That !Eureka! Moment

"These kids were quite sick, both of them. Trying a 'Hail Mary' is allowed under those circumstances, frankly."
"[It's just two reported cases so far] But I think it's extremely encouraging that the outcome for two kids appears to be very different from what typically happens to these children."
"We have a glimmer of hope here."
Dr. Bruce Gelb, pediatric cardiologist, Mount Sinai Hospital, New York

"It [hypertrophic cardiomyopathy] may come back very quickly and be very difficult to control, or it could remain as is."
"There is not a single study, not a single animal or human study that can answer this question."
"We explained everything to the parents. [Now, after more than 17 months of treatment, Lyana's heart has gone from a heart triple its normal size] to pretty much a normal heart."
Dr. Gregor Andelfinger, pediatric cardiologist, Universite de Montreal, Saint-Justine Hospital

Lyana Deslauriers is held by dad Joel as they meet up with Dr. Gregor Andelfinger at Sainte Justine’s Children’s Hospital in Montreal. Christinne Muschi/National Post

Noonan syndrome is a genetic condition preventing various body parts from normal development. It afflicts one baby in every 2,500. Now, a breakthrough in the condition where doctors in Montreal have been able to reverse the most deadly symptom of Noonan syndrome: hypertrophic cardiomyopathy. In its most severe form, this excessive thickening of the heart leads to the death of 70 percent of babies with the condition, before they reach their first birthday.

Noonan syndrome is classified as a RASpathy. RAS genes function to produce proteins controlling cell communication where a chain of proteins transmit signals outside cells to the nucleus within. When the final signal in that cell's pathway reaches the nucleus, the cell responds as instructed; either to divide, multiply or die. Noonan mutation has the RAS genes becoming hyperactive, interfering with the normal flow of contact between cells.

As in the pathway for cancer where cells begin proliferating exponentially, so do these cells; the end result to cause hyper or muted growth in the tissues affected. Roughly a third of children with Noonan syndrome are born with some kind of heart defect, but the extreme form of rapidly progressing hypertrophic cardiomyopathy is rare, and a child born in Montreal two years ago -- Lyana Deslauriers -- had that lethal condition. Her thick dense heart was expected to continue growing until it killed the toddler.

But then her doctors in Montreal tried something different and the results appear to have turned this common, incurable and rare disease from a death sentence to a treatable condition. A cancer drug re-purposed to treat this child's condition appears to have reversed it, shrinking the heart muscle to a normal size to halt it from suffocating itself. The question now is, will withdrawal of the treatment see the condition roar back to life and in so doing, threaten little Lyana's life expectancy as it did before?

"It may come back very quickly and be very difficult to control, or it could remain as is", stated Dr. Andelfinger, the infant's pediatric cardiologist. Lyana's heart structure was revealed by ultrasound before birth to be abnormal when all four of her heart valves were seen failing their purpose, to open and close in concert with each heartbeat, allowing blood to flow in and out. Her heart muscle, oddly thick, was certainly abnormal.

Dr. Gregor Andelfinger meets with his patient, two-year-old Lyana Deslauriers (bottom) and her family. Christinne Muschi/National Post

When she was born in 2017 her facial features reflected Noonan syndrome with an extra skin fold at the inside corner of her eyes, along with a groove between her nose and mouth. The main pumping chamber on both sides of Lyana's heart were obstructed, along with her valves. Standard treatment with aggressive doses of Propranolol, a drug to reduce contraction force of the heart muscles was initiated three days after her birth.

Despite this, her heart continued to grow thicker. Dr. Andelfinger contacted Dr. Gelb at Mount Sinai, the man who had first discovered some of the genes involved in Noonan syndrome. In turn, Dr. Gelb informed his colleague from Montreal of another baby in Germany who had a different mutation in the same gene as Lyana, who was connected to a ventilator in intensive care, her condition if anything more severe than Lyana's.

This led the Montreal and German researchers to study related literature where scientists had started to understand that the mutations driving Noonan's overlap with mutations that are involved in a third of human cancers. Researchers had begun to experiment with genetically engineered mice and when the mice, which developed human-type Noonan's were treated with an anticancer drug blocking the growth cycle, the effects vanished.

The cancer drug trametinib was administered to Lyana and the German child, while both sets of parents were informed no guarantees of success could be given, nor that "deleterious effects" might not ensue. When three months with the treatment passed, improvement of  then-14-week-old Lyana was impressive; in fact both babies' hearts began diminishing impressively. Leaving them eventually after 17 months of treatment with normal-size hearts.

