and rare cases.

In Ontario, exemptions on religious grounds have been accepted up until the present time. But with the growth of a contingent of parents suspicious of medical science coupled with the perceived greed of pharmaceutical companies suspected of creating a market for themselves, parents have been increasingly rejecting vaccinations for their schoolchildren. Implementation of the full schedule of recommended shots for children is of vital importance, however. Not only for the health and welfare of individual children, but for the entire population of schoolchildren.

Video thumbnail for Doctors group calls for parents to prove immunization to schools

"[Should a child suffer a severe side effect resulting in a permanent handicap, rare though it is], we thought they should know they would be compensated for the rest of their lives. Statistically the risks are very low [but while vaccines are overwhelmingly safe], we have to be honest. There are side effects to vaccines."
"I was worried [myself] as a parent, 'Will my kid be the victim — the one in 10 million or six million (who develops) severe encephalitis with this vaccine'?"
"But if everyone decided not to vaccinate their children, we would be back to a situation where we would have tens, and maybe hundreds of deaths yearly in Canada from measles."
Quebec physician Dr. Pierre Harvey, CMA board member
In the end, the motion was rejected, in part due to concerns it might send the wrong message to the public that vaccines are dangerous. Realistically speaking, however, it might have been a far better decision to proceed with the recommendation to aid parents and children, however rare the occasion might be when such assistance can make a huge difference to the quality of life of someone whose condition was brought about as a result of a rarely-occurring side effect.

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Wednesday, August 26, 2015

Physicians Prescribing Pain-Killing Death

"What I frequently see is undisciplined, unstructured and arbitrary use of these medications [most often by] a well-intentioned, but weak-willed and under-informed physician who has lost control of the patient-doctor relationship."
"We don't think that there are malignant, bad doctors knowingly feeding this problem If there are, they are few."
"Quite frankly, patients show up expecting pain treatment and expecting to be pain free."
Dr. Douglas Grant, CEO, registrar, College of Physicians and Surgeons of Nova Scotia

"There is no doubt that we are in the midst of an epidemic of opioid-related deaths."
"Whether it's an overdose, or whether you just had too much drug in your system and you had a couple of glasses of beer and went to sleep, that's enough to do it."
Dr. David Juurlink, head clinical pharmacology and toxicology, Sunnybrook Health Sciences Centre, Toronto

"[There is] massive ignorance [of the complexity of addiction and pain treatment]. The solution is to get better care for pain, and better care for addiction, not to demonize a drug or a class of drugs and try and identify simplistic solutions like increasing the regulation of those drugs."
Dr. Mary Lynch, professor of anesthesia, psychiatry and pharmacology, Dalhousie University, Halifax


In 2014, a greater number of people in the United States died of opioid-related deaths than from car accidents. And that statistic is little different in Canada where the prescription of opioids ruining lives "is a problem of enormous magnitude that is killing people", according to Dr. (Gus) Grant, speaking before delegates at the Canadian Medical Association's annual general council meeting. Doctors prescribing powerful narcotic painkillers like oxycodone, he contended, don't adequately understand the drugs.

Another doctor speaking at the meeting stated that in Canada too, "We kill more people now than cars do." And the simple fact has emerged that Canadian doctors present among the highest prescribers of opioids in the world. Some family physicians practising in the Province of Ontario alone, are responsible for prescribing 55 times the quantity of opioids to their patients, as do other doctors in catering to the health needs of people in their care far more responsibly.


"If we were doing that with something like blood pressure medications or cholesterol meds I think there would be hell to pay, but somehow it's OK because it's only narcotics", commented Dr. Christopher Milburn of Cape Breton. Safe medical practise does not condone the free prescribing of opioids in extremely high dosages. Yet it happens and one woman in British Columbia with multiple identities obtained and filled over 250 prescriptions for a variety of narcotics from various doctors and pharmacies in a six-year period.

Regulators released a report stemming from a two-year investigation which was critical of 46 doctors whom they held responsible for "deficient prescribing practices" related to that rather spectacular fraud case. Across the country police have been intensifying warning about fentanyl, a drug that is so powerful, it can be 50 to 100 times more morbidly toxic than morphine. And even as fentanyl circulates as the street drug of choice, deaths reflecting tainted street formulations of fentanyl have been steadily increasing.

The Canadian Community Epidemiology Network on Drug Use recently released a report pointing out that between 2009-14, fentanyl was identified as the cause or contributing cause of at least 655 deaths. Since OxyContin was reformulated with a "tamper-resistant" version, the drug that was the single most common drug safety problem, helped increase opioid abuse. According to a recently published study, patients prescribed high-dose opioids-- 200 mg or more of morphine per day become 24 times likelier to die from the drugs.

Dr. Juurlink frequently sees patients on 500 mg to 1,000 mg of morphine daily. The result is the occurrence of death, not just from someone "gobbling down a bunch of pills in self-harm". Dr. Grant emphasized that doctors have become "casual", "blase", about prescribing these drugs, and in the process less concerned about safety linked to drug use. As a result, opioids continue to be prescribed at rates and volumes hitting a new high.

The only word of caution, and plea for doctors to be more concerned with the legitimate needs of patients suffering chronic pain was from Dr. Lynch, who spoke of a reality where some patients struggle to be prescribed opioids for legitimate pain control; those with rheumatoid arthritis, for example, or chronic inflammatory bowel disease.

