Adolescent AIDS rates up alarmingly, UN finds

The U.N. Children's Fund says it is alarmed about increasing HIV and AIDS rates among adolescents over the last seven years and is advocating an aggressive program that includes condom distribution and antiretroviral treatment.

In a more positive development, UNICEF found that mother-to-child transmission of HIV has been dramatically reduced and estimated that some 850,000 cases were prevented in low- and middle-income countries.

Its 2013 Stocktaking Report on Children and AIDS released Friday said AIDS-related deaths among those aged 10 to 19 increased between 2005 and 2012 from 71,000 to 110,000. About 2.1 million adolescents were living with HIV in 2012.

Nearly 90 per cent of children newly infected with HIV live in just 22 countries. All except one are in sub-Saharan Africa.

"If high-impact interventions are scaled up using an integrated approach, we can halve the number of new infections among adolescents by 2020," said UNICEF Executive Director Anthony Lake. "It's a matter of reaching the most vulnerable adolescents with effective programs — urgently."

High-impact interventions include:

• Condoms.
• Antiretroviral treatment.
• Prevention of mother-to-child transmission.
• Voluntary medical male circumcision.
• Communications for behaviour change.
• Targeted approaches for at-risk and marginalized populations.

UNICEF found dramatic improvement in prevention of new HIV infections among infants. Some 260,000 children were newly infected with HIV in 2012, compared to 540,000 in 2005.

New, simplified life-long antiretroviral treatment known as Option B+ provides the opportunity to effectively treat women with HIV and to prevent the transmission of the virus to their babies during pregnancy, delivery, and through breastfeeding. The treatment involves a daily one-pill regimen.

Some of the most remarkable successes were in sub-Saharan Africa. New infections among infants declined between 2009 and 2012 by 76 per cent in Ghana, 58 per cent in Namibia, 55 per cent in Zimbabwe, 52 per cent in Malawi and Botswana and 50 per cent in Zambia and Ethiopia.

UNICEF said that globally, the number of AIDS-related deaths overall fell by 30 per cent between 2005 and 2012.

22.45 | 0 komentar | Read More

‘Scary’ number of defibrillators inaccessible to public during an emergency

They can help increase your chance of surviving a cardiac arrest by 75 per cent, but a shocking number of Canada's Automatic External Defibrillators (AEDs) may be inaccessible to the public during an emergency because they are locked away or not registered with 911 personnel.

A CBC Marketplace investigation found that the potential for AEDs to save lives may be severely hampered because there are no national guidelines as to how or where the devices are kept.

There's also no government requirement that they be registered with 911. Registering devices helps 911 dispatchers direct people to the closest AED in case of an emergency.

Watch Marketplace

Watch Marketplace's episode, Shock to the System, Friday at 8 p.m. (8:30 p.m. in Newfoundland and Labrador). Join the conversation on Twitter @cbcmarketplace #defibs

About 40,000 Canadians experience sudden cardiac arrest each year: one every 12 minutes, according to the Heart and Stroke Foundation.

Eighty-five per cent of cardiac arrests in Canada happen outside of hospitals, and having an AED close by can make all the difference. The American Heart Association warns that for every minute lost before defibrillation, the survival rate decreases by seven to 10 per cent. After 12 minutes, the survival rate plummets to less than five per cent.

When CPR and an AED are both used within five minutes of a cardiac arrest, the chance of survival rises by nearly 75 per cent, according to research published in the Journal of the American College of Cardiology.

However, according to one study, fewer than eight per cent of Canadian patients who have a cardiac arrest in public will receive help from an AED before emergency medical personnel arrive, partly because there aren't enough devices available and accessible.

Toronto police officer Laurie McCann, right, used a difibrillator on runner Andrew Rosbrook, left, after Rosbrook collapsed during a Toronto marathon in 2013. (CBC)

"People who have cardiac arrest in public settings tend to do better," Dr. Laurie Morrison, a medical researcher who specializes in emergency medicine, told Marketplace co-host Tom Harrington. "At least somebody gets down and starts chest compressions and somebody else calls 911, and somebody else runs and get the AED.

"So having a cardiac arrest in a public place and not having an AED is a travesty," she said.

The full Marketplace report, Shock to the System, airs tonight at 8pm (8:30pm NT) on CBC Television.

Devices difficult to find

Toronto police officer Laurie McCann knows first-hand how important it is to have fast access to an AED in an emergency. She was on duty at a marathon in Toronto in 2013 when runner Andrew Rosbrook collapsed.

"I knew he wasn't breathing and we needed to do something fast," she said.

"There were no warning signs, no chest pains," said Rosbrook. "I considered myself to be a healthy person."

"The defibrillator was put on and with one shock, he was brought back," McCann said.

Both credit an easily accessible AED for saving Rosbrook's life.

The pair helped Marketplace investigate how difficult AEDs can be to find.

Marketplace sent teams to locate AEDs in three areas of Toronto known to be "hotspots" for cardiac arrests according to a study published this year in the journal Circulation.

In total, the Marketplace teams visited 52 locations including gyms, banks, offices, coffee shops and malls. The teams chose places where a bystander might run to get help in an emergency, or where there were high concentrations of people. Only half of the locations had AEDs.

Click on the graphic to see more on what happens after a person goes into cardiac arrest.

Security staff in many buildings did not immediately know if there was an AED on site. In buildings that did have the emergency devices, many were locked away or accessible only by building personnel, or were not registered with 911, meaning that dispatchers would be unable to direct people to them in case of an emergency.

Half of the AEDs that Marketplace teams found were not registered with 911.

"Scary, isn't it?" said Morrison. "It should be that [if you] purchase one of these devices, you couldn't put it in a building or public place without registering [the AED]," she said.

The Marketplace test is similar to defibrillator "scavenger hunts" in Seattle and Philadelphia that have helped those cities map the locations of devices. The Seattle hunt, which took place this week, offered a $10,000 US prize to the winning team, funded by the Food and Drug Administration and AED manufacturers.

No central registry

While provincial, federal and private funding is sometimes available to increase the number of AEDs in publicly accessible spaces, regulations and policies vary greatly across the country. There are no national guidelines on AEDs or central registry of devices.

Earlier this year, Prime Minister Stephen Harper announced a $10 million initiative to purchase AEDs for recreational facilities and hockey rinks across Canada, all of which will have to be registered with emergency personnel where local or provincial registries exist.

The Ontario government has committed almost $10 million to placing the devices in publicly funded sports and recreation facilities, and in schools with extensive sports programs.

Click on the graphic to see more on what happens after a person goes into cardiac arrest.

Manitoba passed legislation earlier this year that mandates that designated public spaces, including schools, government buildings, malls and homeless shelters, have AEDs and that all devices are registered. Manitoba is the only jurisdiction that mandates that all public places have AED devices, a law that goes into effect in January 2014.

Ontario proposed a similar law in 2010, but while it passed second reading with unanimous support, the bill died when government was prorogued in 2011.

Morrison says that registration of all devices should be mandatory across Canada. The Heart and Stroke Foundation has been pushing for the creation of a national registry.

Morrison was part of a group of researchers from University of Toronto, St. Michael's Hospital and Queen's University that looked to cardiac arrest locations to assess where AEDs should be placed.

Their study, published earlier this year, identified unregistered AEDs as a problem. "A 911 operator would not be able to direct a caller to an unregistered AED, and therefore the likelihood that it would be used in a cardiac arrest is probably low, even if it is nearby. Unregistered AEDs tend to be purchased corporately and remain under lock and key," the study reads.

The study states that in order to be effective, AEDs should be within 100 metres of the scene of a cardiac arrest, so a bystander is able to retrieve it and return within three minutes.

"The most meaningful thing out of that study for me was how little we know about the AEDs that are out there," Morrison said.

22.45 | 0 komentar | Read More

Cpl. Ron Francis turns in RCMP serge after pot controversy

The New Brunswick Mountie at the centre of a debate about smoking medicinal marijuana while wearing his police uniform turned over his formal RCMP red serge Friday.

Cpl. Ron Francis arrived at J Division headquarters in Fredericton as promised to hand over his dress uniform at noon.

Cpl. Ron Francis hands over his RCMP dress uniform Friday at J Division headquarters in Fredericton. (CBC)

RCMP officers had seized Francis's other uniforms and related apparel at his home Thursday night. Francis did not have his dress uniform at his home and said he would turn it over Friday.

Francis was ordered to turn the items in after he was photographed and videoed smoking marijuana in his uniform.

Francis, who is a member of the Maliseet First Nation, held an eagle feather in one hand throughout his visit to headquarters. Before handing over his dress uniform, Francis removed his medal for 20 years of exemplary service to the RCMP with shaking hands.

"It's my medal," a sobbing Francis said to reporters minutes later.

"They can have their uniform. This is my medal," he said. "I earned this. I earned it with my blood, my sweat, my tears.

"I have not one flaw on my service record," said Francis. "My only flaw is I stuck up for the Canadian people.

"And I'd stick up for this country because the government doesn't do anything for them."

Pot helps with PTSD

The 21-year veteran of the RCMP has a prescription for medical marijuana to deal with the post-traumatic stress disorder that he says is a result of his work. Francis believes he should be able to smoke medicinal marijuana while in uniform.

Francis still has his RCMP badge and remains a Mountie, but is on medical leave.

He was upset when fellow RCMP officers arrived at his home Thursday evening to collect his uniforms and gear.

The scene was captured on video by his cousin, and Francis provided a copy of it to CBC News. It contains strong language.

Maliseet elder Imelda Perley went to the station with Francis.

"I'm hoping he will keep his eagle feather, because that's going to be his elder. It's going to be his strength to know that there's a purpose waiting for him and once he gets over his physical part that's giving him struggles today, that he will be able to wear proudly the serge again, hopefully," she said. 

