Marijuana and Pain Management

Fred Lum/Globe & Mail - an employee of a medical marijuana lab handling product

"I think we're in a desperate need for information at the moment."
"Obviously, we need information on both efficacy as well as safety. Does the drug [marijuana] work for a particular condition? Is it safe for patients to use?"
"Though it’s a preliminary study, this clinical trial is significant because we’re looking at two important things. 
"We’re studying how patients respond to the delivery system of vaporized cannabis and we’ll see if there’s a particular ratio of the two major compounds most likely to give an analgesic response. It’s groundbreaking in many ways. The study and people involved will help build our knowledge base. We’re acutely aware of how little information there is out there to help physicians make decisions with respect to medical cannabis."
Mark Ware, pain specialist, associate professor, Family Medicine and Anesthesia, McGill University

   The Production Process CanniMed Facilities  CanniMed

Medicinal cannabis lacks the "high" that distinguishes recreational marijuana, resulting from lower levels of THC present in the product. It is frequently prescribed for low-level pain management, targeting patients suffering with chronic pain. The drug is prescribed for various conditions, including glaucoma, post-traumatic stress disorder, Parkinson's-related tremors, and for pain originating from irritable bowel syndrome and Crohn's disease.

A new study on chronic pain has resulted in findings suggesting medicinal cannabis may present as an alternate prescription other than opioids, to offer relief to pain sufferers. Apollo Applied Research of Toronto funded this new research tracking the experiences of over 300 chronic pain patients over a three-year period, where over one-third of participants had been prescribed a regimen of opioids; oxycodone and fentanyl among them, known for the risk associated with addiction and the potential of fatal overdose.

Resulting surveys of participants in the study -- observations rather than experimental in nature -- found that 45 percent of opiate users reduced their dosage once they began cannabis treatment, with another 35 percent cutting out their opiates altogether. There are problems inherent in the use of any drug, and long-term overuse of marijuana has been linked with decreased memory capacity and impaired cognitive function, along with bronchitis.

Making it mandatory that rigorous scientific evidence be required with respect to potential health benefits. A group of ten medical professionals last month published a peer-reviewed guideline in the journal Canadian Family Physician, suggesting caution requires limited medical cannabinoid use because of "a lack of high-level research". Health Canada approved a first experimental trial in 2015; a randomized, double-blind study by researchers at McGill University, on the efficacy of cannabis treatment for osteoarthritic knee pain.

In the Apollo study every participant was given an individualized treatment plan formulated by their own physician. Researchers followed up by having each participant complete standardized surveys, to determine whether they felt any reduction in the intensity and frequency of pain, along with any other improvements perceived to their quality of life. Participants overall responded with a 20 percent reduction in the severity of symptoms as well as a dramatic reduction in opiate use.

"In total it was close to about 75 percent to 80 percent of [opioid users] that stopped or reduced their opioid use", stated Apollo Applied Research's director of clinical research, Genane Loheswaran. Who elaborated, explaining that the Apollo researchers have as well been searching out cannabis effects among patients suffering from post-traumatic stress disorder, with equally promising results. Apollo has spent over $1-million on this study, but it earns a profit from its relationship with licensed cannabis producers.

Neither of its studies has been published by a peer-reviewed journal as yet. Apollo Applied Research is a division of Apollo Cannabis Clinics, which operates a national referral service for medical marijuana, along with two dedicated clinics in Toronto. They cannot possibly be considered a disinterested source. In defence of his company's interests, Bryan Hendin, company president, stated: "If you look at it for Pfizer, to get a medication out, they're not asking someone else to pay for their clinical trial. At the end of the day, this data will speak for itself."

Dr. Ware, a renowned pain specialist who had been involved in the osteoarthritis study, is himself funded by industry producers Prairie Plant Systems and CanniMed, believing that studies are reviewed, crucially by an ethics board and that findings are submitted for peer review within a credible journal. "I think we still have got a long way to go before we can make recommendations, but it's an area that deserves very serious and very careful attention", he concluded.

