Britain accused of turning a blind eye to female genital mutilation

Britain's reputation for turning a blind eye on the illegal practice of female genital mutilation may be about to change after British doctors, nurses and midwifes decided to take a stand and demand it be treated as child abuse.

Earlier this month, leading British medical groups delivered an extensive report to Parliament, recommending aggressive steps to eradicate the practice, which is still being carried out on young girls from certain African, Middle Eastern and Asian cultures. 

Dr. Deborah Hodes, a community pediatrician in the London borough of Camden, is an expert in the area of child safeguarding. (CBC)

The report revealed tens of thousands of cases of FGM in Britain (as many as 66,000 by some estimates). And while the practice was outlawed in 1985 and carries a maximum penalty of 14 years imprisonment, the country has never seen a single prosecution.

''It's a huge problem in Britain,'' says Dr. Deborah Hodes, a London community paediatrician and chair of child protection with the Royal College of Paediatrics, outlining that more than 24,000 girls are at risk of FGM and more than 66,000 women are living with the consequences. Hodes regularly gets referrals for young girls who underwent cutting — a common term for the practice in the U.K.— or who are at high risk of being cut.

Britain's medical community now wants all front-line health professionals to be better trained in detecting FGM and responding to it, and to report female patients who have had their sexual organs mutilated to police and other services.

FGM, sometimes called female circumcision, involves removing all or part of the clitoris as well as, often, the labia, the "lips" that surround the vagina, to make young girls more virginal and therefore attractive to future mates.

An estimated 140 million girls and women are living with the consequences of the practice, according to the World Health Organization, and in countries like Britain it is often done on young girls who are sent back to their ancestral homelands to have the procedure done. 

Leyla Hussein, a British woman, was once one of these girls. She was taken away to Somalia to be cut when she was seven. She's now campaigning to end the practice.

During her own pregnancy, she recalls, "I was shaking, having panic attacks, my body remembered the trauma. That's when I decided there was no way my daughter was going through that. But I needed the right information to defend my decision to my community.''

Soft-touch Britain

In Britain, anti-FGM campaigners are saying that an overzealous cultural sensitivity has led to authorities being slow to react on the FGM front, with some even questioning whether FGM is actually a British problem.

''It's not so much that I've encountered resistance, but there's a lot of silence," says Hussein. "For me when you're silent, you're consenting.''

In contrast, neighbouring France has adopted a much less tolerant approach to tackling FGM. Its systematic examination of young girls has led to some hundred prosecutions.

''I think England is very tolerant because they put cultural relativism first," says Isabelle Gillette-Faye, a French sociologist. "So if in your country of origin, you cut your girl, then it's possible in England as well.''  

In the western Senegalese village of Diabougo, a mother and daughter walk home after a meeting of women from several communities working to eradicate female genital mutilation. (Reuters)

Gillette-Faye suspects many French girls are sent to "easier" Britain to have the procedure done.

'It's easier to take the Eurostar to go to London, to a private clinic, and have someone cut the girl. It's just easier, it's less money than to go to another country,'' she says.

For her part, Hussein likes France's attitude towards FGM, but allows that an approach like that of the Netherlands' might be more effective.

"What the Netherlands have done really well," she says, "is implement that work in sexual education classes. It's compulsory. Front-line staff working with women and children, every new nurse, every new doctor, every new teacher, has to be trained on FGM.''

'Cultural sensitivity'

In Britain, the ministry of education has so far refused to make FGM training mandatory for teachers, though in a statement it said that "schools can choose to teach about FGM as part of their curriculum.''

That is not enough for some. ''We're talking about girls who are British citizens, and this is against their right to be safe," says Dr. Hodes. "So I don't really think it's a debate.'' 

As a result of the report, parliament's home affairs committee is considering an inquiry into why there hasn't been a prosecution yet in Britain. The Crown Prosecution Service is reportedly looking into a handful of cases that it may bring to trial. 

