Fracture.

Playing soccer has been a hobby/passion/thing to do for the majority of my life.

There’ve been no significant injuries to speak of. Until now.

So let’s talk about ‘the knee’ and pain.

new brace and crutches

A reckless and ridiculous challenge during my last game resulted in a minor fracture of the knee – and some major sit-on-my-butt time.

(Probably best that I go no further in describing the tackle, lest my blood begins to boil once more.)

So, I’ve got a near future filled with crutches, an immobilizer brace, ice, anti-inflammatory drug. Luckily, the future doesn’t hold surgical interventions! For now.

A swollen left knee

* *

Treatment for dummies (like me):

The treatment depends on the type of fracture. If you have an open wound with the fracture (I didn’t!), you may need treatment to control bleeding or prevent infection. You may need surgery to:

1) Remove all small fragments of bone
2) Wire the kneecap fragments together, if possible
3) Remove the kneecap if it has shattered
4) Your provider may put your leg in a brace, splint, knee immobilizer, or cast to keep your knee from moving while it heals.
5) Your healthcare provider may prescribe pain medicine.

**

Pain medication? Well yes. I have been using Extra Strength Advil. And the occasional beer. Sometimes I think I need something stronger. Other times, no.

The National news last night discussed the rise of the opioid crisis and located one of the hot zones in Ohio. The story by Vik Adophia was powerful, well-conceived and executed.

(It’s worth noting that the state of Ohio is suing 5 major drug companies for precipitating the opioid epidemic. The manufacturers of the prescription painkillers are: Purdue Pharma LP, Johnson & Johnson’s Janssen Pharmaceuticals Inc unit, a unit of Endo International Plc, Teva Pharmaceutical Industries Ltd’s Cephalon unit and Allergan Plc.)

Here are some of the top stories related to pain and opioids in the past few days.

Trump declares opioid abuse a national emergency in U.S.

Drug industry faces ‘tidal wave’ of litigation over opioid crisis

Canadian health advocates eye Portugal’s drug model to combat opioid crisis

Record number of drug-related deaths, as opioid crisis hits UK

**

After the knee injury, I immediately thought of Christopher Nolan’s Batman trilogy.

So what’s the future hold…

**

I also thought of Kobe  Bryant’s injury history. And as you can see – the Mamba’s knees featured regularly.

**

Stay tuned for periodic updates.

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.

CFP. Mental Health and Money: Past and Present

A Call for Papers.

Socioeconomic factors and mental health: past and present

Editors: Professor Matthew Smith and Dr Lucas Richert (University of Strathclyde, UK)

This article collection will examine how the relationship between socioeconomic factors and mental health has been and is understood in an array of different places and periods. Although much of the focus of current mental health research and clinical practice is on the neurological aspects of mental illness and psychopharmacological treatment, historical research demonstrates that a wide range of factors — from vitamin deficiencies such as pellagra, and infections such as syphilis to traumatic life events — have contributed to the onset and exacerbation of mental health problems. Among all these factors, one looms largest: socioeconomic status. On the one hand, socioeconomic inequality has been long recognised as a potential cause of mental illness, as the history of mental hygiene and social psychiatry during much of the twentieth century demonstrates. On the other hand, however, the mentally ill have also historically faced much socioeconomic hardship; today, a high proportion of the homeless and incarcerated in many countries suffer from mental illness.

By exploring this topic across time and place, this collection aims to provide a historical context for today’s mental health crisis, and also to inform current mental health policy, especially attempts to prevent or alleviate mental illness through social change.

Insights on a broad spectrum of themes are welcomed, including, but not restricted to

  • Homelessness and mental illness;
  • Social psychiatry and mental hygiene;
  • Community mental health;
  • Forensic psychiatry;
  • Race and mental health;
  • Psychiatry and various economic/political systems (e.g., communism, socialism, capitalism);
  • Socioeconomic factors and child mental health;
  • How health professionals deal with poverty and mental health;
  • Social policy and mental health;
  • Social activism and mental health.

This is a rolling article collection and as such proposals and submissions will be welcome throughout 2017. However, full submissions received by November 1 will be considered for publication as part of the collection’s formal launch in 2018.

Please do think about submitting.

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…

 

Vape Fear – Updated

November 25, 2016 – CBC NEWS

Vaping, e-cigarettes to be regulated by Health Canada

The federal government plans to regulate e-cigarettes to make vaping products less accessible to young people.

