Limit audio devices to an hour a day to protect hearing: WHO

About five to 10 per cent of people who listen to music for more than an hour a day at a high-volume setting for years are considered at high risk of developing permanent hearing loss. (Carlos Barria/Reuters)

Unplug your audio player's headphones after an hour, the World Health Organization recommends to protect hearing.

About 1.1 billion teens and young adults are at risk of hearing loss from unsafe levels blasting from devices such as smartphones, noisy nightclubs and sports events, the United Nations health agency said Friday.

It is based the analysis on studies in middle- and high-income countries.

In workplaces, the top level of noise exposure is 85 decibels for a maximum of eight hours per day. But noise levels at dance clubs may reach 100 decibels, a level the agency says is safe for no more than 15 minutes.

People of all ages can "limit the time spent engaged in noisy activities by taking short listening breaks and restricting the daily use of personal audio devices to less than one hour," WHO said.

About five to 10 per cent of people who listen to music for more than an hour a day at a high volume setting are at high risk of developing permanent hearing loss after five or more years of exposure, according to the European Commission.

The time isn't a hard limit but rather advice to consider for anyone who spends large parts of the day listening to an mp3 player.

The suggestions were based on commonly heard sound levels from personal audio devices in the peer-reviewed literature, said Dr. Shelly Chadha, WHO's technical officer for prevention of deafness and hearing loss.

"It is important to keep the volume low and to determine what is the safe listening level on one's own device," Chadha said in an email.

"These are all preventive actions which can help to avoid the onset of hearing loss in an individual."

In 2008, the Hearing Foundation of Canada said 30 per cent of the 145 students surveyed listened at levels of 91 decibels or higher for an average of 2.9 hours a day.

March 3 is International Ear Care Day.

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Wheat Belly arguments are based on shaky science, critics say

Critics say the anti-wheat claims made by leading health crusader Dr. William Davis are based on shaky science, an investigation by the fifth estate has found.

Davis is the author of the No. 1 New York Times best-selling book Wheat Belly, considered the bible of the wheat-free movement. He argues wheat has killed more people than all wars combined, and that it is responsible for an astonishing array of diseases — diabetes, obesity, Crohn's disease and autoimmune disease, among many others.

He also claims the wheat we eat now is not what it used to be. Rather, it's a genetically modified monster he calls "Frankenwheat" — and he says it's killing us.

In the fifth estate's War on Wheat, Davis tells Mark Kelley, "I'm waging a war against misinformation in health, in which one of the major and most destructive messages is to create a diet rich in healthy whole grains."

Davis is an unlikely warrior. He was a cardiologist in Milwaukee, trying to lose a few pounds to help fight his type 2 diabetes. He never conducted any of his own scientific studies, but found that after cutting wheat from his diet, his blood sugar levels were significantly reduced and his extra weight melted away.

He also heard similar stories from others: "Patient after patient came back and said, 'Well, I did that, my blood sugar's much better and I also lost 43 pounds and I didn't do anything else.'"

Davis and others in the anti-wheat movement are changing the way people eat — 56 per cent of Canadians now report they're cutting down on foods such as bread, breakfast cereals, pastas and pastries. Gluten-free and wheat-free products are filling store shelves, with more than $6 billion in sales last year.

Kellogg's, the world's largest cereal maker, has seen its biggest drop in sales since the 1970s. Food companies are selling off their struggling bread divisions, while wheat sales are plummeting across Canada.

That's because millions of people are going wheat-free, influenced by best-selling health evangelists and celebrities who say wheat is responsible for everything from fat bellies to breast cancer to schizophrenia.

About one per cent of the population does get sick from eating wheat – people with celiac disease. Still others have allergies and sensitivities to wheat. But Davis insists wheat is dangerous for everyone, causing high blood pressure, heart diseases, dementia and cancer.

Anti-wheat claims questionable at best: critics

But the fifth estate's investigation found that experts in the scientific community say scientific claims made by the anti-wheat movement are questionable at best.

Joe Schwarcz, a chemist at McGill University dedicated to demystifying science and debunking big claims, says, "This is one of these arguments that has one smidgen of scientific fact to it, which is then exploded into a whole blob of nonsense."

Schwarcz says he hasn't seen any evidence that wheat has addictive properties, as Davis claims in his book. Schwarcz also says "opioid peptides" are produced when some foods are digested. But just because they can bind to opiate receptors in the brain doesn't mean they produce a morphine-like effect.

"If we're going to say that wheat is addictive," Schwarcz explains, "it's along the line that people like foods that have wheat in them. It's not a physical addiction."

It appears that Davis based this claim mainly on one study of rat brains, done on dead rats in 1979. The fifth estate could not locate any study on humans that conclusively proves wheat is addictive.

Davis also links wheat to mental illness such as schizophrenia. But the study he based his research on was conducted in 1966, and after almost 50 years of research, no one consulted by the fifth estate could point to any definitive study that specifically links wheat to schizophrenia.

What about Davis's claim that today's wheat is not wheat at all, but a "modern creation of genetics research"?

Researchers at the University of Saskatchewan have been studying the genetic profiles of 37 varieties of wheat grown in Canada since the 1800s, to discover if wheat's basic protein structure has been altered in any way.

Sask. study finds basic structure of wheat unchanged

Wheat geneticist Dr. Ravi Chabbar is heading up the Saskatchewan project and is paid to advise the grain industry, but this particular project is being funded by the federal government.

Dr. Chabbar says that over time, wheat has been modified to produce high-yield crops. But when it comes to wheat's proteins – gluten and gliadins – the basic structure of "ancient" and modern wheat is the same.

The Canadian Celiac Association, the American Heart Association, the Obesity Society and the American College of Cardiology all refuse to endorse gluten-free diets for anyone who does not have celiac disease.

But the fact remains that despite the vast majority of scientists and health organizations not supporting much of what Dr. Davis says, more and more people are giving up grains. There is continuous debate – in the media and around the dinner table – about who should be winning the war on wheat.

Yoni Freedhoff, a family doctor and diet expert who runs a nutrition clinic in Ottawa, says the eating guidelines touted in Wheat Belly are similar to other carb-free diets that get results by dramatically reducing the carbohydrates and calories people eat.

He argues that the difference here is Davis, not any miracle cure: "This just took it to another level with a very charismatic doctor, who has a presentation that to me is reminiscent of an evangelical preacher. You know, with 'You can be healed,' and away you go. And I think…it's what people want to hear. We want to believe in magic."

---

Watch The War on Wheat Friday at 9 p.m. (9:30 NT) on CBC's the fifth estate

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Vaping, smoking combo grows in popularity

No one knows if experimenting with e-cigarettes poses as much risk for addiction as experimenting with regular cigarettes. (Regis Duvignau /Reuters)

The first peek at a major study of how Americans smoke suggests many use combinations of products, and often e-cigarettes are part of the mix.

It's a preliminary finding, but it highlights some key questions as health officials assess electronic cigarettes.

"Are e-cigarettes a step toward a cigarette smoker getting off of cigarettes? Or are e-cigarettes a crutch so they can get nicotine in places and times when they wouldn't normally be allowed to smoke cigarettes?" asked Dr. Andrew Hyland of the Roswell Park Cancer Institute, the primary investigator for a huge government study of trends in smoking and tobacco use.

Hyland's study is one of a number of projects that scientists are watching as they explore the public health implications of e-cigarettes. Here are some things to know:

Multiple sources of nicotine

At a meeting of nicotine researchers late Thursday, Hyland presented preliminary findings from the first 20,000 people to enrol in the study, a baseline as the Food and Drug Administration and National Institutes of Health track how use of tobacco products, or alternatives like tobacco-free e-cigarettes, is evolving.

A fraction — 28 per cent of adults and nearly 9 per cent of youths — reported they currently use any type of tobacco product, Hyland said.

About 40 per cent of those current tobacco users report using two or more products. And half say battery-powered e-cigarettes are one of the multiple products they use, Hyland found. In fact, the most common combination was cigarettes and e-cigarettes.

Ultimately, the PATH study — it stands for Population Assessment of Tobacco and Health — will follow 46,000 people ages 12 and older over five years, a source of information as FDA decides how to regulate tobacco-related products.

Why extra interest in e-cigarettes?

Policymakers are debating the health effects of "vaping" as it grows in popularity. Many anti-smoking advocates consider e-cigarettes a safer alternative for smokers who can't or don't want to quit altogether.

E-cigarettes work by heating liquid nicotine into an inhalable vapour. They contain fewer toxic substances than burning traditional cigarettes. But health officials warn that they shouldn't be considered harmless and say much more needs to be known about long-term effects.

Critics ask if they keep smokers addicted or even act as a gateway to hook new users who eventually try tobacco.

Adults vs. kids

Concern about e-cigarettes grew after a different government study in December found some teens who'd never smoked a real cigarette were trying out the electronic kind.

"Is it a passing fancy or something that sticks with them?" Dr. Wilson Compton, deputy director of NIH's National Institute on Drug Abuse, said in an interview with The Associated Press. He hopes that over the next few years, the new PATH study will help tell.

The FDA has proposed regulating e-cigarettes, including banning sales to minors, a step that many states already have taken.

How much nicotine?

No one knows if experimenting with e-cigarettes poses as much risk of hooking someone as experimenting with regular cigarettes, Compton said.

Nicotine levels vary widely by type of e-cigarette, from small amounts to nearly as much as a traditional cigarette, he said. Users learn to puff a bit differently as they draw in vapour, and even the voltage in the device's wires may affect nicotine delivery, he explained. NIDA plans to fund development of what Compton calls a "standard e-cigarette" that will be a yardstick for comparison with the different e-cigarettes on the market.

