Most hockey helmets fail new safety evaluation

Most hockey helmets on the market weren't adequate to reduce the risk of head injuries when an experimental new measurement was used.

When researchers at Virginia Tech's biomedical engineering and mechanics department bought and tested 32 helmets under various impacts, one helmet earned three out of five stars, a "good" rating.

There is no concussion-proof helmet, the researchers stressed. The aim is to have helmet manufacturers lower head acceleration and reduce the risk and number of concussions a player suffers over a season, said study author Stefan Duma, head of Virginia Tech's department of biomedical engineering.

A total of 25 out of 33 helmets tested failed to achieve an "adequate" rating of two stars out of a possible five.

The university's findings included:

• 1 helmet earned three stars, or "good" — the Warrior Krown 360 ($79.98 US).
• 6 helmets earned two stars or "adequate" ($34.99 to $159.99 US).
• 16 helmets earned one star ($26.98 to $269.99 US).
• 9 helmets earned no star ($39.99 to $119.99 US).

Cost had no correlation with a helmet's safety rating in the new tests. (CBC News)

The Hockey STAR (summation of tests for the analysis of risks) formula was designed to evaluate helmets based on the rotational acceleration that occurs when the head turns on impact, as well as linear acceleration, or motion in the direction of the impact. Concussion is more related to rotational acceleration, neurosurgeons say.

Currently, helmets and helmet safety standards are designed to protect against injuries such as skull fractures. But better designs are possible, said Duma.

"They are what we took from the football world, where they are a little bigger, they have a larger offset, they have a different style of padding," Duma said. "We're going to be interested to see the consumer acceptance of that, but it is very much possible."

Cost had no correlation with a helmet's safety rating.

The best way to consider the differences in helmets is by acceleration, Duma said.

The STAR formula considers level of impact, which is not the way helmets are currently certified, Alan Ashare, president of the Hockey Equipment Certification Council, told CBC News. Ashare said the council is interested in the research.

Discussing the report in an interview with CBC News, sports medicine physician Dr. Paul Echlin, of Burlington, Ont., stressed the value of educating young players and enforcing non-contact play to reduce impacts.

Changing player behaviour, such as enforcing elbowing penalties, reduces the number of times a player is hit and the likelihood of sustaining a concussion, said Mike Oliver, executive director of the National Operating Committee on Standards for Athletic Equipment.

The independent U.S. group does research and recommends improvement in sports equipment.

Blaine Hoshizaki, chair of the International Standard Committee for ice hockey equipment in Ottawa, took issue with how the measurements were made in the study, suggesting the lab tests don't replicate the variety of impacts encountered in an actual game.

CSA-approved helmets were developed to prevent major fractures and lethal bleeds, Echlin said. But the relationship between helmet design and concussions is unknown.

Hockey Canada spokesman Francis Dupont said it will continue to monitor new research and rely on the expertise of those involved with helmet quality control and the companies responsible for manufacturing helmets.

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Nunavut leads Canada in childhood respiratory illness: pediatrician

Nunavut has a higher rate of young children being admitted to hospital for respiratory illness than the rest of Canada, says an Iqaluit pediatrician.

Dr. Amber Miners, the pediatrician at the Qikiqtani General Hospital, says many cases are related to viruses such as the common cold or RSV (respiratory syncytial virus), which means they can't be treated with antibiotics.

Nunavut also has more children staying in intensive care or being intubated because of such illnesses, Miners said.

"So sometimes if you need oxygen, it's giving oxygen," Miners told CBC News. "Sometimes it's suctioning out the gunk that's in there so they can breathe easier [or] giving them medicine through the [oxygen] mask — not antibiotic medicine, but medicine that opens up the airways and helps them breathe easier."

In 2014, almost half of the 60 pediatric medevacs to Ottawa from Iqaluit were linked to respiratory illness, and 70 per cent of those children were younger than six weeks old.

In 2013, a study published in the International Journal of Circumpolar Health said Inuit children's hospital admissions for respiratory illnesses such as RSV, pneumonia or bronchitis are costing Northern governments millions of dollars.

"I think a lot of it comes down to access to healthy foods, social determinants of health, housing, overcrowding, poverty, those sorts of things overlay all of health in general," said Miners.  

"We do have a high rate of smoking in Nunavut that definitely affects the lungs, both prenatally and postnatally."

In the Northwest Territories, fewer than four per cent of Inuit babies are hospitalized because of a lower respiratory tract infection, while in Nunavut it's almost 25 per cent and, in Nunavik, almost 50 per cent.

The Kitikmeot region had Nunavut's highest rate, with almost 40 per cent of babies admitted to the hospital.

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Child obesity stirred by 'perfect storm'

Children and teens who are overweight or obese can be identified by regularly monitoring their growth as a first step to help families, new Canadian guidelines for family doctors recommend.

On Monday, the Canadian Task Force on Preventive Health Care released what it calls the first update on childhood obesity guidelines in more than 20 years. It comes as childhood obesity has more than doubled since the 1970s, with about 20 per cent of children and youth classified as overweight and 12 per cent obese , based on height and weight measurements.

A key recommendation is to measure the height, weight and record the body mass index of those under age 18 at appropriate primary care visits using the WHO Growth Charts for Canada.

"There is no simple one answer," said Dr. Patricia Parkin, chair of the child obesity guideline working group. "There's probably a bit of a perfect storm going on right now in this generation, forces throughout our societies and our communities that is leading to these changes in growth patterns in children."

Monitoring growth is important because there's good evidence that for some children, weight gain early in life tracks into adulthood, Parkin said.

Tackling childhood obesity should not be seen as two halves of prevention and treatment but a continuum. (Gabe Hernandez/The Monitor/Associated Press)

For children aged 2 to 17 years who are overweight or obese, primary care practitioners should offer or refer to structured behavioural programs with the goal of achieving healthy growth.

"If primary care practitioners are recognizing that the child is developing an unhealthy growth then that is an exceptional opportunity for them to intervene in some way," Parkin said. 

"The sessions, in the various trials are quite different, but they often include dietary recommendations, lifestyle recommendations, physical activity recommendations mental health support and so on. So these are addressing multiple themes that are associated with overweight and obesity in children."

The SickKids Team Obesity Management Program or STOMP is an example. The two-year program is offered to small groups of those aged 12 to 17 with complex obesity who are  followed closely by pediatricians, a nurse practitioner, dietitians, an exercise therapist, a psychologist and a social worker.

The goal is to improve health overall, not just focusing on weight but also mental health, healthy nutrition, physical activity, sleep patterns and overall functioning, said pediatrician Dr. Catherine Birken of STOMP.

"It's really difficult work to change your individual behaviours," Birken said. "I believe that the way we've constructed our society is not necessarily supportive of maintaining a healthy weight. So we can't just look at one individual child. We have to look at that child within that family, within that community, within that setting, within their culture and traditions and try to tackle healthy weight from all those angles."

Birken points to promising prevention studies in preschool children. For older children, the evidence for prevention, such as with intensive behavioural management, is harder to interpret. There were small differences in healthy weight outcomes among children who received the preventive programs.

The guidelines recommend family doctors should not routinely offer drug treatments to children or youth who are overweight given the risk of side-effects and incremental benefits, Parkin said.

Similarly, primary care practitioners should not routinely refer children or youth to bariatric surgery because there haven't been trials comparing it to behavioural interventions.

Tackling childhood obesity should not be seen as two halves of prevention and treatment, Dr. Carolyn Summerbell of Durham University in Stockton-on-Tees, U.K., said in commentary published with the guidelines in Monday's Canadian Medical Association Journal.

"It is a continuum, and the grey area in the middle is actually where many children lie for at least some time during their childhood," Summerbell said.

The treatment options are limited to behavioural ones, Summerbell acknowledged.

"It is important to consider the experience of primary care practitioners, seeing distressed children (and their families) who so desperately want to lose weight and "be normal," she concluded.

A journal editorial summarized how schools help children and teenagers develop healthy lifestyles to avoid obesity such as:

• Acquire healthy eating habits.
• Make exercise the norm, including commuting to school.
• Mandate physical education throughout all school years.
• Get students moving during school hours instead of sitting for long periods.
• Sell food and drinks with better nutritional quality.
• Start high school later to reflect how teens' circadian rhythms differ from adults.

The task force is an independent panel of clinicians and experts who review the medical literature and grade its quality before making their recommendations. They also developed tools to help physicians interpret the recommendations.

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Health Canada willing to ease fecal transplant rules for recurrent C. difficile

Health Canada has signalled it is willing to loosen the rules on the use of fecal transplants to treat persistent C. difficile infections.

Up until now people who wanted to undergo a fecal transplant to try to cure a recurrent Clostridium difficile infection had to be part of a clinical trial.

