Treatment of Pain Leading to Death

"Some have suggested that [pressure from pharmaceutical industry for use of opioids in chronic pain treatment] may be one of the reasons behind it [heavy opioid use in North America] -- like anything else, it is multisectoral."
"I think it is something we do need to ask ourselves and I think that part of answering that ... is where we are going to find some of the clues as to how we respond."
"People need to have access to these effective medications where used appropriately, but there is tremendous risk potential. People do become addicted to them and people die."
"It affects health-care providers, it affects organizations that represent people who use drugs or have used drugs and their family members ... we need [the] research community on board, we need community associations on board."
"There's a very wide range of organizations that need to be involved in order to address the problem from the point of view of prevention [of opioid abuse] and [pain] treatment."
Health Minister Jane Philpott, Canada

Canada and the U.S. are the world's heaviest opioid users and faced with rising abuse of the painkiller, Health Minister Jane Philpott wants us to start asking why. (File Photo/Toby Talbot/The Associated Press)

Physician and Cabinet minister Jane Philpott is applying herself to the conundrum within the medical community of prescribing painkillers to patients suffering pain and discomfort, and through alleviating their pain, risking drug addiction, overdoses and death. The pharmaceutical industry plays no small part in this viciously revolving scenario of prescription drugs presenting as a threat to the patient community in Canada; a situation reflected in the United States.

Traditional extensive lobbying of doctors and hospitals to influence the trusted use and over-prescription of opioids has long been an issue awaiting urgent attention. Oxycodone, fentanul and morphine and illegal street drugs like heroin are creating an epidemic of addiction and increasingly, drug overdoses. In some quarters a level of control is seen through the use of a nasal spray whose impact is designed to reverse or halt the effects of overdoses.

The naloxone hydrochloride contained in the spray is a recognized medication that has the potential to save lives. While currently available in Canada in an injectable form, Health Canada has recently stepped forward to ensure it could be available as an antidote to overdoses without a prescription in the instances of emergencies occurring outside hospitals "I think that from an international perspective, that's considered to be very good practice, and I'm absolutely convinced that many lives will be saved."

British Columbia has declared a public health emergency, responding to a steep rise in fatal drug overdoses overwhelming the province. In January alone an estimated 74 overdose deaths occurred in British Columbia, on track to exceed the 474 deaths from drug overdoses that struck the province in 2015. And as from January 2017 high doses of painkillers are set to be removed from the Ontario Drug Benefit Formulary. That will affect people 65 or older, those who live in long-term care, receive social assistance or incur high drug costs relative to income.

"We're starting to see doctors prescribe them somewhat less regularly, but they are still  used very, very often. And, I think, too often", commented Dr. David Juurlink, head of the division of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto, who lauds the Ontario Ministry of Health for the "good move" on its part, which may further persuade physicians not to prescribe unnecessarily high doses of the drugs.

Lower doses of the drugs will not be affected by this initiative. The ministry claims that lower doses can in fact be more effective for the purpose of pain relief than high doses, and without the obvious potential for overdose leading to death. So as far as the Ontario Health Ministry is concerned, delisting high doses represents a step forward.

Provincial prison inmates are 12 times likelier than the general public to die of a drug overdose. Within the first year of their release from prison; 77 percent of sudden, unexpected deaths have been  attributed to opioids. The thing of it is, as soon as one aspect of a problem appears to be moderately solvable, another arises to make the situation more complex and dangerous.

A drug specifically used to sedate elephants, a hundred times more potent than fentanyl, is now suspected to be present in  overdoses in a few states in the U.S. Authorities there believe it is mixed with, or passed off as heroin. One of the most potent opioids known, carfentanil makes the confrontation of the proliferation of overdose deaths more complicated.

In central Ohio a man suspected of selling carfentanil, claiming it to be heroin, was indicted on 10 counts this week. He has been connected with a July 10 death, along with nine other overdoses.

Zoo veterinarians carefully wear face shields, gloves and other gear to protect themselves when preparing carfentanil for use. A single drop splotched into an eye or hose could be fatal, according to the American Association of Zoo veterinarians.

Free Enterprise Capitalism and Health Outcomes

"Advocates of e-cigarettes say emissions are much lower than from conventional cigarettes, so you're better off using e-cigarettes."
"I would say, that may be true for certain users -- for example, longtime smokers that cannot quit -- but the problem is, it doesn't mean that they're healthy. Regular cigarettes are super-unhealthy. E-cigarettes are just  unhealthy."
Hugo Destaillats, researcher, Lawrence Berkeley National Laboratory

"[Propylene glycol and glycerine, among chemicals released in e-cigarettes are both considered] probable carcinogens [by federal health officials]."
New study on e-cigarettes' safety

E-cigarettes are growing in popularity (diego_cervo/istock.com)

"This is the first study that demonstrates the fact that we have these highly reactive agents in e-cigarette aerosols."
"While e-cigarette vapour does not contain many of the toxic substances that are known to be present in cigarette smoke, it's still important for us to figure out and to minimize the potential dangers that are associated with e-cigarettes."
Prof. John P. Richie Jr., public health sciences and pharmacology, Penn State

E-cigarettes have been hailed as the brave new world for those unable to or incapable of, or unwilling to surrender the pleasure they find in tobacco and smoking. Heralded as the safe new, modern way of using tobacco, as well as presenting as 'cool' and popular with the young, e-cigarette use has a large and enthusiastic following. This, despite the uncertainties involved and which scientists have been exploring with a final purpose of either designating the practise with a clean bill of  health or dismissal as yet another dangerous practise whose substances spell out nicotine addiction has no practical solution.

Studies have discovered the presence of aldehydes in the vapour of e-cigarettes, not a serendipitous finding, since these are compounds capable of causing oxidative stress and cell damage. Published in early 2015 in the New England Journal of Medicine, the study found that high levels of formaldehyde, a known carcinogen, are produced with the use of e-cigarettes. Later in the same year researchers at Penn State College of Medicine found their own cautionary tale.

Electronic cigarettes were found by the Penn State investigative team to produce the free radical molecules that cause cell damage which can also lead to cancer. Free radicals represent the molecules causing the most oxidative damage in cigarette smoke, a leading cause of smoking-related cancer, cardiovascular disease, skin aging and chronic obstructive pulmonary disease.

The discovery was made that e-cigarettes produce free radicals levels roughly one thousand to one hundred times lower than found in regular cigarettes, but remaining in the range representative of what might be encountered in the air of heavily polluted atmospheres.

