Baby boomers’ long term care goes bust

The long term care of boomers is an unfunded liability. Unlike the Canadian Pension Plan and Old Age Security, the long term care of boomers is not funded at all. Our health care is not prepared to receive their numbers.

image: genx67.com

Other countries with similar long-term care pressures, such as Germany and Japan, have established various forms of public long-term care insurance. Not in Canada.

As it now stands, long-term care falls on the shoulders of family members who provide for 75 per cent of home-care for older Canadians, unpaid. Canadians typically don’t see the gaps in the current publicly-funded care programs until they or a family member falls through them.

Research from the National Institute on Ageing at Ryerson University shows that if Canada continues on its current track, the cost of publicly funded long-term care for seniors – including nursing homes and home care – is expected to more than triple in 30 years, rising from $22-billion to $71-billion, in today’s dollars. Authors of the research, Bonnie-Jeanne MacDonald and Michael Wolfson, warn:

“There is no special fund or program to cover the costs of long-term care in Canada. And it is not covered under the Canada Health Act in the same way as physician and hospital care (Globe and Mail, October 8, 2019).”

Canadians are dreaming if they think that our health care system can deal with the onslaught of boomers that will be falling into long term care. Hospitals are now struggling to place seniors in long-term care facilities and the wave of boomers hasn’t even hit yet.

Private long-term care insurance is available but expensive because of the low number of people buying it. It hasn’t worked here in Canada and is unlikely to work in the future.

Private long-term residences are having trouble staffing. In Kamloops, Berwick on the Park’s supportive living unit will close next year leaving 20 residents without round-the-clock care, despite the fact that residents pay $5,000/month for the service. The director of Berwick wrote to residents:

“There are significant challenges to retain healthcare staff in the current labor environment. An extraordinary amount of energy has been directed at recruitment and onboarding staff to meet the obligations to successfully operate our licensed care unit. The forward looking labor forecast indicates that these challenges will continue for the foreseeable future (Kamloops This Week, October 10, 2010)”

Even if private long-term care were available, many boomers couldn’t afford it. Debt among seniors is increasing according to Stats Canada. In 2016, the proportion of senior families with consumer and mortgage debt doubled since 1999.

Boomers have led privileged lives. They grew up during a period of increasing affluence due in part to widespread post-war government subsidies in housing and education. Baby boomers were more active and more physically fit than any preceding generation and were the first to grow up genuinely expecting the world to improve with time. While they have accumulated wealth, many boomers have lived beyond their means.

Boomers’ optimism for a better world is going to be severely tested as they age.

Canada needs to establish a new long-term social insurance program.  Given that health care is controlled by provinces, a patchwork system will be the likelihood as boomers totter into old age.

The current rickety long-term care system is not prepared for the wave of boomers.

 

 

Meat is bad for you. Wait, it’s OK

Contrary to decades of work, researchers from Dalhousie and McMaster Universities recently found that red meat, including bacon, is not harmful. It wasn’t a new study but rather a “study of studies,” a meta-analysis of existing studies.

image: Foreman Grill Recipes

It was a perfectly flawed study. Perfect because it offered a veneer of the scientific method; flawed because of what it didn’t include.

It didn’t include studies that found the opposite of their conclusion. Those well-researched studies found a link between meat consumption and coronary heart disease, heart attack, Type 2 diabetes, cardiovascular death and all-cause mortality. That’s quite an exclusion.

As well, the researcher’s conclusions were contrary to those of the World Health Organization, the Canadian Cancer Society, the American Institute for Cancer Research, and the American Heart Association. Their findings also diverged from Canada’s new Food Guide which suggests eating less animal protein.

Why did the researchers not include studies that concluded the opposite of their report? They weren’t funded by the cattle or pork industry. The reason that they didn’t include the studies was technical. The self-selected 14 member panel decided that these findings were not of sufficient quality.

What they did include is suspect. For example, they included one trial that dominated their analysis; a trial involved almost 49,000 women. But that trial was designed to examine dietary fat intake, not meat intake says nutritionist Leslie Beck (Globe and Mail, October 2, 2019).  It seems to me that a study purporting to investigate the relationship between meat consumption and health shouldn’t include fat consumption.

