Immoral or Merciful? Canadian Doctors Divided on Medically Assisted Death — Longreads

Some doctors are struggling with allowing Canadians to die on their own terms.

via Immoral or Merciful? Canadian Doctors Divided on Medically Assisted Death — Longreads

Here I share a powerful article by Krista Stevens.

Scottish Crucible. Round 2.

Round 2. Ding Ding.

The 2017 Scottish Crucible’s second lab was graciously hosted by Stirling University on June 1-2 and it rocked the campus. Literally. There was a blue man. A dinosaur. Drawing. Dancing. Sumptuous vistas. Oh yeah, there was a pretty nice castle too!

It began with this view.

Lab 2 was hosted by the irrepressible and commanding Sara Shinton. Honestly, sometimes the participants needed direction as they learnt the ins and outs of ‘brainstorming.’

(Or, as some of us called it: ‘thought-showering.’) No surprise, the phrase didn’t stick.

The thrust of Lab 2 was collaboration. We were enveloped in a cozy bubble, as Sara rightly put it.

How to work together! How to build lasting research partnerships to influence positive change! How to cut across fields and disciplines! The guest speakers were insipiring.

Being a drug historian, I have some thoughts about the tweet below but I’ll keep them to myself.

Chalk this up to aggressive dancing!

Day 2 included further in-depth training on how to develop and drive collaboration.

To start off with, we needed to draw out our research. No easy task.

However, there were other appearances.

For instance, a creepily self-satisfied Dragon…

An introspective blue dude…

DEFRA

But. But. But.

In my estimation, the most exhausting and rewarding of the weekend was…speed collaboration. Think speed dating, on steroids. (I am a drug historian).

The experience was supremely enjoyable. Also: Tiring. Amazing. Harrowing. Enriching. All of these. At the same time.

Minds were spinning.

Ding Ding. Bring on Round 3.

See the previous post on the Lab 1 here.

Or visit the Scottish Crucible here.

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Donald Trump’s FDA and the ‘United States of Oxy’

How will the pharmaceutical industry be impacted under the Trump administration? Who’s the new FDA Commissioner? How will e-cigarettes be effected? How will the opioid crisis be impacted?

Trump’s FDA and “the United States of Oxy”

By Lucas Richert

The US Food and Drug Administration (FDA) may be headed for a major overhaul under the Trump presidency and the agency’s new head, Scott Gottlieb. At a recent meeting with pharmaceutical industry leaders, President Trump asserted that “we’re going to be cutting regulations at a level that nobody’s ever seen before.” His most recent statements, made at a White House confab, echoed loudly throughout the medical and pharmaceutical industries.

Just talk? It’s tough to say, yet supporters of pharmaceutical deregulation have long wanted to reduce bureaucracy and lessen oversight of drugs and devices. Critics, by contrast, contend the drugs market could be destabilized and public health undermined. The tricky task will be to strike the proper balance of speed and safety, as well product innovation and consumer protections.

An American drugstore, circa 1963. Courtesy of Library of Congress.

Scott Gottlieb, a physician and regulator recently approved to lead the agency by the US Senate in a 57-42 vote, pledged he would lower prices, reduce approval times, and fight the widespread abuse of opioid painkillers. This kind of addiction, said Gottlieb, was “a public health crisis of staggering human and economic proportion.”

This rhetoric and attempted reforms at FDA are not new, but the devastating painkiller crisis certainly is.

Opioids

Gottlieb’s critics noted that he was too closely tied with the pharmaceutical industry to tackle the opioid epidemic. “We are suffering this public health epidemic because big pharma pushed pills they knew were dangerous and addictive, the FDA approved them, Senator Ed Markey (D-Mass) told reporters. The United States had been turned into the “United States of Oxy,” Markey added.

The FDA approved OxyContin, a powerful opioid to treat severe pain, such as in the case of patients with terminal cancer. With mild pain, though, the FDA deemed the dangers of addiction too great, and has not allowed the marketing of Oxy for such pain.

Not able to solve the opioid alone, the FDA nonetheless will play an important role. He has made this case quite forcefully. However, Gottlieb’s critics (mainly Democrats) have pointed to his past views on the regulation of opioids. In particular, he has suggested that policies restricting pharmacies and drug distributors might burden innocent patients.

