For many Canadian doctors, managing pain is 'not a high priority'

This week on The Sunday Edition

Michael's Essay: Atheists should stop behaving like persecuted outsiders.

Understanding pain

Dr. Fernando Cervero is working to change the way we think about and treat pain. He's a professor of anesthesia and the director of the Alan Edwards Centre for Research on Pain at McGill University in Montreal. He's also president of the International Association for the Study of Pain.

Documentary: Figures in Flight

We meet a group of convicted murderers, drug dealers and sex offenders, who have spent many decades behind bars. Now... they are learning to dance.

Tackling public pensions

Demographics are threatening public pensions, and two provinces are tackling the problem head on. Michael talks with Alberta's finance minister, Doug Horner, and with the chair of New Brunswick's Pension Task Force, Sue Rowland.

Rebecca Solnit

Rebecca Solnit's new book is called The Faraway Nearby. She's wise and insightful, passionate and compassionate. Among other things, she talks to Michael about what her mother's descent into Alzheimer's taught her about letting go. 

Craig's Retreat

What's it like to live like a monk? Craig Desson reports from his 10-day silent meditation retreat -- waking at 4 a.m. and not reading, writing, speaking or eating after noon.

The headlines are full of breakthroughs heralding new treatments and cures for a host of debilitating and lethal diseases and conditions. 

But for the millions of Canadians who suffer from chronic pain, relief - let alone a cure - is still elusive. 

According to the Canadian Pain Society, one in five Canadians suffers from chronic pain. Yet treatment has not been a priority in our health care system; instead, people who complain of chronic pain are all too often derided as whiners. 

They say doctors are incredulous that their pain - which might have no apparent cause - could possibly be that bad. Or else they're just counselled to grin and bear it.

That nonchalance reflects an attitude in western cultures, where pain is largely considered a sign of virtue and a test of character, says Dr. Fernando Cervero, director of the Alan Edwards Centre for Research on Pain at McGill University.

Attitudes slowly changing

But Dr. Cervero notes that social attitudes are changing. Patients and their advocates are demanding better and more timely treatment for chronic pain. But the medical establishment has not kept pace with those changes. For example, veterinary students receive much more training in pain management than medical students.

The societal change in attitudes toward pain "has not completely permeated all the way to the medical schools," Dr. Cervero told The Sunday Edition's Michael Enright. "In a curriculum that is getting more and more busy with more and more discoveries in medicine – and we all have to fight for time in the medical curriculum – pain is not a high priority."

Dr. Cervero, who will be speaking at an international symposium on pain at McGill University on Oct. 3, says more must be done to make the relief of pain, especially for chronic pain sufferers, a top priority in Canadian health care.

"It's not right for people to suffer unnecessarily," he said.

You can hear Michael Enright's full conversation with Dr. Fernando Cervero on CBC Radio's The Sunday Edition on Radio One this Sunday, just after the 9 a.m. news.

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$1.3B medical marijuana free market coming to Canada

Medical marijuana by the numbers

• Current number of users approved by Health Canada: 37,359.
• Number of patients with personal licences to grow marijuana for themselves: 25,600.
• Number of growers licensed to produce marijuana for a maximum of two patients each: 4,200.
• Current number of entrepreneur applications to grow medical marijuana under new rules: 156.

The Conservative government is launching a $1.3-billion free market in medical marijuana on Tuesday, eventually providing an expected 450,000 Canadians with quality weed.

Health Canada is phasing out an older system on Monday that mostly relied on small-scale, homegrown medical marijuana of varying quality, often diverted illegally to the black market.

In its place, large indoor marijuana farms certified by the RCMP and health inspectors will produce, package and distribute a range of standardized weed, all of it sold for whatever price the market will bear. The first sales are expected in the next few weeks, delivered directly by secure courier.

"We're fairly confident that we'll have a healthy commercial industry in time," Sophie Galarneau, a senior official with the department, said in an interview.

"It's a whole other ball game."

The sanctioned birth of large-scale, free-market marijuana production comes as the Conservatives pillory Liberal Leader Justin Trudeau's campaign to legalize recreational marijuana.

Health Canada is placing no limits on the number of these new capital-intensive facilities, which will have mandatory vaults and security systems. Private-dwelling production will be banned. Imports from places such as the Netherlands will be allowed.

Already 156 firms have applied for lucrative producer and distributor status since June, with the first two receiving licences just last week.

'Enormous' potential profit

The old system fostered only a cottage industry, with 4,200 growers licensed to produce for a maximum of two patients each. The Mounties have complained repeatedly these grow-ops were often a front for criminal organizations.

The next six months are a transition period, as Health Canada phases out the old system by March 31, while encouraging medical marijuana users to register under the replacement regime and to start buying from the new factory-farms.

There are currently 37,400 medical marijuana users recognized by the department, but officials project that number will swell more than 10-fold, to as many as 450,000 people, by 2024.

The profit potential is enormous. A gram of dried marijuana bud on the street sells for about $10 and Health Canada projects the legal stuff will average about $7.60 next year, as producers set prices without interference from government.

Chuck Rifici of Tweed Inc. has applied for a licence to produce medical weed in an abandoned Hershey chocolate factory in hard-scrabble Smiths Falls, Ont.

Rifici, who is also a senior adviser to Trudeau, was cited in a Conservative cabinet minister's news release Friday that said the Liberals plan to "push pot," with no reference to Health Canada's own encouragement of marijuana entrepreneurs.

Rifici says he's trying to help a struggling community by providing jobs while giving suffering patients a quality product.

"There's a real need," he said in an interview. "You see what this medicine does to them."

Revenue to hit $1.3 billion

Tweed Inc. proposes to produce at least 20 strains to start, and will reserve 10 per cent of production for compassionate, low-cost prescriptions for impoverished patients, he says.

Patients often use several grams a day to alleviate a wide range of symptoms, including cancer-related pain and nausea. They'll no longer be allowed to grow it for themselves under the new rules.

Revenues for the burgeoning new industry are expected to hit $1.3 billion a year by 2024, according to federal projections. And operators would be favourably positioned were marijuana ever legalized for recreational use, as it has been in two American states.

Eric Nash of Island Harvest in Duncan, B.C., has applied for one of the new licences, banking on his experience as a licensed grower since 2002 in the current system.

"The opportunity in the industry is significant," he said in an interview.

"We'll see a lot of moving and shaking within the industry, with companies positioning. And I think we'll see some mergers and acquisitions, strategic alliances formed."

"It'll definitely yield benefits to the consumers and certainly for the economy and society in general."

Competition to keep prices in check

Veterans Affairs Canada currently pays for medical marijuana for some patients, even though the product lacks official drug status. Some provinces are also being pressed to cover costs, as many users are too sick to work and rely on welfare.

Health Canada currently sells medical marijuana, produced on contract by Prairie Plant Systems, for $5 a gram, and acknowledges the new system will be more expensive for patients.

But Galarneau says competition will help keep prices in check.

"We expect that over time, prices will be driven down by the free market," she said. "The lower price range will likely be around $3 a gram. ... It's hard to predict."

Saskatoon-based Prairie Plant Systems, and its subsidiary CanniMed Ltd., were granted the first two licences under the system and are already advertising their new products on the web.

Prospective patients, including those under the current system, must get a medical professional to prescribe medical marijuana using a government-approved form.

Health Canada only reluctantly established its medical marijuana program, driven by court decisions from 2001 forward that supported the rights of suffering patients, even as medical science has been slow to verify efficacy.

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Bus drivers should have annual health checks, MPP urges

Drivers of Ontario's city buses should have stricter rules for monitoring their health like those used for commercial airline pilots across Canada, according to the PC transportation critic.

Currently, the Ministry of Transportation of Ontario requires bus drivers younger than 46 years old to submit a medical report every five years to maintain their Class "C" licence. If drivers are older than 46, they have to submit the report every three years.

MPP Frank Klees spent a short time as Ontario's transportation minister before the 2003 provincial election. (Photo courtesy of Frank Klees)

Doctors must also notify the ministry immediately if there is a significant change to a driver's health, such as a heart condition.

Transport Canada stipulates commercial airline pilots have medical checks each year if they are 40 or younger, and every six months if they are older than 40.

"To me there is not a great deal of difference between what a commercial airline pilot does and what a bus driver does every day," said MPP Frank Klees, who was also the province's transportation minister for a short time in 2003.

"I think the Ministry of Transportation here in the province of Ontario would do well to implement a parallel set of requirements."

Bus crash ignites debate on drivers' health

The issue of bus drivers' health has been the focus of some debate after it was learned the driver of OC Transpo Route 76, which crashed into a Via Rail passenger train on Sept. 18, had been prescribed medication to treat a less severe form of diabetes.

The crash killed six people including the driver, 45-year-old Dave Woodard, and five of his passengers: Kyle Nash and Connor Boyd, both 21; Michael Bleakney, 57; Rob More, 35; and Karen Krzyzewski, 53.

But investigators have not linked Woodard's health to the crash and it could be months before the public hears about possible factors in the crash.

(CBC)

In Ottawa, OC Transpo verifies bus drivers' licences regularly, but it does not conduct separate medical checks. Klees said no matter what investigators find after the bus crash, city bus drivers across Ontario should be monitored more carefully.

Craig Watson, president of the Amalgamated Transit Union 279, agrees with Klees. But the man whose union represents Ottawa city bus drivers said the idea would only work if the province footed the bill for all medical checks.

"There is the cost of the time, the effort and the monetary cost of the doctors, which is not covered by OHIP," Watson said.

