Ruminations

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

Monday, October 31, 2016

Commit With Caution

"She's never acted high: falling face-first into her food bowl, chowing down."
"She comes out and socializes."
Lisa Mastramico, Long Beach, California

"Dogs are very sensitive to the effects of THC [tetrahydrocannabinol]. Most pet owners who end up bringing their animals in are in denial."
"[But] they eventually] come clean and say their dog ate one of their brownies [laced with marijuana, with THC the psychoactive property, toxic to animals]."
Steve Blauvelt, veterinarian, Bend, Oregon

"These products show potential, but there’s not a lot of research at this point. No one is even sure what the correct therapeutic dosage is. For example, in the ‘Frequently Asked Questions’ section on one of the websites, a customer asks, ‘How much should I give my pet'?"
"And they answer—I’m paraphrasing here: ‘Whatever you think would help.’ Well, that’s extremely vague."
"We get quite a few marijuana calls at Poison Control. Cats like the plant material better, whereas dogs like to get into the edibles. Depending on how much they get into will determine how aggressive we need to be."
"Most of the time they’re wobbly like they’re drunk, they dribble urine. But 25% of them become extremely agitated, which certainly is not something I would want to put my elderly pet through. In fact, dogs that get into the really large amounts of THC, often need to be put on fluids and have their heart rate monitored." 
"Most of these treats have very low levels of CBD, so they are much safer [than when a cat or dog accidentally eats something of the human's]. It looks like these certainly could be helpful products in some cases, but right now we don’t have enough information. Whether it’s THC or other cannabinoids, the problem is we have no therapeutic dose. We don't know, 'are you underdosing your animal or overdosing your animal?' These are the things we need to determine."

Tina Wismer, medical director, ASPCA Animal Poison Control Center  

"The cannabis plant has many compounds in it. Most people grow cannabis for the euphoric experience of THC. But they’ve been overlooking cannabidiol—commonly known as CBD—which is non-psychoactive."
"What we’ve seen is that some of these dogs respond very rapidly. One woman from Fort Bragg was ready to put down her dog due to how sick and in pain he was, but the day before he was scheduled to go under, she administered our treats and just like that the dog was up, walking around, and acting normally again."
Matthew J. Cote, brand manager , Auntie Dolores, San Francisco Bay  
Still from video -- NBC News

Following the legalization of medical marijuana in Colorado, two veterinary hospitals in the state indicated that the number of dogs treated for marijuana overdoses quadrupled in the five years following. That occasioned a study, published in 2012 in the Journal of Veterinary Emergency and Critical Care. Cannabis features dozens of cannabinoids, including THC [tetrahydrocannabinol]  and CBD [cannabidiol]. The former is imbued with the psychoactive properties that make it so attractive to recreational marijuana users.

And then there is CBD which confers benefits without the high feeling, harmless to humans, harmful to animals. Used to make textiles and paper, industrial hemp is also used in marijuana products manufactured exclusively for pets, containing negligible THC levels. Veterinarian Steve Blauvelt is concerned about the welfare of family pets, brought to veterinary clinics in distress, after coming across their owners' prized marijuana collections, or reacting to sneaking a marijuana laced cookie off a kitchen counter.

The American Veterinary Medical Association has not yet announced their official position on the use of medical marijuana for ailing and elderly pets, to relieve symptoms of ill health or suspected pain due to chronic health conditions. In Nevada,  however, where medical use for humans has been made legal, the state legislature has debated a bill permitting veterinarians to prescribe medical marijuana for pets. There is the issue of health claims that producers of marijuana treats and capsules must avoid.

PHOTO: Treats made with cannabis from a dispensary are now being marketed to old and ailing dogs.
Getty Images
These products, since they have not been approved by the U.S. Food and Drug Administration, may run afoul of the FDA when products are being marketed with health claims since they are regarded as an "unapproved new animal drug", and as such making claims for health properties is seen by authorities as violations of the law (the federal Food, Drug, and Cosmetic Act). At the same time, there are enthusiastic testimonials from grateful pet owners, concerned about the deteriorating health of their pets and seeing them respond positively to products they have acquired containing marijuana.

Little Kitty was twelve years old, with arthritis, spending her days hiding in a closet, snuggling in her plush blanketed bed installed there. Her owner, Lisa Mastramico, looked for something that would make life a little more comfortable for her beloved cat. She had attempted a number of different supplements, but nothing worked. Eventually she obtained a medical marijuana card, enabling her to procure edible oils produced for pets, derived from cannabis, to be squirted into the mouth.

Little Kitty has been restored to her former, younger self, happy to sunbath on the rug in the living room and demonstrating by her manner that the oils administered to her by her owner have virtually given her a new lease on life. "She comes out and socializes", enthused Ms. Mastramico. Other people who love their pets use cannabis-based products to relieve a wide range of pet ills, inclusive of seizures, inflammation, anxiety and pain. And the results have all been reported as positive.
States where medical marijuana is legal

There are some veterinarians who approve of the use of these products, but veterinarians are not authorized to write prescriptions even though marijuana-based products are now in use to ameliorate adverse health conditions for cats and dogs and as well for pigs, horses and other animals. A 12-year-old chow-shepherd mix living in Los Angeles developed bone cancer in 2012 requiring that his front left leg be amputated. The prescribed painkiller left Emmett dizzy. His owner bought him a cannabis-based tincture, sold in California dispensaries. It took four months, but Emmett is now his old self.

Sweet Leaf Shoppe, a medical cannabis delivery service in Los Angeles, was founded by Melinda Hayes in 2014. Her purpose was to work with pet owners and their animals, and in her dispensary she now gives aid to forty animals. Her own boxer-terrier mix Diva, tore a ligament in her right knee; her pitbull-Shih Tzu mix has allergies and anxiety syndrome, and her box turtle Tug, suffers from disorders of the shell and the bones. With her own three pets, Ms. Hayes treats them with cannabis products.

