Hoarder slowly learns to stop clinging to the past

How Brenda McDonald battles tendency to hoard 2:19

How Brenda McDonald battles tendency to hoard 2:19

At some point in the last 19 years, Brenda McDonald just stopped inviting people over to her house.

Drawers were overflowing. Closet doors wouldn't close. There were piles and boxes everywhere of flyers. Magazines. Papers. Stuff.

She'd always been a collector. When she was a kid, if she went to a fair with her parents, she'd grab all the available pamphlets and keep them.

It turned into full-on hoarding sometime after her first child was born, when she couldn't bear to part with any piece of artwork, or any photo, or any item of clothing, no matter how useless or full of holes it was.

"You have boxes here and overfilled dresser drawers there, and you try to hide the clutter, but it doesn't mean it's not there," she said. "You try to push it into corners where no one sees it, but it's there."

McDonald is one of the roughly 14 people who take the annual hoarding course at St. Joseph's Healthcare Hamilton's Anxiety Treatment and Research Centre, where they learn to get their houses in order again.

While it's usually not the extreme cases seen on TV where people sit among garbage piled to the roof, many people come to the program with problems with landlords and bylaw enforcement officers, or with the realization that their collecting is out of control, said Karen Rowa, the psychologist and hoarding expert who runs the program.

McDonald lives in Waterloo and works at the University of Waterloo. She was on a list of willing participants for research trials. She signed up to participate in a research project and the researcher told her about the St. Joseph's program.

McDonald has five children, and for years, she couldn't part with any item they gave her.

"If it was a stick that they said was a person, I kept it," she said.

She kept boxes and boxes of her kids' artwork. She became obsessed with photographing their activities. Every photo was developed, sometimes multiple times.

Greeting cards and kids' artwork

The hardest items to discard, she said, are the ones with emotional meaning. The thought of parting with an item connected to her kids or a lost loved one was unbearable. 

"A lot of hoarding is tied up with emotions. So-and-so died and gave me this. Someone gave me this card and the message is so special," she said.

An air hockey table sat in the living room, but instead of being for air hockey, it became storage. Surfaces and couches became catch basins for clutter. McDonald's family could still use all the rooms of the house, but that's not always the case with hoarders, Rowa said.

"For some of people, it gets to the point where they've lost rooms in their house, including bathrooms and kitchens," said Rowa, who acted as an expert in a season one episode of Hoarding: Buried Alive. "That's a huge problem because obviously, if you can't have a functioning kitchen, it has a huge impact on your day-to-day life."

"At a minimum, people we see here at the clinic have acknowledged this causes them significant distress, whether it be anxiety or guilt or shame or embarrassment. They can't do something in their house that they want to do."

Learning to cope with the anxiety

Group therapy is a big part of the course. Another part is exposure therapy – exposing the hoarder to objects and asking him or her to make a decision, then "sitting with the anxiety until it's a little more tolerable," Rowa said.

At some point during the course, the hoarder leaves an object with Rowa's team to see how much they miss it. In many cases, they don't.

Hoarding is a complex mental health issue, and it impacts as much as eight per cent of the population. Hoarding often starts sometime during childhood and worsens as a person ages, Rowa said.

Hoarders tend to be environmentalists — they want to reuse rather than buy new. They have trouble making decisions. They are also creative, Rowa said. They look at objects and see possibilities for reuse, but it gets out of hand.

Stressful situations such as the death of a parent or a traumatic break up don't cause hoarding, but they can worsen it, Rowa said. So can a loss such as a flood or a fire.

Throwing out a little every day

"All of those sorts of things seem to be a big trigger for a hoarding problem to go from manageable to not manageable."

Hoarders may also feel stress more deeply than the average person, Rowa said. Her team is studying how hoarders physically react to stress to see if it differs from non-hoarders.

McDonald has found ways to deal. She cleans and throws out a little bit every day rather than waiting for it to be a monumental task that she never starts. And she invites people to her house now.

With therapeutic help, her mindset is changing. Instead of buying books, she rents then from the library. In the case of her children's artwork, she had her children choose a few pieces for her to keep and display. She threw out the rest.

"It's a lifelong process," she said. "There are always going to be times where I think 'I should keep it. Maybe I will use it. It would look nice there.' Would, could, should. Then you catch yourself."

---

Common traits of hoarders

Attention problems

Hoarders often have difficulty paying attention. At Rowa's clinic, they see elevated rates of attention problems, including Attention Deficit Disorder. "They have a hard time staying on tasks and thinking things through," she says.

Creative

Hoarders tend to be creative people — sometimes more creative than average, Rowa says. For this reason, they see possibility in every object, so they save it. But they lack follow-through.

Perfectionism

Hoarders are often perfectionists to such a degree that they don't even start something for fear of not doing it right. "Their standards are so high that they never meet them, so they almost go the opposite way and don't even start trying to organize or make decisions."

Emotional stress such as grief or a break up

Stressors such as losing a parent don't cause hoarding, Rowa says. The tendency already exists. But the traumatic incident can worsen it, particularly when it comes to discarding items with a tie to the lost loved one.

Concern for the environment

Many hoarders are keenly aware of the environment and want to reuse things rather than throw them out, Rowa says. 

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Public health officer backs call for greater independence

One of New Brunswick's senior public health officials says he would welcome legislation to protect his independence from political interference.

Public health officers are employees of the Department of Health and the New Brunswick Medical Society announced on Thursday that it is asking all political parties to commit to a law, similar to what exists in provinces such as Ontario and British Columbia, that would guarantee these doctors more independence.

Dr. Denis Allard, the province's deputy chief medical officer of health, said provincial government officials are often anxious about the timing of comments made by public health officers.

The proposed law would guarantee that public health doctors would be allowed to investigate health concerns and speak publicly about them.

Dr. Denis Allard, the deputy chief medical health officer of health, said provincial government officials can be nervous about what he says at times.

"Sometimes it's not so much an issue of pressure, but I would say occasionally it's more with the timing of involvement," Allard said.

"Medical officers would like to be able to, in terms of timing, advise the population as early as possible so they can take the best measures to protect their health."

Allard said those concerns are usually resolved, but he would still welcome a law that would enshrine that independence.

The medical society is raising the issue because of mixed messages from the provincial government two years ago about a report on shale gas by Dr. Eilish Cleary, the province's chief medical officer of health.

Ministers questioned whether she should be studying the issue and whether it would be a public document. It was released publicly in the end.

People's Alliance Leader Kris Austin said his party supports more independence for public health officials. ((CBC))

In the late 1990s, a public health doctor resigned from a committee studying the health impact of an upgrade at the Irving Oil Ltd. refinery in Saint John. The doctor complained that provincial government officials blocked him from getting the information he needed.

Health Minister Ted Flemming rejected the idea that public health officials need a guarantee of independence on Thursday. He said health officers are not under any political pressure.

All other political parties were quick to back the medical society's proposal for a law to guarantee the independence of public health officers.

"The People's Alliance supports transparency in all parts of government and agrees with Dr. [Lynn] Hansen that physician-patient consultation should be in no way limited," said People's Alliance Leader Kris Austin in a statement on Thursday.

"Our physicians are highly trained individuals and they must be allowed to do their jobs without political interference."

Public health officers can enforce quarantines, organize vaccination programs, detain individuals, enter premises, shut down restaurants and monitor water systems.

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Ending maternal, child deaths requires innovation, accountability: experts

Innovation and strong business impulses will be driving factors in reducing maternal and child mortality in the post-2015 development agenda, experts said during the final day of Canada's maternal, newborn and child health summit in Toronto.

World Bank president Jim Yong Kim said a lot has changed since the the world decided on its Millennium Development Goals in 2000, and now there's an opportunity to come up with a vision on how to fund aid projects that will "really stretch people's imagination."

He made the remarks during a panel discussion moderated by Prime Minister Stephen Harper, which also included Tanzanian President Jakaya M. Kikwete, Plan Canada's Rosemary McCarney, World Health Organization director-general Margaret Chan, and Dr. Rajiv Shah of the United States Agency for International Development.

Shah praised Canada for taking the lead on an initiative that he described as a "data-driven, business-like, global project to fully end preventable maternal and child death."

"It has a clear goal, it has clear business plans," he said. "The level of partnership and collaboration represented on stage today, I think exceeds what we have seen in this space and in this sector at any time in the past several decades.

"The United States is proud to have followed in your footsteps, following the Muskoka Initiative."

WHO's Chan said the new $3.5-billion pledged by Canada for post-2015 is important.

"I'd like to stretch money a bit because that speaks volumes about innovative partnerships," she said.

She referred to Grand Challenges Canada, an organization that funds those who come with ideas combining science, technology and business to deliver concrete results in global health projects. She said she was "struck" with their work that significantly reduced the cost of vital signs monitoring.

"These are the kinds of partnerships — innovative partnerships — that we can bring to bear," Chan said, adding that it was the WHO's role to assure the quality, safety and efficacy of the products.

Accountability has also been a huge part of Canada's maternal and child health push since 2010. 