The results of the doctors' experimental treatment for two infants whose lives might have been forfeit by the deadly condition they were born with, saw publication in the Journal of the American College of Cardiology. Now, larger studies are anticipated, and if the results are successfully replicated, a new advance in treating a once-incurable condition will have been achieved.

Two-year-old Lyana Deslauriers is held by her father Joel.   Christinne Muschi/National Pos

Transgenderism and the "Medical Model"

"We generally trust what other people say about their own mental states. If someone says, 'My arm hurts', we typically grant credence to their claims. We have this trust in people's self-reports of their mental states to be within the purview of people's epistemic authority -- authority over knowledge."
"If I were to doubt that person's claim without serious reasons to believe otherwise, I would be committing an injustice because I would unjustly fail to recognize their authoritative knowledge of their own experience of the world."
"When I decided that I wanted to take  hormones to feminize my body, the last thing I wanted to do was to go in front of a psychologist to justify my decision."
"There are people who aren't fully transphobic but who have this kind of very visceral suspicion of trans people and are afraid to move away from the medical model. And the illness model is 'Well, we have to figure out what this illness is because there is this underlying 'disease' we have to cure'."
Florence Ashley, transfeminine bioethicist, masters of law candidate, McGill University

Forcing transgender teens to undergo psychiatric assessments before prescribing them hormone treatment is “dehumanizing” and unjustified, argues transfeminine bioethicist Florence Ashley, of McGill University. - Photo courtesy of Florence Ashley

"We take the use of puberty blockers and/or hormones seriously and all our patients go through rigorous assessments, including a mental-health check to ensure they understand the risks and to ensure gender transition is in their best interest."
"[Those guidelines -- by the World Professional Association for Transgender Health -- recommend assessments by a] trans-competent mental-health professional [to] independently evaluate the youth's gender identity and the youth's ability to consent or assent [to body-changing treatments]."
B.C. Children's Hospital gender clinic

According to Ms. Ashley's new paper, published in the Journal of Medical Ethics just recently, the psychiatric assessments that transgender teens must undergo before medical permission is granted for them to receive permanent gender-alterating treatment including drugs, this 'dehumanizes' the individual. Guidelines currently in effect recommend that adults and transteens intent on receiving potentially irreversible feminizing or masculinizing hormones must first undergo mental-health screening.

According to Ms. Ashley this is a practise that in her opinion devalues the lives and bodies of trans people -- reflecting a mistrust of trans voices, turning the transitioning process into medical treatment specifically meant to address a psychiatric illness. Doctors, she insists, should believe the individual involved, claiming to be trans. Which would ideally include minors with the measured maturity to enable them to determine the future of their own health care.

This paper has been published at the very time that gender clinic wait lists in Canada take up to a year or more before an individual can be seen and evaluated even as experts in the field struggle with the issue of how to determine the age at which a young person is deemed too young for "cross-sex" hormones to be prescribed. Hormones such as estrogens to begin the development process to alter a male at birth "assignment" to a trans girl; similarly testosterone prescribed  for a transboy; a female transitioning to male.

Closeup of two caucasian men holding hands with a rainbow-patterned wristban on their wrists. Forcing transgender teens to undergo psychiatric assessments before prescribing them hormone treatment is “dehumanizing” and unjustified, argues transfeminine bioethicist Florence Ashley, of McGill University. Getty Images

In the former instance, to initiate the process of a trans girl developing a feminized shape, and in the latter case, attaining a more angular jaw, deeper voice and masculine physique in the case of a trans boy. The assessments for "gender dysphoria", the term that psychiatry uses to describe the discordance people may experience if their body doesn't appear to align with their gender identity, left Ms. Ashley with the feeling of having been "exposed, naked and dehumanized", as she put it.

From the perspective of the responsible health provider who thinks first and foremost of the vast and irreversible physical changes that will be taking place with medical intervention, cross-sex hormones have the potential to be the cause of irreversible physical changes including breast development with estrogen, or with testosterone, a permanent deepening of the voice. Ms. Ashley rejects this concern, claiming the drugs represent no greater risk than other medical interventions which no psychological assessments are required to determine the preparedness of the individual to receive.

In most Canadian provinces the law allows for mature minors to reach decisions respecting their own medical care as long as it can be assured they are able to appreciate the "reasonably foreseeable consequences" of such a decision. According to the international medical organization, the Endocrine Society, cross-sex or "gender-affirming" hormones may be administered at age 16, even as young as 13-1/2 in particular circumstances, despite that some experts are concerned that lacking proper assessments teens could begin an irreversible hormone therapy that might later cause them great regret should their gender dysphoria fail to persist.