She has aspirations to increase her business to become a full-service storefront operation welcoming and open to the public to bring their pets in for consultations and follow-up care. "This way, I can combine my two favourite things, dogs and pot", she stated.
Denise says marijuana has improved Miles’ quality of life since the dog developed terminal cancer. (Photo by R. Scott Nolen)

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Sunday, October 30, 2016

Hospitals as Threats to Health

"It is estimated that on any given day more than 1,600 hospital beds across the country are occupied by a patient who suffered harm that extended his or her hospital stay."
"In addition to what these patients and their families go through, their continued need for treatment also has a cost to the system. In that it keeps other people from getting the help they need."
Report: Canadian Institute of Health Information and the Canadian Patient Safety Institute

"How safe are our hospitals? [They could be a lot safer.]"
"What we see is that most patients get safe care, but the results show one in 18 suffer some harm."
"That is a good reminder there is more work to do to make hospitals as safe as possible."
Kathleen Morris, vice-president, research and analysis, Canadian Institute of Health Information
Tens of thousands of people are unintentionally harmed in Canadian hospitals every year, according to new figures. - Ottawa Citizen

The newly released cross-Canada health report used as an example Belleville resident Herbert Strasser, healthy at 72 but after developing spinal abscesses and C. difficile in after-surgery complications, died, with a coroner concluding that his case represented a "perfect storm" of false assumptions and missed clues. His was an unfortunate death that spurred changes at Kingston General Hospital and at Belleville hospitals.

CIHI Patient harm in Canadian hospitals
Source: Canadian Institute for Health Information, Canadian Patient Safety Institute

Of every 18 patients, one patient suffered unintentional harm in 2014-2015 resulting from hospital care that patient received, representing 138,000 patients across the country falling victim to hospital-acquired medical problems through the default of some inadequacy in care. The report, titled Measuring Patient Harm in Canadian Hospitals, highlighted 150 individuals who had the misfortune to have experienced a sponge or other surgical object left inside them, at the conclusion of a surgery.

Of those people so affected, one in eight died, despite authorities feeling themselves unable to claim with any degree if certainty whether it was hospital harm directly implicated in causing those deaths. Additionally, one in five -- about 30,000 people -- suffered more than one form of deleterious health outcome. The rate of such hospital harms is set at 5.6 percent, a steady state in recent years in the country.

A new system to track hospital harm places emphasis on 31 different types of inadvertent health outcomes injurious to people's health prospects. Those range from birth trauma and medication errors to C.difficile infection, patient accidents and medical instruments that have been left in patients during surgical procedures. The purpose of the measuring and tracking on a national scale is to aid hospitals in lowering harm rates and improving patient safety.

Among the most frequently occurring harms listed are urinary tract infections, pneumonia, and electroyte and fluid imbalances. Many hospitals have focused on improving their rates of C. difficile infections, and the going has been extremely difficult. Hospitals devise various protocols to reduce C. difficile, inclusive of organizing SWAT teams to swiftly respond from infection control, housekeeping and logistics department.

Preventable harm can occur in all areas of the hospital.
Preventable harm can occur in all areas of the hospital. (David Goldman/Associated Press)

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Saturday, October 29, 2016

The Emerging Era of Human/Machine Interface

"Everything has to be very small. The smaller, the greater the chance for success."
"We're trying to have an all-in solution. This is a little more complicated [turning light into electricity efficiently] because you're working with an eye."
Ross Cheriton, University of Ottawa PhD student

"Blindness is devastating. Our aim is to have people recognize the faces in front of them and [to] lead a more independent life."
"We don't know where this will lead. We're just beginning. We may be able to use artificial intelligence to relay information that the chip can pick up. Who knows?"
Suzanne Grant, co-founder, CEO, iBIONICS
Ross Cheriton, a PhD student in physics at the University of Ottawa, is working on a micro chip (at right) that will power a "bionic eye" (created by Ottawa startup, iBionics) which will hopefully restore sight for the blind and others within five years. Julie Oliver / Postmedia

There are already bionic eyes in circulation commercially used to aid people without natural sight to 'see' what they could not otherwise. What they see, however, is restricted to shapes and to light. It is still not possible for these people using bionic eyes to read, or to identify features of the faces that might be a hands-breadth away, so the unsighted are only slightly benefited by modern engineering science.

The ambition of an Ottawa company is to develop a new, improved bionic eye that would be capable of doing what the current ones cannot; to replace human eyesight as nearly as possible with tiny transplants and a new source of energy to enable it to function. The bionic eye now on the market for human use is a "retinal prosthesis system", that saw European regulatory approval in 2011 and two years later in the United States.

The system is comprised  of a camera mounted on the frames of eyeglasses feeding a signal to electrodes that have been implanted at the back of the user's eye. The brain's visual cortex enables the user to "see" what appears before them when the optic never is stimulated by an ensuing signal. But there are limits to the ease of use, comfort and the resulting clarity of vision provided by this older bionic eye.

eBIONICS has involved itself in the development of what it has labelled the "Diamond Eye" (a minuscule 3.4-mm box of lab-produced diamond holding the chip) carrying electricity without causing a shock because of the compatibility of diamond with the human body. This advanced version would not require the awkward components currently utilized by the bionic eyes on the market.
Orly Shamir wears the Argus II retinal prosthesis system, a bionic eye that is already on the market.
Orly Shamir wears the Argus II retinal prosthesis system, a bionic eye that is already on the market. Darren Calabrese / THE CANADIAN PRESS

At the present time implanted chips must rely on wires threaded through the wall of the eye which deliver the camera signal and the electrical power required to operate it. The chip of the "Diamond Eye" was developed in Australia, and is meant to be implanted beside the patient's retina, to work like a tiny solar panel, absorbing light from a tiny laser mounted on frames worn by the user. As the laser, aimed into the eye does its part, the chip converts light into electricity to power the implant.

A higher visual resolution will ensue, along with the advance of no wires being required and recharging becoming obsolete. The bionic eyes currently in use feature 60 to 150 electrodes, whereas the "Diamond Eye" has over one thousand electrodes. Ms. Grant of iBIONICS feels confident that in two years' time the bionic eye will have advanced to the point where small-scale clinical trials will be occurring. In five years' time, she feels it will be ready for consideration of FDA approval.

