The hero behind the thalidomide exposé

Frances-Oldham-Kelsey

Dr. Frances Oldham Kelsey 1914 – 2015

by Roxanne Davies

When Dr. Frances Oldham Kelsey (photo, above) applied for post-doctoral work at the University of Chicago, the employer mistook her name for that of a man’s. Sharing with a professor she thought she might be accused of depriving a man of his capacity to support a wife and child, her professor replied, “Don’t be stupid, accept the job. Sign your name and put ‘Miss’ in brackets.”

Thankfully, Dr. Kelsey followed the advice and accepted the job. With an outstanding combination of character and career skills, she would eventually save countless pregnant women and their babies in the US from the thalidomide disaster. Tragically, Canada allowed the drug to be prescribed to Canadian women between 1960 and 1962.

In 1959, the American Food and Drug Agency (FDA) tasked Dr. Kelsey with reviewing thalidomide, a new drug synthesized in 1954 by the German drug manufacturer Chemie Grünenthal. Touted as a wonder drug in Europe to treat insomnia and alleviate morning sickness, which, in some severe cases can last for hours, thalidomide was available over-the-counter in at least 46 countries under many different brand names, from October 1, 1957 into the early 1960s.

Skeptical about the manufacturer’s clinical studies, Dr. Kelsey refused to authorize it for market in the US, noting the company’s arguments for safety were not convincing. Executives from the drug manufacturer wrote, phoned and showed up at her lab to try and persuade her to approve their application, but she would not budge. They called her an obstructionist nitpicker.

In early 1961, Dr. Kelsey spotted a letter in the British Medical Journal written by a Scottish physician who cited incidents of nerve damage among his patients taking thalidomide. Dr. Kelsey asked why the drug’s manufacturer had never mentioned the troubling side effect; she also began to press company officials about the effects of thalidomide on a fetus, for which the drug makers had not done any testing. By November 1961, she was vindicated when the full scope of the thalidomide tragedy began to unfold. News from Europe linked the drug to birth defects, including stunted or missing limbs, heart malformations, deafness and blindness.

Dr. Kelsey was instrumental in ensuring that thalidomide was never prescribed to any pregnant woman in the US. Although thalidomide was withdrawn from the West German and UK markets by December 2, 1961, it is shameful it remained legally available in some Canadian pharmacies until mid-May 1962.

It has been estimated that thalidomide maimed 20,000 babies and killed upwards of 80,000 worldwide. Many families with surviving children filed civil suits, but all the victims had to wait years without support because the criminal trial took precedence. When the criminal trial of employees of Chemie Grünenthal opened in the town of Alsdorf, in the district of Aachen, on May 27, 1968, it promised to be comparable in scale and emotional intensity to the post-war Nuremberg trials. Nearly 700 people crowded the biggest space in the region: a casino. Every day, the judges, lawyers, scientists, press and witnesses passed by three deformed children nursed by Red Cross sisters while their mothers waited inside hoping to learn the cause of their children’s affliction. The trial lasted two and a half years. The trial ended in April 1970 when proceedings were halted because it was deemed there was little public interest in securing a conviction.

More than half a century after the pill’s threat to an embryo was proven, the company that produced the first disaster continued to sell the drug in parts of Latin America, through prescription only, and babies continued to be born with malformations similar to the survivors from the 1960s. Initially Grünenthal had insisted that it was blameless, claiming the thousands of abnormal births were an act of God. The company now admits its role in the drug disaster and that the thalidomide tragedy will forever be part of their history. Grünenthal would eventually provide approximately 100 million marks as compensation for the victims.

Thalidomide is making a comeback as a strictly regulated drug prescribed by doctors to combat serious skin conditions such as leprosy and is being explored as an HIV/AIDS or cancer drug. Celgene Canada, based in Mississauga, Ontario, provides biotech therapies and has rebranded thalidomide as Nightmare Drug to Celgene Blockbuster.

In 2010, the British government officially apologized to people hurt by the drug, after earlier agreeing to pay £20m (US$31m) to thalidomide’s victims. In 2013, a class action suit by Australian and New Zealand victims of thalidomide against the drug’s British distributor Diageo Scotland Ltd. was settled for $89m.

It is unknown how many Canadian women and children were harmed by thalidomide, but in 1991 there were 109 Canadians who could prove they were thalidomide damaged. In May 2015, the Canadian Conservative federal government announced details of the compensation package for the 92 remaining Canadian survivors. They would receive annual pensions of up to $100,000 depending on the severity of their disability for the remainder of their lives. An additional $500,000 was placed in in a medical assistance fund to be accessed by individuals to help with mobility and adaptive tools as required. Prior to the government compensation package, the average thalidomide survivor “survived” on $14,000 a year.

I was humbled by the personal stories and photographs of our Canadian survivors who showed tremendous grit and grace in their daily struggles. It is a sad irony that Dr. Kelsey was not able to save her fellow Canadians, however, remaining survivors have graciously thanked her for her life’s work. Mercedes Benegbi, executive director of the Thalidomide Victims Association of Canada, said the tribute to Dr. Kelsey is deeply deserved: “To us, she was always our heroine even if what she did was in another country.” Dr. Kelsey was born in Shawnigan Lake on Vancouver Island and was a dual citizen for most of her professional life, visiting often, but returning to Canada in her late 90s.

Compassionate, courageous truth-tellers often are responding to a higher calling, a sense of duty and justice. Sadly, many of these men and women end up experiencing long-lasting problems. An Australian study looked at 35 men and women from various occupational backgrounds, who had uncovered harms to the public. “Although whistleblowing is important in protecting society,” the report reads, “the typical organizational response causes severe and long-lasting health, financial and personal problems for whistleblowers and their families.”

Dr. Kelsey showed strength and courage by refusing to bend to pressure from drug company officials and her actions saved countless American women and their babies. Hailed as a hero, she was the second woman only to be honoured by president John F. Kennedy for distinguished federal civilian service.

On her 101th birthday in 2015, Dr. Kelsey received the Order of Canada in a private ceremony in her daughter’s home in London, Ontario. She died less than 24 hours after receiving the award.