"But if it's another safety consideration that the Ontario government would consider … we're all about safety."

Poll question

Do you think city bus drivers should have mandatory health checks each year?

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Public umbilical cord blood bank launches in Ottawa

A newborn baby boy's umbilical cord blood is collected to try to cure his sister of leukemia in Beijing in 2005. Canada is the only G8 country without a national cord blood bank, Canadian Blood Services says. ( China Photos/Getty)

Canada's first ever public blood bank for umbilical cord blood is set to begin taking donations today at an Ottawa hospital.

Canadian Blood Services says its bank will let the public donate instead of discard umbilical cords, which are a rich source of desperately needed stem cells.

It says some 1,000 Canadians are currently waiting for life-saving stem cell transplants to treat diseases such as leukemia, lymphoma or aplastic anemia.

The group says Canada is the only G8 nation that doesn't have a national public cord blood bank.

It says once the bank is fully up and running healthy pregnant women 18 years or older will be able to donate at collection hospitals in Ottawa, Brampton, Ont., Edmonton and Vancouver.

Similar private banks already operate, but CReATe Cord Blood Bank founder Dr. Clifford Librach says the launch of the public bank taking donations for use in non-family patients will spread the word about umbilical cord donations.

"It increases awareness for patients who may not have been aware of this whole process or their options."

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Emerson Curran's father talks about son's organ donation

The father of a 20-year-old man who died in an Edmonton hospital after sustaining head injuries in Yellowknife is hoping his son's story will encourage more Canadians to donate their organs.

Emerson Curran was badly beaten in a fight at a house party in Yellowknife in August and died in hospital in Edmonton. 

Michael Curran, Emerson's father, is now speaking out about how the death of his son turned into an inspiring lesson about the importance of organ donations.

Emerson Curran had been working at Air Tindi in Yellowknife for the summer. He had been studying philosophy at the University of Ottawa.

On Aug. 24 his parents got a call in the middle of the night at their home in Ottawa informing them Emerson had been seriously injured. At the airport they got a second call telling them Emerson's head injury was worse and he was being medevaced to the Royal Alexandra Hospital in Edmonton. By the time his parents arrived there from Ottawa, doctors told them he was gone.

Michael Curran says Emerson had spoken to his mother once during a long car trip about his wish to donate his organs.

"He was sharing his views on life and the afterlife and for some, now we think very odd reason, he made his views on organ donation very clear to my wife, saying if he was to pass. he thought his organs should be used to save the lives of other people."

The Currans asked for Emerson's organs to be donated. His heart, lungs, liver, two kidneys and his pancreas were transplanted.

Michael Curran says he is speaking out about his family's experience because he says a lot of people feel organ donation is done for the recipients, but that there are benefits to the family of the donor as well. 

"This was a nightmare situation that we went through, and the organ donation process for me and my wife was a real sign of hope in a very bleak situation."

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Human egg trade operates in regulatory void

 A Toronto woman who says she was paid thousands to donate her ova is advocating for Canada to protect the health of donors in the wild west of reproductive technology.
 
Claire Burns co-founded a support group called weareeggdonors.com. Burns started the donation process in 2003, which she said was an isolating experience.
 
"Knowing now what I did not know then, I really feel like I wasn't able to make the most informed decision going into egg donation and I would not donate again," said Burns, who has also written a play called Hatched, about egg donation.
 
"It's a women's health issue, so we need to ensure the health of the donors are being respected and prioritized."
 
Egg donors can face complications, said Françoise Baylis, a professor and Canada Research Chair in bioethics and philosophy at Dalhousie University in Halifax.
 
"How many egg donors understand that there's a possibility you could be infertile as a result of your participation in this?" Baylis asked. "The possibility is small."
 
Egg donation is going on overseas and in the U.S., said Dr. Matt Gysler, president of the Canadian Fertility and Andrology Society.  
 
"There is a complication called hyperstimulation syndrome," said Gysler. "Very young patients, like the egg donors often are, are at significant risk. So if you do it, it has to be done very cautiously by a very well-trained individual."

In Canada, the regulations for egg donation are in limbo, Gysler agreed. "Bring it out of the dark and into the open and surrounded by appropriate safeguards for those individuals that are willing to donate."  
 
Baylis explained that in Canada, it's illegal to buy human eggs but it's not illegal to sell them.  
 
"Part of the reason for that difference in the legislation is that we didn't want to target or victimize yet again the women who might be participating in this transaction."
 
Under the regulations, women can also be reimbursed for expenses that have receipts, Baylis said.  
 
Baylis moderated a forum in Toronto on Thursday night that explored the ethical and legal consequences of the trade in human eggs, including the question of what are legitimate reimbursable expenses.
 
Burns, who was one of the panellists, said payments should be allowed.  
 
"I was paid $4,000," Burns recalled in an interview. "It kind of left a sour note in my stomach about the financial transaction having to be so underground."

Baylis said the grey market exists because the federal government will not enforce its own legislation. "If I was being cynical, I would say it's because they don't care about women."

She called on Health Canada to fulfil its responsibilities.

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For many Canadian doctors, managing pain is 'not a high priority'

This week on The Sunday Edition

Michael's Essay: Atheists should stop behaving like persecuted outsiders.

Understanding pain

Dr. Fernando Cervero is working to change the way we think about and treat pain. He's a professor of anesthesia and the director of the Alan Edwards Centre for Research on Pain at McGill University in Montreal. He's also president of the International Association for the Study of Pain.

Documentary: Figures in Flight

We meet a group of convicted murderers, drug dealers and sex offenders, who have spent many decades behind bars. Now... they are learning to dance.

Tackling public pensions

Demographics are threatening public pensions, and two provinces are tackling the problem head on. Michael talks with Alberta's finance minister, Doug Horner, and with the chair of New Brunswick's Pension Task Force, Sue Rowland.

Rebecca Solnit

Rebecca Solnit's new book is called The Faraway Nearby. She's wise and insightful, passionate and compassionate. Among other things, she talks to Michael about what her mother's descent into Alzheimer's taught her about letting go. 

Craig's Retreat

What's it like to live like a monk? Craig Desson reports from his 10-day silent meditation retreat -- waking at 4 a.m. and not reading, writing, speaking or eating after noon.

The headlines are full of breakthroughs heralding new treatments and cures for a host of debilitating and lethal diseases and conditions. 

But for the millions of Canadians who suffer from chronic pain, relief - let alone a cure - is still elusive. 

According to the Canadian Pain Society, one in five Canadians suffers from chronic pain. Yet treatment has not been a priority in our health care system; instead, people who complain of chronic pain are all too often derided as whiners. 

They say doctors are incredulous that their pain - which might have no apparent cause - could possibly be that bad. Or else they're just counselled to grin and bear it.

That nonchalance reflects an attitude in western cultures, where pain is largely considered a sign of virtue and a test of character, says Dr. Fernando Cervero, director of the Alan Edwards Centre for Research on Pain at McGill University.

Attitudes slowly changing

But Dr. Cervero notes that social attitudes are changing. Patients and their advocates are demanding better and more timely treatment for chronic pain. But the medical establishment has not kept pace with those changes. For example, veterinary students receive much more training in pain management than medical students.

The societal change in attitudes toward pain "has not completely permeated all the way to the medical schools," Dr. Cervero told The Sunday Edition's Michael Enright. "In a curriculum that is getting more and more busy with more and more discoveries in medicine – and we all have to fight for time in the medical curriculum – pain is not a high priority."

Dr. Cervero, who will be speaking at an international symposium on pain at McGill University on Oct. 3, says more must be done to make the relief of pain, especially for chronic pain sufferers, a top priority in Canadian health care.

"It's not right for people to suffer unnecessarily," he said.

You can hear Michael Enright's full conversation with Dr. Fernando Cervero on CBC Radio's The Sunday Edition on Radio One this Sunday, just after the 9 a.m. news.

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FDA adds severe warning to Pfizer antibiotic Tygacil

The FDA says Tygacil should only be used in situations where other treatments aren't suitable.

U.S. regulators are putting their harshest warning on Pfizer's antibiotic Tygacil, saying the drug is associated with an
increased risk of death.

The U.S. Food and Drug Administration said Friday Tygacil, or tigecycline, should only be used in situations when other treatments aren't suitable. The intravenous drug is approved as a treatment for complicated skin and skin structure infections and community-acquired bacterial pneumonia.

The FDA will add a boxed warning to the drug label, its most serious type of warning.

In 2010 the FDA said Tygacil was associated with a greater risk of death than other antibacterial drugs. It says a new analysis confirmed that conclusion. The risk was greatest in patients with ventilator-associated pneumonia. Tygacil hasn't been approved for that condition.

The agency said it's not clear why the drug is associated with a higher risk of death compared to other drugs.

Tygacil is listed in Health Canada's online database of approved drugs.

The New York drugmaker reported $335 million US in Tygacil revenue last year, including $152 million in U.S. sales.

Shares of Pfizer Inc. rose 37 cents to $28.89 US in afternoon trading.

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Alberta flood: High River ponds contain E. coli months later

A potentially deadly strain of bacterium, called E. coli 0.157, has been found in two ponds in High River, Alta., according to water test results conducted for CBC News.

CBC hired the independent water-testing company Benchmark Labs to examine water in the flood-ravaged community south of Calgary.

Alberta flood: 100 days later

CBC News has special coverage planned for Thursday and Friday as we look back at the first 100 days since the June flood, including more on soil and water testing from High River.

We will have features on CBC Radio One, our local television news and an interactive online website.

