What do we need to know?

By Aaron Wherry - Wednesday, August 22, 2012 at 9:00 AM - 0 Comments

Helen Branswell notes that the public doesn’t know the precise details of the cancer that killed Jack Layton and considers whether Canadians need more disclosure from political leaders.

Dr. Lawrence Altman has explored the health of U.S. political candidates for decades as the medical reporter for the New York Times. He says it’s surprising that at this point in history a political leader could die of an undisclosed illness — and says it is unlikely American media outlets would have let the issue go easily. ”I think the Times has taken the position that this is information the public is entitled to know,” Altman says of the general issue of leading politicians’ health. Altman is researching a book he hopes to write about political leaders and their health status disclosure.

“My position is that there should be transparency,” adds Altman, who while still writing for the Times is also a senior fellow at the Woodrow Wilson International Center for Scholars in Washington, D.C. ”There’s no reason any illness should keep somebody from running for office. It’s up to the public to decide whether that illness interferes with the ability to carry out the functions of office or whether that person should be elected. But that’s up to the electorate. The issue to me is that the electorate should be fully informed.”

Andre Picard argued that greater disclosure was required after Mr. Layton announced he was stepping away last July. (Chris Selley briefly questioned Picard’s reasoning.)

A few notes on the timeline in Mr. Layton’s case. He was diagnosed with prostate cancer in February 2010. He underwent hip surgery to repair a small fracture on March 4, 2011. Three weeks later, in the lead-up to the 2011 election, he pronounced himself fit for a campaign and said his PSA level was “virtually at an undetectable level” (see also this transcript of John Geddes’ conversation with him). He proceeded with that campaign and seemed to improve as it went on. In late June 2011, he began to feel sore and stiff (see this story for details). On July 20, 2011, he was diagnosed with a new form of cancer. On July 25, 2011, he announced he was stepping aside. On the morning of August 22, 2011, he passed away.

There’s an argument to be made that all party leaders facing an election should, like American presidential candidates, be expected to release some amount of medical information. (American presidential candidates, mind you, are also expected to disclose information about their tax returns.) Here is what Lawrence Altman wrote about candidate disclosures in 2008. I’m not sure I agree that the public needs to know the details of a party leader’s health, but any such practice would obviously have to be applied to all leaders equally.

Will cancer screening actually save your life?

By Julia Belluz - Friday, May 25, 2012 at 9:00 AM - 0 Comments

(Bruce Powell/AP Photo/University of Chicago Medical Center)

“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.

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Dan Hill tells all

By macleans.ca - Thursday, April 5, 2012 at 7:32 AM - 0 Comments

Five months ago, Dan Hill—award-winning singer, songwriter and author—was backstage, 30 minutes away from performing a concert, when he got a call on his cellphone. “Dan, you have cancer,” said his doctor. “Prostate cancer.”

He went on stage and spent the next two hours singing as though he might never sing again. Or so he was told. “It was almost like going into a black hole. I don’t remember anything.”

In the April 16 issue of Maclean’s magazine and reproduced in this e-book special, Hill has written a candid and moving account of what it’s really like to be diagnosed with prostate cancer.

“The first nurse speaks with a strong accent. ‘Compared to when you were 18, how hard are your erections now?’ I squirm and confess I can’t recall.” Maclean’s visited Hill at his home in Toronto to talk more about his experience of  cancer. “Imagine,” says Hill, “that someone said, ‘You can have 10 more years, live a full life—meaning sex life—or you can have 30 more years, but you may not have a sexual life in a typical sense.’ What a decision to make.”

He says he wanted to write the article for “men like me who are oblivious. Don’t make the mistakes I made and just ignore it.” Recovered from surgery now, he’s running and performing concerts. “One of the things I did to make myself feel better is that I kicked up my running even more. I knew that I had to stay active, that I had to keep living as if my life was actually going to unfold naturally because when you stop, when you freeze, and you think about it, that’s when the demons come and can drag you down.”

In a special iPad extra, Maclean’s presents the in-depth feature story, an exclusive video portrait, a medical primer from a leading prostate-cancer doctor and a new song, The Slightest Difference, by the award-winning singer-songwriter—available in the Maclean’s magazine app.