Studies have suggested fecal transplants cure about 90 per cent of recurrent C. difficile cases, like Susan Dunn's of North Bay, Ont. (Brian Tremblay/Canadian Press)

But in new guidance posted online on Monday, the federal regulatory agency said it is open to allowing the treatment to be used outside of clinical trials — a move which proponents suggest may encourage more doctors to do the procedure.

The department has given interested parties 30 days in which to comment on the proposed new position, which will be in effect during the consultation period. A final position will be issued after the submitted comments are reviewed.

Dr. Michael Silverman, who has performed about 50 of the procedures, lauded the federal agency's move.

"This is somewhat brave," said Silverman, chief of infectious diseases at Western University in London, Ont.

"I have empathy for Health Canada on this. They're trying to wade between what's reasonable and what's legalistic. And they are trying to lean on the side of being reasonable and not have what's legalistic get in the way of people who really are suffering and need help."

Recurrent C. difficile infection is a miserable disease that results when the bacterial balance of a person's gastrointestinal tract is knocked out of whack after exposure to antibiotics. In addition to killing whatever bacterium the drugs were targeting, they also kill healthy bacteria which help to maintain a balance in the gut. That allows C. difficile to flourish and take over, causing persistent diarrhea.

Some cases can be cured by using stronger antibiotics. But even then some people cannot clear the infection. Some eventually have to have their colons removed.

Fecal transplants attempt to re-establish a balance in the gut by reintroducing healthy bacteria in the form of stool from a healthy volunteer. The treatment is delivered either through a reverse enema, or is dripped into the gastrointestinal tract in a tube inserted through a nostril.

Studies have suggested fecal transplants cure about 90 per cent of recurrent C. difficile cases — a virtual home run in medicine.

While people who have never had C. difficile may find the procedure repugnant, many who have struggled with debilitating diarrhea literally beg for the treatment from the few physicians who will perform it — people like Silverman or Dr. Christine Lee, a researcher at McMaster University in Hamilton, Ont., who has done more than 400 fecal transplants.

Lee said the new guidance from Health Canada is helpful, and will probably lead more people to do this work.

"I think if they can identify appropriate donors and microbiology laboratory facilities where they're willing to prepare [the transplant], then certainly. But that's not going to be the case for certainly a lot of community hospitals. I think there might still be barriers," she said.

Some laboratories have been reluctant to prepare the donor stool for transplant, Lee noted. And liability concerns may have dissuaded some doctors or hospitals from providing the treatment.

The Health Canada guidance says the donor stool must come from one person, known either to the recipient or to the treating physician. Donors must be screened for relevant infectious disease such as HIV and hepatitis. The guidance says a number of other infectious diseases "may" also be screened for, which Silverman described as a sensible approach.

He suggested Health Canada's move may make the fecal transplant situation in Canada safer. If the procedure is easier to get from the medical community, people will be less likely to try a do-it-yourself transplant at home.

Silverman doesn't believe these procedures have to be done in hospitals, but says it could be dangerous if people used stool from a donor who has not been screened for transmissible diseases.

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Medical pot users could help researchers dispel haze around risks, benefits

The number of Canadians authorized to use medical marijuana has skyrocketed, even as medical experts warn that not enough is known about its risks and benefits. Now some are calling for researchers to tap into that growing pool of users to help answer some of those questions.

In 2002, a year after the government first permitted access to therapeutic cannabis through Health Canada regulations, 500 patients had registered. Today, there are more than 50,000.

This has happened despite the official position of the Canadian Medical Association (CMA) which says that, "there is insufficient scientific evidence available to support the use of marijuana for clinical purposes."

In 2002, a year after the government first permitted access to therapeutic cannabis through Health Canada regulations, 500 patients had registered. Today, there are more than 50,000. (Darryl Dyck/The Canadian Press)

​The CMA says not enough is known about the effects of medical marijuana, the interactions between pot and other medications, or how to prescribe an appropriate dosage. It advises doctors they are not obligated to write cannabis prescriptions for patients.

That is causing frustration for some people with medical conditions who want the option of using medical marijuana rather than other types of prescription drugs.

"It was very difficult to get my prescription," said Jennawae McLean, who uses medical marijuana for chronic pain due to arthritis. "A doctor was willing to prescribe me Percocets and Humira and Lyrica and different pills like this, but they weren't willing to prescribe cannabis … which has no recorded deaths, no overdoses, no negative long-term side effects. It just doesn't make sense."

Medical marijuana is sometimes sold in the form of skin creams, edibles, oils, tinctures or topical medicines, even though this contravenes Canadian law. (The Canadian Press/Jonathan Hayward)

​A 2014 poll conducted by Angus Reid Global showed that 59 per cent of Canadians support the legalization of marijuana. However, the Conservative government is opposed to legalization beyond medicinal uses.

Government guidelines for the medicinal use of pot are outlined in Health Canada's Marihuana Medical Access Regulations (MMAR) and state clearly that prescriptions may be written only by a physician or nurse-practitioner; that medical marijuana must be purchased through a licensed producer, and only as dried plant material; and that it cannot be sold through a storefronts or retail outlets.

Thousands of Canadians are flouting those regulations, and nowhere more than in British Columbia. There are now more medical marijuana shops in Vancouver than there are Tim Hortons - and more shops than in the rest of Canada combined. These stores are selling cannabis and hashish with names like Purple Kush, West Coast Rockstar, Polar Hash and even Barbara Bud, in addition to a variety of edible marijuana products. On-site naturopaths provide medical marijuana access cards, in some cases to those who simply say they are feeling stressed.

Vancouver police are enforcing a prohibition on selling marijuana to minors, however they focus their criminal enforcement efforts on the trafficking of more serious street drugs, such as cocaine, heroin and methamphetamines.

Most of the research into the effectiveness of medical marijuana so far has focused on pain management. However, patients are using it for a variety of conditions ranging from Crohn's disease to chronic seizures. (CBC)

​Vancouver city councillor Kerry Jang said that, based on what has happened in Vancouver, he believes Canada already has de facto legalization of marijuana. "And quite frankly, I'm glad it's above ground in a dispensary where we can regulate and see what's going on, rather than underground."  

Now some are saying that studying this growing base of medical marijuana users could be the way for the medical community to fill gaps in our understanding of its risks and benefits.

Researchers have published thousands of peer-reviewed articles about medical marijuana, mainly on the therapeutic properties of the various cannabinoids found in cannabis plants. But "when you narrow the search down to clinical trials, the number drops dramatically," said Dr. Mark Ware, executive director of the Canadian Consortium for the Investigation of Cannabinoids.

​"If you think about conventional pharmaceutical drug development, there is usually a company behind a new drug that's investing hundreds of millions of dollars in doing those clinical trials in order to make a claim that this drug, at this dose, is effective in the treatment of this symptom, in this disorder," said Dr. Ware, who is also the director of clinical research at the Alan Edwards Pain Management Unit at the McGill University Health Centre.

Dr. Mark Ware says the medical community would benefit from "real world evidence," which could be gathered by monitoring the progress of the thousands of patients who are using therapeutic marijuana. (Tori Weldon/CBC)

​After government approvals, a conventional pharmaceutical drug is launched on the market and the company recuperates its investment. The problem, Dr. Ware says, is that, "there isn't such an interest in investing in that work for herbal cannabis, which is something you can grow in your backyard."

Most of the research into the effectiveness of medical marijuana so far has focused on pain management. However, patients are using it for a variety of conditions ranging from Crohn's disease to chronic seizures.

Dr. Ware says the medical community would benefit from "real world evidence," which could be gathered by monitoring the progress of the thousands of patients who are using therapeutic marijuana.

Meanwhile, patients who want legitimate access to medical marijuana are caught between the government regulations and doctors who don't feel they have enough information about it to provide a prescription. And most doctors who are willing to write marijuana prescriptions do not endorse smoking the drug, recommending instead that patients use it in a way that will not be potentially harmful to their lungs. This may include edibles, oils, tinctures or topical medicines, none of which may be sold legally under current federal rules - although it is legal to buy dried weed with a prescription and make your own.

Vancouver resident Owen Smith has challenged that law all the way to the Supreme Court of Canada. It heard arguments on March 20 and has reserved judgment in the case. It can take at least six or seven months for the Court to publish its decision, which will be near the date of the next federal election, Oct. 19.

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On CBC Radio's The Sunday Edition, starting at 9 a.m. ET March 29:

Our Passwords, Ourselves: These days we are ruled by passwords. They give us access to the world through our phones, laptops, bank machines and credit cards. And that may not be such a good thing, writes Michael Enright.

How much medical is in medical marijuana?: An hour-long special report on cannabis for therapeutic use.

A life on hold - a Kate Wiley documentary: Shelly and Fred Muntau of Vancouver adopted an orphaned child from the Democratic Republic of Congo. But a bureaucratic catch-22 is preventing little Pedro from coming to Canada to join his adoptive parents. They can't get a Canadian visa for him without an exit letter from the Congo, and they can't get an exit letter without a visa.