Growing problem

Adam Greenblatt, executive director of the Canadian Association of Medical Cannabis Dispensaries, said this sort of situation will increase as medical marijuana becomes more common. 

"It does speak to this larger issue of accommodating the need for medical cannabis and accommodating the patients who use it," he said. 

He said medical marijuana can legally be smoked or taken through vaporizers, but vaporizers can be too expensive for some people. 

"Non-smoking alternatives such as cannabis-infused food products like cookies and tinctures and hashish products, these are illegal according to Health Canada," he said. "Patients are essentially being forced to smoke this medicine by the government's own regulations."

He said the Francis's case is bringing important issues to light and he hopes a good resolution is reached. 
 

22.45 | 0 komentar | Read More

Medical marijuana use without safety proof worries doctors

The Canadian Medical Association is worried that as large medical marijuana grow facilities get federal licences, more patients will be clamouring for a drug many doctors are uncomfortable prescribing.

Starting April 1, medical marijuana users in Canada will no longer be able to grow their own. Instead, they'll have to get pot from producers licensed by Health Canada.

Darryl Hudson, chief research officer at Peace Naturals, says his company's goal is to relate different plant varieties to specific ailments with standardized doses. (Kim Brunhuber/CBC)

When the change was announced in June, Health Canada said the number of people authorized to use marijuana for medical reasons grew from less than 500 in 2001 to more than 30,000. The department will no longer be a supplier, and it says the change will provide access to quality-controlled marijuana for medical purposes that is produced under secure and sanitary conditions.

Selected changes to medical marijuana access

Health Canada's website provides information for clients, licensed providers, doctors and nurse practitioners, police and municipalities. It covers everything from what documents clients need during the transition period, to the personal and physical security clearances for providers, to the medical document itself that health professionals fill out.  
 
For example licensed producers can only provide dried marijuana, storefronts are not allowed, and the "Authorization to Possess" will no longer be valid after April 1, 2014. 
 
Key dates 
 
June 19, 2013: Announcement of new regulations to govern the use of medical marijuana formally published. 
 
March 31, 2014: Old (Marijuana Medical Access Program) and new access systems run concurrently until this date. All licences for individuals and designates expire. 
 
April 1, 2014: New Marijuana for Medical Purposes Regulations take full effect. Health Canada will no longer sell and distribute marijuana for medical purposes. All personal and designated production no longer permitted and holders must safely dispose of all dried product and plants. The only legal source to obtain marijuana for medical purposes is from licensed producers.

Mark Gobuty, CEO of Peace Naturals in Clearview Township, south of Collingwood, Ont., is proud of his medical cannabis facility, where some plants are half way through their flowering cycle. The products will be dried out and then sold to clients.

"There's still a lot of giggle factor," Gobuty acknowledged.

He said doctors can sign a letter for patients to get a small amount of marijuana and then get feedback from the patient and the company.

At Peace Naturals, the ultimate goal is to come up with standardized medications from different plant varieties for specific ailments, such as pain, nausea or insomnia, said Darryl Hudson, the company's chief of research.

While a doctor's prescription states an exact amount of drug to be taken at exact times for an exact length, the new system gives physicians permission to say they think it's OK for a specific patient to use marijuana, said Dr. Louis Francescutti, president of the Canadian Medical Association.

"We're asking them to prescribe a product that really has not been tested as rigorously as any other product that's out there and basically writing it with your eyes blindfolded and assuming all the risks that go with it."

Francescutti also has concerns about marijuana's potential dangers, especially when there are other proven medications for controlling pain and nausea available.

When doctors prescribe other medications, they know the benefits and side-effects. But physicians receive little if any training about marijuana.

"I can tell you as an emergency physician, I will not be prescribing any marijuana simply because I don't feel safe that I know exactly what I'm prescribing," Francescutti said.

Regulatory colleges and medical liability experts are also advising physicians to tread gently until the medicinal benefits of marijuana are clearly shown.

There are clinical trials that have demonstrated that cannabis can help with some illnesses and conditions, but they are relatively small in number and short in duration, said Dr. Mark Ware, a professor in family medicine at Montreal's McGill University. He oversees a program where 30 to 40 patients are using cannabis for severe, chronic pain that hasn't responded to conventional treatments.

"We need to get that knowledge out into the hands of the physicians out in the community who are facing this issue everyday," Ware said. "If we don't, they will continue to put their hands over their ears and wish the whole thing would go away."

The growers, CMA, and Ware all want the federal government to fund more studies.

In the meantime, Ware is asking his colleagues to learn about what evidence there is. To that end, he has started a non-profit organization called Canadian Consortium for the Investigation of Cannabinoids to help educate physicians on the medical benefits of marijuana.

22.45 | 0 komentar | Read More

Plain tobacco packs to be reviewed in Britain

Britain announced an independent review of tobacco packaging on Thursday and said it was ready to introduce new laws banning branding on cigarette packets if the report found sufficient evidence to support it.

The British government, which in July delayed a decision on the issue, said the review was due to report back in March 2014 and would look into whether standardized packaging is likely to have an effect on public health, particularly in relation to children.

Australia's plain cigarette packaging is stripped of all logos and instead packages have graphic images. (Australian government/Reuters)

The long-standing debate on the issue pits health campaigners, who back the move, against big tobacco firms which say it would put jobs at risk and encourage smuggling.

In Britain, the subject has also prompted criticism from the opposition Labour party over the extent to which the tobacco industry is able to influence government policy.

After a lengthy public consultation, British Prime Minister David Cameron in July delayed a move to force manufacturers to sell tobacco in plain packets, saying he wanted to see more evidence from other countries on the effectiveness of such a move.

Almost exactly a year ago, Australia passed a law saying cigarettes must be sold in dark brown packets with no colours or logos, with the name of the product printed in a standardized small font.

Elsewhere on Thursday, the Dutch Health Ministry sounded an early warning about the possible health risks of electronic cigarettes, announcing plans to clamp down on labelling ahead of European regulations.

A leading Dutch government health advisory body pointed to a lack of evidence on the possible health effects of e-cigarettes, and said that as a precaution, they should not be used by pregnant women or in the vicinity of children.

New York City is weighing a bill to limit use of electronic cigarettes in public places, the New York Times reported Wednesday.

22.46 | 0 komentar | Read More

Aboriginal seniors have a harder time staying healthy

First Nations, Metis and Inuit of advancing years often have poorer health than their non-aboriginal counterparts but don't receive the same level of health-care services as other Canadian seniors, a report says.

The Health Council of Canada report, released Thursday, says the health of aboriginal seniors can be compromised by poverty, inadequate housing and poor diet, especially for those living in remote areas where nutritious foods may be prohibitively expensive.

Chronic conditions such as obesity, diabetes and heart disease are more prevalent among aboriginal Canadians, compared with the general population, and those disorders can worsen with age.

"The challenge with First Nations, Metis or Inuit is that many of those seniors have lived in poverty throughout their lifespan," said Dr. Catherine Cook, vice-president of population and aboriginal health for the Winnipeg Health Region and a councillor with the Health Council.

"So the challenges will have compounded in that," said Cook, who is Metis. "For example, if you've been eating a diet that is low-cost but high in carbohydrates, you may have acquired some of the illnesses that are chronic in nature, so you may be further down that spectrum of illness."

Mental health issues

Many older aboriginal Canadians also carry the scars of rampant societal racism and the trauma of being torn from their families to live in residential schools, where abuse, neglect and substandard health care were pervasive within the system.

The report says those experiences have resulted in lingering mental health issues for some elders, such as depression or even post-traumatic stress disorder.

But accessing health care can be physically, emotionally and financially challenging for many aboriginal seniors, who may have to travel to urban centres for services that are unavailable in remote or isolated communities.

A lack of access to primary physicians and specialists can lead to worsening health problems, said Wenda Watteyne, director of Metis Nation of Ontario's health and wellness program.

"Oftentimes, complications related to chronic diseases aren't being diagnosed, treated or screened, so oftentimes those diseases reach a point of urgency and people are being treated in emergency wards once it reaches a crisis point," Watteyne said from Ottawa, referring to such complications as kidney failure from diabetes.

Ineligible for program

The Health Council says difficulties obtaining care are exacerbated by confusion over which level of government is responsible for which services and for which aboriginal groups.

For instance, First Nations and Inuit are covered by federal non-insured health benefits, but the Metis are ineligible for that program. The exclusion of First Nations from some provincial programs available to all other provincial residents is also contentious.

"You have a health-care (system) that has completely fragmented service for indigenous people," said Cook, associate dean of First Nations, Metis and Inuit health at the University of Manitoba.

Like many other aboriginal Canadians, Metis often have limited incomes, said Watteyne. "But what is distinct is the Metis' inability to access those non-insured health benefits. So that creates even greater pressures on limited incomes that are there.

"So just the ability to pay for expensive prescriptions, the ability to even cover the cost of transportation to see doctors and specialists (are difficult) because that's not covered either."

Support programs

While the report details the barriers many aboriginal seniors face in accessing health care, it also lists examples of programs begun across the country to provide culturally appropriate services for these "respected and honoured" elder members of indigenous communities.

Metis Nation Ontario has developed 18 community support programs across the province that help seniors access care, said Watteyne. For example, volunteer drivers will transport seniors in northwestern Ontario to Winnipeg for cancer and other specialized care.

Marney Vermette, a registered nurse who oversees an educational program for personal support workers in several reserves in northwestern Ontario, said the key is teaching community health providers to take a holistic approach to seniors' needs.

"So not only looking at the physical aspects of your client, but the spiritual, the mental and emotional, and how important that is in caring for your client," said Vermette, who is the liaison for the Saint Elizabeth First Nations, Inuit and Metis Program, Wabauskang First Nation.

Moving to city a blow

"The goal of this course was to provide health-care providers with the knowledge they would need to keep their elderly clients in the community safely for as long as possible."