Purdue Pharma executives pleaded guilty to misbranding OxyContin pills, but the marketing message became well-established, says a family doctor who laments the widespread usage of high-dose painkillers.
Purdue Pharma executives pleaded guilty to misbranding OxyContin pills, but the marketing message became well-established, says a family doctor who laments the widespread usage of high-dose painkillers. (Toby Talbot/Associated Press)

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Tuesday, August 25, 2015

As Ye Sow, So Shall Ye Reap

"While your health issues may limit your mobility, it does not preclude the opportunity for reoffending."
"That additional information [of Stage 4 cancer] has been forwarded indicating further metastases is not, in the board's opinion, significant new information as it pertains to mitigation of your risk. Rather, this provides information on the normal progression of the disease with which you have been diagnosed."
Parole Board of Canada

"Peter could only move from his bed to his wheelchair, and that was painful and exhausting for him. No reasonable person could feel at risk from someone in that condition."
Christian Collins, older brother of Peter Collins
0627-Collins.jpg
"He [the 22-year-old Peter Collins] was someone who didn’t understand consequences.  He didn’t have any comprehension of what could happen, what it actually meant … "
"I wish I could have spoken to him back then. I wish things hadn’t turned out the way they did. Yeah, ----, you know, but you can’t change any of that. You can only move forward. But certainly, there’s a lot of regret around that."
"In the early years of my incarceration, I took no responsibility for my conduct or my crime. The process of being caught, convicted and sentenced only strengthened my belief that I was the victim."
"It seemed like I was always in trouble, always a bad fit. I couldn’t find my way to fix it and my parents couldn’t figure out how to fix it, either."
"The way I was able to go so far off course as a young person was because it was just me having conversations with me. I was able to justify a lot of my bullshit. But her questions [social worker], her willingness to go through it with me brought me around to the point where I was able to recognize that I was the problem, that I had to change."
"In prison, I found what I felt was a useful social purpose: trying to improve things."
Peter Collins, 53, convicted murderer 
1983-oct-15-a1.jpg

A police veteran of ten years' standing, Constable David Utman was on parole duty at an Ottawa-area neighbourhood. He happened to be sitting at a table at a nearby mall, having a coffee when an armed and belligerent young Peter Collins came on the scene, prepping himself psychologically to commit to a robbery, until he realized the presence of the uniformed police officer. He turned to leave the mall, and then re-thought his action, deciding to return and to challenge Const.Utman.

"Get up asshole, your time has come", the young thug said to the police constable, who in turn made no move. "I told you to get up. Now." Collins repeated, after firing a gun into the wall behind where the policeman sat across from his girlfriend, both on coffee breaks from their jobs. At that the officer picked up his nightstick and slide out of his seat and rose. Collins backed up into the concourse of the mall as the officer repeatedly urged him to surrender his weapon, walking steadily toward him.

"Take out your gun. Go for your gun", Collins kept responding, according to one trial witness, while another recalled him warning the constable "Don't come any closer. Get out of my way or I'll shoot you." As the policeman reached for his walkie-talkie Collins said: "I guess I'll have to kill you", firing a single shot to the officer's chest, and he fell to the ground. At close range, the shot hit its mark to perfection, and the 38-year-old police officer died later of massive internal bleeding.

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Peter Collins grew up in an intact family with four siblings. Family life was emotionally dysfunctional, and by age twelve, he was a runaway. He claims that while living on the street he had been sexually abused by two men who had gained his trust, which led him to turn to drugs to calm his emotional state. He kept company with drug dealers, bikers and sex workers, and had a swastika tattooed on one of his arms, symbolic of his belonging to a criminal underclass.

During his trial for the murder of Constable Utman, when the judge ordered him to stand for his sentencing, he refused, defiantly telling the judge "I don't want to". It made little difference; he was sentenced to an automatic life term of 25 years without parole. "Whatever his motive or reason, Peter Collins shot an unsuspecting, totally innocent policeman. Constable Utman is dead and the motive is a mystery and will remain a mystery. Only Peter Collins knows why. But it appears he isn’t willing to tell us", stated Crown attorney James Stewart at the time.

In the end, Peter Collins served 32 years in prison for murdering police Const. David Utman on October 14, 1983. He applied for compassionate release, suffering from the late stages of bladder cancer. By the time he was diagnosed, the bladder cancer was untreatable. In his request for release from prison to die in the comfort of his surrounding family members, he argued he was no longer any risk to the public.

Since his cancer was diagnosed a year ago, it had spread to his abdominal wall, his lungs and his spine. The Parole Board was unmoved. Collins had, in any event, little confidence he would be released to die at home. "I think I'm going to die in prison: that seems like a reasonable conclusion", he had stated in an interview. While in prison he had reformed himself, become an artist and musician, a social activist and advocate for prisoners.

What he could not erase was the reality that he had murdered a man whose profession it was to uphold the law and protect the public from violent acts forced upon society by people like himself. He had deprived children of their father's presence in their lives, by taking the life of a far better man than himself. Striving to make amends to society after his unspeakable act is one thing; expecting compassion when he failed that very test himself was a hope too far.