Layton: the final enigma

By Colby Cosh - Wednesday, September 7, 2011 at 4:49 AM - 151 Comments

[Olivia Chow] won’t reveal the nature of [Jack Layton’s] final illness: “Jack’s wish is that we don’t talk precisely about what kind because we want to give other cancer patients the kind of hope they deserve and should have. If we talk about this kind of cancer, or that, then if you have that particular kind, you would be really worried…” –The Star, Tuesday

Pardon me, fellow Canadians, but this is preposterous. Olivia Chow’s explanation doesn’t even make sense on its own terms: in the absence of information about what kind of cancer killed Jack Layton, patients with any kind of cancer at all might be frightened or upset by his sudden demise. She is denying us information that could ease the minds of the vast majority of these people. But then, this isn’t the first time we’ve been given a strained, unconvincing excuse for secrecy when it comes to Jack Layton’s health, though it is likely to be the last.

When Jack Layton was first diagnosed with prostate cancer last year, his secretary Brad Lavigne told Canadians that we would not be receiving details of Layton’s treatment because, basically, we are too stupid to handle it. Cancer sufferers, Lavigne argued, might perceive such a disclosure “as general medical advice” and conclude that the same therapies “might be suitable for them.” This was an amazingly brazen answer in an era in which “awareness” is worshipped like a tiki. Jack Layton might have been the first cancer victim in decades who believed that his disease did not provide him with a morally binding opportunity to educate others—that, in fact, his duty was to conceal. The question nobody asked: what if there were prostate cancer patients who might learn, by means of Layton’s example, of a treatment that was truly “suitable”?

Instead, Lavigne’s bizarre rationale was accepted, and questions about Layton’s later hip fracture were shrugged off, even though Canadians have abundant, well-founded reasons to suspect politicians, as a group, of habitually queue-jumping and seeking private care outside the country. The NDP cannot shut up about how Tommy Douglas gave us medicare like some cornball Prometheus bringing fire unto primeval man; its leaders therefore might be regarded as having a special responsibility to rise above such suspicions.

This would be the case even if Layton hadn’t availed himself controversially of private clinics in the past, and it would be the case even if it weren’t for the mysterious affair of April’s disappearing “hip replacement”, when we were all asked to believe that Layton’s sister, who was travelling with him and essentially acting his physical therapist, got an exceedingly rudimentary detail of his treatment wrong. Could happen! It would have been awfully simple for him to confirm it with medical evidence!—he said so himself, and offered to provide that evidence!

But by that time, no one in a position to ask was interested: the adversarial relationship between politician and media had already broken down. It has been pointed out incessantly in defence of Layton’s privacy that Canada, unlike the U.S., has not established a full-disclosure norm in health matters for important politicians. What nobody observes is that the U.S. adopted this norm for very good reasons—reasons with labels like Grover Cleveland, Woodrow Wilson, John F. Kennedy. Long experience of republican government has taught Americans that politicians will tell merciless, outrageous lies about their health status to secure electoral advantage unless a full-disclosure norm is aggressively enforced by the press.

Jack Layton, of course, was never the chief magistrate of a republic—just a man who claimed to be running for our prime ministership in earnest, and, later, a officer of state with responsibility for assembling and leading an alternative government. Still, eventually Canada will, like the U.S., begin to oblige men in his position to be excruciatingly forthright about their health. And eventually someone will spill the beans about what killed him. In the meantime, 4.5 million Canadians who voted for a party led by Jack Layton will just have to wait and see what they actually end up with.

Finger length is a clue to prostate cancer risk

By macleans.ca - Wednesday, December 1, 2010 at 2:11 PM - 4 Comments

According to a study in the British Journal of Cancer, men whose index finger was longer than their ring finger were much less likely to develop prostate cancer. Researchers looked at the hands of 1,500 prostate cancer patients, comparing them to 3,000 healthy men. The length of fingers is believed to relate to sex hormone levels in the womb: being exposed to less testosterone before birth makes a longer index finger, which could protect against prostate cancer later on. More studies are needed, but this could one day be used as a simple test for prostate cancer risk.