Gideon Levy - the most hated man in Israel: Gideon Levy is a highly controversial columnist with the Israeli newspaper Haaretz, who has made life in the Occupied Territories his beat. He is a fierce critic of what he describes as the routine brutality experienced by the Palestinians, and of the settler movement. He has received death threats, and has been labelled a propagandist for Hamas. Levy, who calls himself an Israeli patriot, advocates an international boycott against his own country.

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Pregnant in limbo: How vulnerable women pay for Canada's universal health care

Friday March 27, 2015

The numbers in Canada are hard to nail down, but advocates say there are at least 500,000 people living in Canada who don't have provincial health insurance. And tens of thousands of them are pregnant women.

For many of them, the excitement of bringing a new life into the world comes along with a lot stress and anxiety. They worry that they won't be able to afford the care they and their babies need to be healthy.

But does Canada have a duty to care for these women and their unborn children? Healthcare workers who work with uninsured pregnant women say there's no question Canada does.

Manavi Handa, a Toronto-based midwife, says prenatal care is one of the most cost-effective interventions in all of medicine. She says free healthcare for all pregnant women is not only the right thing to do ethically, but it makes a lot of financial sense too.

"Some studies have shown that every dollar spent on prenatal care saves four dollars to the healthcare system," says Handa.

These are the three stories of women featured in this week's Day 6 documentary, Pregnant in Limbo. The piece was produced by Day 6's Beza Seife.

Yaimy 

When Yaimy found out she found out she was pregnant, she says she had just arrived from Mexico to join her Canadian husband and that the pregnancy wasn't planned. She's waiting for her permanent residency application to be accepted under her husband's sponsorship.

Because of her previous pregnancy, she had to have a medically-necessary caesarean section. 

"Everyone says health care in Canada is free. When I arrived, they told me at the border that I would be able to get health care but nobody told me about this three month wait," she says. In Ontario new-comers need to wait the months before having access to free health care.

Her husband Joel says he made payment arrangements with the hospital ahead of time, when he learned Yaimy wasn't covered for her c-section.

So on the day of Yaimy's scheduled c-section, he says he was shocked when the anesthetist asked him to hand over $800 in cash as his wife was lying in the hospital bed with an IV in her arm. He says the doctor told him she wouldn't administer his wife any medication without the cash.

"Honestly, it's crazy. I go to the bank, I bring the money because I need it for her [Yaimy]," he says.

The anesthetist in this case denied Day 6's interview request.

Saira 

Saira Waheed arrived in Canada from Qatar earlier this year with her husband and two children. Canada approved them as permanent residents before they landed in Toronto.

Because of her previous pregnancies, Saira has to undergo a medically-necessary caesarean section, which she was told could cost $10,000 to $15,000.

"I went to a lot of places for help when I first found this out, and I was basically told the same thing: that there's nothing you can do to avoid the wait, and that this is a government process," she says.

Saira says she and her family have spent the little savings they brought with them to get settled, and that they have no fund or plan to cover the cost of her c-section.

Pamela

Pamela is a 25-year-old woman living in Vancouver, with her common-law Canadian partner and her two year old son. After arriving from Mexico on a tourist visa, her partner has now sponsored her to become a permanent resident.

Day 6 agreed to use a pseudonym because she fears going public with her story could negatively affect her permanent residency application.

"I had no idea what to expect with health care. We just thought we go to the hospital and pay, and done. But we didn't think it was going to be that much," says Pamela, about the $10,000 she says the hospital quoted her to deliver her baby there.

So Pamela ended up having her baby at home with a midwife. She says she would have much preferred to have delivered in the hospital, just steps away from her apartment, but without health coverage she says just couldn't afford it.

 "It was so hard, with no painkillers or drugs.  I was so scared. And I just kept thinking should I have gone to the hospital in the first place? I was in the middle of having a baby and they're [the midwife and doula] telling you that you might end up at the hospital. That's very scary," she says.

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Website lets users put money down on their own weight loss

Losing weight is going competitive as a new website uses people's urge to make money as an incentive to shed pounds.

DietBet is a New York City-based website that launched in 2013.

It allows users to put money on the line that they can win back if they lose a certain percentage of their body weight in a set amount of time.

Ottawa mother Laureen Krumshyn said she bet $200 she'd lose 10 per cent of her body weight in six months and it's working so far.

"It's a competitive thing for me," she said.

"I don't like to lose. It's fun knowing that you've made this commitment and you're motivated to do it."

Billed as a game, DietBet requires users to weigh themselves at the beginning and end of their time frame with photos to verify they're not exaggerating.

Users are encouraged to post photos more regularly but that's optional, as is making their weights public.

DietBet keeps between 10 to 25 per cent of the bet, unless everyone in a group reaches their target in which case they keep none of it.

"The pots can sometimes be really huge in the hundreds of thousands of dollars," said DietBet founder and CEO Jamie Rosen.

"When everyone reaches their goal the pot gets divided equally."

One Ottawa doctor who specializes in weight loss said he had some concerns about the service.

Dr. Yoni Freedhoff says the competitive aspect of DietBet could lead to unsafe weight loss for some people. (CBC)

"By definition if it's a competition, the efforts are going to be extreme," said Dr. Yoni Freedhoff.

"Extreme efforts, while they might lead to fast losses, probably won't lead to long-term losses because extreme efforts aren't sustainable and really it's the long term that matters."

Rosen said they have built in ways to keep people from doing that.

"We've designed it so there's absolutely no incentive to go crazy or overboard on this. In fact, we disqualify you if you lose three times the goal weight," he said.

DietBet's website says it doesn't reward people for losing the most weight or losing weight the quickest and doesn't allow people with a body-mass index under 18.5 to play.

It also says it's launching a new game to help people maintain their weight in "early 2015."

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4 ways for parents to prevent medication errors in children

Baby receives medicine from a syringe (Shutterstock)

Parents should stick with more precise metric measuring devices such as syringes instead of teaspoons to give children the correct dose of medications, U.S. and Canadian experts say.

Unintentional medication overdoses are a preventable problem sending 70,000 children to emergency departments each year in the U.S. alone. It's also a common cause of hospitalizations among children aged zero to four, according to the Ontario Medical Association.

Most medications for children treated as outpatients are given as liquids. On Monday, the American Academy of Pediatrics released a policy statement to address two common sources of preventable errors for liquid medications:

• Incorrect dosing devices.
• Giving the wrong volume.

Pediatrician Ian Paul, the lead author of the statement, said they're calling for a simple, universal standard of metric doses in order to change how doctors write prescriptions, how pharmacists dispense liquid medications and dosing cups, and how manufacturers print labels on their products.

The preferred device to use is an oral syringe, said pharmacist Julie Greenall, director of projects and education at the Institute for Safe Medication Practices Canada in Toronto.

'The spoons in your kitchen drawer are good for soup and cereal and not for medication.'- Julie Greenall, Institute for Safe Medication Practices Canada

"The spoons in your kitchen drawer are good for soup and cereal and not for medication," Greenall said.

Part of the problem with kitchen spoons is they aren't precise to measure a child's medication, Paul said.

Caregivers could also misinterpret millilitres for teaspoons or confuse teaspoons and tablespoons.

People may be confused because they don't understand imperial measurements, which they never learned, Greenall said.

"They don't have that context so they're not going to think, 'Well, this looks like too much volume.' A volume in a syringe,10 millilitres, is not really that much liquid so it doesn't look like this would be too much medication for a baby."

The institute's tips to consumers include:

• Whenever you receive a new prescription, ask why the medicine has been prescribed, what the correct dosage is, and how often to take it.
• If the medicine has been prescribed for your child, the dose may depend on the child's age and weight. Make sure the prescriber and the pharmacy filling the prescription knows your child's current age and weight.
• If the pharmacy dispenses a liquid medicine or you pick one up off the shelf, ask for an oral syringe to measure the dose accurately. Ask the pharmacist to tell you the dose that has been prescribed and then show you how much liquid will provide this dose. If any of the information you receive is different from what you expected, ask the pharmacist to check the prescription with you again.
• Ask the doctor and the pharmacist about any side-effects to watch for and when to contact a healthcare provider for help. This information is especially important when you are giving medicine to babies and young children.

Greenall also thinks it's important the U.S. academy is taking a position on moving to metric units in health care, which could help prevent confusion on both sides of the border.

In 2011, ISMP Canada issued an alert about oral syringes marked in both millilitres and teaspoons after it received a report about a baby who was prescribed 2 mL of liquid antibiotic but the caregiver mistakenly measured two teaspoons or 10 mL — five times the intended dose. The baby had vomiting and diarrhea for 24 hours.

The U.S. academy recommends devices for precise measurements should be distributed with medication.