The family of Constable Utman had opposed the release of his murderer. In letters they sent to the parole board to influence their decision making they wrote of "a suffering that will never end for them", and what they wrote of how they felt of the dreadful event that forever changed their lives was noted by the panelists whose decision was final. A week after that decision was conveyed to Peter Collins, he died in prison of his cancerous condition.

PETER COLLINS

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Monday, August 24, 2015

The European Pathology of Jew-Hatred

Anti-Semitism is virtually unknown in the East, it is a Western disease. Before and during the Second World War official Japan laid out a plan to rescue European Jews from Hitler's extermination plan although Japan was officially aligned with Fascist Germany's Axis alliance. Even so, Japanese society was not infected by suspicion and hatred of Jews; it found them of interest because of the reputation Jews had for business acumen and scientific success.

Not only did the country take in tens of thousands of Jewish refugees desperate to escape the oppressive threats that Nazism meant for their future, but a Japanese consul in Lithuania and his wife managed to rescue another ten thousand Jews from death. The Japanese saw a similarity between Shinto Buddhism and Judaism. Fleeing the Third Reich, European Jewish families travelled to Shanghai, then under Japanese control, where they were able to survive the war.

Asian countries had no tradition of Jew-suspicion and hatred. China and India, members of the Conference of Non-Aligned States led by Nehru, Chou En Lai, Nasser and Tito, saw fit to regard Israel at one time with disfavour, because it was in their economic interests to befriend the Arab states. Once it became clearer to them that much could be gained for their countries' futures by aligning with Israel to further research and business opportunities, that changed; business propelled them, not antipathy toward Jews.

South Korea was fascinated by the unusually high number of Israeli and Jewish scientific Nobel Prize-winners and puzzled over the cause. Their own thinkers concluded that the mental agility required of minds exposed at a young age to Talmud study might be one of the reasons for Jewish ability to think, to imagine creatively, to excel at research and discovery. With this conclusion they thought to introduce Talmudic studies in their schools.

Contrast that to the reception that Jews receive in the countries of the West, where they have historically been barely tolerated, distrusted, blamed and held in contempt. There is a correlation between antipathy toward Jews by Western nations and their respective religions. Judaism was the original monotheistic path to an omniscient, omnipotent being. From Judaism sprang Christianity.

Christians believed that their religion, built from and upon the scaffold of Judaism, perfected monotheism, making Judaism obsolete and redundant. Offense was taken that Jews hadn't the perspicacity to acknowledge this, abandon Judaism and embrace Christianity. Seven hundred years later a middle-aged Arab merchant thought he could perfect Christianity, and inspired by its origins, plucked what he thought useful from both to present to Middle Eastern Bedouins their new religion of Islam.

When Jews refused the Prophet Mohammad's invitation to forsake an outdated Judaism and embrace its updated version of Islam, their tribes were ordered out of Medina and those who refused to leave were slaughtered. Muslims have ever since, while acknowledging both Judaism and Christianity as Abrahamic religions alongside Islam, held both Christianity and Judaism in contempt, exacting a special tax on Jews and Christians to enable them to live in peace alongside Muslims, never as equals.

Western anti-Semitism has a long and dishonourable tradition. The West seems obsessed with Judaism, intolerant of Jewish 'otherness', the Jewish faith and its peoples' inexorable clutching of their authentic monotheism through the millennia, despite the oppressive intolerance that has always characterized Christian-Judaic relations. In the modern era, the State of Israel has appeared as the leading brunt of Western hatred for Jews.

While Israel and Jews are held to a high standard of morals and behaviours, those who oppress them exhibit a paucity of both. Israel is admired for its vitality and resilience, its economic success -- despite having to allocate so much of its resources to defence -- its research and development successes, which other countries clamour to have part of in signing joint ventures that will further their own economies.

Yet while the European Union countries line up to take advantage of Israeli inventions and research successes forging the way into the future of high technology, it also debases itself by regarding Israel as an oppressor of innocent Palestinian refugees as though Palestinian terrorism and violence against Jews have no bearing on the relations between Jews and Arabs.

Israel is invited into membership of the OECD, to become a partner in CERN, as the only non-European member of the European Organization for Nuclear Research, since the obvious adeptness of Jews in both those spheres represents a bonus for Europe. Yet special labelling identifying Israeli products manufactured in the West Bank is righteously imposed, even while products from Tibet in Chinese trade are exempt from any such treatment, along with products emanating from Turkey's occupation of half of Cyprus.

Boycott and Divestment of Israeli academics and products is hugely popular with trade unions and universities in the West; with the migration of Arab and Muslim academics and other economic immigrants to Western countries, a new and incendiary form of anti-Semitism has surfaced, one where the West can make common cause in support of 'Palestinian refugees', holding Israel and Jews to blame for a complex and simmering vendetta against Israel's existence in her historical homeland.

The West insists that Jerusalem, Judaism's capital and the location of Judaism's most sacred site before the existence of either Christianity or Islam, be decreed a capital for a nascent Palestinian state. Taking from the original Palestinians, who were Jews, their Biblical-era heritage and handing it to those denying that there were ever ancient Israelites whose geography Arabs have latterly 'inherited'.

While Christians of ancient heritage are being systematically cleansed through violence and vile discrimination throughout the Middle East, the Vatican looks past the massacres and the torching of churches to sign a treaty placing its own churches in Jerusalem under the care of the Palestinian Authority in a tender acknowledgement of its brotherhood with Islam, and its abandonment of Judaism.