Following the G8 summit, Harper co-chaired a United Nations commission on accountability and transparency to monitor the progress. Among other things, the commission recommended finding new ways to gather health data and improve ways for civil society groups to provide feedback, as well as then sharing the information with the public.

"Not just that we knew in many cases, you know, big numbers were being announced and pledges not necessarily being honoured," Harper explained to the panellists on Friday.

"But also, we understood that entering into the post-recession period, budgets would be extremely tight and to keep focused, we had to be able to demonstrate results, measure what we were doing and show people around the world that we're actually — both donors and recipients were delivering."

One analyst who's extensively studied Canada's foreign aid spending said the government has made a good effort to publish data on maternal and child health projects, but data "is not accountability," just a prerequisite to it — especially considering the information is fragmented.

In a report released Wednesday, Aniket Bhushan of Ottawa-based North-South Institute analyzed the government's spending up until 2013, when only $1.787-billion of the Muskoka pledge was spent (equal to just over 60 per cent). Of that $1.787-billion, the institute was only able to track $1.186-billion at an adequate level of detail but even that had some limitations.

Bhushan recommends one way for the government to meet high expectations on transparency and accountability is to better link related data and present it in a way that people — not just data experts — can understand.

During the panel discussion, Chan noted that the idea of accountability has only recently become pervasive, appearing "in every forum, every meeting, every document we see," with the launch of Muskoka.

"That's a cultural change," she said.

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Sugary drink warning label bill passes in California Senate

The government is responsible to protect the public health and safety of its people, says a California senator in support of a bill meant to counter a spike in health problems involving consumption of too much sugar. (Rich Pedroncelli/Associated Press)

A bill to require sugary soft drinks to carry labels warning of obesity, diabetes and tooth decay passed the California Senate, the latest move by lawmakers in the U.S. aimed at persuading people to drink less soda.

The legislation next goes to the state Assembly, where it is likely to continue to face an ongoing tug-of-war battle between the U.S. food and beverage industry and public health officials, who have lobbied for the measure. Governor Jerry Brown would then have to sign it into law.

If implemented, the measure would put California, which banned sodas and junk food from public schools in 2005, in the vanguard of a growing national movement to curb the consumption of high-calorie beverages medical experts say are largely to blame for an epidemic of childhood obesity.

"Liquid sugar is a significant and unique driver of obesity, preventable diabetes, and tooth decay," said Democratic state senator Bill Monning, author of the bill. "Some people accuse this [bill] of nanny governing and yet it is the government that's responsible to protect the public health and safety of its people."

In 2012, former New York City Mayor Michael Bloomberg spearheaded a citywide ban on sales of oversized sugary soft drinks, but the move was declared illegal by a state judge after a court challenge by makers of soft drinks and a restaurant group. New York's highest court has agreed to hear an appeal.

The California measure, passed on Thursday by a 21-13 vote in the state Senate, marks the second time that Monning, who represents the central coastal area around Carmel, has tried to influence consumers' drink choices.

Last year, he backed an unsuccessful measure that would have taxed soft drinks.

"Putting government warning labels on more than 500 beverages will do nothing to change personal behaviours or teach people about healthy lifestyles," said CalBev, the California arm of the American Beverage Association, in a statement. "The last thing California needs is more warning labels."

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Smoke-free condos on the rise in B.C.

Smoke-free Housing B.C. has been pushing for a ban on smoking in buildings for 10 years, but advocates say the concept is starting to take off with more than 100 apartment buildings now entirely smoke-free.

'Your right to smoke stops when the air hits my nose, and my mouth and my lungs'- Provincial Health Officer Dr Perry Kendall

Less than 15 per cent of B.C. residents smoke, but nearly half live in close quarters in condos and apartment buildings.

Asthma sufferer Kathryn Tanaka says one smoker can affect a lot of neighbours.

"Imagine lying on your couch, watching TV, breathing in smoke," she said. "Imagine having dinner breathing in smoke, going to bed, breathing in smoke, working out everyday breathing in smoke. That essentially is my life right now."

Asthma sufferer Kathyrn Tanaka says one smoker can affect a lot of neighbours. (CBC)

Jack Boomer with Smoke-Free Housing B.C. says it's an issue that's gaining traction.

"As people recognize in their workplace, that they are protected by second hand smoke, they want to go home to their castle and be protected from second hand smoke as well."

Bunny Porteous with First Service Residential Property Management says the condo they manage in Yaletown went smoke-free.

"Over 70 per cent of the people considered that this was a benefit to the building and a benefit to all the owners."

This Yaletown condo tower has voted to ban smoking in individual suites. (CBC)

However, disputes do happen.

Another Coal Harbour condo that went smoke-free a couple of years ago still has five to seven violators a month and is regularly levying $200 fines.

Jeremy Allison says smokers are running out of places to go.

"If I can't smoke outside, then you know, you're paying a lot of money to live in an apartment and you're not allowed to smoke."

But Provincial Health Officer Dr Perry Kendall points out, second hand smoke in a building also prevents others from enjoying their apartments too.

"Your right to smoke stops when the air hits my nose, and my mouth and my lungs," he said.

Smoke-Free B.C. is encouraging people to push landlords to change the rules in rental buildings. It says all it takes is the agreement of 75 per cent of the condo's owners.

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E-cigarettes could save hundreds of millions of lives, scientists tell WHO

More than 50 public health experts and nicotine experts, including five Canadians, are urging the World Health Organization not to classify e-cigarettes as tobacco products, because they say doing so could jeopardize a "significant health innovation" that could save hundreds of millions of lives.

In an open letter to WHO Director General Margaret Chan, the scientists from Europe, North America, Asia and Australia argue e-cigarettes are "part of the solution" in the fight against smoking.

"These products could be among the most significant health innovations of the 21st century — perhaps saving hundreds of millions of lives. The urge to control and suppress them as tobacco products should be resisted," the experts wrote.

The UN health agency seems to view e-cigarettes as a "threat" that should be classified like regular cigarettes, according to leaked documents from a meeting last November.

David Sweanor, a law professor at the University of Ottawa, who works on tobacco control, is one of the signatories.

A move to classify e-cigarettes alongside regular cigarettes would push countries to take similar tough measures to restrict demand, such as through higher taxes. (CBC)

"We're here to try to get rid of cigarettes, we're here to try to make cigarettes obsolete and we have the potential with technology to start to do that, and that would be one of the biggest breakthroughs we've ever had in public health," Sweanor said in an interview.

Sweanor and the other writers refer to "tobacco harm reduction" — the idea that 1.3 billion people worldwide who smoke could do much less harm to their health if they consumed nicotine in a low-risk, non-combustible form, given that the majority of harmful effects attributed to tobacco arises from tar and toxic gases drawn into the lungs.

In response to the letter, Penny Woods, chief executive of the British Lung Foundation, said: "The overall impact of e-cigarette use on public health is currently unclear. While they could prove to be an important tool to help people stop smoking, the unregulated status of e-cigarettes is problematic."

So far, research shows overwhelmingly that e-cigarettes are used by people who want to quit smoking, Sweanor said. There's little evidence e-cigarettes are used by young people to start smoking, although that is a risk, he said.

Nova Scotia plans to introduce legislation in the fall to ban the sale of e-cigarettes to those under the age of 19.

"We don't want to see e-cigarette and flavoured tobacco juice again seeing smoking increase in our province," said Leo Glavine, Nova Scotia's health minister. "We've had too many gains in a province that has high cancer rates and death strongly associated with smoking."

Health Canada continues to advise against the use of e-cigarettes.

"Currently, the advertisement and sale of electronic cigarette products, including e-liquid, that contain nicotine and/or have health claims is non-compliant with the Food and Drugs Act., and is therefore illegal," a spokesman for Health Canada said in an email.

"To date there is not sufficient evidence that the potential benefits of e-cigarettes in helping Canadians to quit smoking outweigh the potential risks. A company would have to provide evidence of safety, quality and effectiveness in order to have its product authorized. Without this scientific evidence, Health Canada continues to advise Canadians, especially youth, against the use of these products."

Health Canada has sent cease and desist orders to sellers of e-cigarettes, mostly because people have been making health claims, said Tony Carver, owner of Evape Electronic Cigarette in Newmarket, Ont.

Carver said the scientists' letter gives him hope.

"I think that is the best news I have ever heard for the electronic cigarette, business it answers a lot of the misinformation that there is out there."

The writers of the letter say they wanted to get their message out now given that the WHO is set to review its tobacco recommendations in Moscow from Oct. 13 to 18.

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Harper won't fund abortion globally because it's 'extremely divisive'

When the Canadian government took on maternal, newborn and child health as its flagship program in 2010, it unwittingly waltzed into the contentious issue of abortion.

And though the government has expressed no desire to talk about abortion, the issue continues to rise, especially amid the inaugural global summit on maternal and child health this week, with critics demanding the government focus more on reproductive health.

in an exclusive TV interview with the CBC's Hannah Thibedeau, Prime Minister Stephen Harper addressed why he's choosing not to fund global abortion services. 

"We're trying to rally a broad public consensus behind what we're doing, and you can't rally a consensus on that issue, as you know well in this country," he said.

"It's not only controversial here, it's controversial and often illegal in many recipient nations."