This will be one of the defining issues of his career.

E-cigs

The Food and Drug Administration’s move in May, 2016 to crack down on e-cigarettes brought regulation in line with existing rules for cigarettes, smokeless tobacco and roll-your-own tobacco. This had been highly anticipated after the FDA issued a proposed rule over two years ago.

“Millions of kids are being introduced to nicotine every year, a new generation hooked on a highly addictive chemical,” U.S. Secretary of Health and Human Services Sylvia Burwell stated during the announcement of the new rules. She asserted, too, that health officials still didn’t have the scientific evidence showing e-cigarettes can help smokers quit, as the industry asserts, and avoid the known ills of tobacco.

The Trump administration recently approved a delay in the FDA’s e-cigs guidelines. It was a decision that divided officials in the public health establishment. And it’s undoubtedly true that several Trump administration officials, including FDA chief Gottlieb, have connections to the e-cig and tobacco industry.

From March 2015 to May 2016, according to Bloomberg, Gottlieb was a director of Kure Corp., a Charlotte, North Carolina-based firm that distributes e-juices and vaping pens in coffeehouse-style lounges known as vaporiums. Of course, he had a financial interest in the company as of March, according to financial and ethics disclosures, and promised to sell his stake if confirmed as head of the FDA.

“How to regulate e-cigarettes is one of the most critical questions on tobacco regulation that the FDA is going to be facing in the coming years,’’ said Vince Willmore, a spokesman for Washington-based Campaign for Tobacco-Free Kids.

Vaping will also be a significant issue for Gottlieb and the FDA. Getting the regulation right matters – not just in the U.S., but places like Glasgow and Vancouver.

FOR MORE ON E-CIGARETTES:

Why aren’t we regulating e-cigarettes?

Do We Regulate E-Cigs, Ban Them, or What?

Red Tape

The writer Matthew Herper suggested recently how “talk of speeding up [drug] approvals for serious diseases first gained traction in the early 2000s.” Actually, the trend extends much further back. Debate about quickening drug approvals has a complex and compelling history.

The FDA under President Ronald Reagan, for instance, offers a useful tool to evaluate the Trump administration’s approach to the FDA and the drug industry.

In mid-January, as Mr. Trump awaited his inauguration and the transition team worked furiously to establish his cabinet and select suitable agency nominees, the FDA generated serious debate. Trump met with Jim O’Neill, a venture capitalist, and a close friend of PayPal’s Peter Thiel. He met with Balaji Srinivasan, a cofounder of genetics testing firm Counsyl.

Both men subscribed to the idea – now conservative doctrine, according to Forbes – that the FDA prevented a flood of new drugs from hitting the market. Neither held an M.D., which has been for years a prerequisite for the FDA’s top job. Yet, by 20 January the frontrunner for the Commissioner’s job was Gottlieb, who had made it known publicly he believed the FDA should trim bureaucratic red tape and approve drugs in a speedier fashion.

Trump ultimately settled on Gottlieb, whose selection was welcomed by the pharmaceuticals sector. His ties to industry were questioned by Democrats, but the vote wasn’t close.

The Gipper’s FDA

Ronald Reagan, whether as a candidate or later President of the United States, did not desire the dismantling of the FDA, but neither did he trust it. In his optimistic view, its authority, like that of many other regulatory agencies, simply needed curtailing.

In 1975, he told an audience at the American Enterprise Institute, a conservative think tank, that the FDA was hurting Americans, yet also made clear he did not wish to totally “eliminate the responsibility of the FDA…”

The problem, as Reagan saw it, rested in the restriction of freedom of choice for American consumers, since the agency had established itself “as the doctor and decided that they will tell us what medicines are effective.”  He felt that a degree of regulation was necessary to protect Americans from each other, but the FDA had overreached and, as bureaucracies do, went beyond “protecting us from poisonous or harmful substances…”

In 1980, the Republican presidential ticket of Ronald Reagan and George Bush promised to change Washington. President Jimmy Carter represented failure, Republicans argued, be it botched rescue attempts and helicopter crashes in the desert, the loss of the Panama Canal, or an impotent economy. The jaunty and upbeat Reagan succeeded in shifting the policy discourse about the size and scope of federal government programs; harkening back to halcyon days, he moved the conversation about which government program to launch (or expand) to how much of a program’s or agency’s budget ought to be cut.