More currently a study published in the journal Environmental Science and Technology points out that propylene glycol, an eye and respiratory irritant and glycerine, a skin, eye and respiratory irritant are present among other chemicals released in the vapour of e-cigarettes, according to the research team at the Lawrence Berkeley National Laboratory. A serious finding, considering that both are known 'probable' carcinogens.

Heating those chemicals within an e-cigarette causes their decomposition, releasing toxic chemicals like acrolein and formaldehyde. The higher the temperature reached within the heating coil of the vaporizer, the greater the emission of chemicals. Even the type of vaporizer makes a difference; a one-heating-coil e-cigarette released higher chemical amounts than the double-coiled vaporizer because it reaches a higher temperature.

Health and Medicine, Jonny Williams via Vlicker

Heading Off Alzheimer's

"The disease is a progressive disease, and both physicians prescribing and treating patients [as well as] patients and their families haven’t understood clearly enough that we’re treating symptoms in a progressive disease — and treating symptoms is still worthwhile."
"[There is hope that new medicines will succeed in stabilizing, even reversing or curing the disease.] So that goal is very valid, but we’re not there yet."
"You see experts from the U.S. expressing concern that drugs we have already are not being used. And I think the general public gets the feeling there’s nothing for Alzheimer’s disease."
"We will need combination medicine. So we don’t want to throw out the gains we have made over the years for the hope there will be one thing that will make the original gains obsolete. We’re not that far in the field that we don’t need these current medicines that we have."
Dr. Sharon Cohen, medical director, Alzheimer’s program Toronto Memory Program -- Alzheimer’s Association International Conference, Toronto

Dr. Sharon Cohen, medical director of the Toronto Memory Program, says that since Alzheimer's is a progressive disease, "treating symptoms is still worthwhile,” even if the next generation of treatments will get at the roots of the disease itself. Researchers and health-care professionals concerned with Alzheimer's are gathering in Toronto this week for an international conference.   (NAKITA KRUCKER / TORONTO STAR) |

"It is unfortunate that only a minority of primary care doctors believe they have received sufficient training to diagnose the disease."

"We see patients regularly for whom the diagnosis of Alzheimer’s was missed. Unfortunately, the result is people with the disease are not getting treated."

"[Approved drugs that affect the cholinergic system — a chemical produced by brain cells essential for memory, behaviour and thinking — have been available since the 1990s and are the only drugs] shown to have a positive impact on all stages of Alzheimer’s disease."
Dr. Rachelle Doody, chair, Alzheimer’s research, Baylor College of Medicine, Texas

Thanks to ongoing medical research and improved quality of health care with new protocols and medicines reaching the market on an ongoing basis, we are living longer, more productive lives enhanced with better health outcomes. The general public is aware that physical activity is necessary to balance lifestyles and remain active. There is a growing tendency among older people who once would have thought of retiring as soon as they could from the active workforce, to continue working rather than put themselves 'out to pasture'.

In the early 1980s ten percent of the American workforce as an example, over age 65 had no plan to leave the workforce and retire. At a time when jobs were plentiful and no baleful glares turned toward older works with the grumble that their persistence in avoiding retirement meant they were keeping younger workers from finding employment fewer people decided to retire. In many industries when older workers did retire their institutional knowledge was lost with their absence.

At the present time the number of older workers remaining in the workforce has doubled, close to 20 percent. And of that number fewer than fifty percent who continue to work have financial pressures keeping them there. Most older people continue their jobs through choice, and most because they find a purpose and satisfaction in continuing to work or even because they have a compulsion "to remain involved".

According to Gallup's Employee Engagement studies, half of retirement age workers are resolved to work past age 65 while ten percent have no aspirations whatever to retire at any age unless compelled to by circumstances beyond their control. It is also recognized that older people in the workforce are more reliable, have a tendency to greater engagement in their work than do younger workers. People over 50, according to Gallup, represent one of North America's fastest-growing groups of prospective entrepreneurs.

Which is to say once their lifetime professional careers come to an end that demographic turns to what is called "encore" careers. To be sure, whether or not to retire is in essence yet another lifestyle opportunity; the choice to remain active in the workforce, or to take retirement leave and look forward to advancing other interests at leisure, though many people in their retirement years remain busy with any number of other distractions from volunteerism to finally seriously pursuing hobbies or travelling extensively.

This past week in Toronto the Alzheimer's Association International met to present research findings and discuss issues relating to that dread disease. Their contention is that jobs involving interacting with others in society, such as teaching, social work, sales and law, can have the effect of dramatically lowering the chance of Alzheimer's onset or other forms of dementia through ongoing mental engagement.

How we were: An elderly woman clutches a comb for her white hair while the dark-haired reflection of a young school teacher, a notebook and red apple in her arms, reflects back in her mirror

France's Bordeaux School of Public Health found that for each additional year of work the risk of dementia onset decreased by 3.2 percent. According to the findings issued from Bordeaux, "those who retired at 65 years old had a 14.6 percent lower risk of getting dementia than those who retired at 60 years old." Other studies follow in similar vein; that works ensures people will be sound in body and mind.

Former lives: A retired fire fighter, who's actual photo is seen tucked in the mirror's top left corner, gazes into his reflection that shows a strapping young fire fighter staring straight back

A British Medical Journal Analysis of 2005 studying Shell Oil employees discovered that 55-year-old retirees were 89 percent more likely to die within ten years of retirement than those who had retired at age 65. Those below the company's managerial and professional rungs; skilled, semi-skilled, unskilled and clerical workers were found to be 17 percent likelier to die at a younger age.

             Gary Burtless, Brookings

Driving While Under the Influence of Conversation

"Cellphones, whether we're manipulating them or not, are dangerous while driving motorized vehicles and should possibly be completely banned."
"There are basically no cases in front of the courts that have held a person criminally responsible for the death of another because they were using their cellphones while driving."
"Regardless of the consequences of their actions, the worst a driver found guilty can face is a fine and a few demerit points."
"Mentalities and legislation [need to evolve placing cellphone use on par with driving while inebriated]."
Quebec coroner Renee Roussel, Montreal

Quebec coroner recommends outright banning of cellphone use while driving. Photothèque Le Soleil

"It's almost unthinkable that something like this could happen on that street [ordinarily quiet and safe, where children can walk without fear of danger]."
"I would never want to destroy someone else's life [being charged with manslaughter over causing a death while using a cellphone]. But I do believe in the notion of responsibility."
Sonia Bouchard, daughter of 75-year-old pedestrian Florilda Castonguay

Florilda Castonguay had a habit of taking a late afternoon walk daily, around the vicinity of her home in St-Alexandre-de-Kamouraska, a town northeast of Quebec City. On Sunday, 29 November last year, she embarked on her usual walk at roughly the same time as every other day: before sundown and early enough to enjoy her walk but ensuring she would return home to prepare dinner for herself and her husband.