Harper doesn't agree with the suggestion that he is exporting his beliefs abroad to other countries by not funding abortion services.

"We're really not taking a position on that. We have taxpayers' money and we have great needs," he said to Thibedeau.

"And frankly, there's more than enough things that we can finance, including contraception, without getting into an issue that really would be extremely divisive for Canadians and donors."

Melinda Gates, who spoke with the CBC's Thibedeau alongside Harper, asked why women had to be put in a situation where they consider abortion in the first place.

"One of the things we don't invest in enough, as a world, are contraceptives. We put women in that situation because they don't have access and when you talk to them in the developing world, they say, 'I want that tool, I want that shot I used to get,'" she said.

"We can work upstream on these issues to help women where they are, so you don't ever put them in that situation, and to me, that's the smart investment to make."

But many, including Canada's opposition parties, disagree.

New Democratic Party critic for international development Hélène Laverdière challenged the government on its summit theme of "Saving Every Woman, Every Child."

"Well, there's 47,000 women who die each year from unsafe abortions," she said in an interview with CBC News.

"So, if we want to save every woman, we have to address that issue too."

According to the World Health Organization, 21.6 million women experience an unsafe abortion worldwide each year. The 47,000 who die make up about 13 per cent of annual maternal deaths.

As part of Millennium Development Goal No. 5, which aims to reduce the maternal mortality rate by 75 per cent from 1990 to 2015, the United Nations secretary general came up with a global strategy for women and children's health. Among other things, it includes saving the lives of women who experience unsafe abortions.

But the hot button issue of abortion is not what critics are necessarily zeroing in on. Abortion just falls under the umbrella of reproductive and women's rights, which critics said have not been addressed nearly enough by the current government.

In a letter sent to Harper on May 28, the Canadian Association of Parliamentarians for Population and Development called on the government to support a "human rights-based, post-2015" plan that ensures gender equality and sexual education.

"Global parliamentarians recommend that women's reproductive health can only be achieved when the human rights of women, girls and youth are realized. Women do not only need health care when they're pregnant. Their overall health as girls, adolescents and youth determine the outcomes of pregnancy, post-partum and neonatal health and survival," the letter reads.

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Harper hosts discussion on maternal, child health post-2015

Live

Politicians, experts in Toronto this week for summit on global maternal and child health

CBC News Posted: May 30, 2014 9:26 AM ET Last Updated: May 30, 2014 10:41 AM ET

Prime Minister Stephen Harper is moderating a panel discussion with aid experts to address the issue of maternal, newborn and child health in the post-2015 development agenda, on the final day of the Canadian government's global health summit in Toronto.

He is joined by World Bank chief Jim Yong Kim, Tanzanian President Jakaya M. Kikwete, Plan Canada's Rosemary McCarney, World Health Organization director-general Margaret Chan, and Dr. Rajiv Shah of the United States Agency for International Development.

CBCNews.ca is livestreaming their talks.

Earlier, Ban and Kim delivered keynote remarks to the summit's audience, praising Canada for taking the lead on the issue of global maternal health.

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Spotlight turns to Canada's maternal health push — but what happens after 2015?

As Canada's maternal, newborn and child health summit — the first of its kind — kicks off today, the Conservative government might very well pat itself on the back.

It's the latest opportunity for a government not known for embracing global humanitarian projects to put its best face forward in front of a distinguished audience.

Some of the confirmed speakers include Tanzania's President Jakaya Kikwete, (with whom Prime Minister Stephen Harper co-chaired a United Nations commission on accountability of maternal health initiatives), Queen Rania Al-Abdullah of Jordan and the Aga Khan — not to mention the chiefs of major global institutions such as the UN, the World Bank and the World Health Organization.

As Canada ardently pushes for improvements on maternal, newborn and child health through the Muskoka Initiative, it might be easy to forget that this is the same government that pulled out of United Nations treaties, lost its seat on the UN Security Council and has generally shunned multilateral initiatives. 

Looking toward 2015 (the year that both the Muskoka Initiative and Millennium Development Goals reach their end), there is the question of whether Canada will wield any influence on the development agenda.

A Haitian mother comforts her son in Port-au-Prince. The federal government's ardent push to improve global maternal health may position it to be a negotiator of the post-2015 development agenda, experts say. (Ana-Bianca Marin/Reuters)

In 2012, UN Secretary General Ban Ki-moon announced a 27-member, high-level panel to advise him on what issues should be focused on post-2015. Canada has no one represented on that panel.

But experts say Canada has been playing a role, albeit not a high-profile one.

A need for visibility

"A lot of the action happens late in the day," said Aniket Bhushan, an aid analyst with the North-South Institute in Ottawa.

He said Canada is still deliberating its position, one that it "can stand by publicly" when the time comes to reveal the new goals.

The recent push for maternal and child health also puts Canada at "a very opportunistic position," Bhushan said.

"You can bet your bottom dollar that [maternal, newborn and child health] will be a part of that."

Diana Rivington, a former director in the Canadian International Development Agency (CIDA), pointed out that Canada is still a member of the UN open working group on sustainable development goals — a forum with about 70 member states. 

She added that the government probably "didn't want to be a part" of the high-level panel.

"We're less likely to engage with this kind of mechanism under this government than when under previous governments," she said in an interview with CBC News.

Stephen Brown, a politics professor at the University of Ottawa, who's edited a book on CIDA and foreign aid, said the government organized this summit out of a need for visibility in international development — an area where "we lack of credibility."

The government, he charged, has neglected the idea of empowering women in favour of painting them as mere victims, calling it a "19th-century approach to charity."

"We're only interested in them insofar as they are walking wombs," he said, pointing to the very name of the summit to illustrate his point — "Saving Every Woman, Every Child."

Brown said empowering women means looking at sexual and reproductive rights, including contraception and access to safe abortions — the latter being a topic that the government and NGOs which receive funding are most keen to avoid discussing. 

A 'principled foreign policy'

According to the World Health Organization, 21.6 million women experience an unsafe abortion worldwide each year. About 47,000 women die from such operations, representing close to 13 per cent of all maternal deaths. 

"Look, the investments that we're making are in prenatal, obstetrical and post-natal care and those are the critical times where we know that the greatest number of deaths occur, either of a mother giving birth or preparing for birth or a child being born," said Status of Women Minister Kellie Leitch in an interview with CBC News on Wednesday.

Leitch, who's also a pediatric surgeon, said the government has a "principled foreign policy" that is epitomized by protecting "the most vulnerable in society — women and children."

"We're making investments in the right places so that we can save as many lives as possible," she said.

Contraception and abortion issues

Amnesty International isn't convinced, saying that the Muskoka Initiative has failed to protect the rights of women and girls because the focus is on mothers, not women. Part of that failure is not funding safe and legal abortions, which would protect sexual and reproductive rights of women who have been forced to marry early and those who have endured sexual violence.

"When we talk about human rights, there is no halfway. Canada cannot pick and choose which human rights to respect and promote. Women and girls must be able to make decisions about their bodies and their lives, and Canada's policies and programming should empower women and girls to make these decisions for themselves," the organization wrote in a blog post on its website on Wednesday.

But Canada didn't always act this way, according to Rivington.

"We used to have more generous positions on access to family planning, use of terms like gender quality, that kind of thing," said Rivington, who spent more than 30 years at CIDA handling human development and gender equality files.

Rivington said that in the past, at forums such as the United Nations, Canada had "major influence on the global conversation on gender equality." 

"We can't participate in that conversation in the same way anymore," she said, a change that was prompted by the current government. 

"We'll still be saving mothers' lives 20 years from now if we don't also work on girls' education, women's human rights, changing legal status and helping government tackle the issue of early marriage," she said. 

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Sexting, pornography findings in youth survey a new warning

One in five high school students surveyed say they received a sext of someone that was forwarded to them by someone else,  with the practice more common in  higher grades.

That is one of the results from a survey of young Canadians released today that may worry their parents when it comes to sexting and pornography, with more teens saying they are seeking it online compared to the results of a 2005 study.

But this new survey might also be reassuring for parents on the question of internet privacy, as it appears that teens are increasingly  aware of how to control access to their social media sites

In what is billed as the largest and most comprehensive study of internet use by young Canadians, the Ottawa-based group MediaSmarts found that 32 per cent of boys in grades 7-11 say they have received a  "sext" -- which they define as "sexy, nude or partially nude photos" -- created by the sender, as have 17 per cent of teenage girls.

Overall, eight per cent of the students said they have sent a sext of themselves, with the proportion rising in tandem with the grade number.

Matthew Johnson, MediaSmarts research director, says 'We have to start including ethics and empathy as a core part of the advice we give to our kids.' (MediaSmarts)

The study, called "Sexuality and Romantic Relationships in the Digital Age," asked 3,158 grade 7-11 students questions about sexting and pornography, and  a total of 5,436 students in grades 4-11, completed the rest of the survey. The participants were recruited through schools and school boards across Canada.

MediaSmarts does research, education and public awareness with the goal of helping youth develop critical thinking skills for interacting with media.

The numbers on sexting are only for youth with access to a cellphone, which is the case for 87 per cent of the older students surveyed.