In 1981, the debate about drug regulation continued to polarize people; finding a middle ground was often difficult, and as the new administration took power, the outgoing FDA Commissioner Goyan articulated a consensus-oriented, centrist approach to drug regulation. Think tanks such as the Heritage Foundation and American Enterprise Institute promulgated changes to the FDA’s mission as a means of unleashing the once-mighty American pharmaceutical industry. This would fuel the U.S. industry and the greater economy.

For some, the FDA transcended presidential politics and ideology.  It protected all Americans – conservative and liberal – as it carried out its duties. “My view,” said the bearded, grey, and somewhat feisty Jere Goyan, “is that government regulation needs to strike a balance between preserving the maximum freedom for individuals while at the same time establishing the rules that are needed for us to live together, to survive as a society.”

Jere Goyan and President Jimmy Carter. Courtesy of Library of Congress.

By voting for Reagan, Americans indicated they wanted “modifications” to the current models – reform rather than removal. “It would be a mistake,” Goyan argued, “a tragic one, to interpret the election results to mean that the public wants a lessening of the standards that provide the foundation for the food and drug industries in this country, standards that make our food and drug supply the best in the world.”

Often, his approach went unheeded, overwhelmed by disputes about individualism and consumer choice and bureaucratic incompetence. One the one hand, many Americans regarded FDA staff members “as a bunch of demented bureaucrats running amok,” even though the agency’s “balanced” regulation of drugs was both “socially valid and moral.”

On the other hand, the president of the Pharmaceutical Manufacturers Association illustrated an alternative. Lewis Engman felt that taking medicines, like smoking cigarettes, was a matter of personal choice. “Any time you interfere with the basic market system,” he said in 1981, “you’re in trouble…the consumer is his own best guardian.”

Impossible as it was to know how the new president would transform the FDA in early 1981, political pundits, economic analysts and pharmaceutical industry insiders suggested that Reagan meant less regulation, which meant industry growth. The President of the National Association of Retail Druggists (NARD), Jesse M. Pike, sent a congratulatory letter to Reagan. It emphasized how delighted NARD was to see him in the White House and just how his regulatory reform beliefs would be good for business. In Pharmaceutical TechnologyJames Dickinson wrote, “everyone expects life to be easier for industry under the new Reagan Administration.”

Apparently, the Washington cocktail circuit was rife with speculation about the new administration repealing the Kefauver-Harris 1962 drug efficacy requirements – a move that would further enhance prospects for industry growth. This was nonsense, according to knowledgeable policymakers and reporters. Still, the fact that the notion was even bandied about, however fancifully, represented a substantial change in the debate about drug regulation.

Reagan promoting Chesterfield, circa 1952

The press envisaged a pharmaceutical industry boom in the near future. Newspapers reported how “The Drug Business Sees a Golden Era Ahead” and that pharmaceutical associations were positively giddy. Rep. James Scheuer (D-NY) publicly denounced the agency’s over-cautiousness and emphasized the need for immediate reform. It was risk averse, to the detriment of sick Americans. Moxalactum, he argued, was an American-made antibiotic for pneumonia used by Marshal Tito in Yugoslavia – yet it was not available in the United States. The narrative Scheuer framed was that the FDA was protecting Americans to death – and this before the onset of the HIV/AIDS crisis.

Mounting enthusiasm about pharmaceutical growth in the wake of the Reagan election was palpable. Reports indicated that the pharmaceutical industry and investors were confident about the future – a golden era – in this new regulatory climate. There was bullishness about drug stocks in general, and many predictions that pharmaceutical companies would start to generate more and more earning in 1981 and 1982. Overall, these stories proved to be accurate.