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Sunday, August 23, 2015

Enlightened Compassion

"...The concept of 'unbearable suffering' has not yet been defined adequately. There are no guidelines for the management of euthanasia requests on grounds of mental suffering in Belgium."
Lieve Thienpont Belgian psychiatrist

"What is presented at first as a right is going to become a kind of obligation."
Belgian law professor Etienne Montero

"...Physicians must remain primary healers."
"Part of the problem with the slippery slope is that you never know when you are on it."
"[Reports published in JAMA Internal Medicine] seem to validate concerns about where these practices [approving euthanasia for psychiatric patients] might lead."
Bioethicists Barron Lerner and Arthur Caplan
Belgian law allows euthanasia for patients who suffer from severe and incurable distress, including psychological disorders.

Belgian law allows euthanasia for patients who suffer from severe and incurable distress, including psychological disorders. Credit Photograph Courtesy Tom Mortier

The growing clamour in the public arena taking place in Canada and the United States for people suffering from incurable chronic illness diminishing the quality of their lives, or those facing certain death after diagnoses of incurable conditions like metastasized cancer or Lou Gehrig's disease is steadily bringing those countries toward the legalization of assisted suicide. Canada's Supreme Court has come down in favour of assisted suicide.

And the medical profession finds itself facing a situation where the healing profession becomes the enabling profession and many physicians struggle with their moral conscience and the pledge taken when they hung out their professional medical shingle to 'do no harm'. Those who believe in the right to die, feel that a medical professional giving them assistance to leave life behind is doing no harm, but rather obliging their wishes.

Many in the medical profession, however, having dedicated their professional lives to improving the quality of life for patients, envision that to be achieving success in mitigating the ill effects of disease or chronic conditions, as much as is medically feasible. Their black bag stuffed with protocols and pharmaceuticals doesn't include drugs to stop the heart and give surcease to suffering patients.

There is suspicion from within the medical community and from the public at large as well, who don't subscribe to the positive aspects of deliberately aiding someone to die, that society, once accustomed to helping people in end-stage medical conditions to take leave of their miserable lives prematurely, will become desensitized to the issue and begin the process of extending the 'right' to people merely dissatisfied with their lives.

A clinic in Belgium served people with depression or schizophrenia and in a few instances Asperger's syndrome, who sought the solution to their problems in euthanasia. One hundred people between 2007 and 2011 reached out to doctors at the clinic for "help". The doctors in their wisdom chose to agree with 48 of that one hundred and agreed to end their "untreatable", "unbearable" conditions by lethal injection.

One of the doctors working at the clinic wrote of her experience, in a BMJ Open journal article. The clinic's operation was legal under the country's 2002 euthanasia statute which includes terminal physical illness and a growing minority of psychological issues. Nine cases of euthanasia resulting from "neuropsychiatric" disorders took place in 2004-05, and the figure rose to 120 in 2012-13.

The Netherlands decriminalized euthanasia in 2002 and right-to-die activists opened a clinic to "help" people whom their family physician refused to "help". In the year that followed euthanasia was approved for six psychiatric patients and another eleven whose complaint was that they were "tired of living".

Dr. Thienpont, working out of her Belgian clinic insisted the clinic respects patients' wishes, while stating that "further studies are recommended". The co-author of the article which was critiqued by Drs. Lerner and Caplan in JAMA Internal Medicine is an advocate of  euthanasia, Wim Distelmans. Dr. Distelmans saw nothing amiss in ending a 44-year-old's life. who was upset over a botched sex-change operation.

Nor did he see anything immoral when he put to death identical 45-year-old deaf twins who claimed to have lost the will to live when they were informed they would eventually lose their eyesight. Another man, given a 30-year prison sentence for rape and murder claimed his incurable impulses to violence and the anguish he felt behind bars qualified him for assisted death.

The irony is that in Belgium there is no death sentence for murder. Dr. Distelmans had second thoughts and decided against acting on his original acquiescence in this instance. In any event Dr. Distelmans is unlikely to face professional chastising since Belgium's Euthanasia Control and Evaluation Commission which reviews cases is co-chaired by himself. And of thousands of cases reviewed since 2002, none were referred to law enforcement.

In the socially and medically enlightened Netherlands, euthanasia accounted for one of every 28 deaths in 2013, three times the figures of 2002. In Belgium's Dutch-speaking area one of every 22 deaths was due to euthanasia in 2013 representing an increase of 142 percent since 2007. Euthanasia for children under 12 has been legalised for terminal physical illness in Belgium.

Activists of the collective Yellow Safety Jacket protest against the proposed statutory amendment legalizing the euthanasia of young children, in Brussels, Feb. 11, 2014.

Julien Warnand—EPA Activists of the collective Yellow Safety Jacket protest against the proposed statutory amendment legalizing the euthanasia of young children, in Brussels, Feb. 11, 2014.