To date, there are not definitive studies of the number of girls at risk of FGM in Canada, but immigration patterns and human rights groups in Canada indicate that the figures could be substantial.  

'The biggest Somali community in the diaspora is in North America, that's a big alarm for me,'' says Hussein.  

''A lot of Canadian women contact us. They suffer in silence, they don't know where to go.''

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No 'healthy pattern of obesity,' review finds

Obesity increases the risk of premature death even in people without high blood pressure, high cholesterol and diabetes, according to a review of studies challenging the idea of "healthy obesity."
 
Researchers in Toronto collected information from eight studies on more than 60,000 people to determine whether people who are obese remain healthy in the long term.  

Their answer is no.  
 
"Our results do not support this concept of 'benign obesity' and demonstrate there is no 'healthy' pattern of obesity," Dr. Caroline Kramer at Mount Sinai and her co-authors concluded.
 
Earlier this year, the myth of healthy obesity was supported by the findings of a study in the Journal of the American Medical Association (JAMA) that concluded being overweight or obese (body mass index of 25 to 34.9 kilograms per metre squared) were associated with lower risk of death from all causes.

But Kramer's team found obese individuals showed an increased risk for deaths and cardiovascular events such as heart attacks, strokes and congestive heart failure when followed for 10 years or more.

The length of followup is key to the evaluation, the researchers said.

The Mount Sinai analysis also showed that obesity seems to increase the risk of premature death and cardiovascular events over the long term even in the absence of metabolic syndrome — the cluster of high blood pressure, high cholesterol and diabetes. The same was true for people who are overweight and metabolically unhealthy.

Researchers measured waist circumference, since excess abdominal fat tissue can contribute to the development of Type 2 diabetes. (Howie McCormick/Associated Press)

"We found that people with obesity, metabolically healthy obesity, they had 24 per cent [greater risk of] more events — cardiovascular events, heart attack, stroke and death — compared to people with normal weight, metabolically healthy," said Kramer. 

"We are not telling people that they have to be skinny, but these results show that if you're overweight, if you are already obese, you should make changes."

The findings are consistent with the notion that obesity is a disease, doctors James Hill and Holly Wyatt of the University of Colorado said in a journal editorial published with the study.

Hill and Wyatt addressed what they called misconceptions about obesity, such as that weight loss and reducing metabolic and heart risks are the highest priority goals in treating obesity.

"Is a person who has lost enough weight to achieve normal metabolic measures but who has sleep problems, orthopedic issues, or difficulty managing stress really 'healthy?' Perhaps we need a more comprehensive measurement of well-being to measure success," the editorial writers suggested.

In public health terms, the priority should be preventing people who are overweight from becoming obese, they said.

Kramer's team did not account for smoking and physical activity in their review.

Suzanne Gracan is 5-6, weighs 220 pounds and does 30-kilometre bike rides regularly.

"I'd be interested in knowing who their subjects were," Gracan said of the findings.

"To generalize and to say that larger people are unhealthy is a stereotype," added Gracan, who created FitZonePlus in Toronto for plus-sized clients seeking yoga, Zumba and personal training.

Another limitation of the research is that it didn't consider elderly populations.  

In 2011, about 18 per cent of Canadian adults were obese based on self-reported heights and weights, according to Statistics Canada.
 
The research was funded by the Leadership Sinai Centre for Diabetes.

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Cancer drug Xeloda linked to severe skin reactions

A drug used to treat breast or colorectal cancer that has spread is associated with very rare cases of severe skin reactions, Health Canada says.

"Very rare cases of severe cutaneous reactions such as Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), in some cases with fatal outcome, have been reported during treatment with Xeloda," Health Canada said in a letter to health professionals on Tuesday.

The regulator said it endorsed the safety information from Hoffmann-La Roche.

Roche said it will work with Health Canada to update the prescribing information for Xeloda to include the risk of severe skin reactions. (Steffen Schmidt/Keystone/Associated Press)

Xeloda (capecitabine) is approved to treat advanced breast cancer or breast cancer that has spread to other parts of the body (metastatic), metastatic colon or rectum cancer and cancer of the colon following complete surgical removal, Health Canada said.

