The Influence of "Big Pharma" in the Medical Community

"Multiple studies have shown that doctors have doubts about the ability of their colleagues to remain unaffected by gifts from drug companies, attending sponsored dinners or other interactions with company representatives, but believe that they themselves are immune from being influenced."
Dr. Joel Lexchin, professor emeritus, School of Health Policy and Management, York University, Toronto

"We thought we were providing a balanced educational message [through teaching a curriculum on safe and responsible prescribing of opioid drugs]."
"It is obvious that the benefits of opioid therapy were exaggerated, and the risks underplayed."
Dr. Brian Goldman, host, White Coat, Black Art, CBC Radio

Big Pharma releases data : CTV News

Dr. Lexchin has written a book out of his experience as a medical doctor and a professor of medicine, exploring and setting out what he has gleaned relating to the public relations campaigns that pharmaceutical corporations launch each time they release a new drug to the market, to influence medical practitioners of its efficacy and usefulness in their practise. Free samples pass between pharmaceutical salespeople and the medical community, and augmenting that simple expedient that allows doctors to hand out those samples 'free' to their patients, other emoluments impress doctors with the generosity of the drug firms, gaining their loyalty in response.

Not that this has suddenly become a new threat to physician neutrality in prescribing what he or she may be convinced is the best possible formula that may aid their patients' medical conditions. It is a situation that has been in common practise for as long as anyone can recall. And it has always been recognized for its pitfalls. That busy doctors are vulnerable to persuasion, and when gifts solidify a relationship the potential is there for unintended malfeasance. It merely becomes simpler for doctors to persuade themselves that a drug whose benefits they have been assured of will satisfy the need of the doctor-patient trust.

Dr. Lexchin's book once again raises concerns relating to those questionable ties between doctors and the pharmaceutical industry. Concurrently, a handful of drug companies have released information to the public declaring how much funding they make available to doctors. This was entirely voluntary in nature, reflecting an emerging movement to bring into law a need for pharmaceutical companies to disclose all and any money given to doctors. This disclosure requirement is common elsewhere, including in the United States, and Canada is preparing to join them in this legal requirement.

Of about 45 drug companies operating in and out of Canada, the ten that released data reported they had dispensed over $48-million to doctors in 2016, without divulging the amounts relating to individual doctors, added to the fact that some of the companies released numbers for only part of the year. No details, furthermore, were available of how that money had been spent; the lump sum figure was all that each of the ten companies provided for public consumption.

Dr. Lexchin's book goes into detail about the connections between pharmaceutical companies and medical students they seek to influence, along with organizations, and individual doctors. Out of the opioid epidemic now raging across North America came additional information about the influence drug companies can exert on individual doctors and the impact that influence can result in, relating to the proliferation of prescriptions. An example was the company that manufactures OxyContin, Purdue. It has been fined over $600-million in the United States on charges of misrepresenting how addictive its product is, but never fined in Canada.

Dr. Brian Goldman, a medical popularizer with a much-listened to program on CBC radio, wrote the forward to Dr. Lexchin's book. He had himself once been hired by Purdue with the understanding that he would develop and teach a curriculum on safe and responsible prescribing of opioid drugs to patients suffering from chronic pain. That curriculum urging caution and familiarity with the product's side effects effectively served to white-wash Purdue's responsibility; it had made the effort, if physicians still prescribed the product unheeding cautions, not its fault.

The trouble was Dr. Goldman witnessed first-hand that doctors continued prescribing large doses of opioids, not bothering in their busy practise to perform due diligence beforehand. For example, screening patients, or monitoring them for possible addiction. As a result, Dr. Goldman decided to distance himself from Purdue. He no longer gave lectures for Purdue, or for any other drug company, a collaboration that had tainted him as he concluded that he was being used and the cover he was giving to Purdue did nothing to offset their influence on how doctors viewed the addictive drug they had been assured was completely safe for patient use.

Human Longevity -- A Controversial Topic

"We just don't know what the age limit might be. In fact, by extending trend lines, we can show that maximum and average lifespans could continue to increase far into the foreseeable future."
"Whether it was luck of their genotype [that has people not] hanging in, staying alive despite disease. They just didn't get sick; that can be a debate. But the fact is that, mostly the people who live a very long time, they were always healthy. They didn't have heart disease or diabetes."
"If this trend [average lifespan goes up] continues and our life expectancy of the average person becomes 100, the longest person might make it to 150."
"Probably not you or me. But maybe our grandchildren and great-grandchildren, because it's an ongoing process."
Siegfried Hekimi, professor of experimental biology, McGill University, Montreal, Quebec

"From now on, this is it. Humans will never get older than 115."
"Further progress against infectious and chronic disease may continue boosting average life expectancy, but not maximum lifespan."
Jan Vijg, Einstein expert on aging, Albert Einstein College of Medicine, Bronx, New York City

"So, people are moving into age 120, but we have no idea where that will end."
"Will these people continue to live longer and longer, or is there a certain limit to life expectancy? I think it's an open scientific debate."
Parminder Raina, scientific director, McMaster Institute for Research on Aging, Hamilton, Ontario

Emma Morano passed away last April. At 117 years old, the Italian woman was the oldest known living human being. McGill Newsroom

Professor Hekimi and co-author Brian Hughes have found fault in the journal Nature-published study out of Albert Einstein College of Medicine where researchers analyzed data retrieved from people who lived to 110 or older between 1958 and 2006 in the United States, France, Japan and the United Kingdom to reach their determination that past 115 years of age the world is not likely to see a future of supercentenarians older than that. It was their studied conclusion that 115 represented the end of the journey for humankind's life expectancy.

People, they were convinced, who at the present time reach 110 do so with no greater life expectancy in the long term than their predecessors who lived to that grand old age in the 1970s. The age of death of the world's oldest had not increased since 1997 when the oldest documented person who ever lived, Jeanne Calment, died at age 122. It was, however, a conclusion that these two Canadian researchers held in doubt, despite its celebrated worldwide sensation.

Their paper also published more currently in Nature, pointed out what they perceived as a flaw in the analysis brought to bear by the Einstein group on the limit they set for supercentenarians, arguing as they did that the maximum human lifespan has plateaued. Work conducted with worms and mice in Professor Hekimi's laboratory has demonstrated that a single alteration in the smallest piece of DNA of nematode worms allows the animals to live five times longer than normal. Their research, they feel, could at some future date allow scientific interventions that would slow down the human biological aging rate.

