Sodium limits for children proposed

Parents trying to reduce how much sodium their children eat to avoid harmful health effects in the future have a new international guide as Parliament debates mandatory limits.

A bill to make the food industry accountable for sodium had its second reading in the House of Commons on Friday.

Pediatricians advise parents to hold the salt shaker. (Caryn Rousseau/Associated Press)

NDP MP Libby Davies' bill focuses on the 77 per cent of sodium Canadians consume from prepackaged foods.

If passed, Bill C-460 would phase in lower sodium levels in foods and add simple, standardized labels.

During second reading, Colin Carrie, the parliamentary secretary for health, said a regulatory approach is not required and that mandatory warnings can't be legislated for individual foods based on Health Canada's targets for categories like breads and cereals.

Mary L'Abbé, a professor of nutritional sciences at the University of Toronto , is a member of the World Health Organization's nutrition committee. On Thursday, the UN agency recommended its first limits on sodium intake for children.

"What we're really doing is setting our children on a path to having the problems of adulthood at younger ages than we ever would have expected," L'Abbe said in an interview with CBC News.

L'Abbé is concerned that children are seeking out salty foods, saying the few studies done at children suggest they are at risk for hypertension — high blood pressure.

The WHO recommends that adults restrict their sodium intake to less than 2,000 milligrams of sodium, or five grams of salt per day, and have at least 3,510 mg of potassium per day.

For a young child who eats two-thirds as much as an adult, his or her sodium intake should be that much lower as well, L'Abbé said. In the absence of regulations, experts said it's up to parents to read labels, choose products low in sodium at the grocery store and ask for them at restaurants.

For Linda Douglas of Toronto, it's a challenge to balance her daughter's sweet tooth and taste for salt.

"If she's having avocado she wants to put salt on, she definitely gravitates towards the salty snacks like chips so we really have to keep an eye on that."

With files from CBC's Kim Brunhuber

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Toronto doctor's boss says he was 'aware' of sex assault allegations

The former head of anesthesiology at Toronto's North York General Hospital testified Friday that he was "aware" of allegations of sexual assault against one of his doctors.

Dr. Stephen Brown was George Doodnaught's boss when the majority of the alleged incidents happened.

Doodnaught, is charged with 21 counts of sexual assault.

Twenty of the assaults are alleged to have taken place in the operating rooms in the hospital between 2006 and 2010. The other assault is alleged to have happened in a private clinic.

Doodnaught, 64, has pleaded not guilty to all charges. He worked at the hospital from 1981 until his arrest in 2010.

Brown testified Friday about hearing a complaint in 2010, directly from one of the alleged victims. It was that complaint that ultimately lead to criminal charges against Doodnaught.

Brown told the court he assured the woman he was taking it seriously and that her complaint would be dealt with by the hospital.

The prosecutor asked Brown, "Was this news to you, or were you aware of previous complaints?"

Dr. Brown told the court, "I was aware."

Two other women had shared similar complaints with Brown years earlier.

In 2007, an 85-year-old woman alleged Doodnaught forced his penis in her hand during a knee replacement operation.

A year later a 48-year-old woman alleged Doodnaught forced his genitals into her hand and mouth while she sedated and undergoing a medical procedure.

Most of the other complainants have described similar assaults taking place in the operating room.

Brown told the court he looked into the first complaint but ultimately decided it had no merit.

He also testified that police launched an investigation of the second complaint, but he never told them that the hospital had previously looked into Doodnaught's conduct.

He testified he told the 85-year-old and her family that Doodnaught was known as a very "hands-on, touchy-feely doctor," with an "excellent reputation."

Brown also told the court that when he made those comments he knew of a third complaint against Doodnaught that had been made in 2006. But that those allegations were unsubstantiated.

By the time the hospital held a formal meeting about Doodnaught after the complaint in 2010, Brown told the court he had "forgotten" about that earliest alleged incident and only told senior hospital staff about the other two.

The trial continues.

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Ottawa endoscopy clinic had 'gross' cross-contamination

An Ottawa doctor at the centre of an HIV and hepatitis scare in late 2011 failed a clinic inspection months earlier due to the use of unsterilized instruments and "gross cross-contamination" from a dirty scope, among other reasons, according to a report from the College of Physicians and Surgeons of Ontario.

Dr. Christiane Farazli quit performing endoscopies in September 2011. (CBC)

Dr. Christiane Farazli, an internist who gave up performing endoscopies at her clinic in September 2011, was accused of using improper cleaning procedures for patients treated between April 2002 and June 2011, when the clinic failed the inspection.