But if an elderly person becomes so sick and frail they require specialized care, it could mean moving to a long-term facility in a city, which can be a blow for the individual, their family and the whole community, noted Vermette.

For the senior, "they're put into homes that are very foreign to them in the way care is provided. They're away from their families, they're lonely," she said. "Even for family members to go visit them, its very costly and I know that it's very difficult."

The senior can feel isolated and adrift because care providers in the long-term care home may not speak their language, the food would be "very different" and the likely regimented routine in the facility would be unfamiliar, she said.

"In my experience, it is also very sad for the community. It is a loss because not only is it a family member, but a lot of times these elders have a lot of (cultural) knowledge that's taken with them." 

22.46 | 0 komentar | Read More

‘Scary’ number of defibrillators inaccessible to public during an emergency

They can help increase your chance of surviving a cardiac arrest by 75 per cent, but a shocking number of Canada's Automatic External Defibrillators (AEDs) may be inaccessible to the public during an emergency because they are locked away or not registered with 911 personnel.

A CBC Marketplace investigation found that the potential for AEDs to save lives may be severely hampered because there are no national guidelines as to how or where the devices are kept.

There's also no government requirement that they be registered with 911. Registering devices helps 911 dispatchers direct people to the closest AED in case of an emergency.

Watch Marketplace

Watch Marketplace's episode, Shock to the System, Friday at 8 p.m. (8:30 p.m. in Newfoundland and Labrador). Join the conversation on Twitter @cbcmarketplace #defibs

About 40,000 Canadians experience sudden cardiac arrest each year: one every 12 minutes, according to the Heart and Stroke Foundation.

Eighty-five per cent of cardiac arrests in Canada happen outside of hospitals, and having an AED close by can make all the difference. The American Heart Association warns that for every minute lost before defibrillation, the survival rate decreases by seven to 10 per cent. After 12 minutes, the survival rate plummets to less than five per cent.

When CPR and an AED are both used within five minutes of a cardiac arrest, the chance of survival rises by nearly 75 per cent, according to research published in the Journal of the American College of Cardiology.

However, according to one study, fewer than eight per cent of Canadian patients who have a cardiac arrest in public will receive help from an AED before emergency medical personnel arrive, partly because there aren't enough devices available and accessible.

Toronto police officer Laurie McCann, right, used a difibrillator on runner Andrew Rosbrook, left, after Rosbrook collapsed during a Toronto marathon in 2013. (CBC)

"People who have cardiac arrest in public settings tend to do better," Dr. Laurie Morrison, a medical researcher who specializes in emergency medicine, told Marketplace co-host Tom Harrington. "At least somebody gets down and starts chest compressions and somebody else calls 911, and somebody else runs and get the AED.

"So having a cardiac arrest in a public place and not having an AED is a travesty," she said.

The full Marketplace report, Shock to the System, airs tonight at 8pm (8:30pm NT) on CBC Television.

Devices difficult to find

Toronto police officer Laurie McCann knows first-hand how important it is to have fast access to an AED in an emergency. She was on duty at a marathon in Toronto in 2013 when runner Andrew Rosbrook collapsed.

"I knew he wasn't breathing and we needed to do something fast," she said.

"There were no warning signs, no chest pains," said Rosbrook. "I considered myself to be a healthy person."

"The defibrillator was put on and with one shock, he was brought back," McCann said.

Both credit an easily accessible AED for saving Rosbrook's life.

The pair helped Marketplace investigate how difficult AEDs can be to find.

Marketplace sent teams to locate AEDs in three areas of Toronto known to be "hotspots" for cardiac arrests according to a study published this year in the journal Circulation.

In total, the Marketplace teams visited 52 locations including gyms, banks, offices, coffee shops and malls. The teams chose places where a bystander might run to get help in an emergency, or where there were high concentrations of people. Only half of the locations had AEDs.

Click on the graphic to see more on what happens after a person goes into cardiac arrest.

Security staff in many buildings did not immediately know if there was an AED on site. In buildings that did have the emergency devices, many were locked away or accessible only by building personnel, or were not registered with 911, meaning that dispatchers would be unable to direct people to them in case of an emergency.

Half of the AEDs that Marketplace teams found were not registered with 911.

"Scary, isn't it?" said Morrison. "It should be that [if you] purchase one of these devices, you couldn't put it in a building or public place without registering [the AED]," she said.

The Marketplace test is similar to defibrillator "scavenger hunts" in Seattle and Philadelphia that have helped those cities map the locations of devices. The Seattle hunt, which took place this week, offered a $10,000 US prize to the winning team, funded by the Food and Drug Administration and AED manufacturers.

No central registry

While provincial, federal and private funding is sometimes available to increase the number of AEDs in publicly accessible spaces, regulations and policies vary greatly across the country. There are no national guidelines on AEDs or central registry of devices.

Earlier this year, Prime Minister Stephen Harper announced a $10 million initiative to purchase AEDs for recreational facilities and hockey rinks across Canada, all of which will have to be registered with emergency personnel where local or provincial registries exist.

The Ontario government has committed almost $10 million to placing the devices in publicly funded sports and recreation facilities, and in schools with extensive sports programs.

Click on the graphic to see more on what happens after a person goes into cardiac arrest.

Manitoba passed legislation earlier this year that mandates that designated public spaces, including schools, government buildings, malls and homeless shelters, have AEDs and that all devices are registered. Manitoba is the only jurisdiction that mandates that all public places have AED devices, a law that goes into effect in January 2014.

Ontario proposed a similar law in 2010, but while it passed second reading with unanimous support, the bill died when government was prorogued in 2011.

Morrison says that registration of all devices should be mandatory across Canada. The Heart and Stroke Foundation has been pushing for the creation of a national registry.

Morrison was part of a group of researchers from University of Toronto, St. Michael's Hospital and Queen's University that looked to cardiac arrest locations to assess where AEDs should be placed.

Their study, published earlier this year, identified unregistered AEDs as a problem. "A 911 operator would not be able to direct a caller to an unregistered AED, and therefore the likelihood that it would be used in a cardiac arrest is probably low, even if it is nearby. Unregistered AEDs tend to be purchased corporately and remain under lock and key," the study reads.

The study states that in order to be effective, AEDs should be within 100 metres of the scene of a cardiac arrest, so a bystander is able to retrieve it and return within three minutes.

"The most meaningful thing out of that study for me was how little we know about the AEDs that are out there," Morrison said.

22.46 | 0 komentar | Read More

MERS virus found in camels in Qatar

Health officials in Qatar have announced they have found MERS or a MERS-like virus in three camels.

The camels were from a single farm where two men also contracted the virus.

Scientists have found a clue that suggests camels may be involved in infecting people in the Middle East with the MERS virus. (Hiro Komae/Associated Press)

The finding provides further evidence that camels can at the very least be infected with MERS or a very similar virus.

But it does not prove camels are driving the outbreak of the new coronavirus, which is a cousin of the virus that caused the 2003 SARS outbreak.

Recently officials from Saudi Arabia also reported a similar finding from a single camel in that country.

The World Health Organization has confirmed 160 infections with the new virus, all in or linked to six countries in the Middle East.

"This is our first clue which further fills out the whole story," says Bart Haagmans, a Dutch virologist who is involved in the effort to test the camel specimens.

"But there's more work to do, especially on routes of transmission."

Haagmans, who is with Erasmus Medical Centre in Rotterdam, says the team believes the findings are solid. They used three different tests, and found multiple fragments of viral RNA.

As well, the camels have developed antibodies to MERS, or a MERS-like virus, he says. Sequencing of that material is ongoing.

It has been reported that other types of animals were also present on the farm. Haagmans says testing of specimens from other animals is still underway.

While the working hypothesis is the virus originated in bats, scientists have been trying to figure out how people are becoming infected with it.

The assumption has been that one or perhaps several species of animals contracted the bat virus and are now spreading it among themselves and occasionally to humans.

A lot of attention has focused on camels. From time to time there have been reports that a person who became infected owned camels or attended camel races. But the WHO says many of the people who have contracted this virus reported no contact with the beasts.

Earlier this year European researchers reported finding antibodies to MERS or a similar virus in camels from Oman, the Canary Islands and Egypt.

But antibodies signal prior infection. To confirm that camels play a role in this story, science needs evidence of current infection.

Even with these findings, much of the puzzle remains to be completed. How are people contracting this virus? What puts them at risk? And what portion of cases involve animal-to-human spread at this point?

"For sure there is a part of the outbreak that is caused by human-to-human transmission," says Haagmans.

"The question is, what is the fraction of these cases? And how many independent introductions do you have through zoonotic" — from an animal —"transmission?"

The team involved in this work — from Qatar, the WHO and the Netherlands — is working on a scientific paper to lay out their findings.

22.46 | 0 komentar | Read More

Tongue device steers wheelchair, plays video game

Maysam Ghovanloo, left, points to a small magnet attached to graduate student Xueliang Huo's tongue that allows him to operate a powered wheelchair and computer mouse. (Georgia Tech)

Tongue-controlled power wheelchairs could allow some people who are paralyzed to do tasks like using a phone and navigate obstacles more quickly, researchers say. 

In Wednesday's issue of the journal Science Translational Medicine, scientists in Atlanta and Chicago describe their initial tests of a wireless device that allows people paralyzed from the neck down to complete tasks by moving their magnet-pierced tongues.
 
The performances of people with spinal cord injuries were up to three times faster with the "tongue drive system" than with the traditional sip-and-puff device — a straw-like tube that patients inhale and exhale into to operate a powered wheelchair in four directions.  
 
The level of accuracy was the same, even though more than half the patients were already experienced with sip-and-puff technology, the researchers said.  
 
"That was a very exciting finding,"  study author Maysam Ghovanloo, a professor in the school of electrical and chemical engineering at the Georgia Institute of Technology, said in a release. "It attests to how quickly and accurately you can move your  tongue."   
 