Ronald Reagan, however, had pledged in 1980, with trademark sincerity, not to gut the FDA. Rather, he made oblique references to the agency’s storied history and resorted to prosaic comments about the danger of hidebound power-hungry bureaucracies. “There’s a certain amount of regulation that is always necessary to protect us from each other,” he told CBS’s Walter Cronkite. “And that I recognize. We don’t want to, for example, eliminate the responsibility of the FDA…”

Much can be gleaned from Reagan’s public statements about the Food and Drug Administration, but they fail to reveal the entire picture. On May 20, 1986, Reagan described a meeting between Paul Laxalt, Jack Dreyfus, and himself. Dreyfus, who had “spent $50 mil. of his own money” was attempting to have the epilepsy drug Dilantin approved and found a roadblock in the form of the FDA. According to Reagan’s personal diary: “The villain in the case is the Fed. Drug Admin & they are a villain.”

 Red Herrings and Empowered Patients

Under the Trump administration, will the FDA play the villain role? President Trump will build on earlier Republican efforts to streamline the agency, whether these took place during Reagan or Bush presidencies. He has promised to remove barriers for overseas drugs and support ‘Right to Try’ laws, which will attempt to provide access to unapproved drugs. Indeed, some of these measures may help patients. And the Trump administration will be the right track if it can safely accelerate drug approvals, promote production and use of generics, and lower drug prices through increased competition.

Gottlieb and others have suggested they would radically restructure the drug approval process –  even if that remains something of a red herring argument. QuintilesIMS Institute, among various other organizations, have determined that the total time between patent and approval has dropped 31% since 2008. Yale researchers hold that the FDA is already considerably faster than Europe and Canada when it comes to approving drugs.

Another area of regulation that ought to be monitored closely is advertising. Every other nation besides the US and New Zealand has concluded that advertising powerful drugs for treating complex illnesses makes no sense when your target market lacks the qualifications to fully grasp the risks. How will powerful painkillers be regulated in the years ahead.

The drug industry wants to empower patients, to invest them in the writing of prescriptions. Looking ahead, it will be important to watch the administration’s and FDA’s role in faciliating this.

FOR MORE ON PATIENT ACTIVISM

Quarrelsome cannabis in the UK

Trimming Down: The Debate over Weight Loss Drugs and the Push for a Leaner FDA, 1979-2001

“The [industry] idea is that consumers are central players in their health management and therefore have a right to be informed of different drugs,” Lewis Grossman, a specialist in food and drug law, told the Los Angeles Times.

Yet, the practice of medicine should not be placed in the hands of amateurs and junk scientists. In the post-truth era, however, when an opioid epidemic soars and drug prices are hitting Americans in the pocketbooks, these “facts” could be lost in the noise.

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Thanks for reading. For more, please follow the blog.

Lucas Richert is a Lecturer in History at the University of Strathclyde (Glasgow, UK). He is the author of Conservatism, Consumer Choice, and the Food and Drug Administration during the Reagan Era. He’s currently at work on a second book, tentatively called Strange Medicines: Drugs, Science, and Big Pharma in Culture.

LSD: Insight or Insanity?, 1968

From the NIH. A post by Professor Erika Dyck on the history of LSD.

Circulating Now from NLM

Circulating Now welcomes guest blogger Erika Dyck, PhD, Professor and Canada Research Chair in the History of Medicine at the University of Saskatchewan. Today, Dr. Dyck shares some insights on a recently digitized film in the Library’s collection highlighted in our Medical Movies on the Web project.

For Rebels, it’s a Kick…

It’s the late 1960s. Teenagers, a hip voice clues us in, are always looking for kicks, and today’s teens express themselves with cool fashions, groovy hairstyles, and kooky pranks. Not so long ago, our narrator played the character of “Plato,” a troubled teenager, in the 1955 classic Rebel Without a Cause. In that film, Plato idolizes the reckless machismo of young Jim Stark (played by James Dean). In an epic display of bravado, Jim and another boy play a game of “chickie run” in which they drive their cars in parallel directly toward a cliff. Jim leaps…

View original post 623 more words

Mad To Be Normal

Mad To Be Normal at the glorious Glasgow Film Theatre. The film stars David Tennant in the lead role and is directed by Robert Mullan.

I was lucky to sit on a panel afterward to offer some historical gems. It was a great conversation with Matthew Smith, Luke Fowler, Richard Warden, and the other attendees…

…oh yeah, and the film was really strong. Here’s a review in the Guardian.