A two-hour surgical procedure would be required to implant the chip, with the implant and the surgery coming in at a cost of roughly $75,000. The new process in development is intended for ease of use and improved resolution. There is also the potential that technology such as it represents might offer benefits beyond what nature has prepared humans to perceive through normal eyesight. It is not beyond expectations that the capacity for night vision, or a hugely enhanced visual acuity might also ensue.
The chip has over 1,000 electrodes.
The chip has more than 1,000 electrodes. Julie Oliver / Postmedia

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Friday, October 28, 2016

An Extraordinary Launch Into Life

"Some of these tumours can be very well-tolerated, so the fetus has it and can get born with it and we can take it out after the baby's born."
"[She was] hanging out in the air ... Essentially, the fetus is outside, like completely out, all the amniotic fluid falls out, it's actually fairly dramatic."
"The part on the fetus we do very, very quickly. It's only 20 minutes or so on the actual fetus. [Most of the time the uterus] a big muscle lined with membranes [is being carefully incised]."
Dr. Darrell Casse, surgeon, Texas Children's Hospital

"LynLee didn't have much of a chance. The tumour was shutting her heart down and causing her to go into cardiac failure, so it was a choice of allowing the tumour to take over her body or giving her a chance at life."
"After the open fetal surgery, her heart had time to heal while I was still pregnant with her, so she has no heart issues now, and is doing amazing[ly well]."
Mother Margaret Boemer
cnn

This is yet another miracle baby in the sense that her life was in imminent danger, and modern medicine had the answer that restored her chances of life and a future. This baby had a sacrococcygeal teratoma, a massive tumour situated between the end of her spine and her backside. This condition is not as rare as one might suppose, affecting one in 35,000 fetuses. A feature that complicates the situation of childbirth, and fears arising from parents' hope that their child will be 'normal'.

In most instances, the tumour is not that large that it presents as a threat to life. After childbirth the tumour is surgically removed and the baby is 'normal'. In tiny LynLee Boemer's case her tumour was immense relative to her size, making it indeed a frightening threat, and a rare one. When the fetus was in its 23rd week, the tumour was almost as large as it was. And while most such surgeries can be performed even as the fetus remains within the womb, this wouldn't work for her.

Instead, the fetus had to be temporarily moved outside the womb to enable the surgeon and his surgical team to have that massive tumour removed. And then, the fetus was returned to continue its gestation period within her mother's womb. All did not go precisely to plan during the procedure. The fetus's heart stopped and that's when a second doctor stepped in to keep it pumping until the baby, umbilical cord left intact, was returned to the womb, the mother stitched back up.

After the baby's final delivery, the first time of several hours' duration while she was shed of that tumour, the second time when she was released from her mother's womb through a Caesarean Section, the tumour re-started. Eight days after LynLee's birth another surgery took place, to remove the second growth. 

A picture showing Mrs Boemer with baby Lynlee and her two older daughters
Paul V. Kuntz/Texas Children's Hospital   
Mr and Mrs Boemer are now parents to three daughters


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Thursday, October 27, 2016

Engineer, Heal Thyself

"I'm just a curious individual. Since I could walk, I've had a screwdriver and a spanner in my hand I'm an engineer. My whole life has been spent asking the question, 'How do we improve this?' Is there a better way?"
"My example is pretty extreme, but it makes the point that pretty much every patient can make a contribution to the health-care system. Even the least intellectually competent of us can say, 'I don't like how that doctor treated me' or 'I found that form difficult to fill in'. If you get that feedback, you can improve things."
"I thought to myself, 'This is an engineering problem'. I asked [the surgeon], 'Why aren't we scanning the aorta. CAD-modelling it, then rapid-prototyping a model and using that to make a support? He just said, 'What?'!"
"I'd love to say I did this for philanthropic reasons, but that would be total crap. I was terrified. For me, it was about self-preservation."
"It was incredible to meet a surgeon who was actually prepared to admit there were things about his job that he didn't know."
"I didn't think I did have the solution. I don't think I have the arrogance and the ego. I just thought, 'Holy s---, I've got to do something'."
Tal Golesworthy, British Chemical Engineer
Tal Goldsworthy, a British engineer from the coal industry, holds a copy of the brace that he designed to fix his own faulty aorta after speaking at a medical conference in Ottawa Wednesday, October 26, 2016. (Darren Brown/Postmedia) Assignment 125131
Tal Goldsworthy invented the device that saved his own life.  Darren Brown / Postmedia

He was terrified and he was desperate to 'do something' with his chemical engineering background, to come up with a solution that would negate the necessity for him to have open-heart surgery to correct a condition he was born with. Tal Golesworthy was born with Marfan syndrome, an inherited disorder of the body's connective tissue. That disorder had the potential to stretch and rupture his aorta. He knew, throughout his life, that sooner or later he would be faced with his condition turned desperate.

He had become accustomed to submitting to regular scans of his heart for the purpose of measuring the amount his aorta was stretching as a result of Marfan syndrome. Scans indicated in 2004 that the situation was reaching a level clearly dangerous to his longevity. A cardiologist was consulted to find out what could be done about his condition. Open-heart surgery was the response, a radical procedure once rare, now commonplace for heart bypasses and valve replacement, for example.

The details of the procedure caused his heart to literally palpitate with fear. His body temperature would be drastically lowered to 18C while he would be connected to a cardiopulmonary bypass machine and his heart stopped. Breathing tubes would be plunged down his throat. A surgery that would take hours would ensue. Recovery would take months. And afterward, he would need to take blood thinners to ensure that a blood clot wouldn't develop to cause a stroke.

(This is simplified, of course. And it's just as well to remember that aspirin is a blood-thinner and millions take aspirin in small doses daily as a heart attack and stroke preventive.)

So Mr. Golesworthy's brain went into overdrive, and he spoke to the surgeon of potential alternatives, a treatment that would bypass the need for that open-heart surgery. Private investors such as friends helped to fund his research and he underwent 30 hours of MRI scans to fine-tune mapping techniques. A computer-aided design professional helped to create a "bespoke" computer model, used to create a plastic copy of his aorta. That copy was used as a platform to tailor a woven, lightweight synthetic mesh that doctors could secure his aorta with, by wrapping it with the mesh.

The result was his invention, ExoVase, to reinforce the aortic artery. It has, to date, been used in six countries; the United Kingdom, Belgium, Poland and New Zealand. The U.S. Food and Drug Administration has placed the device on its study list which could eventually result in its acceptance for use in North America. So far, 80 patients have received his invention. One of them a boy of eleven. Unfortunately, one patient died post-surgery as a result of the surgeon inadvertently cutting an artery during the operation.

As for Mr. Golesworthy, his own aorta now is stable enough that he's been able to put a halt to the annual scan meant to measure its diameter. And he was a guest speaker at a conference called Strategy for Patient-Oriented Research, hosted by the Canadian Institutes of Health Research, meant to examine how doctors and the health-care system, by listening to ideas and responses from the patients they serve, can improve their protocols and outcomes.