BBC News

A coffee-table book with benefits

By macleans.ca - Thursday, October 7, 2010 at 4:00 PM - 0 Comments

Michael Cullen/ Mick Tsikas/Reuters Jack Bush's 'Thanksgiving.' 1954: The Painters Eleven/ Afghanistan defeats Russia to win

PAINTERS ELEVEN:THE WILD ONES OF CANADIAN ART
Iris Nowell

The Painters Eleven were abstract artists based in Toronto who banded together in 1953 with a goal: to make waves in the tranquil pool of Canadian landscape art. In other words, no more pine trees. The Painters Eleven drafted a statement, of sorts, saying, “there is no jury but time.” The work would speak for itself.
In her new book, Iris Nowell helps the rest of us understand this group of abstract artists who dared to create a footprint unlike the Group of Seven’s. So, who were they? Toronto’s top art teachers, illustrators, commercial artists and art directors. They joined the city’s established art societies, cannily, and tried to bring about change from within. It wasn’t easy, but they revolutionized contemporary art in Toronto and bestowed legitimacy on abstract expressionism after it had gained fame in America and the Automatistes had made inroads in Quebec.

Opening the hefty book, readers are immediately treated to 11 colour reproductions—no titles, no dates, no dimensions, no artist name printed politely at the side. Nowell is saying, “Look at these! The work deserves this lavish treatment.” And she’s right. Nowell has given us a coffee table book with benefits. Examining the members’ artistic development toward abstraction, she peppers the text with chatty anecdotes, biographic details and telling character descriptions. If you thought you’d heard all about artist Tom Hodgson’s carousing in his studio, called the Pit, think again. If abstract art was the group’s unifying force, so was boxing and booze—martinis, to be exact, and Walter Yarwood’s Bloody Murphy. Nowell recounts how socialite Alexandra Luke, one of the two females in the group, had to sell an Emily Carr painting to buy art supplies. Her book is an accessible account that leaves the reader with one burning question: who is the mystery benefactor who partially bankrolled this lush publication?
- JOANNE LATIMER

INVASION OF THE PROSTATE SNATCHERS
Mark Scholz and Ralph Blum

The humble prostate is man’s great unknown. Buried somewhere in our nether regions, it is a walnut-sized enigma that (I’m told) is crucial to the reproduction of the species and is accessible only via an almost comically uncomfortable process involving a finger, a rubber glove and a hospital gown. But is what usually follows as necessary as the medical establishment claims?

Not entirely, according to authors Ralph Blum and Mark Scholz, who paired up for what might be subtitled Conversations With and About My Cancerous Prostate. Blum has had prostate cancer for 20 years, and he uses his experience as an example of the near-uselessness of biopsies and resulting surgery—one alarming statistic reveals that roughly 80 per cent of prostate surgeries are unnecessary. Prostate cancer is the whale shark of the cancer world: slow-moving and benign. He and co-author Scholz, himself a doctor specializing in prostate cancer, talk about why men almost always opt for surgery: straight-up fear, the insistence of surgery-mad urologists who run “the prostate cancer world,” the human male’s tendency to want to cut the damn thing out and be done with it. Rather than have surgery, Blum embarked on self-treatment and active surveillance—closely monitoring cancer markers and trying a series of often out-there experimental therapies, some more successful than others. (Spirit-channelling shaman? Silver-infused water? Blum tried them all.) His methods are scattershot, and that’s just the point. By staying positive (and keeping an eye on the markers) there are hundreds of possible treatments for this particular cancer. A breezy and effortless writer, Blum writes endearingly about the emasculating travails of at once losing one’s libido and ability to perform, a side effect of testosterone blocking therapy, while Scholz gives a welcome wariness to the practices of much of the medical establishment. A worthy read for anyone about to assume the position.
- MARTIN PATRIQUIN

HOME AND AWAY:THE SEARCH FOR DREAMS AT THE HOMELESS WORLD CUP OF SOCCER
Dave Bidini

The singer-songwriter from the beloved (and now defunct) Canadian band the Rheostatics is known for writing about games that are played in unlikely places—baseball in Italy, hockey in Hong Kong. Dave Bidini’s latest quirky sport story is a mix of familiar and foreign, as he follows the Canadian homeless soccer team to Melbourne, Australia, for the 2008 Homeless World Cup Tournament.

Bidini does a fine job portraying the Canadian team: Krystal, an 18-year-old black woman who never fit in with her adopted family; Billy, the Greek, who played soccer professionally and then ran his family’s business until becoming hooked on narcotics; sane, sober Jerry, whose multiple failed business ventures left him destitute. Bidini affectionately recounts some of their signature plays on the pitch (street soccer, a four-on-four game with two seven-minute halves, is played on a smaller field to accommodate players’ fitness and health levels)—like the way Jerry would hold the ball underfoot like a man resting his foot on a curbside. And their awkward social forays. Billy suggested that the team adopt “Souvlaki” as its anthem.

