By Kate Lunau - Thursday, September 27, 2012 - 0 Comments
Surprisingly, some obese people seem to be as metabolically healthy as their normal-weight peers
Ragen Chastain, who carries 284 lb. on her five-foot, four-inch frame, has been an athlete since she was a kid: she was cheerleading captain, a varsity athlete and has won three national championships as a competitive country and western dancer. “I focus on my fitness as a dancer, I get my five servings of fruits and vegetables a day and make healthy choices,” says Chastain, 35, who lives in Los Angeles. She isn’t our typical picture of health. With a body mass index of 48, Chastain classifies as morbidly obese. (BMI is a measurement of body fat based on weight and height; 25 or greater qualifies as overweight, and 30 or greater is obesity.)
Obesity has been linked to all sorts of serious health problems, such as hypertension, heart disease and Type 2 diabetes. But not all obese people are alike. Surprisingly, some seem to be as metabolically healthy as their normal-weight peers—maybe even more so. The notion that it’s possible to be “fit but fat” is still very controversial. “I think it can be misinterpreted to suggest that obesity doesn’t matter in many people,” says Robert Ross, an expert in exercise physiology at Queen’s University. “I’m as fat as you can get on the BMI chart,” acknowledges Chastain, author of Fat: The Owner’s Manual. She believes it says little about her overall fitness and health. On her blog, Dances With Fat, she writes: “I am not a thin woman covered in fat, I am a fat woman who is also a very fit athlete.”
A new study in the European Heart Journal, the largest one ever to examine this, suggests just how common these “fit but fat” people might be. Over 43,000 participants were given a detailed questionnaire and physical exam, including a treadmill test. Researchers concluded that 46 per cent of obese participants were metabolically healthy: they didn’t suffer from conditions like insulin resistance, diabetes, high cholesterol or high blood pressure. (To qualify as “metabolically healthy” in this study, they could have one or none of those conditions.) These people were at no greater risk of death from any cause than those who were of normal weight—in other words, their excess pounds didn’t seem to make a difference.
By Julia Belluz - Wednesday, September 26, 2012 at 5:54 PM - 0 Comments
To this day, Dr. John Crosby, a family physician in Cambridge, Ont., remembers the scene perfectly: “She chased me around my waiting room with a walker, screaming and yelling.” The doctor dodged in and out of chairs to avoid getting beaten. “She” was one of his patients. Months later, when she was admitted to hospital and Dr. Crosby went to visit her, she greeted him with: “Oh! If it isn’t Big John Crosby.” She’d never forgive him, she said, not even on her deathbed.
The offense? Dr. Crosby had reported her to the Registrar of Motor Vehicles because she had dementia, and by his calculation, was a potential hazard behind the wheel. In Ontario, according to the Highway Traffic Act, physicians are legally required to report patients who are suffering from a condition that may impair their ability to drive. This is part of their role as guardians in our society, alongside other unpleasant duties like filing reports about gunshot wounds or suspected child abuse. But just because it’s a legal and professional obligation doesn’t make the task any less painful. “It’s one of the hardest things,” said Dr. Crosby. “Patients are always furious with you, no matter what.”
This is why doctors dread telling patients they may be unfit to drive, and it’s why, in 2006, Ontario introduced a financial incentive—$36.25 that doctors could bill the province—for each time they tell on a patient.
Six years later, a New England Journal of Medicine study released today, finds that the rate of reporting by doctors has increased since 2006 and patients who’d received a formal RMV warning were 40 to 45 per cent less likely to be involved in a serious car crash. “In our study, the baseline risk in this cohort of patients was 4.7 serious crashes per 1,000 drivers per year,” said Dr. Donald Redelmeier, a senior scientist at the Institute for Clinical Evaluative Sciences (ICES) and lead author of the report. After the warning, the risk came down to 2.7 serious crashes per 1,000 drivers per year.
By Ken MacQueen - Wednesday, September 26, 2012 at 11:50 AM - 0 Comments
Eating less, a lot less, may not be the secret to a long life after all
The quest for eternal life is as old as death. Searching for the fountain of youth fired the imaginations of explorers and writers for centuries, to no avail. Today, in a variation on a theme, scientists pour their energies into exploring the idea of life extension: living longer by eating drastically less. Calorie restriction (CR) is the buzz phrase: a theory that a nutritious, but extremely low-calorie, diet will extend the life of lab mice, research monkeys and perhaps humans. It gained much of its popular public acceptance through the work of Roy Walford, a California researcher, gerontologist and author of the bestselling Beyond the 120-year Diet: How to Double Your Vital Years.
Walford espoused the idea that you, like him, could live a more vigorous life on just 1,600 well-chosen calories a day. He began linking food to longevity in the 1960s when he restricted the diet of mice by 40 per cent. He reported their lifespans doubled. Walford wasn’t as lucky. He died at 79 of ALS, commonly known as Lou Gehrig’s disease.
For more than 20 years now, the poster primates for CR have been two peckish troops of rhesus monkeys, one at the University of Wisconsin at Madison and a second group of involuntary dieters at the U.S. National Institute on Aging (NIA) in Baltimore. At best, the results of these experiments are mixed and the latest news suggests the fountain of youth is as elusive as ever.