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Wednesday, October 26, 2016

The Healing Arts -- and Murder

"It's devastating. To lose somebody like that. It's sad. You figure he died, and that was it. The next thing you know, you found out [police believe] somebody murdered your father."
Arpad Horvath, Jr., Woodstock, Ontario

"We're living my father's death right now. It's horrific."
"We don't want him to become the poster boy of this tragedy but we would like the story out there: [He was] a wonderful man, a World War II vet, just the best father in the world."
Daniel Silcox, son of James Silcox, 84

"My own voice called to me in the darkness. Others hands lifted me when I chose the light. One year ago today I woke up not dead. 365 days clean and sober."
"Heart beats then sprays/as this next victim pays/her deft dagger's bill."
Elizabeth Wettlaufer, 49, registered nurse

"It's shocking and sad to know that this happened to so many people, and it just seems with my experience there [Caressant Care Woodstock; long-term care residence], that people working there should have paid close attention."
Sabrina Sabic, 17, former student nurse's aid
Elizabeth Tracey Mae Wettlaufer, of Woodstock, Ontario, is shown in this still image taken from video provided by Citynews Toronto in Woodstock on Tuesday Oct. 25, 2016. Police have charged a nurse in southwestern Ontario with murder alleging she killed eight nursing home residents by administering a drug. (THE CANADIAN PRESS/Handout-Citynews Toronto)
Elizabeth Tracey Mae Wettlaufer, of Woodstock, Ontario, is shown in this still image taken from video provided by Citynews Toronto in Woodstock on Tuesday Oct. 25, 2016. Police have charged a nurse in southwestern Ontario with murder alleging she killed eight nursing home residents by administering a drug. (THE CANADIAN PRESS/Handout-Citynews Toronto)
Caressant Care Nursing and Retirement Homes Ltd., operates fifteen such long-[term care facilities mostly in small towns. At their facility located in Woodstock, Ontario, over a period seven years, seven elderly people in their care died. They were between the ages of 74 to 96. Another death took place elsewhere, a resident of Meadow Park long-term care residence, in London, Ontario. All of the eight deaths have now been linked to one woman, Elizabeth "Bethe" Tracey Mae Wettlaufer.

Before her resignation from the College of Nurses of Ontario on September 30, she was entitled to practise as a registered nurse. She worked at a number of extended-care facilities for elderly people, including one that specialized in the care of people with developmental disabilities. The town of 37,000 people has been stunned by the revelation of these murders which had been formally registered, when they had occurred between the years 2007 and 2014, as natural deaths related to age and health conditions.

"The victims were administered a drug, but I'm not in a position at this time to comment on specifics of the drug", advised Det.-Supt. William Merrylee of the London Police Services. Police did not state with any conviction other than to mention that the woman now in detention worked at other long-term care facilities, that the possibility is there that more victims of her nursing ministrations leading to death might yet be uncovered.

The woman whom her neighbours described as "happy-go-lucky" in personality, had evidently recently emerged from the second of two rehabilitation facilities' sessions. She was divorced, wrote poetry, had two cats and a beloved Jack Russell terrier, and was pleasant to her neighbours: "It's hard to believe, really, really hard to believe" said one woman who lives downstairs from former nurse Wettlaufer's fifth-floor apartment. It has been revealed that the woman was made subject to a peace bond earlier in the month.

She was given ten conditions, one of which was that she live with her parents in Woodstock, and she was not to act as a caregiver to anyone. Banned from possessing insulin or any other kind of medication save for her own use, she was barred also by the court order from visiting any long-term care facility, nursing or retirement home or hospital unless she was herself in need of medical treatment. On Tuesday she was charged with eight counts of first-degree murder.

Toronto police had been contacted by Officials from the Centre for Addiction and Mental Health with the information that nurse Wettlaufer had informed hospital staff of actions on her part that caused them "concern". When Toronto police were in possession of the hospital's concerns, an interview with Wettlaufer produced the information that the crimes that were being alleged had occurred outside their jurisdiction. They then contacted the Ontario Provincial Police, and police in Woodstock and London, Ontario, where the crimes were said to have occurred.

The town of Woodstock is reeling in shock, magnified by that felt by the families of the elderly patients whom this woman is now being investigated for murdering. Once the eight murders have been verified, and perhaps others committed elsewhere have turned up, it will be seen what kind of a serial murder this woman was. That she had mental health problems and substance addiction problems and sought help for them may turn out to be a legally feasible defence for her once the case goes to trial.

Ironically, though she planned, committed to and carried out the murders of helpless seniors in her care over a period of years, as a defendant on trial for these crimes much will be made of the fact in law that mental health and addictions are considered to be disabilities. People with 'disabilities' are given fairly lenient sentences in reflection of their conditions considered responsible for the actions they commit; in short excusing them for murder on the basis of illness.

"Most of it [such serial murders] involves IV medication, because you don't even need to poke a needle into the skin of the patient. You can just put a few little drops of additional medication into the IV line, and it's almost just too easy", explained Beatrice Yorker, California State University nursing professor

In a 2014 study of 15 nurses who committed murders in hospitals, research revealed some similarities between them as motivating factors. A history of depression or similar psychological problems, a high incidence of death on the shifts linked to the killers, resulting in colleagues feeling uncomfortable near them; and having drugs in their lockers or in their homes.

In New Jersey and Pennsylvania 29 patients were murdered by nurse Charles Cullen. Following his trial where he was found guilty, he admitted that his murder toll should be increased by at least ten. He was, in fact, suspected of having been the direct cause of another 300 deaths.