Signs and symptoms of severe skin reactions may include:

• Flu-like symptoms.
• Fever.
• Itching of the skin.
• Painful, red or purplish skin rash that spreads and blisters causing the top of the skin to shed.
• Mouth sores.
• Eye burning, itching and discharge.

Patients who develop any of these symptoms should contact their health-care professional immediately.

The company said it will work with Health Canada to update the prescribing information.

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The dangerous anonymity that helps drive online suicides

A University of Guelph student's decision to stream his suicide attempt on the internet this past weekend raises the obvious question about what would drive him to want to end his life.

But equally perplexing is the fact that 200 people signed up to an online chat room to watch him do it — and in some cases goaded him on.

How could anyone take pleasure in witnessing another human take his own life?

Ian Colman, Canada Research Chair in mental health at the University of Ottawa, says part of the answer is that the anonymity of the web allows people to engage in conduct that they likely wouldn't in real life.

"The internet provides a medium through which we can be voyeurs to all sorts of human behaviour," he says.

But a key difference between witnessing a suicide online and seeing one in person, says Colman, is that you're less likely to take action when you see it on a screen.

He says the physical distance from the actual event leads to complacency and a "diffusion of responsibility," meaning those watching are less compelled to try and stop an event like this from being carried out.

In fact, in this case, some of those watching were actively encouraging the young man to go through with his threat, which he did by setting fire to his dorm room and crawling into bed while a webcam live-streamed the event.

That kind of perverse cheerleading can be another aspect of these online spectacles, some psychologists say.

The Guelph student announced his intention to take his life on 4chan, an anonymous message board that has become notorious for its controversial content.

4chan users quickly signed up to watch the video, even encouraging him to go through with his plans.

4chan has a longstanding reputation for anti-social behaviour, says Cole Stryker, author of the book Epic Win for Anonymous: How 4chan's Army Conquered the Web.

Aimee Morrison, an associate professor of English at the University of Waterloo, told CBC's The Morning Edition that the site is like "a perpetual sleepover party with no parental supervision."

Due to its anonymity, 4chan "encourages people to be as outrageous as they wouldn't be if they were operating under their real name," says Stryker.

He says 4chan posters poke fun at every conceivable subject and pride themselves on breaking taboos — in fact, suicide is a recurring topic.

In one of his 4chan posts prior to his suicide attempt, the Guelph student said he was going to be "an hero" — an apparently caustic reference to the death of Mitchell Henderson, a 12-year-old from Minnesota who committed suicide in 2006.

After Henderson died, friends started a memorial page on MySpace, where one poster repeatedly called him "an hero," an awkward phrase that some 4chan posters quickly adopted as a sneering verb for committing suicide.

"It was just a grammar mistake, but it became a meme where people [on 4chan] said, 'You should kill yourself, you should 'an hero,'" says Stryker.

The attitude of many of witnesses in this sort of situation, says Baillie, is that the individual is doing this to themselves, so "if I'm encouraging them, it's that they want to do it anyway."

Ian Colman, University of Ottawa, Canada research chair in mental health epidemiology. (University of Ottawa)

Colman says that what complicates this sort of extreme act is that despite the individual's bluster, it may in fact be an elaborate cry for help.

"They're struggling with something really difficult, and they don't know where to turn, and they're hoping that an extreme gesture like this will precipitate a major change in their lives, for the better," he says.

Even mental health clinicians can have trouble determining whether an individual is serious about taking his or her life, or is hoping for an intervention, he says.

"You can imagine if you're just somebody who's observing a situation online — it can be immensely difficult to figure out whether somebody's actually thinking of going through with something or not."

Desperate act

Officials at the University of Guelph confirmed that on Saturday night, a 20-year-old student apparently tried to kill himself by setting his fourth-floor room at the Dundas Hall residence on fire — while filming it on a webcam.