By Ken MacQueen - Tuesday, September 25, 2012 at 11:33 AM - 0 Comments
Stanford University’s cooling glove speeds recovery and improves athletic performance drastically
Ice baths were all the rage at the London 2012 Summer Games as a way for Olympians to reduce inflammation, speed muscle recovery between events—and make funny faces during the exquisite agony of immersion. Rowers used them, cyclists used them; British distance runner Mo Farah, looking profoundly chilled, took the plunge, and delivered back-to-back gold medals in the gruelling 10,000-m and 5,000-m races. Now, researchers at Stanford University have devised a faster and less cringe-worthy way of cooling the body, speeding recovery and delivering a performance boost “substantially better than steroids.”
The device is a rigid plastic mitt that forms a slight vacuum and circulates cool water to extract heat from the palm of a hand, where blood vessels act as a high-efficiency radiator for the human body. The device, developed by Stanford biologists H. Craig Heller and Dennis Grahn, can alter a person’s core temperature within 10 minutes, raising temperature with warm water for a person coming out of anaesthesia, for instance, or dropping it to speed muscle recovery in athletes.
Use of a single cooling glove between sets of chin-ups turned fellow researcher Vinh Cao into a near superhero, erasing muscle fatigue so much he was able to boost his daily capacity for chin-ups to 620 from 180. Stanford sports teams as well as the local San Francisco 49ers and Oakland Raiders football teams have used versions of the glove, which will soon become commercially available. “The work capacity of muscles was greatly enhanced by palm cooling, and when this benefit was applied to strength-conditioning regimes, the rates of gain were dramatic, exceeding what has been observed through the use of anabolic steroids,” the authors say in a research paper.
By Bob Ramsay - Monday, September 24, 2012 at 11:40 AM - 0 Comments
One man’s frank account of how heart problems sent him into a physical and psychological free fall
“Look, lady, the last time I was in this hospital, I died.”
That was the God’s truth—at least the dying part was. Actually, I’d been back to Toronto General’s emergency unit three times since my heart stopped, the day after I had open-heart surgery in May 2011.
But on this particular morning, three months later, I was lying on a gurney waiting to go into an operating room for yet another heart procedure when the anaesthetist said: “Mr. Ramsay, we’re going to give you something to relax you.” She unwrapped the needle before inserting it into a vein in my wrist. But she missed the vein, and since I was on blood thinners, my wrist began to bleed all over the sheets. The doctor quickly stepped back and asked a nurse to get my “line” going. By now, the sedative was having its effect and I began to feel light-headed. But I was ever watchful. That’s when I told her about dying the last time I was here. It was an inauspicious start.
By Julia Belluz - Tuesday, September 18, 2012 at 5:02 PM - 0 Comments
Just when you thought Facebook couldn’t become any more omnipotent: In May, the social networking giant announced it would allow users to declare their organ donor status on their profiles and link to donor registries in the hopes
of becoming “a big part of helping solve the crisis out there,” as CEO Mark Zuckerberg put it then.
At the time, Science-ish mused about the role the social network could play in getting more people to donate. Today the tool launches in Canada, Mexico, Norway and Belgium—that’s 18 countries in total—and we actually have some preliminary data on the “Facebook effect.”
According to David Fleming
, CEO of Donate Life America, the initial response after Zuckerberg’s announcement “dwarf[ed] any past organ donation initiative.” In California, for example, 70 people each day usually register online as organ donors, while in the 24 hours following the Facebook announcement, 3,900 Californians did the same. But, according to a new report from the U.S., “the dramatic increase in registered organ donors was quickly followed by a dramatic decline. Within two weeks, the rate of registration of new organ donors returned to previous levels.”
By Julia Belluz - Friday, September 14, 2012 at 2:52 PM - 0 Comments
Anyone who has read the news from Canada in the last six months knows that there is a serious labour struggle going on between doctors and governments. In Ontario, the situation has been particularly fraught. Heated negotiations over physician fees—against the backdrop of a $13-billion deficit—have led some of the province’s MDs to warn that, if things don’t change, they’re going to leave for greener pastures.
Radiologists and cardiologists have made public threats, and even idealistic medical students are chiming in. As Stephanie Kenny, of the 2013 class at the University of Ottawa told Science-ish in an email, “The average medical school student today will graduate with $150,000 of debt and will spend 13 years in training after high school before becoming a fully licensed physician.” Though she would “love to practice in Ontario,” she added that “there is a perfect storm brewing that is making this a difficult and unpalatable place to work.”
Now, Ontario Health Minister Deb Matthews says she isn’t buying the chatter. But it’s not that far fetched: Canada has experienced doctor brain drains in the past. In the 1990s, when the government capped spending on physicians, there was a steady trickle of Canadian-trained physicians into the U.S. So Science-ish wondered, based on the data we have about the MD workforce, are we poised for a doctor exodus?
By Julia Belluz - Tuesday, August 14, 2012 at 5:39 PM - 0 Comments
By the age of 25, Sir Michael Marmot, the first in his family to go to university, was already a practicing doctor with a secure future ahead of him. He should have been a contented man. But he wasn’t. As he tells it, he felt there were limits to how he could help his patients in his work as an MD. He saw people every day who were dealing with what he calls “problems in living” that seemed to lead to their poor health.