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Tuesday, October 25, 2016

Facial Fillers -- Not Cupcakes

"All injectors need to be aware of complications, should be able to recognize them when they occur and know how to manage them properly."
Report, American and Canadian dermatologists

"What we're trying to do with this paper is provide our colleagues with awareness about complications and the tool box to deal with them, should they be confronted with them."
"We know there is very high patient satisfaction with these treatments."
Dr. Vince Bertucci, past-president, Canadian Dermatology Association

"Those [clinics where nurses inject facial fillers with no physician supervision] are on the edge of what may be acceptable, or not acceptable by law."
"It's not the best, and it's not something I would endorse."
Nowell Solish, assistant professor of dermatology, University of Toronto

Examine Medical Credentials Before Considering Injectable Fillers


Dermal fillers are an important tool in the armamentarium of an aesthetic dermatologist in the management of ageing skin. A surge in the use of fillers has been witnessed due to increasing awareness among people, easy availability of fillers and increased enthusiasm amongst the dermatologists and plastic surgeons to use this modality. In this era of evidence-based medicine and litigations against doctors, Dermatologists should be vigilant about different acts of omission and commission in the use of fillers. 
M. Vedamurthy, Journal of Cutaneous and Aesthetic Surgery 
As people age, losing the dewy fullness and softness of complexion and skin begins to crease and pucker, those unwilling to surrender to the natural process of aging look for ways that modern cosmetic surgery can plump up the surfaces and return them to the magical transformation of reversing aging to resemble a renewal of youth. The solutions seem simple enough; add a substance that will emulate the fullness and freshness of youth to aging skin. And there are always doctors willing to lend themselves to the enterprise for whom scruples are not too professionally rigid.

Dr. Solish had a recent referral, a patient whose "rejuvenation" had been accomplished by having "fillers" injected into her face at a hair salon, by an accommodating nurse. His services were sought out by the patient who required amelioration of an ensuing condition. These wrinkle fillers are not without their side-effects; not in everyone granted, but they do occur, and they can be fairly serious health conditions brought about by an imperfect understanding and application of the fillers.

"Overcorrections" of aging skin can lead to infections, abscesses, necrosis (death) of tissue, blindness and stroke. Compelling reasons to proceed with caution. And it was the need to address this very situation that led American and Canadian dermatologists to produce a report, published in a recent issue of Facial Plastic Surgery. Celebrity photographs of botched facial procedures such as the March confession by Khloe Kardashian that fillers "f--cked" up her face requiring her to "go and get this whole thing, like, dissolved" aside, people shrug off warnings, feeling nothing untoward will happen.

Padding and plumping the face with synthetic forms of hyaluronic acid (HA), has become extremely popular. HA is the most common filler, a substance produced by the body naturally, its synthetic cousin binding with water to fill in sunken, aging skin. According to the American Society of Plastic Surgeons (inclusive of Canadian doctors), in 2014, 2.4-million procedures were undertaken with soft-tissue fillers; an increase of 274 percent since 2000.

The soft sell from dermatologists is that fillers present little risk and errors can readily be reversed with injection of an enzyme that acts like an antidote to swiftly break down any excess material in the face. They don't speak of technical mistakes leading to "suboptimal outcomes" that can be serious, write researchers of the report in Facial Plastic Surgery who describe cases where deep bruising, swelling or blue tinged skin results from the use of too much or too little filler.

They write of too much filler resulting "in an unnatural look many patients fear", of "lumps and bumps" which linger for weeks and months or years following the procedure. But it is the most serious complications that can occur when those fillers are mistakenly injected into blood vessels effectively cutting off blood supply to tissues that represent a nightmare scenario. The filler is capable of migrating to other  areas in the body and rarely, blindness, stroke and death of the skin can result.

Since January of 2000 Health Canada received 132 reports revolving around facial fillers, 51 of which were deemed to be serious in outcome though "None of these reports had fatal outcomes". It is a medical requirement in Canada that a doctor or a nurse under the direct instructions of a physician inject such fillers. Even so a casual attitude can prevail and as Dr. Solish noted, there are instances he is aware of where unauthorized personnel, not physicians, apply fillers.

Cosmetic injections

The issue

Many Canadians are choosing injectable cosmetic treatments to reduce facial wrinkles and attempt to restore their skin to a smoother appearance. However, consumers should be aware of the potential for adverse reactions that are possible with the use of these products.

Injectable dermal fillers

Dermal fillers are popular and widely used. Both health professionals and consumers should be aware of reported adverse reactions listed on the product labels. These are some of the adverse reaction reports that Health Canada has received for dermal fillers:
  • pain
  • bruising
  • redness
  • swelling or edema
  • nodules (raised bumps)
  • abscesses (sores)
  • infection
  • skin discoloration or hyper-pigmentation
  • allergic reaction
  • improper placement of the material
Many of these adverse reactions are generally temporary, but some could last several months and may require additional treatment and/or procedures to correct. Some of the procedures used to correct an adverse reaction may lead to scars and other skin reactions. A few dermal fillers are intended to be permanently inserted at the site of injection. Since the polymethylmethacrylate (PMMA) microparticles used in these dermal fillers are intended to be permanent, the treatment of potential side effects from these injections is more difficult and surgical removal may be the only solution. Health Canada


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Monday, October 24, 2016

The Ultimate Diagnostic Tool?

"We are getting more and more distanced from our patients."
"It [new handheld ultrasounds] would be the demise of the stethoscope. It'll be a problem."
"In the end, it's not going to be one versus the other. It's going to be, how do you fit the new technology in with the old?"
Dr. Lyall Higginson, Ottawa cardiologist

"Some of the protocols [like medical training in auscultation] tend to be a bit on the casual side -- taking students around to listen to a couple of patients in a clinic, and maybe listening to a couple of recordings."
"You can find out how fast the heart is going and measure blood pressure [with a stethoscope], but you can't really look directly at the function of the left ventricle [heart's pumping chamber]."
Dr. John Finley, pediatric cardiologist, Dalhousie University

"There are conditions where physical findings are very obscure. And often we end up requiring an ultrasound to confirm a physical finding anyway."
"So, you can argue  you can actually jump one step, and save time [with the use of the new handheld ultrasound technology]."
Dr. Chi-Ming Chow, staff cardiologist, St. Michael's Hospital, Toronto
 - VScan
The Vscan is a portable and pocket-size ultrasound device that allows cardiologists to do imaging at the point of care.
Source: Scripps Health

It was a delicate matter; how to listen to a patient's heart without giving offense, when a male physician was treating a female patient. In 1816, Dr. Rene Theophile Hyacinthe Laennec faced that dilemma with an elderly and very overweight female patient. He recalled a phenomenon of acoustics: "If you place your ear against one end of a wood beam the scratch of a pin at the other end is distinctly audible." He wrote this in his paper De l'Auscultation Mediate.

How he solved his little dilemma was recalling that bit of arcane knowledge and responding to it by rolling 24 sheets of paper into a tight roll, one end of which he placed on the patient's chest, the other to his ear. He was then "surprised and elated to be able to hear the beating of her heart with far greater clearness than I ever had with direct application of the ear", which up until that time was routine; a doctor placing his ear directly on a patient's chest to listen to the heart to aid in his diagnosis.