The goal is to provide intuitive, efficient and accurate access to computers, smartphones and environment controls to adjust lights and temperature, for example, as well as to increase mobility.
 
The technology fits in a retainer along the roof of the mouth.  
 
Here's how it works:

• Sensors track the movement of a tiny magnet on the tongue.  
• Pointing the tongue in different directions changes the magnetic field around the mouth, which is picked up by four sensors on a headset.  
• The information is sent wirelessly to an iPod, which then delivers the commands to the powered wheelchair or computer.

The researchers tested the technology in 23 able-bodied participants and 11 with tetraplegia. Within 30 minutes of  training, the researchers said all the subjects were able to do tasks like tapping on targets that randomly appeared on a screen, navigating a cursor through a maze on a computer screen, dialing a keypad and driving a powered wheelchair through an obstacle course. 

Their performances improved with practise.
 
This research was funded by the U.S. National Institute of  Biomedical Imaging and Bioengineering, and the U.S. National Science Foundation. Ghovanloo's company is negotiating a licence for the technology.

22.45 | 0 komentar | Read More

Hockey Canada and other minor leagues sued over concussions

A 14-year-old boy is suing Hockey Canada and other minor leagues after he was cross-checked by an opponent, resulting in a serious concussion.

In 2010, Alexis Turcotte, then 11 years old, was on the ice with his peewee team in Trois-Pistoles, Que., when he was reportedly cross-checked from behind.

When he got up, he was cross-checked again, this time hard in the face.

His mother, Annie Turcotte, was in the stands that day.

"I saw that Alexis wasn't moving. He was completely motionless on the ground," she recalled.

Alexis said he has no memory of that day.

For months afterwards, he stayed in his dark bedroom because noise and lights were too hard for him to bear. His grades suffered, he said, adding that he can no longer play contact sports.

Quebec outlawed cross-checks in minor leagues more than 25 years ago. Despite that, Jean-Pierre Ménard, the lawyer representing Alexis in civil court, said the player who hit his client received nothing more than a two-minute penalty.

A full report on the incident was sent to the local league, Hockey Quebec and Hockey Canada, but Ménard said none of them followed up.

"It's like saying, 'It's not that bad, it's OK,'" said the lawyer. He equates the lack of response to encouraging violence and is seeking $370,000 on behalf of Alexis and his family from the Basques minor hockey association, Hockey Canada, Hockey Quebec and the alleged aggressor and his family.

Ménard said that other victims of bad hockey hits have sued the perpetrators, but this is the first time someone is going after the leagues.

None of the leagues would comment because the case is before the courts.

22.45 | 0 komentar | Read More

Dementia developing at later ages, U.S. study shows

The risk of dementia appears to be falling despite an aging population, U.S. doctors say.

In Wednesday's issue of the New England Journal of Medicine, doctors point to two recent U.S. studies and three from Europe suggesting declines in dementia incidence rates among people born in the first half of the 20th century.

People with dementia do a parachute exercise in the Bronx. A new study shows the age of those getting dementia seems to be getting higher. (Jim Fitzgerald/Associated Press)

"For now, the evidence supports the theory that better education and greater economic well-being enhance life expectancy and reduce the risk of late-life dementias in people who survive to old age," Dr. Eric Larson, of the University of Washington in Seattle, and his co-authors said in their commentary.

They called the consistency of the findings "encouraging and noteworthy," given the projected growth of the population older than 75 years.

"Of course, people are tending to live longer, with worldwide populations aging, so there are many new cases of dementia," Larson said in a release.

"But some seem to be developing it at later ages — and we're optimistic about this lengthening of the time that people can live without dementia."

Earlier this year, the researchers reported in the same journal that people with lower blood sugar levels tend to have less risk of dementia. Focusing on greater physical activity, diet, educational opportunities both in early and later life , treating hypertension and quitting smoking also help prevent dementia, Larson said.

The researchers said the studies serve as a reminder that dementia is a syndrome with complex symptoms but that the vast majority of dementia cases, especially those occurring late in life, tend to involve a mixture of Alzheimer's disease and vascular disease.

British researchers who surveyed more than 7,500 people aged 65 and older between 1989 and 2011 also concluded that populations born later have a lower risk of dementia than those born earlier, probably because of higher education levels and better prevention of heart disease and stroke.

In 2010, a report commissioned by the Alzheimer Society of Canada suggested the prevalence of dementia in Canada will more than double in 30 years with the costs increasing 10-fold if no changes are made. One of the changes suggested is getting people over 65 to increase their physical activity levels.

22.45 | 0 komentar | Read More

Aboriginal seniors have harder time staying healthy

First Nations, Metis and Inuit of advancing years often have poorer health than their non-aboriginal counterparts but don't receive the same level of health-care services as other Canadian seniors, a report says.

The Health Council of Canada report, released Thursday, says the health of aboriginal seniors can be compromised by poverty, inadequate housing and poor diet, especially for those living in remote areas where nutritious foods may be prohibitively expensive.

Chronic conditions such as obesity, diabetes and heart disease are more prevalent among aboriginal Canadians, compared with the general population, and those disorders can worsen with age.

"The challenge with First Nations, Metis or Inuit is that many of those seniors have lived in poverty throughout their lifespan," said Dr. Catherine Cook, vice-president of population and aboriginal health for the Winnipeg Health Region and a councillor with the Health Council.

"So the challenges will have compounded in that," said Cook, who is Metis. "For example, if you've been eating a diet that is low-cost but high in carbohydrates, you may have acquired some of the illnesses that are chronic in nature, so you may be further down that spectrum of illness."

Mental health issues

Many older aboriginal Canadians also carry the scars of rampant societal racism and the trauma of being torn from their families to live in residential schools, where abuse, neglect and substandard health care were pervasive within the system.

The report says those experiences have resulted in lingering mental health issues for some elders, such as depression or even post-traumatic stress disorder.

But accessing health care can be physically, emotionally and financially challenging for many aboriginal seniors, who may have to travel to urban centres for services that are unavailable in remote or isolated communities.

A lack of access to primary physicians and specialists can lead to worsening health problems, said Wenda Watteyne, director of Metis Nation of Ontario's health and wellness program.

"Oftentimes, complications related to chronic diseases aren't being diagnosed, treated or screened, so oftentimes those diseases reach a point of urgency and people are being treated in emergency wards once it reaches a crisis point," Watteyne said from Ottawa, referring to such complications as kidney failure from diabetes.

Ineligible for program

The Health Council says difficulties obtaining care are exacerbated by confusion over which level of government is responsible for which services and for which aboriginal groups.

For instance, First Nations and Inuit are covered by federal non-insured health benefits, but the Metis are ineligible for that program. The exclusion of First Nations from some provincial programs available to all other provincial residents is also contentious.

"You have a health-care (system) that has completely fragmented service for indigenous people," said Cook, associate dean of First Nations, Metis and Inuit health at the University of Manitoba.

Like many other aboriginal Canadians, Metis often have limited incomes, said Watteyne. "But what is distinct is the Metis' inability to access those non-insured health benefits. So that creates even greater pressures on limited incomes that are there.

"So just the ability to pay for expensive prescriptions, the ability to even cover the cost of transportation to see doctors and specialists (are difficult) because that's not covered either."

Support programs

While the report details the barriers many aboriginal seniors face in accessing health care, it also lists examples of programs begun across the country to provide culturally appropriate services for these "respected and honoured" elder members of indigenous communities.

Metis Nation Ontario has developed 18 community support programs across the province that help seniors access care, said Watteyne. For example, volunteer drivers will transport seniors in northwestern Ontario to Winnipeg for cancer and other specialized care.

Marney Vermette, a registered nurse who oversees an educational program for personal support workers in several reserves in northwestern Ontario, said the key is teaching community health providers to take a holistic approach to seniors' needs.

"So not only looking at the physical aspects of your client, but the spiritual, the mental and emotional, and how important that is in caring for your client," said Vermette, who is the liaison for the Saint Elizabeth First Nations, Inuit and Metis Program, Wabauskang First Nation.

Moving to city a blow

"The goal of this course was to provide health-care providers with the knowledge they would need to keep their elderly clients in the community safely for as long as possible."

But if an elderly person becomes so sick and frail they require specialized care, it could mean moving to a long-term facility in a city, which can be a blow for the individual, their family and the whole community, noted Vermette.

For the senior, "they're put into homes that are very foreign to them in the way care is provided. They're away from their families, they're lonely," she said. "Even for family members to go visit them, its very costly and I know that it's very difficult."

The senior can feel isolated and adrift because care providers in the long-term care home may not speak their language, the food would be "very different" and the likely regimented routine in the facility would be unfamiliar, she said.

"In my experience, it is also very sad for the community. It is a loss because not only is it a family member, but a lot of times these elders have a lot of (cultural) knowledge that's taken with them." 

22.45 | 0 komentar | Read More

Medical marijuana privacy breach sparks lawsuit

A Halifax law firm has filed a proposed class-action lawsuit against Health Canada, accusing the federal department of violating the privacy of medical marijuana users.

These letters from Health Canada were sent to about 40,000 medical marijuana users across Canada. (CBC)

Last week, the federal government began sending letters to all those in the medical marijuana access program, explaining upcoming changes that roll out April 1.

The problem is the return address on the outside of the envelope was clearly marked with 'Marijuana Medical Access Program,' and included the user's name and address.

That has some medical marijuana users crying foul, saying Health Canada has jeopardized their privacy, even their safety and job security.

One Nova Scotia man who is allowed to grow his own marijuana said many of his friends and family don't even know he's part of the program.

He's one of 40,000 Canadians across the country that can legally possess medical marijuana. Now, he's not sure who has learned he uses the drug.