Supper-hour host Rosa Marchitelli will anchor CBC News Calgary from High River on Friday.  

Ian Hanomansing will also broadcast part of The National from southern Alberta.

The tests also discovered that three bodies of water in the town exceeded provincial recreational guidelines for total coliform bacteria, said Benchmark Labs head Chris Bolton.

Alberta's Chief Medical Officer of Health Dr. James Talbot released a statement to the media on Thursday reacting to the discovery of E. coli.

"The story that aired on CBC Calgary's Sept. 26 morning show identifies a threat of E. coli in a standing water pond that is not a human drinking water source," said Talbot.

He stressed that public health officials have tested High River's drinking water extensively since the flood and said it remains safe.

"The fact that there still is E. coli in the floodwater around High River is not unexpected. It's also very common to have E. coli 0157 wherever there are dogs, cats, wildlife or runoff from livestock operations," he said.

"We continually track E.coli 0157 infections rates in this province. We did so before the flood, during the flood and after the flood, and there have been no cases in High River this year."

Benchmark Labs did not test drinking water in the town, but Bolton worries about potential contamination.

• Listen to his full interview on the Calgary Eyeopener.

Bolton warned against High River children and pets playing in or around water.

High River resident Miguel Rodriguez shares that concern.

June's flood swamped his family's home in the hard-hit community of Hampton Hills.

Mike Warren of Mending Homes took samples of water in High River for analysis at Benchmark Labs in Calgary. (Brooks DeCillia/CBC)

"I'm afraid to let my kids out and play. There's contamination there for sure," Rodriguez told CBC News.  

Bolton is also worried about pets making humans sick. 

"If your pet's out in the water bringing the wet fur back ... then, that is of immediate concern," he said.

The water expert worries about a deadly repeat of Canada's worst-ever outbreak of E. coli contamination in Walkerton, Ont., roughly 13 years ago. Tainted water in the town killed seven people and made another 2,300 sick. 

"With 0.157, everyone knows what that is. [It] can make you seriously ill or die," Bolton said.

He wonders why provincial authorities haven't warned the public.

"Most people assume that it's OK because there is no public health notice," he said.

"When it had its big flood — its 100-year flood — that came two weeks after the one we had here in Calgary, Ontario immediately posted public health notices once they found levels that were very similar to these," Bolton said.

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Canadian doctor total at record high

All provinces except Manitoba reported an increase in the number of physicians last year, according to reports by the Canadian Institute for Health Information that were released Thursday. (Adrian Wyld/Canadian Press)

Canada had a record 75,142 doctors last year and they earned $328,000 gross on average, according to two new reports.

The annual reports on physician supply and payments for both general practitioners and specialists were released Thursday by the Canadian Institute for Health Information.

"The year 2012 saw the highest level of physicians per capita ever recorded in Canada," the authors of the reports said.

What's more, the six-year trend of growth in the number of doctors outpacing population growth is expected to continue since data from medical schools indicate more students are graduating with MD degrees.

Between 2008 and 2012, the number of female physicians increased by nearly 24 per cent, while the number of male doctors increased by 10 per cent. In all provinces, women represented a larger proportion of family doctors than specialists.

Since 2008, the number of doctors working in rural areas increased five times faster than the rural population, with almost 6,400 physicians in 2012.

But the numbers alone don't present the full picture. It's important to ask not just how many doctors are needed, but where are they most needed and in what specialties, said Geoff Ballinger, CIHI's manager of physician information.

Kristin Speth, 35, of Toronto, has been looking for a regular doctor since she moved from Alberta four years ago. She's had headaches since childhood and has been going to walk-in clinics but is frustrated with the experience.

She's tried the provincial service to find a doctor but keeps getting notices saying there are no leads.

"It is extremely frustrating," said Speth.

"It's just so hard to find someone who will just stay longer than the one year that I need for my physical. They just don't stick around or you know, you can't find anyone who is taking new patients."

 In 2011-12, clinical payments to doctors' offices also increased nine per cent over the previous year to more than $22 billion, the institute reported. In the two previous years, the increases were 6.1 per cent and 7.9 per cent, respectively.

How doctors are paid is also changing.

Fee-for-service payments that reimburse doctors for each clinical service they provide continued to be the majority, at 71 per cent, last year. The average cost per service paid was $56.99.

Out of the gross amount, doctors pay for taxes, rent, salaries and equipment.

Alternative clinical payments, such as paying by hour or by the number of patients in a doctor's practice, rose to 29 per cent, up from 11 per cent of total payments a decade ago.

"Now they're being paid in ways that encourages them to see perhaps fewer patients but spend more time with patients, which is particularly important for older patients or patients with chronic disease," Ballinger said in an interview.

Ontario's health minister, Deb Matthews, said the province is moving towards team-based models of care that maximizes the ability of nurses, nurse practitioners and others to provide primary care.

The per capita number of doctors "becomes a little bit less meaningful than it would have in the old days when you had a family doctor or nothing at all," said Matthews.

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Is the anti-bullying message getting through?

Despite all the high profile media campaigns, government programs and school initiatives launched to address youth bullying, tragic stories continue to emerge about teenagers continuing to suffer.

This week, the mother of 15-year-old Saskatchewan teen Todd Loik, said her son —​ just like Rehtaeh Parsons, Amanda Todd, Jamie Hubley and Mitchell Wilson — killed himself after years of being tormented by his schoolmates.

It was yet another story where bullying looks to have played some role in the suicide of a young teen. But despite the attention governments and school boards are devoting  to developing an anti-bullying strategy, questions remain about how effective is the message, and is it reaching its target audience?

"I guess it's not effective enough if young people are being tormented," said Debra Pepler, a York University psychology professor who helped establish PREVNet — Promoting Relationships and Eliminating Violence Network. 

The issue, however, has certainly gotten its fair share of media attention.

Celebrities have taken part in multimedia anti-bullying campaigns, like the It Gets Better pledge that reached out to gay, lesbian, transgender and other bullied teens. And schools and provinces have also launched initiatives. 

Ontario passed the Accepting Schools Act last year, while B.C. announced its 10-point Expect Respect And a Safe Education (ERASE) bullying strategy. And this year,  Nova Scotia implemented its new Cyber-Safety Act, aimed at protecting victims and holding bullies responsible.

Meanwhile, in June, the prime minister's wife Laureen Harper joined then heritage minister James Moore and Ottawa city councillor Allan Hubley, whose son killed himself after being bullied, to announce $250,000 in funding for the training of 2,400 young people to deliver anti-bullying workshops in their communities and to reach out to others.

Shelley Hymel, a professor in the faculty of education at the University of British Columbia, noted that the issue has become a worldwide concern, and that in some countries progress has been made. Schools that have instituted anti-bullying policies have shown a 20 per cent reduction in the behaviour, she said.

However, she added, "I think the reductions we're talking about, although in the right direction, they're still pretty darn small. Twenty per cent, that means there's 80 per cent still going on. And there are a lot of schools who don't have this as a priority," she told CBC News. "So I think there's still a lot of work to do."

Hymel added that attitudes are evolving for the better on how to approach the problem. Schools and researchers are now taking a much broader view of the issue, and changing many long-held assumptions that include,  for example, that bullying is only carried on by socially incompetent kids.

Rehtaeh Parsons,17, died in April following a suicide attempt. Her family said she had been tormented at school for over a year by lewd comments and photos taken of her, and texted to her classmates. (Facebook)

"One of the big approaches that's happening, and this is kind of worldwide, is getting at peer observers," she said, adding that two or three kids witness every incident.

"We're trying to get kids to move from bystanders to 'upstanders.' Getting the kids involved,  you're trying to change the climate of the school, to where the culture basically says 'this is not OK.'"

Hymel said they've been collecting bullying-related data at B.C schools over the last four years. 

At one school, where the issue became a priority among staff, they initially saw no reductions in bullying.

"But now after four years we're seeing real significant reductions in kids' reports of bullying and victimization. So it takes a long time to change the culture of a school," she said.

Tracy Vaillancourt, Canada Research Chair in children's mental health and violence prevention at the University of Ottawa, cautioned that the media is creating a perception of a bullying crisis that really isn't there, and that research suggests bullying is no worse than it has ever been.

She also said it may still be too soon to measure the effectiveness of some of the recent anti-bullying strategies.

But some of the problems with current programs, she said, is this one-size-fits-all type of mentality. Every school will get the same anti-bullying program without taking into consideration the different demographics and culture of the facility.

"I think what happens is that we have these policy programs that worked in one school, and then we try to roll them out to other schools and they don't work."

There's also more to dealing with bullying than just addressing the problem at school, Pepler said.

"We've put it at the door of the school and said you solve it. And it's not a school problem. It's a problem at home, it's a problem at school, it's a problem with peer groups, it's a problem in the community, it's a problem everywhere we aggregate children and youth.

It's not a problem that schools can solve on their own."

Too often, people are looking for a simple fix or single program that fixes all, Hymel said.

"And the one thing we figured out in 40 years of research in this area is that there's no simple solution and there's no single reason why kids bully.

"There's lots of reason why kids bully and we have to treat each one differently."

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Badger baby sunscreen recall alert issued by Health Canada

Health Canada says parents who purchased affected lots of sunscreen should return the product to the point of purchase. (Courtesy FDA)

Health Canada says two children's sunscreens are being recalled due to contamination with a trio of bacteria that can cause serious infections.

Badger Baby SPF 30 Sunscreen Lotion and Badger Kids SPF 30 Sunscreen Lotion are being recalled in Canada. Additional lots are being recalled in the U.S., which Canadian travellers may have purchased.