 

 

Cannabis ‘Policy Brief’ Announcement

It’s my pleasure to promote the publication of an important Policy Brief on Cannabis by Kathleen Thompson. Over the past few years she has helped drive conversations about the consumption and control of marijuana. Her recent Policy Brief ought to be read by anyone and everyone! Here’s an extract.

LEGALIZATION OF CANNABIS: THE POLICY CHALLENGES AND OPPORTUNITIES

By Kathleen Thompson, PhD, MSW, RSW, BA (Hons)

“The commitment by the Government of Canada to legalize cannabis
and cannabis products presents a complex range of socio-economic
challenges and opportunities. Creating the right legal and regulatory
framework to address the implications, both good and bad, will be
key in determining whether legalization is deemed successful public
policy.
The federal government plans to introduce cannabis legislation in the
coming spring session of Parliament. The legislation will be based on
the recommendations contained in a report issued on November 30 by
a Task Force of experts who studied the issue for the past year. The Task
Force received input from more than 30,000 Canadians, organizations
and professionals. Entitled “A Framework for the Legalization and
Regulation of Cannabis in Canada”, the report recommends allowing
more flexibility in the current federally controlled cannabis cultivation
model. Specifically, the federal government would regulate a safe and
responsible supply chain of cannabis.”

The full document, which has been sent to law enforcement and government officials across Canada, can be read on the Johnson-Shoyama website or downloaded here thompson-policy

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Large Indoor Marijuana Commercial Growing Operation With Fans, Greenhouse, Equipment For Growing High Quality Herb. Cannabis Field Growing For Legal Recreational Use in Washington State
Large Indoor Marijuana Commercial Growing Operation With Fans, Greenhouse, Equipment For Growing High Quality Herb. Cannabis Field Growing For Legal Recreational Use in Washington State

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ABOUT KATHLEEN THOMPSON

Dr. Thompson has worked in health policy analysis and research as a bureaucrat and as a consultant for the last 25 years, specializing in the mental health, disability and corrections sectors.

In 2015, Dr. Thompson created the Cannabis Regulatory Research Group. The focus of the policy research group is on promoting collaborative public policy processes and evidenced-based research with the cannabis industry, governments, academia, civil society and at the United Nations. Additionally, Dr. Thompson consults with individuals and organizations on how to enter the legal cannabis industry.

 

 

Canada’s healthy-eating guide fights to stay relevant

Tis the season. Turkey. Stuffing. Mince meat tarts and more. Many of us worry about that extra helping during the holiday season. And so I was interested to read this on Canada’s story on the BBC site today!

I was especially pleased to hear Dr Ian Mosby’s thoughts! He visited the University of Saskatchewan before I left in August 2016 and he was extremely informative and generous with his time – for both faculty and grad students alike.

* Food History *  (Robin Levinson-King)

Since World War Two, the Canadian government has been telling people what to put on their plate to stay healthy. But with obesity rates on the rise, is it time to start focusing on what to leave off?

Canada’s food guide first appeared in 1942 under the title Official Food Rules and was originally created to help Canadians stay strong and healthy despite meagre wartime rations.

_93073230_screenshot2016-12-20at5-43-47pm

The guide recommended drinking fruit juice, loading up on bread and eating plenty of liver.

Over the years, the publication has used many designs to illustrate the different food groups. In the US, the “food pyramid” became an instantly recognisable illustration of nutritional categories but Canada switched from a “food wheel” to a “food rainbow”.

The Canadian government used to be concerned about people getting enough food, now it’s worried people are getting too much. In the new year, Health Canada will start drafting a new food guide aimed at getting people to eat less.

Despite the commitment to changes, food historian Ian Mosby says the guide may have simply outlived its usefulness.

“It was started as a way to prevent malnutrition. But it’s hard to see what it’s doing in an era where those are not the main health problems facing Canadians.”

When the Canadian government released its rules for healthy eating in 1942, it was marketed as a guide to “health-protective foods”. The rules laid out the bare minimum that a person should eat in order to stay nourished.

“Eat more if you can,” the rules advised.

Daily servings of Vitamin-C rich citrus fruit or tomatoes were advised, along with weekly servings of liver for iron.