Professor Hekimi feels that in the future it is entirely possible that people could live to 150, or even longer. And not, he emphasizes in poor health, citing observational studies of centenarians that demonstrate that a category of individuals somehow manage not to become ill with the body breakdowns that plague us in old age. He foresees that an increased lifespan goes hand in glove with a longer, healthy lifespan. Jeanne Calment, despite her extended lifespan became blind and hard of hearing, had mild heart failure and rheumatism, but was reported to be in good health before she died.

"It was obvious to me this was a weak analysis", Professor Heikimi states of the Einstein study published in October when the biological human life limit was placed at 115 years. That study pointed out that there was a steady increase between the 1970s and early 1990s of supercentenarians' longevity, but that around the year 1995 that kind of life expectancy came to a sudden plateau and stayed there. Their conclusion centered around their belief that there is no greater life expectancy for people reaching 110 today than those who lived back in the 1970s.

The two McGill researchers are critical of the Einstein team decision to split data into one group before an arbitrary date and a second one after that date. They chose themselves not to divide the data set and discovered a long-term increasing trend did in fact manifest in maximum life expectancy, and saw no evidence of the increased trend stalling. The life expectancy of Canadians since 1867, the year of Confederation, has more than doubled to 82 (80 for men, 84 for women). It is reasonable, says Professor Hekimi that maximum lifespan follows a like trend.

There were 8,230 centenarians accounted for in the 2016 Canadian census, representing a 41 percent increase over figures gathered in 2011. Currently North Bay resident Ellen Gibb is the oldest Canadian supercentenarian alive, having greeted her 112th birthday this past April.

The Fountain of Youth by Lucas Cranach the Elder, circa 1546

Youth-Rejuvenating (natural) Hormonal Treatment

"It is something that is being promoted purely on the basis of the marketing, and not based on anything that shows it is better [than conventional hormone-replacement therapy]."
"The main claim is that it is safer than conventional hormone therapy, and there simply is no evidence to support this."
"That kind of regulation [regulatory body investigating only after complaints] is not proactive. Somebody gets harmed first before the regulator acts."
Ubaka Ogbogu, law and pharmacy professor, University of Alberta

"The risks are not yet well understood."
"They [bioidentical  hormone therapy -- BHT] may have the same breast cancer, stroke, blood clot, heart disease and dementia risks that synthetic hormone therapy has."
Health-Link BC

Bioidentical hormone therapy is often called "natural hormone therapy" because bioidentical hormones act in the body just like the hormones we produce. But here again, that tricky word natural muddies the waters. Pregnant mares' urine is natural, but Premarin is not bioidentical, at least not to human estrogen. The same goes for Cenestin, which is made from plants but is not bioidentical.

Check the Internet for websites operated by medical doctors and pharmacies -- doesn't everyone and anyone? -- promising "anti-aging" treatment achieved through the use of natural products, and since they're 'natural' they are, of course, guaranteed to be safe, to be effective and a hugely lauded 'natural' alternative to the kind of hormone-replacement therapy that was at one time prescribed wholesale for menopausal women who failed to appreciate the symptoms of menopause, until an American study revealed its conclusions in 2002 that the standard menopausal drugs actually increased breast cancer, coronary artery disease and stroke risks.

Suddenly hormone replacement therapy that enjoyed such a trusted and ubiquitous prescriptive mode, lost its considerable share of the market, and women searched instead for home remedies like Evening Primrose and soy products to relieve their symptoms of hot flashes and night sweats. And then along came 70-year-old Suzanne Somers touting the miraculous effects of bioidentical hormone therapy to maintain her lithe and lovely youthfulness in apparent agelessness.

Actress Suzanne Somers in 2013 in Toronto as she promoted a book on bioidentical hormone therapy. THE CANADIAN PRESS/Nathan Denette

A new Canadian study points out that despite the claims these businesses make of the extraordinary effectiveness of BHT and particularly the brand they're selling, there has been no research to support their claims and nor are the 'natural' therapies they're busily vouching for approved by national health regulators. This is an elemental failing that has been emphasized by the University of Alberta professors responsible for the study and its conclusions.

Their research is claimed to be the first to study online advertising of the treatment through a scientific lens. It represents added evidence of the influence that those supporting unproven health products have on impressionable consumers, while the purveyors who have bypassed regulatory approval take advantage of their medical credentials to impress those reading their incentivizing advertising that everything they claim is reliable and reflective of reality.

The popularity among the general public of potential consumers of bioidentical hormone therapy has risen sky-high. One U.S. business consultant places the value of the business at $2-billion, in the United States. What has captured the public attention is the inference that the hormones which are derived from plants like soybeans and supposedly compounded specifically by pharmacists to match individual needs, are identical in function and practicality to the hormones the human body produces.

The researchers from University of Alberta studied claims on 100 websites of various health professionals, 59 percent of which were Canadian, to discover that over 60 percent claim bioidentical hormones are safer than conventional hormone-replacement therapy, and a quarter of the sites state the hormones are "protective" against breast cancer, leaving the impression among the gullible that their product had the potential to prevent the disease.

At least half of the sites described the medicines as anti-aging, while 70 percent labelled them as natural products. One in two of the websites were operated by medical doctors, 19 were driven by pharmacies and others reflected the businesses of natural-health practitioners. Lead author of the study, Nese Yuksel, a professor of pharmacy, emphasized that those plant hormones have been chemically processed to mimic human hormones, which places claims of 'natural' hard up against the reality of semi-synthetic.

"They're promoted as being natural, but they're actually not", affirmed Professor Yuksel who had herself worked for two pharmaceutical companies making conventional hormone treatments. As well, a number of women's health and allied medical organizations have reached the conclusion that no basis exists for suggesting that bioidentical hormones are indeed safer or that they are an improvement over conventional replacement hormone therapy.

According to the Food and Drug Administration (FDA) and several medical specialty groups, the hormones marketed as "bioidentical" and "natural" aren't safer than hormones used in traditional hormone therapy, and there's no evidence they're any more effective.
The term "bioidentical" means the hormones in the product are chemically identical to those your body produces. In fact, the hormones in bioidentical medications may not be any different from those in traditional hormone therapy. Several hormone therapy products approved by the FDA and prescribed by health care providers contain bioidentical hormones.
"Natural" means the hormones in the product come from plant or animal sources; they're not synthesized in a lab. However, many of these products still need to be commercially processed to become bioidentical.

