‘No Jab, No Pay,’ not here

Australia has a blunt way of getting parents to vaccinate their children called ““No Jab, No Pay.”

image: Forbes Phoenix

As the name suggests, parents don’t receive welfare payments, tax benefits, and child-care rebates if they don’t vaccinate their children. It can amount to $15,000 annually.

Not only do parents lose payments but unvaccinated children can be barred from daycare and schools during disease outbreaks. Daycares that allow unvaccinated children can be fined up to $30,000.

The exceptions to vaccinations are those children who have some medical condition such compromised immune systems or cancer. These children have a genuine reason not to be vaccinated; and these are the children who can benefit most from everyone else being vaccinated.

Australia has one of the highest vaccination rates in the world. But rates only improved slightly since the ‘No Jab, No Pay’ policy was implemented, from 90 per cent to 93 per cent. The improvement was not entirely because of the threat. A key to their success is a national registry. Health reporter Andre Picard says:

“We should not forget either that, in addition to financial penalties, Australia greatly improved its monitoring of vaccination. Having a register that shows what vaccinations children have – or haven’t – received has contributed greatly to bolstering rates (Globe and Mail, July 9, 2018).”

While it seems effective, it’s not appropriate for Canada. We are similar to Australia in that we are both former British colonies but Australia’s culture is different than Canada’s. Perhaps it’s because they were a former penal colony that the big stick approach is more accepted.

Canada has a hodgepodge of provincial systems with no consistent registry. We need to do better. We now have an immunization rate estimated (because we don’t know) to be 85 per cent. Herd immunity requires rates of 90 to 95 per cent.

There are many excuses for not vaccinating children. One is selfishness. If sufficient numbers of other children are vaccinated, herd immunity protects my child.

These parents don’t remember, or never knew, what it was like when vaccinations didn’t protect against diseases like polio. I do. I remember growing up in Edmonton during the “polio season” when epidemics of the crippling disease raged in the summer and fall. Provincial public health departments tried to quarantine the sick, closed schools, and restricted children from travelling or going to movie theatres. My uncle survived polio but walked with difficulty with the use of a cane and died prematurely because of polio complications.

Another reason is the irrational fear that vaccinations cause disease. While these hard-core anti-vaccination parents receive a lot of press, they only number about two per cent. The other 13 per cent fall into the categories of complacency, those who doubt the necessity of vaccinations, and those who just don’t’ find it convenient to get the vaccinations done.

Convenience is a big factor. Parents don’t get around to vaccinating because it takes time and effort. One-on-one attention is sometimes all it takes, such as an email or phone call reminder.

Canadians need to be encouraged, not bullied into improving or vaccination rate. We need a national registry. Improved rates will provide immunity, not only for their own children but for those vulnerable children who are unable to receive them.

Advertisements

When am I dead?

When I’m dead I won’t be writing these columns. But other than that, indication of my demise might not be certain. The problem is that our definitions of death vary according to legal, cultural, religious and philosophical perspectives.

  image: slideserve.com

There was some dispute about whether Taquisha McKitty of Brampton was dead. Doctors said she was but her parents disagreed. She went into cardiac arrest following a drug overdose and was declared neurologically dead. A death certificate was issued.

McKitty’s father said: “My daughter is not dead -she shows that every day.” He maintains that his daughter shows signs of life: squeezing the hands of loved ones and even shedding tears.

Whether she was living was finally decided through a court decision. A judge ruled that McKitty was, in fact, dead.

Keeping someone alive with life support is not an issue. Canadians are kept alive with pacemakers, kidney dialysis, mechanical hearts and lungs while awaiting transplants. The issue is whether we should maintain one’s bodily functions when they are dead.

McKitty’s family might disagree with my last sentence. If they believe that bodily functions define life, then the squeezing of hands indicates that Taquisha was alive.

Others could argue that breath itself is life. If so, breathing is an indication of life. Genesis 2:7 says: “The LORD God formed the man from the dust of the ground and breathed into his nostrils the breath of life, and the man became a living being.”

Still others believe that the soul, the essence of life, resides in the heart. The ancient Egyptians thought that the heart was vital. During mummification, they discarded the brain by removing it through the nose but kept the heart. They likely believed that as long as the heart is pumping, a person is alive.

In Western culture, the brain defines life because it’s the seat of the mind. Some philosophers suggest that it’s the mind that defines life. They argue that since the mind resides in the brain, and because the brain is a (biological) machine, the mind could reside in any machine. If complex computer could be built, the mind could continue to live in a solid state environment without a body.

The Japanese would disagree. They see the body and mind as a single unit so that the mind is not independent of the brain. To be alive is to experience bodily sensations and desires as well as cerebral thoughts.