Food was expensive in the 1940s and 1950s, and overeating was a luxury few experienced. According to a 1955 survey of household spending, the average family spent about 30% of their earnings each week on groceries, the bulk of which was spent on meat and dairy products.

But by the 1970s, rising incomes and the growing commercialisation of food had completely transformed how people eat, says Mosby.

Sugary cereals, trans fats and TV-dinners became a staple of many people’s diets.

As the price of packaged foods high in sugar and salt plummeted, overconsumption became a bigger problem. The government could no longer just tell people what they should eat, they had to tell people how much.

Consequently, the old black-and-white list of Official Food Rules got a Technicolor makeover and was transformed into Canada’s Food Guide, a consumer-friendly guide for making better food choices.

Critically, a warning to eat sugar, fats and salts in moderation was added in 1982.

Canada's Food Guide 2007Image copyrightHEALTH CANADA
Image captionCanada’s Food Guide 2007

But Canada’s overeating problem didn’t go away. Since 1985, the obesity rate has tripled. Canadians are spending less and less on food overall, but more on eating out and sugary beverages.

It’s possible, food historian Mosby says, to be both obese and malnourished.

The full story is here

And be sure to look at my other posts and articles on weight loss, diet pills, and health!

 

Here’s one vintage healthy-eating advert from my youth…

 

Beyond Vape Fear

Richard Roope, of the RCGP, has recently released a report on e-cigarettes.

images

Essentially, the Royal College of General Practitioners, the official channel for General Practice of Medicine in the UK, has given their informed recommendations to health professionals regarding smoking cessation and the use of e-cigarette.

The recommendations:

1. GPs provide advice on the relative risks of smoking and e-cigarette use, and provide effective referral routes into stop smoking services.

2. GPs engage actively with smokers who want to quit with the help of e-cigarettes.

3. Where a patient wants to quit smoking, and has not succeeded with other options, GPs should recommend and support the use of ENDS.

BEGIN DIGRESSION.

[GENEVA – Electronic nicotine delivery systems (ENDS), of which electronic cigarettes are the most common prototype, are devices that do not burn or use tobacco leaves but instead vaporise a solution the user then inhales. The main constituents of the solution, in addition to nicotine when nicotine is present, are propylene glycol, with or without glycerol and flavouring agents. ENDS solutions and emissions contain other chemicals, some of them considered to be toxicants.The World Health Organization (WHO) submitted a report on Electronic nicotine delivery systems to the sixth session of Conference of the Parties to the WHO Framework Convention on Tobacco Control (COP 6), which occured in Moscow, Russian Federation, from 13 to 18 October 2014.]

END DIGRESSION.

4. GPs recognise ENDS offer a wide reaching, low-cost intervention to reduce smoking (especially deprived groups in society and those with poor mental health, both having elevated rates of smoking).

5. All GPs encourage smokers who want to use e-cigarettes as an aid to quit smoking to seek the support of local stop smoking services.

Harm-reduction has come out on top. Vape Fear has lost this one.

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I have written my fair share about e-cigarettes in Canada, the United States, and Great Britain.

For example:

* ‘Why Aren’t we Regulating E-Cigarettes?,’ Regina Leader-Post [May 16, 2016]

* ‘Let’s Get Proactive with E-cigarettes,’ Saskatoon Star Phoenix [April 24, 2015].

* ‘Lot of Smoke and Mirrors with Vape Policy,’ Saskatoon Star Phoenix [November 28, 2014]

Often, I have suggested a measured response. My sense is, a little bit of regulation can go a long way. Minor rules can make a major difference. Don’t go overboard, but the waters are rough. Vaping should play by the rules, basically.

With my last op-ed back in May, people in Canada weren’t impressed with my approach. Folks were not interested in a middle-ground perspective. Here’s a list of the harshest responses to my articles on vaping. I’m basically the Red Skull mixed with Lex Luthor for suggesting some thoughtful rules might be in order.

1. “Please take the check that you earned from writing this trash and take an ethics course. Or a journalism degree.”

(Uh, I didn’t get paid. Woulda been nice.)

2. “It’s pretty obvious you don’t quite understand how the system works here in Canada…”

(Does anybody. There are no regulations? Ha.)

3. “You help tobacco companies profit from murder.”