Sexting and consent

"While a sext that is only ever seen by the original recipient is unlikely to cause any harm, the risks caused by sexts that are forwarded to or shared with other recipients are obvious," MediaSmarts observes.

"Sexts of boys are more likely to be forwarded than sexts of girls," the report says, and the boys are also twice as likely to report having received a forwarded sext.

Legislation is now before the federal Parliament to make it a crime to transmit intimate images of a person without their knowledge or consent.

In the survey, about a quarter of the youth say that a sext of themselves that they sent was then forwarded to someone else, while 15 per cent say they forwarded a sext that someone else sent them.

"This definitely shows that in our interventions we have to be considering boys as authors as well as recipients of sexts," says Matthew Johnson, the education director at MediaSmarts.

The young people who are forwarding these images "don't see it as an ethical question, they don't see it as an issue of respect," he says, adding they also don't seem to feel empathy for the person portrayed. "We have to start including ethics and empathy as a core part of the advice we give to our kids."

More students seeking porn

More young Canadians today also say they are actively seeking pornography online, compared to the results of a 2005 MediaSmarts survey. That number increased from 16 to 23 per cent.

As expected, the survey finds that teenage boys are much more likely to say they have searched the web for pornography.

Johnson says this is the most striking gender difference in the survey. But he was somewhat surprised that the frequency of seeking out porn is also different for young males.

While it's a minority of teenage boys who say they look up porn online, "those that are, are doing it often."

Johnson cautions that it's possible that the increase in the number of boys who say they are seeking out porn on the internet simply means that they are now less inhibited about admitting it.

Privacy and romance online

When it comes to their online life, Johnson says, "young people absolutely do care about privacy, but they conceive of privacy mostly in terms of controlling access."

MediaSmarts' research finds that many Canadian youth skillfully use their social networks' tools to selectively block content in order to control which of their contacts will see a particular item they post.

As they get older, fewer students say they want their parents and family members to be be able to see what they post on social media, for example.

"It was surprising to us how low romantic partners were on that list," Johnson told CBC News. "Young Canadians' online socializing is primarily focussed towards friends and family, and romantic relationships very much take a back seat," he adds.

As he sees it, romance is something that teens seem to be engaged in primarily offline. "Romantic relationships are a relatively small part of their online lives."

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Obesity, overweight hits third of the world

Modernization has not been good for health, global obesity experts say. (Shutterstock)

Almost a third of the world is now fat, and no country has been able to curb obesity rates in the last three decades, according to a new global analysis.
 
Researchers found more than 2 billion people worldwide are now overweight or obese. The highest rates were in the Middle East and North Africa, where nearly 60 per cent of men and 65 per cent of women are heavy. The U.S. has about 13 per cent of the world's fat population, a greater percentage than any other country.  China and India combined have about 15 per cent.
 
"It's pretty grim," said Christopher Murray of the Institute for Health Metrics and Evaluation at the University of Washington, who led the study. He and colleagues reviewed more than 1,700 studies covering 188 countries from 1980 to 2013. "When we realized that not a single country has had a significant decline in obesity, that tells you how hard a challenge this is."
 
Murray said there was a strong link between income and obesity; as people get richer, their waistlines also tend to start bulging. He said scientists have noticed accompanying spikes in diabetes and that rates of cancers linked to weight, like pancreatic cancer, are also rising.
 
The new report was paid for by the Bill & Melinda Gates Foundation and published online Thursday in the journal, Lancet.
 
Last week, the World Health Organization established a high-level commission tasked with ending childhood obesity.
 
"Our children are getting fatter," Dr. Margaret Chan, WHO's director-general, said bluntly during a speech at the agency's annual meeting in Geneva. "Parts of the world are quite literally eating themselves to death." Earlier this year, WHO said that no more than 5 percent of your daily calories should come from sugar.
 
"Modernization has not been good for health," said Syed Shah, an obesity expert at United Arab Emirates University, who found obesity rates  have jumped five times in the last 20 years even in a handful of remote Himalayan villages in Pakistan. His research was presented this week at a conference in Bulgaria. "Years ago, people had to walk for hours if they wanted to make a phone call," he said. "Now everyone has a cellphone."
 
Shah also said the villagers no longer have to rely on their own farms for food.
 
"There are roads for [companies] to bring in their processed foods and the people don't have to slaughter their own animals for meat and oil," he said. "No one knew about Coke and Pepsi 20 years ago. Now it's everywhere."
 
In Britain, the independent health watchdog issued new advice Wednesday recommending that heavy people be sent to free weight-loss classes to drop about 3 per cent of their weight. It reasoned that losing just a few pounds improves health and is more realistic. About two in three adults in the U.K. are overweight, making it the fattest country in Western Europe.  
 
"This is not something where you can just wake up one morning and say, 'I am going to lose 10 pounds,"' said Mike Kelly, the agency's public health director, in a statement. "It takes resolve and it takes encouragement."

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E-cigarettes shouldn't be stubbed out, scientists tell WHO

A move to classify e-cigarettes alongside regular cigarettes would push countries to take similar tough measures to restrict demand, such as through higher taxes. (CBC)

A group of 53 leading scientists has warned the World Health Organization not to classify e-cigarettes as tobacco products, arguing that doing so would jeopardize a major opportunity to slash disease and deaths caused by smoking.

The UN agency, which is currently assessing its position on the matter, has previously indicated it would favour applying similar restrictions to all nicotine-containing products.

In an open letter to WHO Director General Margaret Chan, the scientists from Europe, North America, Asia and Australia argued that low-risk products like e-cigarettes were "part of the solution" in the fight against smoking, not part of the problem.

"These products could be among the most significant health innovations of the 21st century - perhaps saving hundreds of millions of lives. The urge to control and suppress them as tobacco products should be resisted," the experts wrote.

Leaked documents from a meeting last November suggest the WHO views e-cigarettes as a "threat" and wants them classified the same way as regular tobacco products under the Framework Convention on Tobacco Control (FCTC).

That has set alarm bells ringing among a number of medical experts — and in the booming e-cigarette industry. A total of 178 countries are parties to the international convention and are obliged to implement its measures, with the United States the one notable non-signatory.

A move to classify e-cigarettes alongside regular cigarettes would push countries into taking similar tough measures to restrict demand, including raising taxes, banning advertising, introducing health warnings and curbing use in public places.

Uptake of electronic cigarettes, which use battery-powered cartridges to produce a nicotine-laced inhalable vapour, has rocketed in the last two years and analysts estimate the industry had worldwide sales of some $3 billion in 2013.

But the devices are controversial. Because they are so new there is a lack of long-term scientific evidence to support their safety and some fear they could be "gateway" products to nicotine addiction and tobacco smoking  — though the scientists said they were "unaware of any credible evidence that supports this conjecture".

In response to the scientists' letter, Penny Woods, chief executive of the British Lung Foundation, said: "The overall impact of e-cigarette use on public health is currently unclear. While they could prove to be an important tool to help people stop smoking, the unregulated status of e-cigarettes is problematic."

For tobacco companies seeking to offset the decline in traditional smoking, investment in e-cigarettes was an obvious choice and all the major players now have a presence, prompting Big Tobacco to line up behind scientists on this occasion.

Kingsley Wheaton, director of corporate and regulatory affairs at British American Tobacco, said classifying e-cigarettes as tobacco products would mean smokers find it harder to access a less risky alternative.

In a declaration of interests, none of the scientists said they had received funding from tobacco companies. However, some have carried out research on e-cigarettes or acted as consultants for drug companies making other smoking cessation products, including GlaxoSmithKline, Johnson & Johnson and Pfizer.

The Geneva-based WHO said its position on e-cigarettes was still in flux ahead of a key meeting on the FCTC scheduled for October 13-18 in Moscow, where proposed regulations will be discussed.

"At this point the only thing I can say is that we are elaborating these regulations and they will soon be available to you," Armando Peruga, programme manager for the WHO's Tobacco Free Initiative told reporters this week.

Gerry Stimson, emeritus professor at Imperial College London and one of the organisers of the letter to Chan, told Reuters that the WHO's position was "bizarre" and its stance on e-cigarettes was harsher than that of regulators in Europe and the United States.

"We want to make sufficient noise now before things get too set in stone," he said.

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Child obesity fuelled by stress response

Children who struggle with stress by heading for the cookie jar are more likely to gain body fat, a finding that shows why it's important to handle stress in more positive ways, European researchers say.

At Tuesday's European Congress on Obesity held in Sofia, Bulgaria, researchers presented a study on the link between children's stress, hormones, diet and increasing body fat or adiposity.

In a three-year study of about 500 elementary school children, those with high levels of the stress hormone cortisol and who turned to food for comfort gained body fat, Natalie Michels of the public health department at Ghent University in  Belgium and her colleagues found.

"We see the relation mainly in children with a high sweet tooth consumption," Michels said in an interview. "So those who take a lot of sweet foods … these children we see the stress increased adiposity."

The cortisol might directly influence body fat or indirectly lead to less healthy dietary intake, the researchers say.

The connection between emotional eating and stress is already recognized in adults, but few studies have looked at children, said Sara Kirk, an obesity researcher at the IWK Children's Hospital in Halifax.