"It said medical marijuana access program, right on the letter that was sticking right out of the mailbox for anyone who walked up on my step to see" he said. "Could have been a neighbourhood kid knock on my door, trying to sell tickets to a raffle, that seen that sticking out of there."

The man doesn't want to be identified, in part to keep his family safe. He's also worried about losing his job, where a security clearance is required.

Health Canada has apologized for the gaffe, calling it an administrative error. It is refusing to comment on the legal action.

McInnes Cooper lawyer David Fraser is representing some medical marijuana users and has filed a lawsuit that seeks class-action status in the Federal Court of Canada.

Fraser cautions it could take years to work its way through the courts. The action alleges the privacy of tens of thousands of Canadians was violated.

"Individuals are experiencing significant anxiety about their own security, the safety of their families," Fraser said in an interview. "In many cases, these are people who have small children in their homes. It also includes the elderly."

22.45 | 0 komentar | Read More

N.B. doctors, dietitians call for school menu checkup

In 2005, the New Brunswick government brought in policies to remove food with low nutritional value from school vending machines, cafeterias and fundraisers. (CBC)

Doctors and nutritionists in the province are asking parents, teachers and education administrators to take a closer look at what their school cafeterias are serving.

They're asking parents to anonymously share photos of their children's school menus to see whether cafeterias are following the guidelines set out in the Department of Education policy.

In 2005, the New Brunswick government established rules to remove food with low nutritional value from school vending machines, cafeterias and fundraisers, including candy, sweetened drinks, french fries, pastries and hotdogs.

'We don't want to target any schools, we just want a sense of what's going on in the province'- Vanessa MacLellan, N.B. Dietitians in Action

Foods that have moderate nutrition but contain higher levels of fat, sugar and sodium; for example salted soups, milkshakes and canned vegetables, are offered in a limited way — each about twice a week.

Foods recommended for daily consumption include whole grains, fresh vegetables, white milk and lean cuts of meat.

Some schools are only serving healthy foods, but many still serve foods that have been essentially banned from schools under provincial policy, the New Brunswick Medical Society said in a release.

"Overwhelming evidence shows that healthy habits are established in childhood," said Dr. Lynn Hansen, president of the medical society.

"School cafeterias should be an extension of the classroom — teaching kids healthy eating habits they'll stick with for life."

The initiative to share photographs of school lunches, called Make Menus Matter, is a joint effort between the medical society and the group New Brunswick Dietitians in Action.

Vanessa MacLellan, a registered dietitian and co-chair of the group, said lunches will be tested to get a better idea of what schools are serving.

"You hear of some great success stories, but you also hear of, 'My child is receiving minimum nutritional value food on their menu,'" said MacLellan.

"So it was just, we need to take a look and see if schools across the country are following Policy 711, and if they're not, why they're not, what should be our next steps, and what do we need to do to ensure they can achieve this?"

Photos can be sent to the medical society or uploaded to its "Care First" Facebook Page. The group will remove all identifying child and school-related information.

"We don't want to target any schools, we just want a sense of what's going on in the province," MacLellan said.

"We want to have this campaign, not to blame and shame, but to help and share the right resources. And if schools need assistance from dietitians, that we get it in place … It's a good thing. This campaign is good."

The medical society's "Care First" plan was released at the end of September, and emphasizes preventative medicine and the patient's role in managing their own health.

22.45 | 0 komentar | Read More

H1N1 pandemic death numbers like seasonal flu

A new study suggests the number of people who died from H1N1 pandemic flu in 2009 was similar to the annual toll taken by seasonal flu.

But the authors suggest the comparison is misleading because the people who died during the H1N1 pandemic were a lot younger than the people who succumb to seasonal flu.

Researchers suggest between 123,000 and 203,000 people died worldwide from pandemic flu in the final nine months of 2009. (Reed Saxon/Associated Press)

Lead author Lone Simonsen says that between 62 per cent and 85 per cent of people who died from pandemic flu in 2009 were under 65 years of age.

During typical flu seasons less than 20 per cent of deaths occur in people under age 65.

Simonsen says it's important to look at years-of-life lost, because simply counting deaths doesn't capture the full scope of the global outbreak.

Another finding of the study was that some parts of the world were far harder hit than others, with 20 times more deaths in the Americas than in Europe.

But why that is true remains unclear, says Simonsen, a professor in the school of public health at George Washington University in Washington, D.C.

The study was published Tuesday in the journal PLoS Medicine, a publication of the U.S. Public Library of Science. The authors were from the U.S., the Netherlands, Britain and from the World Health Organization in Geneva.

The WHO reported 18,631 confirmed deaths in the 2009 pandemic, a startlingly low figure for a global event that had, when it first hit the world's radar, appeared to cause an alarming degree of severe disease.

But as the new virus moved from Mexico to other parts of the world, it became clear that this pandemic was not going to be like the Spanish Flu of 1918 or even the milder pandemic of 1957.

For this study, Simonsen and her co-authors looked at mortality data from 20 countries representing 35 per cent of the world's population. Using that data, they built a mathematical model to calculate global figures.

They suggest between 123,000 and 203,000 people died from pandemic flu in the final nine months of 2009. Their model suggests that for the four years preceding the pandemic, between 148,000 and 249,000 people a year died from seasonal flu.

But the authors say the paper likely substantially underestimates the total death toll for the 2009 pandemic. For one thing, says Simonsen, people continued to die from the pandemic strain into 2010 and even later.

And the team wasn't able to get mortality data for many parts of the world. They suggest the true death toll may have been in the 300,000 to 400,000 range.

22.45 | 0 komentar | Read More

First Nation elders appeal for long-term care home

First Nations in northwestern Ontario lack long-term care facilities — and neither the provincial nor federal government will pay for them.

The health director for Eabametoong First Nation said the elders' centre in his community closed 10 years ago due to lack of funding.

"A lot of the people didn't like that," Robert Baxter said. "I think they still want a facility here, in our community."

Robert Baxter is the health director in Eabametoong First Nation. He says it's not likely the community will find the funds to build a long-term care home. (Melanie Ferrier/CBC)

Baxter and others have been trying to get a new facility built, but are coming up empty in their search for funding.

In an email to CBC News, Health Canada said "provinces and territories are responsible ... for providing funding for higher levels of care."

But provincial health officials told CBC News that the North West Local Health Integration Network doesn't fund buildings — it only supports services.

"[It's] just like pulling teeth when you want to get something from those people. It's very hard," Baxter said.

Given the challenges, Baxter said he feels it's unlikely a facility will be built in this remote community.

'Nobody can help me'

It's not good news for Ellen Neshinapaisc, a 77-year-old living in Eabametoong First Nation.

She has lived in Eabametoong since 1964, raised five children there and spent a lot of time on her family's trap line.

"My life right now is so miserable. I can't do anything. Not like I used to back then. I get lonely. I don't know what to do," she said. "I don't know how long I'm going to be able to do what I used to — like cleaning up. If I get sick, nobody [can] help me."

Provincial health officials say a traditional long-term care facility, similar to one found in an urban setting, wouldn't be economical in a remote community. (istock)

Neshinapaisc said she knows of other seniors who have had to move out of the community for long term care.

"I don't want to be like that or go out there and live out there. I want to stay here on the reserve," she said.

"I'm always talking about getting the home care for the elders so that they can be here in their own community."

Buildings not funded

Baxter said Eabametoong's respite centre was a place where seniors could stay when their caretakers needed a break, such as when they needed to go hunting in the summer.

"It ended up being almost like a long-term care facility after a while," Baxter recalled.

"They just couldn't get those people out of there. They just stayed there until they passed away. I know one lady from Mishkeegogamang … I think she was there about the longest … maybe two or three years she was there, or even longer."

The home operated for about 10 years, but began to run into financial difficulties.

"Bills started piling up," Baxter said.

"The only thing that they could do was keep paying the people's wages. Then, they finally had to shut it down."

Susan Pilatzke, a senior director with the North West Local Health Integration Network said she's heard from remote First Nation communities that are interested in building long term care facilities in their communities

But when communities express this kind of interest, the LHIN gives them this advice: "We don't fund buildings … through the LHIN mandate, we help support services."

'I think there's money somewhere.'- Felicia Sagutch, a band councillor in Eabametoong First Nation

Pilatzke said a traditional long-term care facility, similar to one found in an urban setting, wouldn't be economical in a remote community because a certain number of beds is needed to pay for around-the-clock care. She said she doesn't think there would be a need to have that many beds in a remote community.

Something 'for the elders'

Felicia Sagutch, a band councillor in Eabametoong First Nation responsible for the community's health portfolio, said she's spoken to a number of elders who want a long-term care home in the community.

Felicia Sagutch, a band councilor in Eabametoong First Nation, said she's spoken to a number of elders who want a long-term care home in the community. (Melanie Ferrier/CBC)

"It is unfortunate that we don't have a place for them. They passed on [away from the community]," Sagutch said.

"You know, the last message I got from one of the ladies that was in hospital was, 'Get something for the elders. It's sad to be here … to be away from family.' That's what she said. 'Work on it. Get a place for your elders. They need to be home.'"

Sagutch said she's determined to work on getting a facility, even though she knows it won't be easy to get the money.

"You never know how much support we're going to get," she said. "That's my thoughts. Money … I think there's money somewhere. That's my feeling. There's got to be money somewhere."

22.45 | 0 komentar | Read More

Doctor describes delivering baby on KLM flight

Canadian family medicine resident Erin Sullivan credits her time as a Northern nurse for helping her deliver a baby on board a KLM flight before it made an emergency landing in Yellowknife earlier this month.

The KLM Airbus 330 was on its way from Amsterdam to Calgary on Nov. 14 when flight attendants made an announcement asking if there were medical personnel on board, Sullivan said.

Sullivan is a former emergency and critical care nurse who recently graduated from medical school in Ireland.

She answered the call and found a woman in distress in one of the airplane's washrooms. The woman, who was in labour, spoke no English.