"Pink Viagra"

"Where are the crowds of women with low libido clamouring for Addyi?"
"They never existed, except in a public relations firm's fantasy."
PharmedOut, Georgetown University Medical Center, Washington

"The FDA is being responsible ... yes."
"[However], some people are now arguing REMS [risk evaluation and mitigation strategy] was a scare tactic the FDA imposed because it didn't particularly like being dragged back into this whole debate about whether HSDD [hypoactive sexual desire disorder] is truly an unmet medical need."
"[Female sexuality is] a much more sophisticated process [than what Viagra overturns by increasing blood flow to the penis]."
Dr. Jim Pfaus, professor of psychology, Concordia University, Montreal

The Food and Drug Administration on Tuesday, Aug. 18, 2015, approved the first prescription drug designed to boost sexual desire in women, a milestone long sought by a pharmaceutical industry eager to replicate the ockbuster success of impotence drugs for men. AP Photo/Allen G. Breed

Professor Pfaus has a personal interest in the debate, having led some of the earliest studies to determine effects of flibanserin [Addyi] on female rats' sexual desire and resulting copulation. And while he conducted research for the Canadian Institutes of Health Research, he also was in receipt of consulting grants from Addyi's original formulator, Boehringer Ingelheim, before it was bought out by Valeant Pharmaceuticals International, headquartered in Quebec.

There are those who claim that governmental drug regulators have set up barriers for access to this 'pink Viagra', restricting access by requiring doctors and pharmacies to obtain certification to prescribe or dispense the pills. Instructions that accompany the drug include the warning that women using it must never drink alcohol while using the drug, which has the capacity to cause low blood pressure and syncope, a sudden loss of consciousness.

When Sprout Pharmaceuticals obtained FDA approval for the Addyi it was producing, realizing success on the third try after the drug had seen rejections over safety concerns, Valeant bought the copyrighted formula along with the company itself for $1-billion. That gamble rested on the assumption that Addyi would turn out to be as successful on the consumer market as its male predecessor has been.

However, there is a world of difference between the two drugs' interaction with the human body; Viagra's effect was mechanical, while Addyi's is psychological, in essence sending its message to the brain. Addyi must be taken daily, unlike Viagra whose calculated use is just before sex, to increase blood flow to the penis. Unlike Viagra which sold over a half million prescriptions in its first month on the market in 1998, a mere 23,000 prescriptions were dispensed for flibanserin in the U.S. since 2015.

When it was approved in August 2015 by the U.S. Food and Drug Administration, it was said to be with the proviso that advertising on television or radio not take place for the first year-and-a-half of its commercial availability. In Canada the drug remains in uncompleted review status by Health Canada, though it had been submitted over a year ago for approval. Critics of the drug feel its lackadaisical uptake reflects women's unwillingness to use Addyi.

It comes at quite the cost; $800 (U.S. monthly), and nor is its effect particularly assured. It is recognized as a risky drug which produces an average single extra "sexually satisfying event" per month more than would a placebo replacement. Valeant is now free to begin advertising its controversial wares through "education awareness" campaigns to convince women that their sex problems are commonplace, and they can rely on a pill to achieve the quality of sex they deserve.

Sex on the brain -- Irving Penn

Their public relations advertising campaign is entitled Find My Spark, offering a sex health quiz and video clips where doctors who see women with low sex drive empathize with those who feel "inadequate -- as a woman, as lovers and as partners". "Information" campaigns with subtle messages such as: "that it is imperative that women be sensitized to this public health problem" are now on the horizon.

Illegal Asian Wildlife Trade on the Menu

"Legal trade stimulates demand, confuses law enforcement efforts, and opens a huge opportunity for laundering illegal products, which is why ivory markets are now being closed globally."
Scott Roberton, director, Wildlife Conservation Society, Asia program

"When fingers are pointed at China about their tiger farms, they tend to point the finger back at the U.S. and say, 'They have as many tigers as we have, why are  you not criticizing them'?"
Leigh Henry, senior policy adviser, World Wildlife Fund

At the Kings Romans complex in Laos, tigers roam cages. Photograph Adam Dean, The New York Times

It seems rather lunatic, and likely because it is certainly immoral, yet across the United States an estimated five thousand tigers are held in petting zoos and even as attractions at truck stops. Most unbelievably they are also privately owned by people who seem to feel that a tiger out of its natural element will do just fine as a pet living somehow in their backyards. The kind of stupidity and hubris exhibited by people who don't appear to be capable of thinking beyond their own vain conceits is mind-boggling. But they're not on the menu.

On the other hand, there is yet another dimension to the keeping of these large cats in confinement, away from their natural habitat, and that is for the purpose of entertainment yes, but also as culinary stars in the East, where jaded tastes require a pick-me-up such a placing rare animal meat on the menu. As unlikely as it may seem, there are those people living in the East whose 'refined' tastes include a yen for tiger meat on their plates.

In Laos, a casino operated and owned by Hong-Kong-based Kings Romans Group comes complete with hotels, a cockfighting and bullfighting ring, a shooting range, shopping center and a zoo. This leisure entertainment complex is located in an area named the Golden Triangle Special Economic Zone. As for the zoo, it is claimed by conservationists that it is in fact a holding centre, a farm where animals are raised for slaughter.

Throughout Southeast Asia such farms are commonplace, where big cats of noble lineage are kept, illegally butchered for a profitable industry comparable in illegality, harmfulness and profitability to the global drug and arms trades, alongside that of human trafficking. All of which speak volumes for the sensibilities and morality invested by nature in human beings.

At Kings Romans, restaurants feature plates of bear paw, pangolin (on the endangered list) and sauteed tiger meat. Tiger wine is also available for the discerning food-and-wine aficionado. "The place is just a mess. Pretty much anything goes", commented Debbie Banks, with the Environmental Investigation Agency in London, who in 2015 with the group Education for Nature-Vietnam issued a report.

Kings Roman Group casino, Golden Triangle Special Economic Zone. Photographs by Adam Dean for The New York Times

From that report the world could have learned that meals, medicine and jewellery produced from tigers, leopards, rhinoceroses, bears and elephants -- all protected species -- were being sold openly in the economic zone, spurring the Laotian government to stir itself to raid a few businesses. Little, however, changed beyond that "cosmetic effort", reports Ms. Banks.

In Laos, an estimated 700 tigers are held on farms, with thousands more believed kept throughout Southeast Asia. There are over 200 breeding centers in China where an additional 5,000 to 6,000 tigers are kept. Contrast that with the fact that fewer then four thousand tigers remain in their wild natural setting. It has been rumoured from trusted sources that some Laotian politicians are involved in the farms.