"Many physicians are worried that patients who ask for medical cannabis want to use it for recreational purposes. Yet we hear repeatedly from patients that they’re trying to control severe symptoms and cannabis appears to be helping them. They want to achieve a quality of life they can’t have with other medication. By studying medical cannabis we’re trying to strike a balance between what patients tell us and address physicians’ concerns. The hope is to find a happy medium, a dose patients can safely use that minimizes side effects but helps them live with less pain."
Mark Ware, pain specialist, associate professor, Family Medicine and Anesthesia, McGill University

Consumer Fraud?

"I'd be shocked with the alcohol limits having been loosened [in Canada] as every presentation I've ever seen on Addyi has come with very strict instructions to abstain completely."
Dr.Lori Brotto, regional psychologist, Tri-Cities Sexual Health Services, British Columbia

"The effects on blood pressure related to alcohol were actually slightly less than in the previous study."
"When we're talking about limiting, we would say limit to one drink, like a standard size drink, over the course of two to three hours."
"We believe there is an indication, a use for this medication. [But] it is limited ... and there are lots of warnings and precautions."
Dr. Supriya Sharma, chief medical adviser, Health Canada

"Health Canada has done a real disservice to women who may not be educated about how little the drug works as compared to placebo, and who may find themselves in a situation where they experience dizziness or loss of consciousness or a feeling of sedation -- which couldn't be a worse combination when we're talking about a drug linked to sex."
Thea Cacchionio, professor of gender studies, University of Victoria 

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 blockbuster success of impotence drugs for men.   AP Photo/Allen G. Breed

What good news! "Pink Viagra" is finally available to women in Canada, thanks to Health Canada giving it the all-clear! Women who need it, will finally get the boost to their libido they've been hungering for. Health Canada held off on its approval since there was only one study undertaken to assess its effect when taken with alcohol; and that study tested men; for a female-centric drug.... So a more recent women-only study was done and its result reassured Health Canada that the drug's interaction with alcohol, while noted, was not quite as awful as previously believed.

Once on pharmacy shelves, the product will present with a warning that women 'limit their alcohol intake'. In stark contrast to the American market where the drug is restricted and women are required to abstain completely from alcohol, while using the drug, reflecting the medical-health risks they face of severe low blood pressure and fainting. Since this is a drug that must be taken daily to be effective, quite unlike the men's Viagra [taken only when needed], alcohol abstention is complete.

As the first prescription drug ever designed as a treatment of hypoactive sexual desire disorder [a diagnosis which some experts claim pathologizes women found not to reflect a typical 'norm'], its critics claim it is, in fact, no more superior in functionality than a placebo in producing one extra 'sexually satisfying event' each month. While Viagra works by boosting blood flow to the penis, Addyi's effect is to 'adjust' brain chemicals directing sexual interest and desire; a biomechanism not yet quite fully understood.

The U.S. Food and Drug Administration for its part, had rebuffed Addyi twice before approval was granted in 2015 in the wake of lobbying from a group calling themselves Even the Score, which just happened to have its activities funded by the makers of Addyi, Sprout Pharmaceuticals. The lobbying group lodged an accusation that the regulator was sexist in approving sex medication for men, but not for women. And when the drug was launched in the U.S. a black-box warning came with it.

That  high-alert warned that when used in combination with alcohol, Addyi increases the risk of severe hypotension and syncope [loss of consciousness]: "Do not drink alcohol if  you take ADDYI" the alert warned, as an uncompromising guide. Based on a study of 25 people of whom 23 were male, the study administered Addyi with the equivalent of two to four glasses of wine taken over a ten-minute period in the morning.

Meant to be taken once a day at bedtime only [in case women faint; additional side effects include nausea and vertigo], the Addyi pills didn't come cheap. A month's supply was priced to set the user back $800, a cost that many insurers are reluctant to pick up. and because drug benefit management plans and insurers balked at the price, understandably sales of Addyi in the United States were rather lacklustre.