Best stethoscope for doctors

And thus was the stethoscope born. Born and brought into popular usage across Europe and then North America. As for Dr. Laennec, described as a "diminutive, asthmatic and very shy" doctor and just incidentally a tuberculosis specialist, he died at the unfortunately early age of 45, in 1826, aged 45. His innovation lived long after him, and the medical profession has had great reason to be grateful for his iconic moment of invention.


Doctors are never, ever seen without that icon of diagnosis slung around their necks, for the stethoscope has been used as an indispensable tool ever since. Examine a patient and the stethoscope has pride of place in the doctor's little black bag of necessary accoutrements. It has taken two hundred years for modern technology to arrogantly bring into the field of medicine a replacement for the reliable, sturdy stethoscope. Of course, any instrument is only as good as the human using it.

And as it happens, as technology brings along changes that it harrumphs in triumph improve everything -- it also dumbs down those special senses and operating capabilities that people were exposed to, to become proficient in their use -- to make us entirely reliant on a mechanical device to give us the data that a skilled professional could once deduce. Where once general practitioners were known to be indeed generalists, capable of doing just about anything that medical science offered, they have now become specialists in doing little other than referring on to other medical professionals.

And even then, the routine examination that patients were exposed to as the hands, eyes and ears of the practising physician focused on the physiognomy presented at any given time along with probing the patient's narrative to gain a diagnosis, now the doctor is more likely to be focused on the computer sitting before him as he interviews the patient while engaging in an absolute minimum of hands-on exploratory check-ups.

So now there is discussion among health professions, some of whom are pro-scope, others who are wedded to any and all types of emerging, useful and accurate technology whose use has led to doctors whose skills are nowhere near those of the preceding generations who took pride in practising medicine as a healing art extraordinaire. There are studies suggesting that the hand-held ultrasound devices' diagnostic capacities are more accurate than with the use of the mere stethoscope.

Indeed, one study saw first-year students exposed to 18 hours of training with the ultrasound technology correctly identifying more cardiac abnormalities than the trained cardiologists whose preference was the use of traditional stethoscope examinations. It's like the new self-driving vehicles where drivers have the impression they no longer have to bother being alert and capable of driving on their own, becoming passengers in cars driven mechanically as the cars themselves become robots.

The doctors who took their training seriously and devoted their professional lives to practising medicine with pride and professionalism are capable of turning an experienced ear to what they hear with the agency of the humble stethoscope. Where a normal murmur, vibration-like, signifies normalcy and a whooshing sound signals potential problems. What happens when the electrical grid fails or batteries are unavailable, and doctors schooled in the use of the hand-held devices must turn to the stethoscope?

Just asking.

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Sunday, October 23, 2016

Breathtakingly Audacious Corruption

"Mr. Martin has hundreds of thousands of dollars to spend on his campaign and to woo the very small Shuswap electorate. It's unlikely any of his opponents have those kind of resources. Hopefully, voters get access to the full information about how their council has been run and change things."
"Corruption in our political system -- whether on or off reserve -- can never be tolerated or overlooked, as integrity is foundational to democracy."
"[Shuswap members] deserve to know exactly what has gone on with their band leadership and millions of their dollars."
Jordan Bateman, spokesman, Canadian Taxpayers Federation
Bethany Lindsay/Postmedia/File
Bethany Lindsay/Postmedia/File   The Shuswap First Nation has an on-reserve population of about 100 people, and is located on the outskirts of Invermere near the B.C.-Alberta border
 
When the previous Conservative-led government in Canada enacted the First Nations Financial Transparency Act, to ensure that band members on and off reserve were kept informed of what their band councils were engaged in, and how they used the funding available to them through Aboriginal Affairs and Northern Development Canada, it was revealed by investigative reporters that the Shuswap First Nation, a tiny British Columbia band, had been manipulated to transfer $4.2 million of band funding over a period of 3-1/2 years to a single family.

This is a one-hundred member band, whose members live on their reserve located on the outskirts of Invermere close to the British Columbia-Alberta border. A forensic audit carried out by Ernst & Young authorized and funded by the federal government after revelations in the news media pointed out this gross mismanagement of band funds, was verified when the auditors produced a thirteen-page report made available to band members and handed over as well to the RCMP for investigation.

Incumbent Shuswap First Nation Chief Barbara Cote helped wrest control of the band from the family of former chief Paul Sam.
Postmedia/File   Incumbent Shuswap First Nation Chief Barbara Cote helped wrest control of the band from the family of former chief Paul Sam.

Current Chief Barbara Cote, along with the band's two councillors advised band members through a written statement that "It [the matter of the abuse of band funds] is under RCMP investigation." A "general and widespread lack of supporting documentation" was highlighted in the Ernst & Young report, noted in their completed audit. Which made note of a lack of proof that expenditures existed related to transactions undertaken by the band, which had a disconcerting habit of advancing the financial affairs of the Sam and Martin family.

In his 80s and confined to a wheelchair, the band chief was paid, tax-free, $741,262 to administer the band affairs, representing one hundred individuals of the band; that would be the equivalent of $1.3 million had taxes have had to be paid on that salary. Paul Sam's wife Alice Sam, in her capacity as the band's bookkeeper received $690,481 as her salary, equivalent to $1.2 million. While their son, Dean Martin was paid slightly below $1.4 million between April 2011 and November 2014.

Alice Sam (left) and then-Shuswap First Nation Chief Paul Sam in 2014. Dan Walton / Columbia Valley Pioneer files
And it is former Chief Sam's son Dean Martin who is now casting himself as an incoming chief should the band choose to vote him into office, and usher out the three incumbents, Chief Barbara Cote and councillors Tim Eugene and Rosalita Pascal who have represented the interests of the band ever since the Sam family was locked out and ousted when it was revealed through the media how they had manipulated band funds to service their personal craving for wealth.This, despite the police probe into the illegality of the transactions the Sam family had engaged in to enrich themselves, preying on the band's trust.