All Southeast Asian nations signed on to the Convention on the International Trade in Endangered Species (CITES), in effect agreeing that tigers can be bred, but only for conservation purposes. Conservationists have a stock of evidence that zoos and farms serve as fronts for commercial big cat breeding in Laos and other Asian countries.

Two tiger farms in China are supported by government investment. In China there are government officials who feel that such facilities should be legal, on the basis that their presence relieves pressure mounted to hunt wild animals for their body parts and organs. An investigation that took place in 2008 revealed that half of 78 wildlife farms surveyed launder animals caught in the wild.

That investigation by Vietnamese officials in tandem with the Wildlife Conservation Society, was augmented by a later 2016 study of 26 Vietnamese wildlife farms which found that each and every one took part in laundering; presenting animals as being farmed when in fact they were caught in the wild.

A tourist at Thailand's Tiger World, Photograph by Adam Dean for The New York Times

Overdose Capital of the U.S.

"Heroin is the devil's drug, man. It is."
"No one wants their family to find them face down with a needle in their arm."
"But no one stops until they're ready."
Cliff Parker, 24, heroin user, Akron, Ohio

"July 5, 2016 -- that's the day carfentanil hit the streets of Akron."
Captain Michael Shearer, commander, Narcotics Unit, Akron Police Department

Drugs seized by Montgomery County (Ohio) Sheriff's officers  (Montgomery Sheriff's Office)

Akron, Ohio got their initiation into the devastating effects of a powerful sedative used to sedate huge beasts like elephants, when it appeared on their streets likely sourced from China through the Internet and being used to adulterate more expensive drugs for higher profitability. People using illicit street drugs looking for a kick, and a high more dramatic than the ones they'd become accustomed to and were dissatisfied with, began to get more than they'd bargained for.

On the day that Captain Shearer was commemorating with huge regret, 17 people overdosed, with one of them dying over a tortuous nine hours. The following six months saw 140 overdose deaths of people testing positive for carfentanil, verified by the county medical examiner. With fentanyl, the still-highly-dangerous but more moderate of the two drugs and carfentanil, overdoses can present as sufficiently severe that even multiple doses of naloxone -- the anti-overdose medication -- can barely rescue people from death.

Fentanyl has been around for awhile. Its legitimate use in the medical community is that of a pain reliever. It is commonly prescribed in amounts carefully judged by those skilled in pain management for people suffering pain. It is also used in hospital settings during surgery and following surgery to help manage the pain that accompanies surgical intervention and its follow-up recovery. As such its use is monitored and carefully gauged and stopped once its work is deemed to have succeeded.

But it is also a drug that has been seen more and more frequently during drug seizures over the past three years across North America. Most frequently fentanyl is sold as heroin on the street. Alternately drug traffickers make use of it to produce cheap counterfeit prescription opioids. Its cousin carfentanil is 5,000 more powerful than heroin, and it is well known that a few grains of the drug can be lethal.

Lisa Roberts gives a naloxone auto-injecter to a group of women who live under a bridge in Portsmouth, Ohio. (Jon Castell/CBC)

So much so that the requirement of multiple applications of naloxone to save a life has become common. Rescue crews (first-responders) "are hitting them with 12, 13, 14 hits of Narcan with no effect", observed Doyle Burke, the chief investigator at the Warren County coroner's office in Ohio. And this situation is only  going to become more common, with overdose deaths continuing to spiral upward, according to Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention.

As Dr. Frieden points out, this represents the sole aspect of American health becoming significantly worse over accelerated time. In excess of two million Americans are thought to be dependent on opioids, with another 95 million who used prescription painkillers in the past year. "This epidemic, it's got no face", commented Chris Eisele, president of the Warren County Fire Chiefs' Association. Lawyers, accountants, young adults and teens from middle-class backgrounds attend Narcotics Anonymous meetings in Deerfield Township.

There has been 312 drug deaths in Summit County in 2016 alone, a 45 percent increase from 2015, and over triple the 99 cases that the medical examiner's office saw just two years earlier. Last year -- according to Gary Guenther, chief investigator of the county medical examiner's office -- saw so many deaths that the county was forced to have refrigerated trailers brought onto site to store bodies when the morgue had run out of space, on three occasions.

"The problem is getting worse every day. We don’t have enough police resources to combat it. We work very hard, it’s changed our jobs."
"We’re trying to be proactive. People say to us: ‘We didn’t know, we don’t understand’ the scope of the crisis."
"I don’t know, with everything that’s out there, how some people still don’t know [about the epidemic]."
"They're overdosing in the jails and in courtrooms."
Montgomery County Sheriff Phil Plummer

Public health nurse Lisa Roberts leads Project DAWN, the first program in Ohio to put the anti-overdose drug naloxone into the hands of users. (Jon Castell/CBC)

On The Cancer Front....

"Currently, every year we're seeing an increase in the number of cancer cases in Canada. So between now and 2030, for example, we expect to continue to see a dramatic increase in the number of cancers diagnosed in Canada."
"That is a reflection of the growing and aging population. About 90  percent of all the cancers that we expect to be diagnosed in 2017 will be among Canadians 50 years of age and older."
"Declines in death rates have been largely driven by decreases in lung cancer incidence and mortality. So tobacco control in general has had a big impact on our death rates."
Leah Smith, epidemiologist, Canadian Cancer Society

Four cancers -- prostate, breast, lung and colorectal -- remain top of the list reflecting the most common cancer malignancies to strike Canadians. Those four types of cancer account for over half of the diagnoses of cancer and the trend continues into 2017. More people are expected to die of lung cancer than any other cancer, an anticipated number of 21,100 for 2017, representing more deaths from one cancer alone than the other three top-listed cancers in combination (19,200).

Approximately 45 percent of newly diagnosed cases occur in that segment of the population aged 70 and older, according to Ms. Smith. As greater numbers of the population age, so does the number of diagnoses of cancer rise. Cancer is projected to cause death to roughly one in four Canadians. Yet mortality rates have been steadily declining from the time in 1988 when deaths due to cancer were at their peak.

That decline is largely attributable to screening for cancer performed at an increased rate, along with improved treatment, adding up to larger survival rates among women. There are not many families who have missed an acquaintanceship with this dread disease, either from one close, or a number of distant members being diagnosed. And some unfortunate families have been deluged with an incidence of diagnoses that seems to hit just about everyone in the family.

In one family alone an aunt died of breast cancer, and when her niece became a new mother her husband developed osteosarcoma requiring a bone transplant and "dramatic" bouts of chemotherapy. Three uncles then succumbed to lung cancer as a result of lifelong smoking habits. And then the woman's father developed fatal colon cancer. After which her brother was diagnosed with skin cancer. The woman herself was diagnosed then with breast cancer. And then her mother had a soft-tissue sarcoma, dying two years after diagnoses.