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Saturday, August 22, 2015

Rental Income Squared

"In the beginning, nothing seemed amiss. Gubb's rent cheques cleared. Over email he struck all the right notes: polite, responsible, diligent."
"But within a few months we would learn Gubb didn't live in our house. Instead, he had converted our four-bedroom semi into an illegal rooming house and was sub-letting to as many as sixteen people"
Sonia Verma, Toronto property owner
The Tenant from Hell
Wilf Dinnick and Sonia Verma moved to Qatar in 2014 and rented their west-end home to people who seemed like ideal tenants. (Images: House by Dave Gillespie; Gubb, Dinnick and Verma via Facebook)

A young and presumably reasonably affluent couple whose profession, news journalism, appears to be one that has market appeal on the international circuit, became accustomed to moving and living at foreign destinations, making their temporary homes wherever they landed, and enjoying as was their privilege, a cosmopolitan lifestyle. When they did move back to Canada, the Toronto housing market was cooling down in the heat of a temporary recession.

They committed themselves to becoming Toronto property owners. They became owners of a red-brick Victorian semi-detached building located on Lakeview Avenue in the city. And then their peripatetic lifestyle kicked in again, with husband Wilf Dinnick taking a new position in Doha, Qatar. What to do with the newly-acquired house -- rent, sell? Concerned that when they eventually returned to Canada to take up permanent residence booming house prices would put a replacement out of their reach, they decided to keep the gem they had, and rent it out in their absence.

Makes good financial sense, there are plenty of people who do the same, people in the same situation this young couple found themselves in, as well as those who buy properties as rental investments. The house was advertised at $4,000 monthly and before long a prospective tenant appeared, a man working in sales who drove a Range Rover and seemed to have reasonable financial security.

On the rental application he filled out, a solid income appeared, and a high credit rating. He had written that he, his girlfriend, his brother and his father would occupy the house. The lease was signed to everyone's satisfaction and the couple left the country to begin a new phase in their lives.
All seemed well until an email written by a Toronto friend involved in journalism alerted them to the fact that their house had been altered physically and was being used as a rooming house.

The rooms were divided with the installation of new walls, and each bedroom was rented out for $550 monthly per person. Toronto is well known in Canada as being second only to Vancouver for high home sale and rental prices. Apartments can be hard to come by. University students in particular look for affordable accommodation while they acquire degrees. The couple was advised to hire a trouble-shooter.

A 47-year-old woman who had distinguished herself locally as a paralegal who got things done "People say I'm a mix of a bloodhound, a cop and Erin Brockovich", quipped over the telephone with the home owner, who hired her with the conviction that if anyone could help, surely this person could.The paralegal informed the renters, all young women, that they were being exploited, and the person representing himself as the home owner was a scam artist.

The paralegal contacted Toronto Fire Services informing them that the scam artist was operating an illegal rooming house. Inspection found nine violations, and tagged the owners with $50,000 in fines; charges later dropped when the situation became evident. The renter threatened the owners with a law suit. When, however, he attempted to have the people whom he rented to give false witness, the conversation, recorded, was sent to the Toronto Landlord & Tenant Board.

Municipal regulations won the day. Everyone left the house. The owners set to work to restore their property to its original condition. And a month later found new, reliable tenants, a family who would live in their home in their absence enabling them to eventually return to a house that was still a home.

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Friday, August 21, 2015

A State of Shock and Fear

"I went into a state of shock and fear [on the diagnosis of breast cancer]. It [mastectomy] takes away your feeling of attractiveness."
"Compared to women who really have cancer, it is nothing. But the mastectomy was for no reason, and that's why it bothers me."
Therese Taylor, Toronto
Therese Taylor of Mississauga, Ontario, had a mastectomy four years ago after a diagnosis of ductal carcinoma in situ. She now believes it was unnecessary. Credit Michelle Siu for The New York Times

"It's not an emergency. It's just not an emergency. We need to stop the urgency, be more thoughtful, start generating different approaches, think about it as prevention."
Dr. Laura Esserman, director, University of California, San Francisco breast care centre

"The surgeons cure 97 percent of it [cases of DCIS; ductal carcinoma in situ]. If you did nothing ... we don't know what would happen.
Dr. Steven Narod, breast cancer expert, Toronto

Dr. Narod is the lead author of a study undertaken by researchers at Women's College Hospital and the University of Toronto. The results of the study, called an observational study, one which visits medical records to assess whether treatments had an impact on patients are controversial. In the case of women diagnosed with ductal carcinoma in situ (DCIS), the purpose of the study was to identify whether treatment, resulting in single or double mastectomies or radiation effectively increased life expectancy.

The study's conclusion was published in the journal JAMA Oncology. And the conclusion is a matter of controversy. The very nature of the study -- observational -- is incapable of rendering proof that one course of action is superior in its end-result over the others. But the authors do argue that mastectomies don't appear to increase survival chances.

Almost 97 percent of the one hundred thousand women diagnosed with DCIS between 1988 and 2011 featured a 1.1 percent death rate ten years following treatment, a percentage that rose to 3.3 percent two decades following treatment. The study lent the impression to the researchers that while up to 3.3 percent of the women died, aggressive early treatments did not appear to impact on the disease course.

Cancerous cells are found in the milk ducts of the breast, in DCIS. The standard treatment is surgical removal of the affected portion of the breast, after which radiation treatment is recommended to minimize the risk of of the cancer returning or spreading. For some women the prospect of return or spread leads them to seek surgery removing the affected breast, or both breasts for complete peace of mind.

Clearly, Therese Taylor regrets her impulse to choose surgery. When she was 51 four years earlier, her doctor recommended a mammogram based on having felt a lump in her right breast. As things turned out, the right breast was fine, but DCIS was detected in her left breast; a surgeon informing her "it was consistent with cancer", recommending she have a mastectomy.