Moreover, two private companies: Shuswap Woodlands Restoration and KDC Sand & Gravel benefited by an additional $1.36 million in undocumented funds from the band's financial reserves. Two of Dean Martin's sons own each of these companies. As well, an additional $66,481 was used during that three-year period "on flights to destinations such as Las Vegas, Chicago and Varadero, Cuba for travel of an apparent personal nature", concluded the Ernst & Young audit.
Dean Martin, candidate for election in the Shuswap First Nation, and son of former chief Paul Sam and former councillor Alice Sam.
Dean Martin, candidate for election in the Shuswap First Nation, and son of former chief Paul Sam and former councillor Alice Sam. Greg Amos / Columbia Valley Pioneer Files

Yet, there's more that the audit discovered which they revealed in their report. Two amounts of $15,000 had been "diverted" for the purpose of clearing the credit card debts of Dean and his son Richard Martin, with another $20,000 going to pay down Dean Martin's former wife Pam's line of credit. Another $28,000 was used to pay for travel and accommodation for a softball team. These revelations are a shocking example of what some First Nations reserves are labouring under, under the guidance and direction of conscienceless leaders.

According to its 2015-16 financial statements, there is a $211,333 loan listed as an outstanding liability, taken out by KDC Sand & Gravel. Another drag on band expenses is the litigation launched against some ex-employees, including Dean Martin. In view of this egregious example of criminal malfeasance on the part of the elected chief and councillors of the Shuswap First Nation until they were removed once news of their skullduggery became public knowledge, it seems peculiar indeed that the current Trudeau government is prepared to revoke the First Nations Financial Transparency Act, citing their view that insufficient consultation with First Nations took place before the act was brought into law.

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Saturday, October 22, 2016

Drug Use Impeding Safety and Security Protocols

Illustration
Police block off access to Weeds, a marijuana dispensary on Danforth Avenue in Toronto on May 26, 2016. (Don Peat / Postmedia Network)
"There are safety implications associated with alcohol and drug use and abuse in the workplace." 
"That has to be appropriately managed and mitigated by employers, and that is not going to change in the future."
Barbara Johnston, employment lawyer, Calgary

"If I have a beer on a Friday night, I'm fit for work Monday morning; it's not an issue. That's the analogy that you're likely going to see, if and when marijuana does get legalized."
Tom Duke, lawyer, Miller Thomas, Edmonton

"I feel that it's not my company's business what I do in my own time. If marijuana were to be legalized, and nothing changes in regard to how they test and why they test, people could be fired left and right for nothing."
"I feel generally the risk is pretty low for me, because I know what I'm doing. The only time I really do it [smoke a joint] is when I know for sure that I'm not going to have to go for a pre-employment test. Say I just took one now; I would probably go home and smoke a joint."
Anonymous oilfield crane operator
"The urine tests can't identify people who are impaired. The tests are just picking up users, not those that are a safety risk."
"If the test for alcohol could only tell if you've had a drink in the last two or three days, would that be justified? Most people would laugh at that because drinking is so commonplace."
"But this is basically what is being done with drug testing."
Scott Macdonald, assistant director, Centre for Addictions Research, British Columbia

"If somebody has an addiction, it's a bit clearer that the employer has a duty to accommodate the addiction."
"Where it can get tricky is if somebody is a recreational users; they don't have an addiction."
Monette Maillet, senior general counsel, Canadian Human Rights Commission, protection branch
Colorado marijuana legalization
Since marijuana has been legalized in 23 states – including Colorado, where this woman was photographed –employers have had to navigate between long-held workplace standards and new legal protections. Photograph: Mark Leffingwell/Reuters

THC, the active ingredient in marijuana, remains in the human system and detectable longer than alcohol would, along with heroin, cocaine and other water-soluble substances. Marijuana, on the other hand, can be detected through urine tests for up to 30 days because THC is fat-soluble. According to scientists, screening urine measures for inactive metabolites and not active substances.

With this in mind, a Vancouver company, Cannabix Technologies, is collaborating with chemists in Florida hoping to develop a breathalyzer test for THC, to replace current detection methods. The experience of a recreational pot smoker who was hired as a receiving inspector at an Alberta oilsands operation -- a safety-sensitive position -- is instructive in this regard. He informed his superiors before taking the urine test that he smoked pot five days before taking the test.
Thomas
THC stays in a person’s system longer than alcohol, heroin or cocaine. (Mark Yuen / Postmedia News)

When the test confirmed marijuana in his urine, he was fired. He responded by filing a human rights complaint on the basis of discrimination on the grounds of disability. But this man had conceded he was a recreational smoker and for him addiction was not the issue. When workers believe they have been let go on the issue of addiction, they can fall back on the disabilities claim, one that under Canadian law has protected legal status.

A precedent was set by the Ontario Court of Appeal on a different case, finding drug-testing technology is unable to measure an employee's relative intoxication and that being so, random tests do not justify claims when employers attempt to achieve the "Legitimate goal of a safe workplace free of impairment." The above Alberta oilsands case challenged employers working to make certain dangerous workplaces remain safe, bearing in mind the need to avoid allegations their decision making is unfair or discriminatory.
Thomas
A file photo of a crane in Fort McMurray, Alberta. (Carl Patzel / Postmedia Network)

Suncor Energy has focused its efforts in this regard on a lengthy court battle to achieve their goal of introducing random drug and alcohol testing at its Fort McMurray operations, with the union Unifor representing workers, arguing that random tests violate personal privacy rights even as they fail to increase safety since tests  do not measure impairment, but rather "off-duty conduct".

In response, the company retorts that the measures have been unsuccessful in solving safety concerns at job sites in view of the fact that an "out of control" drug culture permeates society, and this is a deep social issue it has been dealing with. To support its case, the company presented evidence in court of 2,300 security incidents linked to drugs and alcohol over a nine-year period.

Of seven workers who died at their job sites at Suncor from the years 2000 to 2012, three workers were found to have been suffering under the influence of drugs or alcohol. "We wouldn't be pursuing this if we didn't feel it was absolutely necessary", commented Sneh Seetal, Suncor spokeswoman.

In workplaces where the anonymous crane operator felt entitled to his recreational activities, largely involving smoking joints, the game is to outsmart those random checks. The unnamed worker manages that by timing himself so that when a new worksite is being contemplated for him to report to, coinciding with the administration of a urine test, he abstains from marijuana use prior to the test, then resumes his habit immediately the test is taken.

Heavy equipment operators, miners, truck drivers and other safety-sensitive positions are the sole concern of employers subjecting employees to urine tests for the presence of THC. Where the presence of an intoxicant mild enough not to be thought to impair someone in an ordinary workplace with no danger factor involved, employer tests for THC will not likely be an issue once marijuana is legalized in Canada.