Manufacturer W.S. Badger Company Inc. says the microbes found cause pneumonia, meningitis and infections of the blood, bone, urinary tract and gastrointestinal system.

Those with weakened immune systems from such conditions as cystic fibrosis, cancer or diabetes, or with burns or other skin conditions, have a heightened risk of infection.

In healthy consumers, bacteria can enter the body through cuts and burns and may cause skin and blood infections, as well as eye and outer ear infections.

Health Canada says parents who purchased affected lots of sunscreen should return the product to the point of purchase.

The sunscreens were found to contain Pseudomonas aeruginosa, Candida parapsilosis and Acremonium fungi, but no adverse reactions from use of the products have been reported to Health Canada or the company.

Badger Baby SPF 30 Sunscreen Lotion and Badger Kids SPF 30 Sunscreen Lotion are sold across Canada. Two importers have been identified: Purity Life Health Products in Acton, Ont., and Christmas Natural in Burnaby, B.C.

The Canadian recall affects Badger Baby sunscreen lots 3057A and 3132A and Badger Kids sunscreen lot 3164A.

The U.S. recall also includes "Baby" sunscreen lots 3024A, 3063A, 3063B, 3132A and 3133A.

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Badger baby sunscreen recalled for microbial contamination

W.S. Badger Company is voluntarily recalling certain lots of Daily SPF 30 Kids & Baby Sunscreen Lotions after microbial contamination was found during a routine quality check. (Courtesy FDA)

Some Badger baby sunscreen lotion is being voluntarily recalled because of potential microbial contamination.

"The products were tested and found to be contaminated with Pseudomonas aeruginosa, Candida parapsilosis and Acremonium fungi," the U.S. Food and Drug Adminsitration said.

The sunscreens are sold in Canada and U.S. online and at major retailers as well as independent food co-ops and pharmacies, the U.S. regulator said.

In a notice to customers on its website, the company listed three lots and UPC codes for recalled products sold in Canada and seven for products sold in the U.S.

No adverse reactions have been reported due to use of the products, W.S. Badger Company said.

"My understanding of the toxicologist's report is that the 'organisms' found in the failed products are also commonly found in the environment and on our skin," CEO Bill Whyte said on the company's website on Tuesday. "They are unlikely to cause problems except for in immune-compromised persons or for persons with severely damaged skin."

The issue was discovered during routine re-testing. The preservative system in several lots had been compromised, Whyte said.

He added that he was reassured that over 20,000 have been sold with zero reports of adverse reactions.

As a precaution, the company is recalling all lots of SPF30 Baby Sunscreen Lotions.

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Dermatology apps 'an area of buyer beware'

Smartphone apps could misdiagnose melanoma. (The Canadian Press)

Mobile apps to track and diagnose skin diseases are widespread and have the potential to expand the delivery of care but should be used with caution, researchers say.

In Wednesday's issue of JAMA Dermatology, researchers identified a total of 229 dermatology-related apps for uses such as monitoring psoriasis, diagnosing melanoma and giving sun screen advice.

"This is an area of buyer beware because there are no regulations and no guarantees that these apps are providing accurate medical information," Dr. Robert Dellavalle, senior author of the study and a professor of dermatology at the University of Colorado School of Medicine, said in a release.

Smartphones apps are useful in dermatology since visual exams are key to diagnosis and management, the study's authors said.

On Monday, the U.S. Food and Drug Administration said it will only regulate apps that act like medical instruments, such as those that perform ultrasounds.

Dermatology apps vary in function, from documenting lesions and uploading photos to a dermatologist for feedback to logging treatment regimens. Many apps are disease guides that focused on one disease, such as acne, rosacea, psoriasis or eczema.

The 10 apps with the most consumer reviews were:

1.  Ultraviolet-UV Index.
2.  VisualDx.
3.  SPF.
4.  iSore.
5.  SpotMole.
6.  Pocket Derm.
7. Skin Scan.
8. Doctor Mole.
9. What's My Rash?
10. Skin Conditions.

The study's authors said the apps offer the chance to expand care to underserved communities.

About 51 per cent of the apps targeted patients.

Dellavalle said he thinks most apps are generally safe but he would cross-reference them with other apps, other people and your doctor.

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Home colorectal screening tests to be launched next year

Dr. Eshwar Kumar, co-CEO New Brunswick Cancer Network, says the tests will launch in the Saint John area early next year and be rolled out across the rest of the province within 18 months. (CBC)

The New Brunswick government is getting ready to roll out a new home-based colorectal screening program early next year.

Certain people between the ages of 50 and 74, who face an average risk of colon cancer, will be able to do a test at home, which will determine if any further testing is needed.

"Over the course of time, we expect that the number of colonoscopies that are being done as first line screening will decrease," said Dr. Eshwar Kumar, the co-chief executive officer of the New Brunswick Cancer Network.

"A good screening program is something that will change the natural history of the disease and it will also be cost effective and colorectal cancer screening I think is a good example of that."

Colonoscopies are more invasive and expensive, he said.

The province first talked about an at-home test kit back in 2009, but officials say it took a lot of planning and time to develop the technology.

Kumar says the test was picked for its sensitivity and accuracy.

They will be sent to a lab in Campbellton for processing.

Anne McTiernan-Gamble, chief executive officer of the Canadian Cancer Society in New Brunswick, says screening saves lives.

Colorectal cancer accounts for 13 per cent of all cancers in Canada, she said.

"In New Brunswick, that would be 600 cancers this year," said McTiernan-Gamble. "It's the second leading cause of cancer deaths in Canada."

The program is expected to launch in the Saint John area first and take 12 to 18 months to roll out across the rest of the province.

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'Mental patient' costumes pulled from British stores

British retailer Asda says it is "deeply sorry" for selling a costume designed to look like a blood-splattered straitjacket. (Finbarr O'Reilly/Reuters)

Two British supermarket chains have apologized for selling Halloween costumes that made insensitive references to mental health issues.

Mental health groups condemned retailer Asda for offering an outfit including a blood-splattered straitjacket and a meat cleaver, labeled as "mental patient fancy dress costume."

Paul Jenkins, chief executive of the charity Rethink Mental Illness, said the costume was "breathtakingly insensitive" and would add to the stigma surrounding mental illness.

Asda, which is owned by U.S. retail giant Wal-Mart, said Thursday it was "deeply sorry" and would be making a large donation to a mental health charity.

Tesco also apologized, for a costume consisting of an orange boiler suit emblazoned with the words "Psycho Ward."

Both stores said the costumes had been removed from sale.

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Clue to universal flu vaccine found, researchers say

A group of scientists say they have found a clue that could lead to developing an influenza vaccine that will not require changing every year with each new strain.

Researchers used the 2009 swine flu pandemic as a sort of natural experiment, gleaning from it a way of understanding why some people resist influenza better.

The research was published in the journal Nature Medicine today.

"New strains of flu are continuously emerging, some of which are deadly, and so the Holy Grail is to create a universal vaccine that would be effective against all strains of flu," Prof. Ajit Lalvani from the National Heart and Lung Institute at Imperial College London, who led the study, said in a release.

Researchers at Imperial College in the U.K. collected blood samples from 342 volunteers (both staff and students at Imperial) during the swine flu outbreak and collected data on all symptoms experienced over the next two flu seasons.

People who managed to avoid severe illness as a result of the flu strain were found to also have more virus-killing immune cells (CD8 T cells) in their blood at the onset of the pandemic, according to the research.

Based on that discovery, researchers assumed a vaccine that could stimulate production of these cells might be effective in preventing more flu viruses.

"The immune system produces these CD8 T cells in response to usual seasonal flu. Unlike antibodies, they target the core of the virus, which doesn't change, even in new pandemic strains," Lavlani said.

"Our findings suggest that by making the body produce more of this specific type of CD8 T cell, you can protect people against symptomatic illness. This provides the blueprint for developing a universal flu vaccine."

The flu vaccines that are already out there make the immune system produce antibodies that recognize structures on the surface of the virus and prevent infection with the most common strains of influenza. Because of that, they have to be changed and updated each year as popular strains change and evolve.

The aforementioned T cells were previously thought to protect against the flu, but were only recently tested with regards to humans during a pandemic.

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Women and alcoholism: author describes ‘global epidemic’

Journalist and author Ann Dowsett Johnston is now a member of the "sisterhood of sobriety," but for years she wrestled with a dependence on alcohol. 

"I grew up with an alcoholic mother who was heavily cross-addicted to Valium … I was very conscious of not getting into trouble, and deluded myself for a long time, not realizing how progressive it was."

Her fondness for Pinot Grigio graduated from a social drink to private binges. There were black outs, and public outbursts.

• Michael Enright's Essay - Myths about policing: Policing is not one of the most dangerous occupations, police don't have sufficient training for crises, and they must submit to civilian oversight.
• Ann Dowsett Johnston: The author and journalist talks about her battle with addiction, and the growing issue of alcoholism among women worldwide.
• Yukon Gold and Netted Gems: How PEI potato farmers David and Brian Best launched a crowdfunding campaign to save their farm.
• Saving the Symphony: Some predict half of North America's symphonies will go bankrupt in the next few years. Toronto Symphony Orchestra music director Peter Oundjian talks about the challenges and joys of his job.
• The Moral Stain of Drone Warfare: Mark Bowden talks about the secretive and controversial world of drone warfare.
• Sunday School with Michael Enright: Michael admits he can't tell a raven from a robin. Birder par excellence Sarah Rupert teaches him how to identify birds by their calls.