Because of the conclusion published by the researchers suggesting there seems to appear nothing is to be gained by aggressive proactive treatment, an editorial accompanying the article suggests that its findings indicate that a move to dial back treatment offered to women diagnosed with DCIS would seem to be appropriate. Dr. Esserman was the editorial's lead author.

She felt that the article's findings are fully supportive of the theory that some women diagnosed with DCIS may not need any surgery; she recommends ongoing monitoring of their condition, treatment being offered if the cancer is seen to be progressing. Emulating the manner in which many prostate cancer cases are now handled.

Her conclusion stands in contrast to the lead author of the research paper who believes the death rate might conceivably be higher than the 3.3 percent seen after two decades if women didn't undergo surgery to remove the cancerous cells. The controversy in this matter echoes what ensues in any scientific-medical situation where studies lead to polarizing theories. This is just yet another one.

The chief medical officer of the American Cancer Society, Dr. Otis W. Brawley, states he is not prepared to abandon treatment, preferring to wait for a large clinical trial which would select patients randomly for mastectomies, lumpectomies or no treatment of DCIS, often referred to as Stage 0 breast cancer, which might conclude from the resulting evidence that treatment is unnecessary for most patients.

That treatment tends to be excessive, however, is also a reality: "In medicine, we have a tendency to get too enthusiastic about a technique and overuse it. This has happened with the treatment of DCIS", he admitted.

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Thursday, August 20, 2015

Privileged Sociopathy

"This case is about Owen Labrie sexually assaulting a 15-year-old girl. It's about how he thought about this for months. How he made a plan."
Prosecutor Catherine Ruffle, Merrimack County Superior Court, Concord, New Hampshire

"This [assault and rape of young girls] is not filtering down from college to high school. It's always been there in high school."
Elizabeth Armstrong, sociology professor, University of Michigan

"Allegations about our culture are not emblematic of our school or our values, our rules, or the people that represent our student body, alumni, faculty, and staff."
St.Paul's School website, Concord, New Hampshire

"[There is the annual dance, named Screw where] the sexual desirability of younger girls is determined by their value on the screw marketplace."
"There was the common denominator of sex and sexuality as the pathway to belonging and 'welcoming' for girls."
Shamus Khan, St.Paul's School alumnus, author of Privilege: The Making of an Adolescent Elite at St.Paul's School
News of the allegation has left students horrified and questioning its spring rite.
Suzanne Kreiter/Globe staff

St.Paul's was inaugurated in 1856 as an Episcopal [Anglican] preparatory school. It rests on 800 hectares of bucolic countryside in the White Mountain State, on the outskirts of the capital, Concord. Girls were admitted in 1972; in total the school enrols roughly 530 students. The cost of attending St. Paul's is fairly steep; tuition, room and board clock in at $53,810 U.S. annually.

It is an Ivy League academic institution. Among its notable alumni are John Kerry, FBI director Robert Mueller, Garry Trudeau, creator of the Doonesbury comic strip; there are 13 U.S. ambassadors who graduated from the school, three Pulitzer Price winners, and scions of the Astor and Kennedy families. The school accepts the attendance of moneyed foreigners; in the 2014-15 class 17 percent originated from 25 foreign countries.

According to the defense lawyer, J.W. Carney, representing now-19-year-old Owen Labrie who was a senior at St.Paul's School in 2014, exercising the tradition of a "senior salute", interpreted as senior students' parting shot at the school related to forcefully sexually assaulting freshman female students, "The girls would be honoured and proud about this that they were the focus of the senior salute".

Owen Labrie, left, the defendant in the rape case, and J.W. Carney Jr, his lawyer, after Mr. Carney cross-examined Mr. Labrie's accuser on Thursday in Concord, N.H. Credit Pool photo by Geoff Forester

The school culture is known to encourage upperclassmen who would normally not acknowledge the presence of younger peers, as being beneath them, to access the clture of the "senior salute" where a segment of the students "take great pride" [in Labrie's own words] in having sex with younger students before leaving the school, at graduation. Owen Labrie was among them, seeing nothing untoward in forcing himself sexually on a trusting, younger student.

In an interview with a detective assigned to the case where the freshman whom he assaulted lodged a formal complaint, Owen Labrie was quick to speak of a contest atmosphere, with older boys actively competing to increase their "score" with the most girls. A tally was scribbled in indelible marker on a wall behind washing machines, which the school kept painting over. He was himself "trying to be No.1." Presumably, in preparation for the real world?


He had focused on one girl out of a list of young female students. He sent her grooming emails, gaining her interest and her trust. It is flattering for a young girl, after all, to attract the attention of an upperclassman. It is that interest in and of itself that young girls find their ego responding, not the expectation that they would be proud to be sexually assaulted. Labrie obtained a passkey, brought the girl to a campus mechanical room, and raped her.

Owen Labrie was an academic and social leader at the school. At graduation he was honoured with the Rector's Award for "selfless devotion to school activities", a ceremony that took place two days after he had assaulted the complainant, a 15-year-old student at the school. Harvard accepted his application to attend that elite academic institution. At St.Paul's he was a prefect, given special responsibility for being of assistance to younger students.