Eating our way to better mental health

Science shows we can

DRUG BUST
by Alan Cassels

Let food be thy medicine and medicine be thy food. – Hippocrates

There are very few golden bullets in medicine, very few. But some pharmaceuticals are extremely useful, especially if you’ve got type 1 diabetes, heart disease, severe pain or asthma. Then your drugs may be saving your life.

But, as I’ve said before, the problem with an overly drug-centric approach to healthcare is that it relentlessly eclipses other options. Much of our medical care is underpinned by research dominated by drug makers with the resources to conduct large, randomized, controlled trials. We need those studies, but we find the treatments that do not fit the profit paradigm are starved for respect and research funds, meaning the bias deepens and we end up with the kind of health care that society has decided to pay for.

Particularly problematic in our pharma-centric world are psychiatric treatments, often studied in questionable trials for short periods of time on people with indeterminate diagnoses. They are then used incredibly liberally even when evidence emerges, as it has with antidepressants and antipsychotics, that many people are being hurt by them.

Increasingly, even though society is swallowing growing amounts of drugs for such conditions as anxiety, depression, ADHD, mood and anxiety disorders, the prevalence of those disorders continues to climb. Where is the kid asking why the Emperor is naked? If we’re spending so much more every year on drugs for psychiatric illness, why aren’t the rates of mental illness dropping? Something is wrong here.

I think about this in the context of some friends of mine. They are having a terrible time with their daughter, who is so anxious she can’t go to school. I’m not sure what’s going on, but it appears she’s in a real rough space. She’s been taken to the hospital on numerous occasions and there have been several attempts to get her to see a child psychiatrist. She hasn’t been prescribed any drugs yet, but I’m pretty sure that when she finally gets in to see the psychiatrist, she’ll begin her entrée into the world of psychiatric drugs.

This is the standard road travelled by many people who are depressed, anxious, sleepless or hyperactive, yet there may be other options worth exploring. Certainly, cognitive behavioural therapy (‘talk’ therapy) and exercise come to mind. We’re also witnessing the growing area in the use of micronutrients – the essential minerals and vitamins we consume in our food and its importance to our mental health.

Bonnie Kaplan, an emeritus professor at the University of Calgary, has spent much of her professional life studying micronutrients, particularly in the context of mental health. The body and brain require a fairly large array of vitamins, minerals and essential fatty acids and when we have deficits it’s possible our brains suffer even more than our bodies. In our phone conversation, Bonnie tells me, “This is all about nutrition above the neck. The brain is the biggest consumer of nutrients.”

Because people have genetic differences, respond to stress differently and, hence, have different micronutrient needs, it is plausible that many of us could have nutrient deficiencies that affect our mood. We have to remember that nutrients are involved in every biologic, chemical and physiologic process.

“There are 50 known genetic mutations in the realm of physical health, where an alteration in the ability of enzymes to grab and hold the nutrients that they need for optimal metabolism is impaired. They need extra nutrients to make the pathways work,” Bonnie says.

She brims with enthusiasm noting there are somewhere in the neighbourhood of 45 clinical trials testing micronutrients in a variety of mental health conditions, including insomnia, ADHD, psychotic disorders, mood and anxiety. And she’s seen the greatest benefits using them to treat irritability, mood dysregulation, bipolar-type symptoms and explosive rage.

As an example of the kind of research out there, she describes an “amazing study from Spain,” best known for studying links between nutrition and cardiovascular disease, but which has also evaluated links to mental health. The researchers took about 9,000 people with no mental disorders and looked closely at what they ate, quantifying their intake of prepared pastries, processed foods and other forms of junk food. They divided the participants into three groups, depending on their consumption of processed foods, and waited about six years to find out who would be diagnosed with a mood or anxiety disorder.

“Those in the study who consumed the least processed food had a very low probability of developing mood and anxiety disorders. The group in the middle were generally ok, too,” Bonnie told me. “But those with the highest intake of processed foods were at high risk of becoming depressed or anxious.”

Bonnie is well aware of the difficulty this research has in making any inroads in the pharma-dominated world of psychiatry. Whether it is Omega-3s, vitamin D or calcium, so much research energy is put into studying single nutrients at a time. Many times she has seen researchers unable to get funding to study broad-spectrum micronutrients because of the central research tendency – and perhaps human nature – to want to find a single magic bullet. One reviewer asked, while looking down the list of 40 or so micronutrients in a nutritional formula proposed for a study, “Which is the important one?”

“They’re all important!” Bonnie exclaims. There is a strong rationale for studying a large batch of micronutrients together, which comes in a ‘broad spectrum formula,’ because the body requires all kinds of vitamins and minerals to work properly.

Another surprising finding came from a study in adults with psychotic disorders. Everyone was initially given a broad-spectrum micronutrient supplement. After a month, they were supposed to be randomized to receive either the supplement or a placebo in a blinded fashion. The wheels fell off the study when the patients refused to be randomized because they didn’t want to take a chance in giving up the formula. If the study participants themselves are that adamant about the effectiveness of the formula, there is probably something there!

There are a number of companies that produce broad-spectrum formulas containing vitamins, minerals and antioxidants and one might wonder how much bias seeps into this research, as we see in the pharmaceutical world, when the manufacturer pays for the research, gives out research grants and otherwise shapes the research in ways that support its product?

Having witnessed the intertwining of the pharmaceutical industry and the mental health world, and the resulting corruption of the mental health scientific literature, Kaplan and her colleagues have insisted on putting a firewall between the manufacturers and the research: they won’t accept research money from those making micronutrient formulas.

Researchers like Bonnie Kaplan are doing exactly the type of research the world needs more of. Most probably, there is a great link between nutrition and mental health. The way we currently treat mental illness needs a complete rethink and it must include better research and a better use of a range of treatments – even things we eat.