Tune in to the CBC Radio broadcast at 9 a.m. ET on Sunday, Sept. 22, or visit The Sunday Edition's website to listen to them online.

In the winter of 2008 she went into rehab and got sober.

She began to rebuild her life, but as she was sitting in recovery meetings in church basements she noticed a significant number of women at those meetings – women of all ages and from all walks of life.

Alcoholism is considered largely a male problem, so Dowsett Johnston, a journalist by profession, began to look into the relationship between gender and alcohol.

She found that some researchers believe there is a "global epidemic" in women's drinking, and that alcohol producers are creating products specifically aimed at women.  

"We are looking at a very savvy marketing industry looking at an entire gender and hoping to woo them, and they've done a very good job," she said.

Shame, stigma and silence inhibit women from sharing their stories of addiction, especially in a culture that romanticizes its relationship with the bottle.

In 2011, Dowsett Johnston won an Atkinson Fellowship and wrote a groundbreaking 14-part newspaper series on women and alcohol. But she hadn't gone public with her own story.  Until now.

In a candid interview, she talks to The Sunday Edition's Michael Enright about her new book, Drink, the Intimate Relationship Between Women and Alcohol. She discusses her personal journey away from drinking, and how a growing number of women face this addiction. To listen to the interview, click the audio icon at the top of this page or on The Sunday Edition's website.

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Terry Fox draws crowd for Walk of Fame induction

Marathon of Hope runner Terry Fox's attempted cross-Canada run to raise money for cancer research earned him a place on Canada's Walk of Fame on Saturday and drew the loudest cheers, 32 years after his tragic death.

A legion of fans endured a steady drizzle outside Toronto's Elgin Theatre and came as far away as British Columbia to chant the name of the late one-legged athlete and humanitarian.

"We're so proud," said Rolland "Rolly" Fox, Terry's father, who collected the honour on his son's behalf and wore Terry's image on his lapel.

In April 1980, Terry Fox embarked on his Marathon of Hope, an incredible cross-Canada run on an artificial leg to raise money for cancer research. Terry was forced to end his run when his cancer returned. He died on June 28, 1981. (Therapy Content)

The elder Fox believes his son would have felt "honoured" by his induction, but despite Terry's indelible and visible impact — with the annual Terry Fox Run now raising millions worldwide — he would, as a father, have no hesitation in taking it all back. In fact, Rolly's late wife, Betty, once called the famed run a "stupid thing to want to do."

"It's true that if Betty and I could have talked him out of it, we would have," said Fox. "But he was of age, and there was no way we could have stopped him. He would have gone regardless.

"The fight against cancer continues, and one day we will have a cure for all cancers."

It was an odd and varied crowd indeed that came out for the Walk of Fame induction ceremony, a testament to the diverse eight-person class of famous Canadians awarded stars this year.

Young people armed with camera phones came to glimpse pop songbird Carly Rae Jepsen, who was not inducted but was on hand to receive the Allan Slaight Award; others were clad in Team Canada red and cheered on Olympic hero and inductee Christine Sinclair; others still came out in support of music producer Bob Ezrin, actors Victor Garber and Alan Thicke, human-rights advocates Craig and Marc Kielburger, and the late pianist Oscar Peterson.

Peterson and Fox are the two posthumous inductees this year, a rare exception from the one-per-year rule in recognition of the Walk of Fame's 15th anniversary.

The awards will be televised on Oct. 27 on Global.

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Newfoundland doctor fighting for more polio vaccines

A doctor from Newfoundland and Labrador is trying to get more children access to polio vaccinations across the world.

Bruce Aylward, the World Health Organization's assistant director general for polio, said new outbreaks of the viral, infectious disease, are being reported in conflict-ridden nations with poor health care, such as Somalia and Kenya.

"Very quickly this has turned into an explosive outbreak with nearly 200 children now — paralyzed children and even adults — paralyzed across those two countries, and even right across the border into Ethiopia," he said.

According to Aylward, efforts to eradicate the disease can be dangerous work.

He said in parts of Pakistan, near the Afghanistan border, there is a mistrust of the program.

"There have been some real violent episodes both in Pakistan and in Nigeria where we've had actual attacks, and even in some cases the murder of vaccinators," Aylward said.

According to Aylward, there are suspicions the vaccinators are part of a western conspiracy, and some people also believe the polio vaccination causes impotence.

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Alzheimer's causes half of long-term care cases

David Hilfiker knows what's coming. He was diagnosed with Alzheimer's so early that he's had time to tell his family what he wants to happen once forgetfulness turns incapacitating.

"When it's time to put me in an institution, don't have me at home and destroy your own life," said the retired physician, who is still well enough that he blogs about the insidious progress of the disease. "Watching the Lights Go Out," it's titled.

Nearly half of all seniors who need some form of long-term care -— from help at home to full-time care in a facility — have dementia, the World Alzheimer Report said Thursday. It's a staggering problem as the global population ages, placing enormous strain on families who provide the bulk of that care at least early on, and on national economies alike.

Indeed, cognitive impairment is the strongest predictor of who will move into a care facility within the next two years, 7.5 times more likely than people with cancer, heart disease or other chronic ailments of older adults, the report found.

"It's astonishing," said Marc Wortmann, executive director of Alzheimer's Disease International, which commissioned the report and focused on the problems of caregiving. "What many countries try to do is keep people away from care homes because they say that's cheaper. Yes it's cheaper for the government or the health system, but it's not always the best solution."

And dropping birth rates mean there are fewer children in families to take care of aging parents, too, said Michael Hodin of the Global Coalition on Aging.

"Very shortly there will be more of us over 60 than under 15," he noted.

Today, more than 35 million people worldwide, including 5 million in the U.S., are estimated to have Alzheimer's. Barring a medical breakthrough, those numbers are expected to more than double by 2050.

This week, the U.S. National Institutes of Health announced $45 million in new Alzheimer's research, with most of the money focused on finding ways to prevent or at least delay the devastating disease. The Obama administration had hoped to invest $100 million in new Alzheimer's research this year, a move blocked by the budget cuts known as the sequester. Overall, the nation has been investing about $400 million a year in Alzheimer's research.

But the disease's financial toll is $200 billion a year in the U.S. alone, a tab expected to pass $1 trillion by 2050 in medical and nursing home expenditures — not counting unpaid family caregiving. The world report puts the global cost at $604 billion 

Thursday, families affected by Alzheimer's and aging advocates said it's time for a global push to end the brain disease, just like the world's governments and researchers came together to turn the AIDS virus from a death sentence into a chronic disease. 

"We need a war on Alzheimer's," said Sandy Halperin, 63, of Tallahassee, Fla., who was diagnosed with early-stage Alzheimer's three years ago. He now finds himself stumbling for words, but still visits lawmakers to urge more funding.

Meanwhile, the world report focuses on caregiving, stressing how the needs of people with dementia are so different than those of other ailments of aging, such as cancer and heart disease.

People with dementia begin needing some help to get through the day early on, to make sure they don't leave the stove on or get lost, for example. Eventually, patients lose the ability to do the simplest activities of daily life, and can survive that way for a decade or more. Often family members quit their jobs so they can provide round-the-clock care, and the stress can harm their own health.

The world report said families need early education about what services are available to help before they're in a crisis, plus training in how to handle the behavioural problems of the disease — such as not to argue if their loved one thinks Ronald Reagan is still president, or how to handle the agitation at dusk known as sundowning, or how to react when the patient hits someone.

Two-thirds of the calls that Home Instead Senior Care, which provides in-home personal care services, receives are from families that did no planning until the patient had a crisis, such as wandering or a fall, said its president, Jeff Huber.

Hilfiker, the blogger with early Alzheimer's, takes that education idea a step further. He tells everyone he knows that he has Alzheimer's as a way to break some of the stigma, "so when I make dumb mistakes, I don't need to be embarrassed," he said Thursday.

He urges other patients to plan their end-of-life care early, while they're still cognitively able to participate. He believes that telling his wife no extraordinary care — no feeding tubes, for example — will ease her burden.

Hilfiker's big unanswered question: "If I'm at peace with my disease, does that make it easier to care for me later?

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Man brewed beer in his gut, say researchers

A Texas man who stumbled into an emergency room showing signs of drunkenness has become a medical anomaly – he was diagnosed with auto-brewery syndrome.

The 61-year-old man was found to have a blood alcohol level of .37, five times the legal limit in Texas. Medical staff assumed he was inebriated, but the man insisted he hadn't had one drop of alcohol all day. They were also told he had spent the past five years with bouts of intoxication that didn't involve drinking booze.

Having a beer gut took on a new meaning for a Texas man studied by U.S. researchers, who found that his overgrowth of yeast in his body was making him drunk because he was brewing beer from within. (Rick Rycroft/Associated Press)

In a report published in Scientific Research Publishing, U.S. researchers Barbara Cordell and Dr. Justin McCarthy tested out what they call "gut fermentation syndrome."

Cordell and McCarthy were alerted about the man's condition and a few months after his emergency room visit, they decided to test out their theory.

The man returned to the hospital and was kept there for 24 hours. During that time, he was only fed a diet of carbohydrate-rich foods. The researchers soon had their answer.

The patient had an infection with Saccharomyces cerevisiae, a common yeast. Whenever he ingested starch — pasta, bread or soda — the yeast fermented along with the sugars, turning into ethanol. 

He was brewing beer in his gut.

"He would get drunk out of the blue — on a Sunday morning after being at church, or really, just any time," Cordell said in an interview with NPR this week.