He has pleaded not guilty to ten counts, including felonious sexual assault. He never, he insists, had sex with his accuser, though their encounter, he says, was consensual. The court case with its revelations to the public arena, highlights a connection between privilege and perceptions of sexual entitlements; and for the victims, sexual predation and vulnerability, taking place in American colleges and high schools.

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Wednesday, August 19, 2015

Nature's Human Disease Arsenal

"I had to be tube fed, suctioned all the time. And my body was literally just wasting away. I would not wish it on my worst enemy."
"It is such a devastating illness and the journey is so lonely, and you never really come back to the person you were."
Sonia Whyte-Croasdaile, nurse/social worker, post toxic epidermal necrolysis
Peter J. Thompson/National Post
Peter J. Thompson/National    PostSonia Whyte-Croasdaile, a survivor of toxic epidermal necrolysis, at her Milton home. Four years later, She is still suffering the debilitating after-effects of the disease.
"This is a travesty [not pre-testing patients for TEN...toxic epidermal necrolysis]. It's the kind of thing that when I started doing research in this 30 years ago, we prayed would exist: to be able to screen people, and not give drugs to the wrong people.... Why there are blinders on about this, I do not understand."
"We've got good science, we've got good ways of preventing something, but [in Canada] we don't have the cohesiveness or the focus."
Dr. Neil Shear, head, drug-safety clinic, Synnybrook Health Sciences Centre, Toronto

"It's not very well known, to be honest with you. In our dermatology community, guys don't screen for it and don't recognize it [toxic epidermal necrolysis]."
Bruce Carleton, head, pharmaceutical outcomes program, British Columbia Children's Hospital
The skin condition named toxic epidermal necrolysis is triggered generally by allergic reactions to prescription drugs. As such, it should be preventable, if care is taken to test patients before prescribing drugs, particularly those known to be implicated in causing TEN in some susceptible people. According to Dr. Carleton, a "perfect storm" inclusive of genetics, drugs and health condition appears to trigger TEN.

There are dozens of drugs suspected of having the facility to trigger toxic epidermal necrolysis. The list includes common sulpha antibiotics. The connections of some drugs with those genetically predisposed to TEN have been studied, and according to Dr Shear, tests in these instances should be automatic, to prevent TEN onset. Particularly susceptible are people of Han Chinese, southeast Asian or South Asian heritage.

The drug allopurinol, prescribed for gout and other diseases, for example, should only be taken by patients who have been pre-tested. Those tests have been available for at least six years; their cost ranging from $100 to $200 per test, and their application capable of preventing up to 70 percent of cases of TEN. Wide use of the test could result in far fewer people presenting with the dread skin disease.

The label for allopurinol, for example, makes clear that there is a known link between a specific HLA gene and TEN, while going on to state that the value of screening for the gene "has not been established". Ms. Whyte-Croasdaile, 47, was stricken with TEN, acquiring burn-like blisters on her body. Her state progressed to the point where she was almost incapable of swallowing, was almost blind, and was hospitalized for six weeks.

Four years after her recovery, debilitating after-effects of the disease continue to blight her existence. She had to regrow her eyebrows, eyelashes and toenails. She had to learn to walk again, and was able to eat only baby food for a while. Her mucous membranes were damaged to the extent that she no longer produces saliva, so eating is difficult, and her congenitally dry eyes are constantly irritated.

Peter J. Thompson/National Post
Peter J. Thompson/National Post    Sonia Whyte-Croasdaile holds a photo of herself in hospital while she was suffering from toxic epidermal necrolysis.

Because it is not routine to test patients for their genetic susceptibility to acquiring toxic epidermal necrolysis before drugs are prescribed in this risk group, people are succumbing to the disease, and suffering its consequences. And they are dire, including death. In Singapore, health authorities urged doctors to test patients for a specific gene before prescribing the epilepsy drug carbamazepine. That resulted in a huge reduction in the incidence of TEN, or that of the less severe Stevens-Johnson syndrome.

TEN's early onset symptoms are readily mistaken for those of influenza. And then the skin begins to blister and peel, painful lesions spreading across the entire body, invading the mouth and throat, damaging mucous membranes. The large, open sores that are produced become prone to infection which can lead to sepsis, organ failure and ultimately death.

Over the ten years ended March 2012 a study identified 141 cases of TEN and 567 of Stevens-Johnson disease in Ontario. Of that number 127 people died in hospital or in two months of their release from hospital. Of the TEN patients 23 percent died.

The burn unit at Edmonton's University of Alberta Hospital typically sees between three to ten cases annually of TEN. Plastic surgeon Dr. Ted Tredget recalls a few years back treating two patients with the disease at the same time.

Several DNA variations involving "HLA" genes that are linked to TEN have been identified which are capable of predisposing people to the reaction as a result of using specific medications. Advances in genomics have benefited in acquiring new knowledge about this dreadful disease.

Now, the issue is convincing federal and provincial regulators and the pharmaceutical industry to agree that routine genetic screening before administering certain drugs should be a recommended proactive course of action.