Ottawa Public Health investigated Farazli after the inspection, and then sent 6,800 letters to former patients warning them to get tested for HIV, hepatitis B and hepatitis C.

After a year-long investigation, public health officials said they found no cases linked to the clinic.

College releases reports on dirty clinics

The report on Farazli's Carling Ave. clinic's failed inspection was one of 11 released publicly Friday by the college, which has investigated out-of-hospital premises since April 2010.

The college accused Farazli of reusing single-use items, such as snares, that would pose "immediate potential harm to patients' health using unsterilized instruments and it promotes the transmission of diseases."

The report also accused a registered nurse at the clinic of failing to monitor vital signs during a procedure, as well as dipping biopsy forceps in formaldehyde before "re-inserting the same forceps into the patient's esophagus without first rinsing it in water."

The full report can be found at the bottom of this page.

The college has posted inspection reports online for all 280 of Ontario's out-of-hospital premises online. They can be searched through a public register.

The facilities will be inspected every five years unless the college receives specific information about a facility, according to the college's deputy registrar.

"Part of the public interest is ensuring that physicians are competent and that facilities in this case are safe, and that the care provided is safe and the quality is there, and that there's information available to members of the public to make informed decisions about their care," said Dan Faulkner.

The public health investigation into Farazli cost the city $770,000 but the provincial government promised to reimburse those costs.

There was also a $10-million class-action lawsuit filed against Farazli in late 2011, including 1,200 former patients.

Dr. Farazli clinic inspection report by

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Marijuana stays illegal in Canada after Appeal Court ruling

Canada's ban on marijuana was effectively upheld Friday when Ontario's top court struck down an earlier court decision that said Canada's laws related to medicinal pot were unconstitutional.

In overturning the lower court ruling, the Court of Appeal ruled the trial judge had made numerous errors in striking down the country's medical pot laws.

Among other things, the Appeal Court found the judge was wrong to interpret an earlier ruling as creating a constitutional right to use medical marijuana.

"Given that marijuana can medically benefit some individuals, a blanket criminal prohibition on its use is unconstitutional," the Appeal Court said.

"[However], this court did not hold that serious illness gives rise to an automatic right to use marijuana."

Currently, doctors are allowed to exempt patients from the ban on marijuana, but many physicians have refused to prescribe the drug on the grounds its benefits are not scientifically proven.

The Canadian HIV/AIDS Legal Network called the decision a disappointing missed opportunity.

"Allowing the current regulations to stand unchanged will leave many people with serious health conditions without effective access to legal authorization to use cannabis as medicine," said Richard Elliott, executive director of the network.

"People shouldn't have to risk going to prison in order to get the medicine they need."

Doctors reluctant to prescribe marijuana

The ruling comes in the case of Matthew Mernagh, 37, of St. Catharines, Ont., who suffers from fibromyalgia, scoliosis, seizures and depression.

While he argues marijuana is the most effective treatment of his pain, he said he was unable to find a doctor to support his application for a medical marijuana licence.

Mernagh resorted to growing his own and was charged with producing the drug in April 2008.

In April 2011, Ontario Superior Court Justice Donald Taliano found that sick people cannot get access to medical marijuana through appropriate means. He said that forced ill people who should be able to get the drugs to resort to criminal acts.

Taliano struck down the laws prohibiting possession and production of cannabis as unconstitutional but the ruling was put on hold pending the federal government's appeal, which was heard last May.

The Appeal Court found Taliano had relied on "anecdotal evidence" and drew unfounded conclusions that the medicinal pot scheme made it almost impossible for patients to get legal access to the drug.

"The trial judge found that the 'vast majority' of those who needed medical marijuana were unable to get physicians to sign [exemption] declarations," the Appeal Court said.

"The record does not support the trial judge's inference that they failed to obtain medical declarations only because Canadian physicians are boycotting the [medicinal pot scheme]."

Osgoode Law Prof. Alan Young said the Appeal Court decision should not be seen as an endorsement of the medical marijuana program.

"They simply didn't feel the evidence was sufficient," Young said. "The case is important to show people that the program is still failing."

He noted the court started off in its judgment by noting this was the third time the Appeal Court was reviewing the medicinal pot scheme and the government was already making changes.

In December, Health Minister Leona Aglukkaq announced Ottawa would no longer grant medical marijuana licences to users, and only doctors would be able to prescribe pot.

In Friday's decision, the court said Mernagh had failed to provide evidence from a doctor that he met the criteria for a medical exemption to the country's pot ban.

"It was not open to the trial judge to hold that Mr. Mernagh and the patient witnesses who had not obtained medical declarations were entitled to exemptions," the Appeal Court said.