“That’s a song?” asked the coach. “A song, a food. Whatever,” was Billy’s reply.

Bidini also aptly covers the range of homeless experiences represented by the 54 nations who competed at Melbourne, including the all-female Cameroon team who left their street babies back home. Bidini holds a “long-standing belief in the redemptive properties of sport,” and to some extent, his book reflects this ideal. After returning to Canada, Billy reconciled with his parents and Krystal started playing soccer semi-professionally. But Bidini also hints at the fact that homelessness is too complex a problem to be solved by a soccer ball. He mentions players getting high before games and going AWOL for days at a time. He asked a young, strung-out Australian woman what the tournament meant to her. “I don’t get very mushy about things,” she replied. “That’s my life, you know, and that’s how I f–ked it up.”
- DAFNA IZENBERG

THE LAMPSHADE
Mark Jacobson

In early 2006, just months after hurricane Katrina, Skip Henderson was prowling the melancholy streets of New Orleans when he came upon a junkie selling storm-ravaged items. Among them was a small lamp.

Henderson’s collector’s eye recognized the metal frame as a central European, mid-20th-century work. But the shade . . . What is this made of? he asked. “The skin of Jews.” Henderson had no reason to believe it, but sent the shade to a journalist friend, Jacobson, who passed it along to a genetic lab. The verdict arrived 118 years to the day after Hitler’s birth: human origin.

With that, Jacobson’s utterly engrossing and profoundly disquieting search for answers is off and running. He re-examines the postwar stories that the Nazis didn’t just murder Jews by the millions but rendered their body fat into soap and their skin into leather. Ilse Koch, the so-called Bitch of Buchenwald—immortalized in the B movie Ilsa, She-Wolf of the SS—reportedly ordered such lampshades made, once as a birthday present for her husband, the camp commander. Buchenwald’s American liberators displayed a table of horrors that included a purportedly human-skin lampshade. But that lampshade disappeared, no others surfaced and no charges were ever entered in war-crimes trials. Most scholars long ago dismissed the beliefs as myths that captured the essence of a genocide both diabolical and prosaically industrial.

Even the shade’s drug addict seller, who had stolen it from an abandoned home, had no real reason to think it was a Holocaust artifact. He was just one of the many people Jacobson encounters—all of them of an age to remember the old stories—who somehow instinctively recognize the shade for what it is. In the end, its stubbornly murky origins matter less to Jacobson than a single question: what on Earth should he do with it? No Holocaust museum would accept it, leaving Jacobson, as he leaves the reader, with a hard choice: bury the shade—and all hope of further discovery—or keep both in the land of the living.
- BRIAN BETHUNE

GREAT HOUSE
Nicole Krauss

As she did in The History of Love, the American writer weaves seemingly disparate stories around a singular object—this time, a massive desk—and only at the novel’s conclusion do all the interconnections become clear. There’s a solitary novelist in New York who borrowed the desk from a passionate young poet, subsequently tortured and killed in Pinochet’s Chile. In Israel, a widower struggles to make sense of his antagonism toward his adult son. In London, a waifish pair of siblings rattle around an antique-filled house while their father combs the Earth to find the furniture the Nazis stole from his parents before killing them. Nearby, a professor of literature stumbles across a secret that his wife, a supremely self-contained woman now suffering from dementia, has kept all her life.

Each story takes the form of a confession, and each is, in itself, deeply compelling, both because the characters’ voices are so distinct and because their situations are so richly imagined. Here’s the New York novelist explaining a lover’s reasons for dumping her: “The gist was that he had a secret self, a cowardly, despicable self he could never show me, and that he needed to go away like a sick animal until he could improve this self and bring it up to a standard he judged deserving of company.” And here’s the widower, berating his son for renting a BMW: “You’re such a big shot that you can’t accept a Hyundai like everyone else? You have to specially pay extra for a car made by the sons of Nazis?”