It was a cold day as late November can be, but the street (typical of most suburban areas where sidewalks are mostly absent on esidential streets in a car-centric society) was crusted with dirty snow and ice at the edges, leaving Mrs. Castonguay to walk closer to the centre of the road than might be usual under other circumstances, though the road wasn't icy underfoot. She was hit from behind at 3:30 p.m., mere seconds after a man driving facing her, noticed her presence ahead, and just as a vehicle drove in the opposite direction, behind her.

That vehicle plowed into the fit and healthy woman. On contact, the car's bumper collided hard with the back of her knees and she tumbled violently over the car. According to witnesses, the driver called 911 and tended to the woman as she lay unconscious in the street. When the ambulance arrived, paramedics assessed her condition and speedily took her to hospital, with a severely fractured skull. By 6:40 p.m., the 75-year-old Florilda Castonguay was pronounced dead.

Police were told by the driver that he had been distracted by his passenger and as a result braked only at the last second, according to the coroner's report. However, the length of the skid marks led police in a different direction; they felt that the car had been driven about 30 kilometres per hour as it hit Mrs. Castonguay and ruled out the potential of the driver having to contend with the sun obscuring his vision, nor were there other vehicles present, to distract him.

With the use of cellphone records in their thorough investigation, it was discovered by police that the driver had been using his cellphone, despite his categorical denials. The records indicated otherwise. The coroner's report had ruled that the death was an accident. On the other hand, the coroner took pains to point out that the law does not sufficiently recognize the potential danger to the public weal when people use cellphones while driving, even though the use of cellphones while driving is illegal.

Coroner Roussel recommended the possibility of technological devices such as jammers cutting off cellphone signals as long as the phone is in a vehicle, to make it impossible for people to use them while driving a vehicle. She pointed out that hands-free Bluetooth systems too, though less hazardous, remain a major distraction to a driver who should be focusing on the road and vehicular and pedestrian traffic, not a conversation.

As for Mrs. Castonguay's family, they are in deep grief mode Her husband had fallen ill following his wife's death. And their daughter has her hands full looking after her bereaved widowed father.

"Cellphones, whether we’re manipulating them or not, are harmful while driving motorized automobiles and will probably be utterly banned" coroner Renée Roussel wrote in her investigation into the death of a seventy-five-year-old Quebec woman. DARRYL DYCK / THE CANADIAN PRESS

Ottawa's Deadly Arrest Revisited

"Memory is one of the least reliable pieces of evidence in a court of law. That's where cameras come in."
"I tell my students in class: 'Videotape to your heart's content. It's legal."
"Anything that will facilitate the truth coming out should be welcome."
Darryl Davies, professor of criminology, Carleton University, Ottawa

"The post-mortem report is critically important. The police have a right to use force. The question is:
Was the force reasonable?"
"If they [police] had arrested him or detained him and the person went into medical distress, then they have a duty to make sure that this person receives medical care immediately."
Ian Scott, former Special Investigations Unit director

YouTube video screen grab of Abdirahman Abdi outside his front steps following arrest.

"Many members of the Ottawa Muslim and Somali communities have serious concerns about how this tragic incident unfolded, including whether prejudice had something to do with Mr. Abdi's treatment."
"A thorough investigation [is called for, into Abdirahman Abdi's arrest and subsequent death associated with that arrest]."
Ihsaan Gardee, executive director, National Council of Canadian Muslims

"It's not normal. The way [the police] acted was not reasonable."
"We easily fall to the trap of the emotions to say, 'Us against them'. Especially what's gone on now in America. We don't want that kind of thing to happen. We don't experience the same things as in America -- especially in Ottawa."
Abdourahman Kahin, founder, Muslim Presence, Ottawa

"We've lost a neighbour We're shocked, we don't know why this happened, but we wanted to come together."
"That's one of the most important things we can do as a community over the next several weeks -- talk to each other."
"You know, I am looking forward to finding out what happened from the investigation, but I do trust that this is a fairly isolated incident. [The police have been] fantastic community partners [in the neighbourhood."
Ottawa Municipal Hintonburg Councillor Jeff Leiper

Mourners arriving for a memorial pass flowers laid outside the apartment where Abdirahman Abdi lived and was fatally injured after being arrested by Ottawa Police officers.
THE CANADIAN PRESS/Justin Tang

There is a slightly clearer understanding of what occurred and the time elements involved in Sunday's tragedy that led to the death of 37-year-old Abdirahman Abdi, a man known to his neighbours as being on the autistic spectrum with a clear mental disorder and unable to verbalize his thoughts to communicate with others. While he was known to be intellectually fragile, he was also regarded as a peaceful man. On Monday he died in hospital, a situation resulting from rough treatment by police in the process of arresting him.

Police had responded to 911 calls which were reporting that the man was inside a Bridgehead coffee shop in Hintonburg -- very close to the family apartment where Mr. Abdi lived with his parents and siblings -- where he was behaving in a physically abusive manner. Evidently he had been grabbing at women's breasts. It wouldn't have taken long for police to respond, an administrative police building was situated nearby. And when police arrived on the scene, they ordered Mr. Abdi, whom they described as continuing to be "assaultive", to surrender himself.

Instead -- and it isn't known whether he would have understood what was being communicated to him, despite living in Canada for the past nine years -- the man fled the short distance (270 metres) to the street where his apartment building stood. He was captured, shot with pepper spray, hit with batons with some notable measure of physical force, according to witnesses. Finally he was arrested and handcuffed. By then he was face down on the ground, comatose, blood on his face and spreading on the pavement.

People witnessing the event saw a violent beating, and they recorded what they saw on cellphone video. Two experienced Ottawa Police Services officers have been identified and removed from active duty while the SIU investigates what precisely had taken place, to determine responsibility. The officers are well thought-of, neither having ever experienced disciplinary proceedings. One had been commended for extensive volunteerism helping a women's charity, the other received a commendation for skill, good judgement and dedication to a high standard of police conduct and humanitarianism.

One witness had recorded 27 minutes while Mr. Abdi lay on the ground, as police wiped blood from his face and performed chest compressions before and after the arrival of paramedics. It had previously been asserted it took 15 minutes before paramedics arrived, and another ten minutes before the victim was conveyed by ambulance to hospital. But actual records show that paramedics arrived five minutes and 24 seconds following their dispatch.