And the researcher’s findings were flawed in another way. They did not distinguish between the consumption of red meat and processed meat, despite evidence that processed meat such as bacon is more harmful.

It’s not surprising that their study should come to the conclusion that it did. Obviously, what’s included will determine the outcome.

The researchers at Dalhousie and McMaster Universities were exhaustive in a peculiar way. They were exhaustive in the number of findings: they conducted not just one review but five.

Three of the reviews analyzed more than 100 observational studies involving more than six million participants. These types of studies link associations between consumption and health by following people for decades to see if participants who became ill or died.

Another of the five reviews analyzed randomized controlled trials, studies that show cause and effect of eating more or less red meat.

The researchers were thorough enough to appear scientific but blind in excluding accepted knowledge. They couldn’t see the forest for the trees.

The authors acknowledged their lack of confidence in their data. They conceded that their recommendation was weak but judging by the headlines they received, you wouldn’t know it.

Finally, studies on groups of people don’t necessarily predict outcomes for individuals. Leslie Beck says:

“A large body of evidence suggests that a high intake of red and processed meat increases the risk of ill health. I acknowledge that the risk on an individual level may be small, and that it’s your overall diet that matters most when it comes to health, not one food.”

Health Canada cracks down on cell injection clinics

The glossy ad in arrived in my mailbox within days of reading that Health Canada was clamping down on private clinics offering cell injection treatments.  The ad was for a seminar on Regenerative Medicine at five interior B.C. locations. The one in Kamloops was on Monday, July 15, 2019.

image: The Mandarin

The ad didn’t make clear what Regenerative Medicine was but it looked like cell injection from the information given.

“Learn from the most significant medical breakthrough in natural medicine this century,” claimed the ad. They ask: “Do you suffer from knee pain, back pain, osteoarthritis neuropathy join pain, COPD.”

The ad provided disclaimers. “Regenerative Cellular Therapy is considered experimental. It has not been evaluated or approved by Health Canada. It is not offered as a cure for any condition, disease, or injury,” and “We want to be transparent with you and disclose that this therapy is experimental/unproven and not everyone responds to the therapy.”

Fair enough but what, exactly, are the treatments?

It was only after phoning the number in the ad that I was given a website where I could find out more about the Regenerative Medicine and Anti-Aging Institute. RMAAI appears to be located in Washington State. While thin on details, the website says:

“At RMAAI we offer premiere regenerative medicine. The foundation of regenerative medicine includes growth factors, cytokines, proteins and mesenchymal stem cells. These are a fundamental piece of our natural and holistic approach to your healthcare needs.”

According to Wikipedia, mesenchymal stem cells can grow into other cells such as bone cells, cartilage cells, muscle cells, fat cells.

Regenerative Medicine, it turns out, is the harvesting of your own stem cells and re-injecting them at the site of injury with the hope that they will replace injured cells. I guess if I had attended the seminar, I might have found this out.

Health Canada has declared cell injection clinics to be illegal.

While the therapy is promising, Health Canada has a number of issues with the way cell therapy is administered at commercial clinics.

Michael Rudnicki, director of Canada’s Stem Cell Network, agrees that while there stem cell research is promising, it is not ready for clinical use. Referring to the banned clinics, he says:

“These treatments are unproven. These clinics are for profit. They are not research enterprises (Globe and Mail, July 10, 2019).”

Health Canada’s has medical and legal issues with the clinics.

The transfer of my own cells back into my body seems safe. Not so, says Health Canada because the procedure can introduce bacteria or viruses and stimulate unwanted immune reactions and tumour formation. “Indeed, a number of serious adverse events have been associated with use of autologous [self] cell therapies and strategies to mitigate these risks are needed,” says Health Canada.

The legal issue is that cell injections fall under the Food and Drugs Act. As such, they are classified as drugs and must be authorized for use in Canada. In addition, principles for labelling and quality control must be adhered to and the devices used to process the cells have to be classified under the Act.