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'It scares people off': Why Canada isn't ready to talk about ‘3-parent’ babies

A British parliamentary decision to approve a controversial fertility procedure that would produce so-called "three-parent babies" has captured the imagination of people who believe it could save lives.

But experts say that a fear about "designer babies" and the strict laws that govern reproductive technology in Canada have had a chilling effect on any discussion here about the procedure.

"I think part of the problem is that potential punishments are so severe that it scares people off," says Sara Cohen, a Toronto fertility lawyer.

"There's no conversation about this, there's none," Cohen said. "We're talking about a really significant topic medically. I think at the very least we should be having a conversation about it."

On Feb. 3, the U.K. parliament voted in favour of allowing clinical trials for Mitochondrial Replacement Therapy (MRT), which would prevent mothers who carry a specific type of Mitochondrial disease from passing it on to their newborns.

Dr. Mark Tarnopolsky, a medical professor at McMaster University in Hamilton and an expert on the disease, says the decision gives hope to mothers who carry it.

"These women have a potentially fatal disease," Tarnopolsky says. "They essentially have a Sword of Damocles hanging over their head with this disorder, where if they have a fairly high burden of the disorder, they are likely to pass it on to every subsequent offspring."

The two MRT procedures

Mitochondrial disease refers to a group of disorders affecting the mitochondria, which are tiny structures located within almost all cells of the body. The mitochondria act as the powerhouse of the cell by converting food and oxygen into energy.

According to MitoCanada, an organization that supports Canadians who suffer from the disease, 1 in 5,000 people have some form of it.

Treatment for the disease is limited and no known cure exists. Most children who have the disease do not live longer than their mid-teens.

The cause of the disease is a genetic mutation in the mitochondria itself. The mutation causes the mitochondria to stop producing energy, and when mitochondria cannot produce energy, cells fail and in turn the body's organs can fail, causing death.

Since 2008, scientists in the U.K. have researched two procedures to prevent this mutation from being passed on to newborns.​

One procedure involves removing the nucleus from an embryo containing the mutated mitochondria and transferring it to a donor embryo containing healthy mitochondria. The embryo is then implanted in the mother's uterus.

This graphic shows an embryo repair procedure where the DNA, or nucleus, of the embryo comes from the parents, while the cell and mitochondria come from the female donor. (CBC)

The other procedure is similar but involves transferring the nucleus from the mother's unfertilized egg to a donor's egg containing healthy mitochondria.​ The embryo is then fertilized and implanted in the mother's uterus.

This graphic shows how the DNA, or nucleus, of the mother's egg can be put into the egg of the female donor, who has healthy mitochondria. This creates an egg with the mother's DNA that is free of mitochondrial disease. (CBC)

​

Babies born from this procedure inherit 99.9 per cent of their DNA from the parents, with the other 0.1 per cent coming from the donor, according to a report from the U.K.-based think tank Wellcome Trust.

Legal concerns

At present, MRT remains illegal in Canada, under the Assisted Human Reproduction Act.

Passed in 2004, the legislation states no person can knowingly "alter the genome of a cell of a human being or in vitro embryo such that the alteration is capable of being transmitted to descendants."

It also states that any person found guilty of breaking the law can face fines of up to $500,000, or a jail sentence of up to 10 years, or both.

Because of this, many in Canada's scientific community want to take a wait-and-see approach with the British ruling, says Dr. Neal Mahutte, president of the Canadian Fertility and Andrology Society.

"Let's see what the results show in the next five to 10 years," Mahutte said. "At some point, people might be confident enough to say, 'Well, maybe we should start doing that in other countries.'"

Mahutte does believe that most fertility clinics in Canada would want the government to review the legislation as a whole. He says research in the field has evolved rapidly since 2004 and some other aspects of the legislation may also need updating.

Mahutte also says that some difficulty exists in communicating this to Health Canada, the ministry responsible for administering the legislation. This is partly because the ministry has been slow to reorganize ever since being given responsibility for the legislation in 2012.

"It's still very difficult to put forth any questions when they come up," Mahutte said.

The 'designer baby' fears

A specific ethical concern may also explain why the topic receives little discussion.

According to Health Canada's website, altering the genetic code of an embryo was made illegal to prevent so-called "designer babies." This term refers to babies created to have "specific genetic traits that the intended parent(s) consider to be desirable."

Video: MRT procedure

'3-parent' fertility treatment2:45

"I think the reality of what they're doing in the U.K. is so far removed from that," Mahutte says. "The mitochondrial DNA do not code for any traits at all."

Cohen feels that government tried to calm public fears that science would one day give parents the option of creating designer babies by outlawing any altering of the genetic code.

"We legislated before we were even there," Cohen said. "We legislated in concern of the potential of the worst possible science-fiction outcome that could exist one day."

Although provisions of the legislation may have discouraged debate on MRT, Tarnopolsky believes a dialogue about it will eventually begin in Canada.

"When a sophisticated first-world country like the U.K. deems this appropriate to move forward, I see no reason why that dialogue should not be open, and open soon, in Canada."

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Blood pressure treatment needs to go global

About 13 per cent of the 1 billion people with hypertension worldwide have it under control. (Thomas Kienzle/Canadian Press)

About 10 million heart attacks and strokes worldwide could be averted in a decade by treating high blood pressure in half of those who need it, two leading public health agencies say.

Hypertension or high blood pressure is the main risk for cardiovascular diseases such as heart and stroke that are responsible for one in three deaths worldwide, according to the U.S. Centers for Disease Control and Prevention.

In Thursday's issue of The Lancet, CDC director Tom Frieden and his colleagues wrote a commentary describing a treatment project for hypertension. It draws on how HIV and tuberculosis treatment were provided in poorer countries.

"Heart disease and stroke are silent killers — on a mass scale," Frieden said in a release.

To him, the question is how quickly can programs to tackle hypertension be established worldwide. While only 13 per cent of the 1 billion people with hypertension worldwide have it under control, treatments can be made relatively inexpensive even though most patients need two different medications for optimal control, the authors said.

The standardized treatment would include specifics on drug doses, involve doctors, community volunteers, pharmacists and nurses, reduce barriers for patients such as providing once-daily medications, and track progress.

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Failed abortion lawsuit launched against Ontario gynecologist

A former patient of a disgraced eastern Ontario gynecologist is suing him for $1 million over an alleged botched abortion.

Tania Brown of Carleton Place, Ont., has filed a statement of claim in the Ontario Superior Court of Justice in nearby Perth. She alleges Dr. Michel Prevost committed "gross negligence and medical malpractice" with respect to her failed abortion.

Brown claims on Oct. 4, 2011 she visited Prevost in Almonte, Ont., about 50 kilometres west of Ottawa, to undergo an abortion.

The statement of claim says Prevost aimed to complete a "chemical abortion" where he administers a combination of methotrexate and misoprostol to terminate the pregnancy. It alleges the doctor injected incorrect doses that led to a failed abortion.

Brown told CBC News she only realized the abortion failed four months later, and later carried the baby to term. She gave birth to a five-pound boy with fetal abnormalities, including a smaller brain and a hole in his heart, she added.

Brown later gave the boy up in an open adoption, her claim states.

None of Brown's allegations against Prevost has been proven in court.

Prevost's lawyer Karen Hamway said she would file an intent to defend, and later a statement of defence, on behalf of her client. She would not comment on the case any further.

On Feb. 2, Prevost resigned from practising medicine after the College of Physicians and Surgeons of Ontario found he was "incompetent in his practice of obstetrics and gynecology." 

Michel Prevost resigned as a doctor after the College of Physicians and Surgeons of Ontario found he was "incompetent in his practice of obstetrics and gynecology."

A medical inspector found Prevost "lacked knowledge, skill or judgment" in his treatment and care of 28 patients, according to a decision released by the college. That included two failed abortions that resulted in fetal abnormalities in pregnancies that went to term..

However, the college admitted it did not investigate whether or not the fetal abnormalities were caused by the medications.

In January 2013, Prevost voluntarily signed an undertaking to cease the prescription of methotrexate and misoprostol for the purpose of terminating pregnancies, according to the college.

Prevost has also signed an undertaking stating he would not reapply to practise medicine in Ontario, and he will never practise obstetrics or gynecology in any jurisdiction, the college said.

Brown's claim states the college informed her about their findings in December 2014, and she said she decided to seek legal counsel.

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Hamilton hospital live tweets Jerry Walczak's heart surgery

Live

The procedure was live Tweeted starting at 6 a.m.

CBC News Posted: Feb 27, 2015 8:37 AM ET Last Updated: Feb 27, 2015 10:27 AM ET

Jerry Walczak will undergo an aortic valve replacement and left atrial appendage occlusion at Hamilton Health Sciences. You can follow the procedure live here on Twitter. (Hamilton Health Sciences)

Jerry Walczak is undergoing heart surgery at Hamilton General Hospital Friday. The hospital began live Tweeting the procedure 6 a.m. Friday.

According to the Hamilton Health Sciences Twitter account Walczak, 59, is one of more than 1800 patients who will have heart surgery at the hospital this year.

Walczak's surgeon, Dr. Richard Whitlock says he has a blocked heart valve and the procedure will require doctors to "cut out his heart valve and sew in a new valve."

Walczak said he hopes the surgery will allow him to live for many more years. "With three daughters which are still relatively young hopefully I will be a grandfather one day... and not a grumpy one because my heart is going to be healthy," he said. "I can take their abuse."

​Here's a video Hamilton Health Sciences produced to introduce Walczak and the procedure he's having done Friday:

Cardiac Live Tweet from Hamilton Health Sciences on Vimeo.