Moreover, complaints that police waited too long before radioing for paramedics appear to have misjudged the time element, since Police Chief Charles Bordeleau quotes record-keeping that indicates within 23 seconds of Mr. Abdi's requirement for medical assistance being noted, the call for paramedic assistance went out. At police headquarters the priority nature of the call was emphasized to paramedics.

The 26-minute time frame quoted appears to have taken in the time the first calls reporting Mr. Abdi groping women at the coffee shop began, to the time he was conveyed to hospital. Police are shown at various times in the bystander videos attempting to apply pressure to the fallen man's bleeding head. His death is in the category of a suspicious in-custody death. Only a post-mortem examination will reveal the cause of death.

That, and the results of the SIU investigation will determine whether or not the police officers involved will be cleared of wrong-doing in the use of excessive force.

A Family's Misfortune

"You can't go against five cops at once. It was unnecessary."
"[There was blood] all over the place He looked weird -- he looked dead. It was weird that they didn't [immediately] call paramedics. It took way too long. Everything was moving very slowly."
Asli Mohamed, 20, Hintonburg area, Ottawa 

"I told the police he's a crazy man. They hit, they hit, they hit, they hit everywhere. Then he was unconscious. Then I was scared. Then I'm shocked."
"It's the first time in my whole life I see a human being hit by another human being. He's usually fine [the victim']. I don't understand."
Zainab Abdallah, building resident, neighbour

"I think we're all just surprised because we live in Ottawa and we don't really encounter these kinds of problems."
"I wanted to give the benefit of the doubt, but the way that the situation played out it seemed like it was because we were like immigrants or we were black."
"[The Somali community were not being treated] the way we were supposed to [not] being cared for the way [they] were supposed to [that Sunday morning]."
Mariam Ali, 18, University of Ottawa student

Abdirahman Abdi, 37, was a Somali-Canadian with mental health issues, whose family moved to Canada eight years ago. He was pronounced dead Monday afternoon after losing vital signs during a confrontation with police on Sunday morning. (Images supplied by family)

"Sometimes police have a perceived notion of what a person is doing, or what will happen. They don't always have all the facts. They have only seconds to make an assessment. They are operating on the best information they have at the time."
"You could get two or three psychiatrists to sit there, and they would disagree about the diagnosis [mental state of a suspect]. Then you have a young officer with three years' experience [on the job] with only seconds to react [to an ongoing situation]."
"Police have one main objective: compliance. Stop what you're doing, or come with me. People are shocked when police use force. But police have to do what the law compels them to do."
"There is such a range of possible situations. All situations are so complex [police training cannot possibly encompass all potential situations and the best-case reactions]. You can't give them recipes You can't give them formulas. It's really about observation and focusing on the risk of harm, not doing a diagnosis."
"We don't ask police to do a diagnosis on the scene. You don't want police to assess if someone is mentally ill -- are they delusional? Are they schizophrenic? Are they under the influence? You want police to focus on the behaviour."
Rick Parent, 30-year police officer, professor of criminology, Simon Fraser University

Const. Dave Weir, left, and Const. Daniel Montsion, centre, are seen kneeling by Abdirahman Abdi outside his apartment building on Hilda Street. CBC News has learned both officers are the subject of an SIU investigation into Abdi's death. (YouTube) 

Dr. Parent points out from his experience, his education and his observations and the study of statistics and crime literature that about a third of the 15 to 30 police shootings that take place in Canada annually, have a mental health component. And this incident that took place several days ago in Ottawa was one of those. Police had been called to a Bridgehead cafe on Wellington Street near the apartment building where many Somali community members live. Staff at the cafe complained that 37-year-old Abdirahman Abdi, who was non-verbal, was harassing a woman.

When police arrived the man fled, despite being told to stop, and a foot chase ensued. A relatively short one, given the short distance between the cafe and the apartment block. Witnesses described the fleeing man being tackled, brought to the ground by several police officers who proceeded, they said, to kick, punch and beat the subdued man with their batons. He was handcuffed, and lay there, bleeding on the sidewalk.

It took ten minutes, said the onlookers, before the injured man was taken in hand by paramedics and given medical attention. Someone had recorded a 27-minute video which clearly shows the man, wrists cuffed behind his back, trousers pulled down, lying face down for close to ten minutes before the arrival of paramedics and CPR was started. A later news report indicated that the two police officers had been instructed by whoever took their 911 call to initiate CPR; when paramedics arrived they took over.

Witnesses also said that police made an effort to seize cellphones held by bystanders, recording the event. Zainab Abdallah, a resident of the building where Abdirahman Abdi's family also lived watched him run toward the apartment door, the officers in close pursuit, shouting at him to stop. Failure to comply saw him tackled and taken to the ground. When the man was taken to hospital by paramedics, his condition was grave. There were rumours that air had been cut off to his brain.

Despite emergency application by medical personnel at the hospital the man did not survive the physical ordeal and trauma he had suffered. His family is devastated and desolate. They had arrived from Somalia as refugees to Canada in 2009. Both parents have steady jobs. Their oldest son was known to have mental incapacity. In most situations Canada will not permit immigrants to bring in family members who suffer chronic illness of any kind.

The cruel irony, of course, is that refugees who flee violence in their home countries to find haven in other countries, sometimes find instead of a peaceful future, a future cut short by a horrible misadventure of some kind, not necessarily of their own making. It might also be noted that young men from the Somali community are over-represented in proportion to their numbers, in incidents of criminal activity and violence.

The police officers involved in this unfortunate incident with its dreadful outcome are under suspension, while the oversight body that is brought in to investigate when incidents such as this occur, the Special Investigations Unit, is set to launch a probe. Whatever the probe comes up with, the details that have so far emerged do not look very complimentary to these members of the Ottawa Police Force.