Dr. Cacchionio, who had testified against Addyi before the FDA, characterized as "completely unethical", any easing of warnings around drinking while using Addyi. And in the Canadian drug monograph including the precaution that mixing alcohol with Addyi increases risk of low blood pressure and fainting, prescribing doctors are encouraged to merely caution women against "excessive alcohol intake", not recommend complete abstinence.

Treatment with flibanserin, on average, resulted in one-half additional satisfying sexual event per month

The March of Science and Survival

"I want to make very clear that this device is not related to complete etogenesis -- never intended to be, will never be and it's just not likely to happen."
"It's a fantasy to think there's going to be this convergence of growing embryos and extracorporeal support."
"Half our kids in nursing homes with cerebral palsy are derived from extreme prematurity -- that's what this device is designed to address."
Alan Flake, fetal surgeon, Children's Hospital of Philadelphia

Dr. Alan Flake, left, is leading a team developing Biobag, or artificial womb, to help keep babies born severely premature alive. Emily Carr / Children’s Hospital of Philadelphia

"You do need to get past things like, well [an early embryo] has no heart or other parts, but it's clear that at some level growing embryos in dishes will intersect the technology to keep embryos and fetuses alive artificially."
"That is absolutely inevitable and will happen."
"What makes you think they [parents] wouldn't want to spend a lot of money to grow their kids in an artificial incubator, presuming you don't rob them of some type of feedback from the pregnant mom that they need to grow well?"
"There will be people who say, 'it's just unnatural. That's just not the way God intended for us to have babies'."
Arthur Caplan, professor of bioethics, New York University's Langone Medical Center

"In the United States, in the year before last, we had over one million abortions. Now, imagine if states like Oklahoma mandated women who were getting abortions to put the fetus into an artificial womb.:"
"Let's say half kept the fetus after it was born and the other half didn't. Not only would we have a situation where many women who would like an abortion for reasons other than bodily autonomy couldn't get it. We would have an amazing number of babies."
Scott Gelfand, bioethicist, Oklahoma State University

"What we're really talking about now is, what happens after our voluntary moratorium on not culturing embryos past 14 days goes away? And how far backwards can you work from the Biobag and other functions to cover the entire spectrum of gestation?"
"We really don't know how long a conceptus can be cultured [in the lab] due to the moratorium. So, let's explore that limit."
"Ask the question: what would it take to increase the time that an embryo can be cultured from two weeks, to four weeks?  I think we have the technology and knowledge to work through these challenges."
Dr. Roger Pierson, director, University of Saskatchewan Reproductive Biology Research Institute

A human foetus at approximately 20 weeks gestation. In recent decades the limit of viability for premature babies has been pushed back to about 23 weeks. Photograph: Medical-on-Line / Alamy/Alamy

Imagine that there is consensus in the medical community and research supports this new way for medical science to ensure that premature babies are born healthy, enabled by this intervention to embark into a life with an assured health outlook through the medium of taking an early fetus and gestating it in a bag or a box, taking it to delivery as a healthy baby. New research has produced the concept of a "biobag", translucent, polyethylene sacks complete with synthetic amniotic fluid.

Researchers who developed the Biobag plan to test its efficacy soon on human babies, hoping this "extra-uterine" device will succeed in revolutionizing the treatment of extremely premature newborn babies, as a bridge between a natural womb and the outside world. To allow babies born at 23 to 25 weeks of gestation additional critical time for their organs to mature from fragile to capable. 

This concept of an artificial womb might appeal to some as a way to free women from the tedium, discomfort and risks of pregnancy and childbirth. Single gay men might view the prospect as a gift, a surrogacy alternative. Two international teams succeeded recently in maintaining human embryos conceived through IVF alive in a laboratory for 12 to 13 days, surpassing the old record of nine days. 