Kaplan sees the huge price governments and individuals are currently paying for the relatively ineffective pharmaceutical model of psychiatric care. They need to know that micronutrients, while no magic bullet, could be a very effective and safe way to help many people with mental health challenges. In two published studies, they have shown that micronutrient treatment was not only more effective, but it also cost less than10% of conventional care. It seems that governments could save a bundle if they helped contribute to the research and the treatments.

Kaplan has established two donor-advised charitable funds and has already raised over half a million dollars to support the clinical trials of junior colleagues around the world who are passionate about studying the use of nutrition for mental health. Contact her at kaplan@ucalgary.ca or donate directly to this kind of research through the Calgary Foundation.

Alan Cassels is a former drug policy researcher, a writer and the author of several books on the pharmaceutical industry.

Long life, great health

photo of Vesanto Melina

NUTRISPEAK
by Vesanto Melina

When you consider the diseases and deaths of older people in your family, does it seem like your life might follow a similar pattern? Well, it turns out that changing your lifestyle can actually change your genes. Through lifestyle choices, we can turn on the genes that keep us healthy and turn off the genes that contribute to chronic inflammation, oxidative stress and the oncogenes that promote prostate, breast and colon cancer.

Studies have shown that within three months, a shift in habits can alter more than 500 genes. One researcher on this subject, Dr. Dean Ornish, revolutionized medicine with his powerful evidence that four lifestyle choices – adopting a plant-centred diet, getting moderate and regular exercise, reducing stress and not smoking – could turn around heart disease. Starting with prostate cancer, Ornish has extended his research into the exploration of various cancers.

One study was co-conducted with Elizabeth Blackburn, who received the 2009 Nobel Prize for her research on telomeres, the protective ends of our chromosomes that control aging. They are like the plastic tips at the end of shoelaces that keep your shoelaces from unravelling. The telomeres keep your DNA from unravelling. As our telomeres get shorter, our lives get shorter and the risk of disease and premature death increases. Blackburn investigated the actions of telomerase, the enzyme that can replenish and counteract the shortening of telomeres.

Short telomere length in blood cells is associated with ageing and ageing-related diseases, such as cancer, stroke, vascular dementia (Alzheimer’s), cardiovascular disease, obesity, osteoporosis and diabetes. For example, men with shortened telomere length in prostate-cancer-associated stromal cells are at a substantially increased risk of metastasis or dying from prostate cancer.

I had the privilege of being a staff dietitian on some of Ornish’s groundbreaking research on the reversal of cardiovascular disease through the four lifestyle changes noted above. Participants adopted low-fat diets centred on whole plant foods. Simple and inexpensive lifestyle changes were shown to turn around disease indicators within a short period of time, not just by affecting symptoms, as drugs do, but by also addressing the underlying causes.

Whoopi Goldberg says, “74 is the new middle age.” This month, I turn 75 and I hope I am just two-thirds of the way along the path! On March 31, I will be speaking in Vancouver on creating a life lengthening lifestyle. I’ll also address the latest tips about dietary sources of iron, optimal serum ferritin levels, keeping blood glucose level throughout the day, protective phytochemicals and practical tips for excellent protein intakes on plant-based diets. This event takes place in Vancouver`s first cohousing community, a modern form of village that was first developed in Denmark in the early 1970s. Cohousing effectively solves some of the problems of isolation that can occur in modern urban living and allows for the psychosocial support that has been shown to reduce risk of chronic disease.

Vesanto Melina Vesanto Melina is a Vancouver dietitian and co-author of the award winning Becoming Vegan: Comprehensive Edition and other books. www.nutrispeak.com


EVENT Register to see Vesanto Melina in person (limited seating)

Friday March 31, 7:15 PM at Vancouver Cohousing through Meatless Meetup
www.meetup.com/MeatlessMeetup/events/236730119/
email: vesanto.melina @gmail.com

Supplement your heart

healthy food and supplements

What can we do to keep our hearts beating to their fullest so we can live a long and healthy life? We need to get educated.

by Krista Boulding

February is heart month. Not only should we celebrate the emotional heart, but we also need to honour the health of our anatomical heart.

The heart, arteries, veins and blood make up the cardiovascular system. This system is primarily responsible for delivering oxygen and nutrients to our cells and removing wastes. The heart can pump 2,500-5,000 gallons of blood at 100,000 beats per day to accomplish these important tasks. The heart is a powerful little machine that needs daily support to ensure it remains healthy and active throughout our lives.

According to Statistics Canada, heart disease is the second leading cause of death. Every seven minutes, someone will die from a heart attack or stroke. It is known as the silent killer because most problems go undetected until it becomes too late. But let’s focus on the positive; prevention is our best medicine. What can we do to keep our hearts beating to their fullest so we can live a long and healthy life? We need to get educated.

The term cardiovascular disease (CVD) is actually referring to the health of our arteries. Arteries can become clogged with a plaque build-up that impedes blood flow and can arrest it altogether. When blood flow to the heart stops, a person suffers a heart attack. When blood flow to the brain stops, a person suffers a stroke. This plaque build-up is called atherosclerosis and is absolutely in direct relation to our diets and lifestyle. The good news is this can be completely prevented and even reversed.

Studies have shown that people with diets low in essential fatty acids are at an increased risk for heart disease. Omega 3s, whether from plant or animal sources, have a protective effect on the cardiovascular system. They can lower LDL cholesterol, triglyceride levels, blood pressure and also inhibit platelet aggregation. We must add cold-water fish to our diet, such as salmon, sardines or halibut. If you don’t get enough fish in the diet, try a supplement such as salmon or krill oil. Make sure it is high quality and contains the naturally occurring astaxanthin, a potent antioxidant that will protect the heart and arteries from free radical damage and inflammation. Alternatively, if you’re vegetarian/vegan, your best bet is to supplement with algae oil. Be careful with consuming excess flax oil as it oxidizes very quickly and can actually cause more damage than good. Buy it in small quantities and never heat it.