"I politely asked the flight attendants to clear out business class as fast as they could, and got her positioned between the last two rows, because that was the widest area we had," she said. "Thank goodness for the extra leg room in those sections."

She was joined by a number of nurses who also happened to be on board the flight, but she was the only physician. 

By the time she opened up the on-board medical kit and put on one of the two pairs of sterile gloves included, "Delivery was imminent," she says.

She describes the obstetric supplies in the medical kit as "scanty" and consisting of two sets of sutures, one pair of scissors, and one umbilical cord clamp.

"You know when they go around with the moist towelettes in the beginning? I had a couple of packs of those ready in case she started bleeding," she says. "But other than that I had nothing."

To Sullivan's relief, the woman gave birth without complications. She delivered a vigorous, healthy, baby boy who appeared to be full-term.

However they couldn't clamp the umbilical cord properly to cut it, because that requires two clamps, until one of the nurses had an idea.

"She said, 'Wait, I know,' and she grabs her purse and she's fumbling through it and she pulls out one of those plastic clasps you use to reseal potato chip bags with, and I'm like 'Perfect!'" says Sullivan.

She credits her Northern nursing experience for helping her make do with what was available.

"Up north we had to do a lot of MacGyver-ing when we ran out of supplies and things like that," she said.

When the plane landed in Yellowknife, the mother and child were taken by ambulance to Stanton Territorial Hospital while the remaining passengers stayed on board. The flight then continued on to Calgary after a short delay. 

22.46 | 0 komentar | Read More

I'm a doctor and I have cancer

How the hell did I wind up doing this? I think to myself. 

I'm staring at an 18-gauge needle, filled with a potent medication called Neupogen. It's going to stimulate my bone marrow to put out more cells to fight infection. I have to take it because the chemotherapy damages my immune system.

I'm on chemotherapy because I have cancer. I'm 27, and I'm a physician training in internal medicine. Three months ago, I was only concerned with how many exhausting hours of call I had to do in a week. 

But I had been keeping an eye on this swelling on the left side of my neck. It just seemed bigger to me than it should be. When you're a doctor, you're always worried you have cancer. 

Then, one day I'm just being my paranoid self and feeling my neck and I notice the left side of my neck is bigger, and there are a few other large nodes there.

Lumpy necks are usually nothing. You can get lumps when you're sick or if you've had a viral infection. But I hadn't been sick for months, and I had no flu-like symptoms. I just had this thing in my neck, and this feeling in my stomach.

"Dad, feel this," I say. 

The diagnosis

My father has been a physician for 36 years. He has one feel of my neck. Then his face goes ashen. 

"How long has this been there?" he asks. 

"Somewhere between three and six months." 

"Three and six months!" 

"God. Yeah. I just thought it was a reactive lymph node."

"For six months?!" 

"Dad…"

"Nik, the only reason I'm telling you this is because the last time I felt something like this the guy had lymphoma."

I went silent. Lymphoma is a type of cancer. I could have cancer. 

A visit to my family doctor, a referral to a hematologist, and a painful biopsy to the neck later and ding ding ding, I have cancer. Hodgkin's lymphoma. Stage 2A. Chemotherapy to begin immediately. 

The next thing I know, I have a permanent IV line in my arm, sitting in the chemotherapy suite at the Health Science Centre in St. John's and I'm wondering if this cocktail of drugs hanging next to me will save my life or leave me breathless and infertile. 

Injections and hair loss

It's hard to believe that all that happened about two months ago. I take a deep breath. I need to be here right now. 

I fully snap out of the past and my own head as the needle enters my skin. 

Now is the hard part. I inject the substance into my body. It burns and hurts, and I don't want to do it. I want to stop and pull it out. Instead, I breathe, curse quietly and finish the injection. I pull out the needle and slap an alcohol swab over the entry point. The pain of the needle subsides, but in a few minutes, I'll start to sweat and have bone pain. 

I down some Tylenol and make my way upstairs, where I go to the computer to write all this down.

The computer keyboard looks like a black dog just shed over it. That's my hair. Thank you, chemo. As if being five-foot-five and having cancer isn't bad enough for my love life, I'm losing my hair.

Why I'm doing this

I'm not sure why I'm telling you all this.  

The only thing I can figure is that cancer is this huge topic and it's usually handled so dramatically. Some people make it out to be a Rocky-style fight, others approach it as this wonderful Eat, Pray Love-style experience, or they find themselves in a staring contest with the Grim Reaper, puking their guts out, and waiting to die.  

The truth is, cancer is kind of all those things, and also, kind of none of them.  

I think I want to try to make it easier for people who have cancer and people who know people with cancer to understand each other a bit better.  

Maybe I just want people to understand me a bit better. Right now, that's all I've got. 

22.46 | 0 komentar | Read More

Lonely seniors forge friendships through 'little brothers' campaign

Meals on Wheels can deliver a hot meal. A doctor can prescribe pills. A personal support worker can help with dressing, or a bath. They're all important, but what many old people need most is a whole lot harder to come by.

A friend.

Researchers say the impact on health of being lonely is comparable to smoking 15 cigarettes a day. Lonely elders are more likely to die of a heart attack and are at a higher risk for dementia, depression and anxiety.

And it all happens far from public view, behind closed doors. In Quebec, an organization called "Les Petits Frères: La grande famille des personnes âgées seules" is trying to break through that isolation.  More than 1,000 Quebec seniors are matched with younger volunteers, with the idea of creating a real and ongoing friendship.

The Sunday Edition

Coming up Nov. 24 on CBC radio's The Sunday Edition, starting at 9 a.m. Eastern:

• How food waste contributes to global instability: Tim Benton, UK Champion for Global Food Security.
• Margarethe von Trotta: Feminist director honoured with major award.
• The Deaf Musician:  Peter Stelmacovich relies on technology to stay in band.
• Everything You Always Wanted to Know about Goldman Sachs, But Were Afraid to Ask.

Everything Les Petits Frères does is rooted in the idea that human connection is essential to life. Their motto is "Les fleurs avant le pain," which translates as Flowers Before Bread.

Les Petits Frères was founded in France by Armand Marquiset, a wealthy, debonair Catholic intellectual. In 1939, while praying at Notre-Dame Cathedral, Marquiset decided to dedicate the rest of his days to helping out "les petits frères," little brothers who were less fortunate than he was.

At the end the Second World War Marquiset signed up volunteers. They began feeding impoverished elderly people who had lost all their close family members in the war.

Marquiset believed that loneliness was as great a problem as hunger. He began inviting isolated seniors to vacation at his elegant family estate. He renamed it Le Château de Bonheur - The Chateau of Happiness - where he threw lavish parties, making sure there were lots of flowers and laughter.

A traffic jam of walkers

Today, Little Brothers - Friends of the Elderly as it is known in English - flourishes in eight countries, including the United States. It's almost impossible to keep up with the growing demand for what it has to offer.

Nathalie Brunet greets Henri Gauthier during one of his noon visits to Les Petits Freres in Montreal. (David Gutnick/CBC)

But while it has been in Canada now for 50 years, it hasn't spread beyond Quebec.

​At noon on a weekday afternoon, there is a traffic jam of walkers and wheelchairs in the front hallway of the downtown Montreal headquarters of Les Petits Frères. The air smells of perfume, roast beef and home-made apple pie.

Every few minutes the front door swings open. Another guest is gently led in, welcomed with smoked salmon hors d'oeuvres, and then led to the dining room where there are bouquets of fresh cut roses and lilies on every table.

Benny Valente is a volunteer driver. "I have nothing to do, they have nothing to do, so we get together and we have something to do."

​For others, Les Petits Frères is about much more than that. In between forkfuls of mashed potatoes, 78-year-old Henri Gauthier tells a table-mate about life in his two room apartment in a rent-subsidized residence. "I feel lonely, you know, and I don't want to talk about it. Sometimes I hate that, la vie c'est la vie, life is life. Sometimes I say, 'I do not care,' I hate myself, you know."

Susan Valente is a volunteer, and many conversations with the seniors she meets have convinced her how important these lunch dates can be. "Without Les Petits Frères a lot of people would commit suicide," she says.

Her husband Benny agrees. "Somebody should  start off the organization on the English side, because the way it is now it is only the French side doing this."

There are few English speakers – either seniors or volunteers - involved with Les Petits Frères. The organization is very much old-school French-Canadian.

The headquarters of Les Petits Frères in Quebec is in the Plateau Mont-Royal neighbourhood in Montreal. (David Gutnick/CBC)

Les Petits Frères has no religious or government affiliation. The organization is financed by private donations and is fiercely independent.

To get help you must be 75 years old and have no family members living nearby. Seniors are referred by social workers, nurses or neighbours. It doesn't matter whether they live alone or in a residence, whether they are sick or healthy, rich or poor - they just have to say they are lonely.

​Peter McGrail is one of the people who draws support from the organization. He's pretty good at steering his electric wheelchair through the narrow halls of his senior's apartment tower in Montreal's east end, which Les Petits Frères helped him find when others didn't work out.

McGrail is a bachelor: he worked for decades at Eaton's, decorating store windows from Toronto to Halifax. After he retired he enjoyed attending concerts, tinkering with antique clocks and gardening at his cabin. But then McGrail's health and his finances went south.

By the time he was 80, life was grim. His only friends were the birds and chipmunks he fed in the park.

"I thought of  suicide a few times," he says, "When you are down and out at Christmas time, you look out the window and see a cement wall, and it is snowing out and you don't know what to think, what to do, so you just lie down."

Nathalie Brunet is the the program coordinator at Les Petits Frères. She remembers the phone call from a social worker asking if the organization could see one of her clients - an Anglophone - who was in trouble.  