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Vaping, smoking combo grows in popularity

No one knows if experimenting with e-cigarettes poses as much risk for addiction as experimenting with regular cigarettes. (Regis Duvignau /Reuters)

The first peek at a major study of how Americans smoke suggests many use combinations of products, and often e-cigarettes are part of the mix.

It's a preliminary finding, but it highlights some key questions as health officials assess electronic cigarettes.

"Are e-cigarettes a step toward a cigarette smoker getting off of cigarettes? Or are e-cigarettes a crutch so they can get nicotine in places and times when they wouldn't normally be allowed to smoke cigarettes?" asked Dr. Andrew Hyland of the Roswell Park Cancer Institute, the primary investigator for a huge government study of trends in smoking and tobacco use.

Hyland's study is one of a number of projects that scientists are watching as they explore the public health implications of e-cigarettes. Here are some things to know:

Multiple sources of nicotine

At a meeting of nicotine researchers late Thursday, Hyland presented preliminary findings from the first 20,000 people to enrol in the study, a baseline as the Food and Drug Administration and National Institutes of Health track how use of tobacco products, or alternatives like tobacco-free e-cigarettes, is evolving.

A fraction — 28 per cent of adults and nearly 9 per cent of youths — reported they currently use any type of tobacco product, Hyland said.

About 40 per cent of those current tobacco users report using two or more products. And half say battery-powered e-cigarettes are one of the multiple products they use, Hyland found. In fact, the most common combination was cigarettes and e-cigarettes.

Ultimately, the PATH study — it stands for Population Assessment of Tobacco and Health — will follow 46,000 people ages 12 and older over five years, a source of information as FDA decides how to regulate tobacco-related products.

Why extra interest in e-cigarettes?

Policymakers are debating the health effects of "vaping" as it grows in popularity. Many anti-smoking advocates consider e-cigarettes a safer alternative for smokers who can't or don't want to quit altogether.

E-cigarettes work by heating liquid nicotine into an inhalable vapour. They contain fewer toxic substances than burning traditional cigarettes. But health officials warn that they shouldn't be considered harmless and say much more needs to be known about long-term effects.

Critics ask if they keep smokers addicted or even act as a gateway to hook new users who eventually try tobacco.

Adults vs. kids

Concern about e-cigarettes grew after a different government study in December found some teens who'd never smoked a real cigarette were trying out the electronic kind.

"Is it a passing fancy or something that sticks with them?" Dr. Wilson Compton, deputy director of NIH's National Institute on Drug Abuse, said in an interview with The Associated Press. He hopes that over the next few years, the new PATH study will help tell.

The FDA has proposed regulating e-cigarettes, including banning sales to minors, a step that many states already have taken.

How much nicotine?

No one knows if experimenting with e-cigarettes poses as much risk of hooking someone as experimenting with regular cigarettes, Compton said.

Nicotine levels vary widely by type of e-cigarette, from small amounts to nearly as much as a traditional cigarette, he said. Users learn to puff a bit differently as they draw in vapour, and even the voltage in the device's wires may affect nicotine delivery, he explained. NIDA plans to fund development of what Compton calls a "standard e-cigarette" that will be a yardstick for comparison with the different e-cigarettes on the market.

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Quebec man still waiting after surgery rescheduled 4 times

Bruce Alan Gordon says he was in disbelief when he showed up at Cité-de-la-Santé Hospital in Laval for a scheduled surgery only to have it cancelled — four times.

Gordon, 61, says each time his surgery was cancelled it was because of an emergency at the hospital.

'I thought they were joking.'- Bruce Alan Gordon, patient whose surgery was cancelled 4 times

"We got there at 7:30 in the morning and they came to see me at five past noon. I thought they were joking," he said.

In preparation for his surgery, Gordon, who is diabetic, had taken pills, received injections and hadn't eaten since the day before.

"It's the mental preparation, the emotional preparation. The countdown is on, and you get to the last day and say 'Well, in another 12 hours I'll be there.' You psych yourself out."

Gordon faces challenges getting around — one of his legs was partially amputated because of complications from his diabetes. The surgery would enable him to receive dialysis treatments from home.

Cité-de-la-Santé Hospital told CBC it does not provide comment on individual cases, but said it is one of the busiest in the province.

Dr. Alain Goudreau, Cité-de-la-Santé's director of professional and hospital services and medical affairs,  said the hospital takes in nearly 200 emergency patients per day.

"Our goal at the hospital is to have a zero-rescheduling rate for surgeries. But if someone comes into the emergency department with a life-threatening condition, there's no way to tell how long that surgery will last. In that case, we postpone a scheduled surgery to the next available time that the surgeon is available," said Goudreau.

That's something that worries patients' rights groups.

""It's ironic because we have enough beds, we have enough rooms, but we don't have the staffing to take care of patients," said Paul Brunet, president of Conseil pour la protection des malades.

Gordon has been given yet another date for his surgery. He hopes this time his appointment in early March won't be postponed.

"In a hospital, there's always going to be an emergency. But if this keeps going on and on, maybe one day my case will be an emergency, where I'm going to have to go to the hospital in an ambulance," said Gordon.

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ADHD diagnosis can double risk of premature death, researchers say

People with attention deficit hyperactivity disorder are about twice as likely to die prematurely as those without the disorder, say researchers.

Researchers followed 1.92 million Danes, including 32,000 with ADHD, from birth through to 2013.

"In this nationwide prospective cohort study with up to 32-year followup, children, adolescents and adults with ADHD had decreased life expectancy and more than double the risk of death compared with people without ADHD," Soren Dalsgaard, from Aarhus University in Denmark, and his co-authors concluded in Wednesday's online issue of Lancet.

Actress Kirstie Alley holds a picture of Raymond Perone while testifying in favour of a bill designed to curb the over-prescribing of psychotropic drugs. Danish researchers studying ADHD say medications can reduce symptoms of inattention and impulsivity. (Phil Coale/Associated Press)

"People diagnosed with ADHD in adulthood had a greater risk of death than did those diagnosed in childhood and adolescence. This finding could be caused by persistent ADHD being a more severe form of the disorder."

Of the 107 individuals with ADHD who died, information on cause of death was available for 79. Of those, 25 died from natural causes and 54 from unnatural causes, including 42 from accidents.

Being diagnosed with ADHD along with oppositional defiant disorder, conduct disorder and substance use disorder also increased the risk of death, the researchers found.

Mortality risk was also higher for females than males, which led Dalsgaard to stress the need for early diagnosis, especially in girls and women, and to treat co-existing disorders.

Although talk of premature death will worry parents and patients, they can seek solace in knowing the absolute risk of premature death at an individual level is low and can be greatly reduced with treatment, Stephen Faraone, a professor of psychiatry and director of child and adolescent psychiatry research at SUNY Upstate Medical University in New York, said in a journal commentary published with the study.

Faraone noted two of the core symptoms of ADHD, inattention and impulsivity, would seem to be risk factors for accidents. A previous study by the Danish researchers suggested medications that reduce symptoms of inattention and impulsivity were associated with better performance in a driving simulator.

The editors of the Canadian Journal of Psychiatry argued there's been a "radical over-diagnosis" of mental illness and prescriptions compared with decades ago when treatment involved more psychotherapy.

Similarly, a commentary published in the Canadian Medical Association Journal said antipsychotic prescriptions to treat mood and behaviour disorders in children and youth has increased dramatically despite concerns about lack of efficacy and adverse events such as weight gain, diabetes and abnormal movements. It said the rise in prescriptions reflects complex societal, economic, political and cultural issues. 

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SAD no longer: Brilliant light cure for seasonal disorder

"As soon as December came around, I was moody, I always wanted to cry, I was feeling suicidal", says Grace Kaiche. "I slept a lot and didn't want to leave the house and I couldn't get most of my work done."  

Kaiche has been diagnosed with Seasonal Affective Disorder or SAD. At 26, she had suffered from SAD for two winters before discovering what for her has been a miracle cure.

SAD is a seasonal depression that hits a small portion of the population of the Northern Hemisphere, disproportionately women, during the darker winter months.

Up to four per cent of Canadians,or as many as 140,000 people, are clinically depressed during the winter, says Dr. Robert Levitan, a psychiatrist at the Mood and Anxiety Disorders Clinic at the Centre for Addiction and Mental Health (CAMH) in Toronto.

Levitan says 80 per cent of SAD sufferers are women between the ages of 18 and 45. About half of those would have this severe form of seasonal depression. Canadian winters can affect up 15 per cent of people with a milder form of SAD known as subsyndromal SAD. The rest of us might silently suffer through a case of what's commonly called the winter blues or winter blahs.

Dr. Robert Levitan, a psychiatrist at the Centre for Addiction and Mental Health (CAMH) in Toronto, recommends light therapy to combat SAD. (Manmeet Ahluwalia/CBC)

For those who are clinically depressed, Levitan has been prescribing light therapy based on his many years of research – and for Grace Kaiche, the results are brilliant.

Every morning now she sits for half an hour in front of her high-intensity ultraviolet-filtered bright-light unit on loan from CAMH. Eight weeks after first trying bright-light therapy she says, "It literally rescued me. It really surprised me that a light box could make such a big difference in my life."

'This light is like magic'

Kaiche adds, "From the very first day I felt a change. I've started going to the gym again.  Now I get excited to use the light therapy because I know that my energy level will increase and my negative thoughts will disappear."  

She adds, "This light is like magic."

When Kaiche became so depressed in winter, she would not have guessed that her lethargic mood might have been a survival tactic of our evolutionary past.

Levitan and other scientists who study mood disorders believe that SAD really is a vestige of our cave-dwelling ancestors.  

"We think that Seasonal Affective Disorder is something in our genes from our past and in modern society it becomes a nuisance at best, and in severe cases quite a serious problem that requires urgent treatment."