“At this inner-city hospital where I was working, we had a lot of immigrants at this time, and they would come in with pain in the tummy,” he told Science-ish in a gentle, grandfatherly whisper. “We’d give them some white mixture and send them home. And I’d think to myself, ‘they’ve come in with problems in living and we’ve given them a bottle of white mixture and told them to go back to the problems in living that they had before’.” For Marmot, it seemed like a futile approach: Patients’ problems needed to be addressed outside the walls of the clinic as well.
That’s why he left his secure job to move to California to study epidemiology, looking at disease trends in well-defined populations and how they correlated with people’s life circumstances. As Marmot recalls, his supervisor at the time— sociologist-turned-epidemiologist Leonard Syme—told him, “Just because you’re a doctor, doesn’t mean you understand the causes of ill health. You understand something about biology and medical conditions but you’ve got to learn something about society if you really want to understand the causes of ill health.”
Since then, Marmot, now 67, has led some of the world’s most compelling studies on the “social determinants of health.” In some 30 years of research on members of the British Civil Service, known as the Whitehall Studies, he established a link between their relative rank and risk of cardiovascular disease and death (the lower the status, the higher the risk). This, despite the fact that they were all relatively well off.
Marmot has looked at other health oddities, such as why residents of some areas of Glasgow, Scotland have a 28-year gap in life expectancy compared to those living in other neighbourhoods, and how the disease patterns of Japanese migrants in America transform to resemble those in their adopted fellow countrymen over time.
This research has shed light on the intuitions he had as a young doctor: There are real, tangible ways in which seemingly non-health related matters—where you live, your rank at work—impact human health. Now, the self-described “evidence-based optimist” is bringing his message to Canada’s doctors. Yesterday, Marmot, a research professor in epidemiology and public health at the University College London, was the special lecturer at the Canadian Medical Association general council meeting in Yellowknife.
During his address to what’s known as the Canadian parliament of medicine, Marmot won Science-ish’s heart when he said: “Let’s have a dream of a fairer world but let’s harness the evidence to have the pragmatism to achieve it.” Later on, he sat down with Science-ish to share insights about his life in science, the nature of evidence in policy, and the impact he hopes his research will have. Here’s an excerpt:
By Julia Belluz - Monday, August 13, 2012 at 10:20 AM - 0 Comments
Q&A: Dr. Anna Reid talks to Julia Belluz about inequality, the status of physicians and the need for the federal government to join the conversation
Julia Belluz is an associate editor at the Medical Post and a regular contributor to Macleans.ca, where she writes Science-ish, a weekly fact-checking blog on health and health care policy. Follow Julia on Twitter @juliaoftoronto
For the first time ever, the Canadian Medical Association’s annual general-council meeting — known as the parliament of medicine in this country — is taking place in the Northwest Territories, land of the midnight sun, a large aboriginal population, and great holes in access to health care. The meeting is happening in Yellowknife because the CMA roams the country and gathers in the hometown of its new president, in this case, Dr. Anna Reid, a local emergency physician and an advocate of health equality.
There’s no conference hall large enough for the 400-some doctors and health-policy wonks who have descended on the subarctic capital, so they will convene in the gym of a local high school. Before the meeting, Dr. Reid spoke to Maclean’s about her view of the health system in this country and her year ahead.
By Julia Belluz - Thursday, August 9, 2012 at 10:32 AM - 0 Comments
You’re achy, slightly feverish, and that rash you’ve had on your back for a week hasn’t gone away. In a haze, you log online to peruse WebMD. After all, you’re a pretty savvy researcher, even a nerd, and you just want to find out what might be ailing you.
POW! WAM! BAM! The suggestions about the causes of your symptoms cascade over you like a tsunami of anxiety. Syphillis! Lyme disease! Dengue Fever! All are equally plausible, according to Dr. Google. Even though you know the Internet has a tendency to tell you that you have cancer when you really have a cold, your heart begins to race, your cheeks flush, and you start imagining what your friends will say at your funeral.
In many ways, the Internet has leveled the playing field between health-care providers and patients, and the questions we ask Google about our health woes are probably more honest than the ones we’d ever dare ask our doctors.
By Julia Belluz - Thursday, August 2, 2012 at 2:20 PM - 0 Comments
“And if we can stop the transmission, we can stop the disease.”—Dr. Julio Montaner, director of B.C.’s Centre for Excellence in HIV/AIDS, July 19, 2012
At first glance, it seemed wasteful, almost insanely so. After the international AIDS conference in Washington, D.C., last week, health officials from B.C. were trumpeting mass population screening for HIV in their province, and eventually, beyond. According to the media reports, if we could get everyone who has ever been sexually active tested (on a volunteer, not mandatory, basis) it could mean “the beginning of the end” of AIDS.