I asked if RMAAI by email if they intend to offer seminars on cell injection therapies. As of the time of publication, I had no reply.

Sometimes it’s not easy being a pro-vaxxer

Despite the fact that vaccines have saved uncountable lives and virtually wiped out smallpox, polio, tetanus and rabies, vaccine risks exist. When those risks result in death, people lose trust in all vaccines.

image: Skeptical Raptor

Look at what happened in the Philippines. In 2015 they purchased three million doses of a new dengue vaccine.

Dengue is not as deadly as it might seem. Three-quarters of people infected by the mosquito-borne virus don’t notice anything. The remainder fall into three groups – symptoms similar to the common cold; or a fever accompanied by headache, pain behind the eyes, aching joints and bones that sometimes leads to internal bleeding; or the most deadly, dengue hemorrhagic fever and dengue shock syndrome where plasma seeps out of capillaries, liquid pools around organs, massive internal bleeding ensues. The brain, kidneys and liver begin to fail (Scientific American, April, 2018).

In the Philippines with a population of 105,000, dengue kills an average of 750 people a year. Any death is one too many but that number doesn’t even put dengue-deaths in the top ten list of killers. Of infectious diseases, many more die from pneumonia and tuberculosis.

The dengue vaccine wasn’t cheap. Made by the pharmaceutical company Sanofi Pasteur, Dengvaxia cost more than the entire national vaccination program for 2015, which covered pneumonia, tuberculosis, polio, diphtheria, tetanus, pertussis, measles, mumps and rubella. And it would reach less than one percent of the population.

Some wondered if the vaccine Dengvaxia had been oversold to the Philippine government in a panic mode.

Here’s where the nightmare for pro-vaxxers comes in.

Internist Antonio Dans and paediatrician Leonila Dans at the University of the Philippines Manila College of Medicine discovered some startling results: young children who were vaccinated were more like likely to suffer from dengue that those who weren’t vaccinated.

They found this out by studying publications by the makers of the vaccine, Sanofi Pasteur. While it worked for older children, for younger ones, the vaccine made things worse.

The two Dans warned the Philippine secretary of health in 2016 of their findings but in the meantime, the World Health Organization said that there was no problem.

“It was either believe us or believe the WHO,” said Antonio Dans. “If I were them, I’d believe the WHO. I mean, who were we? We were just teachers in a small medical school.”

The Philippine secretary of health responded with her own warning: doctors who engaged in “misinformation” on the vaccine would be responsible for every death from dengue that could have been prevented.

Then Eva Harris, a dengue expert at the University of California, Berkeley, found strong evidence in 2017 to support the Dans:

Harris’s evidence made the world take notice. Now Sanofi Pasteur and the WHO don’t recommend Dengvaxia for young children who have not been previously infected.

The reasons why Dengvaxia makes matters worse for children who have not been infected and better for those who have is puzzling. There are a few theories but it’s debatable.

The confusion has led to lack of confidence in vaccinations. In 2015, 93 per cent of Filipinos strongly agreed that vaccines are important.  In 2018, less than a third thought so.

Now, Filipinos suspicious of vaccines aren’t getting kids vaccinated and several outbreaks of measles have occurred.

Vaccines save lives but in a rush to save lives at any cost, the rollout of Dengvaxia was too soon and the cost was a loss of confidence of all vaccines.

Persuade, don’t malign anti-vaxxers

 

If we really want to convince parents to vaccinate their children, name-calling and vilification is not the way to go.

image: Wired

Yet, that seems to be a common tactic. You don’t have to go far on social media to find out. Here’s an example from Twitter:

Craig Levine @AstronomerXI “Let’s call #antivaxxers what they are: pro-disease, pro-death, pro child-suffering, ignorant, arrogant, stupid, fanatical, brain-washed, pathetic, selfish.”

Having lived through polio epidemics as kid, I don’t have to be convinced of the benefits of vaccination. Polio vaccines not only saved lives, it removed my fear of going to movies and school, and of going out to play.