In the video, the student, whose name has not been released, sets the fire, turns off the lights and crawls into bed.

The Guelph Fire Department extinguished the blaze. The student suffered serious but non-life-threatening injuries and is now in stable condition at Guelph General Hospital, according to the university.

Dr. Patrick Baillie, a senior psychologist with Alberta Health Services, says the basic explanation for wanting to watch such a spectacle is morbid curiosity.

He says it's the same reason so many people sought out the video of Luka Magnotta allegedly killing Chinese exchange student Jun Lin last spring, to the point where all that voyeurism crashed Best Gore, the site housing the video.

"These things have a certain shock value," he says.

Speaking specifically about the Magnotta clip, Dr. Baillie said "everybody knows precisely what's in this video, and yet people are going for that gruesome, wow-I-haven't-seen-something-quite-like-this-before."

With files from Andrea Bellemare

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STARS air ambulance flights suspended in Manitoba

The Manitoba government has grounded STARS air ambulance flights in the province while officials investigate the death of a woman who died after being transported by the service.

On Monday afternoon, the province announced that the Shock Trauma Air Rescue Society would be temporarily suspended on the advice of medical professionals.

STARS Air Ambulance services have been suspended in Manitoba following an incident on Nov. 28. (RCMP)

Health Minister Erin Selby told reporters she has instructed her department to suspend STARS flights after concerns were raised about the woman's death.

According to officials, the female patient went into cardiac arrest late in the evening on Nov. 28 and was taken from somewhere in the province's southern health region to Winnipeg for further care.

Provincial officials said the woman had been cleared for takeoff, but died after landing in Winnipeg.

The province has deemed her death as a critical incident and officials are now investigating to determine what sort of oxygen the woman was given and if it was adequate.

More specifically, investigators will determine what, if anything, happened on board that had an impact on the woman's death.

'Basic medical practices and basic medical advice appears not to have been followed.'- Gerry Delorme, Manitoba Health

Gerry Delorme, Manitoba Health's executive director of health emergency management, joined Selby at the news conference and told reporters that based on this incident and two others, "basic medical practices and basic medical advice appears not to have been followed."

The province is also having an external reviewer look at 15 cases.

Founded in Alberta in 1985, STARS operates a helicopter air ambulance service in Manitoba, Alberta and Saskatchewan.

In 2011, Manitoba signed a 10-year agreement with the society that would see the helicopter and its crew provide support to the province. Since signing the agreement, the air ambulance has flown nearly 700 missions in the province.

The suspension only applies in Manitoba, and the STARS review could take several weeks.

Officials said a contingency plan is in place to deal with cases that require an air ambulance. Lifeflight and a basic air ambulance service will be expanded into Manitoba's southern communities.

Manitoba Health currently operates 24 basic air ambulances and two Lifeflight jets that are staffed by a physician, officials added.

STARS will co-operate with review

STARS spokesperson Colin Fast said officials will co-operate with the province's review of its operations.

"We'll be completely open and transparent with them, and we look forward to dealing with the review as soon as we can," he told CBC News.

Fast said while he expects STARS helicopters will be back in the air soon, the service has never been suspended like this before.

"This hasn't happened at least in the recent past," he said.

"I mean, we have gone through periods where [we've] basically gone out of service due to, you know, weather or mechanical reasons for a short period of time. But no, not an order like this."

STARS has saved dozens of lives since it began permanent operations in Manitoba, Fast added.

But the opposition Progressive Conservatives accused the NDP government of failing Manitobans by signing a contract with STARS without tending a contract for air ambulance services first.

"I was shocked, mainly because a few years ago when the government went into a contract with STARS, we spent hours and hours and hours asking the government questions," Tory deputy leader Myrna Driedger said.

Driedger said she is skeptical that any review of STARS will improve service.

Liberal MLA Jon Gerrard agreed that the government should have issued a tender for contracts instead of signing on with STARS.

Gerrard called on the province to disclose its full investigation to the public.

"People's confidence in STARS is shaken a little bit with this sort of incident," he said.