The Irate Tobacco Industry

"[Plain packaging for cigarettes represents a vital step forward to end] a tragedy of the 20th Century."
"Smoking doesn't kill all smokers -- it only kills half of them. If a fifth of Canadians are smoking, it means one in ten Canadians is going to die prematurely."
"People are always worried about youth -- as they should be -- but I think it will be [mandated plain packaging] powerful for everybody. It rebrands the products for them. This time, the package is going to look and feel different."
"Even for the longtime smoker, it will be a new chapter in their relationship to this drug to which they are addicted."
"It's [the renewed initiative to tackle turning people away from smoking] the first burst of energy we've had at the federal level since 2000. There's an excitement about what comes next. It feels like we're back in the game -- it's a different game."
Cynthia Callard, Physicians for a Smoke-Free Canada

"With results like this [Australia's anti-smoking packaging initiative], one has to ask why the Canadian government continues to cite Australia as the model to follow."
"Nobody in Canada starts smoking because of the packs, which are already hidden from public view and covered with graphic health warnings."
Jeffrey Guiler, spokesman, Imperial Tobacco Canada

"That's not the opinion of the Australian government [that the experiment undertaken to convince people to stop smoking because of the health hazards graphically displayed on cigarette packaging hasn't succeeded] or independent analyses, and I've never seen that from anyone who hasn't been paid by the companies."
"The difference is there's no other consumer product that if you use it exactly as you're supposed to, it kills you."
"All of the evidence right now suggests that light or low-tar cigarettes are either as harmful as, or more harmful than, the cigarettes that were sold in the 1950s or 1960s. That is the false impression that is being conveyed on packing."
"Canada came close to doing this [severely regulating packaging] 30 years ago. This is the last remaining bastion of their [tobacco industry] marketing and that is why they fight this so hard. The industry has come out and said, 'Any country that does this we'll fight it and we'll fight it with all of our resources."
David Hammond, School of Pubic Health, University of Waterloo

Sean Kilpatrick, The Canadian Press

Although there has been a notable decline in the numbers of Canadians who remain smokers, tobacco products remain in use by over five million Canadians. And that unwillingness or inability to wean themselves away from tobacco is costly in terms of long-term health and longevity for far too many people, as well as being costly to the universal health care system. Hospitals in Canada feature signage geared to persuade people just how harmful to health smoking is. At hospital heart units persuasive arguments are presented and offers made to enroll smokers in smoking-cessation clinics.

The simple reality is that tobacco kills, and as a result of its ubiquity despite society having become accustomed to regulations that don't permit smoking in public areas, including shopping malls, supermarkets, restaurants, bars and offices, the pervasive habit of dependency on tobacco has reached a plateau. Fewer people may smoke than the numbers that did decades ago, but those who remain caught in the orbit of tobacco pay the price. Smoking causes the death of 37,000 Canadians annually.

Smoking among youth is not quite as 'cool' as it once was, and there has been a noted decline. Among young people one in six report having smoked in the past month, according to data compiled by Health Canada. The kind of plain packaging that also plainly sets out in blatant gruesome photographs the effect on the human body that can commonly occur with smoking is used in Australia, the United Kingdom and France. Ten additional countries are considering its use as a necessary step in a public campaign.

An Australian bookshop employee handles packaged cigarettes that have to be sold in identical olive-brown packets bearing the same typeface and largely covered with graphic health warnings, with the same style of writing so the only identifier of a brand will be the name on the package.  (WILLIAM WEST)

Understandably, the tobacco industry that has fought back against bad press for decades is none too pleased at this more recent federal government decision to force them to change their packaging to reflect its contents' deleterious effect on human health. According to Igor Dzaja, general manager of JTI-Macdonald Corp. the focus of the government should be on illegal cigarettes "instead of implementing another misguided regulation". For as far as the industry is concerned the imposition of plain packaging "interferes with consumers' freedom".

Traditional designs on packaging were geared toward persuading people that smoking was harmless, "modern", "elegant", and their packaging was "unique" to their tastes; slimmer, 'lighter', and for the younger set, cooler with pink highlights on packaging appealing particularly to girls and young women. Even the initiative to "perfume" packs  was geared to appeal to young women who bought the argument that smoking guarantees they will be slimmer smoking less harmful skinny sticks.

Additional areas of prospective debate on the issue of cessation-persuasion would likely include heavier price controls, reducing commercial venues where tobacco can be bought, and enhanced exposure to training for doctors to help make their arguments to their patients more effective, that stopping the use of tobacco will improve their health and the quality of their longer, more productive lives.


A mock-up design of a standardised cigarette pack in the U.K.. This image is fully compliant with both the EU Tobacco Products Directive and the U.K. standardised tobacco packaging regulations. Tobacco giants have lost a legal challenge in London against rules for standardised packaging.  (HANDOUT)

Medical Trust in Indonesia

"We are in crisis right now."
"This is a medical emergency and we have to overcome this."
Dr. Aman Bhakti Pulungan, head, Pediatrician Association, Jakarta, Indonesia

"Fake vaccines arose because there was a scarcity of vaccine a few years ago that led hospitals and clinics to look for imported vaccines."
"Also because the middle class demanded imported vaccines rather than locally made."
Jane Soepardi, director of surveillance, health quarantine and epidemiology, Indonesian Health Ministry

"I was shocked and very disappointed when the hospital management asked me, along with about 300 other parents to bring our children for revaccination, because the vaccine that is injected into our children turned out to be fake."
"How could this happen?"
"We need a medical checkup, not only an explanation. We need concrete compensation."
Danang Susilo, father of 14-month-old

"The attitude of the Indonesian people, especially the middle class, is that they look at the building and the facility and they say: 'This is the best hospital'."
"But nobody knows if it really is a good hospital or not because there is no quality control, no quality assurance done by the government."
Dr. Kartono Mohammad, (former) head, Indonesia Medical Association

An Indonesian health official prepares a vaccine injection during a revaccination program for children who were earlier given fake vaccines, at a community health center in Jakarta, Indonesia on Monday, July 18, 2016. (AP / Achmad Ibrahim)

Dr. Mohammad points to federal regulations in place theoretically alongside the reality of lax, if not absent enforcement where the vaccine scandal, as far as he is concerned is symptomatic of more larger-reaching problems. Monitoring and enforcement of regulations to ensure the administration of safe vaccines can be assured, is simply absent. And this is the largest component of failed responsibility by the government to the safety of the country's most vulnerable, its children.

Vials identified by their labelling as vaccines have been increasingly discovered to be carrying nothing but saline solution sometimes mixed with antibiotics that have been found to be used at 37 hospitals and clinics located in nine cities throughout the country, according to revelations by Indonesia's Food and Drug Agency. Investigations have resulted in 23 people being arrested, among them three doctors.

When a nation of over 250 million people discovers that something as elemental as protecting their infants from diseases whose efficacy and reliability is generally taken for granted in a well-regulated and operated health system, has failed the test of trust, the response will be guaranteed outrage. Indonesian president Joko Widodo paid a personal visit to a clinic where several hundred children were scheduled for revaccination.

There, he appealed to parents and the public at large for patience while his government investigates further the "extraordinary crime" that has been uncovered of false vaccines, which have been a problem, as it has been revealed, as far back as 2003. Dr. Pulungan, as head of the country's pediatrician society has attested that to his knowledge no children are known to have died resulting from their unprotected status against diseases they were supposed to be vaccinated against.