In Canada, Greenall said some smaller pharmacies may provide a reference in both millilitres and teaspoons but prescription medications and medication device are in millilitres. 

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Germanwings crash pressuring airlines to improve psychological screening of pilots

To the Dusseldorf crewmates who knew him, First Officer Andreas Lubitz gave no sign he was mentally unstable.

They didn't know about the torn-up doctor's note found in his home, or another sick note excusing him from flying the very day he crashed Germanwings Flight 9525 into the French Alps.

Lubitz had never come forward with any problems.

How and why the 27-year-old apparently hid his illness is now the focus of investigators and is also putting renewed scrutiny on pilot screening. Whether mandatory psychological tests could have prevented Lubitz from downing the airliner, killing all 150 people on board, is a question that will be explored in the coming weeks and months.

Must 'self-identify' psychological issues

All the rules governing international flights are based on standards set by the International Civil Aviation Organization, notes aviation safety expert Suzanne Kearns.

But Kearns, an associate professor who teaches about human factors and aviation safety at Western University, says those regulations largely focus on physical well-being and what to do in the event a pilot becomes incapacitated or suffers a heart attack in the air.

A pilot stands inside the cockpit during boarding for the Germanwings flight 4U9441, formerly flight 4U9525, from Barcelona to Dusseldorf. (Albert Gea/Reuters)

"You would get an electrocardiogram for your heart, audiograms for your hearing, they'd check your vision for colour-blindness, check your weight," she said.

"But there's not been much of a focus on mental health."

Pilots are only required to "self-identify" if they've been seeing doctors for mental health issues, as well as declare whether they're taking medication or dealing with mental problems.

For most pilots, who have spent years of studying and between $50,000 and $100,000 spent on flight-school training, there would be little incentive to do that, though.

"The reality is they all know if they lose their medical, they have no careers," Kearns said.

Hard to test for mental illness

French gendarmes and investigators work amongst the debris of the Germanwings Flight 4U9525at the site of the crash, near Seyne-les-Alpes, French Alps. (Emmanuel Foudrort/Reuters)

In Canada, annual physicals for commercial pilots are performed by Transport Canada-approved doctors.

Pilots 40 and older would be required to obtain a medical certificate every six months.

However, the most rigorous "category 1" medical certificates do not include a psychological testing component.

The international Aerospace Medical Association published a 2013 report recommending more mental health screening among pilots following the apparent mid-flight panic attack suffered by JetBlue captain Clayton Osbon.

While Philip Scarpa, president of the association, acknowledged "there's room for improvement" for mental health screening of pilots, he said "it's a nebulous topic because mental illness is hard to test for."

People pay their respects at a memorial for the victims in the village of Le Vernet, near the crash site, on Friday. (Robert Pratta/Reuters)

"Depression, anxiety, mania, alcohol and drug abuse -- those things can be asked about during periodic aeromedical exams," Scarpa said.

"The caveat is it needs to be effective, and trying to look for the serious sudden psychological diseases is not going to be effective."

Until psychological tests can be perfected and guarantee against false positives, he said, it would be difficult to begin grounding pilots.

Sick note not enough

During medical certificate assessments, a doctor can note down any suspected psychological triggers or symptoms in a "Remarks" section.

In Lubitz's case, however, doctor sick notes for an undisclosed illness would not have been enough to stop him from flying.

German police officers carry bags out of a house believed to belong to the parents of crashed Germanwings flight 4U 9524 co-pilot Andreas Lubitz in Montabaur on Wednesday. (Kai Pfaffenbach/Reuters)

That might only have been possible had he outed himself or admitted he was suffering from anxiety – something Kearns said pilots have a hard time acknowledging.

For its part, the Aerospace Medical Association suggests the adoption of "safe zones" designed to encourage pilots under psychological distress to self-report. These could go a long way towards changing the stigma surrounding mental illness, it says.

When his mother passed away, James Phillips, the international affairs director with the German Pilots Association, relied on an aviation support line.

'I called and said, "I'm not fit to be in the cockpit...and my airline said, 'Take two weeks off. Call us when you feel better.'- James Phillips, German Pilots Association

"I called and said, 'I'm not fit to be in the cockpit because I am concentrating on my mother,' and my airline said, 'Take two weeks off. Call us when you feel better,'" Phillips told CBC News Network.

"I think this should actually be the real way to go forward, but I realize it's based on a trust and honesty situation, which sometimes is very difficult."

Protecting privacy

Losing flight hours is another concern for younger pilots making meagre starting salaries, Kearns said.

If a pilot feels momentarily unsafe or unfit from a mental health perspective, it is hard to see how that wouldn't be perceived as a permanent career-ender, she said.

German police officers stand outside a house believed to belong to crashed Germanwings flight 4U 9524 co-pilot Andreas Lubitz in Montabaur. (Ralph Orlowski/Reuters)

As for how rules surrounding a pilot's mental health status would square with privacy, Minister of Transport Lisa Raitt told CBC News Network that Canada's Aeronautics Act includes provisions to ensure the privacy of a pilot is protected in such cases.

"There will be information given to the airline as to why their pilot doesn't have a certificate of fitness, but really the medical treatment — the dossier itself — is kept very private between the individual and the Transport Canada-affiliated doctor," she assured.

One way or another, Kearns expects aviation safety management systems will increasingly consider mental health disclosure guidelines in light of the Germanwings disaster.

"The reality is the culture will have to shift before anything can change, though," she said.

"Pilots have to learn mental health is not something you can tough out, or just grin and bear. It's something we need to encourage people to seek treatment for."

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Medical pot users could help researchers dispel haze around risks, benefits

The number of Canadians authorized to use medical marijuana has skyrocketed, even as medical experts warn that not enough is known about its risks and benefits. Now some are calling for researchers to tap into that growing pool of users to help answer some of those questions.

In 2002, a year after the government first permitted access to therapeutic cannabis through Health Canada regulations, 500 patients had registered. Today, there are more than 50,000.

This has happened despite the official position of the Canadian Medical Association (CMA) which says that, "there is insufficient scientific evidence available to support the use of marijuana for clinical purposes."

In 2002, a year after the government first permitted access to therapeutic cannabis through Health Canada regulations, 500 patients had registered. Today, there are more than 50,000. (Darryl Dyck/The Canadian Press)

​The CMA says not enough is known about the effects of medical marijuana, the interactions between pot and other medications, or how to prescribe an appropriate dosage. It advises doctors they are not obligated to write cannabis prescriptions for patients.

That is causing frustration for some people with medical conditions who want the option of using medical marijuana rather than other types of prescription drugs.

"It was very difficult to get my prescription," said Jennawae McLean, who uses medical marijuana for chronic pain due to arthritis. "A doctor was willing to prescribe me Percocets and Humira and Lyrica and different pills like this, but they weren't willing to prescribe cannabis … which has no recorded deaths, no overdoses, no negative long-term side effects. It just doesn't make sense."

Medical marijuana is sometimes sold in the form of skin creams, edibles, oils, tinctures or topical medicines, even though this contravenes Canadian law. (The Canadian Press/Jonathan Hayward)

​A 2014 poll conducted by Angus Reid Global showed that 59 per cent of Canadians support the legalization of marijuana. However, the Conservative government is opposed to legalization beyond medicinal uses.

Government guidelines for the medicinal use of pot are outlined in Health Canada's Marihuana Medical Access Regulations (MMAR) and state clearly that prescriptions may be written only by a physician or nurse-practitioner; that medical marijuana must be purchased through a licensed producer, and only as dried plant material; and that it cannot be sold through a storefronts or retail outlets.

Thousands of Canadians are flouting those regulations, and nowhere more than in British Columbia. There are now more medical marijuana shops in Vancouver than there are Tim Hortons - and more shops than in the rest of Canada combined. These stores are selling cannabis and hashish with names like Purple Kush, West Coast Rockstar, Polar Hash and even Barbara Bud, in addition to a variety of edible marijuana products. On-site naturopaths provide medical marijuana access cards, in some cases to those who simply say they are feeling stressed.

Vancouver police are enforcing a prohibition on selling marijuana to minors, however they focus their criminal enforcement efforts on the trafficking of more serious street drugs, such as cocaine, heroin and methamphetamines.

Most of the research into the effectiveness of medical marijuana so far has focused on pain management. However, patients are using it for a variety of conditions ranging from Crohn's disease to chronic seizures. (CBC)

​Vancouver city councillor Kerry Jang said that, based on what has happened in Vancouver, he believes Canada already has de facto legalization of marijuana. "And quite frankly, I'm glad it's above ground in a dispensary where we can regulate and see what's going on, rather than underground."  

Now some are saying that studying this growing base of medical marijuana users could be the way for the medical community to fill gaps in our understanding of its risks and benefits.