"It needs to be restored with a full public report and assurance that whatever the problem is, is corrected."

Toddler's case puts spotlight on air ambulance

Earlier this year, the society became the subject of a lawsuit after a Manitoba toddler suffered brain damage shortly after being transported by STARS.

Two-year-old Morgan Moar Campbell was picked up by a STARS crew in Brandon on May 2 and rushed to Winnipeg's Children's Hospital.

Morgan Moar Campbell, age 2, suffered brain damage after a STARS flight. His parents are now suing the air ambulance society.

He was sedated during the flight and had a breathing tube inserted in his throat. The tube somehow came out while he was being moved from the helicopter to an ambulance in Winnipeg, according to Morgan's parents, Blair Campbell and Emily Moar.

Morgan suffered brain damage as a result.

The family's lawyer, Robert Tapper, told CBC News the family was appalled to hear there are now three critical incidents involving STARS that are under review.

"When this is the sort of thing that causes the health authorities to actually have to go to the very unusual step of suspending them, there's a systemic issue at play here," said Tapper.

"Someone is not watching. Someone is not delegated to watch. Something is happening in a systemic way to cause this kind of injury."

Tapper said the family is "very nervous" because they believe their child was victimized, "and there seems to be some credence to that belief."

Manitoba Health is currently reviewing the incident.

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Babies can try allergy-provoking foods as early as 6 months

Babies may eat peanuts, eggs and other potential food allergens as early as six months, Canadian pediatricians say.

Children with a parent or sibling who has a food allergy or another allergic condition like eczema, asthma or hay fever are considered at high risk of developing a food allergy.

On Monday, the Canadian Paediatric Society published a position statement on allergy prevention in high-risk infants that was endorsed by the Dietitians of Canada.

Once parents introduce a new food to babies, doctors recommend giving it several times per week. (Darryl Dyck/Canadian Press)

Previously, the message to many parents had been to delay the first time they given high-risk foods to babies.

There's no evidence that delaying the introduction of potential allergens like peanuts, fish or eggs beyond six months helps to prevent allergy, said Dr. Edmond Chan, a pediatric allergist and his team.

"We thought we had good intentions about protection, but ironically we may have generated a rise in food allergy through those [previous] recommendations," Chan said.

The group also advises against avoiding milk, egg, peanut or other foods while pregnant or breastfeeding because there's no evidence that avoiding them helps to prevent allergy and there are risks of maternal undernutrition and potential harm to the infants.

When Stephanie Schick's four-year-old daughter eats yogurt, she gets fully washed down to help protect her six-year-old sister, who has a dairy allergy.

"We did delay with our first born giving the peanuts because we had such a rocky ride with a lot of the other first foods," Schick recalled. "For the first born, that was the message."

Now, the Canadian pediatric group said while these foods can be introduced to high-risk babies, the decision about when should be individualized and based on the parents' comfort level.

The American Academy of Pediatrics reversed its recommendations in 2008, but Chan said not enough Canadian family doctors and parents have heard about the change. 

Once parents introduce a new food to babies, doctors recommend giving it several times per week with a soft mashed consistency to avoid the risk of choking to maintain a child's tolerance.

For example, Chan suggested parents could mix a small amount of peanut butter with a starter food like rice cereal. Or if a parent is apprehensive, they could talk to a pediatric allergist about testing the food at the doctor's office.

Doctors continue to recommend breastfeeding exclusively for the first six months. For mothers who cannot or choose not to breastfeed, pediatricians suggest hydrolyzed cow's-milk-based formula, based on limited evidence.

Food allergies affect about seven per cent of Canadians. Some research from Australia suggests food allergy in babies is increasing, affecting more than 10 per cent of one-year-olds.

Researchers continue to investigate whether introducing potential allergens earlier, at four to six months, has any protective effect.

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Having cancer is tough, but it might be worse for my dad

The really strange thing about having cancer is that I don't feel like I'm the person most changed by it.