Still, survival rates are increasing for some cancers in particular, quite dramatically. Of Canadians diagnosed and treated for cancer, some 60 percent will survive five years or longer. With the exception of pancreatic cancer which has an eight percent, five-year survival rate, representing the most negative prognosis of the 23 malignancies reported on by the Canadian Cancer Society. An estimated 5,500 Canadians will be diagnosed with cancer of the pancreas, of whom 4,800 will die of the disease.

It is estimated that in 2017:

• 103,100 Canadian men will be diagnosed with cancer and 42,600 men will die from cancer.
• 103,200 Canadian women will be diagnosed with cancer and 38,200 women will die from cancer.
• On average, 565 Canadians will be diagnosed with cancer every day.
• On average, 221 Canadians will die from cancer every day.

Lung, breast, colorectal and prostate cancer are the most common types of cancer in Canada (excluding non-melanoma skin cancer). Based on 2017 estimates:

• These cancers account for half (50%) of all new cancer cases.
• Prostate cancer accounts for about one-fifth (21%) of all new cancer cases in men.
• Lung cancer accounts for 14% of all new cases of cancer.
• Breast cancer accounts for about one-quarter (25%) of all new cancer cases in women.
• Colorectal cancer accounts for 13% of all new cancer cases. 

The Globe's Foremost Apex Marine Predator

"We've been chased out of the Bering Sea. [Electronic noisemakers to frighten them off?] It became a dinner bell."
"It's possible at some point they [Orcas] might start hitting the pot [conversion to giant fishing traps called pots]."
"When I started fishing in the early '80s, when we saw a whale it was an event. Now, they circle the boat."
Paul Clampitt, co-owner F/V Augustine, Washington State

"[Orca pods close to the Aleutian Islands are like a] motorcycle gang."
"You'd see two of them show up, and that's the end of the [fishing] trip. Pretty soon all forty of them would be around you."
"[Pulling up lines to see some fish merely gnawed] That was them teaching the little ones. It's unfortunate the orcas are putting us out of business, because they're really a phenomenal mammal."
John McHenry, owner, F/V Seymour, Alaska, Aleutian Islands

The animals have learned to target individual boats, and are leading fishers on high-speed chases to get away : AP Photo/Elaine Thompson)

Are animals intelligent? Can they assess situations and react to them to further their own interests? Ask the fishermen who have been experiencing some unusual episodes of new behaviour expressed by aggressive orcas, forming pods skilled in harassing boats and harvesting their fish. "Since 1997, reports of depredation have increased dramatically", a report by the Southeast Alaska Sperm Whale Avoidance Project has noted.

It has by now been well enough witnessed and documents that orcas can patiently wait for fishermen to acquire a halibut cache, even if it takes all day, to then move in to strip the fishing lines. Cod and halibut fishers off the coast of Alaska have traditionally experienced peaceful coexistence with the orcas in the region. That was then; now the orcas have turned on the fishers to strip them of their catches.

Sperm whales, large and square-headed, have been pillaging fishing lines as well. A video taken in 2006 by the Avoidance Project succeeded in filming one of the 50,000-kg whales as it delicately shook loose fish from a fishing line. "I've had the same sperm whale follow me 70 miles", complained Michael Offerman of the F/V Kristiana.

The Bering Strait separating western Alaska from Russia appears to be the locus where the worst incidents of whale hijacking of fishers has been taking place, though fishing boats across Alaska have been reporting orca harassment. The cost of fish loss from orcas appropriating the fish from lines was estimated at $500 daily, according to a 2014 study.

While a 2015 study of fishing boats in Uruguay where similar fishing techniques are used discovered "the presence of killer whales in the fishing ground seems not to affect the catch per unit effort."  A rebound of North Pacific whale populations resulting from the 1980s moratorium on commercial whaling appears to be linked to the increasing predation of whales on fishing boat catches.

Up to the rebound, cod and halibut fishers' experience had been that of moving among populations of whales surviving the hunt by whaling fleets, where survivors had learned that the approach of a boat engine spelled danger to them. Earlier, in the 1990s, researchers had discovered that a sudden collapse in Pacific sea otter populations was caused by orca predation.

The orca social structure is a complex one; just like humans they have regionally distinct languages and strategies for hunting. Orcas have often been observed to be strategizing new hunting tactics, and teaching those advantageous new techniques to other whales. Alaska fishers claim to be seeing an increasing number of juveniles taught by their elders to snatch fish from fishing vessels.

Inuit have also observed that orcas swimming deeper into the Arctic as a result of polar ice cover melting, have been preying on slower-moving local fauna. Orcas, stated an Inuit interviewed for a 2012 study, would sometimes kill "hundreds" of belugas at one time. "When the killer whales had left the kill site, Inuit would collect the maqtaq (blubber) from the numerous dead belugas."

Making their home in all seven of the world's oceans, orca pods have been witnessed killing other top marine predators, including great white sharks, walruses and leopard seals.

File -- National Post

The Perspective of Moderation

"Lectins are plant proteins that protect the plant and its seeds from being eaten by basically hacking into the animal's immune system, causing the animal to have inflammation."
"The most troublesome plant lectins are found in the hulls of grains, in beans and legumes, and the nightshade family -- specifically the peels and seeds of tomatoes, peppers, eggplants, etc."
"Although I am a voracious plant predator, one has to realize that there is not a human need for fruits and vegetables; just ask an Eskimo."
Dr. Steven Gundry, cardiovascular surgeon, medical researcher, writer, U.S.

This is a medical researcher who believes that lectins, which are the proteins located in some species of plants which nature devised for their protection from predators, could represent the root cause of a number of diseases. Lectins, according to Dr. Gundry, have the potential of causing inflammatory effects on the human body, stimulating gut-related health outcomes such as leaky gut, autoimmune disorder and weight gain.

The condition of inflammation is a warning sign that things are not right. And inflammation is involved in many of the body's health issues, some of which will pass, and others which will help cause far more serious injury to the body.