Researchers have published thousands of peer-reviewed articles about medical marijuana, mainly on the therapeutic properties of the various cannabinoids found in cannabis plants. But "when you narrow the search down to clinical trials, the number drops dramatically," said Dr. Mark Ware, executive director of the Canadian Consortium for the Investigation of Cannabinoids.

​"If you think about conventional pharmaceutical drug development, there is usually a company behind a new drug that's investing hundreds of millions of dollars in doing those clinical trials in order to make a claim that this drug, at this dose, is effective in the treatment of this symptom, in this disorder," said Dr. Ware, who is also the director of clinical research at the Alan Edwards Pain Management Unit at the McGill University Health Centre.

Dr. Mark Ware says the medical community would benefit from "real world evidence," which could be gathered by monitoring the progress of the thousands of patients who are using therapeutic marijuana. (Tori Weldon/CBC)

​After government approvals, a conventional pharmaceutical drug is launched on the market and the company recuperates its investment. The problem, Dr. Ware says, is that, "there isn't such an interest in investing in that work for herbal cannabis, which is something you can grow in your backyard."

Most of the research into the effectiveness of medical marijuana so far has focused on pain management. However, patients are using it for a variety of conditions ranging from Crohn's disease to chronic seizures.

Dr. Ware says the medical community would benefit from "real world evidence," which could be gathered by monitoring the progress of the thousands of patients who are using therapeutic marijuana.

Meanwhile, patients who want legitimate access to medical marijuana are caught between the government regulations and doctors who don't feel they have enough information about it to provide a prescription. And most doctors who are willing to write marijuana prescriptions do not endorse smoking the drug, recommending instead that patients use it in a way that will not be potentially harmful to their lungs. This may include edibles, oils, tinctures or topical medicines, none of which may be sold legally under current federal rules - although it is legal to buy dried weed with a prescription and make your own.

Vancouver resident Owen Smith has challenged that law all the way to the Supreme Court of Canada. It heard arguments on March 20 and has reserved judgment in the case. It can take at least six or seven months for the Court to publish its decision, which will be near the date of the next federal election, Oct. 19.

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On CBC Radio's The Sunday Edition, starting at 9 a.m. ET March 29:

Our Passwords, Ourselves: These days we are ruled by passwords. They give us access to the world through our phones, laptops, bank machines and credit cards. And that may not be such a good thing, writes Michael Enright.

How much medical is in medical marijuana?: An hour-long special report on cannabis for therapeutic use.

A life on hold - a Kate Wiley documentary: Shelly and Fred Muntau of Vancouver adopted an orphaned child from the Democratic Republic of Congo. But a bureaucratic catch-22 is preventing little Pedro from coming to Canada to join his adoptive parents. They can't get a Canadian visa for him without an exit letter from the Congo, and they can't get an exit letter without a visa.

Gideon Levy - the most hated man in Israel: Gideon Levy is a highly controversial columnist with the Israeli newspaper Haaretz, who has made life in the Occupied Territories his beat. He is a fierce critic of what he describes as the routine brutality experienced by the Palestinians, and of the settler movement. He has received death threats, and has been labelled a propagandist for Hamas. Levy, who calls himself an Israeli patriot, advocates an international boycott against his own country.

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Ontario's children's advocate wants inquest into 12-year-old's suicide

Ontario's provincial advocate for children and youth wants the provincial coroner to launch an inquest into the death of a 12-year-old  boy from Cobourg who committed suicide in August after years of intervention from nine different children's mental health services and agencies.

"How does that 12-year-old boy end up hanging from a tree?" Ontario's youth advocate Irwin Elman said to the fifth estate, as part of its investigation into the death of Chazz Petrella seven months ago. "I want to know."

Here, Elman said, is "a 12-year-old boy who has, by all accounts, some real strengths, [is] really engaging and for a number of years has had services in his life, people in his life."

the fifth estate investigation has found that Chazz was twice unable to access testing and care that might have been important because funding was not approved by the non-profit agency Service Coordination for Children and Youth, which is funded by the provincial government and has a mandate to develop integrated service plans for children with special needs.

He also never received a firm diagnosis or treatment plan despite being in and out of three public schools, two specialized residential facilities for children with behavioural issues, a private school  for children with special needs and an in-patient psychiatric crisis centre.

Chazz's parents hope that a coroner's inquest will give them the answers they are looking for.

"I think there has to be accountability," says his mother, Janet Ashby-Petrella. "It doesn't have to be personal accountability, but there has to be someone to say that these are flaws in the system that have to be held accountable by each one of these agencies."

Chazz Petrella was 10 in this photo. He took his life two years later. (CBC)

Tracy MacCharles, Ontario's minister for children and youth services, declined to be interviewed about the issues Chazz's story raises, with her office at one point citing privacy concerns. Instead she provided a statement that said her ministry is working "tirelessly" to fix what she calls "gaps" in Ontario's mental health system.

Dr. Dirk Huyer, Ontario's chief coroner, confirms that his office is investigating Chazz Petrella's death, a process that can take months. That investigation would need to be completed before a decision would be made about whether to call a full inquest.

The problems Chazz faced with Ontario's mental health agencies are not new.

There have been at least eight different government reports in Ontario all emphasizing the need to do better when it comes to children and mental health.

Canada also has the third-highest youth suicide rate in the industrialized world.

And suicide is the second leading cause of death for youth aged ten to 19.

To help deal with this reality, Elman launched Canada's first provincial inquest database online in 2013.

The site features searchable recommendations from the more than 26 inquests in the last 15 years that involved the deaths of children and youth.

Ontario's children and youth advocate Irwin Elman created a searchable database of all inquest results in the province that deal with the deaths of children. (CBC)

The database includes suicides, homicides and accidental deaths. Elman hopes that giving the public access to this information will provide a resource for families and increase transparency and accountability.

Among the existing recommendations, at least four different coroners' juries over the past 14 years have cited specific systemic changes that, had they been implemented and enforced, might have helped Chazz and his family.

These include making comprehensive mental health assessments a priority to be done as soon as a child is identified as having problems, and assigning each family a government-appointed guide, someone to help navigate the fragmented system and to protect the child's interests. 

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Pregnant in limbo: How vulnerable women pay for Canada's universal health care

Friday March 27, 2015

The numbers in Canada are hard to nail down, but advocates say there are at least 500,000 people living in Canada who don't have provincial health insurance. And tens of thousands of them are pregnant women.

For many of them, the excitement of bringing a new life into the world comes along with a lot stress and anxiety. They worry that they won't be able to afford the care they and their babies need to be healthy.

But does Canada have a duty to care for these women and their unborn children? Healthcare workers who work with uninsured pregnant women say there's no question Canada does.

Manavi Handa, a Toronto-based midwife, says prenatal care is one of the most cost-effective interventions in all of medicine. She says free healthcare for all pregnant women is not only the right thing to do ethically, but it makes a lot of financial sense too.

"Some studies have shown that every dollar spent on prenatal care saves four dollars to the healthcare system," says Handa.

These are the three stories of women featured in this week's Day 6 documentary, Pregnant in Limbo. The piece was produced by Day 6's Beza Seife.

Yaimy 

When Yaimy found out she found out she was pregnant, she says she had just arrived from Mexico to join her Canadian husband and that the pregnancy wasn't planned. She's waiting for her permanent residency application to be accepted under her husband's sponsorship.

Because of her previous pregnancy, she had to have a medically-necessary caesarean section. 

"Everyone says health care in Canada is free. When I arrived, they told me at the border that I would be able to get health care but nobody told me about this three month wait," she says. In Ontario new-comers need to wait the months before having access to free health care.

Her husband Joel says he made payment arrangements with the hospital ahead of time, when he learned Yaimy wasn't covered for her c-section.

So on the day of Yaimy's scheduled c-section, he says he was shocked when the anesthetist asked him to hand over $800 in cash as his wife was lying in the hospital bed with an IV in her arm. He says the doctor told him she wouldn't administer his wife any medication without the cash.

"Honestly, it's crazy. I go to the bank, I bring the money because I need it for her [Yaimy]," he says.

The anesthetist in this case denied Day 6's interview request.

Saira 

Saira Waheed arrived in Canada from Qatar earlier this year with her husband and two children. Canada approved them as permanent residents before they landed in Toronto.

Because of her previous pregnancies, Saira has to undergo a medically-necessary caesarean section, which she was told could cost $10,000 to $15,000.

"I went to a lot of places for help when I first found this out, and I was basically told the same thing: that there's nothing you can do to avoid the wait, and that this is a government process," she says.

Saira says she and her family have spent the little savings they brought with them to get settled, and that they have no fund or plan to cover the cost of her c-section.

Pamela

Pamela is a 25-year-old woman living in Vancouver, with her common-law Canadian partner and her two year old son. After arriving from Mexico on a tourist visa, her partner has now sponsored her to become a permanent resident.

Day 6 agreed to use a pseudonym because she fears going public with her story could negatively affect her permanent residency application.