Some, he agrees, may have become ill and the cause obviously not fully understood. Inoculations routinely used are those for measles, whooping cough, hepatitis and diphtheria. And their matched vaccines were labelled as imported brands. Dr. Pulungan understands that only one percent of vaccines used nationwide have been imported. A mob of raging parents appeared on television haranguing a doctor, punching and spitting on him at an eastern Jakarta hospital.

Members of Indonesian parliament have been approached by angry parents demanding action on the urgent file. The Health Ministry estimated that five thousand children from among 4.8 million who were immunized in the current year, were recipients of the fake vaccines. According to the director of surveillance with the ministry, the fake vaccines contained no harmful ingredients, though the possibility of infections resulting was possible, related to unsafe processing in their production.

The endemic corruption, overcrowding in hospitals and a severe shortage of doctors are conditions not conducive to trust by the population in the health care system. Those Indonesians who have money to spare seek treatment often in neighbouring Singapore or Malaysia. While parents are beside themselves with concern over the well-being of their children, it seems that the government had prior knowledge it failed to act upon.

Women wait for information about the alleged use of fake vaccines on their children at a hospital in East Jakarta, Indonesia   Antara Foto/Sigid Kurniawan/via Reuters

In 2013, a report from GlaxoSmithKline about counterfeit vaccines bearing their logo and guarantee was received by the Indonesian Food and Drug Agency. The person behind the scheme was apprehended and fined a grand sum total of under $100. And then in 2014 and 2015 other problems surfaced. In 2016, PT Sanofi-Aventis Indonesia, a subsidiary of the French Sanofi, informed Indonesian national police that fake vaccines were surfacing with its product labels affixed.

Hospital workers (R) collect information from parents who believe their children may have received fake vaccines at a hospital in East Jakarta, Indonesia  Antara Foto/Sigid Kurniawan/ via Reuters

Through sexual contact

• Zika virus can be spread by a man to his sex partners.
• In known cases of sexual transmission, the men developed Zika virus symptoms. From these cases, we know the virus can be spread when the man has symptoms, before symptoms start and after symptoms resolve.
• In one case, the virus was spread a few days before symptoms developed.
• The virus is present in semen longer than in blood.

 

Now, an additional complication has arisen, where scientists have discovered a case where a woman was responsible for spreading the Zika virus to a man, in the United States. Many researchers now acknowledge that mosquito infection of the Zika virus, while the major vector for transmission, is not the only one. And it is concerning that sex, not generally acknowledged to spread Zika through intimate contact, is now recognized as yet another driver of the condition.

Women in Latin America, according to two reports, are likelier to be infected than are men, even though both genders are equally exposed to the presence of mosquitoes, and thus equally vulnerable to be infected with Zika by mosquito bites. The differences in the genders seem to appear and become evident at the age when sexual activity is initiated by natural processes, fading as women become older.

It is known that the Zika virus persists in semen for months which explains why it is that women attempting to conceive are given clear warning to avoid unprotected sex with men from areas where the virus is prevalent. Argentina, Canada, Chile, France, Germany, Italy, New Zealand, Peru, Portugal and the continental U.S. have all reported infections that were almost certainly passed through sex.

A study released in May by Brazilian and European biostatisticians found that in Rio de Janeiro with its 6.4 million population, "a massive increase of Zika in women compared to men existed". The study authors found that women generally visit doctors more frequently than do men, including pregnant women; to be tested for Zika. Even so, women remained 60 percent likelier than men to be infected.

And it was sexual transmission, according to Flavio C. Coelho, a Vargas Foundation biostatistician, and the lead author of the study, that "was the most probable cause". Donald A. Berry, a biostatistician at the University of Texas M.D. Anderson Cancer Center waved off the results of the study, with the admonition that confusion over dengue with similar symptoms is so common that these variables alone could have accounted for the infections differential between men and women.

Researchers at the Colombian health ministry and the U.S. Centers for Disease Control and Prevention studied birth defects linked to the virus, finding age and gender disparities. Young boys and girls in Colombia had been infected with the Zika virus at approximately similar rates. After age 15, once sexual activity began, female rates of infection rose steeply. Women in Colombia by age 25 to 29 proved three times likelier as opposed to men of the same age to be diagnosed with Zika.

But as the women became older the margin began to taper off, until after age 64 the infection rates stabilized, and were comparable in numbers. According to Margaret A. Honein of the C.D.C., women 45 to 64 years of age in Colombia were nearly twice as likely as men of that age group to be infected. And no evidence exists that sexual transmission was an issue in the first Zika outbreaks that took place on Yap Island in Micronesia and in French Polynesia in 2007 and 2013 respectively.

Sun Driving Skin Cancer

"For years, dermatologists have observed that patients in the U.S. often have more sun damage [which can lead to wrinkles, leathering, sagging, brown 'age' spots and even skin cancers] on the left side of their faces than on the right."
"Why? Research increasingly points to ultraviolet A [UVA] radiation penetrating through car windows."
"The UV exposure we receive driving a car especially adds up. In a U.S. study by Singer et al the researchers found asymmetric photodamage [sun-induced skin damage] on the face, with more brown pigment [colour] and deeper wrinkles on the left. The more time subjects spent driving a vehicle, the more severe their photodamage on the left side."
Dr. Susan Butler, dermatologist, co-author, Journal of the American Academy of Dermatology study

Karl-Josef Hildenbrand / AFP / Getty Images   The sun's rays can penetrate car windows, dermatologists say.

Vehicle windshield glass is laminated for safety reasons, giving the glass additional strength, a safety measure that ensures there are two sheets of glass with a sandwiched layer of thin plastic between them. Governments looking to enhance safety in the event of accidents with a view of reducing harm from flying glass shards in the event of vehicle collisions mandated this special windshield precaution. Not so however, with other glass windows in a vehicle.

The glass on the side and back windows was left as is, without tempered-glass [-hardened] since there was no need foreseen to have them treated in the same way as the windshield. Now, it seems that observation and research have led to the understanding that ultraviolent light beamed to the surface of the Earth which arrives in UVA and UVB form [UVB the more damaging; its short waves filtered out by car windows], sees the UVA rays penetrate those side windows.

The more complex glass with the light plastic sheeting in the centre is efficient at filtering out both UVA and UVB light; an unanticipated byproduct of serendipity in providing safety in crashes from flying glass, and at the same time offering a shield from the harmful sun rays that penetrate the side window glass. Which went a long way to explaining the puzzle that dermatologists struggled with; the presentation of patients with damaged skin, including skin cancer on people's left side of their faces and necks.