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Aboriginal people more likely to suffer heart attacks

First Nations people are more likely to be admitted to hospital for a heart attack and at an earlier age than residents of areas with a low aboriginal population, a new report finds.

Thursday's report by the Canadian Institute of Health Information's report on hospital care for heart attacks in First Nations areas is the institute's first look at the topic.

Once hospitalized for a heart attack, aboriginal people are likely to fare as well as others, the report's authors said.

But residents of areas with high concentrations of First Nations are also more likely to have other complication conditions such as Type 2 diabetes.

"The results presented in this report highlight that disparities exist in rates of heart attacks and hospital experiences of heart attack patients from high-Aboriginal and low-Aboriginal," the report's authors concluded.

Despite higher needs, residents living in high First Nations areas were less likely to have angiograms to take pictures of their arteries or to receive ballooning to open up blocked arteries.

The researchers analyzed seven years of hospital records to compare residents of areas with a high concentration of First Nations people to locations with small aboriginal concentrations.

Heart attack patients from high First Nations areas had similar mortality rates within 30 days of hospital admission once factors like age, sex and other illnesses were taken in account.

Areas were defined as having high proportions of First Nations if a third or more of residents self-identified as First Nations.

Researchers turned to geographical comparisons to overcome inconsistencies in how hospitals record patients' ethnicity.

They said socio-economic disadvantage plays an important role in health inequalities but they couldn't assess the impact because of small sample sizes. It's thought that longer term studies could provide more insight into the differences in complications and survival after cardiac treatment.

Residents of areas with a relatively high proportion of Inuit were less likely to be admitted for a heart attack than residents of remote low-Aboriginal areas. Despite distance barriers, procedure rates were similar.

Métis in Manitoba and Ontario also had higher risk for and higher rates of heart attacks than their non-Métis counterparts.

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17 cough and cold products recalled

A total of 17 cough and cold products are under recall because of defective caps that could allow a child to take harmful amounts, Health Canada says.

Novartis Consumer Health Canada is recalling the products, including Jack and Jill, Triaminic, Neo Citran and Buckley brands, the department said in an advisory Thursday.

"Children may be able to open the bottle and ingest the product," the advisory said. "The ingredients of the affected products may be harmful to children and as such, ingestion of these products may cause serious adverse health consequences, including death."

Health Canada and Novartis said they haven't received any adverse reactions reports in Canada regarding the defective cap.

Novartis Consumer Health in the U.S. received four adverse event reports for Triaminic Syrups related to the issue.

"The products being recalled were produced at the Novartis Consumer Health manufacturing facility in Lincoln, Neb., prior to the voluntary suspension of operations in December 2011," Novartis Consumer Health Canada said in a statement.

Buckley's Complete was also manufactured until January at another site using the same Lincoln bottle and cap components.

"A consumer complaint in the U.S. in late November 2012 triggered an internal investigation by Novartis Consumer Health that determined a voluntary recall was in the best interest of consumers."

The company asked retailers to stop selling the products immediately and return them.

The products were distributed across Canada.

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High sodium levels should be disclosed, health groups urge

A coalition of Canadian medical groups wants all food companies to be required to clearly disclose on the label if the amount of sodium in their products exceeds Health Canada's targets.

The move comes as the World Health Organization recommended new daily consumption limits on sodium for children.

The public health advice aims to reduce blood pressure. High blood pressure increases the risk of heart disease and stroke.

"Foods that fail to meet Health Canada's sodium-reduction targets …would be required to disclose that fact on food labels so long as that failure persists," the Centre for Science in the Public Interest said in a statement Thursday.

"The bill also obliges the federal government to implement the regulatory reforms concerning nutrition labelling on prepackaged foods and chain restaurant menus, advertising to children, nutrition standards for food procurement, and other measures."

Food & Consumer Products of Canada, which represents companies that manufacture and distribute food and beverages, said sodium reduction is a priority.

"Manufacturers have been on a journey of gradually reformulating products and introducing new ones," the group said in a statement responding to the measures proposed in Bill C-460.

The bill calls for the sodium reduction strategy to be implemented, which would:

• Require food manufacturers to lower sodium levels.
• Alert consumers if they have not done so.
• Ensure that consumers have access to clear information to make healthy food choices.

The public health moves aim to tackle elevated blood pressure, which the WHO called the number one cause of death and disability globally.

"These guidelines also make recommendations for children over the age of two," Dr. Francesco Branca, director of WHO's department of nutrition for health and development, said in a release. "This is critical because children with elevated blood pressure often become adults with elevated blood pressure."

The international guidelines vary depending on the child's size, age and energy needs, and apply to children over the age of two.