• Inflammation is the body's attempt at self-protection to remove harmful stimuli and begin the healing process.
• Inflammation is part of the body's immune response.
• The first stage of inflammation is often called irritation, which then becomes inflammation - the immediate healing process.
• Inflammation is followed by suppuration (discharging of pus). Then there is the granulation stage, the formation in wounds of tiny, rounded masses of tissue during healing.
• Acute inflammation - starts rapidly (rapid onset) and quickly becomes severe.
• Chronic inflammation - this means long-term inflammation, which can last for several months and even years.
• Our infections, wounds and any damage to tissue would never heal without inflammation - tissue would become more and more damaged and the body, or any organism, would eventually perish.
• Chronic inflammation can eventually cause several diseases and conditions, including some cancers, rheumatoid arthritis, atherosclerosis, periodontitis, and hay fever.
• Although scientists know that inflammation plays a key role in heart disease and several other illnesses, what drives inflammation in the first place is still a mystery.
• It should be remembered that inflammation is part of the healing process. Sometimes reducing inflammation is necessary, but not always.

Studies, including one report published in the BMJ Medical Journal, have indicated that the consumption of an excess of lectins is capable of damaging the intestinal lining to trigger chronic inflammation. Chronic inflammation can be responsible for the onset of asthma, Crohn's disease and arthritis, as pointed out in a scientific paper published in Live Science. In other words, eating some species or genus of fresh, unadulterated fruits and vegetables may now come with a caution.

On the positive side, Dr. Gundry also points out that some plant foods that fit his potentially dangerous labelling contain as well health-enhancing befits such as polyphenols which have the capacity to improve the immune system, as well as the brain, nerve and blood vessel functions. But does that balance out the caution being issued on avoiding lectin-containing vegetables and fruits?

Yet another headache for those people who are ultra conscious of avoiding gluten and genetically modified grains and food products, along with saturated fat (whose reputation has recently been given a reprieve), excess salt and the avoidance of sugar, fructose, glucose, etc. But wait: nutritional advice that goes heavy on the recommendation of weighing one's diet heavily in favour of fresh fruits and vegetables on a daily basis needn't be thrown into the waste-bin.

Remember that old adage of moderation being the key to solve most problems? Even the ancients knew all about moderation, they called it the Golden Mean, and for good reason. Dr. Gundry's book The Plant Paradox, may focus on the potential for ill in certain fresh vegetables on the human alimentary system, but take a close look at what he says; they may cause problems. And they may not.

It's somewhat similar to scientists isolating a certain ingredient or chemical or mineral that they believe to be cancer-causing, because in laboratory mice they have proven to be so. And then one discovers that in the experiment, the test animals were exposed to the carcinogenic item in massive amounts, amounts so great that in the natural world that massive intake would simply never occur.

In the case of lectins suspected to be a source of inflammation onset, it's not a little that goes a long way; it's a lot that may cause the problem. How likely is it that anyone will pig out on eggplant for example, eating it in great amounts on a continuous basis? Consuming reasonable amounts of fresh fruits and vegetables with a focus on variety and quality not quantity and not favouring a very narrow type, ensures we get the vital vitamins and minerals and roughage required in our diet.

So go ahead, eat a colourful and fresh variety of fruits and vegetables daily, and be reasonable about amounts you consume.

Inflammation helps wounds heal

Our immediate reaction to a swelling is to try to bring it down. Bearing in mind that inflammation is an essential part of the body's attempt to heal itself, patients and doctors need to be sure that the treatments to reduce swelling are absolutely necessary and to not undermine or slow down the healing process.

The first stage of inflammation is often called irritation, which then becomes inflammation - the immediate healing process. Inflammation is followed by suppuration (discharging of pus). Then there is the granulation stage, the formation in wounds of tiny, rounded masses of tissue during healing. Inflammation is part of a complex biological response to harmful stimuli. Without inflammation, infections and wounds would never heal. 

Sex Roulette

"Oftentimes, people don't realize they have a gap in their knowledge. People don't know what they don't know."
"I don't think we can call that [2006 survey questioning Canadian women where 64 percent reported an unintended pregnancy, with 61 percent reporting in 2017] much of [a] change."
Dr. Jennifer Blake, chief executive, Society of Obstetricians and Gynaecologists of Canada

"A person who is using withdrawal as a contraceptive method is someone who has not planned for contraception, period. They haven't thought about the need to practice contraception. A significant proportion of Canadian women are essentially making a spontaneous decision in the absence of any planning for sexual activity."
"It's fair to say a wide swath of the sexually active adult population in Canada is not taking care of their sexual and reproductive health."
"We sometimes make the assumption that as teenagers grow into young adults and then into full adulthood, they become naturally more responsible. But we know condom use declines with age. I don't see anything that shows people get better at protecting sexual and reproductive health as they get older."
Alex MacKay, executive director, Sex Information and Education Council of Canada

Condoms are one of the favoured forms of contraception, according to a survey of more than 3,200 Canadian women. WPpost image

A recent survey undertaken by the Society of Obstetricians and Gynaecologists of Canada revealed some interesting, somewhat surprising and most certainly disappointing realities. One of the survey's major findings was that women no longer seek contraceptive information from doctors; instead they look online for their options, even though many of the women responding to the survey stated that they don't necessarily trust online information.

The fact that women, who at one time saw their doctors on a yearly basis for an annual Pap smear, and that routine has been placed on a back burner, with women seeking out their family doctor less frequently may explain in part the situation. What was also revealed was that one in four women has no idea how to proceed when they miss taking a birth control pill, or other hormonal contraception.

IN response to this situation the SOGC is preparing to release a new online source they have named S.O.S., meant to guide women through that scenario and what their response should be. The website SexandU.ca has also been relaunched, with plans to publicize a media campaign later in the year. An online program will expose women to the best forms of contraception from among an array of options, based on age and circumstances.

What the results of the survey revealed that turned out to be the most surprising element relating to contraceptive methods was the identification of one of the most favoured contraception methods; withdrawal. Women in the survey placed withdrawal in third place, following birth control pills and condoms, out of a menu of various contraceptive options.

While Dr. Blake doesn't mind acknowledging that withdrawal can be recognized as a type of contraception, she emphasizes that this cannot be considered a sound pregnancy prevention method, in particular for younger people. Let alone the concerns surrounding the contact and spread of sexually-transmitted infections.

That, added to the fact that most women appeared unaware of many of the contraceptive options that currently exist, surprised the researchers. That many women knew nothing of intrauterine devices (IUDs) as representative of one of the most effective contraceptives available, points to a severe lack of responsibility on the part of women of child-bearing age who are sexually active. A mere 3.7 percent of women in the survey reported having used a copper IUD, while 7.1 percent only had used an intrauterine system or hormonal IUD.

The survey results appear to confirm previous research findings that birth control pills and condoms overwhelmingly represent the most popular forms of birth control. Yet the frequency with which women cite withdrawal as a contraceptive method has the researchers concerned. Withdrawal was used by close to 29 percent of women between the ages of 15 and 19 who responded to the SOGC survey.