“The proposed act amends the Tobacco Act to regulate vaping products as a separate class of products,” Health Canada said in a statement on Tuesday November, 22.

The aim is to protect young people and non-users from nicotine addiction while allowing adults access to e-cigarettes.

“We know that there is some evidence to suggest that the use of vaping products can be used as a harm-reduction tool for people who are current smokers,” Health Minister Jane Philpott told reporters in the Commons.

“But at same time, they have [been] shown to be an enticement for young people to take up smoking and become addicted to nicotine.”

The government aims to regulate the manufacture, sale, labelling and promotion of e-cigarettes and vaping products.

A key part of the legislation introduced in the Senate is to regulate health claims, such as that a vaping product will help smokers quit.

The legislation would cover vaping products with and without nicotine.

Other measures in the proposed legislation include:

  • A ban on the sale and promotion of all vaping products to those under age 18.
  • Prohibiting the promotion of flavours that appeal to youth, such as candy flavours.
  • Creating regulatory authority to display health warnings on vaping devices.

*****

Here’s my original article.

In Martin Scorsese’s 1991 remake of Cape Fear, Robert De Niro plays sociopathic Max Cady, who has recently been released from prison. Years earlier, his attorney, Sam Bowden portrayed by Nick Nolte, deliberately withheld evidence during a criminal trial which would have seen Cady acquitted.

This of course enraged Cady and fueled a desire for revenge. As punishment, he stalked and brutalized the Bowden family. Yet, being a true believer, he also felt that by carrying out his terrible deeds he was helping Bowden achieve a type of moral and spiritual redemption. In short, he felt his actions were serving Bowden’s interests.

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In 2016, consumers, politicians, and health officials are going through Vape Fear. Due to lack of evidence, we are being tested by a product in the marketplace with a potential to improve health outcomes and cause other, if unknown, health problems.

It’s a dual-purpose product, in that it has recreational and medical applications. And in the public arena, opponents and supporters of e-cigarette regulations have contested the best approach to it.

Supporters of stiff regulation declare that children and young people need to be shielded from products that imitate smoking and might encourage nicotine addiction. (Think Mrs. Lovejoy in the Simpsons.) They favour regulation that might guarantee product safety and quality. These individuals also usually advocate on behalf of a precautionary approach – at least until there is sufficient evidence that e-cigarettes don’t undermine recent successes at controlling tobacco.

Opponents of stiff regulation, by contrast, argue that vaping is significantly less harmful than conventional cigarettes and beneficial in helping smokers to quit. They want minimal restrictions on availability and often absolute freedom for advertising, promotion and the use of e-cigarettes in public. (Think Charlton Heston and guns being pried from his cold dead hands.) Restrictions, this camp argues, might put off smokers from swapping to safer alternatives and limit the opportunity of curbing tobacco consumption. Here harm reduction trumps all other suits.

Now, against this messy backdrop, governments have taken action.

New EU regulations in May imposed standardised quality control on liquids and vaporisers across the union. They also required disclosure of ingredients in vaping liquids and child-proofing and tamper-proofing for liquid packaging.  And the NHS has backed e-cigarettes as a quitting aid.

In March, the Scottish government’s Health Bill banned under-18s from both buying the devices and limiting their advertising, which followed Health Scotland’s position paper in March 2015 that “NHS Boards must balance the benefits of e-cigarettes use to smokers with any potential concerns about impact on non-smokers.”

Meanwhile, the U.S. government has also taken broad steps to crack down for the first time on e-cigarettes, which have been growing in popularity among teens and is projected to be a 4 billion dollar industry this year.

The Food and Drug Administration’s move in May brought regulation of e-cigarettes 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 two years ago on how to supervise the e-cigarette industry.

“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 don’t have the scientific evidence showing e-cigarettes can help smokers quit, as the industry asserts, and avoid the known ills of tobacco.

In all of this, though, a Vape Fear persisted.

Similarly, heart experts recently found that vaping damages key blood vessels in the heart in a similar way to normal cigarettes, and it’s “far more dangerous than people realize.” University College London heart expert Professor Robert West noted, “It would certainly be fair to say the study shows electronic cigarettes are not without any risk.”

Researchers at the European Society of Cardiology Congress in Rome thus decided to call the NHS decision to support e-cigarettes “premature.”