Obesity has many contributing causes, and more knowledge about the role of stress is important because it influences our behaviours, Kirk said.

"We need to understand how the environment influences our decisions about food," Kirk said. "We need to think about the widespread availability of heavily processed, nutrient-poor but energy-dense foods that are highly palatable. So when we're feeling stressed, we're more likely to reach for those kinds of foods because they're everywhere around us."

Those environmental factors influence us "every minute of the day."

"One of the things that we really need to get a grip with in society is this environment undermining our health behaviours. Stress fits into that picture, but we have to recognize that that picture is very complex," Kirk said.

The Belgian researchers found there were children with high cortisol levels who didn't cope by eating sweets and didn't gain additional weight — evidence that better stress management may be important for reducing obesity.

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AIDS ward closes in B.C. as death rate plummets

A dramatic fall in the number of cases of AIDS in B.C. means a Vancouver hospital ward that once treated those dying of the disease will be repurposed to treat those living with HIV.

The repurposing of Ward 10C at St. Paul's Hospital in downtown Vancouver marks one more step toward an "AIDS-free B.C.,"  Premier Christy Clark said on Monday morning at the special announcement.

Ward 10C was originally opened as an AIDS ward in February 1997 during the peak of the HIV/AIDS epidemic in the city. At the time, approximately one person per day was dying from HIV/AIDS.

But since then, early diagnosis and advances in treatment have led to a dramatic increase in the survival rates, according to B.C.'s Health Minister Terry Lake.

"British Columbia's dedication to the fight against HIV/AIDS has meant that we have reduced AIDS cases in Vancouver by over 80 per cent since 1996," said Lake.

"There was a time when there weren't enough beds to care for the numbers of people living with HIV," said Michel Sidibé, UN under-secretary general and executive director for UNAIDS, who joined the announcement at St. Paul's with Dr. Julio Montaner, the director of the B.C. Centre for Excellence in HIV/AIDS.

"The pioneering work of Dr. Montaner and the leadership of British Columbia have helped to ensure that people living with HIV live longer, healthier lives and as a result HIV clinics are starting to close. This is an important milestone towards ending the AIDS epidemic," said Sidibé.

"It was not that long ago that HIV/AIDS was a death sentence, and those who came to this ward at St. Paul's were here to die," said Dr. Montaner.

"Today, Ward 10C will provide treatment, support and care for those living with HIV-related issues. We have worked hard to make this day happen, and I commend everyone who has supported our efforts."

Last month the B.C. government announced all adult residents will be offered free voluntary HIV testing every five years or less, in order to help identify an estimated 1,500 people in the province who are unaware they have the disease.

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Melanoma a fast rising cancer in Canada

Melanoma, the deadliest form of skin cancer, is on the rise among Canadian men and women, but it is also one of the most preventable forms, according to a new report.

The Canadian Cancer Society's annual statistics report shows skin cancer rates in the past two decades have increased, especially among those over 50. Yet it's the risky trends among younger people that the society is worried about.

"More Canadians are spending time out in the sun and protecting themselves less than they used to," said Prithwish De, an epidemiologist with the Canadian Cancer Society in Toronto.

"It's the younger Canadians under the age of 30, specifically between the ages of 16 and 24, that tend to spend the most time out in the sun without protecting themselves very much and also that's the same age group that tends to use indoor tanning the most."

A single, blistering sunburn before the age of 20 can double a person's chance of developing melanoma. Research also suggests that people who first start using indoor tanning beds before the age of 65 are also at higher risk.

British Columbia, Ontario, Quebec, Newfoundland and Labrador, Nova Scotia, New Brunswick and P.E.I. have tanning bed legislation to help protect young people.

The society expects over 80,000 skin cancer cases in Canada this year — nearly the same number of cases of the top four cancers combined, namely lung, breast, prostate and colorectal.

Dr. Asif Pirani is a reconstructive plastic surgeon in Toronto who treats patients with skin cancer.

"Skin cancer can be very serious and yet it can be very easily prevented with sun-smart prevention techniques," Pirani said.

If you are going to be out in the sun for more than 30 minutes, apply sunscreen over exposed skin at least 20 minutes before heading out, he advised.

Other sun safe strategies include:

• Wear a wide-brimmed hat.
• Wear sunglasses and lip balm.
• Plan outdoor activities before 11 a.m. and after 4 p.m. when the sun is not at its strongest or at times of the day when the UV Index is 3 or less.
• Seek shade.
• Don't use indoor tanning beds.

Overall, an estimated 191,300 new cases of cancer and 76,600 deaths from cancer are expected to occur in Canada this year. Rates of the disease are generally stabilizing for new cases and declining for deaths, the society said.

Four types of cancer — lung, breast, colorectal and prostate — account for 52 per cent of newly diagnosed cancers.

The annual report was prepared in partnership between the Canadian Cancer Society, the Public Health Agency of Canada, Statistics Canada and provincial and territorial cancer registries.

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Spread of Ebola in west Africa is not under control, says WHO expert

Guinea's capital Conakry has recorded its first new Ebola cases in more than a month, while other previously unaffected areas have also reported infections in the past week, according to the World Health Organization.

The spread of the two-month-old outbreak, which Guinean authorities had said had been contained, risks further complicating the fight against the virus in a region already struggling with weak healthcare systems and porous borders.

"The situation is serious, you can't say it is under control as cases are continuing and it is spreading geographically," Dr Pierre Formenty, a WHO expert who recently returned from Guinea, told a news briefing in Geneva on Wednesday.

"There was no decline. In fact it is because we are not able to capture all the outbreak that we were under the impression there was a decline," he said.

The WHO reported two new cases, including one death, between May 25 and 27 in Conakry. They were the first to be detected since April 26. An outbreak in the capital could pose the biggest threat of an epidemic because the city is Guinea's international travel hub. 

Telimele and Boffa - two districts north of Conakry that were previously untouched by the disease - both confirmed outbreaks through laboratory testing, the WHO said. Twelve cases, including four deaths, were reported there between May 23 and 26, while suspected Ebola infections were documented in the adjacent districts of Boke and Dubreka.

Aboubacar Sidiki Diakité, who heads the Guinean government's efforts to halt the virus's spread, said the origins of all the new outbreaks had been traced back to cases in Conakry.

"The problem is that there are families that refuse to give information to health workers. They hid their sick to try to treat them through traditional methods," he told Reuters.

The outbreak - the first deadly appearance of the haemorrhagic fever in West Africa - spread from a remote corner of Guinea to the capital and into Liberia.

Sierra Leone reported its first confirmed outbreak of the disease earlier this week.

The WHO has documented a total of 281 clinical cases of Ebola, including 185 deaths in Guinea since the virus was first identified as Ebola in March.

The disease is thought to have killed 11 people in Liberia, thought there have been no new cases there since April 9.

Sixteen cases - seven of them confirmed through laboratory testing and another nine suspected - have been reported in Sierra Leone's Kailahun district, where four people were believed to have died of the disease.

Ebola, which has a fatality rate of up to 90 per cent, is endemic to Democratic Republic of Congo, Gabon, Uganda and South Sudan. Researchers believe the West African outbreak was caused by a new strain of the virus.

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Simple, inexpensive approaches can save lives of mothers and newborns

Every year, 2.9 million newborn babies worldwide die from mostly preventable causes, but a few simple steps can save lives, doctors say.

Starting Wednesday, Prime Minister Stephen Harper hosts a three-day global summit in Toronto called Saving Every Woman Every Child: Within Arm's Reach, which aims to shape future collaborations to improve the health of women and children.

An estimated 289,000 women died in 2013 from complications in pregnancy and childbirth, down from 523,000 in 1990, according to the World Health Organization. 

But given current trends, the agency says most countries will not achieve the target of a 75 per cent reduction that the international community pledged for from 1990 to 2015.

Dr. Jean Chamberlain Froese is the executive director of Save the Mothers, which works to reduce the numbers of mothers dying in childbirth through education of professionals in the developing world.

Her goal is to have the professionals themselves bring about a culture change so mothers can have a dignified and safe delivery. If not, Chamberlain Froese said, women will vote with their feet and stay home, where complications can be deadly for both the woman and her baby. 

Chamberlain Froese worked in Uganda for nine years and in Yemen for five years. She's also the director of the international women's health program at McMaster University in Hamilton.

Major causes of deaths for mothers. (WHO)

About 15 per cent of pregnant women will have a life-threatening complication, regardless of where in the world they are. The difference, Chamberlain Froese said, is that while mom and baby may have a rough road in Canada, they have access to a hospital where blood, anesthesia for C-sections and medication are standard and high-quality care is available around the clock.

Those differences explain in part why Uganda loses 6,000 women to childbirth complications every year compared with about 20 per year in Canada.

In the lead-up to the summit, WHO pointed out five ways to save more lives:

• Quality care before, during and after childbirth.
• Safe blood supplies.
• Essential medicines such as antibiotics and oxytocin.
• Contraception and safe abortion services.
• Every death counted and its cause recorded.

Last week, the medical journal The Lancet published a series of papers that outline the progress and challenges to improve newborn survival around the world.