The judge in McKitty’s case ruled that the brain is central in determining death. If the brain is dead, so is the mind. This opinion coincides with doctors’ assessments. Dr. Sonny Dhanani, a pediatric critical care physician in Ottawa, concludes:

“When brain death occurs, there is no blood and oxygen going to it. The brain ceases all function. There are no functions left to be lost. This means there is the irreversible loss of any ability to have thoughts or feelings or memories (Globe and Mail, July 6, 2018).”

I won’t know when I’m dead and given the definitions of life, maybe no one else will be sure any time soon.

Homophobia contributes to loneliness

Men haven’t always avoided open displays of affection for each other. Rachel Giese author of Boys: What It Means To Become A Man says:

“Our squeamishness about male friendship is a historical anomaly: connections between men have been idealized throughout Western history and understood as foundational to society, culture, and art. The veneration of men’s friendships can be charted as far back as ancient Greece (Walrus magazine, May 2018).”

  image: Mental Floss

Before the mid-1800s, society was structured around organizations of men –guilds, religious orders, service clubs, sports teams and the military. Displays of affection and confessions of love between men were common and unremarkable. In his essay “On Friendship,” French philosopher Michel de Montaigne describes his relationship with deceased friend as one with “souls mingling and blending with each other so completely that they efface the seam that joined them.”

Such gushes of emotion would be suspect in today’s society. Even the innocuous term “bromance” carries a certain discomfort. “It celebrates same-sex fondness,” says Giese, “but does it with a smirk—as if two men caring for another needs to be explained or justified.”

Culture changed at the start of the twentieth century as women became more integrated into public life. Schools, places of work, and politics were no longer the exclusive domain of men. Marriage shifted from an arrangement between families to one based on romance and love. The nuclear family replaced the male-dominated associations as the centre of culture and society.

Victorian values made homosexuality a perversion and a threat to social order: platonic friendships became suspect. These values resist change. Men are defined as the opposite of women, the head and provider of the family -and heterosexual. In this context, homosexuals are seen to be the opposite of a “real man.”

Homophobia has a toxic effect on boys. Professor Niobe Way has studied the emotional landscape as boys mature. The common notion is that boys are less communicative, invulnerable and less capable of intimacy, than girls. However, Professor Way found genuine affection among boys. One fifteen-year old told her of his feelings for another boy: “[My best friend and I] love each other…. I guess in life, sometimes two people can really, really, understand each other and really have a trust, respect and love for each other. It just happens, it’s human nature.”

As adolescent straight boys approach manhood, the fear of being perceived as a homosexual grows. They leave behind friends as they explore the uncertain terrain of romantic relationships of women. They are vulnerable as they no longer have a foot in either world.

Professor Way believes that young men are suffering from a “crisis if connection” as a result of being told that real men can’t be close to each other. Men can end up lonely at a cost to their health. Former U.S. Surgeon General Vivek Murthy speaks of loneliness, isolation and weak social connections:

“[They] are associated with a reduction in lifespan similar to that caused by smoking fifteen cigarettes a day and even greater than that associated with obesity. Loneliness is also associated with a greater risk of cardiovascular disease, dementia, depression, and anxiety.”

New doctors need to give up sense of entitlement

There are more doctors than ever before; yet two million Canadians can’t find one.

  image: davegranlund.com

An estimated 30,000 Kamloopsians don’t have a family doctor, although only about one-half of them are looking if national averages apply.

Something doesn’t add up. Why can’t Canadians find a doctor if there is a surplus? It’s complicated.

First, recent graduates of medical schools can’t find the residency they want. Without a residency, they will never become doctors.

This year, 2,980 will graduate from Canada’s 17 medical schools. They will compete for 3,308 residency spots. That would seem like every graduate should get a spot. However, 917 of those spots are in Quebec which means that there is a shortage for English-speaking graduates.

Then there is the arcane process of matching graduates to residencies which leaves some out. Health reporter André Picard says:

“But matching a graduate to a residency spot is a complex process, overseen by the Canadian Resident Matching Service (CaRMS). Medical students apply to CaRMS in one or more specialties; committees select who they wish to interview and rank them; graduates rank the programs and, finally, an algorithm spits out a match, and the student is legally bound to take that residency spot (Globe and Mail, May 1, 2018).”

Graduates have become pickier. They get assigned in residency specialties where they don’t want to work. As a result of preferences and the complexities of CaRMS, 115 graduates are unmatched this year. Jobs are waiting for them -there are 78 unfilled positions, 65 of them in family medicine.

The unmatched graduates have invested a lot. They have accumulated an average debt of $100,000 during four years of training. Taxpayers have invested a lot. We are on the hook for their subsidized education. The cost of training a medical student is $250,000.