He explains: "Conserving energy and protecting ourselves during the ice age when food resources would have been sparse used to be very adaptive and helpful to our ancestors, especially women in their child-bearing years."

But how could something that once helped humans survive through long harsh winters become a debilitating disorder for some people today?

Levitan, who is also a University of Toronto professor and a light therapy pioneer in Canada, says,  "We're prolonging our work day far beyond where nature would permit it."

The mood change has to do with our circadian rhythms, he says. 

"We are affected by having to remain productive in the decreased hours of sunlight. In our distant past we'd be hibernating", says Levitan. "We really are just animals."

Suicidal thoughts

Kaiche was feeling more and more like acting on her suicidal thoughts when she went to her family doctor, who prescribed an anti-depressant.

"I was worried about the side effects of mood-altering drugs," says Kaiche, but she tried them anyway and found they didn't really work for her.

Then she found Levitan and his clinic at CAMH. Kaiche became a subject in an ongoing study about light therapy and winter depression.  

Her experience with light therapy is backed up through scientific research. Levitan was co-author of a large study that found "over time the chance of responding to light was exactly the same as responding to medications." 

The study also found light therapy tended to work immediately, with fewer adverse side effects.

Levitan says that by April or May the longer daylight hours usually will help patients feel completely normal again.

During Kaiche's last session, Levitan advises her to monitor her progress. "I think it's just a matter of continuing through the winter, probably until the end of March or so, and then starting again next fall and you should be fine."

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Ebola-recovered doctor in New York blames fear mongering for poor response

Dr. Craig Spencer, the first Ebola patient in New York City, says his activities before he was hospitalized were widely reported and criticized, but little attention was paid to the science of disease transmission. (Richard Drew/Associated Press)

A doctor who contracted the deadly Ebola virus and rode the subway system and dined out before he developed symptoms said the media and politicians could have done a better job by educating people on the science of it instead of focusing on their fears.

"When we look back on this epidemic, I hope we'll recognize that fear caused our initial hesitance to respond — and caused us to respond poorly when we finally did," Dr. Craig Spencer wrote in an article published Wednesday in The New England Journal of Medicine.

Spencer, an emergency room physician, was diagnosed with Ebola on Oct. 23, days after returning from treating patients in Guinea with Doctors Without Borders. His was the first Ebola case in the largest U.S. city, spurring an effort to contain anxieties along with the virus. He was treated at a hospital, recovered and was released on Nov. 11.

News of Spencer's infection unnerved some New York residents, particularly after they learned that he rode the subway system, ate out and went bowling in the days before he developed a fever and tested positive.

Spencer said little attention was devoted to the fact the science of disease transmission and the experience of previous Ebola outbreaks suggested it was "nearly impossible for me to have transmitted the virus before I had a fever."

"Meanwhile, politicians, caught up in the election season, took advantage of the panic to try to appear presidential instead of supporting a sound, science-based public health response," he said.

After Spencer's diagnosis, New York Gov. Andrew Cuomo and New Jersey Gov. Chris Christie announced mandatory 21-day quarantines for travellers who have come in close contact with Ebola, which has infected more than 14,000 people in West Africa and has killed more than 5,000.

Cuomo and Christie called federal health guidelines inadequate when they announced their quarantine plans.

But the governors, Spencer said, did not "sufficiently consider the unintended side-effects."

The threat of quarantine may cause sick people to defer seeking treatment or cause health care responders returning from affected countries to "alter their travel plans or misreport their exposure to avoid quarantine," said Spencer, whose treatment included a transfusion of blood plasma from another Ebola survivor.

"We all lose when we allow irrational fear, fueled in part by prime-time ratings and political expediency, to supersede pragmatic public health preparedness," Spencer wrote.

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Diet research built on a 'house of cards'?

The next time a headline about diet and disease catches your eye, check the fine print of the study.

If it is based on a food questionnaire — and there's a good chance it will be — then the conclusions should be handled with caution.

'We're talking about hundreds if not thousands of papers published every year.' - David Allison, University of Alabama at Birmingham

That's because people don't tell the truth, not even to scientists.

Scientists know this. Research has proven it. It's been an awkward problem in nutrition science for more than 40 years.

And that's long enough, according to an international group of nutrition researchers. They've launched a campaign to end the use of one of the most common research tools in nutrition science.

"All of these studies, if they are based on self-report estimates of energy intake, really don't contain scientifically meaningful information," said David Allison, a prominent obesity researcher at the University of Alabama at Birmingham and lead author on a report signed by 45 scientists from around the world.

This matters, the expert group warned, because the flawed data could result in public health policies that are not science-based, but built on a "house of cards," Allison said.

"We're talking about hundreds if not thousands of papers published every year."

Asking who ate what, and when

Is a high-fat diet linked to breast cancer?  Do fruit and vegetables protect against Alzheimer's disease?  How much of obesity can be explained by eating too many calories?

To get those answers, scientists need to gather data about who ate what, and when. So they ask research subjects to self-report, to think back, sometimes over months and years, and fill in a detailed food questionnaire about what they ate.

Other studies ask people to keep food diaries. And sometimes the researchers do random spot checks, calling subjects and asking them to remember everything they've eaten for the last 24 hours. 

'The correct answer is that, on average, obese people eat more than non-obese people. The wrong result was found and that confused the field for many years by relying on self-report.'- David Allison

But because humans are very bad at admitting or remembering what they ate, all the self-reported methods have shown evidence of bias.

For years, scientists were puzzled by paradoxical findings that obese subjects were eating fewer calories than people of normal weight.

"That was completely wrong," Allison said. "The correct answer is that, on average, obese people eat more than non-obese people. The wrong result was found and that confused the field for many years by relying on self-report."

There's also a tendency for research subjects to tilt their dietary recall towards healthier behaviour.

What about a recent study concluding that Americans are eating fewer calories?  It was based on self-reported data.

"We can't say they're wrong, they could be right. We don't know and, frankly, they don't know. And no one can know because we don't have the legitimate information," Allison said.

He admits the group is taking a controversial stand that has sparked mixed reaction from the nutrition science community.

'A refreshing point of view'

"It varies a lot with who you ask," Allison said. "Much of the scientific community applauds us and says it's a refreshing point of view."

"And as you might expect, some individuals who have based much of their research career and program on the use of these methods say we can't abandon them because in part we don't have anything better."

Marian Neuhouser of the Fred Hutchinson Cancer Research Centre in Seattle, who has done some of the research that has exposed the bias in self-reported data, agrees the data is flawed. But she says if researchers perform a backup biomarker study they can correct for some of those biases.

Biomarker studies using urinalysis are accepted methods of accurately measuring energy intake. But that requires research subjects to be brought into a lab for a urine test. Researchers say that's too expensive and impractical for large-population studies.

Considering the obesity epidemic and the level of chronic disease, surprisingly little work is being done to improve methods, said Ross Prentice, a professor of biostatistics at the Hutchinson Centre.

Technical solutions being considered include chin-mounted "chew monitors," or wrist monitors that measure hand-to-mouth movements.  Some have suggested using smart phones to take photographs of food.

Allison prefers a biologically based approach, perhaps a test of breath or urine for products of digestion, which does not depend on the honour system and the fallibility of human memory.

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Wanuskewin chef incorporates local ingredients into diabetic-friendly menu

The chef at the Wanuskewin Heritage Park Restaurant is working to address health issues by creating a menu of delicious, but healthy foods.

One of the ways Chef Ryan Young is doing that is by cutting out prepackaged foods and making nearly everything from scratch from locally sourced ingredients.

"You buy local, you support local, and that on its own is a healthy trend," said Young, who runs the kitchen on the edge of Saskatoon.

Ryan Young is the executive chef at the Wanuskewin Heritage Park Restaurant. (Rachel Bergen/CBC News)

Part of the reason Young is so invested in creating a healthy menu for the customers is his own personal health. He's a Type One, insulin-dependent diabetic.

"Seeing people come out and not eating healthy and not eating the way they need to be eating sort of spurred not only my ideas of how I should be eating but at the same time, knowing what they need and being able to give them the option to have it," he said. 

Young said he's taken steps to make dishes diabetes-friendly. He uses less refined sugar in food and more whole grains. One of the biggest changes he's made is prioritizing local ingredients and making food from scratch.

Young said there is a misconception that healthy food is flavourless and boring, and that's not true.

"That's a big goal of mine, to say that great food and great health can go at the same time, and on the same plate," he said. 

Moving forward, Young said he hopes to build a greenhouse at Wanuskewin within the next two years.

Young sent this recipe into CBC News. Bon appétit! 

---

2 teaspoons of canola oil

1/2 cup of wild rice

1/2 cup of quinoa

​1/2 cup of red lentils

1 cup of chickpeas

1 apple, diced to a medium size

1 onion, diced finely

4 stalks of celery, diced finely

1 red bell pepper, diced finely

1 orange, zested.

1/2 cup of orange juice

6 cups of vegetable or chicken stock

Directions: Heat the pan with the first nine ingredients. Once it smells like toasted nuts, add the orange zest, juice, and soup stock. Cook for 45 minutes to one hour. Strain and serve warm.

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Measles vaccinations urged in Europe amid outbreaks

Travel-related measles cases will continue to occur in Canada, health authorities say. (Eric Risberg/Associated Press)

Measles vaccinations need to be immediately stepped up in all age groups, the World Health Organization's European office urged Wednesday after the region recorded 22,000 cases since the start of 2014. 

Both eastern and western Europe continue to experience large outbreaks.

Since the beginning of last year, cases include:

• Kyrgyzstan —7, 477.

• Bosnia and Herzegovina — 5340.