The biobag artifical womb is intended to improve the survival rates of premature babies. Photograph: Jellyfish Pictures/Getty Images/Science Photo Library RM

There is a voluntary prohibition among scientists, limiting human embryo research to the point before the "primitive streak" appears; a band of cells marking the initiation of the brain and spinal cord; a 14-day cut-off. Neo-natologists on the other hand, are pushing toward the "threshold of viability" representing the stage and age when a fetus might reasonably be expected to survive outside its mother's womb without incurring brain damage.

In the hospital of today, neonatal care intensive units are able to save babies born within 22 or 23 weeks' gestation. These are babies so unready to live life outside the womb that their skin reveals translucent blood vessels. Pointing to the potential benefits of artificial wombs where ectogenesis translates as a tightly controlled, sterile environment where nutrients and hormones naturally required to produce optimal growth to maturity can be calibrated and monitored.

It is not unforeseeable that artificial wombs could change the biological process through social-medical engineering entirely. Leaving women to reproduce without risk to their physical, economic and social well-being. Planning time off work for complications related to pregnancy, and no nine-month finale of the body convulsing to produce a full-term baby. There are some who speak of a failure of psychosocial emotional ties between mother and baby without the traditional physical connection.

On the other hand, the perceived freedom that ectogenesis could deliver could also produce a situation where women are seen to be irrelevant in the production of the next generation. Aside from which there are those who postulate that this type of "immaculate conception" could lead to society reconsidering legal limits on a woman's right to abortion. Should a viable fetus be safely removed from a woman's body, some scholars envision a scenario where courts might consider women's right not to be pregnant through mandating ectogenesis.

An artificial womb could help keep babies born severely premature alive. Children’s Hospital of Philadelphia

Choices: Punishing or Aiding the Mentally Ill

"State hospitals began to realize that individuals who were there probably could do well in the community. It was well-intended, but what I believe happened over the past 50 years is that there's been such an evaporation of psychiatric therapeutic spaces that now we lack a sufficient number of psychiatric beds."
"When people are going back and forth from prisons to hospitals, that's a sign they might have benefited from longer-term treatment options."
"[Health care providers are] rather leery about these individuals because these people are, often at least according to the stereotype, high-cost patients who maybe are difficult to treat or noncompliant." 
"I think the stigma that we should be really focused on and worried about actually emerges out of our health care system more than from the public."
"[What is needed is] a continuum of care that ranges from outpatient care and transitional-type housing situations to inpatient care."
"Many times individuals who really do require intensive psychiatric care find themselves homeless or more and more in prison. Much of our mental health care now for individuals with serious mental illness has been shifted to correctional facilities."
Dominic Sisti, medical ethicist, University of Pennsylvania School of Medicine

"It took a lot of effort to move away from the practice of warehousing people."
"Locking people up long-term is no treatment [for mental illness] at all."
Jennifer Mathis, Bazelon Center

At Cook County, where a third of those incarcerated suffer from psychological disorders, officials are looking for ways to treat inmates less like prisoners and more like patients. 
Charles Rex Arbogast / AP

"No one seemed to care enough a generation ago, when so many [people with mental illness released from institutions to live on their own] became homeless." 
"Now that they're going to prison, well, these are horrendous tragedies, and if there were beds available, you wonder how many of these tragedies could be avoided."
Dr. E. Fuller Torrey, founder, Treatment Advocacy Center

Dr. Sisti, medical ethicist, co-authored a paper with the title "Bring Back the Asylum", published in 2015 in the journal JAMA (Journal of the American Medical Association). In that paper urging the necessity of restoring asylums to house and medically aid people with mental illness, rather than leaving them to end up homeless on the streets, committing petty and sometimes more serious crimes so they end up in prion, the paper's authors focused on the Worcester Recovery Center and Hospital in Massachusetts.

Using this state hospital that was opened in 2012, as an example of responsible medical intervention, it was pointed out the hospital has a range of treatments, therapy, and vocational training, working with an annual budget of $80 million, for the 320-private-room hospital. According to a Massachusetts state spokeswoman, the average length of stay for adolescents is 28 days while the average for continuing care (more intensive cases) worked out to 85 days' stay.