Also, some graduates want a regular job where they work only 40 hours a week as in a hospital in a so-called “hospitalist” position. At $150 an hour, a hospitalist makes $300,000 a year with no overhead. Compare that with a doctor in his own private practice. After paying staff and rent, a doctor would have to earn $400,000 a year to take home that much -and they’d work longer hours with less medical equipment and fewer support staff such as nurses. But there are only so many hospitalist positions.

One-half of Canada’s physicians focus on sports medicine or palliative care says Dr. Danielle Martin on CBC’s the Current:

“. . .they’re not practicing what we would think of as full scope full service cradle-to-grave primary care family medicine, and that is what those people who are lining up at Dr. Pengilly’s clinic and asking [for a primary caregiver].”

Doctors need to abandon their sense of entitlement says Picard. We need more general practitioners, especially in small cities and rural Canada. Enrolling in medical school doesn’t entitle graduates to jobs wherever they want, in the speciality of their choice.

“Becoming a doctor is hard,” says Picard, “It’s also a privilege. We need a system that ensures the right doctors are working in the right places, not on where personal desires can trump societal needs.”

Self-administered death made easier

A new drug in Canada will make medically-assisted death easier. It can’t come soon enough.

image: Bayshore Healthcare

If I had a terminal illness that made my life a living hell, I would want medical assistance in dying (MAID). Since it has been legal in Canada since 2016, it should be easy. All I have to do is find a doctor who is willing to administer the drugs. And then make sure I’m living in the right place -that’s where things get tricky, as Horst Saffarek found out.

Horst Saffarek lived in a Catholic residential care facility in Comox, B.C. When his lungs began to fail, he wanted help in dying. The publicly-funded Catholic institution wouldn’t allow MAID at their facility, citing moral principles.

Horst was becoming frailer each day and breathing became difficult. His daughter, Lisa Saffarek, told CBC’s The Current:

“It’s scary, you know, especially when you can’t breathe, every moment is scary.”

Horst was faced with the choice of essentially suffocating to death or he could be transferred to a facility that allowed MAID. He was transferred to Nanaimo where he would have to wait ten days as required by law.

I can only imagine the terror that he was going through: struggling with every agonizing breath and seeing relief being delayed.

“Dad was obviously very frail,” said Lisa Saffarek, “We did need to transfer him. He was ended up, you know, his oxygen levels were falling, and we wanted to try and meet his wishes.”

The transfer from Comox to Nanaimo, an hour and a half ride by ambulance, was gruelling. Horst Saffarek died the day after the transfer without the comfort of MAID.

Not only was Horst Saffarek’s suffering needlessly prolonged, but his family felt anguish as well. Lisa and her sisters had planned to spend the last moments of their father together but they were robbed of that:

“But it just – it took away from us being able to celebrate dad and just to enjoy our last moments with him.”

The law protects doctors by allowing them to opt out of MAID. Institutions have no such legal option. Religious healthcare facilities receive public funding same way that others do. If a procedure is legal, and public funds are involved, how can an institution prohibit it?

In small centres like Comox, religious healthcare facilities are the only ones in town. Because they employees are not necessarily religious, and neither are the patients, the title “religious facility” loses meaning. In reality, they are public facilities with an historic religious origin.

The solution is to take matters into one’s hands. A new drug has been made available to make that happen. Secobarbital, the most common drug used in many countries, is now available in Canada. Unlike existing drugs that can take a long time, Secobarbital is fast-acting, doses are a relatively small in volume, and self-administration is easy.

Existing drugs can take hours, even days, to work. They taste bad. They don’t work if they cause nausea and vomiting, or when the patient falls asleep before consuming the large volume required.

For those who suffer from an agonizing terminal illness but live in remote or small communities where there is only one doctor who doesn’t provide MAID, or they live in a care home that decides to flout the law, Secobarbital could provide relief.

Horst Saffarek’s experience leaves me wondering why I should suffer the vagaries of the anachronistic legacy of institutions, and other’s moral values, that impose themselves on my life and death. Whose life is it, anyway?

 

 

His health, her health

Medications affect women differently than men but you wouldn’t know it from prescribed drugs.

Take the sleep drug Ambien, for example.  After the drug had been placed on the market, it was found to have a dramatically different effect on women. The U.S. Food and Drug Administration found that five times as many women were experiencing driving impairment eight hours after taking the drug. As a result, doctors now prescribe “sex-specific” Ambien which is a lower dose. In Canada the drug is sold under the name Sublinox. But sex-specific prescriptions are the exception rather than the rule.

Doctors prescribe the same drugs for men and women even though they have only been tested on men. Researchers have known about this weakness of drug trials for a long time. Dr. Marcia Stefanick, professor of medicine at Stanford University explains:

“Indeed, drug metabolism, tolerance, side effects and benefits differ significantly between the average man and woman for many widely prescribed medications, with women having a 50 to 70 per cent higher chance of adverse reaction (Scientific American, September, 2017).”