• Russian Federation  — 3,247.

• Italy   — 1,674.

• Germany  — 583.

WHO's European director Zsuzsanna Jakab said she was "taken aback" by the numbers.While cases in Europe and Central Asia fell by half from 2013 to 2014, the infections threaten the goal of eliminating measles there this year. 

"We must collectively respond, without further delay, to close immunization gaps," Jakab said in a statement. "It is unacceptable that, after the last 50 years' efforts to make safe and effective vaccines available, measles continues to cost lives, money and time."

Measles outbreaks continue to occur in Europe, WHO said, because there are pockets of susceptible people who aren't immunized or aren't fully protected by vaccination.

Earlier this week, health officials in Berlin announced a toddler died of measles. In calling for increased efforts to vaccinate children, Health Minister Hermann Groehe said authorities might consider making the shots mandatory. 

Travel also increases the risk of exposure to the highly infectious disease, which spreads in populations who are not vaccinated, public health authorities say.

Public health measures to control outbreaks also include improved surveillance to detect and investigate suspected cases, rapid testing of cases and a search for links between cases to prevent spread.

In 2014, the United States had its highest number of cases in two decades. Currently, more than 150 people have been infected, including many linked to a wave of illness that authorities believe was sparked when an infected person from out of the country visited Disneyland in late December 2014.

Lab tests show some Canadian cases of measles are related to the strain circulating in the U.S. and others are not, the Public Health Agency of Canada says. The agency calls measles relatively rare in Canada thanks to high immunization rates, adding travel-related cases will continue to occur.

Most people recover from measles within a few weeks. The infection can be serious, commonly causing diarrhea and pneumonia, and in rarer cases encephalitis and death.

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3 Austrian men 1st to get bionic hand reconstructions

Milorad Marinkovic says the bionic hand has allowed him to hold things like a sandwich or bottle of water, and more importantly, to play with his three children. (Ronald Zak/Associated Press)

Three Austrians have replaced injured hands with bionic ones that they can control using nerves and muscles transplanted into their arms from their legs.

The three men are the first to undergo what doctors refer to as "bionic reconstruction," which includes a voluntary amputation, the transplantation of nerves and muscles and learning to use faint signals from them to command the hand.

Previously, people with bionic hands have primarily controlled them with manual settings.

"This is the first time we have bionically reconstructed a hand," said Dr. Oskar Aszmann of the Medical University of Vienna, who developed the approach with colleagues. "If I saw these kinds of patients five to seven years ago, I would have just shrugged my shoulders and said, 'there's nothing I can do for you.'"

He said while some patients might be candidates for a hand transplant, that has its own complications, including having to take anti-rejection medicines for the rest of their lives.

Aszmann and colleagues described the cases of the three men in a report published online Wednesday in the journal Lancet. The men decided on amputation only after having the bionic hand strapped onto their injured hand, to see how the robotic one might function.

For Milorad Marinkovic, 30, who lost the use of his right hand in a motorbike accident more than a decade ago, the bionic hand has allowed him to hold things like a sandwich or bottle of water — and more importantly, to play with his three children.

"I can throw things, but it is harder to catch a ball, because my right hand is still not quite as quick and natural [as my left]," said the Vienna based-clerk.

Dr. Simon Kay, who authored an accompanying commentary and performed Britain's first hand transplant, said there would always be major limits to bionic hands. He pointed out that the brain has thousands of ways to send messages to the human hand but that a robotic prosthetic can't handle such complexity.

"The question is always going to be: How do we get the message from the mind to the metal?" he said.

Patients like Marinkovic, however, have few complaints about the bionic hand, which proved especially popular with his son. When he first got the device, his son, then 4, would put on the bionic hand and proudly walk around with it, telling the other kids in his kindergarten class that "my father is a robot."

Marinkovic says using his bionic hand is nearly as natural as using his uninjured hand.

"I can do almost everything with it. I just don't have any feeling in it."

An unrelated study published last year gave patients some feeling in a prosthetic hand by relaying signals to the brain in a temporary experiment and other replacement hands can do things like grip objects but are controlled externally.

Aszmann estimated the new procedure costs around 30,000 euros ($33,960 US). The study was paid for by groups including the Austrian Council for Research and Technology Development and a laboratory which receives funds from Otto Bock, maker of the prosthetics used.

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Florida ‘doctor’ who treated aboriginal girls with leukemia ordered to ‘cease and desist’

Brian Clement, the director of the Florida health spa that treated Makayla Sault and another First Nations girl suffering from leukemia, has been ordered to stop practising medicine without a licence and fined for representing himself as a medical doctor. 

In documents obtained by CBC News, Florida's Department of Health say they have probable cause to believe the director of the Hippocrates Health Institute treated two children battling leukemia "with unproven and possibly dangerous therapies."

In July, 11-year-old Makayla Sault attended the Hippocrates Health Institute after leaving chemotherapy at McMaster Children's Hospital in Hamilton.

Makayla Sault, 11, died last month after a relapse of leukemia. She attended the Hippocrates Health Institute after leaving chemotherapy treatment last year.

Makayla died last month, after suffering a relapse of leukemia. Her death is currently being investigated by Ontario's coroner's office.

J.J.  is another 11-year-old girl with leukemia who left chemotherapy to attend the Hippocrates institute last August. Her identity can't be revealed because of a publication ban.

Her mother told CBC News that she was convinced her daughter should abandon chemotherapy after speaking with Clement.

"By him saying, 'Oh yes, no problem we can help her,' that's the day I stopped the chemo."

Clement denies having said this to the girl's mother. 

''They would use the word cure. 'We're going to cure your illness,'"- Steven Pugh, former nurse at Hippocrates Health Institute

She says J.J. was treated with laser therapy, vitamins administered intravenously and a strict raw food diet that she was advised to maintain for two years.

A letter from Florida health authorities hand-delivered to Clement and dated Feb. 10, 2015, orders him to "cease and desist" and accuses him of misrepresenting himself as a medical doctor. Clement has been ordered to pay a fine of $3,738 US and was given 30 days to respond. 

The investigation is continuing and the Department of Health warns, "This citation does not prevent other administrative, civil or criminal prosecution."

Practising medicine without a licence is a felony in Florida, and if convicted Clement could face a range of penalties including jail time.

Former employees suing Clement

CBC News has spoken to former employees who are pursuing legal action against Clement. Steven Pugh worked as a nurse at the Hippocrates Health Institute and claims he was fired for speaking up about Clement practising medicine, including prescribing treatments to patients facing serious illnesses. 

He says he was concerned that Clements, and his wife, Anna Maria, were giving false hope to patients.

"They would use the word cure. 'We're going to cure your illness,'" Pugh says.

Brian and Anna Maria Clement are co-directors of the Hippocrates Health Institute in Florida. (Hippocrates Health Institute)

​Hippocrates is licensed as a "massage establishment," and neither of the Clements is a licensed medical doctor, though both have referred to themselves as doctors with clients.

Prior to CBC's investigation, the Clements used "Dr." to describe themselves on the institute's website, but have since deleted those titles.

Degrees from 'diploma mill'

Clement claims to have a doctorate of naturopathic medicine and a PhD in nutrition from the University of Science Arts and Technology (USAT), based in Montserrat.   

However, USAT president Orien Tulp said, "Brian Clement, he is not a naturopathic doctor from USAT. I can guarantee that. He shouldn't be making false claims for one. If he is, I'll withdraw his degree."

George Gollin, a professor at the University of Illinois who has investigated USAT, calls it a diploma mill.

"It's horrible," Gollin says. "I could have printed him a degree on a laser printer and it would be … just as indicative of training and skills. What I think is terrible is that he's using this, as I understand it, to treat patients who are desperately sick children."

Do you have more information about this story? Contact connie.walker@cbc.ca and/or marnie.luke@cbc.ca

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Peanut allergies can be reduced in high-risk children, study suggests

Peanut allergies were substantially less likely to develop among children at high risk if they ate snacks containing peanut butter early in life compared with those who stayed clear of it, a large new randomized trial suggests.

The prevalence of peanut allergies has grown in North America, Western Europe and Australia to between 1.4 to three per cent and is on the rise in African and Asian countries. Peanut allergies can cause reactions ranging from hives and abdominal pain to life-threatening anaphylaxis.

Doctors have looked to randomized trials for guidance on when the best time is to introduce peanuts. Monday's issue of the New England Journal of Medicine provides some answers.

"Our findings showed that early, sustained consumption of peanut products was associated with a substantial and significant decrease in the development of peanut allergy in high-risk infants," pediatric allergy Prof. Gideon Lack of King's College London and his co-authors concluded.

The study included 640 infants with severe eczema, egg allergy or both, which put them at high risk of developing a peanut allergy. They had standard skin-prick tests to check for peanut sensitivity and were then assigned to eat a peanut-containing snack at least three times a week or to avoid peanuts until five years of age.

Eating snacks with peanuts was associated with an 86 per cent reduction in peanut allergies at 60 months among those who tested negative on the peanut skin-prick test initially — 13.7 per cent versus 1.9 per cent.

'She started with redness and swelling and I knew at that point something was terribly wrong.'- Christina Fiorini

Dr. Hugh Sampson of the Icahn School of Medicine at Mount Sinai in New York wrote a journal editorial published with the study. Sampson said he considers the study to be a landmark because it answers the question of cause and effect and could lead to a significant decrease in peanut allergies in the population.

Questions remain, Sampson said, such as:

• Will lesser amounts of peanut suffice?
• Will tolerance last if children stop consuming peanuts regularly?
• Can the findings be applied to other allergy-provoking foods, such as milk, eggs and tree nuts?
• What do the findings mean for children who aren't at high risk?