Those committed to urging legislators to reconsider the asylum as a modern-day intervention tool to help those in the community regain their mental equilibrium to resume their status as healthily functioning members of the community point out that this financial investment is well spent. The cost of housing a resident at modern state mental facilities is an annual $150,000, whereas good community care inclusive of housing, is estimated by experts to cost a reasonable $30,000 a year.

"The more you spend on these hospitals, the less is available for community care", insists David J. Rothman, historian at Columbia University in New York, co-author of an account of Willowbrook State School, shuttered after complaints of abuse in 1987. In the wake of a number of mass shootings in the United States of late, President Trump has issued a call to once again build and operate mental institutions.

The very thought of returning to the days when people with mental problems were mass institutionalized is anathema to Jennifer Mathis of the Bazelon Center whose function is to litigate on behalf of people with mental disabilities. Originally established in Europe at the turn of the 19th Century, the first therapeutic asylums were founded just as modern psychiatry came of age. Intended to provide for their inmates a protective environment as well as medical assistance, the ideal turned to nightmare.

The institutions and in particular state hospitals, became mass warehouses of society's unwanted. In some of these institutions only a single medical doctor would be held responsible for the health and welfare of hundreds of residents. Living conditions often deteriorated, to reflect squalid, abusive conditions. And then, by 1960 the first drugs able to blunt psychosis -- chlorpromazine -- was available to prescribing medical professionals allowing tens of thousands of people the opportunity to live independently.

The Community Mental Health Act was initiated in 1963 by President John F. Kennedy; unsurprising in light of the fact that one of his own sisters had been shuttered away in one of those grim institutions. That act was intended as a mechanism to put an end to institutional abuses, creating a system of community-based care. A  hoped-for best-case scenario where mental patients could be stabilized and live fairly secure, independent lives in the community.

Released from institutions, inmates were meant to move back into the neighbourhoods they were familiar with. Access to a doctor, therapists, at-home services and other assistance would be available as required. Theoretically, the money saved through hospital closures could then be used in support of independent living. State governments, however, failed to provide adequate care and the result was a swelling of homelessness through to the 1980s.

Such social initiatives went beyond the United States; its neighbour to the North which often looked at supposed advances in social management to the U.S., followed suit and the acute problem of the mentally unstable living on the streets of cities occurred in Canada as well. And the social phenomenon of people with mental disabilities increasingly ending up in prison, generally for non-violent offenses, began to take its toll. Experts estimate the presence of 100,000 inmates living with psychosis in the U.S. today.

And at the same time the number of public psychiatric beds available in the United States has plummeted to 11 per 100,000 people from 360 per 100,000; the number that prevailed in the 1950s. The Treatment Advocacy Center founded by Dr. Torrey lobbies for increased beds for people with severe mental illness, estimating that more than 90 percent of people with psychosis could be stabilize and discharged within weeks, with acute care.

When the Northville Psychiatric Hospital closed, many of the patients either had to leave southeast Michigan for hospitals elsewhere in the state or ended up in community programs that haven't always met their needs, an advocacy group says.

Paul Sancya/AP

Proceed With Caution

"The consumption of cannabis causes a particular combination of relaxation and euphoria, commonly referred to as a 'high'."
U.S. National Academies of Sciences, Engineering and Medicine

"[Single dose of cannabis sativa effect on medical colleagues who were] articulate and fairly stable people [unleashed the onset of abnormal sensations], always abrupt and immediate."
"[One of those sensations: sustained hilarity] The whole idea of the experiment would suddenly seem enormously amusing."
"The test subjects reported events occurring in immediate sequence that] seemed separated by an eternity of time."
South African neuroscientist and psychiatrist, Frances Ames, 1958, Journal of Mental Science

"[Though pot users had not consumed marijuana in the month leading up to the study] memory distortion [occurred, suggesting a long-lasting compromise of memory and cognitive control mechanisms involved in reality monitoring."
2015 Spanish research results

The highly rated variety of medical marijuana known as "Blue Dream" was displayed among other strains at a cannabis farmers market in Los Angeles in 2014.   Frederic J. Brown/AFP/Getty Images

Will Lawn of University College London clinical pharmacology unit, lead author of a study published in 2015 where researchers asked volunteers to inhale pot vapour through a balloon on one occasion, a placebo vapour on another, appeared to affirm that cannabis use has no effect on motivation when people are sober. Other research conclude that long-term use of marijuana has been associated with cognitive impairment, particularly acute in learning and recalling new experiences; seen to affect not the mature so much, but the young.