Of course, there was much overselling in the media—with headlines like: “B.C. aims to end HIV/AIDS with widespread testing“ and “B.C. launches massive program to wipe out HIV/AIDS.” But this screen-everybody approach also seemed dubious from a public health viewpoint. Given the well-known problems associated with over-testing, over-screening, and over-diagnosis in other areas of medicine—from PSA testing to pap smears—why try the catch-all method with HIV? What about the traumas related to false positives and the sheer monetary cost of such an encompassing plan? Plus, Canada doesn’t have a high prevalence of HIV/AIDS. Why would we adopt mass screening for a disease that mainly impacts marginalised or hard-to-reach groups that probably wouldn’t be captured anyway? Science-ish called Dr. Julio Montaner, one of the leading proponents of the program, to find out more.
By Julia Belluz - Friday, July 27, 2012 at 5:10 PM - 0 Comments
With the recent outbreaks of vaccine-preventable diseases—whopping cough and measles—in Canada and the U.S., public-health commentators are reminding us that the failure to get our shots (and boosters) is not only a threat to our personal health, but also to those around us. This aphorism is repeated all the time when it comes to routine immunization, a warning about how easily nearly eradicated diseases can become endemic again.
Please click on the infographic to see a full-size version of the image.
To better understand how, exactly, the butterfly effect can play out across borders, Science-ish called Dr. Tariq Bhutta, a Lahore-based pediatrician and chairman of Pakistan’s Polio Eradication Certification Committee, who advises the World Health Organization on polio eradication. The crippling and deadly illness, for which there is no cure, has been wiped off the face of all but three countries—Pakistan, Afghanistan and Nigeria. And in recent years, even places where polio was eliminated, including Canada, have seen resurgences of the virus.
The newest threat to the polio eradication effort is so-called ‘polio warfare,’ waged by militants in the tribal areas of Pakistan who vowed to impede the distribution of the vaccine until the U.S. stops its drone war in the country. This also seems a tit-for-tat for a fake vaccine campaign the CIA staged in an attempt to locate Osama Bin Laden by using DNA from his family. Caught in the middle of the standoff are hundreds of thousands of unvaccinated children, health workers who have been injured or killed, and years of public health progress in the region.
By Julia Belluz - Thursday, July 19, 2012 at 9:00 AM - 0 Comments
When patients go into the hospital for a surgery, it’s next to a miracle they ever leave the building unscathed. It’s not that hospital administrators and health professionals don’t do their best to protect patients—they do. But with the incredible complexity of surgeries and modern hospital systems, the intricate pathways of care, there are infinite possibilities for things to go wrong.
In the media, we tend to focus on the risks related to hospital-acquired infections or the wild pre-checklist days. But there’s another danger that isn’t talked about much outside of medical circles: getting a blood-borne infection, such as HIV, hep C and hep B, from your health-care provider.
Precautions are taken at every turn to make sure diseases aren’t transmitted from doctor or nurse to patient—and vice versa. And the risk of transmission is remote. Extremely, utterly, almost infinitesimally remote. To give you a sense, according to the U.S. Centers for Disease Control, the occupational risk of infection with hep C after a needlestick injury or cut is less than two per cent. That’s somewhere between the risks related to HIV (less than one per cent) and hepatitis B (six to 30 per cent, though surgeons working today would be vaccinated for hep B).
In Canada there have been no documented cases of physicians transmitting hep C or HIV to patients since modern antiviral therapies came on the scene to treat blood-borne pathogens and doctors started implementing what’s known as “universal precautions”—or avoiding contact with patients’ bodily fluids by using gloves, gowns and masks. There has been one reported case of hep B transmission, but it occurred before antivirals and universal precautions. Worldwide, the documented number of health-care worker to patient transmissions of blood-borne infections since 1991 has been “exceedingly low.”
Yet, provincial medical regulators in Canada are targeting blood-borne pathogens in surgeons. The College of Physicians and Surgeons of Ontario just introduced a new policy that asks surgeons—and those who assist in surgery—to report if they have been tested for the blood-borne pathogens hep B, hep C, and HIV in the last year.
By Julia Belluz - Thursday, July 19, 2012 at 6:53 AM - 0 Comments
Fear of transmission from physician to patient has some regulators taking no chances
In the early 1980s, just as AIDS was emerging along with the surgical precautions that came with it, Dr. Wayne Gregory was a resident at Sunnybrook Hospital in Toronto. Back then, he says, “We were the only trauma centre in Toronto.” So he learned the art of medicine on gunshot victims and patients severely injured in car crashes. At the end of his shifts, the surgeon from Brampton, Ont., now 57, recalls, “I remember frequently coming home and changing out of my greens, and my underwear would be soaked in blood.”
Over 30 years later, in 2009, the College of Physicians and Surgeons of Ontario (CPSO) introduced a contentious practice regarding surgeons and diseases transmitted through blood. The college, like its counterparts in B.C. and Saskatchewan, started asking doctors who do exposure-prone procedures—where there is a risk of exposing a patient to a doctor’s blood, usually through a needle prick or scalpel cut—to declare whether they’ve been tested for blood-borne infections on their annual licence-renewal forms.
Gregory answered honestly: he hadn’t. In his years of opening up patients’ chests and abdominal cavities, he never got screened for HIV or hepatitis C, and only once for hep B. “You wouldn’t automatically get tested,” he says. “A lot of people get tested if they are applying for insurance. But just for screening purposes, it’s not routine among surgeons.”