As in her previous two novels, there’s a lot about the writing life—many of the characters are writers, or would like to be—but Krauss no longer seems to be angling for an A from the postmodern tricksters who have influenced her style. Here, narrative is the point. She doesn’t quite tie everything together convincingly in Great House, but the characters feel so real, and the sense of loss they share is so powerfully distilled, it’s easy to forgive minor construction flaws.
- KATE FILLION

GOD AND SEX: WHAT THE BIBLE REALLY SAYS
Michael Coogan

A serious scholar (editor of  the New Oxford Annotated Bible) with a sense of humour, Harvard lecturer Coogan has long been bemused by the way all sides in various debates, from abortion to same-sex marriage, reference the Bible without knowing much about what it really says. The language of sex and of beauty is culturally specific, he points out, and while the male speaker in the Song of Songs clearly means high praise for his lover when he compares her hair to “a flock of goats streaming down from Mount Gilead,” a modern beau would be ill-advised to say as much to his beloved. Likewise, sexual euphemisms, which range from the familiar carnal overtones of “knowing” to the less often recognized use of “feet” for genitalia: the Israelite heroine Jael was able to drive a tent peg into an enemy commander’s skull because “between her feet he knelt down, there he fell, wasted” (Judges 5:27).

The meat of the book, though, lies in Coogan’s discussion of what Scripture says about current hot-button issues. Almost all sexual transgressions involving women, from adultery to incest and rape, are treated as property crimes, because they usurp another male’s rights to a woman or diminish her financial value. Abortion is not mentioned, and the few references to fetuses are not clear about their status as human persons.

As for homosexuality, the last of the New Testament’s three condemnations (Romans 1:26-27) speaks of homoerotic relations as divinely imposed, a concept, Coogan notes, “not very far from the modern view that sexual orientation is innate,” not chosen. The Old Testament’s two explicit references are found with other instances of Israelite rejection of what scholars call “category confusion”: crossbreeding animals, planting different crops in the same field, wearing clothing woven from different kinds of yarn. Needless to say, these are prohibitions long ignored. And just as we no longer scan the Bible for agricultural advice, Coogan concludes, we ought to be at least as wary about its social policy prescriptions.
- BRIAN BETHUNE

Mitchel Raphael on Lisa Raitt’s Mojo and why Layton's mom-in-law said ’I told you so'

By Mitchel Raphael - Friday, February 12, 2010 at 9:00 AM - 3 Comments

Labour Minister Lisa Raitt and her partner, Bruce Wood, got to pet a small Siberian tiger at this year’s Dragon Ball in Toronto. The mega gala, which celebrated the Year of the Tiger, raises money for the Yee Hong Centre for Geriatric Care. Raitt couldn’t wait to tell her kids about the tiger because they are now a cat family: they have two twin orange felines, Mojo and Saffi. Raitt was a dog person until Laureen Harper convinced her that cats were the way to go. Because they need less attention they are ideal pets for a busy politician.
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Strombo v. Layton

By Aaron Wherry - Thursday, February 11, 2010 at 12:48 PM - 0 Comments

The NDP leader talks—begins at about the four minute mark—to George about cancer, health care and the New Democrat cause. Deep insight into the eternal optimism of the New Democrat mind contained therein.

The Commons: Jack Layton doing as Jack Layton does

By Aaron Wherry - Monday, February 8, 2010 at 5:01 PM - 24 Comments

It was perhaps a bit odd that Jack Layton’s disclosure last week that he has been diagnosed with prostate cancer would be cause for consideration of his political career and public life to date. He is by no means doomed and is entirely likely to make a full recovery. But perhaps we in this culture crave any opportunity to pause for reflection.

As it is, Mr. Layton seems more inclined to carry on, showing up this afternoon to explain how and why the next session of Parliament should be dedicated, sort of like the Titanic, to putting “women and children first.” Here was Jack Layton as he is, and seemingly as he always has been: insistent and demanding and righteous and demanding, for the most part, to be greeted without irony. Continue…

Layton's fight

By Aaron Wherry - Saturday, February 6, 2010 at 12:46 AM - 27 Comments

Stephen Harper, Michael Ignatieff and Gilles Duceppe extend their best wishes. News and reaction from the Globe, Star, Post, Sun, CBC and CTV. Canadian Press has a primer on prostate cancer.

Testing for prostate cancer 10 years earlier

By Cathy Gulli - Tuesday, May 5, 2009 at 2:18 PM - 4 Comments

When it comes to your health, can you be too cautious? That’s the persistent debate happening over a blood test used to screen for prostate cancer that some doctors say actually “overdiagnoses” the disease in men.

The controversy peaked again last week when the American Urological Association called for men 40 or older who are expected to live at least another decade to be offered prostate-specific antigen (PSA) testing. Previously, the AUA recommended the test for men 50 or older—which is in line with the Canadian and American cancer societies. The discrepancy highlights the confusion among health organizations and even patients about the pros and cons of PSA testing.

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