(Jeez, really?! C’mon it’s my birthday.)

4. “…governments are making decisions based on MONEY, NOT PUBLIC HEALTH.”

(No comment.)

5. “What tobacco lobbyist wrote this trash?”

(I’m no tobacco lobbyist, but I sure do think they’re funny in the movies. Aaron Eckhart, anyone?)

Anyway, read the piece and decide for yourself. And share. http://leaderpost.com/opinion/columnists/why-arent-we-regulating-e-cigs

Gin, Beer, and Chicken: Hogarth’s Art and More

A new piece of art commissioned by the Royal Society for Public Health (RSPH) re-imagines William Hogarth’s classic 1751 cartoon Gin Lane. It depicts a society preoccupied by junk food rather than gin.

This is pretty amazing timing, considering this is the focus of my Disease and Society lecture this week!

_91991260_meginlane300dpia3
Reimagined Version by Thomas Moore

According to the BBC, the original showed the damaging effects of a gin craze sweeping London as well as a population suffering from deadly infections common at the time. Cholera. Syphilis. You name it. In contrast, Thomas Moore‘s new picture shows how obesity and mental health issues are today’s big health threats.

The updated version shows a mother salivating over yummy junk food, which she is also feeding her child. In contrast, Hogarth’s 18th century version focuses on a mum more interested in gin and snuff, who is suffering from syphilis sores.

Another stark difference is the prominent payday lender shop, replacing the pawnbrokers of 1751. (Just need a betting shop in there!) Moore’s modern version highlights the popularity of high street chicken shops today, while Hogarth’s work shows people almost skeletal with starvation.

gin-land
Gin Lane by William Hogarth

And…Beer Lane

hogarth

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FULL BREAKDOWN OF CHANGES

gin-lane-2016-annotated-jpg

The overall scene is the same street as presented in the original, but has been developed and modernized so that it is representative of a typical street scene in London, or indeed anywhere in the UK today.

  1. The central character has been reinvented. Where the original depicts a mother who is drunk and too pre-occupied with taking snuff to care for her baby, Gin Lane 2016 instead shows the mother preoccupied with eating junk food, which she has also fed to her child.
  2. A pawnbroker is one of the significant and thriving businesses in the original piece. In the modern version, this has been replaced by one of the payday lenders which have become a feature of many high streets, and are perhaps a 21st century equivalent. The desperation of one of the customers leaving the payday lender represents the mental ill health associated with debt.
  3. The chicken shop is a representative feature of the obesogenic environment which is at the heart of Gin Lane 2016 – busy, vibrant, and packed full of glum looking customers.
  4. The man contemplating throwing himself off the top of a building is a nod to the original in which a barber is seen hanging, having committed suicide because his customers could no longer afford to have their hair cut. Suicide is now the single biggest killer of men under 45 in the UK.
  5. The original arch has been converted into Gin Lane tube station, with commuters glued to their smart phones – a depiction of the busy, potentially lonely existence of many Londoners today.
  6. Junk food adverts provide another reflection of the ubiquitous power of marketing in our obesogenic environment.
  7. The distillery from the original piece has become a busy pub, replete with rowdy drunk customers.
  8. A news vendor hands out a paper with another headline about the threat posed by obesity.

Courtesy of https://www.rsph.org.uk/about-us/news/gin-lane-2016-iconic-artwork-reimagined-for-the-21st-century.html

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My lecture this Friday will definitely be connecting the past with the present…

GIN AND JUICE

 

Ultrarunning: Nature and Native Americans

Mo Farah, you wuss! It’s time to take it to the next level with ultrarunning. Here’s an excerpt from “Beer, candy fuelled ultrarunner’s record-breaking race,” by Lindsey Crouse.

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At a time when “endurance running” no longer means mere marathons – and even 160-kilometre races are attracting the masses – Karl Meltzer, a former ski-resort bartender, has proved he can suffer longer and faster than almost anyone else. When he staggered onto Springer Mountain in Georgia before dawn Sunday, Meltzer set a record for completing the Appalachian Trail. He covered the 3,524 km over 14 states in 45 days 22 hours 38 minutes.