In comparison, 45 percent of women between 20 and 29 and 42.7 percent of women between 30 and 50 also made contraceptive use of withdrawal; age demographics that the medical profession might imagine would know better. Concern was also raised over the fact that greater numbers of young women between the ages of 20 to 29 used withdrawal than did teens.

That old adage that "We get too soon old and too late smart" appears to have undergone a strangely unaccountable reversal.

Pregnancy and Marijuana Don't Gel

"Our worry is that because it is made legal [marijuana], people may think it is not a problem."
"While it will be legal [in Canada by July 2018], the SOGC's position is that we believe there are adverse effects on brain development from marijuana consumption until the brain development is finished, which is not until the early 20s. It is legal, but should be strongly discouraged."
"There are safe and more effective medications for nausea in pregnancy. My hope is that it is not used because of the adverse effects on brain development."
"This rise [of marijuana use in pregnancy] is purported to be a combination of the frequency of prescribed opioids for pain control in pregnant women, illicit use, and an increase in opioid-substitution programs for treatment of addiction -- opioids are now being used by a more diverse population that includes pregnant women."
Dr. George Carson, president, Society of Obstetricians and Gynecologists, Canada

"We really want to look at what women are doing now related to substance use -- what is happening during pregnancy, what do women believe, what are their behaviours and where do they get their information."
"We know that 15 percent of women drink alcohol during pregnancy, we don't have the same information around cannabis use -- we are scrambling to try to figure out how we can help target those populations."
Dr. Jocelynn Cook, chief scientific officer, SOGC

Marijuana Use During Pregnancy and Lactation
ABSTRACT: Cannabis sativa (marijuana) is the illicit drug most commonly used during pregnancy. The self-reported prevalence of marijuana use during pregnancy ranges from 2% to 5% in most studies. A growing number of states are legalizing marijuana for medicinal or recreational purposes, and its use by pregnant women could increase even further as a result. Because of concerns regarding impaired neurodevelopment, as well as maternal and fetal exposure to the adverse effects of smoking, women who are pregnant or contemplating pregnancy should be encouraged to discontinue marijuana use. Obstetrician–gynecologists should be discouraged from prescribing or suggesting the use of marijuana for medicinal purposes during preconception, pregnancy, and lactation. Pregnant women or women contemplating pregnancy should be encouraged to discontinue use of marijuana for medicinal purposes in favor of an alternative therapy for which there are better pregnancy-specific safety data. There are insufficient data to evaluate the effects of marijuana use on infants during lactation and breastfeeding, and in the absence of such data, marijuana use is discouraged. 

The medical proscription against the use of alcohol during pregnancy is very well known throughout society. The fact that children are born with withdrawal symptoms in fetal alcohol syndrome is a blight on society. These are children whose full mental faculties have been impaired, whose development along the milestones of maturity will never catch up to their peers whose mothers did not indulge in alcohol and drugs during pregnancy.

Yet despite all that is known and that these behaviours during pregnancy bring into the world children whose full potential will never be realized, it seems that an almost casual use of marijuana among women during pregnancy is taking place. At a time when caution and care is required to ensure that the developing fetus has all the advantages that genetic inheritance can bestow upon a new life, a kind of low-grade epidemic of marijuana use meant to counter the early nausea stages of pregnancy appears to have become routine.

And it is this identified behaviour that has physicians concerned for the future of these children. Medical marijuana is already legal in Canada. In a year's time marijuana will be freely available for consumption when a new law is passed and regulation guidelines are in place, but even so there are concerns over the potential for the kind of abuse that law enforcement and society grapples with in the instance of driving while impaired by alcohol, soon to be joined by pot-impaired driving offences.

That marijuana is being promoted among some within society as an effective anti-nauseant during early pregnancy has become a growing problem in Canada. Concerning for a number of reasons, not least among them that a growing body of evidence isolates negative effects on brain development resulting from marijuana exposure; the executive functions of the brain affected, along with behaviours.

Dr. Jocelynn Cook of the Society of Obstetricians and Gynecologists of Canada points out that the second leading killer of women during pregnancy is substance use linked to the ubiquitous presence of fentanyl. The steadily emerging trend of opioids among women in pregnancy is concerning to the medical community. As it is, Canada is known to have some of the highest rates of cannabis use among developed nations by adolescents, and along with it, a rapid rise in opioid use.

Resulting in an increasing number of babies born addicted to opioids. Dr. Carson feels that convincing a pregnant woman addicted to opioids to seek medical treatment through a methadone program can still help to improve both her health and that of her baby. Cannabis remains the most used illicit substance during pregnancy, with estimates ranging from under two percent to over 15 percent in prevalence.

The report recently issued by the Society of Obstetricians and Gynecologists of Canada points out that its widespread use "may be due in part to its reputation as a harmless drug", while during pregnancy no drug is harmless.

Fast Facts

• Using marijuana during pregnancy may increase your baby’s risk of developmental problems.

• About one in 25 women in the U.S. reports using marijuana while pregnant.

• The chemicals in any form of marijuana may be bad for your baby – this includes edible marijuana products (such as cookies, brownies, or candies).⁹

• If you’re using marijuana and are pregnant or are planning to become pregnant, talk to your doctor.    

Ultra-Commercializing Motherhood -- Darwin Spinning in his Grave

"We hope to begin cases [in Canada] within the next few weeks.This technique is a new platform. How far it  can go, I really cannot imagine."
"When the world's first heart transplant occurred in South Africa, the community was afraid the doctor had transferred the soul of one person into another."
"[The first babies born from IVF (in vitro fertilization) in 1978 were considered] an unnatural abomination."
"We have the world's first successful [three parent] birth. Of course there is need for long-term study of that baby, and other cases. [However], we had twenty years of research before moving to the first case study."
Dr. John Zhang, New Hope Fertility Clinic, Manhattan

Dr John Zhang with the world’s first baby born using DNA from three people. The baby is reported to be healthy. Photograph: New Hope Fertility Center

"This is unethical, irresponsible and exploitative."
"The chance of failure with IVF for women over the age of 45 is 98 percent. At best (and this is unlikely), this experimental intervention might reduce the chance of failure to 70 percent."
"This is about selling false hope."
Dr. Francoise Baylis, bioethicist, Dalhousie University

"We know that we're very close [medical science] to being able to make a gamete out of any type of body cell."
"Right now we make gametes naturally -- men make sperm, women make eggs. We put them together, magic happens, and you have a baby."
"Here we're starting to understand reproduction at a cellular level. The next step is to say, well, if I can do this in an egg cell, why can't I make an egg cell? Why can't I make a sperm cell? Why do you have to be female to make an egg?"
"There are big-picture questions, and what Zhang's done is give us another step on the ladder to attacking those big-picture questions."
"We fixed this person's infertility -- we change their microcellular structure, and that child goes off and reproduces. What is it they pass on? And what is it their children pass on?"
"It's accelerating our evolutionary process in a completely unprecedented way."
Dr. Roger Pierson, infertility expert, University of Saskatchewan

Mitochondrial diseases can be passed from mothers to their children in DNA.