Magnesium is an extremely important mineral for the health of our hearts. It is well proven that people who die from heart attacks have lower than average levels of magnesium in their systems. This mineral can increase energy production within the heart muscle; it dilates arteries to allow better blood flow, and can improve heart rate. At the least, men should get 350mg and women, 300mg of magnesium daily. You can find magnesium in all green, leafy vegetables, legumes, nuts, seeds and whole grains. Food should always be your number one choice for getting nutrients, however, with the depletion of our soils, it can be difficult to get enough magnesium in our diets. It is now advisable for everyone to supplement with this mineral. As a general daily dose, choose 200-400mg of a highly absorbable chelate such as magnesium bisglycinate.

Garlic has been used successfully in reducing platelet aggregation, part of the early stages of atherosclerotic plaque. It is an excellent blood thinner and will help reduce high blood pressure. If you choose to increase the garlic in your diet, make sure it is raw and consume it very quickly after crushing. The medicinal compounds, specifically the allicin, are very reactive and will diminish rapidly. Heat will also destroy these compounds, so add your garlic in right at the end of cooking. There are many supplements available that try to outsmart nature; I still think it’s a wise choice to simply eat what the Earth gives us. However, if you choose to supplement, aged garlic extract may be the answer. It is rich in S-allyl-cysteine, a compound that shows a high bioavailability and strong antioxidant activity. This may be the more important ingredient to look for, rather than the allicin, in a garlic supplement.

Coenzyme Q10 (CoQ10) is a vital part of ATP production in our hearts. ATP is the energy currency in our cells that give our hearts the life force they need to pump blood through our bodies. By supplementing with CoQ10, studies have shown an increase in cardiac output and stroke volume. It is especially important to take extra CoQ10 if you’re on statin drugs to lower cholesterol, as these pharmaceuticals diminish the body’s CoQ10 levels. It is sadly ironic that we would take a drug to supposedly protect our cardiovascular system and end up suffering a heart attack as a side effect. CoQ10 can be found in organ meats such as liver, heart, kidneys, and also in fatty fish, red meat and eggs. If you’re a vegetarian, you can find it in smaller amounts in peanuts, broccoli, cauliflower and spinach. Make sure your animal sources are organic and free-range, as this will greatly increase the levels of CoQ10 in the product. If you choose to supplement, there is a broad range, from 30 mg to 300 mg depending on one’s individual needs. It is also worth noting that the ubiquinol form is better absorbed and utilized by the body.

Vitamin K2 is now in the spotlight as the missing ingredient in cardiovascular health. K2 ensures the calcium we ingest through food or supplements finds its way to our bones rather than depositing in our arteries. Atherosclerotic plaque consists of calcium, fats, cholesterol and other debris. It is clear now in the scientific literature that cholesterol and saturated fats are not the bad guys when it comes to plaque formation; it’s actually excess and displaced calcium. Taking a calcium supplement without adequate K2 levels in the body will increase our risk for heart disease. K2 is found in animal products such as meat, eggs and dairy. But make sure they are grass-fed as this greatly increases the K2 content. Green leafy vegetables are only a source of vitamin K1. While very good for you, it does not have the bone and artery protective benefits of K2. Our body can synthesize K2 from our gut bacteria, and to a small degree from K1, however, it is highly beneficial to supplement with this heart and bone protective nutrient. Aim for about 120 mcg per day.

Most of us don’t give much thought to our hearts; they unconsciously beat away inside our chests. February is here to remind us not to take them for granted. Our hearts need love, emotionally and physically. Take the time this month to really appreciate the amazing muscle that pumps life throughout our bodies. Eat heart healthy whole foods, supplement wisely and get that heart pumping with daily movement.

Happy Valentines Day!

Note: If you are currently taking medication or have been diagnosed with heart disease, it is always wise to talk with your doctor or pharmacists before embarking on a new supplement program.

Originally published at healthywaynaturalfoods.com Krista Boulding is a holistic nutritionist through the Edison Institute ( www.edisoninst.com) and a level-2 nutrition coach through Precision Nutrition (precisionnutrition.com). She provides private nutrition consultations, group wellness programs, and offers a variety of nutrition-based lectures throughout the year. Krista believes that true health can only be achieved through a combination of self love, nourishing whole foods and specific lifestyle practices. She is passionate about all things related to food, life and fitness. Find out more about her at www.kbstrengthandwellness.com

photo-montage by Tom Voidh

Don’t let heart disease and stroke sneak up on you

stehhoscope and heart

Prevention is the best medicine

When I do get into the rhythm of being active – doing cardio classes, getting up a little earlier to make the walk or fit in some exercise before work – my mood is better, my stamina improves and I know I’m prolonging my life by improving my overall health.

by David Sculthorpe

What if I told you that up to 80 percent of premature heart disease and stroke are preventable? For every 10 people diagnosed with these conditions before age 75, we could have prevented eight of them.

It’s true, and a shocking statistic, when you think about it because heart disease and stroke continue to be leading causes of death in this country.

At this point, you may be asking yourself, “If we can save eight out of 10 people, why aren’t we doing more? Why does heart disease and stroke still take a life every seven minutes?”

What’s holding us back? Usually, it comes down to two factors: 1) People think it’s never going to happen to them. 2) Changing habits is hard.

Eating better and moving more is challenging for most people, including myself. I try to work out at least three times a week, but all too often I’m too busy or too tired to get to it. I try to walk to and from work every day, but there are many days when I’m in too much of a rush to get to work or eager to get home to my wife and kids so I take the car.

When I do get into the rhythm of being active – doing cardio classes, getting up a little earlier to make the walk or fit in some exercise before work – my mood is better, my stamina improves and I know I’m prolonging my life by improving my overall health. And I know being too busy is the worst excuse for not being active.

The saying “Use it or lose it” definitely applies. I want to be walking, skiing, playing tennis and being active long after I’ve retired. And I know the best way to ensure that happens is to be doing more of those things right now.

There’s a lot each of us can do to reduce our own risk. But we can’t do it alone. Preventing that 80 percent of premature heart disease and stroke will take the full engagement of governments, industry, schools, the healthcare system, every aspect of society. It will also take our best minds, such as researchers like Dr. Grant Pierce.