Added to all this is the idea of vaping garage labs, a part of e-cigarette mythology that’s difficult to shake. While no one has been publicly exposed for mixing juice in an actual garage, many in the industry have confessed privately that some set-ups that are only marginally better. It was and remains the nascent industry’s dirty little secret.

In my home country of Canada, Vape Fear is certainly present. According to the CBC’s celebrity doctor Brian Goldman, “my sense is that key thought leaders in Canada are alarmist about e-cigarettes.” They “ignore evidence,” “cling to the notion that nicotine addiction, as opposed to combusted tobacco products, is the paramount health problem,” and “overestimate concerns that e-cigarettes act as a gateway to regular tobacco use.”

For Goldman, it’s well past time that his colleagues “look up the facts” and stop “dissing a smoke cessation tool with a lot of potential.” It can serve the interests of public health. Jesse Kline for the National Post has likewise told Canadians, “Don’t believe the fear campaign — e-cigarettes can save millions of lives.”

In Cape Fear, Sam Bowden’s teenage daughter – played by Juliette Lewis – was tormented and assaulted by De Niro’s Max Cady, but she manages to survive. She tells the audience that her holiday in North Carolina had been so peaceful beforehand, “when the only thing to fear on those enchanted summer nights was that the magic would end and real life would come crashing in.”

With vaping, we know this won’t occur until all multitudinous studies have been completed. And regulators and health authorities reach consensus.

Until that point, the regulation and use of e-cigarettes in Canada, the United States, and Scotland will continue to spark serious challenges and health concerns.

Without reliable data and hard evidence, and in a state of affairs where no one has a claim to the unassailable truth, regulations that curtail access and promotion to young people appears to be the surest policy in overcoming Vape Fear.

The Economics of IVF

Money matters, public health spending, and policy decision-making. When mixed with the life sciences and babies, these issues become even  more complex.

In an earlier article, I wrote about legal developments in the sperm donation industry, which have raised questions about reproduction technologies and sperm banks in Canada and beyond.

I noted that three separate Ontario families have recently launched lawsuits against a U.S.-based sperm bank and its Canadian retailer, alleging they were misled about their sperm donor’s background history – and this included a criminal record and significant mental illness. Not minor oversights.

Picture1

The families – all of whom used Donor 9623 – have brought suits against Xytex Corp., a Georgia-based company, and Ontario-based Outreach Health Services because, they were allegedly deceived.

Donor 9623 was marketed as very well-educated, a model of fitness, and a popular donor, and allegedly this wasn’t the case at all.

*

Ontario is leading the country in other ways. According to the National Post’s Tom Blackwell, “‘Huge’ demand for IVF treatment in Ontario — where it’s fully funded — has wait lists stretching to 2018.”

Essentially, Ontario’s decision to become the lone province to fully fund in-vitro fertilization has proven incredibly popular, with clinics taking just weeks to sign up this year’s limit of 5,000 patients. As Blackwell put it, this created “an almost instant logjam.”

The Ontario policy took effect late last December, but fertility specialists say they’re booking would-be parents into as late as 2018.

“Clinic caseloads.” writes Blackwell,  “have more than doubled in some instances, as the clientele grows increasingly diverse for a service that normally costs patients up to $10,000 a shot.”

*

The Toronto Star called this policy a “Baby Lottery.” Rather sensationally, the Star criticized the policy like this: it was “supposed to be a solution for people struggling to make a child. Instead, would-be parents are finding themselves bumped from oversubscribed waiting lists, weeded out entirely, or competing in a high-stakes baby lottery.”

Most provinces, including Saskatchewan, still do not fully fund the service (where embryos created by combining egg and sperm in a lab are inserted in the patient’s womb), although Manitoba and Quebec provide partial tax credits and New Brunswick offers a one-time grant.

On the one hand, public funding has been promoted partly as a means to stem the epidemic of multiple births stemming from fertility treatments. According to Blackwell, patients paying out of pocket “often push for use of two or more embryos at a time —increasing the likelihood of multiples as well as pregnancy…” And the Ontario program mandates that just a single embryo be “transferred.”

On the other hand, critics suggest that the lucrative industry should stick to single-embryo treatments regardless, and argue there are much more “pressing” demands for scarce health-care resources.

What do you think?

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