Peter McGrail shows off his studio apartment, which he found with help from Les Petits Frères in Montreal. (David Gutnick/CBC)

"Mr. McGrail has diabetes," she says, and he was not eating the foods he needed. "His eyes were getting weaker, so of course he could not see if something was dirty, if something was misplaced."

McGrail was in a difficult situation and like many seniors was "depressed and starting to think suicidal thoughts."

Les Petits Frères helped McGrail get medical help and found a home suited to his needs and his budget. He also became a regular guest at the organization's fancy four course meals. But most importantly, Les Petits Frères twinned McGrail with a volunteer.

"They got me a gentleman," he says "to come and see me once a week, just to talk. It  takes the weight off you, worrying. If it wasn't for Les Petits Frères, I don't know where I would be."

To the last breath and beyond

Nathalie Brunet looks over today's party. Despite the delicious food, laughter and flowers, there's a hint of sadness in her - this week there's an empty chair at one of the tables.

Madame Lucille Mclaughlin had just died. She was 80.

Les Petits Frères will make sure what happens next will be done just right.

"Our commitment is to take care of them to the end. That also means after," says Nathalie.

Les Petits Frères  takes charge of funeral services when no-one else steps up. There are six areas reserved for "Old Friends" in the  Notre-Dame-des-Neiges Cemetery on Mont Royal. At some funerals there are but a handful of mourners.

"If we were not there," says Nathalie Brunet, "there would not be anybody else."

[Listen to David Gutnick's full radio documentary about Les Petits Frères. Click the link at the top of this page or visit The Sunday Edition's website.]

22.46 | 0 komentar | Read More

Krokodil hunt: Tracking the elusive, 'flesh-eating' street drug

If headlines in the past few weeks are to be believed, a "Flesh-eating 'zombie' drug" that could devour users "from the inside out" is finding its way onto American streets. Then came reports suggesting that "krokodil," a cheap and highly addictive homemade substitute for heroin that surfaced first in Russia about 10 years ago, had appeared in Ontario's Niagara region.

But so far, neither the U.S. Drug Enforcement Agency nor Health Canada has identified krokodil, also known as desomorphine, in any samples they've analyzed since the DEA found two instances of it in 2004.

'When you have new drugs like this, it's very difficult to get a sense of their presence early on.'- Matthew Young

And police in Niagara are now saying the reported cases of the drug — an ugly concoction of codeine mixed with common products such as gasoline, lighter fluid, paint thinner or industrial cleaning oil — haven't been medically confirmed.

Krokodil is named for the Russian word for crocodile and its tendency to turn users' skin rough and scaly. The injectable opioid can cause brain damage and severe tissue damage, sometimes leading to gangrene, amputations and even death. It has also been linked to pneumonia, blood poisoning, meningitis, liver and kidney problems, rotting gums and bone infections.

The horrific health problems the drug has caused among the well over 100,000 users in Russia and Ukraine have been well documented by researchers in publications such as the International Journal of Drug Policy. But so far there is no solid, official proof that krokodil has reached Canada.

The recent news reports about the drug coupled with the lack of hard evidence to back them up underline how difficult it is for health and law enforcement officials to keep up with the evolving mix of street drugs.

"When you have new drugs like this, it's very difficult to get a sense of their presence early on," says Matthew Young, a senior research and policy analyst at the Canadian Centre on Substance Abuse in Ottawa.

The drugs are too new to be asked about in surveys, and so attention turns to whether there have been seizures or samples confirmed in labs. And then, suggests Young, people consider any anecdotal information that may be circulating.

'A lot of hype'

"New drugs tend to have come along with a lot of hype attached to it, especially when there are images like there are out there on the internet that are associated with [krokodil]," Young says.

In this case, the images and videos posted online out of Russia are disturbing, showing krokodil users suffering everything from gaping lesions to exposed bone.

"The harms associated with krokodil are extreme and unprecedented," say the authors of a report that appeared in the International Journal of Drug Policy earlier this year.

But when it comes to definitive proof from official channels that the drug is actually on the street on this side of the Atlantic Ocean, there is none.

In the U.S., where the headlines about krokodil have been almost apocalyptic, the DEA is "very concerned about the possible appearance" of the drug, special agent Joseph Moses said in an interview from Washington.

"But to date, none of our forensic laboratories has analyzed an exhibit found to contain desomorphine."

A sample sent recently to the DEA's forensic laboratory in Chicago turned out to be heroin.

"We get a lot of calls about this … because it's such a gruesome imagery, with the area surrounding the point of injection dying," said Moses. "We have a lot of people who want to call it a trend, but we aren't seeing it."

No samples identified

The DEA did identify two samples as desomorphine in 2004, but have made no similar identifications since then.

In Canada, Health Canada is aware of reports of desomorphine, the department said in an email.

A man checks with his lips the temperature of syringe with heroin injection at a flat in the Russian town of Tver, 170 kilometres northwest of Moscow, on Nov. 13, 2010. Use of krokodil, a substitute for heroin, emerged in Russia about a decade ago. (Reuters)

"To date, Health Canada's drug analysis service has not received any samples that have been identified as containing desomorphine."

Late last week, the Canadian Community Epidemiology Network on Drug Use, which is co-ordinated by the Canadian Centre on Substance Abuse, issued a bulletin noting that there had been "no confirmed reports" of desomorphine in Canada in the past two months.

"It is possible that some unconfirmed reports were made after observing severe wounds at injection sites among intravenous (IV) drug users," the bulletin said.

While krokodil has been on the centre's radar screen, Young said in an interview before the bulletin was issued that he was skeptical of reports it had surfaced in Niagara.

"I don't see the motivation there for opioid users to go towards a dirtier, even less safe alternative to what they currently have."

More reports

In Niagara, word of krokodil surfaced about a year ago at AIDS Niagara, through its StreetWorks outreach and harm reduction program that works with drug users.

StreetWorks co-ordinator Rhonda Thompson says a woman came into their offices and "was very adamant" that she had seen krokodil in Niagara.

"You kind of have to take these things with a grain of salt. It was only report from one client."

Then about three weeks ago, another person came into their office and said two people were in a Niagara Health System hospital because of the effects of injecting krokodil.

Another person also turned up at the StreetWorks' Niagara Falls office and, Thompson says, showed their nurse wounds on his arm that weren't abscesses "like we're used to seeing.

'Maybe these are just old-fashioned staph infections — who knows — but it certainly needs to be looked at.'- Rhonda Thompson

"It's more like they're ulcers that go deep into the soft tissue," says Thompson.

"He said it felt like burning, and his symptoms started to develop a week after he started using this particular purchase of heroin. He thought he was buying heroin and he's never had any experience ... in the past where these sorts of ulcers and lesions were happening."

In a separate interview with CBC Radio's As it Happens on Friday, Thompson said there have been about a dozen cases of unusual wounds and "pretty significant" soft tissue damage among drug users in the region in the past two months.

Thompson spoke with staff at Niagara Regional Police (NRP), who issued a public statement that krokodil had been reported in Niagara Region. Police later said the reported cases had not been medically confirmed.

The Niagara Health System also said it had no confirmation of krokodil.

"Reports that we have treated patients at the Niagara Health System for conditions related to krokodil are unconfirmed," David Barry, manager of outpatient addiction services at the NHS, said in an emailed statement.

"We will continue working closely with our community partners to ensure we are doing everything we can to educate people about the health risks of using krokodil or other drugs."

Other possibilities

One of problems for the krokodil hunters is that the harm the drug can do to the body can resemble other types of infections or health conditions.

"The symptoms associated with krokodil can be mistaken with the complications that long-term users of injectable drugs like heroin can develop through infections from reusing needles and exposing themselves to all sorts of bacteria," NRP said in a release.

Thompson also wondered if what was observed in Niagara might have been the result of infections not specific to krokodil.

"I find it very hard to believe that little old Niagara would be the only one experiencing this, if this is in fact what it is. Maybe these are just old-fashioned staph infections — who knows — but it certainly needs to be looked at."

Young says he will continue to be on the lookout for any evidence krokodil may be in Canada.

"There's no indication that this drug will not come here. We're keeping an eye out for it. I just think that the conditions aren't really ripe for a drug such as this making its way to Canada," Young says.

"We can't say with any 100 per cent certainty that it's not here either. We can only say we have no confirmed reports."

22.46 | 0 komentar | Read More

Lung cancer kills more Canadian women than in 'peer' countries

Lung cancer death rates in Canada are among the highest in the world, especially among women, a new report shows. 
 
Thursday's report from the Canadian Institute for Health Information (CIHI) uses international health-care data from the Organization for Economic Co-operation and Development. The OECD includes 34 countries and CIHI compares the performance of Canada's health system with what it calls its "peers" —  Australia, France, Germany, the Netherlands, New Zealand, Sweden, the United States and the United Kingdom. 

It's not clear why non-smoking women are at twice the risk of developing lung cancer as non-smoking men, says Dr. Natasha Leighl. (CBC)

 
The report's authors focused on lung cancer, noting that at 58 deaths per 100,000 population, lung cancer mortality in Canada is higher than the OECD average of 43 per 100,000. All other peer countries had fewer lung cancer deaths than Canada, except for The Netherlands which had the same rate. 
 
More people die from lung cancer than from prostate, breast and colorectal cancers combined. In 2009, lung cancer was responsible for 19,110 deaths or eight per cent of Canada's mortality, according to Statistics Canada. 
 
By gender, Canada's lung cancer mortality rate among women in 2012 was 47.0 per 100,000 compared with the OECD average of 26.5 per 100,000. In men, Canada's rate was 72.3 per 100,000 versus 66.3 per 100,000. 
 
"If we look back over the last 30 years, Canada's smoking rate among men has been consistently lower than the OECD's, while for women the smoking rate was at times higher than OECD average," the report's authors said. 
 
"This may help explain why Canada's results for lung cancer mortality in men ranks better than its results for women." 