The danger is real. A measles outbreak in the U.S. is at a 25-yar high. Three-quarters of those who caught the extremely contagious disease are children or teenagers.

Canada has large pockets of unvaccinated children. In Ontario, they have things in common:

“Those students tended to have things in common. For instance, unvaccinated children with non-medical exemptions were more likely to go to private or religious school, or be home-schooled, live in a rural area or a community with a small- to medium-sized population and be located in the southwest and central west regions (Globe and Mail, April 30, 2019).”

The Vancouver area is also experiencing a measles outbreak this year. And in neighbouring Washington a state of emergency was declared due to a measles outbreak -although no cases have been linked to B.C.

As is typical of character assignation, reluctant parents have been unfairly grouped together. But they are not monolithic say professors Julie Bettinger and Devon Greyson of UBC and the University of Massachusetts, respectively:

“While dismissing non-vaccinating parents as anti-science, uneducated, conspiracy theorists might be tempting, we find these stereotypes represent only a small minority of this population (Globe and Mail, April 22, 2019).”

Professors Bettinger and Greyson found that these stereotypes represented a minority of non-vaccinating parents. They surveyed, interviewed, and observed more than 2,000 parents to understand what causes vaccine hesitancy and how to address it.

First, despite the characterization of non-vaccinating parents as “pro-death” and “pro child-suffering,” they have the best interests of their children at heart. Additionally, they care about other children who can’t be vaccinated and who are at risk.

Yes, they may fear the safety of vaccines as a result of what they have heard from people they trust. Some lack of knowledge of the extensive testing and safety monitoring that ensures our safe vaccine supply. Sometimes their reluctance is born from a lack of trust and a perceived betrayal by the health care system -they don’t believe anything medical researchers tell them.

Some indigenous people don’t trust the colonial system that decimated their communities by purposely introducing disease.

They may live in remote areas and face barriers of getting to clinics. Access can be a problem for urban dwellers, too, for those who can’t get time off work to take in their children.

Some fear talking to health-care providers about their concerns because they’ll be labelled as “one of those parents.”

The remedy to vaccination-resistance is not easy. Trustworthy relationships must be developed. Mobile clinics with extended hours will help. Name-calling and the failure to address the genuine concerns of parents will only deepen the divide.

 

 

We’ve evolved to move

Herman Pontzer’s discovery defied common sense. He found that exercise doesn’t result in weight loss.

image: Best Health Magazine Canada

Defying logic, upsetting the plans of many to lose weight through exercise, and threatening exercise industries -there is no connection between exercise and calories burned.

Pontzer, an anthropologist at Duke University, lived with the Hadza people of northern Tanzania. He wanted to find out how many calories these hunter-gathers burned. It’s a grueling, energy-intensive lifestyle. He compared the calories burned by the Hadza with those burned by average adults in the US and Europe. They were the same. Even comparing average and sedentary adults of the Western world, they were the same. Pontzer was astonished:

“When the analyses came back from Baylor [university], the Hadza looked the same everyone else. Hadza men ate and burned about 2,600 calories. Hadza women about 1,900 calories as day -the same as adults in the US or Europe, We looked at the data every way imaginable, accounting for effects of body size, fat percentage, age, and sex. No difference. How was it possible? What were we missing (Scientific American, February, 2017)?”

I was astonished, too, when I read the article two years ago. Isn’t the obesity epidemic caused by lack of exercise? Can’t I eat that piece of cake and work it off in the gym? If exercise doesn’t reduce weight, why bother exercising?

I’m no anthropologist but both the fuel and the exhaust of our bodies are basic -oxygen in, carbon dioxide out. If we can measure CO2 output, that’s a measure of calories burned. A clunky way of measuring CO2 would be to have subjects wear a mask that collected CO2 while they exercised or sat around: not very practical.