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As commentator Lindsey Crouse put it, Meltzer, 48, is a little different from other titans of the newly booming ultrarunning scene. He is six years older than Scott Jurek, who was featured in the bestselling book about almost-barefoot endurance running, Born to Run – and who set the former Appalachian Trail record last year (46 days 8 hours 7 minutes).

In a sport checkered with mantras such as “clean living,” Jurek sustained his trek on a vegan diet. Staples of Meltzer’s diet, by contrast, included Red Bull and Tang. Jurek incurred a $500 (U.S.) fine and public outrage for opening Champagne at the summit of Mount Katahdin in Maine during his record run. When Meltzer finished on Sunday, he walked down the mountain, sat in a chair and sated himself with pepperoni pizza and a beer. It was the latest milestone in an unusual professional racing career.

Meltzer moved to Utah to ski in 1989 and started running the next year. He came to long-distance racing in his late 20s. Primarily a skier, he worked as a bartender at the Snowbird ski resort but took summers off to run. Now, based in Sandy, Utah, he became an ultrarunner in 1996 after completing a 160-km race nearby in just more than 28 hours. In a sport built on superlatives – faster, longer, more, more, more – his 160-km trail race portfolio is formidable: He has won 38 of them, more than anyone else in the world.

That’s intense.

***

What’s the story with Ultras? How it works.

According to the IAAF, ultra races are contested over two different types of race modalities, either over a set distance or a set time. Examples of the former would be 50km, 100km and longer events while illustrations of the latter would be something like 6hr, 24hr, and multi-day events. Both are gaining popularity with the masses and bring their own unique challenges to the racers.

Races are organised on a) trails where athletes get to enjoy the serene environment of a forest. b) track when athletes do not have to venture too far from their start/finish areas and are always within visible region. c) road where athletes can enjoy their road running days and run through both quiet and busy streets. Some ultra races are a combination of two or more of the available terrain, and some also span a few stages and are run over a course of days.

How popular?

As reported by The Guardian, despite the growing interest, the organisation of ultras is still rather disparate, with independent races popping up all over the place, giving the sport a slightly amateurish feel, with camaraderie playing a large part. Some of these are billed as a gentle introduction to ultras. Others, such as Whistler’s Meet your Maker make no bones about what they are: 50 miles of undulating singletrack alpine terrain. So if you really want to run across the US’s national parks, there’s an ultra for you. And if you fancy tackling 4,600m of altitude gain in Luxembourg’s Little Switzerland, you’re in luck.

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“Running has seen tremendous growth in the past 20 years,” says Topher Gaylord of Mountain Hardware, an outdoor equipment company that has turned its attention to ultras enthusiastically. “There’s been a tenfold increase in trail events, and the events have seen a massive rise in participation because it’s such a natural way to engage with the environment.”

Nature and Native Americans

Often, the discussion around modern ultrarunning in the U.S. (and to a lesser extent, Canada) revolves around nature and the ways in which Indigenous peoples ran, and ran, and ran some more…

As Andy Milloy phrased it “In the Beginning: Native Americans,” without horses, using only dogs as pack animals, Native Americans were conditioned to cover great distances on foot from an early age. It was recorded that Apache Indians, who were renowned for their toughness, at the age of 15 or 16 had to undertake a long run over rough country carrying a load on their back. Young men would be expected to go without sleep in a vigil that could last 48 hours. They then were required to go out into the wilds for two weeks, living through their own skill and toughness. An adult Apache could travel on foot over the roughest terrain from fifty to seventy-five miles a day, keeping this up for several days at a stretch.

Outstanding runners in such a culture would become key figures in holding together widespread associations, such as the Iroquois Confederacy, or even loose groupings of proximal tribes, by carrying news and other urgent messages. A typical example of the role such runners played is recorded in Peter Nobokov’s excellent book “Indian Running.” In the 1860s a messenger runner of the Mesquakie tribe in his mid-fifties ran 400 miles from Green Bay, Wisconsin to warn Sauk Indians along the Missouri River of an enemy attack. Such messenger runners were probably part of the culture of the Sauk, Creek, Omaha, Kickapoo, Osage, and Menominee tribes, and possibly many others. Such runners dedicated their lives to this endeavour, following a strict diet and often practicing celibacy. On their runs they would carry a dried buffalo heart.

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