The research was led by Prof. Joy Lawn of the London School of Hygiene & Tropical Medicine and Save the Children, U.K., with Prof. Zulfiqar Bhutta at Toronto's Hospital for Sick Children and the Aga Khan University in Karachi, Pakistan.

The first step is to recognize there's a problem, Bhutta said.

"One of big issues around global newborn survival is that nobody counts them, nobody measures them. A large proportion of babies, newborn babies worldwide, actually don't even have a birth certificate," he said in an interview with CBC Radio's Metro Morning.

After the birth counts, Bhutta called for accountability on improvements as well as low-cost solutions that can make a difference to newborn survival such as:

• Breastfeed early and exclusively.
• Give birth in a clean environment.
• Make sure there's a clean delivery kit for every birth.
• Take good care of a newborn's cord.
• Keep small and preterm babies warm.

Bhutta estimates the running cost to provide these measures at reasonable coverage across the world, particularly in low and middle income countries, is less than $6 billion a year or less than a couple of dollars per baby.

That's not a huge investment to make, not only for survival but also to increase development potential and economic growth of countries, he said.

The research shows that although there's been an overall reduction in the number of child deaths worldwide, most of the reductions have taken place for older children. About 44 per cent of all deaths in children under five are in the first month of life, according to The Lancet.

It's the deaths of the youngest, those who take a breath but die because women and babies aren't cared for adequately around delivery time, that cry out for attention and solutions, Chamberlain Froese said.

"These babies are dying not because we lack the knowledge to save them; they are dying for a lack of attention and investment," philanthropist Melinda Gates co-wrote in the journal with Rwanda's health minister, Agnes Binaghawo.

Harper set maternal and newborn health as an international priority in 2010 at the Muskoka Initiative during the G8 summit in Ontario's cottage country.

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The made-in-Canada problem facing medical scans: Kelly Crowe

Albert Mann winced as he sat upright on the scanner bed to talk to me. A large camera had just processed an image of his body, reading the gamma rays radiating from his bones.

I asked him what he had to do to prepare for this test. "What did I have to do? Get cancer," he said.

Down the hall, seven other camera rooms were buzzing with patients having similar scans. At this hospital in Brampton, Ont., the machines run six days a week.

Across Canada, about 20,000 patients undergo nuclear imaging procedures every week and the field of nuclear medicine is growing around the world.

But almost all of it rests on an increasingly fragile supply of radioactive isotopes, a short-lived medical product made mostly by small research reactors, and a looming shortage has specialists worried.

"I don't want to sound alarmist," said Dr. Norman Laurin, president of the Canadian Association of Nuclear Medicine. "But it's going to have medical consequences. There are people who are going to be denied care, or have a different kind of care that might not be the best for them."

These patients probably won't know there's a problem until their test is cancelled, or they have to wait months for a diagnosis. But if they ask enough questions they'll find out the shortage of medical isotopes is largely a made-in-Canada problem.

Going out of business

Most Canadians don't realize it, but this country has been an international leader, the world's largest single supplier of medical isotopes used in nuclear imaging, for more than 50 years.

What's an isotope

A medical isotope is radioactive material that is injected into the body, binding to specific tissue, and emitting gamma rays that are detected by special cameras.

These diagnostic tests have become an essential tool for helping diagnose cancer and heart disease, among other ailments, but the system will collapse without a reliable supply of the delicate isotopes, which decay quickly, losing radioactivity in six hours.

That means they cannot be stockpiled. So every day fresh isotopes are produced in nuclear reactors and quickly shipped around the world before they expire.

But all of that is about to end. Buried deep in the federal budget bill, now winding its way toward approval, is something called the Nordion and Theratronics Divestiture Authorization Act.

In a few short sentences that amendment removes all foreign ownership restrictions on Canada's medical isotope processor, Nordion, paving the way for the former Crown corporation to be sold to a U.S. firm.

The buyer, Sterigenics, is ready and waiting with an offer on the table. Shareholders will vote on May 27.

"The sale of Nordion represents the end of the road for the Canadian nuclear medicine file," says Dr. Norman Laurin said. But it is not so much the sale itself as the pending shutdown of the medical isotope production at the aging Chalk River research reactor in 2016 that will affect the diagnostic imaging business across this country.

The federal government is determined to close Chalk River's isotope production as planned in less than two years, and when it does up to 40 per cent of the world's isotope supply will vanish, with no new supplier ready and waiting to fill the void.

Exit the business

Last week, Nordion reminded its investors about that problem. "Currently, the company does not have an alternative supply of reactor-based medical isotopes," it said in a news release. "It cannot be certain that it will be able to secure an alternate source of commercial supply that is viable."

Nordion says it is looking for a new source, but where? There are only a handful of other research reactors in the world producing isotopes, and most are also at the end of their life, and prone to the same repeated and unexpected shutdowns that have plagued Chalk River.

The new technologies for making the key isotope ingredient — technetium-99 — without a nuclear reactor are still in the research stage, with too many infrastructure and regulatory hurdles to be ready when Chalk River stops production.

Nordion bluntly warns that "if the company is unable to secure a long-term supply of medical isotopes it may exit the reactor-based medical isotope segment of its business." And that's exactly what some analysts expect will happen.

A nuclear medicine technologist at Toronto General Hospital prepares a patient for a gamma camera that takes body images after patients are injected with technetium. (Canadian Press)

A recent report by the Nuclear Energy Agency of the Paris-based Organization for Economic Co-operation and Development is assuming Nordion's isotope processing capacity will disappear.

"The loss of Canada's processing capacity in the second half of 2016 reduces current global processing capacity by approximately 25 per cent in that period." the report says.

It also says there is "an increased risk" of supply shortages beginning as soon as next year.

Been down this road

That OECD warning triggered flashbacks for those Canadian nuclear medicine specialists who lived through the white knuckle crisis in 2009 when a leak shut down Chalk River for 15 months at the same time as an isotope-supplying Dutch reactor went down for repair.

In the political chaos that followed, Prime Minister Stephen Harper announced Canada would be getting out of the isotope business by 2016.

Ottawa would not follow the advice of its expert panel and build a new research reactor. Instead it offered $25 million in research money to encourage an alternative supply chain.

It would be up to the market to solve the problem of long-term isotope supply. And that likely means higher prices, because alternative processes like PET scans (positron emission tomagraphy) are more expensive, and because private isotope suppliers will have to charge more to recover costs and make a profit.

"These isotopes are going to become more expensive, and I think it's right they should become more expensive," says OECD economist Ron Cameron. "In some cases they were sold at below the cost of producing them, that is economically unsustainable."

In other words, Canada helped create the world of nuclear medicine by making the supply of isotopes affordable, but without that low-cost option the situation changes.

It's the latest chapter in Canada's storied history of nuclear medicine, from the pioneering days in the 1950s, as this country moved from innovator and international leader to faltering player.

There is a sadness among scientists and doctors as they watch this era of once ground-breaking science quietly come to an end.

"Getting out of it I think is a mistake," says Dr. Laurin. "It will mean a loss of Canadian know-how and expertise. Very good science will be lost, business and jobs are going to go elsewhere or be lost altogether, so I personally think it's a mistake.

"I may be biased because I'm a physician and I need what's being made at Chalk River for patient care. But if you look at it from a Canadian point of view, I think it's a loss for the entire community, not just Ontario, but all of Canada."

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Measles outbreaks spotlight need for national registry

Mariam, 3, suffering from measles, lies in her mother's lap after being brought to hospital in Lahore, Pakistan, last May. The uncommon but severe complications of the vaccine preventable illness include pneumonia, meningitis and encephalitis. (Mohsin Raza/Reuters)

Measles outbreaks across Canada could increase unless a national vaccination registry and other preventive steps are taken, a Canadian medical journal editorial argues.

Measles will not remain within provincial borders because it has such a high transmissibility or contagiousness, Dr. Gordon Giddings said in Monday's issue of the Canadian Medical Association Journal.

Measles "must be managed and monitored with a national solution," Giddings concluded in an editorial.

The "disfiguring and paralyzing ravages" of conditions like measles are not routinely seen in Canada today.

So far this year, British Columbia's Fraser Valley has experienced an outbreak and there have been cases in Alberta, Saskatchewan, Manitoba and Ontario.

Internationally, the Public Health Agency of Canada's travel notice earlier this month said measles continues to be imported in Brazil and the U.S. The Philippines has an ongoing outbreak and Vietnam is also experiencing one. Japan reports three times more cases than the same time period last year. Australia and the United Kingdom are also dealing with outbreaks from imported cases.

More than 90 per cent of unvaccinated people who are exposed to the measles virus will contract the disease, the U.S. Centers for Disease Control and Prevention notes in encouraging vaccination.

Canada's most recent national data, a decade old, suggests a trend of decreasing immunizations. The fall in uptake for the shots likely contributed to Canada placing 28th out of 29 of the richest countries for childhood vaccination rates, Giddings said, pointing to a UNICEF report published last year.

"The simple fact is that low vaccination rates are contributing to preventable disease outbreaks," Giddings said.