JGI/Tom Grill/Getty Images

The technique is described as a spindle nuclear transfer. The first baby conceived through this new technique was born last September. The baby's mother had lost two other children; she was a carrier of a progressive neurological disorder led by a mutation in her mitochondrial DNA; a lethal-to-survival condition for a newborn. Dr. Zhang performed a mitochondrial replacement using the mother's egg in a laboratory in the United States. The embryo transfer took place in Mexico to evade U.S. laws where the procedure is banned.

The process proceeds with the removal of the nucleus of the mother's egg containing the maternal DNA, then injecting it into the egg of a young donor. The donor egg which has been stripped of its own nucleus possesses a younger mitochondria. And since this is the mechanism whereby energy is provided to every living body cell, the mitochondria of older women have a decreased energy-output, less able to fuel cell division post-fertilization to achieve pregnancy.

The new egg, 'reconstituted' is then ready to be fertilized with the sperm of the male partner at which time the embryo that results is transferred to the older mother's womb. And in the best-case scenario, which is what the procedure aims for, in due time a healthy baby results. Dr. Zhang's creative new methodology exchanges nuclear contents to turn the donor egg into a 98.9 percent genetic match to the mother, leaving a less-than-significant DNA contribution of 1.1 from the donor.

The mitochondrial transfer technique is aimed at those with a high risk of passing on debilitating diseases. Photograph: Ben Birchall/PA

This startling new direction in altering a would-be mother's egg to expunge the reality of a devastating mitochondrial disease being transmitted to children while still retaining the gross bulk of the mother's DNA to distinguish her children as her very own is understandably viewed with suspicion if not downright alarm by many in the medical community. Yet another addition to the already-lucrative fertility industry, Dr. Zhang's method boasts a capacity to "reverse the effect of age" on human eggs.

Among those viewing this technique with alarm are those who speak of the hubris in medical science out-running nature's formula for reproduction resulting in fears of deliberately designed genetic enhancement; "designer babies", with the technology utilized to 'edit' eggs and sperm of their less-favoured traits and substitute them with more elegant versions. Apart from which the long-range effects of how these genetic manipulations will eventually play out in the future through following generations represents a worrisome potential into the unknown.

Fighting Ebola in Africa

"It was a dream response .. better than the best-case scenario. Everybody worked together, which was beautiful to see. The response was very quick, very strong and very well co-ordinated."
"[The nurse in the DRC whose swift response helped avert an outbreak of Ebola] deserves a medal."
"We want to learn from him [how he was able to quickly reach a determined conclusion, then seek to have it verified, to use his reaction as a model elsewhere]."
"[The latest Ebola outbreak] tells you that you don't need vaccines and drugs if everything is done perfectly. But, at the same time, it is nice to have them if you need them."
Dr. Gary Kobinger, director, Centre for Research in Infectious Diseases, Laval University

Still from WHO video

  
In the two years between 2014 and 2016, the largest Ebola outbreak in history took place in West Africa, killing over 11,000 people before it was brought under control. And while the World Health Organization holds that the risk of further cases of Ebola remains low, a small number of confirmed cases of Ebola have been identified, and some are suspected but not verified.

In West Africa matters did not proceed in a medically sound manner in identifying the Ebola outbreak, much less treating it and isolating patients so the highly communicable disease did not spread. Among the people struck, a lot of hostility and misinformed judgements interfered with medical personnel attempting to do their utmost to stifle the outbreak and treat those affected.

There was delay and there was a panicked reaction during the West African Ebola outbreak. In an isolated village in Guinea villagers were convinced that health workers were in fact infecting people, not helping them. Villagers attacked the health workers, refusing to accept that they were there for a defined purpose, to help stop the spread of the disease, to educate people how best to proceed to avoid contamination.

In early May, in a remote area of the Democratic Republic of Congo a male nurse's swift action helped to prevent another cataclysmic outbreak of Ebola by flagging an ill patient as presenting in his opinion, as a candidate for Ebola when he appeared to be suffering from hemorrhagic fever. The nurse quickly forwarded a sample of the patient's blood for testing.

That sample was conveyed on back country roads by motorcycle from that remote region to Kinshasa, the country's capital, where testing could be carried out. And when it was, it was confirmed that the patient did indeed have Ebola, as the nurse suspected. The result of that confirmation enabled medical teams to respond with alacrity to prevent an outbreak.

The Democratic Republic of Congo, it may be recalled, has been embroiled in an interior conflict for years where marauding bands of rebel groups attack villages, slaughter and rape and lay waste. When the government has dispatched the military to combat the rebels another type of mayhem similar to that mounted by the rebels occurs, with DRC soldiers engaging in mass rape. Millions of people were killed and though the conflicts have ebbed, in some parts of the country rebel militias prevail.

Dr. Gary Kobinger, who had set up a laboratory in one of the regions affected in DRC, tested suspected cases of Ebola, aiding in surveillance of the spread of the disease. People in the remote areas which had been affected, he said, were cooperative with health authorities, enabling them to trace the spread and ultimately contain it, unlike what had occurred in West Africa.

Dr. Kobinger as the former head of the special pathogens program at the National Microbial Laboratories in Winnipeg was involved in the development of the experimental Ebola vaccine, VSV-EBOV, along with the anti-viral treatment, ZMapp. It is his intention to speak with the alert nurse to gain an understanding of the type of training he had received.

Dr. Koninger is involved in helping to build capacity in those parts of Africa affected by Ebola, for the purpose of protecting against future outbreaks of infectious diseases, with the hope also of improving local health care and research. To that end, he is being funded by the International Development Research Centre.

The anti-viral therapies and the Ebola vaccine, created at the National Microbial Laboratories in Winnipeg are still experimental, but before their creation no drugs were available to prevent or fight Ebola. The WHO has authorized their use in special situations and they have proven their value, though still undergoing testing.