In Britain, Australia and Japan, it would be the right side of the face that is affected, for obvious reasons, reflecting the side of the road driven on. In a study that took place in 2010 of American subjects, it was noted that skin cancer on face and neck appeared on the left side in 52.6 percent of cases and on the right side in 47.4 percent of instances. A total of 890 patients were studied; these were people who had arrived for skin cancer surgery at a single medical clinic.

In Australia, the effect of right-side skin cancer has been named "cabbie cancer", to reflect drivers spending their working day in cars and their resulting susceptibility. It is unknown why it should be so, but studies reveal that the occurrence is more commonly seen in male than in female drivers. A California ophthalmologist who happens to also be a medical editor on the website WebMD, published an analysis of how much UV light penetrates side car windows.

Sun shining through a car's side window can be a skin cancer risk, dermatologists have said. Digital Vision, Getty Images

Dr. Brian Boxer Wachler studied the phenomenon in 29 vehicles manufactured by fifteen different companies, produced between 1990 and 2014 from the perspective of how eyes are affected by the influx of UV light penetration in vehicles. He found that the average side window succeeded in blocking out 71 percent of UV light, but also found that four of the cars studied blocked over 90 percent. His results saw publication recently in JAMA Opththalmology.

Until all car windows feature the same kind of three-ply protection, with two pieces of glass sandwiching a thin plastic sheet for the windshield, the recommendation is that alert people take to applying sunblock for UV protection, even while driving.

Zoran Bozecevic / Postmedia  Research has shown that ultraviolet A rays can penetrate through car windows.

Born To Sing

"When you know you're going to die, you can control what your last words are. This is sort of like that. There's nothing that exists on the face of this earth that I love more than singing. Even as a kid, I never wanted to be a fireman or a policeman or an astronaut, it was always a singer."
"They [surgeons] told me, 'Any longer than that [a month after the original scheduled surgery date] and you're going to die'. I just wanted to know how much longer I could have to sing and to make this record."
"When they told me they were taking my voice, I didn't go hide in the corner. I started a crowd-funding campaign. It wasn't about focusing on the grim reality. It was about being able to make the last statement, being able to say this is my last song, my last record. A chance to say thank you. I want the album to be out before I die."
"I think it's going to suck [life without a voice]. I think it's going to be really sh---y. But ... I want to think of funny ways of handling it. I want to be able to walk into a room and still make people laugh."
"I just don't want to get angry. I don't want to be a bitter sick person. I don't want it to be my identity I don't want to be, 'the guy who had his larynx removed'. I'm a total person. This is just something that's happened."
John Cody, 53, singer, songwriter, musician, Montreal, Quebec

Canadian singer/songwriter John Cody is about to have surgery on his cancerous larynx, and so finishing up his album has become a mad rush.  (Rick Madonik / Toronto Star)

When he was four years old, John Cody had come into possession of a broken microphone, and he cherished having it, imagining no doubt, as a child will, that somehow it still worked and he could project himself with it to an appreciative audience, and he began aspiring to make that a reality. At age twelve he taught himself  how to play guitar, he wrote his own songs by age 15, and by the time he turned 17, began playing professionally. Music became his life's purpose and pleasure.

He is a born performer. And he's been around. So have  his songs, recorded by other musical artists. He has an American gold record hanging on the wall of his one-bedroom apartment in Montreal, recognizing his performance on "Life is a Highway". He has another for his role in co-writing "The Fundamental Things" for Bonnie Raitt. Among those who have recorded some of his songs have been Holly Cole and Lynn Miles.

But he also has three of his own solo albums. He lived for 21 years in Los Angeles. But he has returned to his home base of Montreal where his parents and other family members still live. And he aspired to produce his final recording at a studio in Toronto. It will be his fourth album, produced to a very tight deadline, to beat the surgery that will still his voice forever. It isn't the colon cancer he's had for years, or the degenerative auto-immune disease, nor the umbilical hernia surgery scheduled for fall surgery.

What felled John Cody's voice was simple misfortune. Four days ago he underwent surgery to have his larynx removed because there was no other option than to excise the cancer that had invaded his larynx. All he ever wanted was to have his voice soar into the atmosphere. And it no longer will. He only learned of the cancer that had struck his larynx in March and his reaction was to convince surgeons to hold off as long as possible, to enable him to leave a final legacy.

He had to focus not on the cancer that was destroying his larynx and his future as a musician, but the practical details of how to go about funding another album. It would take $15,000 to pay for studio time, equipment to be rented, musicians to be engaged. And he didn't have the funding required. He lives on social assistance in his apartment alone but for his cat, Root Beer.
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A charity providing emergency relief to those in the Canadian music industry stepped forward.The Unison Benevolent Fund has paid his rent for the past year, and helps with the groceries. Cody posted his fundraising situation on he  youcaring.com site, and $4,000 was raised in small donations from friends and admirers. In June, Slaight Music of Toronto -- dedicated to aiding the development of Canadian musicians, contributed a critical $10,000 toward the recording goal.

During the recording sessions cortisone injections and ventilators helped him through the studio sessions to ease the pain and discomfort in his throat. Since then, he's been preparing for the time when he could no longer speak by recording some of his typical expressions on his iPad. At the touch of a screen his voice will respond when he is with people and wants to express a thought. He plans to learn sign language. And he has recorded sentences through a voicebank, vocalID.co.

"At the end it can synthesize your voice so when you're using adaptive devices, it's actually your voice instead of a robot voice. There's so much to do but I have such little energy. I feel like a plate spinner who hasn't rehearsed", he sighed. He hadn't wanted a percutaneous tracheotomy that would have left him the ability to speak through an electronic device.

"But then I wouldn't be able to play my chromatic harmonica, which would make me very unhappy. I'm not going to play the harmonica out of my neck."