By Scaachi Koul - Wednesday, July 11, 2012 at 2:26 PM - 0 Comments
Study shows women may eat more and gussy themselves up at certain times of the month
A woman’s menstrual cycle can affect her weight, mood and willingness to openly yell, “Oh, my God, does anyone have a tampon!?” in a bathroom when caught without one. But it turns out that it may affect other aspects of her life, too.
According to a new study from Concordia University, the menstrual cycle can affect other aspects of life too, specifically how you consume everything from clothing to burgers.
The study comes from Concordia’s Research Chair in Evolutionary Behavioral Sciences and Darwinian Consumption, Gad Saad, and his doctoral student and co-author, Eric Stenstrom. Gaad is also the author of The Evolutionary Bases of Consumption.
Fifty-nine female participants were chosen and over 35 days, they kept detailed diaries on their clothing choices, calorie consumption, purchases, and “beautification behaviors,” including attention paid to hair and makeup.
The study analyzed the daily responses to survey items, including when each participant wore clothes that attracted sexual attention, how long she spent making herself beautiful, and whether she ate food high in calories. The researchers found that there was an increase in appearance-related behaviors during the fertile days of a woman’s cycle.
The infertile phase, however, is when the women in the study peaked in their craving and consumption of high-calorie foods, not to mention peaking in their food purchases.
Finally, research that shows us what many women would attest to from their own experience.
But the researchers offer a more scientific explanation for these behaviors than the generic “I’m on my period so it’s okay that I put this entire pizza in my mouth.”
“Women consume more calories during the luteal [infertile] phase because they’ve evolved psychological and physiological mechanism that favoured non-mating-related activities like food foraging,” Saad says. “These consumption behaviors take place without women’s conscious awareness of how hormonal fluctuations affect their choices as consumers.”
Although this may make women feel like a slave to evolutionary desires (or give us a perfectly good reason to buy self-tanners and French fries), Saad says it could lead to consumption-related apps for women. For example, if a woman’s iPhone alerts her that she shouldn’t go grocery shopping since she’s on day 23 of her cycle, she’ll be aware of how her biology affects her consumption.
Another possible advantage: a scientific excuse to eat everything for a week out of every 28 days. Not that one was really needed anyway.
By Anne Kingston - Monday, June 25, 2012 at 5:29 PM - 0 Comments
Internal documents show why Canada has not kept its promise to accelerate contentious clinical trials for MS
On June 3, 2010, Peter Liu, a scientific director of the Canadian Institutes of Health Research (CIHR) in Ottawa, sent an internal email outlining his thoughts on a procedure causing medical and political schisms—and inciting patient activism. Liu, head of the Institute of Circulatory and Respiratory Health, was responding to CIHR executives’ request for his opinion about chronic cerebrospinal venous insufficiency, or CCSVI, a condition identified by Paolo Zamboni in 2008. Zamboni, director of vascular diseases at the University of Ferrara in Italy, made headlines in Canada in November 2009 with his hypothesis that multiple sclerosis, long viewed as a neurodegenerative condition, had vascular roots and was linked to blocked veins draining blood from the brain and the spinal cord. He found venous angioplasty—sending a balloon to open an obstructed blood vessel—alleviated, even arrested, symptoms.
Zamboni’s pilot study yielded amazing results but lacked scientific rigour: it was small and non-blinded; no one could duplicate its results, including Zamboni. Still, it stirred rare hope among the estimated 75,000 Canadians suffering from the incurable, degenerative condition. By June 2010, many were travelling out of country, paying upwards of $10,000 for CCSVI scanning and treatment unavailable to them at home. Some returned with YouTube testimonials, others with dashed hopes, others with complications. The issue had become a flashpoint. People with MS were mobilizing for treatment. CCSVI was up for debate in the House of Commons. The CIHR, which hands out just under $1 billion annually for scientific funding and reports to Parliament through the Ministry of Health, was under pressure to act. Canada has one of the highest per capita MS populations: three people are diagnosed every day. Eight provinces wanted to co-fund pan-Canadian trials, according to CIHR documents obtained by Maclean’s under an access to information (ATI) request.
By Julia Belluz - Friday, June 15, 2012 at 11:06 AM - 0 Comments
At a meeting of doctors in B.C. last week, Science-ish listened in as a couple of surgeons complained about slow turnovers between procedures in their operating rooms. These Vancouver physicians said they’ve had to send anxious patients home who were scheduled for surgeries or wile away coffee breaks waiting for their theatres to be prepped. The reason for the slowness? Money—or so they believed. While they are paid on a fee-for-service basis, the cleaners and nurses who prepped the OR are salaried. The discord in payment models seemed to cause a discord in the OR: The doctors felt the salaried hospital workers had little incentive to move quickly, while they did. Patients’ lives hung in the balance.
Science-ish ran the anecdote by health-care analyst Steven Lewis, and he got right to the heart of the tensions that can flare among groups of health professionals. “That’s hugely disrespectful to nurses and housekeepers to make the assumption that the only thing that would motivate them to work efficiently and effectively is to be on the same the fee-for-service treadmill as those physicians,” he said.
But was there a grain of truth to the story? Does how we pay health-care workers impact patient care?