A team of Spanish researchers in 2015 reported that it would appear heavy pot users are more vulnerable to "memory distortions" due conceivably to decreased activity in the hippocampus, the region of the brain associated with memory. This same study suggested that those leaning heavily on pot use may recall events that had never in reality occurred; conclusions reached through the study involving 16 test subjects each of whom had used cannabis on an average of 42,000 times over a 21-year period.

A committee of the U.S. National Academies of Sciences, Engineering and Medicine noted that during acute cannabis intoxication "sociability and appetite for sweet and fatty foods appears heightened possibly driven by THC", the active ingredient in marijuana's propensity to interfere with neurons in the brain ordinarily suppressing appetite, according to a study in Nature. Researchers injecting mice with THC resulted in the neurons responsible for shutting down eating suddenly accelerating. "It's like pressing a car's brakes and accelerating instead", commented lead author Tamas Horvath.

As for the paroxysms of laughter, though difficult to explain, there are suggestions highlighted by studies that marijuana's anti-depressant effects and the drug's capacity in increasing blood volume in the right frontal and left temporal lobes in the cerebral cortex, the brain areas felt to be associated with "mirth and laughter", may provide the eventual, accepted explanation. Yale School of Medicine researchers reported in 2015 that THC increases random "cortical noise" in the brain of healthy volunteers.

Thomson Reuters

This is the kind of 'white sound' we know as background. For reasons not quite understood, some people experience a "robust syndrome" mimicking aspects of schizophrenia, according to Dr. Deepak Cyril D'Souza, professor of psychiatry at Yale, the study's senior author. Symptoms of paranoia and voices appear, suggesting heavy pot use could precipitate or hasten schizophrenia, particularly in early or mid-adolescence.

Take note: Heavy pot use may depress a man's reproductive potential through affecting the morphology (size and shape) of sperm, according to a study published in the journal Human Reproduction. The study found that males under 30 with under four percent normal sperm to be almost twice as likely to have used cannabis in the last three months. The study took into account (controlled for) other factors such as BMI, type of underwear, smoking, alcohol consumption or a history of mumps.

Simply put, sperm with morphology issues become clumsy and functionally compromised; instead of swimming toward an egg to fertilize it as normally occurs, these sperm swim poorly and crash into the female reproductive tract hopelessly. Decreased libido in men has been attributed to chronic cannabis use. Research suggests that cannabis suppresses ovulation in its effect on women. Further, marijuana has been linked to early pregnancy loss and low birth weight babies. Animal data in the works suggest as well that the use of pot during pregnancy impairs fetal brain development.

Wait, there's more. The academies of sciences review finds the best evidence suggests that smoking pot doesn't increase risk for lung, head or neck cancers in adults although "modest" evidence exists linking it to a subtype of testicular cancer. Whether cannabis increases the risk of heart attack or stroke remains unclear, but some evidence has been found for anti-inflammatory effects. The use of pot prior to driving does increase the risk of involvement in a crash, but there is no evidence it increases the likelihood of developing depression, anxiety or post-traumatic stress disorder.

"Cannabis withdrawal", caused by sudden termination of heavy daily pot use, has been newly referenced in the fifth, latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Withdrawal symptoms can include irritability, anger, or aggression, restlessness, sweating, fever, chills and hypersomnia (sleeplessness).

People suffering from the newly-recognized "cannabis use disorder" may spend hours daily under the influence of pot; alternately spend a lot of time to obtain, use, or recover from the effects of cannabis along with a requirement for substantially increased amounts of the drug to continue to enjoy the required effects.