Dr. Susan Waserman, an allergist and immunology at McMaster University in Hamilton, is conducting a similar clinical trial in children aged five to 10, which also includes a placebo.

"I think that we've had some idea about this for the past few years when all the avoidance we've been recommending seemed to make no difference. This study now nails it down I think in quite an impressive fashion that early introduction appears to be helpful," Waserman said.

"If I do have a family where this is a child who is at high risk because of eczema, because of another sibling with peanut allergy, because of allergic parents my advice would be to introduce peanut early."

While the discovery has the potential to become widespread, Waserman cautioned people to speak with their doctor first.

Christina Fiorini of Woodbridge, Ont., has a nine-year-old daughter, Katarina, with an anaphylactic allergy to peanuts, lobster, crab and shrimp. Fiorini discovered the peanut allergy when Katarina was two, and came into contact with peanut butter.

"She started with redness and swelling and I knew at that point something was terribly wrong. I went for the Benadryl as I called 911," Fiorini recalled.

"When the ambulance care workers got there, she had blown up. She had swelled significantly. The redness was out of control."

While Fiorini thinks it's best to expose a child early on, fears of that day still haunt her and make her reluctant to expose her sons, Christian, 7, and Leo, 19 months, to peanuts.

"We see Christian and Katarina's allergist and asthma specialist regularly and we always have this conversation. I always leave the office saying 'Yes, I'm going to.'" It hasn't happened yet.

The new findings were also presented Monday at the annual meeting of the American Academy of Allergy, Asthma and Immunology. At the meeting, Sampson presented his results on using a patch to deliver small doses of peanut protein to increase tolerance in people aged six to 55.

Lack's study was funded by U.S. National Institute of Allergy and Infectious Diseases, Food Allergy and Research Education, Medical Research Council and Asthma U.K., U.K. Department of Health, National Peanut Board and the United Kingdom's Food Standards Agency.

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Mystery measles in Ontario came from unknown origins

The measles strain infecting people in Ontario is one that hasn't been previously identified, and so far its origins remain mysterious.  

The origin of the measles cases in Ontario remain a mystery, but they are of a strain not previously seen in Canada. (U.S. Centre for Disease Control and Prevention)

Scientists at the National Microbiology Laboratory in Winnipeg have received nine strains from Ontario with the same genotype, said Matthew Gilmour, the lab's scientific director general.

"It's not to imply this is a new strain in Canada. Just one that hasn't been identified yet," Gilmour said Monday.

The public health investigation needs to continue to complete the puzzle.

The laboratory has confirmed the nine strains from Ontario all bear the D4 genotype, a trait that's similar to but not identical to one in Europe, Gilmour said.

"If you have an exact match to a genotype in another country, the epidemiological information reveals the person travelled to that country, that's when the puzzle starts to come together."

To confirm the history of an outbreak requires two pieces: the genotype and a link to the originating location, such as a travel history.

What the genotype sequencing information eliminates is the possibility Ontario's cases are connected to the Disneyland outbreak in California, which has been confirmed as the source in Quebec's Lanaudière region, northeast of Montreal.

It also helps to rule out the possibility that this measles strain was introduced twice to Ontario by people travelling to the province independently of each other from different places.

"The fact they are related to each other brings you back to you've had some introduction of a virus into the system and now it's spreading locally," said Dr. Michael Gardam, an infectious disease specialist at Toronto's University Health Network.

"What it does is it makes you ask more questions. You've got a strain that isn't related to anything else, so this is entirely a mystery as to where it came from. I think that's the really perplexing part of this."

It may be that the virus came from a part of the world that lacks the sophisticated ability do this type of viral sequencing, Gardam said. If so, the mystery may never be solved.

But in public health terms, the lab sequencing findings don't change anything. Each measles case still needs to be followed and the vaccine offered to prevent spread, he said.

In hospitals, genome sequencing information "tends to blow up your preconceived notions" Gardam added, and serves as a reminder to check assumptions.

Measles is a highly contagious, vaccine-preventable disease. Symptoms develop about 10 days after exposure and include fever, a red blotchy rash, red watery eyes and white spots in the mouth.

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Pro-anorexia, bulimia communities thriving online

Photos of emaciated women proudly displaying their protruding hips and ribs, as well as thinspirational quotes "fat-shaming" those who dare to eat, continue to thrive on social media, despite the best attempts by sites like Instagram to temper the reach of the pro-eating disorder community. 

Some girls gain thousands of followers posting pictures of "thigh gaps" and "bikini bridges," as well as underweight celebrities and thinspirational quotes like model Kate Moss's mantra: "nothing tastes as good as skinny feels."

"It just provides a lot of positivity for them, just in a very maladaptive way," says Edward Selby, of the more visual outlet that sites like Instagram provide.

An assistant professor of clinical psychology at Rutgers University in New Jersey, Selby is the director of a lab there that studies what makes people more likely to develop anorexia (self-starvation), bulimia (binge-eating and purging) and other eating disorders.

About one in 20 young women in Canada has an eating disorder, according to the Toronto-based National Initiative for Eating Disorders.

And people suffering from these diseases often feel good after exercising, purging, swallowing a laxative or doing other things that contribute to their illness, Selby says.

They get caught in a "cyclic feedback loop," with the positive emotions pushing them to engage more in these risky behaviours.

Online pro-anorexia and bulimia communities simply add to that loop by celebrating a person's unhealthy achievements, he says.

The #thinspo world

'It would help me in my eating disorder, like in the most negative way.'- Antonia Eriksson

"Finally under 130! Woohoo!" writes one user with a photo of her feet on a scale. "Yay congrats," reads a response.

Another girl posts a screen grab from an app claiming that she's been fasting for more than a day. It receives 32 likes and a "great job" among the comments.

Some also leverage likes, retweets and comments to set rigid rules about eating and exercise. "Name a food and I won't eat it for two weeks," reads one user's Instagram photo. Another user posts an intricate workout list; for each share, she'll do one set of those exercises.

Not all accounts appearing to promote pro-eating disorder content identify as such, of course. Some post disclaimers denying the association.

Antonia Eriksson posted this photo to her Instagram account shortly after being admitted to hospital for an eating disorder in September 2012. She started an Instagram account then to chronicle her recovery. (Antonia Eriksson/Instagram)

​Antonia Eriksson, a 20-year-old student living in Linköping, Sweden, perused some of these "thinspirational" accounts nearly three years ago when she was struggling with an eating disorder.

"They're really dangerous," she says. Eriksson is now in recovery from anorexia, and runs an Instagram account and blog focused on fitness and healthy eating. But back then, she was easily triggered into unhealthy behaviour by those images.

"It would help me in my eating disorder, like in the most negative way... It would keep me sick," she says.

When she was hospitalized for anorexia in September 2012, she deleted all those accounts from her Instagram feed.

But while she managed to completely break from viewing all this the pro-eating disorder content, she says it can be easy for people to "get stuck" in the #thinspo world.

More than 100,000 visitors to one pro-ana site

Instagram isn't the first online space on which the pro-anorexia and pro-bulimia community converged. They started springing up as websites and on LiveJournal, an online diary platform launched in 1999.

Dr. Rebecka Peebles, co-director of the Eating Disorder Assessment and Treatment Program at The Children's Hospital of Philadelphia, has been studying pro-anorexia sites for more than a decade.

In 2010, she published an analysis of what's found on more than 200 of these sites — one of which, she says, has more than 100,000 visitors.

Most of the websites her team studied showcased thinspirational images or writing, like the so-called thin commandments, to encourage weight loss and disordered eating. While most offered dieting and fasting advice, nearly half offered tips and tricks specific to disordered eating.

British model Kate Moss is often quoted in the thinspirational community after saying, 'nothing tastes as good as skinny feels.' (Jonathan Short/Invision/The Associated Press)

Those types of websites still exist, but the community has since expanded onto social media. Tumblr, Twitter, Instagram and YouTube all have pro-anorexia and pro-bulimia content that is "very, very similar" to the sites Peebles studied.

In 2012, Instagram attempted to curb the community's growth by banning #thinspiration, #probulimia, #proanorexia and other hashtags that glorify self-harm. It also threatened to disable those accounts. But people simply tweaked their hashtag use, relying on more neutral ones (#anorexia, #bulimia, #anagirl) or ones with altered spelling (#thinspooooo, #thygap).

Now, a quick warning about graphic content pops up if someone clicks onto a troublesome hashtag, and users can opt to view the #thinspooooo or be re-directed to the National Eating Disorders Association.

Tumblr, Facebook and Pinterest have also attempted to circumvent users' access to material that promotes self-harm.

#ANAwarriors promote recovery

Peebles has "mixed feelings" about shutting down the sites because much of their content is similar to what shoppers can see on the covers of tabloids at a grocery store checkout.

Additionally, not all the content is inherently negative, she says. Her study found that nearly 40 per cent of the sites included pro-recovery information. Many of the troubling Instagram posts also include pro-recovery tags: #EDrecovery, #ANAwarrior, #BeatANA.

She believes that reflects the nature of the disease. "Part of you wants to get better, and part of you wants to stay sick."

Eriksson was once an #ANAwarrior. She started an Instagram account, which has since grown to nearly 40,000 followers, the day before she was hospitalized to document her six-week in-hospital treatment and recovery.

What she calls her Instagram family helped motivate her recovery. "I wanted to show them that it was possible," she says. "So I just kept fighting it."

As she got stronger and healthier, she changed her account name to eatmoveimprove and now posts pictures of #fitspo or fitness inspiration: fruit-filled oatmeal bowls, selfies with flexed, toned muscle and inspirational quotes.