I'm staring out my kitchen window while having some lunch when I notice Dad eating too. We often have lunch together these days; he makes a point of coming home whenever he can.  

I look at him, I study his face and posture, and think about everything that has happened recently in our lives and I've got to tell you I find this whole thing extraordinarily sad – for him. 

Let me explain. Although my father and I are very different people we enjoy each other's company. I like my Dad as a person, I enjoy talking with him, and as we both get older our relationship becomes more fun.

But my cancer has been really hard for him. 

About Dr. Joshi senior 

Dad has been practising internal medicine at the Health Sciences Centre in St. John's for 34 years. He's a proud Newfoundlander and Canadian and he still gets miffed when patients ask him if he's going home for the winter. "I am home," he replies in his British accent.

He is an avid workaholic, but that hasn't aged him. Not one bit.

The only things that aged him were when my fiancée left and when I got cancer. 

And I feel like such a selfish little ass. All the recent pain in his life is because of me. 

Cancer affects more than the patient

I think that's one of the things about having cancer that no one talks about. We're all centred on the patient, but the fallout from the cancer bomb hits the people closest to you.  

I know this sounds morbid, but I'm not really worried about if I die.

As far as I'm concerned, me dying is bad for everyone else. I'm dead – what do I care? But my family would be left haunted without me.

I think I feel guilty about that. 

I've watched my illness transform my father. He used to worry about my spending habits or the girls I was dating.

Now, he worries that the chemotherapy may predispose me to a life-threatening condition, or worse, that it's not working and that we're losing time as those cellular bastards replicate over and over and over again. 

Do good, and good things should happen

Some would say that's the burden of knowledge from being a doctor, but it's more than that. 

My father thought he would do good in this world and care for people and nothing truly terrible would ever happen to him or his family again. 

I say again because his family lost everything in Tanzania and Kenya during the uprisings in the 1960s when they had to flee East Africa.

My father made his way through medical school on scholarships, working summers in a canning factory, and after my grandfather died, sleeping in that canning factory on a burlap sack. 

When I think about it, in the long history that is my father's life, this year was probably the worst year in 40 years. This is the year, that despite all the good he continued to do, all he received for his efforts was heartache.

The way I see it  

I look at my situation differently. I don't think life owes us anything. I think life says to us, "I'm not fair, but I'm beautiful. Take as big a piece of me as you possibly can because you're all gonna die eventually." 

I don't think there's any action he or I could have done now or in the past that would have stopped me from getting cancer.

Bad things happen to everybody, saints and sinners alike. You can't bargain with life. You can't say I'm going to be a good person and nothing bad is going to happen to me.  

But when it all hits the fan, when things get bad in our lives – and at one point things will be bad in everyone's life – that's when we show what we're made of. That's all the choice and power we have in this world. 

I'm not sure whether anyone is watching, I'm not sure if it makes a difference to this planet of six billion people, but I try to live my life as if it does matter, because that's what makes me happy. 

That's how I'm coming to terms with my cancer. 

I'm just sorry that my father suffers through me. And that's not fair, but I guess that's life.

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Healthy obesity a myth, review finds

The notion that someone can be obese yet still healthy is a myth, say researchers, who found that obesity carries a higher risk of premature death compared to that of normal-weight people, regardless of cholesterol, blood pressure and blood-sugar readings.

In an analysis of data pooled from several previous studies, researchers at Toronto's Mount Sinai Hospital found people who were obese but metabolically healthy had a significantly increased risk of having a heart attack or stroke and of dying prematurely.

Researchers measured waist circumference since excess abdominal fat tissue can contribute to the development of Type 2 diabetes. (Howie McCormick/Associated Press)

"Our research findings challenge the myth that there is such a thing as healthy obesity if people maintain normal-range readings of cholesterol, blood glucose and blood pressure," said endocrinologist Dr. Ravi Retnakaran, co-author of the study in this week's Annals of Internal Medicine.