A woman holds up a cannabis plant during a demonstration. www.sciencemag.or

Co-Living in California : Diminished Expectations?

"If you think about the most private things that you do, a lot of them are related to the bathroom."
"So that's probably the hardest part [to become accustomed to in co-living]."
Jon Dishotsky, co-founder, CEO, Starcity, San Francisco

"People talk all the time about what they dream of, and I decided to stop talking about it and just do it. I was looking for more meaning."
"The more I live her, the freer I feel."
Carla Shiver, 38, Starcity renter

Starcity caters to workers who earn less than $90,000 a year.

Chip Somodevilla / Staff / Getty Images

Where a niche opportunity appears, there an entrepreneur will arise. There is a not-unreasonable expectation in Western society that if you're a member of the middle-class you can always work your way upward and eventually become a home-owner. If not own your very own home, then be able to rent one that suits your station in life. If you live in San Francisco, Vancouver, Toronto, Tokyo, London, perhaps not.

In San Francisco the search for a reasonable rental opportunity consumes the interests of those working as servers, teachers, lounge musicians, copywriters, merchandise planners, bookstore salespeople simply searching out a decent place to live. Wages in the service industry are not overly generous, and those earning those wages are not overly optimistic that they will find a place of their own serving their modest needs.

Along came a new development company whose vision is to serve those hopelessly searching out modest living arrangements. And have they got a deal for you! That is, if you're not too fond of acquiring things in abundance. In these new accommodations shared bathrooms are the norm for those renting a bedroom -- furnished, mind -- and little else. No kitchen(ette), no living room, no bathroom.

Common space at a Starcity building in San Francisco.  

Starcity

Three buildings comprising 36 units each have so far been developed by Starcity And it's on a roll. There are nine additional properties in development stage. And the company has an assured list of eight thousand people signed up and anxious to take advantage of their offer. With that kind of demand Starcity is in the process of buying up a dozen additional buildings, a one-star hotel included.

Parking garages, office buildings and old retail stores are all prospective future Starcity properties awaiting development. So far, $18.9 million in venture capital has been raised, enabling the hiring of a team of planners, giving the company the confidence to promise that it will have hundreds of units open in and around the San Francisco Bay Area in 2018, and thousands scheduled by 2019.

Residents of these properties are given a bedroom, about 10 - 20 square meters in size. Some units will offer a private bath at a higher rent. The company figures, however, a ratio of one bathroom for every two to three bedrooms equals large-scale affordability. Starcity rooms rent furnished for $1,400 to $2,400 monthly, with utilities and WiFi included. Whereas an average one-bedroom apartment in the city rents for $3,300.

Furnished bedroom; bed, night table, chair    Starcity

The demographic lining up for the opportunity to rent these Spartan bedrooms furnished with bed, chair and night-table are those who earn $40,000 to $90,000 annually, most in the age range of early 20s to early 50s. Those who become accustomed to living in these arrangements appear to feel quite comfortable about their decision.

The experience of Carla Shiver, originally from Albany, Georgia, typifies an accommodation to a different lifestyle. When she lost her position at Verizon last year the company offered her a transfer-job at a store in San Francisco. She earns roughly $85,000 a year. Sounds like good money but aware she could never afford a house in San Francisco, she decided to take the plunge.  She drove west with her Yorkie-Pomeranian, choosing to leave her husband behind with divorce proceedings.

Now she rents a room for $2,200 a month, with a queen-size bed, bedside table, and a chair. She shares a bathroom with other renters, along with a kitchen and living room. She can have Starcity staff do laundry for $40 a month, clean her room for $130 a week and arrange for dog care if she decides to. The responsibility for everything being looked after lies with building managers who restock bathroom and kitchen supplies and plan community events.

Starcity residents have access to a communal kitchen and living room.