Canada's performance in relation to the average for OECD countries. (CIHI)

 
Dr. Natasha Leighl, a medical oncologist at Toronto's Princess Margaret Cancer Centre, said she's seeing a rising proportion of people who've never smoked that are diagnosed with lung cancer.  

"We know that non-smoking women are at twice the risk of developing lung cancer as non- smoking men and we really just don't understand why that is," Leighl said. "We've talked about environmental risks as well as things like air pollution, things like radon, but there may even be some genetic differences." 
 
For many other health indicators, CIHI's researchers said Canada's results were within the band of average performers between the 25th and 75th percentiles.  
 
Canada performed well on indicators such as potentially avoidable hospital admissions for diabetes and asthma. Canada rated high on the OECD's measure of the percentage of people who eat at least a serving of fruit or vegetables per day. But Canada's Food Guide recommends eating seven to eight servings of fruits and veggies daily, meaning it is possible Canadians aren't eating enough to improve the quality of their diet, CIHI's authors said. 

Canada also performed well on breast cancer screening and breast cancer survival, which the researchers said could be due to early detection and effective treatment. 

Patient safety is an area where Canada performed poorly. Most peer countries except New Zealand and Australia outperformed Canada on leaving behind fewer foreign bodies, like sponges, after surgery. Adopting the Surgical Safety Checklist, which reminds operating room staff to do a final count of equipment like sponges and instruments, has been recommended for all operating rooms.  

CIHI's authors called post-operative pulmonary embolism and deep vein thromboembolism —  serious blood clots — in hip and knee replacements especially important given that rates of the joint replacements are on the rise. Canada's rate, 888 per 100,000 discharges, for the common and preventable complication was the third-highest among OECD countries, where the average was 541 per 100,000.
 
Canada performed slightly below the OECD average on four patient experience indicators. For example, 81 per cent of Canadians said that their doctor spent enough time in consultation with them, compared with OECD average of 87 per cent.

22.45 | 0 komentar | Read More

Top court backs Ontario's ban on pharmacy-brand generic drugs

The Supreme Court of Canada has upheld Ontario's right to bar pharmacy chains like Shoppers Drug Mart and Rexall/Pharma Plus from selling their own house-brand versions of popular generic drugs, dismissing an appeal filed by the companies earlier this year.

The question before the court was whether the province could prevent Shoppers and the Katz Group, which owns the Rexall/Pharma ​Plus chain, and other drug stores from selling their own generic drugs simply by introducing new regulations to that effect under current laws, which it did in 2010, or if it had to pass new laws.

'If pharmacies were permitted to create their own affiliated manufacturers whom they controlled, they would be directly involved in setting the [province-covered drug] prices and have strong incentives to keep those prices high.'- Supreme Court of Canada

The court ruled Friday that Ontario didn't overstep its powers by amending the laws governing how prescription drugs are sold in the province to make the changes it wanted and that the changes were consistent with the intended purpose of those laws — namely, reducing drug costs.

"The 2010 private-label regulations contribute to the legislative pursuit of transparent drug pricing," the court said in its ruling.

"They fit into this strategy by ensuring that pharmacies make money exclusively from providing professional health care services, instead of sharing in the revenues of drug manufacturers by setting up their own private label subsidiaries.

"If pharmacies were permitted to create their own affiliated manufacturers whom they controlled, they would be directly involved in setting the [province-covered drug] prices and have strong incentives to keep those prices high."

The unanimous decision is one that will be closely studied by other provinces, such as British Columbia, Alberta and Quebec, that have also been revisiting their provincial drug pricing plans in recent years in the face of prices they say are increasingly out of step with what people in jurisdictions outside Canada are paying for drugs.

So far, Ontario is the only province to ban the sale of private-label generic drugs.

Ontarians paying more for drugs

Ontario is one of the largest purchasers of prescription drugs in the world and spends about $4.3 billion a year on its provincial prescription drug plan. According to the Ministry of Health and Long-Term Care, compared to some U.S. states, Ontario pays as much as five times more for some of the most popular generic drugs for conditions such as diabetes and high blood pressure.

Shoppers Drug Mart and the Katz Group, which owns the Rexall and Pharma Plus pharmacy chain, appealed the ban on private-label generic drugs but lost. (Graeme Roy/Canadian Press)

The discrepancies are even larger when compared with New Zealand, where the 2007 price of the blood pressure medication enalapril was less than one-twentieth of what it was in Ontario, according to the ministry's comparison.

In recent years, Ontario has been trying to reduce those drug costs.

In 2010, the Ontario government amended the Drug Interchangeability and Dispensing Fee Act and the Ontario Drug Benefit Act, which govern how prescription drugs are sold and how the province reimburses pharmacies for the cost of those drugs.

Under the changes, it prohibited pharmacies from having their own private-label generic drugs included in the province's Formulary, which lists drugs covered under the Ontario Drug Benefit Program.

"Private-label products" could also not be declared "interchangeable" with brand-name drugs as generic drugs are. It's that interchangeability that obliges pharmacists to dispense generic drugs unless the prescribing physician specifies otherwise or the patient agrees to pay.

These restrictions essentially banned the sale of private-label drugs in the privately and publicly insured prescription drug markets in Ontario.

Shoppers Drug Mart 'disappointed'

Large chains like Shoppers and Rexall wanted to have the option of selling their own generic drugs in order to save money by not having to buy them from an arm's-length third party. Shoppers created a subsidiary for that purpose in 2009 called Sanis Health Inc. It manufactures generic prescription drugs that are sold under the Sanis label at Shoppers pharmacies — although it outsources the actual making of those drugs to other pharmaceutical companies.

According to the court document outlining Shoppers Drug Mart's appeal, Sanis currently sells 82 drugs in every province except Ontario, as well as in the Yukon and Northwest Territories.

Ontario Premier Kathleen Wynne said Friday's Supreme Court decision will help the province ensure Ontarians get the best generic drug prices possible. (Mark Blinch/Canadian Press)

​

The pharmacy chains argued that selling generic drugs through their own manufacturers under house brands would allow them to offer the drugs at lower prices, but skeptics said any savings from such a process would likely not be passed on to consumers but be used to recover revenue that pharmacies have lost in recent years.

Ontario feared that allowing private-label drugs would reduce competition and drive up prices of generic drugs for the province, and in 2010, it rejected Sanis's application to have several generic drugs listed in the Formulary and to have them designated as "interchangeable."

On Friday, the governing Liberals said the court's decision would ensure Ontarians pay the lowest possible prices for generic drugs.

"We're very pleased that our program and our initiative has been supported, because there's no reason that people in Ontario should pay more for the same drugs than people in other parts of the country," Premier Kathleen Wynne said during a visit to Leamington, Ont.​

Shoppers issued a short statement saying that it respects the decision but is "disappointed with the outcome."

Changes consistent with mandate

In February 2011, the Ontario Superior Court of Justice ruled that the province went too far in barring the pharmacy chains from selling their own generic drugs, but later that year, an appeal court reversed that decision, which is what forced Shoppers and Katz to appeal to the highest court.

On Friday, the Supreme Court ruled that the province's intervention to restrict the kind of generic drugs that pharmacies could sell did not constitute an outright ban.

"Private-label regulations do not prohibit manufacturers from selling generic drugs in Ontario's markets; they restrict market access only if a particular corporate structure is used," the court said. "That cannot be characterized as a total or near-total ban on selling generic drugs in Ontario."

It stressed, however, that the court's role was not to assess whether the government's 2010 regulations were "necessary, wise or effective" but whether they were consistent with the purpose of the original legislation, which, the court said, was to control the cost of prescription drugs by promoting transparent pricing and eliminating price inflation along the drug supply chain.

The limits on private-label drug sales the government introduced were consistent with those aims, it said.

Other revenue streams

The court battle over pharmacies' right to sell their own generic drugs is a symptom of some of the cost-cutting measures the province has undertaken in recent years.

In 2006, Ontario banned the so-called rebates manufacturers of generic drugs would pay pharmacies to give them incentives to carry their products. Some have estimated these payments added up to as much as $750 million a year.

It was then that chains such as Shoppers started to look for ways to make up that lost revenue and set up subsidiaries such as Sanis to manufacture and sell their own private-label drugs.

Pharmacies in Ontario have seen some of their revenue streams dry up in recent years as the province has moved to phase out fees drug manufacturers used to pay them to carry their generic drugs. (Mark Blinch/Reuters)

​

In 2010, Ontario also announced its intention to phase out professional allowances, which generic drug manufacturers paid to pharmacies in lieu of the cancelled rebates and which covered patient services such as blood pressure and flu clinics and home drug deliveries to seniors. The eradication of these, to be completed by 2014, would cost pharmacies hundreds of millions of dollars in revenue a year and force them to cut back many of these services, the drug store chains argued.

But Ontario said the allowances were subject to abuse and often went toward fringe benefits, bonuses and overhead costs and that generic drug manufacturers incorporated the cost of the allowances into their prices.

In 2012, the province also reduced how much it will pay for the 10 top-selling generic drugs from 25 per cent of the price of the brand-name equivalent to 20 per cent. It said the move would save about $55 million a year and allow the province to increase spending in other areas such as social assistance and disability payments.

Peter Sklar, retail analyst at BMO Nesbitt Burns, estimated in the Globe and Mail at the time that the move would cut 1.8 per cent from the roughly $10 drug stores get per prescription covered by the public drug plan.

Alberta recently reduced what it pays for generic drugs from 35 per cent to 18 per cent of the price of the brand-name equivalent.

Health Minister Deb Matthews said Ontario's changes to generic drug pricing and fees "have delivered better value for our precious health-care dollars and are saving Ontarians $500 million a year."

"We continue to re-invest these savings to give our patients greater access to new drugs," she said in a statement Friday. "Today's decision upholds this progress and is a victory for Ontarians."

22.45 | 0 komentar | Read More