John Cody at his last public performance, which became an emotional affair.  (Todd Korol) 

Blood Transfusion Outcomes

"We were surprised by the one result and we're trying to explain why, now [a clinical study is needed in confirmation of database-matching study]."
"It [a reasonable explanation] just hasn't expressed itself [donors under 30 or 40 might have pre-disease compromised blood]. Maybe that's at play."
"These results are intriguing and suggest that if you require a transfusion, your clinical outcome may be affected by the blood donor's age and sex. However, it is important to remember that our study was observational in nature, which means it cannot be considered definitive evidence."
"Donors should still donate because blood transfusions are life-saving and that’s a really important message."
Dr. Dean Fergusson, senior scientist, director, The Ottawa Hospital clinical epidemiology program

"[The surprising results could have something to do with the immune system of younger blood donors] Young people have an immune system that is more active and aggressive against invasions."
"We should not change our transfusion practices based on a single study. It is the first to have made this observation and it has yet to be confirmed."
Dr. Michaël Chassé, intensive care physician, CHU de Québec, formerly affiliated with the Ottawa Hospital Research Institute

If the study's results are confirmed, it could be the start of more personalized blood transfusions. (Ryan Remiorz/Canadian Press)

This is a study whose results astonished the researchers who had anticipated an entirely other result than that which they found when studying the outcome of patient mortality after blood transfusions.
The wide-ranging survey, conducted by researchers affiliated with the Ottawa Hospital Research Institute (OHRI), demonstrated an unmistakable link existed between the age and gender of donors and the risk of death in blood transfusion recipients in the year following the transfusion.


It was discovered by the study researchers that the mortality rate of 36 percent accompanied transfusion of six units of red blood cells from a female donor as opposed to a 27 percent mortality rate when transfused blood came from a male donor. This is a finding that certainly runs counter to both the wisdom of common assumption, previous studies and the preferences of youthful blood donors over that of more mature subjects to help build Canada's blood bank inventory.

Those patients who received red blood cells from women between the ages of 17 and 20 experienced an eight percent increase in risk of death per unit transfused. There was a narrower risk of death experienced with each unit transfused when the donor age group ranged between 40 to 50-year-old women. It could be, mused Dr. Fergusson, that the higher mortality rate reflected the quality of the blood from younger, pre-menopausal women who are inclined toward anemia.

Furthermore, he stated, pregnant women carry antibodies derived from their children. In contrast, males carry only their own antibodies. Blood from older donors, theorizes Dr Fergusson, has a tendency to improve survival rates for the simple reason that if older people are still able to donate it equates with their having healthier bodies, since they haven't succumbed to the chronic conditions and diseases that often accompany the passage to old age.

All of this is pure speculation, even if within the realm of educated guessing. It will only be when clinical tests and studies verifying these initial findings validate the conclusion, that medical science will know with certainty cause-and-effect. Donors under 30 or 40, stated Dr. Fergusson, could conceivably be in a pre-cancerous, -heart disease or other ailments state. The findings, however, should not deter young women from donating blood, until clinical confirmation.

For the study, Dr. Chassé and his colleagues analyzed anonymous medical records made available to them for the purpose of studying 30,503 patients who received 187,960 blood transfusions from 80,755 separate donors through collaborating with Canadian Blood Services (CBS) and four Ontario hospitals. The group of patients was followed over a seven-year period to compare the survival rate of patients who received blood from donors of different ages and genders.

Vice Renewals Rediscovered

"These are preventable deaths ... what ends up being more than a death a day following each cheque issue. It would be warranted to look at methods ... to try to reduce this avoidable mortality."
"You see this cheque-week after cheque-week, month after month, year after year. The pattern is so consistent."
Michael Otterstatter, B.C. Centre for Disease Control epidemiologist

"You've been in a state of stress and survival and hunger and cold for the whole month and  you get this [welfare payment]."
"I think anyone's reaction would be to spend a little on what gives you enjoyment."
Trish Garner, B.C. Poverty Reduction Coalition

Rob Kruyt / Postmedia   “You’ve been in a state of stress and survival and hunger and cold for the whole month and you get this (welfare payment),” says Trish Garner of the B.C. Poverty Reduction Coalition. That impulse to indulge after a month of austerity. can be fatal.

 

"Most Canadians would argue that their investment in social assistance programs should be for the assistance of that individual's well being, rather than harming them."
"And alcohol ... and illicit drugs harm people."
Dr. Joel Ray, internal-medicine specialist, St.Michael's Hospital, Toronto

People line up in Vancouver to pick up their welfare checks on a Welfare Wednesday.
GLENN BAGLO / VANCOUVER SUN

A new study by British Columbia researchers published in the International Journal of Drug Policy that looked at illicit drug use and the connection between a sudden resurgence of drug overdoses and the regular receipt of welfare payments coinciding, has led to the conclusion that one triggers the other. At the very least, one enables the other. The regular monthly welfare payments meant to be used for the necessities of life are being used for what down-and-out drug addicts consider the necessities of their lives.

Their survival in addiction-mode is linked to where their next fix will come from, when it arrives, and what they can afford. Suddenly, with a cheque in their hands cashed and ready to go, they are able to acquire their fix and there are no immediate restrictions in what they can afford. This is being called the "cheque effect", the kind of flirting with dangerous outcomes that drug abusers expose themselves to when bingeing.

Why a research project had to be undertaken to understand that this is happening is strange, since it has long been known that this is what happens to alcoholics when they receive their monthly stipend through welfare, enabling them to march right over to acquire the brand of alcohol that most suits their purpose of becoming thoroughly alcohol-sodden, and the consequent risk to life. Perhaps not as immediately as with drug overdoses, but perfectly effective given enough time.

Links are also being theorized with respect to the issue of cheque-and-acquisition exacerbating the epidemic of Fentanyl abuse and death. Toronto scientists embarked on their own similar study earlier in the year and they concluded that the phenomenon induces people receiving monthly payment to binge on alcohol. It is as though we cannot get it through our heads as a society that human nature cants us toward instant gratification, where we grasp at what appears to be opportunity while not pausing to think rationally.

This is why people who win a lottery so often lose all their winnings in short order as a result of splurging on costly possessions and flinging their winnings about with reckless abandon on what they think they want and what will comfort them, until they discover there is nothing left to be careless with and they're back where they began, in too-short order, hardly chastened, but regretful nonetheless. It's something called human nature.

But the studies have provided for some stimulative thought on the part of provincial ministry officials who may now study the results of the research perhaps to make the determination that one monthly cheque might be divided into smaller cheques available more frequently throughout the space of a month. And if they think it through to its conclusion they might realize that if there were three cheques instead of one, then there might result three splurges instead of one.

In fact, researchers in Canada and the United States and elsewhere in the world have understood that evidence is ample of the cheque phenomenon, the results of which also include beyond overdoses and mortality, more numerous hospital emergency visits. The B.C. study went through data provided by coroners' reports and statistical analysis demonstrated a trend over the period studied.

Twice as many fatal overdoses occurred on the Thursday and Friday after the issuance of regular Wednesday cheque days. An average of 15 deaths a year in British Columbia were linked to cheque timing. In contrast, the Ontario study examined ambulance calls related to licensed establishments in the Toronto area over a nine-year period. Four times as many drunk-related calls to bars and three times as many assaults occurred on cheque day or the day following.