Researchers reviewed eight studies from the last decade, which included a total of more than 61,000 participants who were followed for a mean period of 11 years. Almost 4,000 of the subjects had cardiovascular events such as a heart attack of stroke.

The studies evaluated subjects' metabolic status, including cholesterol levels, blood-sugar levels and blood pressure. Measurements also included waist circumference, as excess abdominal fat tissue can contribute to the development of Type 2 diabetes, for example.

The studies compared fatal and non-fatal cardiovascular events, as well as other causes of death like cancer, across three weight categories — normal, overweight and obese.

Researchers said the comparative risks for premature death in the three weight groups became especially apparent after 10 years of followup.

Lead author Dr. Catherine Kramer said that even in the absence of such markers as high blood pressure or elevated cholesterol, an obese person with a body mass index, or BMI, of 30 or greater had a 24 per cent higher risk of having a heart attack or stroke or of early death compared to a normal-weight person.

"So we are telling people and doctors that it is not OK to be obese, even though you don't have metabolic abnormalities," Kramer said in an interview Monday. "This excess of weight still confers increased risk for cardiovascular events."

For study participants who were overweight, with a body mass index of less than 30 but greater than 25, the risk of cardiovascular events was the same as for normal-weight subjects during the study periods.

"But we also evaluated all metabolic parameters — lipids, blood sugar, blood pressure — and we show that people with metabolically healthy overweight already have increases [in levels] compared to normal weight," said Kramer.

While those readings weren't yet in the so-called unhealthy zone, "this is a sign for us. Maybe they are still healthy now, but in five, 10 years, maybe [the excess weight] will have an effect on metabolic health."

In an accompanying editorial, Drs. James Hill and Holly Wyatt of the University of Colorado say the Toronto researchers provide strong evidence that "healthy obesity" is a myth.

"The review casts doubt that any obese persons have no long-term risk for cardiometabolic disease," they write. "Obesity affects almost all aspects of human function and physiology.

"Obesity also increases risk for Type 2 diabetes, kidney disease and some types of cancer. It is linked to orthopedic problems, reproductive problems, depression, asthma, sleep apnea, renal disease, back pain, skin infections and cognitive decline. Obesity produces social stigma and overall reduced quality of life.

"It would be a mistake to label obese persons as healthy on the basis of only the presence or absence of risk factors for cardiometabolic disease."

Kramer said that regardless of lab tests that point to a healthy metabolic profile, doctors need to stress to overweight and obese patients that they are potentially shortening their lives and strongly encourage them to shed excess pounds through diet and exercise.

"Our message to physicians is that for obese individuals, normal metabolic status regarding blood pressure, cholesterol and blood glucose is not protective. If they can start to lose weight, that's a benefit."

In 2011, about 18 per cent of Canadian adults were classified as obese.

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Silent Santa programs cater to children with autism

The beginning of December marks the unofficial launch of mall Santa season, and for many families it's an essential, though often chaotic, part of the holidays.

But for parents of kids with special needs, a trip to a busy, noisy mall isn't always at the top of their to-do list.

Vicki Harvey is autism outreach coordinator with Autism Nova Scotia as well as a mall Santa trainer. She's part of a program that's setting aside appointment times for children with autism to visit Santa before the mall opens.

"We'll often see kids come into a large area, where there's lots of sound happening and they're so overwhelmed that their hands are over their ears and they can't focus and they want to leave the experience," Harvey explains.

But when the kids come in for the Silent Santa program, it's an entirely different experience, Halifax Shopping Centre marketing director Stephanie Guilfoyle says.

"We have the opportunity to see the shopping centre when it's not open and when the lights are down," she says. "There are Christmas lights and quiet music, it's actually quite relaxing. So that's what we're hoping will come across because these children do have special needs that we need to address."

Even Saint Nick and the elves behave differently during the Silent Santa program. They don't expect the kids to get on Santa's lap and staff won't make eye contact with the children unless it's appropriate to do so.

Families also arrive in small groups so they're not competing with hordes of rambunctious children.

The Avery twins, Brandon (left) and Kyle, will get their first picture with Santa in over a decade this year.