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Tuesday, August 18, 2015

Plundered and Endangered

"I will use (Dante's) tusks to hunt the people who kill elephants to learn what roads their ivory plunder follows, which ports it leaves, what ships it travels on, what cities and countries it transits, and where it ends up."
"Will artificial tusks planted in a central African country head east or west toward a coast with reliable transportation to Asian markets? Will they go north, the most violent ivory path on the African continent? Or will they go nowhere, discovered before they're moved and turned in by an honest person'?"
Bryan Christy, National Geographic investigative reporter
A pile of 15 tonnes of ivory confiscated from smugglers and poachers is arranged before being burnt to mark World Wildlife Day at the Nairobi National Park
Each pair of tusks represents one dead elephant ... Quartz, Africa

Those are the questions that Bryan Christy, a lawyer who turned to the journalism profession, recognized recently as National Geographic's Explorer of the Year, asked himself. He ended up having a far better idea, after his journey with a pair of credibly fake elephant tusks, understanding the nexus between illegal ivory poaching, the demand from Asian sources for ivory despite elephant ivory's protected status, and one of Africa's most perniciously vicious criminal enterprises.

Bryan Christy concocted a trial, planning on planting fake elephant tusks embedded with tracking devices, to determine who might take them and where they might be taken to, to get a more complete and reliable picture of routes taken by smugglers dedicated to filling orders by clients as unscrupulous as they are, undeterred by the reality that intelligent creatures whose welfare is a concern for the international community are being slaughtered at an unsustainable rate to satisfy an illegal trade.


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Mr. Christy enlisted the aid of taxidermist George Dante for the creation of fake elephant tusks which had to be sufficiently convincing to pass the scrutiny of experienced poachers. Then he turned to Quintin Kermeen, an animal tracker, to help conceal tracking devices within the fake tusks. And then, he set out with the tusks carried in a suitcase, taken with him on a trip to Dar es Salaam in Tanzania. At the airport an official thought something suspicious appeared on an X-ray machine and ordered the suitcase opened.

Producing a letter of explanation meant to certify the artificial nature of the tusks, he was met with skepticism and ended up arrested, his belongings confiscated. "I unzip my suitcase to expose two fake tusks and hand him [official in Tanzania] letters from the U.S. Fish and Wildlife Service and National Geographic certifying that they're artificial."
"A crowd gathers. Officials are pointing fingers and arguing. Those looking at the tusks think I'm an ivory trafficker. Those looking at the X-ray screen, which shows the trackers inside, think I'm smuggling a bomb. After more than an hour of animated debate, they phone the airport's wildlife expert. When he shows up, he picks up a tusk and runs his finger over the butt end. 'Schreger lines', he says. Exactly, I say, 'I had them' ..."
"He points a finger at me, and yells, 'You are a liar, b'wana!' In ten years he's never made a mistake, he says: The tusks are real. I spend a night in police custody, where I'm given a desk to sleep on. National Geographic television producer J.J. Kelley takes the floor in the waiting area. He asks for water for me and is led out of the building. When he returns hours later, he has three chicken dinners and several bottles of beer, paid for by the police chief. The three of us eat together (the police chief, a Muslim, leaves the beer to us). In the morning, after officials from Tanzania's Wildlife Division and  the U.S. Embassy arrive, I'm released."

The Tanzanian officers waved him off at the airport, and he congratulated them for doing precisely what their positions as wildlife defender-conservationists mandated that they do, in holding him in suspicion  until they were certain that he was not a smuggler. Mr. Christie did manage to plant his artificial tusks on the black market in the Central African Republic at a small village along the major ivory route that smugglers are known to use, from the Garamba National Park to the Democratic Republic of Congo, to Sudan.

As he anticipated, the tusks were taken up and ferried north along the prior-identified route, from central Africa to Darfur where the civil war continues to rage. "My artificial tusks sit motionless for several weeks, a pair of tear-shaped blue dots on my computer screen, which displays a digital map of the eastern corner of Central African Republic. Then, like a bobber in a fishing hole, a nibble. They shift a few kilometres. Suddenly they move steadily north, about 15 kilometres a day along the border with South Sudan, avoiding all roads. On the 15th day after they began to move, they cross into South Sudan and from there make their way into the Kafia Kingi enclave, a disputed territory in Darfur controlled by Sudan."

Mr. Christie had heard from the grapevine, including from direct witnesses, among them Kony's Lord's Resistance Army (LRA) defectors, that terrorist chief Joseph Kony and the LRA see huge value in elephant poaching since the proceeds they realize go a long way to financing their reign of terror as they cross national borders across Africa to kill, to rape and to kidnap defenceless villagers, including among them children who are forced to join their parties, the girls as sex slaves, the boys as nascent fighters-in-training.

Kony's own hunting parties are known to have slaughtered elephants in national parks like Garamba, according to investigators that Mr. Christy interviewed. The LRA trades the ivory to the Sudanese Armed Forces and receives in exchange, weapons and ammunition. "So far, they've [his artificial tusks] travelled 965 kilometres from jungle to desert in just under two months. Their path is consistent with the route Kony's defectors tell me ivory takes on the way to the warlord's Kafia Kingi base" [in Darfur]. They're in a place 2.2 degrees Fahrenheit cooler than the ambient temperature. So perhaps they've been buried in the backyard."


Imperiled survivors: A herd migrates across Chad, once home to tens of thousands of elephants. After a surge in poaching, only about 1,000 remain. (Kate Brooks) smithsonianmag.com

"Ivory operates as a savings account for Kony" remarked Marty Regan, with the U.S. State Department's Bureau of Conflict & Stabilization Operations, in a conversation with Bryan Christy.

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