Dr. Pierce, a professor of medicine at the University of Manitoba and the Institute of Cardiovascular Sciences at St. Boniface Hospital, found that consuming ground flaxseed can dramatically reduce blood pressure, having the same positive effect as medication. Imagine something as simple as adding three tablespoons a day to home-cooked meals has the potential to reduce the number of heart attacks and stroke by as much as 50 percent.

Research like this, which was made possible by Heart and Stroke Foundation donors, gets me excited because I passionately believe prevention is our biggest defence against heart disease and stroke. I can’t stress this enough: we’re up against two of the leading killers of Canadians. We need to throw everything we’ve got at them.

That’s why we launched the Heart and Stroke Foundation blog. Here, you’ll find the latest innovations in heart and stroke research plus heart-healthy recipes, inspiring stories of change and survival, and simple, tangible ideas that will help you and your family feel better and live longer and stronger. Our aim is to stop heart disease and stroke in its tracks.

I hope you will join us on this journey and visit our blog regularly. We look forward to hearing from you and sharing your ideas.

Are you at risk? Find out by taking the free online Heart&Stroke Risk Assessment at https://ehealth.heartandstroke.ca/

David Sculthorpe is the CEO at the Heart and Stroke Foundation. www.heartandstroke.ca

Getting to the bottom of the opioid crisis

It starts by looking at prescribing practices

DRUG BUST
by Alan Cassels

More than a decade ago, UBC’s Therapeutics Initiative (TI) published a very alarming newsletter. It made virtually no waves at the time, but it struck me as a dire prediction of the state of prescribing in British Columbia.

The newsletter simply asked two questions about benzodiazepine use in BC. This class of drugs include products like Ativan and Valium ­– or generic drugs that end in ‘pam’ – and zopiclone and are typically prescribed for anxiety and insomnia. The TI asked how many people in BC were using benzos and of those, how many were using them contrary to recommendations?

As prescription drugs go, benzos are widely, widely used even though they are recommended only for “short-term” use, typically less than 14 days. The benzos are not supposed to be taken over the long term because they are considered highly “habit forming,” the euphemistic way of saying they can be addictive. Once you take them for too long, stopping can be hell and those who try to quit abruptly will face withdrawal symptoms so bad they’ll just go back on the drug.

Over time, benzodiazepines lose their effectiveness, yet there is good evidence that when a patient becomes tolerant, the doctor may just increase the dose. Long-term use of the drugs can cause learning, memory and attention problems and their use is linked to falls, injuries, hip fractures and other types of accidents. The other important thing is that the benzos are frequently found on the street and up to 80% of street drug users are also taking benzos.

The TI’s analysis found that nearly 10% of the BC population – about 400,000 people at the time – used benzos (based on 2002 data) and of those, 170,000 people received amounts “incompatible with short-term or intermittent use.” In other words, almost 5% of the BC population were essentially at risk of being physically dependent on a drug they got from a prescription pad.

The current opioid crisis seems a modern version of the same phenomenon replaying itself, but this time the stakes are much, much higher. Even though we have some of the best monitoring systems in the country – e.g. BC PharmaNet, a computerized, province-wide drug data system – it doesn’t stop dangerously poor prescribing and poor monitoring by those whose job it is to protect patients: the BC College of Physicians and Surgeons.

Searching for insight into BC’s current opioid crisis, I came across a 2015 report titled “Together We Can Do This,” written by a panel of 73 experts in addiction medicine and pharmaceutical policy in BC. It helpfully maps out why BC broke all records in overdose deaths last year (914) and why, unless there is drastic action to improve prescribing, people in this province will continue to die from overdoses in massive rates. These experts lay out a series of strategies to address BC’s opioid addiction, an urgent cause given we’ve got among the highest overdose-related death rates in the world.

The report noted BC “dispenses more than double the amount of opioids compared to Quebec, the lowest opioid dispensing province. Additionally, from 2005 to 2011, the rate of dispensing strong opioids in BC increased by almost 50% overall, including a 135% increase in oxycodone dispensation.”

Now, with thousands of addicts in BC and daily reports of new deaths, there is a lot of pre-election interest on the part of the reigning BC Liberals, as money is doled out for safe injection sites, naloxone kits – the drug to revive a person who is overdosing – and increasing the training of emergency personnel. BC’s provincial health officer is talking about “clean heroin” and giving addicts provincially subsidized opioids, yet all this energy trying to clean up the damage misses the point that it was mostly created in the first place by poor prescribing and poor drug policies.

That’s the view of this expert panel, which concluded, “Despite the scale of the present public health problem, strategies to meaningfully address unsafe prescribing have not been implemented.” They add that many people who are addicted to heroin or other intravenous drugs started out with pharmaceutical opioids and “ultimately, prescribers are largely responsible for the burgeoning illicit market in pharmaceutical opioids that has developed on the streets of BC.” And here’s the kicker: “The entry of organized crime groups into the manufacturing of counterfeit pharmaceutical opioids, which often contain fentanyl, to fuel the street market for illicit or diverted opioids is arguably a direct result of long-standing, unsafe physician prescribing practices.”

Added all together, the crisis is a political and medical boondoggle. Like the dangerous abundance of benzodiazepine use in BC the TI documented a decade ago, we are seeing the same sort of lax approach to prescribing around the opioids. The headlines may focus on the illicit fentanyl-spiked drugs killing citizens at astonishing rates, but the real story is in the high rate of opioid abuse and addiction happening in the wider BC population. In the wider pool of opioid addicts are our friends and neighbours who have thousands of prescription pills, including Dilaudid, Oxycontin, morphine, T-3s and many other opioid pills, sitting in their medicine cabinets, leaving them and other family members who might want to experiment open to abuse.

In my small circle of friends, I know of at least two men who had hip surgery last year and both were discharged with scripts of 100 pills of Oxycontin, enough to turn both of those men into addicts. I know teenagers who were given Oxycontin following wisdom teeth extraction. And another friend, a very successful professional, came within inches of being addicted to the painkillers he was prescribed for a lower back problem.