By Anne Kingston - Friday, June 8, 2012 at 4:16 PM - 0 Comments
The dream-like images were commissioned by a PR firm that represents Novartis Canada, makers of a controversial MS drug
Caitlin Cronenberg is a young photographer who has made a name for herself chronicling fashion and celebrity—as well as the cinematic process of her filmmaker father, David Cronenberg. So a press release issued last week headlined “Caitlin Cronenberg Exposes the Reality of Young Women Living with MS” appeared to signal a bold—even brave–departure for her. Multiple sclerosis, or MS, is a chronic degenerative condition that can lead to paralysis, depression, and blindness. It’s a mysterious condition; progression varies radically; its cause is unknown. Nobody even knows how many Canadians have it: the much-repeated statistic of 50,000 to 75,000 people is out of date, an MS Society of Canada spokesperson told me months ago.
It doesn’t lend to easy imagery. So I wondered: Is Cronenberg now delving into the dark, uncomfortable territory annexed so well by her dad?
But the “reality” that Cronenberg’s one-night exhibit, DREAM/AWAKE, exposes is less about MS than about how a pharmaceutical giant can create buzz amid advertising restrictions—in this case, by linking a fashionable female photographer to a prescription drug targeted at young women. That’s whom multiple sclerosis strikes most—three times more frequently than men.
Cronenberg was hired for the gig a few months ago by Weber Shandwick, the PR firm that represents Novartis Canada, a sub of the US $46-billion Swiss pharmaceutical giant Novartis AG. “They told me they came up with the idea for the installation with me in mind,” Cronenberg told me in a telephone interview. She was flattered. She also has family friends afflicted with MS, she says. A former neighbour she’s fond of is now wheelchair-bound.
Cronenberg was given “total artistic freedom” on the project, she says, although the client provided three women to be photographed, all of whom were diagnosed with MS in their 20s or 30s, when the condition often strikes. Rebecca Webster of Weber Shandwick explains the women were chosen after they were “nominated by their treating neurologists who felt strongly that this project was important to raise awareness about MS, especially among women.”
The three had had success taking Novartis’s Gilenya, a $31,000-a-year oral MS pill approved by Health Canada in March 2011 (until then, MS drugs had to be injected). Gilenya isn’t explicitly mentioned in the press release. But as it happens, one of the women, Himani Ediriweera participated in Gilenya’s clinical trials and was quoted enthusing about the drug in a 2011 press release.
Cronenberg says she based 12 photographs on the women’s stories. The resulting staged tableaux exude a dreamy, unworldly vibe that make no reference to illness—one woman appears to be in a childhood bedroom; another stands next to a red BMW and a toy sailboat; a third is in a shadowy room festooned with pages of paper. The press release describes the photographs in dramatic, yet upbeat terms: “The images demonstrate the feelings of loss—of body, family, opportunity or work–and how each woman has reclaimed her life through treatment and become a figure of inspiration for young women fighting the disease.”
The exhibit of Cronenberg’s photographs was a one-night pop-up event on May 30, “World MS Day,” staged at a Toronto gallery that rents out to corporations wanting to imbue an event with arty patina (Loblaw Companies launched a new packaged food line there last year). Webster describes the affair as “invitation-only for media and influential people.” Cronenberg donated the work to a silent auction with proceeds going to the MS Society of Canada. “Several thousands of dollars were raised,” says Webster, declining to be more specific.
The show was marketed as bringing “awareness” to MS—and received media attention as a result, including Cronenberg being interviewed on the CBC. The line between “awareness” and “promotion,” however, is fragile, given Health Canada’s strict regulations governing direct-to-consumer advertising of prescription drugs. Regulations allow drug companies to use a brand name but not talk about what a drug does. Direct to consumer information—those public awareness ads on TV discussing a specific condition—has to be balanced and can’t use brand names.
But social networking has created new grey areas. Cronenberg’s photographs themselves contain no branding, no mention of Gilenya or Novartis—though the exhibit and press release mentioned the company and there are now plentiful linkages between Cronenberg, the MS Society of Canada, Novartis and Gilenya exist online. (Health Canada is investigating the exhibit to see “if it was promotional in nature,” a spokeswoman told me.) Where the hopeful claim that “each woman has reclaimed her life though treatment” in art show PR fits into the rigid regulatory equation is new territory.
What also doesn’t have to be mentioned in the press release for the exhibit—because the photographs are technically part of an art exhibit and not a commercial—is “side effects.” And in Gilenya’s case, 84 people died during its worldwide clinical trials, though some of those deaths were not directly linked to the drug. Instances of adverse effects are so high that neurologists must monitor people closely for six hours after the first dose. In February, 2012, Health Canada put Gilenya under review, though the drug still can be prescribed. Concerns were raised after 11 new deaths (a number that has since risen to 15) were linked to it (none were in Canada but there were more than 50 averse-effect reports).
One woman with MS expresses conflicted feelings about the exhibit. “Positive images are a great thing,” says Chrystal Gomes, 46, who was diagnosed with MS when she was 28 and has never taken MS drugs. She “loved” Cronenberg’s pictures but dislikes the drug sponsorship—and the message: It makes me mad,” Gomes says. It gives the impression that MS patients need drug treatment to reclaim their lives, which is so wrong.”