But where safety and sobriety loom large in importance to job performance the issue of on-the-job drug testing representing an invasion of privacy and likely discriminatory action to be settled by the human rights commissions they are referred to, are unlikely to get a free pass, given the issues involved. The crane operator who feels justified in taking steps to avoid getting caught as a recreational marijuana user is gambling with safety, feeling he is always in control.

He is also gambling with his future job prospects, with the security a steady job ensures, enabling him to support his wife and two young children. But he is prepared to take that gamble, that if he is somehow caught out he can be fired for a positive test just for having marijuana detectable in his urine, irrespective of whether he was high on the job at the time the test was taken.

No such employees can claim in their self-defence that they had no idea of the potential consequences of their habit. The union representing their interests as a matter of course is obligated to inform employers that failure to pass such tests "can affect your entire career." On the other hand, if and when a detection device more accurate in determining the reflex condition of an employee on the job comes into action, this will all become moot.

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Friday, October 21, 2016

The Respectability Branding of Weed/Pot/Ganga

bob marley quote about bob marley smoking quotes weed bob marley ...smoking weed quotes bob marley quote on marijuana and music quote life ...

"First, we take away any of the vernacular such as 'weed', 'pot', 'ganga'. In terms of imagery, we skew away from any green leaves or even the word marijuana."
Olivia Mannix, Cannabrand, Colorado cannabis product branding group

"We're very excited to bring Marley Natural to Canada. Yeah, mon!"
"We have the same values [as Privateer Holdings, Seattle]; social change, environmental sustainability, and to actually build a professional, responsible and legal cannabis industry."
"Daddy's message was unity, personal freedom and social justice. It is what he sang about, what he fought for, and how he lived. It's timeless, and it still resonates."
Cedella Marley, daughter of Bob Marley

"We set out on this old-fashioned, boots-on-the-ground adventure to go to places like northern California, Oregon, Washington, Colorado, British Columbia, Jamaica, Israel, Spain, the Netherlands, trying to understand the status of the cannabis industry."
"We set out to create our own brand at Privateer. We chose to wear suits. We weren't going to use the typical slang words and cliches.. We weren't going to use the leaf all over the place or the colour green."
Brendan Kennedy, CEO, Privateer Holdings, Seattle

"I remember leaving that meeting and thinking two things: One was, if these guys are right, this is probably the biggest opportunity we've seen come through Heckler's [public relations/branding/advertising] doors since Starbucks."
"This plant had been demonized for a long time. There were conceptions of the consumer that were fairly inaccurate. So for me from a branding perspective, coming into a situation where you really have some things working against you, and to see how you could really work in a marketplace that had these strong preconceptions [was appealing]."
"We are literally witnessing the beginning of the end of cannabis prohibition worldwide, and the healing of various nations and economies worldwide in terms of job creation and tax benefits."
Scott Lowry, brand director, Privateer Holdings
Willie Nelson.
American country singer Willie Nelson takes a drag off a joint while relaxing at his home in Texas circa 2000. (Liaison / Getty Images)

With the aromatic scent of the use of marijuana losing its illicit status as the year-old Liberal administration in Canada is on track to legalize marijuana use beyond its health/medical application for those who can acquire the go-ahead from Health Canada, buying their medical marijuana from licensed dealers, there is so much profit to be made by generally retailing marijuana that pot shops have opened in all major Canadian cities -- illegally, since the weed is not yet in that legal status -- risking police raids and shut-downs.

There is so much money to be made from the sale of this product that has so many strains and presentations that celebrities are lining up their own profit margins, buying into the production and sale of pot, lending their famous names to the enterprise in exchange for a boost in their bottom line. Marley Natural, a line of hemp body products and smokeables is just one such example; a winner since of all celebrities the late Bob Marley's name and reputation was inextricably wound into that of ganga's attributes that has attracted so many to the habit.

The dearly departed Marley aside, celebrity licensing has gone into overdrive with Willie Nelson, Snoop Dogg, Nick Lachey, Whoopi Goldberg, Wiz Khalifa and Melissa Etheridge all leaping into the lucrative business of hawking cannabis under their imprimatur. Investors in the steadily emerging and runaway market may be enthralled with the use of marijuana themselves and see no reason why everyone shouldn't have easy access to their particular brand, most of all, because it will make them rich.

Brands, according to Brendan Kennedy of Privateer Holdings, a private equity firm raising capital to invest in the "cannabis space", won't emerge resulting from regulatory change, they are, conversely set to "fuel the cultural change" taking place. His investing venture and his partners invested time and energy in scoping out the market before they took the plunge to commit to fully engaging in it. What they emerged with was the impression that an image problem lingered around the drug's use, and they set about to change that, to make it respectable.
Now, words matter. Take for example, the very word 'Marijuana', it is henceforth to be referred to as 'Cannabis'. And the word 'dealer' with its uneasy connotations of trafficking has become the much more respectable 'budtender', a riff on bartender, ha-ha. 'Paraphernalia' has surrendered to 'ancillary items', so much more innocent in sound if not intent. And goodness me, 'stoned' now is to be referred to as 'deepened perception', infinitely more acceptable. The pejoratives 'pothead' and 'stoner' now merely refer to 'enthusiasts'; how anodyne can you get?
Among other initiatives they undertook to make everything more publicly civil, aside from investing in a proven online cannabis resource, was to land one of Canada's coveted medical cannabis licences; legal and respectable. And they opened a production facility in Nanaimo, British Columbia, branding it "Tilray", an innocuous name with no connotations hearking back to ganga's grubby antecedents. And, of course, they brought aboard the Marley Natural brand; a trifecta of meticulous planning.

Although it remains illegal to patent or trademark psychoactive edibles or cannabis smokeables in the United States in view of marijuana's classification as a Schedule One drug along with heroin, by bringing aboard a high-profile celebrity figure, a social patent is achieved, readily given to being touted on line through all the tentacles of popular social media. Say an Instagram post or a Tweet, so far-reaching that millions across various states, territories and countries can be alerted to its availability even though advertising is prohibited.

Snoop Dogg
Snoop Dogg exhales lungfuls of blunt smoke on stage at WaMu Theater in Seattle, Wash. on April 19, 2014. (Jordan Stead / seattlepi.com / The Associated Press)


There's no stopping this train; it's full speed ahead!

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