'It would behoove health care providers to listen more carefully to the intoxicated patient who denies ingesting alcohol.'- Barbara Cordell and Justin McCarthy, researchers

The man's wife eventually bought a Breathalyzer as well.

The researchers say they suspect that antibiotics that the man took after surgery in 2004 may have destroyed his gut bacteria, allowing for the yeast to flourish.

The cure was easy. The man was put on a low-carbohydrate diet and given antifungal medication to purge him of the yeast.

Cordell and McCarthy say the syndrome is rare and say there have only been about five cases in the last 30 years.

In conclusion, they say "this is a rare syndrome but should be recognized because of the social implications such as loss of job, relationship difficulties, stigma, and even possible arrest and incarceration. It would behoove health care providers to listen more carefully to the intoxicated patient who denies ingesting alcohol."

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Life's Extra Strength Muscle and Back Pain recalled

Life Brand's Extra Strength Muscle and Back Pain medication is the latest over the counter medication to be recalled by Vita Health due to labelling issues.

For Life's Muscle and Back Pain, the issue is that a missing warning statement affecting those with kidney disease, chronic alcoholism or those who take CNS depressants.

Last week Health Canada said that Vita Health's voluntary recall also included Personnelle Cold and Flu-in-One Extra Strength Convenience Pack. The product is missing a "reference to important information," the regulator said.

Vita Health has voluntarily recalled various Rexall, Compliments, Safeway, Life Brand and other over-the-counter cold medications because of labelling errors since 2011.

Some packages are missing warnings and alerts and others might be labelled as having childproof caps while they actually do not.

A complete list of the recalled items can be found here.

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Women and alcoholism: author describes ‘global epidemic’

Journalist and author Ann Dowsett Johnston is now a member of the "sisterhood of sobriety," but for years she wrestled with a dependence on alcohol. 

"I grew up with an alcoholic mother who was heavily cross-addicted to Valium … I was very conscious of not getting into trouble, and deluded myself for a long time, not realizing how progressive it was."

Her fondness for Pinot Grigio graduated from a social drink to private binges. There were black outs, and public outbursts.

• Michael Enright's Essay - Myths about policing: Policing is not one of the most dangerous occupations, police don't have sufficient training for crises, and they must submit to civilian oversight.
• Ann Dowsett Johnston: The author and journalist talks about her battle with addiction, and the growing issue of alcoholism among women worldwide.
• Yukon Gold and Netted Gems: How PEI potato farmers David and Brian Best launched a crowdfunding campaign to save their farm.
• Saving the Symphony: Some predict half of North America's symphonies will go bankrupt in the next few years. Toronto Symphony Orchestra music director Peter Oundjian talks about the challenges and joys of his job.
• The Moral Stain of Drone Warfare: Mark Bowden talks about the secretive and controversial world of drone warfare.
• Sunday School with Michael Enright: Michael admits he can't tell a raven from a robin. Birder par excellence Sarah Rupert teaches him how to identify birds by their calls.

Tune in to the CBC Radio broadcast at 9 a.m. ET on Sunday, Sept. 22, or visit The Sunday Edition's website to listen to them online.

In the winter of 2008 she went into rehab and got sober.

She began to rebuild her life, but as she was sitting in recovery meetings in church basements she noticed a significant number of women at those meetings – women of all ages and from all walks of life.

Alcoholism is considered largely a male problem, so Dowsett Johnston, a journalist by profession, began to look into the relationship between gender and alcohol.

She found that some researchers believe there is a "global epidemic" in women's drinking, and that alcohol producers are creating products specifically aimed at women.  

"We are looking at a very savvy marketing industry looking at an entire gender and hoping to woo them, and they've done a very good job," she said.

Shame, stigma and silence inhibit women from sharing their stories of addiction, especially in a culture that romanticizes its relationship with the bottle.

In 2011, Dowsett Johnston won an Atkinson Fellowship and wrote a groundbreaking 14-part newspaper series on women and alcohol. But she hadn't gone public with her own story.  Until now.

In a candid interview, she talks to The Sunday Edition's Michael Enright about her new book, Drink, the Intimate Relationship Between Women and Alcohol. She discusses her personal journey away from drinking, and how a growing number of women face this addiction. To listen to the interview, click the audio icon at the top of this page or on The Sunday Edition's website.

22.45 | 0 komentar | Read More

Man brewed beer in his gut, say researchers

A Texas man who stumbled into an emergency room showing signs of drunkenness has become a medical anomaly – he was diagnosed with auto-brewery syndrome.

The 61-year-old man was found to have a blood alcohol level of .37, five times the legal limit in Texas. Medical staff assumed he was inebriated, but the man insisted he hadn't had one drop of alcohol all day. They were also told he had spent the past five years with bouts of intoxication that didn't involve drinking booze.

Having a beer gut took on a new meaning for a Texas man studied by U.S. researchers, who found that his overgrowth of yeast in his body was making him drunk because he was brewing beer from within. (Rick Rycroft/Associated Press)

In a report published in Scientific Research Publishing, U.S. researchers Barbara Cordell and Dr. Justin McCarthy tested out what they call "gut fermentation syndrome."

Cordell and McCarthy were alerted about the man's condition and a few months after his emergency room visit, they decided to test out their theory.

The man returned to the hospital and was kept there for 24 hours. During that time, he was only fed a diet of carbohydrate-rich foods. The researchers soon had their answer.

The patient had an infection with Saccharomyces cerevisiae, a common yeast. Whenever he ingested starch — pasta, bread or soda — the yeast fermented along with the sugars, turning into ethanol. 

He was brewing beer in his gut.

"He would get drunk out of the blue — on a Sunday morning after being at church, or really, just any time," Cordell said in an interview with NPR this week.

'It would behoove health care providers to listen more carefully to the intoxicated patient who denies ingesting alcohol.'- Barbara Cordell and Justin McCarthy, researchers

The man's wife eventually bought a Breathalyzer as well.

The researchers say they suspect that antibiotics that the man took after surgery in 2004 may have destroyed his gut bacteria, allowing for the yeast to flourish.

The cure was easy. The man was put on a low-carbohydrate diet and given antifungal medication to purge him of the yeast.

Cordell and McCarthy say the syndrome is rare and say there have only been about five cases in the last 30 years.

In conclusion, they say "this is a rare syndrome but should be recognized because of the social implications such as loss of job, relationship difficulties, stigma, and even possible arrest and incarceration. It would behoove health care providers to listen more carefully to the intoxicated patient who denies ingesting alcohol."

22.45 | 0 komentar | Read More

Dr. Donald Low, public face of Toronto SARS crisis, dies

Dr. Donald Low, a leading Canadian infectious disease expert who rose to prominence while helping Toronto cope with the SARS crisis that killed hundreds worldwide a decade ago, has died at age 68 after being diagnosed with a brain tumour.

Low was the microbiologist in chief at Toronto's Mount Sinai Hospital and a professor at the University of Toronto.

'It's a big loss to all of us in microbiology.'- Allison McGeer, Mount Sinai Hospital

After the 2003 breakout of severe acute respiratory syndrome in Toronto, Low oversaw regular updates to the public about the syndrome, which eventually killed 44 people in Canada and nearly 800 worldwide.

Dr. Allison McGeer, director of infectious disease control at Mount Sinai hospital, worked with Low and knew him for 25 years.

In an interview on CBC Radio's Metro Morning shortly after news of his death broke, McGeer said Low provided a  voice of calm to a city gripped by fear during the SARS outbreak.

"He was the face and a good piece of the brains behind our response to SARS," McGeer told host Matt Galloway. "What many of us in Toronto don't recognize is the loss he leaves behind to microbiology and infectious diseases in Canada, and to all of his research work in emerging diseases around the world. It's a big loss to all of us in microbiology.

"With Don, no problem is ever too large," said McGeer. "You simply lay it out, you put it in its pieces, you figure out how to deal with it and you move on. That may be his biggest legacy."

Dr. Michael Gardam, from the University Health Network, told CBC News that Low's commitment to keeping the public informed during the outbreak was a unique trait. 

"The thought you would have a world renowned expert really seeing it as one of his major jobs … to go directly to the public and actually talk about what's going on … I can't tell you how unusual that is," he said.

Low died Wednesday evening after battling a brain tumour. "As a husband and a father — nobody better," his wife, Maureen Taylor, told CBC News.  "His kids adore him and he was everything to me."

McGeer credits Low for his role in not only studying infectious diseases, but also in teaching other doctors in the field.

"He created the generation of people that we now count on to study antimicrobial resistance and emerging infectious diseases," she said.

Dr. Donald Low, leading Canadian health expert who rose to prominence during the SARS crisis, has died. (Frank Gunn/Canadian Press)

"One of the standing jokes in microbiology at Mount Sinai was that nobody ever leaves. There was no temptation. He was the best boss you could imagine."

According to Mount Sinai's website, Low was a fellow of the Royal College of Physicians and Surgeons of Canada. He completed his undergraduate training and postgraduate training in medicine and infectious diseases at the University of Manitoba and his training in medical microbiology at the University of Toronto. 

Low's primary research interests were in the study of the epidemiology and the mechanisms of antimicrobial resistance in community and hospital pathogens. 

Low published more than 385 papers in peer-reviewed journals and was a reviewer for several organizations including the Medical Research Council, Health Canada, New England Journal of Medicine, Journal of American Medical Association, and the Proceedings of the National Academy of Science, and had been cited some 3600 times.

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Alzheimer's causes half of long-term care cases

David Hilfiker knows what's coming. He was diagnosed with Alzheimer's so early that he's had time to tell his family what he wants to happen once forgetfulness turns incapacitating.