"I had no idea what to expect with health care. We just thought we go to the hospital and pay, and done. But we didn't think it was going to be that much," says Pamela, about the $10,000 she says the hospital quoted her to deliver her baby there.

So Pamela ended up having her baby at home with a midwife. She says she would have much preferred to have delivered in the hospital, just steps away from her apartment, but without health coverage she says just couldn't afford it.

 "It was so hard, with no painkillers or drugs.  I was so scared. And I just kept thinking should I have gone to the hospital in the first place? I was in the middle of having a baby and they're [the midwife and doula] telling you that you might end up at the hospital. That's very scary," she says.

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Germanwings crash pressuring airlines to improve psychological screening of pilots

To the Dusseldorf crewmates who knew him, First Officer Andreas Lubitz gave no sign he was mentally unstable.

They didn't know about the torn-up doctor's note found in his home, or another sick note excusing him from flying the very day he crashed Germanwings Flight 9525 into the French Alps.

Lubitz had never come forward with any problems.

How and why the 27-year-old apparently hid his illness is now the focus of investigators and is also putting renewed scrutiny on pilot screening. Whether mandatory psychological tests could have prevented Lubitz from downing the airliner, killing all 150 people on board, is a question that will be explored in the coming weeks and months.

Must 'self-identify' psychological issues

All the rules governing international flights are based on standards set by the International Civil Aviation Organization, notes aviation safety expert Suzanne Kearns.

But Kearns, an associate professor who teaches about human factors and aviation safety at Western University, says those regulations largely focus on physical well-being and what to do in the event a pilot becomes incapacitated or suffers a heart attack in the air.

A pilot stands inside the cockpit during boarding for the Germanwings flight 4U9441, formerly flight 4U9525, from Barcelona to Dusseldorf. (Albert Gea/Reuters)

"You would get an electrocardiogram for your heart, audiograms for your hearing, they'd check your vision for colour-blindness, check your weight," she said.

"But there's not been much of a focus on mental health."

Pilots are only required to "self-identify" if they've been seeing doctors for mental health issues, as well as declare whether they're taking medication or dealing with mental problems.

For most pilots, who have spent years of studying and between $50,000 and $100,000 spent on flight-school training, there would be little incentive to do that, though.

"The reality is they all know if they lose their medical, they have no careers," Kearns said.

Hard to test for mental illness

French gendarmes and investigators work amongst the debris of the Germanwings Flight 4U9525at the site of the crash, near Seyne-les-Alpes, French Alps. (Emmanuel Foudrort/Reuters)

In Canada, annual physicals for commercial pilots are performed by Transport Canada-approved doctors.

Pilots 40 and older would be required to obtain a medical certificate every six months.

However, the most rigorous "category 1" medical certificates do not include a psychological testing component.

The international Aerospace Medical Association published a 2013 report recommending more mental health screening among pilots following the apparent mid-flight panic attack suffered by JetBlue captain Clayton Osbon.

While Philip Scarpa, president of the association, acknowledged "there's room for improvement" for mental health screening of pilots, he said "it's a nebulous topic because mental illness is hard to test for."

People pay their respects at a memorial for the victims in the village of Le Vernet, near the crash site, on Friday. (Robert Pratta/Reuters)

"Depression, anxiety, mania, alcohol and drug abuse -- those things can be asked about during periodic aeromedical exams," Scarpa said.

"The caveat is it needs to be effective, and trying to look for the serious sudden psychological diseases is not going to be effective."

Until psychological tests can be perfected and guarantee against false positives, he said, it would be difficult to begin grounding pilots.

Sick note not enough

During medical certificate assessments, a doctor can note down any suspected psychological triggers or symptoms in a "Remarks" section.

In Lubitz's case, however, doctor sick notes for an undisclosed illness would not have been enough to stop him from flying.

German police officers carry bags out of a house believed to belong to the parents of crashed Germanwings flight 4U 9524 co-pilot Andreas Lubitz in Montabaur on Wednesday. (Kai Pfaffenbach/Reuters)

That might only have been possible had he outed himself or admitted he was suffering from anxiety – something Kearns said pilots have a hard time acknowledging.

For its part, the Aerospace Medical Association suggests the adoption of "safe zones" designed to encourage pilots under psychological distress to self-report. These could go a long way towards changing the stigma surrounding mental illness, it says.

When his mother passed away, James Phillips, the international affairs director with the German Pilots Association, relied on an aviation support line.

'I called and said, "I'm not fit to be in the cockpit...and my airline said, 'Take two weeks off. Call us when you feel better.'- James Phillips, German Pilots Association

"I called and said, 'I'm not fit to be in the cockpit because I am concentrating on my mother,' and my airline said, 'Take two weeks off. Call us when you feel better,'" Phillips told CBC News Network.

"I think this should actually be the real way to go forward, but I realize it's based on a trust and honesty situation, which sometimes is very difficult."

Protecting privacy

Losing flight hours is another concern for younger pilots making meagre starting salaries, Kearns said.

If a pilot feels momentarily unsafe or unfit from a mental health perspective, it is hard to see how that wouldn't be perceived as a permanent career-ender, she said.

German police officers stand outside a house believed to belong to crashed Germanwings flight 4U 9524 co-pilot Andreas Lubitz in Montabaur. (Ralph Orlowski/Reuters)

As for how rules surrounding a pilot's mental health status would square with privacy, Minister of Transport Lisa Raitt told CBC News Network that Canada's Aeronautics Act includes provisions to ensure the privacy of a pilot is protected in such cases.

"There will be information given to the airline as to why their pilot doesn't have a certificate of fitness, but really the medical treatment — the dossier itself — is kept very private between the individual and the Transport Canada-affiliated doctor," she assured.

One way or another, Kearns expects aviation safety management systems will increasingly consider mental health disclosure guidelines in light of the Germanwings disaster.

"The reality is the culture will have to shift before anything can change, though," she said.

"Pilots have to learn mental health is not something you can tough out, or just grin and bear. It's something we need to encourage people to seek treatment for."

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Ontario's children's advocate wants inquest into 12-year-old's suicide

Ontario's provincial advocate for children and youth wants the provincial coroner to launch an inquest into the death of a 12-year-old  boy from Cobourg who committed suicide in August after years of intervention from nine different children's mental health services and agencies.

"How does that 12-year-old boy end up hanging from a tree?" Ontario's youth advocate Irwin Elman said to the fifth estate, as part of its investigation into the death of Chazz Petrella seven months ago. "I want to know."

Here, Elman said, is "a 12-year-old boy who has, by all accounts, some real strengths, [is] really engaging and for a number of years has had services in his life, people in his life."

the fifth estate investigation has found that Chazz was twice unable to access testing and care that might have been important because funding was not approved by the non-profit agency Service Coordination for Children and Youth, which is funded by the provincial government and has a mandate to develop integrated service plans for children with special needs.

He also never received a firm diagnosis or treatment plan despite being in and out of three public schools, two specialized residential facilities for children with behavioural issues, a private school  for children with special needs and an in-patient psychiatric crisis centre.

Chazz's parents hope that a coroner's inquest will give them the answers they are looking for.

"I think there has to be accountability," says his mother, Janet Ashby-Petrella. "It doesn't have to be personal accountability, but there has to be someone to say that these are flaws in the system that have to be held accountable by each one of these agencies."

Chazz Petrella was 10 in this photo. He took his life two years later. (CBC)

Tracy MacCharles, Ontario's minister for children and youth services, declined to be interviewed about the issues Chazz's story raises, with her office at one point citing privacy concerns. Instead she provided a statement that said her ministry is working "tirelessly" to fix what she calls "gaps" in Ontario's mental health system.

Dr. Dirk Huyer, Ontario's chief coroner, confirms that his office is investigating Chazz Petrella's death, a process that can take months. That investigation would need to be completed before a decision would be made about whether to call a full inquest.

The problems Chazz faced with Ontario's mental health agencies are not new.

There have been at least eight different government reports in Ontario all emphasizing the need to do better when it comes to children and mental health.

Canada also has the third-highest youth suicide rate in the industrialized world.

And suicide is the second leading cause of death for youth aged ten to 19.

To help deal with this reality, Elman launched Canada's first provincial inquest database online in 2013.

The site features searchable recommendations from the more than 26 inquests in the last 15 years that involved the deaths of children and youth.

Ontario's children and youth advocate Irwin Elman created a searchable database of all inquest results in the province that deal with the deaths of children. (CBC)

The database includes suicides, homicides and accidental deaths. Elman hopes that giving the public access to this information will provide a resource for families and increase transparency and accountability.

Among the existing recommendations, at least four different coroners' juries over the past 14 years have cited specific systemic changes that, had they been implemented and enforced, might have helped Chazz and his family.