Cronenberg knows the exhibit isn’t photo-journalism: “I would never say this is a general statement about MS,” she says. “To look at it, you wouldn’t even think this is about MS. I wanted it to be uplifting.” She knows the subjects influenced content: “I was so lucky because women I was working with had happy endings to their stories; if someone had appeared in a wheelchair, I would have made her story different to make sure it was properly presented.”
Of course, a company selling a MS drug won’t want to be associated with imagery referencing the harrowing truths of the condition. (For a more candid portrayal, see these self-portraits by Patricia Lay-Dorsey.)
The exhibit shows how social networking is reframing the way we see illness and disease—and how drugs may be stealthily marketed. It’s also another reminder of how women remain the primary target of Big Pharma marketing, as discussed in the important book Push to Prescribe. While MS is too complicated a condition to summon the pretty, sanitized “pinkwashing” that now surrounds breast-cancer, the move to frame it as a “women’s” disease portends similar campaigns.
The drug company-doctor network the exhibit reveals is also concerning. That neurologists are providing patients for a Pharma-sponsored “awareness” campaign that doesn’t add one whit of “awareness” should raise red flags—and a passel of questions.
By Julia Belluz - Thursday, June 7, 2012 at 5:11 PM - 0 Comments
People hate getting vaccines. Apparently even vaccinologists.
“I don’t like to get immunized,” Science-ish was surprised to hear from one of Canada’s most esteemed vaccine researchers this week. “I do, and I will continue, but I put it in the same category as going for a colonoscopy,”
With the re-emergence of diseases like measles and whooping cough, and parents increasingly seeking alternative vaccination schedules or opting out of shots all together, policymakers are scrambling to figure out what to do. In California, for example, the state legislature is now looking at a bill that would require parents who want to decline vaccines for their kids to seek counseling from a doctor.
Here in Canada, some hospitals have begun essentially forcing health-care workers to get the flu shot if they want to keep their jobs. We’ll never see that kind of measure applied to the general population, so for now: What do we know about what works when it comes to getting people to comply with vaccine guidelines?
By Julia Belluz - Thursday, May 31, 2012 at 6:28 PM - 0 Comments
It’s been a year since Science-ish launched with the aim of scrutinizing the news coverage of health topics, and holding politicians, opinion leaders and journalists to account for misusing or misrepresenting science. The modest goal of the blog was, and remains, to help readers wade through the evidence on a given subject and get a sense of what the science actually shows.
So what has Science-ish learned in 12 months of fact-checking the reporting on everything from the health effects of asbestos, to whether the benefits of urban cycling outweigh its harms, how and if cancer screening will save your life, the “cures” for autism, dubious mental health statistics, and just about every health story in between? Here are five key lessons for telling science from science-ish:
By Alex Ballingall - Thursday, May 31, 2012 at 11:47 AM - 0 Comments
Who would have thought that a little lizard spit could help dieters with self-control?
One of the most challenging aspects of dieting is self-control—you simply want what you can’t have. But new evidence out of Sweden suggests a way around that. A substance called exendin-4, which is a peptide found—oddly enough—in the saliva of North America’s only venomous lizard, the Gila monster, may be able to stop those pesky cravings for snacks both savoury and sweet.
Researchers at the University of Gothenburg’s Sahlgrenska Academy decided to look into exendin-4 after they noticed patients receiving it for treatment of Type 2 diabetes tended to lose weight (previous research had shown it helped control blood-sugar levels). Working with lab rats, assistant professor Karolina Skibicka and her colleagues found exendin-4 effectively dispelled rodents’ cravings for chocolate and sugar. Given the mechanism that causes cravings—the release of dopamine in the brain—is the same in rats and humans, their hope is that exendin-4 can be used to chemically reduce the urge to overeat. “With the Western world obesity epidemic ballooning, any help to reduce food intake and body weight can have enormous health potential,” says Skibicka.
The results of their study, published in the Journal of Neuroscience, have caused speculation that the substance might also hamper alcohol addiction, since the dopamine circuitry of the brain is also involved in the desire to drink.
By Kate Lunau - Wednesday, May 30, 2012 at 10:23 AM - 0 Comments
Side effects from cancer treatment could be greatly minimized if we can harness tiny particles
About 186,400 Canadians will be diagnosed with cancer this year, according to the Canadian Cancer Society. Despite these numbers, “every cancer is essentially a rare disease, as you get down deep in the genetic profile,” says Pieter Cullis, a professor of biochemistry and molecular biology at the University of British Columbia. He and others are working toward a future when individual patients will receive a drug therapy tailored precisely to them—delivered in tiny nanoparticles that reach right down into the cancer site.
Most cancer drugs permeate a patient’s entire body. “Only one per cent goes where it’s supposed to,” Cullis says, and the other 99 per cent can cause harmful side effects. He has developed a way to package drug molecules inside nanoparticles “one-hundredth the size of a typical cell” and made of lipids, the same material that makes up the membrane around each cell in our bodies.
These nanoparticles are designed to circulate through the system, eventually passing through the tumour. Because blood vessels at this site are newer, they’re a bit “leakier” than elsewhere in the body, Cullis says, so nanoparticles tend to accumulate there, and then release their entrapped drug molecules. “If we can get even five per cent [of the drug] to the tumour, we’ll see big benefits” and fewer unnecessary side effects, he says.