Caroline Cakebread/Business Insider

"Most of the residents, who range in age from their early 20s to early 50s, have no political philosophy around communes nor any previous experience in them."
"Moving in was a practical decision they each made. But after they arrive, what they are most surprised by is how much the building changes them."
Nellie Bowles, The New York Times

 BORN Ontario: Children's Hospital of Eastern Ontario

"I think we have some of the best data in the world in Canada, particularly in Ottawa."
"This is an investment by the Ontario government in a program that has contributed to the welfare [of babies] in Ontario and, as a benefit, will be able to help countries around the world."
"We are using metabolic fingerprints -- unique patterns in specific molecules found int he blood -- to help estimate gestational age."
 Dr. Kumanan Wilson, research chair, public health innovation, Ottawa Hospital Research Unit

"One of the things that drew us to the project was the opportunity to learn how we could implement similar screening -to Ontario's] in the kinds of places the Gates Foundation was involved in, where there may also be the opportunity to help these kinds who are affected."
Dr. Pranesh Chakraborty, Newborn Screening Ontario

Ottawa Methods Centre, CHEO

The health outcomes of babies in developing countries around the world is on the cusp of being immensely improved as a result of studies and analyses of blood samples routinely taken from newborns in the province of Ontario, analyzed at the Children's Hospital of Eastern Ontario. Funded with a million-dollar grant from the Gates Foundation, a research program is set to aid in identifying the gestational age of low-resource countries newborns.

This, in turn will aid in undertaking public health measure in the prevention of pre-term births, the prevalence of which is considered an urgent international health challenge for the international community. Data gained from blood tests performed on each newborn in Ontario, stored at BORN (Better Outcomes Registry and Network) Ontario, situated at CHEO for public health innovation will now be seeing its endeavours bearing fruit abroad where it is sorely needed.

Blood routinely collected to enable screening of newborns for illnesses that can then be treated with swift intervention served its own vital interests in screening that blood derived from 140,000 newborns in the province annually. Data derived from testing the blood becomes part of the invaluable data bank. With the use of that data, Dr. Wilson, along with Dr. Steve Hawken from The Ontario Hospital and University of Ottawa succeeded in creating an algorithm to determine gerstational age of babies based on newborn blood collection data.

This vital work of developing and validating their purpose-built algorithm saw recent publication in The American Journal of Obstetrics and Gynecology, and EBioMedicine medical journals. Being tested using newborn data from Bangladesh, Zambia, China and the Philippines, the algorithim is expected to bring results enabling the medical community to reduce pre-term birth and improve newborn health outcomes.

Plans are underway to extend the testing to sub-Saharan Africa and South Asia, enabled by the new funding from the Gates Foundation. Blood taken from newborns in addition to determining gestational age, will be tested for congenital hypothyroidism and sickle0-cell disease, among other treatable diseases. Dr. Chakraborty has been brought into the project along with other researchers from Stanford University.

Knowledge of gestational age at the time of birth is important for distinguishing the preterm from the small-for-gestational age (SGA) infant, whose medical needs and expectations for achieving significant development milestones may be different. Reliable gestational age estimates are also useful for quantifying population burdens of preterm birth, which can facilitate appropriate allocation of resources to hospital centres and regions of greatest need. In many low-income and middle-income countries, maternal access to prenatal care, in particular to ultrasound dating services, is limited and imprecise measures, such as last menstrual period, fundal height, or examination of the newborn are relied on for gestational age estimation.^1–3 Given that gestational dating based on knowledge of last menstrual period is frequently unreliable^4–6 and postnatal physical examinations are subject to variability based on subjective scoring and poor performance in extreme preterm and SGA infants,^{7 8} new methods of providing gestational age estimates at the time of birth are required. This need has been recognised by organisations who have sought to improve data on preterm birth^{9 10} and also develop new ways to measure gestational age. 
The National Center for Biotechnology Information

Dr Kumanan Wilson, left, and Dr. Pranesh Chakraborty are part of a study to analyze data newborns' blood to better understand pre-term birth around the world. Jean Levac / Postmedia