These include making comprehensive mental health assessments a priority to be done as soon as a child is identified as having problems, and assigning each family a government-appointed guide, someone to help navigate the fragmented system and to protect the child's interests. 

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Superbug plan will reduce antibiotic resistance by 2020, Obama pledges

The White House aims to maintain the ability of current antibiotics to fight illnesses and develop new treatments.

The White House on Friday announced a five-year plan to fight the threat posed by antibiotic-resistant bacteria amid fears that once-treatable germs could become deadly.

Repeated exposure to antibiotics can lead germs to become resistant to the drugs, so that they are no longer effective. The U.S. Centers for Disease Control and Prevention estimates that drug-resistant bacteria cause 23,000 deaths and 2 million illnesses each year in the United States.

The World Health Organization said last year that bacteria resistant to antibiotics have spread to every part of the world and might lead to a future where minor infections like strep throat could kill. Antibiotic resistance also threatens animal health, agriculture, and the economy.

In an interview with WebMD, President Barack Obama said over-prescribing antibiotics is a serious problem.

"Studies have consistently shown that a lot of America's antibiotic use is unnecessary," he said. He said he hopes his plan will create a system to show real-time rates of antibiotic use and where cases of drug resistance are being reported. "If we can see where these drugs are being over-prescribed, we can target our interventions where they're needed most."

The White House's overall goal is to prevent and contain outbreaks of infections at home and abroad. It's aiming to maintain the ability of current antibiotics to fight illnesses and develop new treatments.

The plan is the result of an order Obama signed in September forming a task force on the issue. Obama also has asked Congress to nearly double its funding to fight antibiotic resistance to $1.2 billion US.

Critics said the White House needs to go further, particularly in terms of the antibiotics used in animals processed for meat. The U.S. Food and Drug Administration has already successfully encouraged many drug companies to phase out the use of antibiotics used for animal growth promotion. But advocacy groups have called on the agency to limit other uses of animal antibiotics as well, such as for disease prevention when holding animals in crowded conditions.

"Once again, the administration has fallen woefully short of taking meaningful action to curb the overuse of antibiotics in healthy food animals," said New York Democratic Rep. Louise Slaughter, a microbiologist who has sponsored legislation to stop routine antibiotic use in animal farming.

"With 80 per cent of the antibiotics produced in the United States being used in agriculture mostly for prevention, any meaningful solution to the looming antibiotic resistance crisis must begin with limits on the farm — and trusting a voluntary policy that lets industry police itself will not bring about real change," she said.

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Pregnant in limbo: How vulnerable women pay for Canada's universal health care

Friday March 27, 2015

The numbers in Canada are hard to nail down, but advocates say there are at least 500,000 people living in Canada who don't have provincial health insurance. And tens of thousands of them are pregnant women.

For many of them, the excitement of bringing a new life into the world comes along with a lot stress and anxiety. They worry that they won't be able to afford the care they and their babies need to be healthy.

But does Canada have a duty to care for these women and their unborn children? Healthcare workers who work with uninsured pregnant women say there's no question Canada does.

Manavi Handa, a Toronto-based midwife, says prenatal care is one of the most cost-effective interventions in all of medicine. She says free healthcare for all pregnant women is not only the right thing to do ethically, but it makes a lot of financial sense too.

"Some studies have shown that every dollar spent on prenatal care saves four dollars to the healthcare system," says Handa.

These are the three stories of women featured in this week's Day 6 documentary, Pregnant in Limbo. The piece was produced by Day 6's Beza Seife.

Yaimy 

When Yaimy found out she found out she was pregnant, she says she had just arrived from Mexico to join her Canadian husband and that the pregnancy wasn't planned. She's waiting for her permanent residency application to be accepted under her husband's sponsorship.

Because of her previous pregnancy, she had to have a medically-necessary caesarean section. 

"Everyone says health care in Canada is free. When I arrived, they told me at the border that I would be able to get health care but nobody told me about this three month wait," she says. In Ontario new-comers need to wait the months before having access to free health care.

Her husband Joel says he made payment arrangements with the hospital ahead of time, when he learned Yaimy wasn't covered for her c-section.

So on the day of Yaimy's scheduled c-section, he says he was shocked when the anesthetist asked him to hand over $800 in cash as his wife was lying in the hospital bed with an IV in her arm. He says the doctor told him she wouldn't administer his wife any medication without the cash.

"Honestly, it's crazy. I go to the bank, I bring the money because I need it for her [Yaimy]," he says.

The anesthetist in this case denied Day 6's interview request.

Saira 

Saira Waheed arrived in Canada from Qatar earlier this year with her husband and two children. Canada approved them as permanent residents before they landed in Toronto.

Because of her previous pregnancies, Saira has to undergo a medically-necessary caesarean section, which she was told could cost $10,000 to $15,000.

"I went to a lot of places for help when I first found this out, and I was basically told the same thing: that there's nothing you can do to avoid the wait, and that this is a government process," she says.

Saira says she and her family have spent the little savings they brought with them to get settled, and that they have no fund or plan to cover the cost of her c-section.

Pamela

Pamela is a 25-year-old woman living in Vancouver, with her common-law Canadian partner and her two year old son. After arriving from Mexico on a tourist visa, her partner has now sponsored her to become a permanent resident.

Day 6 agreed to use a pseudonym because she fears going public with her story could negatively affect her permanent residency application.

"I had no idea what to expect with health care. We just thought we go to the hospital and pay, and done. But we didn't think it was going to be that much," says Pamela, about the $10,000 she says the hospital quoted her to deliver her baby there.

So Pamela ended up having her baby at home with a midwife. She says she would have much preferred to have delivered in the hospital, just steps away from her apartment, but without health coverage she says just couldn't afford it.

 "It was so hard, with no painkillers or drugs.  I was so scared. And I just kept thinking should I have gone to the hospital in the first place? I was in the middle of having a baby and they're [the midwife and doula] telling you that you might end up at the hospital. That's very scary," she says.

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How my mother's life and death influenced my difficult BRCA surgery choice

When Kenzie Broddy tested positive for the BRCA 2 gene, she was told her risk of breast cancer was close to 70 per cent and chance of ovarian cancer was close to 20 per cent. (Courtesy Kenzie Broddy )

My mother battled breast and ovarian cancer for years. The chemotherapy sessions, surgeries and radiation were a full-time job that gradually weakened and debilitated her. Her body gradually died, but never once did I see her spirit and determination to live diminish. Regardless, seeing the strongest woman I ever knew slowly become tired and lifeless was incredibly painful.  

Five days before she died, she said this to me: "If I knew then what you know now, everything would have been different. If I could have gone back and changed everything, you don't think I would? I think about it all the time."

In her final remission of ovarian cancer, my mother tested positive for the BRCA 2 gene mutation. This was before Angelina Jolie made headlines with her BRCA 1 story. We didn't know such a gene existed. But we knew that recurring cancers riddled my family. At age 27, I also tested positive for the BRCA 2 gene.

This meant my risk of breast cancer was close to 70 per cent and my chance of ovarian cancer was close to 20 per cent. In the initial moments of my genetic diagnoses, I felt it was a curse. It was the defining factor that meant years of suffering for my mother and ultimately I feel the cause of her death.  

After two years of gathering information about what options were available to me, I decided to undergo a prophylactic double mastectomy. This was not my only option. But I felt it was right for me. There is regular screening available for high-risk patients. There are drug options that lower the risk of these cancers, like birth control and tamoxifen. But I knew that the idea of living my life, constantly looking over my shoulder for a cancer diagnoses was not for me. It was not a life I was willing to take on.

There were many factors to consider. I wasn't a mother yet. I was now 28 years old, but not young enough to be out of the realm of impending cancer. The surgery meant that I would lose the ability to breastfeed my future children. It also meant bodily scars, loss of feeling in both breasts and two very invasive surgeries. 

The timing of this surgery forced me to plan my future accordingly. I decided, when weighing out possible scenarios, that cancer was far worse than not being able to breastfeed.

My partner had a lot of influence in my experience. He attended all my appointments ready with questions. He listened to all my concerns. And most of all, he reminded me that my health is what mattered most to him. To all men in a similar situation: Your actions in this are important and valued. And your wife or girlfriend will care greatly how you react and how you show support.

My double mastectomy surgery was a success. But it was hard and painful. All of the tissue was removed from both of my breasts and over time implants were slowly filled to stretch the skin back to my original breast size. It felt like a Mack Truck was parked on my chest. But slowly and with time, like all pain, it got better and I became stronger.

In six months, I had a second and final surgery, which was the cosmetic reconstruction. It's now behind me, and I feel no less like a woman than I did before. With or without clothes, no one could ever tell what my body has been through. I feel empowered and secure about my future well-being. I'm very lucky to beat the devil I know, instead of being hit by the devil I don't.

I still have a 20 per cent chance of ovarian cancer. After I have children, I have decided that I will have a full hysterectomy.