Despite knowing of the difference, few women are included in trials. In a review of 258 trials of cardiovascular treatments, only 27 per cent of the participants were women, and of those only one-third were reported by sex.

Despite years of “Red Dress” campaigns, most people and many physicians still think heart disease is a man’s disease. They are surprised to learn that heart disease is the number-one killer of women, far exceeding deaths from breast cancer. Physicians are less familiar with the symptoms of heart disease in women. In men, the main symptom is chest pain, whereas in women symptoms can include back pain, nausea, headache and dizziness. Women’s symptoms are seen as “atypical” because men don’t report them.

Chauvinistic blindness excludes half the population.

Heart disease also involves the build-up of plaque in the arteries. Men, and older women, tend to suffer from a blockage in one location. Younger women are more likely to have diffuse plaque along the entire artery with the same effect. Because a local block is not found in a younger woman, she could be diagnosed as “free from of heart disease” even though at risk of a fatal heart attack.

The other sex is sometimes overlooked in trials. Men are often neglected in studies for ailments thought to be unique to women. Osteoporosis, characterized by reduced bone strength, is considered a woman’s disease because white women are twice as likely to suffer a bone fracture as white men. As a result, fracture prevention trials include few men. But one-third of hip fractures are in men –and they have worse medical outcomes than women

Men are more susceptible to viral, bacterial, parasitic and fungal infections than women; the exception being sexually transmitted infections such as HIV and herpes which is more prevalent in women. However, women’s resistance to infection comes at a price. Women constitute 70 per cent of cases where a robust immune system attacks her own body in autoimmune diseases.

Professor Stefanick lauds the Canadian Institutes of Health Research for promoting the inclusion of sex and gender in drug trials and wishes the U.S.  Government would do the same. She adds:

“We need further mandates, through policy and funding restrictions, to ensure that female biology makes it into textbooks and testing protocols.”

Blockchain could improve food security

The future of cryptocurrencies such as the bitcoin might be unclear but the technology behind it is solid. Blockchain is the digital ledger where bitcoin transactions are kept. It’s transparent, secure and open for all to see.

    image: Realty Biz News

The origin of blockchain is mysterious. Some person, or group, with the anonymous name Satoshi Nakamoto is credited with inventing blockchain. Who this person is remains obscure.

Blockchain’s usefulness goes beyond cryptocurrencies. Its property of transparency could improve food security. Sylvain Charlebois, professor in food policy and distribution at Dalhousie University explains:

“Blockchain technology allows for users to look at all transactions simultaneously and in real time. In food, for example, a retailer would know with whom his supplier has dealt. Additionally, since transactions are not stored in any single location, the information is almost impossible to hack (Globe and Mail, December 13, 2017).”

If you are buying pork chops in a grocery store, for example, and wanted to know the complete history the animal before you buy, you could scan the QR code on the label and within seconds know the date of the animal’s birth, use of antibiotics, vaccinations, and where the animal lived. (QR codes are a type of bar code in the shape of a square.)

The Public Health Agency of Canada reported earlier this month that 21 people became sick after eating romaine lettuce. While PAHC knew what caused the illness (E. Coli 0157) they didn’t know where the lettuce came from. Tracing contaminants can be a matter of life and death.

“Every year, more than four million Canadians get food poisoning. In recent years 474 cases of [the deadly disease caused by E. Coli 0157] have been reported annually,” says foodqualitynews.com.

Big Food is considering blockchain as way of tracing contaminates. Wal-Mart sells 20 per cent of all food in the U.S. and tested blockchain compared to standard methods of tracing food. They traced the source of mangoes in one of their stores using the standard method and it took six days, 18 hours, and 26 minutes to trace the fruit back to its original farm. Using blockchain technology, it would take 2.2 seconds for anyone –consumers and suppliers alike- to find out anything they want. And it would prevent good food from being thrown out.

“During an outbreak of a food-related health scare, six days is an eternity,” says Prof Charlebois, “A company can save lives by acting quickly. Blockchain also allows specific products to be traced at any given time, which would help in the reduction of food waste. For instance, contaminated products can be traced easily and quickly, while safe foods would remain on the shelves and not in landfills.”

Blockchain won’t be implemented without the involvement with everyone along the food chain. The record will only be as good as the data entered. Giants like Wal-Mart can force supplier participation.

Governments could also force compliance. With the health of consumers at stake, regulated participation would make the records complete and useful.

Cryptocurrencies may be a fleeting gimmick to have investors part with their money but let’s not throw the blockchain out with the bitcoin.