What can we do if those prescribing the opioids simply don’t know the potential harm they could be causing? It has been well documented that our physicians’ dependence on weapons-grade opioids has been shaped by the drug industry. In the mid-1990s, Purdue Pharma, the makers of Oxycontin, spent millions underwriting Canada’s pain guidelines, paying “key opinion leaders” in the physician community to downplay the dangers of opioids and infiltrating medical school textbooks and medical schools, teaching our young doctors about managing pain. Opioids are very effective for pain, but for many people, there are many cheaper, safer, simpler and far less addictive medicines that can effectively treat pain instead of the expensive patented opioids pushed by their makers.

To my mind, the biggest scandal is that physicians continue to allow themselves to listen to pharmaceutical industry messages and to be educated by the drug salesmen and tainted experts. Many doctors won’t be schmoozed by drug reps, but others don’t see a problem. Hence, this is not the last prescribing disaster we will have to deal with.

I wish I could say the BC Liberals are doing all the right things, carefully monitoring prescribing and using their considerable clout through PharmaCare to stop this carnage. But they’re not. Beholden to pharma’s donations, they act as if powerless to stop the flow of prescribed opioids. We used to have programs in place that monitored prescribing, but there has been no political will to restart them. BC PharmaCare no longer takes advice from the Therapeutics Initiative and we’ve seen the slow death of drug safety evaluations in BC since the 2012 Ministry of Health firing scandal.

The BC College of Physicians and Surgeons will pretend to be tough with new guidelines and try to crack the whip on flagrantly bad opioid prescribing, but it may just drive even more people to the street to find the pain relievers they’ve become addicted to.

We’ve got many reasons to vote in a new government in May. Our spectacular rate of overdose deaths continues to climb. It is a national shame that deserves local blame. Christy Clark’s government’s addiction to donor dollars continues to make us a laughingstock of the world and the only ones not laughing are the dead, the dying and the addicted.

Alan Cassels is an author and drug policy researcher in Victoria.

Earth-friendly diets

photo of Vesanto Melina

NUTRISPEAK
by Vesanto Melina

Some people are saying, “Take extinction off your plate.” What? I already take shorter showers. Every week, I deposit my recycling into the right bins. I walk whenever I can. I ride my bike a lot, when it’s not so icy I’ll kill myself. I car-share. Isn’t that enough?It seems not. Agriculture is one of the largest contributors to greenhouse gas emissions – greater than all transport put together – and our current dietary choices are propelling us toward extinction.

Rearing livestock for animal products requires far more land, water and energy than producing plant foods. Producing a kilo of beef generates 27 kilo of CO2, compared to 0.9 kg per kilo of lentils. That’s 30 times as much! While new technologies for animal farming are available, a recent study found they only reduced greenhouse gas emissions by 9%.

One kilo of beef delivers 194 grams protein; one kilo of lentils: 246 grams protein. According to a 2016 Oxford study, adopting vegan diets globally would cut food-related emissions by 70%. That’s an excellent reason to order falafels or curried chickpeas rather than a burger or fried chicken. But how can you make lentils taste even remotely as good? One can start by picking up a veg. cookbook or doing a web search for “vegan lentil recipe.” You’ll find 825,000 tasty results within 0.51 seconds.

The Scientific Committee of the Dietary Guidelines – a conservative group – now provides evidence that diets with more plant foods and less animal products are linked with less environmental damage. Many scientists are calling for a great reduction in livestock production to reverse climate change and to use less water, fossil fuels, pesticides and fertilizers.

The Academy of Nutrition and Dietetics makes the point that, compared with producing 1 kilo of beef protein, 1 kg protein from kidney beans requires 18 times less land, 10 times less water, 9 times less fuel, 12 times less fertilizer, and 10 times fewer pesticides. Beef production generates considerably more manure waste than other animal or fish farming, but they are all strong polluters. Pig farming creates immense toxic manure ponds. The Environmental Protection Agency states that about 70% of all water pollution in rivers and lakes in the US results from animal farm waste.

The 620 million chickens slaughtered every year in Canada – plus 9 billion each year in the US – create a lot of chicken shit before they die. And that’s not counting the waste that comes out when they travel down the conveyer belt as their throats are slit and tumble into what workers call fecal soup. No wonder chickens are linked with salmonella food poisoning.

The use of antibiotics as growth promoters and to prevent and treat farm animal diseases generates antibiotic-resistant bacteria. Antibiotic resistance passes to humans, causing difficult-to-treat illnesses, resulting in greater morbidity, mortality and health care costs.

Does this situation strike you as crazy? By relying on meat and other animal products, we make ourselves obese; raise our risk of cardiovascular disease, type 2 diabetes, hypertension and cancers; and then destroy our planet. Want to really make a change?

Vesanto Melina is a Vancouver dietitian (www.nutrispeak.com) and a member of Meatless Meetup.

EVENT: February 24, 7:15 PM: A showing of the documentary Cowspiracy should make for an interesting discussion afterwards. Register at www.meetup.com/MeatlessMeetup/events/236729787/

Optimal winter health

Winter’s short days can make us feel lethargic and a little depressed; the long hours spent indoors hibernating on the couch can have a major impact on our overall wellbeing. To avoid the effects of old man winter, fight your hibernating instincts by embracing the season, while taking the necessary precautions to be healthy. To help you get there, the Canadian Health Food Association (CHFA) has these five tips for natural winter wellness.

Opt for healthy comfort food

In winter, we crave simple carbs because they are rich in tryptophan, causing our feel-good hormones such as serotonin and dopamine to temporarily increase. These foods, which are typically refined and have little nutritional value, cause a quick increase in our blood sugar followed by a quick decrease causing us to crave more. To avoid this vicious cycle while satisfying your cravings, opt for more complex carbs including oatmeal, legumes, soups and stews.

Shake it up and sleep it off

When it comes to exercise, don’t let winter be an excuse. Develop a well-rounded fitness routine that includes cardio and strength training. Also, give yourself plenty of rest time. Restful slumber helps fight depression and eliminates extra amounts of the stress hormone cortisol. Adequate amounts of exercise and sleep should be non-negotiable in maintaining a healthy lifestyle this winter.