"When it's time to put me in an institution, don't have me at home and destroy your own life," said the retired physician, who is still well enough that he blogs about the insidious progress of the disease. "Watching the Lights Go Out," it's titled.

Nearly half of all seniors who need some form of long-term care -— from help at home to full-time care in a facility — have dementia, the World Alzheimer Report said Thursday. It's a staggering problem as the global population ages, placing enormous strain on families who provide the bulk of that care at least early on, and on national economies alike.

Indeed, cognitive impairment is the strongest predictor of who will move into a care facility within the next two years, 7.5 times more likely than people with cancer, heart disease or other chronic ailments of older adults, the report found.

"It's astonishing," said Marc Wortmann, executive director of Alzheimer's Disease International, which commissioned the report and focused on the problems of caregiving. "What many countries try to do is keep people away from care homes because they say that's cheaper. Yes it's cheaper for the government or the health system, but it's not always the best solution."

And dropping birth rates mean there are fewer children in families to take care of aging parents, too, said Michael Hodin of the Global Coalition on Aging.

"Very shortly there will be more of us over 60 than under 15," he noted.

Today, more than 35 million people worldwide, including 5 million in the U.S., are estimated to have Alzheimer's. Barring a medical breakthrough, those numbers are expected to more than double by 2050.

This week, the U.S. National Institutes of Health announced $45 million in new Alzheimer's research, with most of the money focused on finding ways to prevent or at least delay the devastating disease. The Obama administration had hoped to invest $100 million in new Alzheimer's research this year, a move blocked by the budget cuts known as the sequester. Overall, the nation has been investing about $400 million a year in Alzheimer's research.

But the disease's financial toll is $200 billion a year in the U.S. alone, a tab expected to pass $1 trillion by 2050 in medical and nursing home expenditures — not counting unpaid family caregiving. The world report puts the global cost at $604 billion 

Thursday, families affected by Alzheimer's and aging advocates said it's time for a global push to end the brain disease, just like the world's governments and researchers came together to turn the AIDS virus from a death sentence into a chronic disease. 

"We need a war on Alzheimer's," said Sandy Halperin, 63, of Tallahassee, Fla., who was diagnosed with early-stage Alzheimer's three years ago. He now finds himself stumbling for words, but still visits lawmakers to urge more funding.

Meanwhile, the world report focuses on caregiving, stressing how the needs of people with dementia are so different than those of other ailments of aging, such as cancer and heart disease.

People with dementia begin needing some help to get through the day early on, to make sure they don't leave the stove on or get lost, for example. Eventually, patients lose the ability to do the simplest activities of daily life, and can survive that way for a decade or more. Often family members quit their jobs so they can provide round-the-clock care, and the stress can harm their own health.

The world report said families need early education about what services are available to help before they're in a crisis, plus training in how to handle the behavioural problems of the disease — such as not to argue if their loved one thinks Ronald Reagan is still president, or how to handle the agitation at dusk known as sundowning, or how to react when the patient hits someone.

Two-thirds of the calls that Home Instead Senior Care, which provides in-home personal care services, receives are from families that did no planning until the patient had a crisis, such as wandering or a fall, said its president, Jeff Huber.

Hilfiker, the blogger with early Alzheimer's, takes that education idea a step further. He tells everyone he knows that he has Alzheimer's as a way to break some of the stigma, "so when I make dumb mistakes, I don't need to be embarrassed," he said Thursday.

He urges other patients to plan their end-of-life care early, while they're still cognitively able to participate. He believes that telling his wife no extraordinary care — no feeding tubes, for example — will ease her burden.

Hilfiker's big unanswered question: "If I'm at peace with my disease, does that make it easier to care for me later?

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Life's Extra Strength Muscle and Back Pain recalled

Life Brand's Extra Strength Muscle and Back Pain medication is the latest over the counter medication to be recalled by Vita Health due to labelling issues.

For Life's Muscle and Back Pain, the issue is that a missing warning statement affecting those with kidney disease, chronic alcoholism or those who take CNS depressants.

Last week Health Canada said that Vita Health's voluntary recall also included Personnelle Cold and Flu-in-One Extra Strength Convenience Pack. The product is missing a "reference to important information," the regulator said.

Vita Health has voluntarily recalled various Rexall, Compliments, Safeway, Life Brand and other over-the-counter cold medications because of labelling errors since 2011.

Some packages are missing warnings and alerts and others might be labelled as having childproof caps while they actually do not.

A complete list of the recalled items can be found here.

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Braces for curved spines cut need for surgery

Toni Lopez, who suffers from chronic back pain stemming from scoliosis, receives a back massage from Martha Garcia, at her home in Sacramento, Calif. Bracing significantly decreases progression of high-risk curves in patients with an adolescent form of scioliosis. (Rich Pedroncelli/Associated Press)

Bracing the spine in teens with a curvature is more effective than watching and waiting in preventing the need for surgical correction, Canadian and U.S. surgeons have found.

Scoliosis is a type of spinal curvature that now affects mainly girls beginning in adolescence. If the curvature worsens to more than 50 degrees after maturity it increases the risk of severe deformity and compromising lung function. 

In Thursday's online issue of the New England Journal of Medicine, orthopedic surgeons from the Hospital for Sick Children in Toronto and three U.S. institutions said bracing significantly decreased progression to needing surgery.

"I won't be so much telling kids that I don't know whether it works," said study co-author Dr. James Wright, surgeon in chief at the Hospital for Sick Children. "I'm going to be saying, it does work and I'm afraid you have to wear it."

The researchers concluded that in adolescents with idiopathic scoliosis who were considered to be at high risk for curve progressing that would eventually warrant surgery, bracing was associated with a significantly greater likelihood of reaching skeletal maturity with a curve of less than 50 degrees, compared with watching and waiting.

The findings will have a direct impact on clinical practice in assessing orthopedic patients for bracing, Wright said.

The rate of treatment success in terms of preventing the need for surgery was 72 per cent in the bracing group compared with 48 per cent in the untreated group. In the bracing group, 41 per cent also had a successful outcome even though they spent little time wearing the brace. The braces contained a device that indicated when they were being worn. 

But wearing a brace has financial, emotional and social burdens that need to be considered, Dr. Eugene Carragee of Stanford University School of Medicine in California and Dr. Ronald Lehman of Walter Reed National Military Medical Center in Bethseda, Md., said in a journal commentary published with the study.

"We agree with the authors that the equally important finding of this study is that so many growing children with adolescent idiopathic scoliosis seem to do just fine with no treatment at all; the challenge for the field going forward is to identify children who are most likely to benefit from bracing," the commentators said.

The trial of 242 patients was designed as a randomized trial but 126 ended up choosing their care. The study's authors said they minimized but did not eliminate the potential bias from the nonrandomized patients.

Scoliosis develops in about three per cent of children younger than 16 but less than one per cent have progressive curves that need treatment, previous research suggests.

The study was funded by the U.S.National Institute of Arthritis and Musculoskeletal and Skin Diseases, the Shriners Hospitals for Children, the Canadian Institutes of Health Research, Children's Mercy Hospitals and Clinics, the University of Rochester and SickKids Foundation.

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Dr. Donald Low, public face of Toronto SARS crisis, dies

Dr. Donald Low, a leading Canadian infectious disease expert who rose to prominence while helping Toronto cope with the SARS crisis that killed hundreds worldwide a decade ago, has died at age 68 after being diagnosed with a brain tumour.

Low was the microbiologist in chief at Toronto's Mount Sinai Hospital and a professor at the University of Toronto.

'It's a big loss to all of us in microbiology.'- Allison McGeer, Mount Sinai Hospital

After the 2003 breakout of severe acute respiratory syndrome in Toronto, Low oversaw regular updates to the public about the syndrome, which eventually killed 44 people in Canada and nearly 800 worldwide.

Dr. Allison McGeer, director of infectious disease control at Mount Sinai hospital, worked with Low and knew him for 25 years.

In an interview on CBC Radio's Metro Morning shortly after news of his death broke, McGeer said Low provided a  voice of calm to a city gripped by fear during the SARS outbreak.

"He was the face and a good piece of the brains behind our response to SARS," McGeer told host Matt Galloway. "What many of us in Toronto don't recognize is the loss he leaves behind to microbiology and infectious diseases in Canada, and to all of his research work in emerging diseases around the world. It's a big loss to all of us in microbiology.

"With Don, no problem is ever too large," said McGeer. "You simply lay it out, you put it in its pieces, you figure out how to deal with it and you move on. That may be his biggest legacy."

Dr. Michael Gardam, from the University Health Network, told CBC News that Low's commitment to keeping the public informed during the outbreak was a unique trait. 

"The thought you would have a world renowned expert really seeing it as one of his major jobs … to go directly to the public and actually talk about what's going on … I can't tell you how unusual that is," he said.

Low died Wednesday evening after battling a brain tumour. "As a husband and a father — nobody better," his wife, Maureen Taylor, told CBC News.  "His kids adore him and he was everything to me."

McGeer credits Low for his role in not only studying infectious diseases, but also in teaching other doctors in the field.

"He created the generation of people that we now count on to study antimicrobial resistance and emerging infectious diseases," she said.

Dr. Donald Low, leading Canadian health expert who rose to prominence during the SARS crisis, has died. (Frank Gunn/Canadian Press)

"One of the standing jokes in microbiology at Mount Sinai was that nobody ever leaves. There was no temptation. He was the best boss you could imagine."