For adults, the new recommendation suggests less than 2,000 milligrams of sodium intake per day. The current limit is 2,000 milligrams.

Last year in Canada, 17 health organizations called on the federal government to implement a sodium reduction strategy, which includes an interim goal of reducing average daily sodium intake from 3,400 mg to 2,300 mg by 2016.

Most people consume too much sodium and not enough potassium, the UN agency said.

The potassium recommendation is for at least 3,510 milligrams a day.

Potassium-rich foods include beans and peas, nuts, vegetables such as spinach, cabbage and parsley, and fruits such as bananas, papayas and dates.

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Health Canada to review acne drug for blood clot risk

Health Canada says it is reviewing all available safety information on the drug Diane-35 following France's decision to ban the medication in response to the deaths of four women over the last 25 years.

The women died of blood clots linked to their use of Diane-35, an acne drug that is also widely prescribed as an oral contraceptive because it halts ovulation. It has been sold in France since 1987.

France's National Agency for the Safety of Drugs and Health Products said this week that Diane-35, made by Bayer and licensed in 135 countries, would be withdrawn from sale in three months. Meanwhile, doctors are banned from prescribing the medication.

Available since 1998 in Canada, Diane-35 is approved only for the temporary treatment of severe acne in women who are unresponsive to other treatments, Health Canada said Thursday.

However, the drug is often prescribed "off-label" as a contraceptive.

Blood clots are a rare but well-known side-effect of oral birth control pills and other hormonal products such as Diane-35, said the federal department, noting that the product monograph for the drug contains clear warnings about this potential adverse effect.

Health Canada said Diane-35 should not be used in patients with a medical history that puts them at risk for blood clots, including smoking, being overweight or a family history of the condition.

The department has issued previous warnings about the increased risk of blood clots associated with Diane-35 compared with estrogen/progestogen contraceptives, and has cautioned against using the acne drug for birth control.

Consumers experiencing symptoms of a possible blood clot — including persistent leg swelling, leg pain or tenderness, chest pain, or sudden shortness of breath or difficulty breathing — should seek immediate medical attention.

Doctors should be told about any medications being taken, including Diane-35, Health Canada said.

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Leafy greens top source of food poisoning in U.S.

About 1 in 5 illnesses were linked to leafy green vegetables, the CDC found. (Rogelio V. Solis/Associated Press)

A big U.S. government study has fingered leafy greens like lettuce and spinach as the leading source of food poisoning, a perhaps uncomfortable conclusion for health officials who want us to eat our vegetables.

"Most meals are safe," said Dr. Patricia Griffin, a government researcher and one of the study's authors who said the finding shouldn't discourage people from eating produce. Experts repeated often-heard advice: Be sure to wash those foods or cook them thoroughly.

While more people may have gotten sick from plants, more died from contaminated poultry, the study also found. The results were released Tuesday by the U.S. Centers for Disease Control and Prevention.

Each year roughly 1 in 6 Americans — or 48 million people — gets sick from food poisoning. That includes 128,000 hospitalization and 3,000 deaths, according to previous CDC estimates.

It's estimated there are about 11 million cases of foodborne illness in Canada every year, according to the Canadian Food Inspection Agency's website.

The new report is the most comprehensive CDC has produced on the sources of food poisoning, covering the years 1998 through 2008. It reflects the agency's growing sophistication at monitoring illnesses and finding their source.

What jumped out at the researchers was the role fruits and vegetables played in food poisonings, said Griffin, who heads the CDC office that handles foodborne infection surveillance and analysis.

About 1 in 5 illnesses were linked to leafy green vegetables — more than any other type of food. And nearly half of all food poisonings were attributed to produce in general, when illnesses from other fruits and vegetables were added in. It's been kind of a tough month for vegetables.

A controversy erupted when Taco Bell started airing a TV ad for its variety 12-pack of tacos, with a voiceover saying that bringing a vegetable tray to a football party is "like punting on fourth-and-1." It said that people secretly hate guests who bring vegetables to parties.

Hygiene standards on farms

The fast-food chain on Monday announced it was pulling the commercial after receiving complaints that it discouraged people from eating vegetables.

Without actually saying so, the CDC report suggests that the U.S. Food and Drug Administration should devote more staff time and other resources to inspection of fruits and vegetables, said Michael Doyle, director of the University of Georgia's Center for Food Safety.

Earlier this month, the FDA released a proposed new rule for produce safety that would set new hygiene standards for farm workers and for trying to reduce contact with animal waste and dirty water.