#Fitspo and orthorexia

Ericsson's and other fitspo accounts are often criticized for promoting another rigid standard of beauty. She says she is often asked about orthorexia, an obsession with healthy eating, but refutes accusations that she's crossed over to the opposite end of the eating disorder spectrum.

'If we were helping them effectively, I think the websites would be a lot less intriguing to them.'- Dr. Rebecka Peebles

She preaches balance: working out for the love of it and nourishing your body to give it energy.

She allows herself to give in to treat cravings, with the occasional Ben & Jerry's ice-cream or slice of pizza.

She acknowledges having bad days and openly discusses them on her blog.

"Today, I deal with my feelings," she says. "Food and anxiety are not connected today. Workouts and anxiety are not connected today."

Selby says health-care professionals can be concerned about recovering anorexics developing orthorexia.

Many with the disease view it as "kind of a friend" he says, and doctors haven't come up with a great answer for how to help them replace it as they move closer toward a healthy weight. He believes it's important to help patients apply the skills that made them successful at weight loss to a healthier, more productive activity.

'Walking wounded' left undiagnosed

Peebles is more concerned about the large eating disordered population that doctors aren't even working with.

One of her studies found that the majority of people frequenting pro-anorexia and pro-bulimia sites had a healthy body mass index (a way doctors measure a person's body fat by using height and weight). Out of more than 1,200 people surveyed, 54 per cent fell within a healthy BMI range. About 21 per cent were overweight or obese.

Despite not being underweight, these people "scored out of the stratosphere" for disordered eating behaviours, says Peebles. Nearly three-quarters of the respondents had purged, binged or used a laxative to help them lose weight.

This means physicians are missing identifying those with eating disorders among seemingly normal, overweight and obese populations, she says.

"Who are the walking wounded with these illnesses that ... are all among us and we're not identifying and helping them?" she asks. "If we were helping them effectively, I think the websites would be a lot less intriguing to them."

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Quebec measles cases jump to 19 in Lanaudière region

Another Quebecer has contracted measles, according to the department of public health in the Lanaudière region, just northeast of Montreal.

The person visited a Rogers store at the Galeries Joliette shopping mall during the incubation phase, meaning he or she was highly contagious at the time.

The person was unvaccinated, but the public health department says it's possible it's not linked to the previous cases in the Lanaudière region.

Public health authorities are asking people who went to the Rogers store at Galeries Joliette between Feb. 12 and 19 to call 450-755-2111 ext. 2404 or report to the CLSC on Sunday or Monday.

Earlier in February, 10 unvaccinated people living in the Lanaudière region were diagnosed with measles after a trip to Disneyland.

There are now 19 declared cases of measles in the region.

Public health department spokeswoman Pascale Lamy said there were eight cases of measles in the Lanaudière by Feb. 3. That number jumped to 10 on Feb. 11, and then again to 18 within the last couple of days. 

She said some of the 19 have since been cured.

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Sick and tired: Institute of Medicine proposes new diagnostic criteria for chronic fatigue syndrome

If you can't pronounce myalgic encephalomyelitis (ME), you may be in the company of some health-care professionals: Information about the condition, commonly called chronic fatigue syndrome (CFS), is included in fewer than one-third of medical school curricula around the world.

The public has questioned the disease's legitimacy, and so far, it is impossible to identify by medical testing: Some wait years to find out why they are too tired to lift their arms to wash their hair in the shower or get out of bed in the morning.

But following an Institute of Medicine (IOM) committee report, those aspects of ME/CFS could change for Canadians who suffer from it.

Statistics Canada reports that number to be 400,000 and growing.

The IOM report, which was released to the public on Feb. 10, is complete with recommendations for new diagnostic criteria for ME/CFS.

It even includes a proposed new name: Systemic exertion intolerance disorder, or SEID.

"They're trying to make it easier to tag people," said CBC house doctor Peter Lin on Wednesday's Information Radio.

"Because all of a sudden, you have a real condition... Disease means 'this is real,' whereas syndrome kind of means 'collection of [symptoms].'"

The U.S. Department of Health and Human Services (HSS), which issued a contract to the IOM for the report, must decide how to implement and accept the findings. 

Canada must decide whether to adopt them.  

Lin says even the prospect of change allows health-care professionals to imagine improved circumstances surrounding SEID, including those in the workplace of those afflicted by it.

"By being tagged with this name, then basically the patient realizes that...for insurance purposes and for work, now it becomes real."

Redefining an illness

The HHS, the Centres for Disease Control and Prevention (CDC) and four other health organizations asked an IOM expert committee to examine evidence of ME/CFS.

Members of the committee completed the project in one year, and submitted their report, Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness, to the HHS in January.

According to the report, those findings include new diagnostic criteria that will facilitate diagnosis: An aspect of ME/CFS known to complicate the lives of those who suffer from it, some consulting with several doctors before discovering the source of their symptoms.

"The illness previously known as ME/CFS is known to have many symptoms," Dr. Lucinda Bateman told the CBC.

Bateman is a general internist and clinical specialist in the diagnosis and management of SEID. She served on the IOM committee and runs the Fatigue Consultation Clinic in Salt Lake City, Utah.

"The most common criteria used [to diagnose the illness now]...are the 1994 Fukuda Criteria," she said.

According to the CDC, the Fukuda Criteria ask that the patient undergo medical history, mental and physical examinations, and laboratory tests before being diagnosed with ME/CFS. 

In order to meet the criteria, the patient must be chronically fatigued for more than six months and experiencing at least four of eight symptoms, including but not limited to muscle pain and headaches of a new type, pattern or severity.

In their report, the IOM committee recommends that doctors look for the following three core symptoms when diagnosing SEID: 

• The impairment of one's ability to engage in pre-illness activities that lasts more than six months 
• The worsening of symptoms after exposure to physical or cognitive stressors
• Unrefreshing sleep

Additionally, the committee encourages doctors to identify one of two other symptoms in patients: Cognitive impairment or the worsening of symptoms when one stands up.

"The...criteria for SEID are more simple, because after evidence review, many of the symptoms in previous case definitions don't seem to be present in everyone all the time, or even in a consistent pattern," Bateman said.

"The SEID diagnostic criteria focus on the most common, prevalent and constant symptoms based on large studies of ME/CFS patients."
 

 

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Click on this CBC News graphic for information about symptoms of SEID.
 

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Treating SEID

While the IOM report may help patients reach quick diagnoses and provide medical documentation to employers that warrant time away from work to rest, the findings do not include a cause for the illness or, as a result, a proposed cure.

"And so what we do is we manage each symptom," Lin said.

Exercise programs to help strengthen muscles and sleep studies or medications are examples of what doctors may recommend for those suffering from SEID.

"So even though there is no quick fix, what we do is try and manage those symptoms so these people can live."

Lin advises those who suspect they may have SEID to adjust their sleeping habits before consulting a physician.

"Get two, three weeks worth of good sleep and if you feel better...then you don't have this condition," he said.

If adequate sleep does not relieve symptoms — the key to SEID, according to Lin, is that sleep will not ease the overwhelming sensation of exhaustion — doctors are expected to run blood tests to rule out disorders that manifest themselves in similar ways. 

Anemia or thyroid issues, as examples.

The report implies changes in diagnoses from the perspective of a doctor, too, Lin says.

According to the IOM committee, many health care professionals are aware of SEID, but may not understand it or lack knowledge about how to diagnose and treat it.

"...This disease will now sort of pop up higher on the list of things that we will be considering," he said.

Do you believe ME/CFS, now known as SEID, is a legitimate disease?

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Meet the researcher who wants to end the cancer that's been killing her family

A Newfoundland woman who has seen a generation of her family die from a rare form of stomach cancer is bringing new hope to people who may face the same fate.

Samantha Hansford is part of a British Columbia team of researchers whose work identifies the probability that certain people have of getting hereditary diffuse gastric cancer, a rare type of cancer that has affected numerous Newfoundland families. Many people have opted to have their stomachs removed after the gene has been detected. 

'My mother, after she found out that she tested positive, was informed by her geneticist that screening your stomach every so often won't detect this cancer at an early stage. The best way to prevent the cancer is to get your stomach completely removed. So, that's what she did,'- Samantha Hansford

"It certainly means a lot for me and it means a lot for a small number of families around the world that have been affected by this rare disease that has a really high mortality rate," said Hansford, whose interest is both personal and professional. 

"Gastric cancer is the third leading cause of cancer deaths worldwide. So, having this research behind it is pretty groundbreaking."

Hansford, 26, grew up in St. John's before completing a graduate program at the University of British Columbia. She currently works as a research assistant at the B.C. Cancer Agency, which released new research this month that focused on carriers of the deadly gene behind the cancer. 

Interview with Samantha Hansford6:01

​

The findings show that 70 per cent of the men who carry the gene will develop gastric cancer by the time they reach 80, while 56 per cent of women will develop the disease. Additionally, 42 per cent of the women with the gene also risk developing breast cancer.

Hansford said the research is groundbreaking because the findings better arm people who carry the cancer-causing gene known as CDH1 in understanding the chances they have of developing this particular stomach cancer.

It also identifies other gene mutations that increase the risk for people not carrying the CDH1 gene.

Past studies were small, looking at fewer than a dozen families whose members have the gene.

The study released last week involved 75 families and is the largest of its kind to date.

Family 'riddled' with rare cancer

Hansford says the findings are very personal, as the toll that stomach cancer has taken on her family is what led her into the scientific research field.

"My grandmother was diagnosed with breast cancer in the late '90s. She lost seven of her siblings to either gastric cancer — or, stomach cancer — or breast cancer," she said.

"She's buried seven of her siblings alone. She's survived both breast cancer and she was diagnosed with stomach cancer as well in 2002, the very same year and actually the very same week that my aunt Arleen, her daughter, was dying of this exact form of cancer at the age of 40. So, our family is very riddled with it."