Dose up on vitamins and minerals

Iron, zinc and vitamin C are key to a healthy immune system that will ward off cold and flu viruses. Foods rich in these nutrients include dark, leafy greens, red and yellow fruits and vegetables, lean red meats and pumpkin seeds. Taking a daily multivitamin is a great insurance policy to ensure you are getting your required daily intake of essential minerals and vitamins.

Go for garlic

The sulfur-containing compounds in garlic help increase the potency of two important cells of the immune system: T-lymphocytes and macrophages. These are essential to help battle the flu and colds. Opt for odourless capsules if you want to avoid the strong taste of garlic.

Use coconut oil

As the temperature continues to drop, you have probably noticed the negative effects on your skin as it becomes dry, flaky and itchy. Walking down the aisles of the store, it’s quickly apparent that the choices of lotions and potions to stop dry skin are endless, but which product should you choose? There’s one superfood solution that is inexpensive, works wonders, and will perhaps make you think you’re on a tropical island: coconut oil is the perfect product to help ward off the attacks of Canada’s harsh winters. “Coconut oil has increasingly gained popularity in Canada, and for good reasons. Its multiple uses are impressive, but most importantly, it is a truly remarkable skincare product,” says Helen Long, president of the Canadian Health Food Association (CHFA). “It is a known fact that winter can wreak havoc on the skin. Adding coconut oil to your skincare routine is a particularly good way of protecting yourself against the damages of bitterly cold winds and dry indoor conditions.”

Coconut oil is rich in medium-chain fatty acids, which allows it to retain the moisture content of the skin while helping it to look and feel silky smooth. It also has high quantities of vitamin E, an essential nutrient for healthy skin growth, repair and the prevention of premature aging. Coconut oil is also rich in many proteins that contribute to cellular health and tissue repair. CHFA recommends that you winter-proof your skin with coconut oil by using it in the following ways:

Moisturizer: simply rub a small amount of coconut oil wherever you have dry or cracked skin. Your skin will absorb the oil quickly, plus it smells wonderful.

Exfoliant: making your own natural exfoliant by mixing coconut oil with natural exfoliating substances like sea salt or sugar is a great way to remove dead cells that accumulate on your skin throughout the winter.

Lip balm: applying chemical products on your lips is a sure way to ingest potentially harmful substances. Substitute your chemical lip balm for coconut oil and keep your lips moist and protected throughout the winter.

Source: Canadian Health Food Association The Canadian Health Food Association is Canada’s largest trade association dedicated to natural health and organic products. Its members include manufacturers, retailers, wholesalers, distributors and importers of natural and organic products. www.chfa.ca

photo © Teresa Kasprzycka

Housing crisis a public health emergency

houses behind bars

Some physicians have gone so far as to label homelessness a palliative diagnosis. Not having a home can be lethal. Homelessness causes premature death, poor health and is a significant burden on our health care system.

by Tim Richter and Ryan Meili

One of the biggest factors that determine whether people will stay healthy or wind up needing emergency or chronic medical care is where they live. People without access to stable housing are at higher risk of illness, and their likelihood of recovering well from that illness is greatly diminished.

How bad is Canada’s housing crisis? According to the newly released National Shelter Study, Canada’s emergency shelters are packed to the rafters. People are languishing in homelessness longer, and their ranks increasingly include seniors, veterans and families with children. Shamefully, Indigenous Canadians are over 10 times more likely than non-Indigenous people to end up in emergency shelter.

This report paints only a partial picture of homelessness in Canada, including only emergency shelters. The sad reality is that over 35,000 Canadians are homeless on a given night with more than 235,000 Canadians experiencing homelessness at some point every year, whether they sleep in shelters, on the street, couch surf, wait unnecessarily in hospital or other temporary accommodation.

Beyond a crisis of housing and poverty, homelessness is a public health emergency. The longer people are homeless, the worse their health becomes. A recent report from British Columbia suggests life expectancy for people experiencing homelessness in that province is half that of other British Columbians.

Some physicians have gone so far as to label homelessness a palliative diagnosis. Not having a home can be lethal. Homelessness causes premature death, poor health and is a significant burden on our health care system.

Today, more than 1.5 million Canadian households live in core housing need, with over half of those households living in extreme core housing need (living in poverty and spending over 50 percent of their income on housing).

The crisis stands to get worse before it gets better as federal operating agreements for older social housing expire and over 300,000 more households risk losing the subsidies that keep their housing affordable.

In the last 20 years, as Canada’s population has grown, federal funding for affordable housing has dropped more than 46 percent. This has meant at least 100,000 units of affordable housing were not built. Canada’s homelessness crisis is the direct result of this federal withdrawal from housing investment. The new federal government has promised a National Housing Strategy, and has begun consultations.

The most pressing problem – finding stable housing for those who are currently homeless or at risk for homelessness – is one that, fortunately, can be solved. We need to start by collecting real-time, person-specific data on homelessness and expanding the application of the Housing First model of supportive housing for individuals with greater challenges. Housing First (www.homelesshub.ca) is an evidence-based approach to ending homelessness that provides direct access to permanent housing and support.

Tim Richter is the president and CEO of the Canadian Alliance to End Homelessness (www.caeh.ca), a national movement of individuals, organizations and communities working together to end homelessness in Canada. Ryan Meili is a Family Physician in Saskatoon, an expert advisor with Evidence Network and founder of Upstream.

Billions wasted on cholesterol myth

DRUG BUST
by Alan Cassels

The alleged benefits of lowering our cholesterol have never materialized and we have wasted tens of billions of dollars over the last two decades, deluded by a myth. It’s time to drop that myth.

Though it may appear to my readers that I have cried wolf far too often on cholesterol-lowering drugs, I’m prepared to howl at the moon at least one more time. If you’ve read my columns over the last decade, you’ve seen me rant about the futility and absolute waste involved in our society’s collective obsession with cholesterol and our foolishness in swallowing a paradigm promoted by the pharmaceutical industry and the specialists in their employ. The alleged benefits of lowering our cholesterol have never materialized and we have wasted tens of billions of dollars over the last two decades, deluded by a myth. It’s time to drop that myth.