People have asked me if my decisions are based on those of the actress Jolie. I want to be very clear. Jolie has raised huge awareness on a game-changing development in familial cancers. If she has helped just one woman get tested for the BRCA gene and potentially saves her life with proper prevention then she did a remarkable thing. But, this is not the kind of decision that falls on a celebrity bandwagon. No woman is doing this because of celebrity admiration. They are doing it to save their life, just like Jolie did.

BRCA mutations account for about five per cent of all breast cancers and up to 11 per cent of all ovarian cancers, according to the Canadian Cancer Society. If your family has a history of breast, ovarian or prostate cancer, please talk to your family physician. This all starts with a conversation between you and your doctor.

At this point, I feel the mutation was not a curse. It was empowerment. To live in a time where we have access to such knowledge and to be in a position to make a clear choice in preventing cancer in my life is amazing.

I know now that my mother's death was not in vain. It is because of her that I and other family members were tested and have taken the proper steps to try to ensure our ending doesn't have to be the same as hers.

Kenzie Broddy is a producer at CBC News Network.
 

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Human embryo modifications must be halted, scientists urge

The emerging ability to modify human embryos in a way that gets passed on to future generations has raised alarm bells for scientists who've called for a moratorium.

In the last two weeks, statements published in the journal Nature and the journal Science by Nobel laureates and from the International Society for Stem Cell Research called for a pause on genome editing experiments on human embryos.

It's the risks associated with modifying human sperm and eggs that might have unforeseen consequences, which spurred the "uh oh" moment now, said Timothy Caufield. He holds the Canada Research Chair in health law and policy at the University of Alberta in Edmonton.

"The concern is can we use this technology in an inappropriate way to alter the genome, alter the germ line to alter our human genetic heritage," Caufield said.

Advances in genome manipulation technologies have provided molecular biologists with the tools to delete genes, repair a mutation or add new DNA. (Jim Young/Reuters)

In Canada, researchers can change the genetic structure of a cell that doesn't get passed on. But changes to a gene that gets passed on are banned.

Genome editing is a very powerful tool, said Edward Lanphier, one of the authors of the Nature paper and chair of the Alliance for Regenerative Medicine.

"Patient safety is paramount among the arguments against modifying the human germ line (sperm and eggs,)" Lanphier and his co-authors wrote.

There is a precedent to using the force of moral persuasion to press pause on certain experiments. In 1975 in Asilomar, Calif., researchers, doctors and lawyers agreed to guidelines on moving DNA between species until there was more comfort with the results and the ability to predict effects, said Alta Charo of the University of Wisconsin Law School, one of the authors of the Science paper.

More recently in the United Kingdom, there was a similar stop-and-reflect period on mitochondrial DNA replacement,   the so-called three-parent baby technique.

Advances in genome editing technologies equip molecular biologists with scissors to delete genes, repair a mutation or add new DNA. Modifications to sperm and egg cells which get passed on to future generations is now technically possible.  

"They could also be used to cross a boundary that heretofore collectively humanity has said we don't want to cross," Lanphier said.

Lanphier is also the president and CEO of Sangamo Biosciences in Richmond, Calif., which is conducting clinical trials to evaluate genome editing as a "functional cure" for HIV by modifying the immune system's T cells.

It's the combination of technological advances and rumours of human embryo experiments that's sparked the urgency.

"I think it's more than just rumours," Lanphier said. "It's a broad-based perception that these papers are pending publication."

The pending publications show genome editing technologies can be used in human embryos and it does change the germ line, he said.

The Science and Nature papers differ on whether to allow basic research on human embryos to continue.

What's agreed is this is a critical moment for experts to come together to discuss the technology and reach a collective decision on how or if we want the technology applied to engineering the human genome.

Charo welcomes discussion among scientists and the public on applications of the technology.

"I think that is very reassuring and it moves people back to exalting the scientists and away from thinking of them as Dr. Frankenstein," Charo said. 

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Ebola's toll worst in babies, WHO study finds

Patrice Gordon, a B.C. nurse practitioner and Red Cross delegate, cared for a one-month-old baby with Ebola in Sierra Leone. Nearly every infected child under age 1 had a fever, researchers have found. (Red Cross/Canadian Press)

Ebola has taken its greatest toll on babies. About 90 per cent of children under age 1 who caught the virus in West Africa died from it, the first large study of the epidemic's impact on children suggests.

Those a little older — ages 1 to 4 — fared not much better. Ebola proved fatal for nearly 80 per cent of them, too, the study found. It is based on case sampling and tracking of more than 1,000 children by the World Health Organization's Ebola Response Team. The work was published as a research letter Wednesday by the New England Journal of Medicine.

Ebola has sickened more than 23,000 and killed more than 10,000 since the epidemic began more than a year ago. Guinea, Sierra Leone and Liberia have been hardest hit.

People over 16 make up 79 per cent of the confirmed and probable cases in which ages are known. The new report looks at the rest.

Key findings:

• Kids got sick faster: The average incubation period was about 7 days in babies under 1 and nearly 10 days in 10-to-15-year-olds. It can be as long as 21 days in adults.
• Nearly every child under age 1 had a fever, and all children under 16 were more likely to have this symptom than adults.
• Children were less likely than adults to report belly, chest, joint or muscle pain, or trouble breathing or swallowing, but that may be because young kids have trouble describing these things, not that their symptoms actually were different from those in older people.
• The death rate was lowest among children 10 to 15 years old. People over 45 fared almost as poorly as children under 5 in terms of survival.

The findings dovetail with what Doctors Without Borders has been seeing.

"Young kids don't do well," especially those under 5, one of its physicians, Dr. Armand Sprecher, said at an American Society of Tropical Medicine and Hygiene conference in New Orleans in November.

There are no specific drugs or vaccines to fight Ebola, but some experimental ones are being tested.

The study was supported by the Bill and Melinda Gates Foundation, the U.S. National Institutes of Health and others.

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Ontario's children's advocate wants inquest into 12-year-old's suicide

Ontario's provincial advocate for children and youth wants the provincial coroner to launch an inquest into the death of a 12-year-old  boy from Cobourg who committed suicide in August after years of intervention from nine different children's mental health services and agencies.

"How does that 12-year-old boy end up hanging from a tree?" Ontario's youth advocate Irwin Elman said to the fifth estate, as part of its investigation into the death of Chazz Petrella seven months ago. "I want to know."

Here, Elman said, is "a 12-year-old boy who has, by all accounts, some real strengths, [is] really engaging and for a number of years has had services in his life, people in his life."

the fifth estate investigation has found that Chazz was twice unable to access testing and care that might have been important because funding was not approved by the non-profit agency Service Coordination for Children and Youth, which is funded by the provincial government and has a mandate to develop integrated service plans for children with special needs.

He also never received a firm diagnosis or treatment plan despite being in and out of three public schools, two specialized residential facilities for children with behavioural issues, a private school  for children with special needs and an in-patient psychiatric crisis centre.

Chazz's parents hope that a coroner's inquest will give them the answers they are looking for.

"I think there has to be accountability," says his mother, Janet Ashby-Petrella. "It doesn't have to be personal accountability, but there has to be someone to say that these are flaws in the system that have to be held accountable by each one of these agencies."

Chazz Petrella was 10 in this photo. He took his life two years later. (CBC)

Tracy MacCharles, Ontario's minister for children and youth services, declined to be interviewed about the issues Chazz's story raises, with her office at one point citing privacy concerns. Instead she provided a statement that said her ministry is working "tirelessly" to fix what she calls "gaps" in Ontario's mental health system.

Dr. Dirk Huyer, Ontario's chief coroner, confirms that his office is investigating Chazz Petrella's death, a process that can take months. That investigation would need to be completed before a decision would be made about whether to call a full inquest.

The problems Chazz faced with Ontario's mental health agencies are not new.

There have been at least eight different government reports in Ontario all emphasizing the need to do better when it comes to children and mental health.

Canada also has the third-highest youth suicide rate in the industrialized world.

And suicide is the second leading cause of death for youth aged ten to 19.

To help deal with this reality, Elman launched Canada's first provincial inquest database online in 2013.

The site features searchable recommendations from the more than 26 inquests in the last 15 years that involved the deaths of children and youth.

Ontario's children and youth advocate Irwin Elman created a searchable database of all inquest results in the province that deal with the deaths of children. (CBC)

The database includes suicides, homicides and accidental deaths. Elman hopes that giving the public access to this information will provide a resource for families and increase transparency and accountability.

Among the existing recommendations, at least four different coroners' juries over the past 14 years have cited specific systemic changes that, had they been implemented and enforced, might have helped Chazz and his family.

These include making comprehensive mental health assessments a priority to be done as soon as a child is identified as having problems, and assigning each family a government-appointed guide, someone to help navigate the fragmented system and to protect the child's interests. 

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