Pontzer used a simple but elegant method employing “doubly labelled water.” This otherwise ordinary water has two tags, one isotope of hydrogen and one of oxygen. Subjects simply drink the special water and pee in a cup later. They are not confined in any way; they go about their daily business. Their urine now contains both isotopes in different amounts. The number of hydrogen isotopes is used as a reference. The number of oxygen isotopes indicates the amount of CO2. Subtract the two numbers and you have calories burned. The results were confirmed later using a device similar to a Fitbit.

Two years later, Pontzer wrote another article with some answers. (Scientific American, January, 2019).

This time he wondered how our close relatives, the apes, can live a sedentary lifestyle and not suffer from the the diseases we get from lounging around all day. In the wild and in zoos, apes sit around most of the day but don’t get carido-vascular and metabolic diseases. Humans who lounge around as much as apes suffer from type 2 diabetes, heart and brain disease.

Using doubly labelled water on apes (they are surprisingly cooperative in the collection of urine), he found that apes had evolved so that their calorie consumption matched their activity. They had evolved to lounge around.

Long ago when we were hunter-gatherers, our calorie consumption matched our daily activity. Now we don’t have to exercise and so we don’t. The problem is that calories not burned in exercise gum up the works. When we don’t exercise, calories are burned anyway. In a way not understood, calories not burned in exercise lead to an unhealthy outcome: carido-vascular disease and poor brain health.

Pontzer’s message is clear: “Exercise is not optional; it is essential.”

Big Food vs. Canada’s Food Guide

The interests of the food industry don’t always coincide with healthy eating. What’s at stake is Canada’s new Food Guide. It’s a big deal.

image: Globe and Mail

Canada’s Food Guide is widely respected. Seventy-five years after its first launch, it’s the second most requested government document after income-tax forms. It’s distributed to dieticians and doctors for patient advice and to schools and hospitals for creating meal plans. The new guide will be around for a long time, so it’s important to get it right.

Understandably, big food lobbies want the new guide to endorse their products. Even intergovernmental departments disagree on what should be recommended. One agency, Health Canada, wants the new food guide to “shift towards more plant-based foods,” less red meats, and to limit “some meats and many cheeses” high in saturated fats.

Another agency, Agri-food Canada, disagrees. They are in the business of promoting the sale of red meat and dairy industries. Last year, AAFC officials wrote a memo marked “secret” in which they worried:

“Messages that encourage a shift toward plant-based sources of protein would have negative implications for the meat and dairy industries.”

The pressure on Health Canada comes from other food manufacturers as well. Recently, the “Canadian Juice Council” surfaced. Nutritionists had never heard of them before their bright orange booth appeared at the annual conference of the Canadian Nutrition Society. Nutritional biochemist Dylan MacKay said: “I’d never seen or heard of them before and I’ve been going to CNS conferences for years (Globe and Mail, November 23, 2018).”

The origin of the Canadian Juice Council was obscure despite the presence of a web page and a Twitter account (with 2 followers). Food reporter Ann Hui isn’t surprised at the obscurity:

“And no wonder. The Juice Council doesn’t exist in the way you might expect: as an institution disseminating impartial facts and information about juice. Rather, it was created by the lobbying arm of the beverage industry – in a practice known as ‘astroturfing,’ used by lobbyists in all kinds of industries to create the appearance of a grassroots movement and a larger chorus of voices than actually exists.”

Ann Hui found that the Canadian Juice Council was an invention the Canadian Beverage Association whose members include Canada Dry Mott’s, Coca Cola Canada, and PepsiCo Canada. The industry supports 60,000 Canadians workers, 20,000 of those directly.

The Canadian Beverage Association is worried about changes in the Canada Food Guide that would remove the equivalency of whole fruit to juice. The old guide says that a half-cup of juice is a substitute for one portion of fruit.

The new guide, to be released soon, will advise Canadians to avoid drinks high in sugar. One 12-ounce bottle of orange juice contains about the same amount of sugar as 12 ounces of Coke – more sugar than the World Health Organization recommends for the average adult in a single day. Excess sugar consumption is linked with heart disease, obesity and diabetes.

The government is in a hard spot –do they support an industry that employs thousands of workers in the making of an unhealthy product or the health of Canadians who consume it?