Ever since the early 1990s when the first cholesterol lowering drugs were being introduced to the market, no one had really ever heard of “high cholesterol” and certainly no one was going to their doctor just to get something checked that they never knew existed, that they couldn’t feel and which was responsible for zero symptoms. Then along came the blockbuster statins and physicians followed guidelines that told them a patient’s cholesterol level was an important risk factor for death by coronary heart disease (CHD). The hypothesis said that if you measured and lowered the cholesterol of patients deemed “high risk,” those patients would live longer and avoid dying from heart attacks. So how’s that working out?

Not so well, according to a study published in March of this year that probably delivered some of the boldest evidence yet and which should absolutely trash our enthusiasm for lowering our cholesterol. A European research team led by Dr. Federico Vancheri of Italy looked at statin consumption across 12 countries in western Europe between the years 2000 and 2012. During that time, the use of statins increased dramatically all across Europe – as well as in North America – yet his team wanted to know how this increase was reflected in the numbers of people who died of heart attacks. After all, with statins being used by tens of millions of patients, how many fewer heart attack deaths were there?

Here’s the good news: in all countries over that 12 year period, there was lower CHD mortality in 2012 compared to 2000; that is to say, fewer deaths by heart attack. The drop in those numbers is thought to be attributed to a range of things: healthier diets, more exercise, lower rates of smoking, better treatment once you had established heart disease, and so on.

However, things didn’t look so good when you looked at individual countries. The researchers found that “when the different countries were compared, there was no evidence that higher statin utilization was associated with lower CHD mortality, nor was there evidence that a high increase in statin utilization between 2000 and 2012 was related to a larger reduction in CHD mortality.” In other words, despite all the statin prescribing, it had no effect on the one thing we expected to see: lower rates of heart attacks. This kind of research is not exactly new. There was an earlier Swedish study that showed the differences in a large sample of municipalities where the amount of statin prescribing had zero effect on the rate of heart attacks or CHD death.

Despite this kind of bad news for the statin manufacturers, the world is not exactly mourning the loss of a very costly – and now proven wastefully ineffective – pill. Just last month, many of us watched in horror as we witnessed a high-quality source of health information – the US Preventive Services Task Force (USPSTF) – come out with the astonishing recommendation that statins should be used by even more of us.

In their analysis, the USPSTF amassed a massive amount of data from over 70,000 patients from 19 different trials. They wrote that low-to-moderate-dose statins should be given to “adults aged 40 to 75 years without a history of cardiovascular disease (CVD), who have one or more CVD risk factors and a calculated 10-year CVD event risk of 10% or greater.” Practically speaking, this means tens of millions more Americans were offered statins.

Sounds good, right? Not so fast. Remember, the people they are recommending take statins are basically healthy, middle-aged people, folks with no established heart disease, 90% of whom will live perfectly happily without a heart attack or stroke over the next 10 years. These are NOT sick people perched on death’s doorstep.

So, what’s up? It always surprises me when an otherwise reputable and trustworthy source gives absurd advice, especially given all the statin scandals and shenanigans we’ve seen over the last two decades.

In case you don’t believe me, here are some key reasons we should ignore the advice to give more statins to more people, as the task force recommended. I must acknowledge Drs. Rita Redberg and Mitchell Katz who wrote a scintillating editorial on this USPSTF recommendation and whose arguments I am partially summarizing here.

The first thing to know is that the body of studies examined by the USPSTF is tainted, as it included many people taking statins for ‘secondary’ prevention – for example, people with established heart disease and hence considered at much higher risk. You cannot extrapolate how they fared on statins to healthier people without established heart disease.

The second thing is that the evidence they looked at didn’t contain the kind of detail we need. The USPSTF didn’t examine what we call primary data, which are the actual reports from the subjects in the statin trials. Without actual patient reports, we’re only getting the results of what someone has chosen to summarize for us. Sorry, that isn’t good enough. Also, if you only examined the published reports of statins, you are being naive because we know that most of the trials on statins were done by the manufacturers and they have a tendency to bury negative data. The result? An overly rosy picture of the effects of statins.

Thirdly, there was a major bit of missing information in those data, specifically what we call “all-cause mortality.” Only half of the trials they looked at reported how many patients died from cardiovascular causes, heart attacks and strokes. The problem with missing data is you are only getting half the picture so you end up concluding the drugs are safer than they actually are. You wouldn’t conclude how rich you are by only looking at your assets, would you? No, of course not. You need to know your liabilities and debts as well. Same with statins. Without both sides of the equation, you are at risk of being misled.

We need to remind ourselves of one key thing: people of ‘low risk’ may have very little chance of benefiting from a statin, but will have an equal chance of harm. In this group of healthy, low-risk people recommended to take statins, the benefit/harm math shifts and they are more likely to be hurt than helped.

Overall, the danger of recommendations like these is that more people will be convinced they are at high risk when they aren’t and take a drug that is unlikely to help because it is only proven to help those with established heart disease. We have known for a long time that statins can cause muscle aches, weakness, fatigue, cognitive dysfunction and an increased risk of diabetes. Why would you want to take your chances?

Maybe all the statin denialism is just part of the post-truth world and people tend to believe what they want to believe despite the overwhelming evidence in the other direction. Are you a ‘low-risk’ person who still wants to take a statin? Then you should have to pay for your denialism.

Statins are currently the fourth most costly drug to BC’s Pharmacare budget, and with over 400,000 British Columbians consuming statins every day, costing taxpayers and patients about $100 million per year, couldn’t we just admit the experiment is over, it was a failure and it’s time to move on?

Alan Cassels is a drug policy researcher and writer. In each of his past four books, the latest which is called The Cochrane Collaboration: Medicine’s Best Kept Secret, he has written about statins. Follow him on twitter @AkeCassels www.alancassels.com