By Kate Lunau - Tuesday, May 29, 2012 at 9:44 AM - 0 Comments
One in 10 pills swallowed is for unapproved use, with little science to back it. No one is keeping track.
When Rachel Lavallee’s son Sam was born five years ago, she was determined to breastfeed, despite a low milk supply. She spoke to her doctor about domperidone—a drug prescribed to treat stomach ailments, that has been used for at least 30 years to help women boost milk production. “It just about doubled my milk supply,” says Lavallee, 32, a nurse in Halifax. When son Alex was born last August, she took it again. “For baby number two, it was the same,” she says.
This March, Health Canada issued an advisory, stating the risk of abnormal heart rhythms or sudden death may be higher in patients taking higher doses of domperidone, or in those over age 60, based on two new studies. A letter from the Canadian Lactation Consultant Association noted the average age of patients in the studies was 72 and 79, respectively. “When I looked at the [studies] it was based on, it has nothing to do with new mothers,” says Joan Fisher, a lactation consultant in Ottawa. Lavallee, who takes three tablets four times a day, is unfazed. “Based on my age, health, and my reasons for taking it, I feel the benefits outweigh the risks.” After discussing it with her family doctor, she continues to take the drug. Countless other women are doing the same.
When doctors prescribe domperidone to increase milk production, it’s an off-label use, meaning it hasn’t been approved by Health Canada. It’s not the only drug used this way. Quinine, an anti-malaria medication, has long been prescribed to treat nighttime leg cramps; antipsychotic drugs are frequently given to dampen some symptoms of dementia. At Apex Compounding Pharmacy in Toronto, pharmacist-owner Ara Papazian has raspberry-flavoured lollipops laced with ketamine, a powerful anaesthetic prescribed to those who suffer from chronic pain. “We make Viagra in a lozenge. As opposed to the guy taking a pill one hour before the act, he can pop this under his tongue and he’s good to go within 15 minutes.” Papazian sometimes recommends an anti-cancer drug, tamoxifen, in an ointment to help heal scars.
By Cathy Gulli - Monday, May 28, 2012 at 1:27 PM - 0 Comments
Some kids may simply be less mature than their peers, and under pressure to perform to unfair norms
“Mommy knows best” is a popular expression but it’s not a universally accepted truth. Several months ago, Jacqueline Howard refused to believe that her eight-year-old son Oliver had attention deficit hyperactivity disorder. Oliver’s teachers, however, “just wanted him medicated and to be very compliant and quiet in class. And the psychologists [wanted] to engage my son in huge amounts of counselling and programs,” recalls Howard.
But she had her own explanation for Oliver’s supposed bad behaviour in school. Born in mid-December, he was the youngest student in a split class of third and fourth graders, making some of his peers up to three years older than him. “So of course he’s noticeably immature. Of course he’s noticeably unfocused,” says Howard. “My gut instinct was that there’s not much wrong with my son. He’s just stressed out and people are setting really high expectations for him at a really young age, which he can’t fulfill.”
Howard’s view—as seemingly logical as it was maternal—was nonetheless largely dismissed, even after groundbreaking research published in the March issue of the Canadian Medical Association Journal showed that, yes, in fact, the youngest children in a class are much more likely to be diagnosed with ADHD. “It seemed that a lack of maturity was, in some cases, being misinterpreted,” explains Richard Morrow, lead author of the study and health research analyst for the PharmacoEpidemiology Group at the University of British Columbia in Vancouver. The findings “are definitely of concern,” he says. “We want to avoid medicalizing a normal range of childhood behaviour. Children mature naturally at different rates.”
By Julia Belluz - Friday, May 25, 2012 at 9:00 AM - 0 Comments
“There is a powerful narrative among support groups and cancer survivors: Screening saves lives. . . For the most part, it’s wishful thinking. And it demonstrates the growing gap between what screening (and science more generally) can offer, and what the risk-averse public wants it to be.”—Globe and Mail, May 21, 2012
A recent recommendation by a U.S. government advisory panel to ditch the PSA test for prostate cancer has reignited the call for a cancer screening rethink. It’s no longer okay to abide by the “screen early, screen everybody” maxim, the conversation goes, echoing the one that emerged when the frequency of routine screening for breast cancer was scaled back last year.
Now, it’s good to be having these discussions: We do need to change how we think about cancer screening. In recent years, with the advent of incredible technologies that detect diseases before we feel sick, we’ve seen the emergence of “overdiagnosis.” The term describes cancer that is diagnosed but would not necessarily cause death or even symptoms because the cancer never grows, it regresses, or it spreads so slowly, the person dies before knowing any harm. That’s right, not all cancers are deadly or even harmful. As well, every single body displays at least a couple of benign abnormalities that can be seen as trouble. This is why mass screening has the potential to “rapidly turn perfectly healthy people into patients,” says the Canadian health policy researcher and author of Seeking Sickness, Alan Cassels.
Science-ish, though, wondered whether PSA testing and mammograms—usually the inspirations for the anti-screening cri de coeur because they can lead to overdiagnosis and unnecessary surgeries—are the exceptions in cancer screening or the rule.