Meanwhile, CDC officials emphasized that their report should not be seen as discouraging people from eating vegetables. Many of the vegetable-related illnesses come from norovirus, which is often spread by cooks and food handlers. So contamination sometimes has more to do with the kitchen or restaurant it came from than the food itself, Griffin noted.

Also, while vegetable-related illnesses were more common, they were not the most dangerous. The largest proportion of foodborne illness deaths — about 1 in 5 — were due to poultry. That was partly because three big outbreaks more than 10 years ago linked to turkey deli meat.

But it was close. CDC estimated 277 poultry-related deaths in 1998-2008, compared to 236 vegetable-related deaths. Fruits and nuts were credited with 96 additional deaths, making 334 total deaths for produce of all types. The CDC estimated 417 deaths from all kinds of meat and poultry, another 140 from dairy and 71 from eggs.

Red meat was once seen as one of the leading sources of food poisoning, partly because of a deadly outbreak of E. coli associated with hamburger. But Griffin and Doyle said there have been significant safety improvements in beef handling. In the study, beef was the source of fewer than 4 per cent of food-related deaths and fewer than 7 per cent of illnesses.

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MRI-friendly implantable defibrillator a life-changer

An Ontario woman who is the first in North America to receive a unique implantable defibrillator says she now feels fantastic and relieved that doctors can monitor both her heart and brain as closely as needed.

Justine Bovenkerk, a 35-year-old mother and dental assistant in Newmarket, Ont., needed a defibrillator to treat a condition that can cause her heart to both race and slow. Doctors say she also requires regular MRIs to monitor lesions in her brain.

Dr. Atul Verma was excited to find an implantable defibrillator that worked not only for his patient's heart but also her brain monitoring needs. (Courtesy Southlake)

"It puts us into a quandary," said Dr. Atul Verma, a cardiologist and cardiac electrophysiologist at Newmarket's Southlake Regional Health Centre in Ontario who treats Bovenkerk. CTs are not as effective for monitoring and current pacemakers that are safe for MRIs only speed up the heart.

Bovenkerk needed an implantable cardioverter defibrillator, but the current metallic devices aren't compatible with the magnetic fields of an MRI. That's when Bovenkerk's medical team turned to a model that is approved for use in Europe. Within five days, Health Canada approved the application to try it in her case as the device meets Canadian, U.S. and European regulations for reliability.

"We're excited we're able to give Justine exactly what she needed," Verma said Wednesday.

"The big difference which makes it compatible with MRI are there are some subtle engineering changes in the design of both the defibrillator and the wires that attach to the defibrillator to make them less likely to interact with the magnets."

Bovenkerk was diagnosed with myotonic dystrophy at age 24 when she experienced problems getting her hand muscles to relax. After her younger brother suffered sudden cardiac death, genetic tests showed she and her mother and siblings all had the heritable condition. She is the most affected.

In December, paramedics took Bovenkerk to Southlake after she awoke to find she was blind in her right eye and her arm was numb. The brain lesions were diagnosed during the hospitalization.

"One minute it just feels just like pins and needles or something and then all of sudden I just have no feeling. I was like 'OK, this is not normal.'"

The minimally invasive implant procedure was performed on Dec. 24 — just in time to allow Bovenkerk to spend Christmas Day at home with her husband and six-year-old son as he wished in a letter to Santa.

Bovenkerk recalled the night Verma told her the implant was approved. "I started to cry. I'm under the hands of the best care. It was a relief to know that when I go home, if something happens, I feel safe. I don't have to worry so much. It was an amazing feeling.

"If it had happened about two years ago, this wouldn't even be option," Verma said.

Before the implant, Bovenkerk said she was often tired from her heart rate slowing and stressed over the possibility of being rushed to hospital. Now she said she feels excellent, has returned to work and is starting to resume workouts at the gym.

Although Bovenkerk is still wearing zip-up shirts to avoid lifting her arm too high, she was able to enjoy building a snowman recently. Initially nervous to be a guinea pig, Bovenkerk is now happy to share her story with other Canadians who may need an implantable cardioverter defibrillator.

While Bovenkerk's situation is rare, Verma said older individuals often need a defibrillator and some could benefit from MRIs, such as for stokes or other neurological conditions.

He pointed to studies that suggest between 10 per cent to 25 per cent of patients who get an implantable defibrillator may need an MRI at some point in the next two decades. The hope is that MRI will pick up changes early enough when medical treatment can make a difference to the course of the illness.

The Southlake hospital has a provincial mandate to deliver advanced diagnostic and treatment services within six regional programs, including cardiac and cancer.

Verma said the Berlin-based manufacturer of Bovenkerk's implantable defibrillator confirmed it was the first import of the device to North America.

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