His national solution includes:

• Promptly and accurately identifying children and adults who are due or overdue for vaccinations to contain outbreaks.
• Harmonize vaccine schedules, which currently vary by province and territory, to help simplify public health messages and education.
• Introduce a national vaccination registry, which could help target education campaigns towards specific groups and geographic regions.
• Oversee a national committee's work on vaccine hesitancy. 

"Unless these measures are put in place, Canadians can expect to see more measles outbreaks," he concludes.

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Ebola patient in Sierra Leone pulled from hospital by family

Relatives of an Ebola patient in Sierra Leone took her home from a community health centre despite protests from medical staff, risking spreading the deadly and highly infectious disease, a senior health official said on Tuesday.

The family said they did not trust the medical system and feared she would die if a transfer to the general hospital in the town of Kenema went ahead, Amara Jambai, the health ministry's director of disease prevention and control, said.

Lawmakers and community leaders would try to talk to family members and persuade them to return her to hospital, he said.

Employees of the sanitary control of Conakry airport check passengers before they leave Guinea in April. Guéckédou in Guinea is currently the epicentre for Ebola, the World Health Organization says. (Cellou Binani/AFP/Getty)

There has been no news of the woman, whose identity has been kept secret, since she was taken from Koindu to her village nearby, Jambai said by telephone from the capital Freetown.

Koindu shares a border with what the World Health Organization (WHO) says is the Ebola virus disease epicentre of Guéckédou in Guinea.

Asked about the risk posed by her removal from hospital, Jambai said: "She can infect others, her family members and also those in the community. There is no news of her condition because she has been taken away so we need to search and find her and make sure that it [Ebola] doesn't spread."

Five people have died in Sierra Leone's first confirmed outbreak of Ebola virus, WHO said on Monday, signalling a new spreading of the disease which regional officials had said was under control.

Ebola, a haemorrhagic fever with a fatality rate of up to 90 per cent, is believed to have killed some 185 people in neighbouring Guinea and Liberia since March in the first deadly appearance of the disease in West Africa.

The West African outbreak spread from a sparsely inhabited corner of Guinea to the capital, Conakry, and into Liberia, causing panic across a region struggling with weak healthcare systems and porous borders.

A total of 258 clinical cases have been recorded in Guinea since the outbreak was first identified as Ebola, including 174 deaths — 95 confirmed, 57 probable and 57 suspected — WHO says.

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The made-in-Canada problem facing nuclear medicine: Kelly Crowe

Albert Mann winced as he sat upright on the scanner bed to talk to me. A large camera had just processed an image of his body, reading the gamma rays radiating from his bones.

I asked him what he had to do to prepare for this test. "What did I have to do? Get cancer," he said.

Down the hall, seven other camera rooms were buzzing with patients having similar scans. At this hospital in Brampton, Ont., the machines run six days a week.

Across Canada, about 20,000 patients undergo nuclear imaging procedures every week and the field of nuclear medicine is growing around the world.

But almost all of it rests on an increasingly fragile supply of radioactive isotopes, a short-lived medical product made mostly by small research reactors, and a looming shortage has specialists worried.

"I don't want to sound alarmist," said Dr. Norman Laurin, president of the Canadian Association of Nuclear Medicine. "But it's going to have medical consequences. There are people who are going to be denied care, or have a different kind of care that might not be the best for them."

These patients probably won't know there's a problem until their test is cancelled, or they have to wait months for a diagnosis. But if they ask enough questions they'll find out the shortage of medical isotopes is largely a made-in-Canada problem.

Going out of business

Most Canadians don't realize it, but this country has been an international leader, the world's largest single supplier of medical isotopes used in nuclear imaging, for more than 50 years.

What's an isotope

A medical isotope is radioactive material that is injected into the body, binding to specific tissue, and emitting gamma rays that are detected by special cameras.

These diagnostic tests have become an essential tool for helping diagnose cancer and heart disease, among other ailments, but the system will collapse without a reliable supply of the delicate isotopes, which decay quickly, losing radioactivity in six hours.

That means they cannot be stockpiled. So every day fresh isotopes are produced in nuclear reactors and quickly shipped around the world before they expire.

But all of that is about to end. Buried deep in the federal budget bill, now winding its way toward approval, is something called the Nordion and Theratronics Divestiture Authorization Act.

In a few short sentences that amendment removes all foreign ownership restrictions on Canada's medical isotope processor, Nordion, paving the way for the former Crown corporation to be sold to a U.S. firm.

The buyer, Sterigenics, is ready and waiting with an offer on the table. Shareholders will vote on May 27.

"The sale of Nordion represents the end of the road for the Canadian nuclear medicine file," says Dr. Norman Laurin said. But it is not so much the sale itself as the pending shutdown of the medical isotope production at the aging Chalk River research reactor in 2016 that will affect the diagnostic imaging business across this country.

The federal government is determined to close Chalk River's isotope production as planned in less than two years, and when it does up to 40 per cent of the world's isotope supply will vanish, with no new supplier ready and waiting to fill the void.

Exit the business

Last week, Nordion reminded its investors about that problem. "Currently, the company does not have an alternative supply of reactor-based medical isotopes," it said in a news release. "It cannot be certain that it will be able to secure an alternate source of commercial supply that is viable."

Nordion says it is looking for a new source, but where? There are only a handful of other research reactors in the world producing isotopes, and most are also at the end of their life, and prone to the same repeated and unexpected shutdowns that have plagued Chalk River.

The new technologies for making the key isotope ingredient — technetium-99 — without a nuclear reactor are still in the research stage, with too many infrastructure and regulatory hurdles to be ready when Chalk River stops production.

Nordion bluntly warns that "if the company is unable to secure a long-term supply of medical isotopes it may exit the reactor-based medical isotope segment of its business." And that's exactly what some analysts expect will happen.

Dr. Norman Laurin, president of the Canadian Association of Nuclear Medicine: "It's going to have medical consequences." (CBC)

A recent report by the Nuclear Energy Agency of the Paris-based Organization for Economic Co-operation and Development is assuming Nordion's isotope processing capacity will disappear.

"The loss of Canada's processing capacity in the second half of 2016 reduces current global processing capacity by approximately 25 per cent in that period." the report says.

It also says there is "an increased risk" of supply shortages beginning as soon as next year.

Been down this road

That OECD warning triggered flashbacks for those Canadian nuclear medicine specialists who lived through the white knuckle crisis in 2009 when a leak shut down Chalk River for 15 months at the same time as an isotope-supplying Dutch reactor went down for repair.

In the political chaos that followed, Prime Minister Stephen Harper announced Canada would be getting out of the isotope business by 2016.

Ottawa would not follow the advice of its expert panel and build a new research reactor. Instead it offered $25 million in research money to encourage an alternative supply chain.

It would be up to the market to solve the problem of long-term isotope supply. And that likely means higher prices, because alternative processes like PET scans (positron emission tomagraphy) are more expensive, and because private isotope suppliers will have to charge more to recover costs and make a profit.

"These isotopes are going to become more expensive, and I think it's right they should become more expensive," says OECD economist Ron Cameron. "In some cases they were sold at below the cost of producing them that is economically unsustainable."

In other words, Canada helped create the world of nuclear medicine by making the supply of isotopes affordable, but without that low-cost option the situation changes.

It's the latest chapter in Canada's storied history of nuclear medicine, from the pioneering days in the 1950s, as this country moved from innovator and international leader to faltering player.

There is a sadness among scientists and doctors as they watch this era of once ground-breaking science quietly come to an end.

"Getting out of it I think is a mistake," says Dr. Laurin. "It will mean a loss of Canadian know-how and expertise. Very good science will be lost, business and jobs are going to go elsewhere or be lost altogether, so I personally think it's a mistake.

"I may be biased because I'm a physician and I need what's being made at Chalk River for patient care. But if you look at it from a Canadian point of view, I think it's a loss for the entire community, not just Ontario, but all of Canada."

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Uncommon birth defect appears in 3 babies in homes on 1 road

Three mothers who live on the same Moncton, N.B., road and who have babies with the same birth defect want more research into gastroschisis, which causes the intestines to stick outside of the body through a hole beside the belly button. 

The three women live within blocks of each other and gave birth in the last 16 months.

"To me, it came off as not a coincidence. I thought it was really weird. With the numbers that are given, I just didn't understand how all three could be so close," said Natalya Beatty, mother of daughter Rylee.

'He's laughing, and walking and playing, but you know, on the inside he's in a lot of pain.- Andrea Cunningham, mother of baby born with gastroschisis

Beatty gave birth last month. She was immediately airlifted to the IWK Health Centre in Halifax for emergency surgery.

"They put her bowels into a silo — it's like a big bandage thing — and then they had the surgery. They put all her bowels back in through her belly button," said Beatty.

While at the IWK, Beatty met other moms and discovered the connection.

All three women live on Salisbury Road in Moncton, within eight kilometres of one another. Before meeting at the IWK, the moms didn't know each other personally.

Now, they're wondering what might have caused their children's birth defects.