Tracey Avery has twin 13 year olds with autism, Kyle and Brandon. For her boys, wait times were a discouragement.

"Sometimes you have to wait ... it might be a long time and then Kyle will want to know exactly how long, so it's really hard to put a time on something like that," she says.

The Silent Santa program is "ideal for us," she adds. "We haven't gone to a mall to see Santa since the boys were probably two."

But now, because Avery knows exactly what to expect, she can better prepare her children for their visit. She says that's also something many people with autism crave — predictability.

"They'll both be really excited and I'll finally get a picture of them with Santa and it'll be something that they can talk about the whole Christmas season."

Over the past couple of years, Silent Santa programs have been popping up all over North America, and most major centres in Canada now have at least one participating mall.

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Having cancer is tough, but it might be worse for my dad

The really strange thing about having cancer is that I don't feel like I'm the person most changed by it.

I'm staring out my kitchen window while having some lunch when I notice Dad eating too. We often have lunch together these days; he makes a point of coming home whenever he can.  

I look at him, I study his face and posture, and think about everything that has happened recently in our lives and I've got to tell you I find this whole thing extraordinarily sad – for him. 

Let me explain. Although my father and I are very different people we enjoy each other's company. I like my Dad as a person, I enjoy talking with him, and as we both get older our relationship becomes more fun.

But my cancer has been really hard for him. 

About Dr. Joshi senior 

Dad has been practising internal medicine at the Health Sciences Centre in St. John's for 34 years. He's a proud Newfoundlander and Canadian and he still gets miffed when patients ask him if he's going home for the winter. "I am home," he replies in his British accent.

He is an avid workaholic, but that hasn't aged him. Not one bit.

The only things that aged him were when my fiancée left and when I got cancer. 

And I feel like such a selfish little ass. All the recent pain in his life is because of me. 

Cancer affects more than the patient

I think that's one of the things about having cancer that no one talks about. We're all centred on the patient, but the fallout from the cancer bomb hits the people closest to you.  

I know this sounds morbid, but I'm not really worried about if I die.

As far as I'm concerned, me dying is bad for everyone else. I'm dead – what do I care? But my family would be left haunted without me.

I think I feel guilty about that. 

I've watched my illness transform my father. He used to worry about my spending habits or the girls I was dating.

Now, he worries that the chemotherapy may predispose me to a life-threatening condition, or worse, that it's not working and that we're losing time as those cellular bastards replicate over and over and over again. 

Do good, and good things should happen

Some would say that's the burden of knowledge from being a doctor, but it's more than that. 

My father thought he would do good in this world and care for people and nothing truly terrible would ever happen to him or his family again. 

I say again because his family lost everything in Tanzania and Kenya during the uprisings in the 1960s when they had to flee East Africa.

My father made his way through medical school on scholarships, working summers in a canning factory, and after my grandfather died, sleeping in that canning factory on a burlap sack. 

When I think about it, in the long history that is my father's life, this year was probably the worst year in 40 years. This is the year, that despite all the good he continued to do, all he received for his efforts was heartache.

The way I see it  

I look at my situation differently. I don't think life owes us anything. I think life says to us, "I'm not fair, but I'm beautiful. Take as big a piece of me as you possibly can because you're all gonna die eventually." 

I don't think there's any action he or I could have done now or in the past that would have stopped me from getting cancer.

Bad things happen to everybody, saints and sinners alike. You can't bargain with life. You can't say I'm going to be a good person and nothing bad is going to happen to me.  

But when it all hits the fan, when things get bad in our lives – and at one point things will be bad in everyone's life – that's when we show what we're made of. That's all the choice and power we have in this world. 

I'm not sure whether anyone is watching, I'm not sure if it makes a difference to this planet of six billion people, but I try to live my life as if it does matter, because that's what makes me happy. 

That's how I'm coming to terms with my cancer. 

I'm just sorry that my father suffers through me. And that's not fair, but I guess that's life.

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