According to Mount Sinai's website, Low was a fellow of the Royal College of Physicians and Surgeons of Canada. He completed his undergraduate training and postgraduate training in medicine and infectious diseases at the University of Manitoba and his training in medical microbiology at the University of Toronto. 

Low's primary research interests were in the study of the epidemiology and the mechanisms of antimicrobial resistance in community and hospital pathogens. 

Low published more than 385 papers in peer-reviewed journals and was a reviewer for several organizations including the Medical Research Council, Health Canada, New England Journal of Medicine, Journal of American Medical Association, and the Proceedings of the National Academy of Science, and had been cited some 3600 times.

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Alzheimer's causes half of long-term care cases

David Hilfiker knows what's coming. He was diagnosed with Alzheimer's so early that he's had time to tell his family what he wants to happen once forgetfulness turns incapacitating.

"When it's time to put me in an institution, don't have me at home and destroy your own life," said the retired physician, who is still well enough that he blogs about the insidious progress of the disease. "Watching the Lights Go Out," it's titled.

Nearly half of all seniors who need some form of long-term care -— from help at home to full-time care in a facility — have dementia, the World Alzheimer Report said Thursday. It's a staggering problem as the global population ages, placing enormous strain on families who provide the bulk of that care at least early on, and on national economies alike.

Indeed, cognitive impairment is the strongest predictor of who will move into a care facility within the next two years, 7.5 times more likely than people with cancer, heart disease or other chronic ailments of older adults, the report found.

"It's astonishing," said Marc Wortmann, executive director of Alzheimer's Disease International, which commissioned the report and focused on the problems of caregiving. "What many countries try to do is keep people away from care homes because they say that's cheaper. Yes it's cheaper for the government or the health system, but it's not always the best solution."

And dropping birth rates mean there are fewer children in families to take care of aging parents, too, said Michael Hodin of the Global Coalition on Aging.

"Very shortly there will be more of us over 60 than under 15," he noted.

Today, more than 35 million people worldwide, including 5 million in the U.S., are estimated to have Alzheimer's. Barring a medical breakthrough, those numbers are expected to more than double by 2050.

This week, the U.S. National Institutes of Health announced $45 million in new Alzheimer's research, with most of the money focused on finding ways to prevent or at least delay the devastating disease. The Obama administration had hoped to invest $100 million in new Alzheimer's research this year, a move blocked by the budget cuts known as the sequester. Overall, the nation has been investing about $400 million a year in Alzheimer's research.

But the disease's financial toll is $200 billion a year in the U.S. alone, a tab expected to pass $1 trillion by 2050 in medical and nursing home expenditures — not counting unpaid family caregiving. The world report puts the global cost at $604 billion 

Thursday, families affected by Alzheimer's and aging advocates said it's time for a global push to end the brain disease, just like the world's governments and researchers came together to turn the AIDS virus from a death sentence into a chronic disease. 

"We need a war on Alzheimer's," said Sandy Halperin, 63, of Tallahassee, Fla., who was diagnosed with early-stage Alzheimer's three years ago. He now finds himself stumbling for words, but still visits lawmakers to urge more funding.

Meanwhile, the world report focuses on caregiving, stressing how the needs of people with dementia are so different than those of other ailments of aging, such as cancer and heart disease.

People with dementia begin needing some help to get through the day early on, to make sure they don't leave the stove on or get lost, for example. Eventually, patients lose the ability to do the simplest activities of daily life, and can survive that way for a decade or more. Often family members quit their jobs so they can provide round-the-clock care, and the stress can harm their own health.

The world report said families need early education about what services are available to help before they're in a crisis, plus training in how to handle the behavioural problems of the disease — such as not to argue if their loved one thinks Ronald Reagan is still president, or how to handle the agitation at dusk known as sundowning, or how to react when the patient hits someone.

Two-thirds of the calls that Home Instead Senior Care, which provides in-home personal care services, receives are from families that did no planning until the patient had a crisis, such as wandering or a fall, said its president, Jeff Huber.

Hilfiker, the blogger with early Alzheimer's, takes that education idea a step further. He tells everyone he knows that he has Alzheimer's as a way to break some of the stigma, "so when I make dumb mistakes, I don't need to be embarrassed," he said Thursday.

He urges other patients to plan their end-of-life care early, while they're still cognitively able to participate. He believes that telling his wife no extraordinary care — no feeding tubes, for example — will ease her burden.

Hilfiker's big unanswered question: "If I'm at peace with my disease, does that make it easier to care for me later?

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Man brewed beer in his gut, say researchers

A Texas man who stumbled into an emergency room showing signs of drunkenness has become a medical anomaly – he was diagnosed with auto-brewery syndrome.

The man was found to have a blood alcohol level of .37, five times the legal limit in Texas. Medical staff assumed he was inebriated, but the man insisted he hadn't had one drop of alcohol all day. They were also told he had spent the past five years with bouts of intoxication that didn't involve drinking booze.

Having a beer gut took on a new meaning for a Texas man studied by U.S. researchers, who found that his overgrowth of yeast in his body was making him drunk because he was brewing beer from within. (Rick Rycroft/Associated Press)

In a report published in Scientific Research Publishing, U.S. researchers Barbara Cordell and Dr. Justin McCarthy tested out what they call "gut fermentation syndrome."

Cordell and McCarthy were alerted about the man's condition and a few months after his emergency room visit, hey decided to test out their theory.

The man returned to the hospital and was kept there for 24 hours. During that time, he was only fed a diet of carbohydrate-rich foods. The researchers soon had their answer.

The patient had an infection with Saccharomyces cerevisiae, a common yeast. Whenever he ingested starch — pasta, bread or soda — the yeast fermented along with the sugars, turning into ethanol. 

He was brewing beer in his gut.

"He would get drunk out of the blue — on a Sunday morning after being at church, or really, just any time," Cordell said in an interview with NPR this week.

'It would behoove health care providers to listen more carefully to the intoxicated patient who denies ingesting alcohol.'- Barbara Cordell and Justin McCarthy, researchers

The man's wife eventually bought a Breathalyzer as well.

The researchers say they suspect that antibiotics that the man took after surgery in 2004 may have destroyed his gut bacteria, allowing for the yeast to flourish.

The cure was easy. The man was put on a low-carbohydrate diet and given antifungal medication to purge him of the yeast.

Cordell and McCarthy say the syndrome is rare and say there have only been about five cases in the last 30 years.

In conclusion, they say "this is a rare syndrome but should be recognized because of the social implications such as loss of job, relationship difficulties, stigma, and even possible arrest and incarceration. It would behoove health care providers to listen more carefully to the intoxicated patient who denies ingesting alcohol."

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Mental health care needed by 1 in 6 Canadians

About one in six Canadians said they needed mental health care last year, Statistics Canada reports.

The findings are included in the agency's 2012 Canadian Community Health Survey on mental health that was released Wednesday. The survey results were based on a national sample of more than 25,000 people 15 or older in the 10 provinces.

The need for mental health care was mainly for counselling, the survey suggests. Other mental health care needs were for medication and information.

"An estimated 600,000 had a perceived unmet mental health care need, and more than 1,000,000 had a partially met need," the report's authors said, extrapolating from the sample.

About 17 per cent of the population 15 or older reported having had a mental health care need in the past 12 months, the agency found. Of these:

• 67 per cent said their needs were met.
• 21 per cent said their needs were partially met.
• 12 per cent said their needs were unmet.

"The presence of a mental disorder, higher distress, and chronic physical conditions were positively associated with perceiving a mental health care need, many of which were unmet or only partially met," the report's authors concluded. "As well, higher levels of distress predicted a greater likelihood that needs would be unmet or partially met."

About 75 per cent of those with a mood or anxiety disorder such as depression or bipolar disorder reported a need for mental health care, compared with 25 per cent of those with a substance abuse problem.

Counselling needs were the least likely to be met, with 65 per cent showing it was met, 16 per cent partially and 20 per cent unmet.

Dr. Ian Dawe, physician-in-chief at Ontario Shores Centre for Mental Health Services in Whitby, Ont., said the report misses a large swath of other illnesses such as schizophrenia and panic disorders.

Dawe said that patients often say it's relatively easy to get prescription medications, but needs for counselling go unmet.

"This study really speaks to unmet needs outside of the medication realm, and I think that's very consistent with what we're hearing," he said.

He said barriers include cost for those without workplace or private insurance for therapy outside of a doctor's office.

Arthur Gallant, 23, of Burlington, Ont., was diagnosed with anxiety and depression when he was 13. Gallant said he now can't afford the services of a psychologist. 

"It comes at a cost of about $150," Gallant said, for two sessions a week. "That's my entire income."

Most perceived barriers to receiving mental health care were related to personal circumstances, although almost one in five who reported barriers said they were related to features of the health care system, such as language barriers.

About four in 10 with an unmet or partially met need said they preferred to manage the need on their own. Camille Quenneville, chief executive of the Canadian Mental Health Association's Ontario division, attributed that to the stigma associated with mental health issues.

There is a tremendous need for mental health care services in the community and hospital systems, Quenneville said.

"We know today in Canada, 500,000 people didn't go to work because they're struggling with their mental health," she said. "So I think if employers alone stepped up and wanted to work and help those in their workplace with their mental health issues and recognize the existing need that we know is there, I think we would make tremendous strides."

Gallant said many people are also being rejected by family, friends and employers because of the lack of understanding what mental illness truly is.

In a related report, the agency found higher rates of mood disorders and of generalized anxiety disorder among females, while males had higher rates of substance abuse issues.

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