'It's surprising,' doctor says

Gastroschisis facts:

• Gastroschisis occurs early in pregnancy, when muscles that make up baby's abdominal wall don't form correctly.
• Young parents, those with low-incomes and mothers who smoke/drink during pregnancy are at greater risk of having baby born with gastroschisis.
• Soon after baby is born, surgery needed to repair defect. 
• If defect is large, multiple surgeries may be required to place organs back inside body cavity.
• Babies with gastroschisis often need to receive nutrients through IV and antibiotics to prevent infection.

Source: U.S. CDCP

Dr. Natalie Yanchar is a pediatric surgeon and researcher who tracks cases of gastroschisis across Canada.

"It's surprising, especially when you hear it in that context, but until we look at it critically, we can't really draw any assumptions from it," said Yanchar.

The birth defect is uncommon, but not rare, she said. It occurs in about one in every 10,000 babies, worldwide.

Of those, about six per cent don't survive.

Yanchar said doctors have yet to identify hot spots in Canada where the birth defect may be more prevalent.

She said there isn't any evidence that the birth defect is more common in Moncton or even New Brunswick, for that matter.

"We are always hesitant to sort of assume this might be a hot spot until we look at it really critically," she said.

Difficult journey

While Beatty's daughter, Rylee, was able to go home after one surgery and about a month in the hospital, another woman who lives on the street is still waiting for her child to come home.

Andrea Cunningham's son, Dylan Rosie, was born 16 months ago and is still in hospital.

Andrea Cunningham and her 16-month-old son, Dylan Rosie, in the hospital where they have lived for Dylan's entire life. (Teghan Beaudette/CBC)

Dylan has had 13 surgeries and nearly 20 blood transfusions, and has never eaten on his own. He is fed through a tube in his stomach and wears a small backpack that holds the food being pumped into his stomach.

"He's laughing, and walking and playing, but you know on the inside he's in a lot of pain," said Cunningham. "He's just kind of adapted to it. It's his normal now." 

Normal for Cunningham is travelling back and forth between the IWK and Moncton, where her young daughter is living with her grandparents.

"It makes it a struggle — to divide yourself in half," said Cunningham.

She sleeps on a cot in the bathroom attached to Dylan's hospital room so he can have more room to play.

Cunningham was six weeks from graduating college when Dylan was born. Her education and job have been on hold ever since.

Dylan's next surgery, which will take out some of his bowel, is scheduled on Cunningham's birthday. If that surgery doesn't work, he will have to have a bowel transplant.

The third mom did not want CBC to reveal her name. She gave birth within the last few weeks and confirmed she lives on the road, just blocks away from the other two women.

"I mean, I've thought about thousands of things — if it's an environmental thing, if there are other causes," said Beatty.

All three moms said regardless of whether it is a coincidence, they want more research done on what causes the defect.

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Seniors left with big bills as banks deny travel insurance claims

Three customers who bought travel insurance from Canadian banks are outraged after being left with large foreign medical bills.

"They're like a good gambler that never loses," said Cyrus Derakhshan of Oakville, Ont. He is fighting RBC over a $16,500 claim denial for his 70-year-old mother. "For them it's 'Heads I win, tails you lose.'"

Cyrus Derakhshan is suing RBC after it denied his mom's travel health insurance claim, citing 'misrepresentation' of her medical history. (CBC)

The banks refused to pay in these cases, based on how the customers answered broad-ranging questions about their health when they bought their policies.

"They hold all the cards in their hand. It's a poker game, and I don't think we are the winners," said Jean Tetiuk, of Toronto, whose $12,000 claim was rejected by CIBC.

In each case, the medical emergencies abroad had nothing to do with any pre-existing conditions they were asked about.

Paid extra, claim still denied

Another CIBC travel insurance customer, Carmen Peixoto of Chilliwack, B.C., fights back tears when she talks about the $10,000 medical bill she is stuck with.

Carmen Peixoto wipes away tears as she talks about the $10,000 hospital bill she is left with, after CIBC refused to pay her claim. (CBC)

"I worked too hard, all my life. And this bank is taking advantage of me? I am really upset. Really, really upset."

The 69-year-old has high blood pressure. She paid CIBC an extra $100 premium to make sure her travel insurance would cover her for that. When her blood pressure soared, on her trip last year, she was taken by ambulance to a Zurich hospital.

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CIBC later refused to pay, because Peixoto filled out a CIBC questionnaire — sent to her after she returned from her trip — answering that she had not been treated for a heart condition. Before buying the policy, she had only answered health questions over the phone.

Records show she was tested for heart problems in 2011, after she had pain in her arm, but doctors found nothing significant. Because of those tests, CIBC said Peixoto should have answered yes to the heart condition question. 

"I was never treated for a heart condition. I never had a heart condition. I've been tested and different things but I never had a problem before. And I still don't have a heart problem," said Peixoto.

She is also upset because CIBC was asking her health questions after the fact, while at the same time adjudicating her claim.

"I was tricked, because they never had any intention of paying this claim. And I find that totally incredible."

Tetiuk, another senior, is also furious at CIBC for refusing to pay her $12,000 US medical bill, after she was treated for a blood clot in her lung in Cape Cod, Mass., in 2012.

Unrelated minor health issues cited

Insurance investigators dug into her medical records and found a routine colonoscopy had detected a mild condition called diverticulosis, which caused no symptoms and needed no medication.

CIBC said that because of that, she should have said yes to its question about whether she had a bowel disease. It also said she should have disclosed that she has ostopenia, or low bone density. 

Toronto resident Jean Tetiuk's $12,000 travel insurance claim was rejected by CIBC. (CBC)

"Everyone over 60 has this condition, for sure. And diverticulosis was determined when I had a colonoscopy — and I was told to eat a high-fibre diet and come back in another 10 years," said Tetiuk, who has appealed the denial, with no success.

"If I'm not being treated and I am not taking prescription drugs, in my mind I don't have a condition that I should be revealing. I don't even think about it."

Go Public asked CIBC for a response to these cases, but didn't hear back before deadline.

Suing the big bank

Derakhshan is taking RBC to court over the claim denial for his mother, Roghi Derakhshan. He bought the policy for her, and when asked over the phone about his mom's medical history, he said no to a question about whether she had heart problems. 

"RBC Insurance gives you the illusion that they are asking you questions in layman terms and that these are just general questions," said Derakhshan.

RBC denied 70-year-old Roghi Derakhshan's $16,500 travel insurance claim. (CBC)

His mom has atrial fibrillation — heart palpitations with no adverse effects — and, like many older people, takes baby Aspirin to prevent problems.

Derakhshan said he answered no to the question, because RBC's questionnaire said a heart condition "does not include extra beats or palpitations, for which you have not taken medication or received treatment."

RBC later said that because Derakhshan's mom has cardiac checkups and tried other medication briefly, that counts as treatment. 

Her $16,500 claim — for unrelated treatment of a bacterial lung infection in Geneva — has been denied, citing "misrepresentation" of her medical history.

"My mom was already paying close to $400 for one month of insurance. She was spending thousands of dollars to go on this European trip," said Derakhshan.

"Do you think that for another measly $100 of insurance I would have any reason to misrepresent or lie on her behalf?"

Derakhshan is suing RBC for $25,000 in small claims court.

"My objective is bigger than my mom's case. I want to stand up for people who have gone through the same thing, and my final goal is to change policy."

RBC justifies denial

The head of RBC's insurance division, Martha Turnbull, told Go Public that even though Derakhshan didn't intend to answer the question incorrectly, the claim denial is justified.

Martha Turnbull, head of RBC's insurance division, says that even though Derakhshan didn't intend to answer a question incorrectly, it would be unfair to other customers to pay his mom's claim. (CBC)

"It's a very regrettable decision," said Turnbull who added that RBC denies two per cent of claims, for all types of insurance it sells.

"Unfortunately, we need to make consistent decisions for all clients. Denying a claim is the most difficult decision we make in the claims department. We take our responsibility and accountability to our clients very seriously."

She also said RBC will fight this case in court.

"We will not be settling it," said Turnbull. "We are making sure that we treat every client with the same respect and care and that if the clients answer the questionnaire correctly they pay the correct premium, they're not in turn subsidizing people who don't answer the questions correctly."

Insurers hold 'legal weapon'

Insurance broker Bruce Cappon is lobbying for provincial regulators to force insurance companies to be more up front about what the medical questions really mean. 

"The way the system is rigged right now is that insurers have a legal weapon. The misrepresentation clause is a legal weapon," said Cappon.

Ottawa insurance broker Bruce Cappon is lobbying regulators to make it tougher for insurance companies to reject claims for unrelated health issues. (CBC)

"I find it very unfair that you are asking these people to fight back when the remedies would be very simple, just to add a few changes to the regulations."

He also thinks it should be illegal for insurers to refuse to pay for treatment unrelated to any pre-existing conditions.

The industry association wouldn't say what percentage of travel medical claims are denied for misrepresentation, but that it is trying to educate consumers on the pitfalls.

"Know your health and consult a health-care provider if you have any questions," said a spokesperson for the Travel Health Insurance Association of Canada. 

Cappon advises people to go as far as checking their medical records before buying policies, because that is what the insurance companies look at.

"There's no onus on the insurance providers to first provide the consumer with the information they need to make an accurate response. And that's what's got to change."

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