Hansford was a teenager in 2006 when Dr. David Huntsman, a St. John's-raised cancer geneticist at the B.C. Cancer Agency and the University of British Columbia looked at her family's long and painful history with gastric and breast cancer and identified CDH1 as the killer gene.

"Because it carries such a high mortality rate, it means that it is very, very difficult to detect at an early stage. So, the main and only way to prevent stomach cancer if you carry the mutation is to get your stomach prophylactically removed," she told CBC News. 

"My mother, after she found out that she tested positive, was informed by her geneticist that screening your stomach every so often won't detect this cancer at an early stage. The best way to prevent the cancer is to get your stomach completely removed. So, that's what she did," she said. 

"And my uncle, when he found out he was positive, he actually went through the surgery as well."

Family connection drove research interest

Hansford also underwent the genetic testing as part of Huntsman's work when she was a teenager and found out that she does not carry the gene. (Neither does her only sister, Erika.) 

Interview with Geralyn Hansford3:12

It was his work that attracted Hansford to the field of scientific research. She completed a degree in biochemistry at Memorial University, and then decided to contact Huntsman who was working in British Columbia. 

"I basically wrote him and said, 'Can I come out and see if I have an interest in this research,' and he decided to take me on as a research assistant."

That move started her on the road to the research that was published last week in the medical journal JAMA Oncology. Hansford credits the B.C. Cancer Foundation and UBC for their help in funding and making the research possible.

"It's been extremely rewarding," she said. 

"I feel like I'm carrying on my aunt's legacy and the last thing she wanted was for anybody else in our family to suffer from this disease. So, although the mutation has been found and it's kind of closed off with our family and done there, I feel like I'm helping other families all over the world to kind of not have to go through that same burden of uncertainty of not knowing if they're at risk or not."

Family proud of daughter's research work

Hansford's mother Geralyn, whose surgery to remove her stomach was done nine years ago, says she is bursting with pride over her daughter's involvement in the research.

Geralyn Hansford had her stomach removed nine years ago as a pre-emptive move against the possibility of being diagnosed with the rare gastric cancer that has ravaged her family. (Submitted by Geralyn Hansford)

"It's a personal thing. I made my decision based on the information that Dr. Huntsman had at the time, and I now know that I don't fear of living or dying with stomach cancer. And to know that Samantha and the team she has worked with at the BC Cancer Agency, the work that they're doing will help so many other people like it helped me almost nine years ago to make a decision that can save your life," Geralyn told me.

"It's mind-boggling to think how fortunate people are now that they have, that we have people like Samantha and Dr. Huntsman and his team of people working on this type of research. It's just wonderful."
 
Just days after the research team released its findings, Samantha found out she is moving home to St. John's in the fall. She received word she has been accepted to the medical school at Memorial University, where her sister Erika is already in her last year of residency. For Geralyn ​Hansford, to hear all this good news in the same week is a much-needed blessing for a family so familiar with bad news.
 
"To think that it was, unfortunately, through Arleen's death and the time leading up to her death was what helped both our daughters — Erika, who's in her last year of residency as a doctor and now Samantha in the field that she's in and now just most recently been accepted to med school here at university at Memorial — it was through that that they both decided to get in that field," she said. 

"Arleen would be so proud."

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Dementia patients' errors leave their wives battling financial institutions

Two women devastated by the effects of dementia in their loved ones found themselves at their wits' end with large financial institutions, which they said did nothing to help after their spouses made irrational transactions that cost them dearly. 

"It leaves you with a feeling of being very powerless in the face of big business," said Debbie Radloff-Gabriel, from Kingston, Ont.

Sun Life repeatedly refused to undo the damage to her family's finances, despite her pleas and medical evidence about her husband's illness. 

"We were vulnerable … and we had no recourse," she said.

Sun Life repeatedly refused to make things right for the Gabriel family, but after questions from Go Public it has promised to reinstate both policies. (CBC)

The company didn't make things right until contacted by Go Public. Radloff-Gabriel had fought Sun Life for four years, after her husband inexplicably cancelled his life insurance.

Bruce Gabriel has Alzheimer's and vascular dementia. As his mind was slipping, in 2010, he called up his insurance agent — when his wife was away at work — to cancel his two policies.

He had paid more than $17,000 in premiums since 1983 and cashed in for less than $2,000 on policies that would have paid his family $140,000 when he dies.

'A terrible shock'

"It was totally out of character, and it was a terrible shock for me and for us as a family," said Radloff-Gabriel.

It left Gabriel slowly dying from his illnesses, with no insurance. He couldn't get new policies, because of his condition.

"I feel like we were stolen from," Gabriel said, while obviously struggling to express his views.

"It robs us of that sense of security," his wife said. "We are already dealing with so many losses and challenges day to day."

Gabriel, 64, is a lawyer and former insurance agent. He can't work anymore and needs full-time care.

"When Mr. Gabriel cancelled his policies … his mind was impaired by a dementing process, which had accelerated quickly," wrote Dr. Brian McDonald, a specialist in psychiatry, in a 2011 letter to Sun Life.

"He was not competent to make such a momentous decision, with such financial consequences, for his family at that time."

Judy Alsager lost her husband Richard Keep last month. Until Go Public got involved, BMO was taking steps to force the sale of her property over unpaid payments for an expensive SUV he had purchased impulsively. (CBC)

"Given the extent of his impairment … I can say with confidence that Mr. Gabriel must have had symptoms of dementia at the time that his insurance policies were cancelled," wrote another geriatric psychiatry specialist who went to bat for him with Sun Life in 2012.

Sun Life won't budge, then an about turn

Because Gabriel wasn't fully tested until three months after the policy cancellation, though, the doctors' letters weren't enough proof for the company.

"These do not provide any new evidence that your husband was incompetent and therefore, incapable of making the decision he made," Sun Life wrote to Radloff-Gabriel in 2012.

More rejections came in subsequent letters, after she appealed to two ombudsmen. However, as a result of Go Public's inquiries, Sun Life has now changed its position.

"We are making an exception on compassionate grounds in this unique case," said spokeswoman Carmela Antolino.

"We are prepared to reinstate Mr. Gabriel's two life insurance policies.… Our thoughts‎ are with the Gabriel family as they deal with this condition."

Similar story with B.C. vehicle loan

Judy Alsager of Williams Lake, B.C., had similar frustrations with the Bank of Montreal.

Her husband Richard Keep died last month from a brain tumour. She said he'd suffered for five years, with dementia, initially diagnosed as the effect of Parkinsons.

Richard Keep suffered for years from dementia and died of a brain tumour. (CBC)

In 2012, at age 76, his wife said Keep impulsively went into the local Toyota dealership and financed a new Highlander — without her knowledge — even though he already had a car.

"He did very crazy things, which lots of people do with dementia," said Alsager.

"He was agitated. Couldn't sit still. Wanted to get things done right now. Wanted to buy things, but didn't have the funds. Other people noticed it. I don't understand how you could sit with him as a salesman and not see this."

The BMO financing was almost $70,000, with monthly payments of $800 over seven years.

"At that point, a doctor had told him, 'You have already outlived how long you should have lived,' just with the Parkinsons," said the widow.

Alsager went into the dealership immediately, insisting it cancel the deal, and it agreed.

"I had offered to reverse the contracts and I would take the vehicle. It would essentially cancel the deal and he would owe no money," said general manager Gerald Overton of Heartland Toyota.

Overton said he ultimately couldn't do that, though, because Keep wouldn't agree and the vehicle was in his name.

Keep financed this new Toyota Highlander for $70,000 while his wife says he was suffering the effects of his illnesses. (CBC)

Alsager said her husband wouldn't give her power of attorney and she was unable to have him declared incompetent, until it was too late. She said her husband's driver's licence was revoked, because of his impairments. Keep also didn't make the loan payments.

BMO moved to take home, then made it right

The Toyota has been sitting unused, Alsager said, but instead of repossessing it, BMO's law firm went to court to force the sale of her home.

"I've sent them a letter saying come and get the car, and they never responded," said Alsager.

In her letter to BMO's lawyer, she described her husband's illnesses and informed him he was unable to defend himself in a legal action against a bank.

The lawyer wrote back — to her husband — saying he couldn't speak to her without signed consent from him. After being contacted by Go Public, however, BMO told Alsager she can now return the vehicle to Heartland Toyota and she will be off the hook.

After Go Public alerted BMO to Alsager's dilemma, it offered to remove the lien on her house and forgive the debt if she returned the vehicle to the dealership. (CBC)

"I am pleased to advise that the dealership will be in touch with you to arrange to have the Toyota Highlander returned to them," wrote J. Raymond O'Kane, BMO's managing director and head of retail automotive finance.

"BMO will [then] arrange for the full car loan amount to be paid out and we will discharge the lien on your property."

Compassion needed, says advocacy group

The Alzheimer Society is calling on all financial institutions to be more compassionate and flexible, as the number of Canadians with dementia is expected to double in coming years.

"There 's a loss of executive function, the ability to make complex decisions, to understand financial transactions," said David Harvey, of the Alzheimer Society in Ontario.

He suggests large companies can and should step up after the fact to reverse or mitigate financial damage to a family where there is medical evidence of cognitive impairment.

David Harvey of the Alzheimer Society of Ontario says financial institutions need better, more flexible policies that recognize the challenges facing clients with dementia. (CBC)

"These large institutions need to put in place good basic consumer protections … a cooling-off period for example, when contracts can be annulled," Harvey said.

"It certainly is time for us to review these policies and to update them, given our changing knowledge of cognitive impairment and the risks related to our aging population."

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