By requiring a mental health assessment instead of taking the transgender person’s word, doctors ‘deny the authority trans people have over their own mental health experiences.’

On The Side of Caution

"I was twenty when I got pregnant and it was unplanned. I was going out at least once a week to the bar and drinking -- not binge drinking but what I would consider social drinking."
"When I found out I was pregnant, I stopped drinking completely."
"I don't even think people realize they doing it, but when you tell people that your child has FASD [Fetal Alcohol Spectrum Disorder] they have an automatic reaction, and it's not one of sympathy or empathy -- it's judgement."
Wanda White, Waterloo, Ontario

"While the original recommendation [Centers for Disease Control and Prevention: Sexually active women should refrain from drinking if not using birth control] may have been intended to ensure safe pregnancies and healthy children, its underlying message was unmistakable: Women should consider themselves first a vessel for human life and make decisions about their health and behaviour based on that possibility."
"[It was] incredibly condescending, tone-deaf and paternalistic."
Rebecca Rutz, Mashable.com 

"The focus shifted from the woman who was essentially killing herself through alcohol abuse to the idea of having to protect the foetus."
"In a sense what we've done is create three categories of people: men, women and pregnant women."
Janet Golden, professor of history, Rutgers University

"To put it mildly, I'm not crazy about the implication that pregnant women are incapable of deciding for themselves -- that you have to manipulate our beliefs so we do the right thing."
Emily Oster, economist, author Expecting Better

Well, that's all fairly interesting, the discussion the epidemic of FASD in society and linking it deleteriously in the sense that women should be alert to the dangers they place their future children in by asserting their independence and social culture through refusal to allow the medical community to steer them toward safety in giving birth to children who have the right to a normal life. Women may have the right to determine whether they will carry a foetus to full term and birth, but morally do they have the personal authority to refuse to ensure that child will develop normally?

When the Centers for Disease Control and Prevention issued its unequivocal recommendation in 2016, alerting women of childbearing years who also imbibe alcohol of the dangers involved, they were performing their moral duty to society and to women as well as their children. That women chose to slam that advice as condescending is both defensive and offensive; in short they have the right to ruin both their lives and that of their offspring in the interests of complete autonomy. And, of course, society should uncomplainingly pick up the pieces, as it were.

The CDC did rear back, though having given notice that three million American women were at risk of exposing their babies in utero to alcohol, and in the words of Anne Schuchat, principal deputy director of the CDC, "Why take the chance?", had every reason to think their sensible advice would be taken as it was meant to: a caution. It meant, it later responded, to "empower" women to enable them to make a choice that would be healthy both for themselves and for their children.

Women were offended, feeling placed in that old category of straitened society where when women were seen to imbibe it must be proof positive of their degraded values as "skid-row prostitutes", as Professor Golden of Rutgers put it. Women, having reached the point of societal equality with men, feel no restrictions should be placed on their alcohol consumption just as none are placed on their male counterparts. Who don't, after all, get pregnant and give birth to vulnerable little human beings.

Alcohol, to a good many women, means liberation from mean societal attitudes.

As such they feel convinced there is no need to change their routine of social drinking during pregnancy. Emily Oster in her 2013 book argues while heavy drinking poses an obvious risk, no evidence exists that an occasional glass of wine will do harm to a foetus, that abstinence is advised by doctors simply because they don't feel women are possessed with the free will and strength of character to stop at the first drink in favour of caution.

It is certainly interesting that research on FASD seems to reflect an idea that women of financial means will never have their lives disrupted by the danger of FASD, that it is the poor, intellectually impoverished marginalized women who are susceptible to having children whose intellectual and physical milestones will be degraded as a result of mothers who drank while pregnant. Smart, rich women don't get addicted, right?

According to sociologist Caroline Tait, the early studies in Canada on FASD focused on reserves primarily; "Indigenizing the diagnoses", whereas in the United States, children of minority groups became the focus of FASD. New studies appear to agree that over 70 percent of women in Canada consume alcohol but since 18 percent are at risk for chronic substance use, this is really an issue of social importance. Women metabolize alcohol differently than men, are more vulnerable to addiction at lower levels.


Beyond this, alcohol has a greater impact generally on women's health than it does for men's. Studies indicate that drinking may herald increased rates of breast cancer and heart disease. Alcohol-related harm which includes FASD makes no discrimination between social class, education or profession. Women of all socio-economic groups are vulnerable. Educating and treating women who remain defiantly resistant to reality becomes a priority -- to be convinced that sometimes decision-making is driven by proven repercussions.

In Canada a new project has been launched by The Canada FASD Research Network with the aim of filling in some gaps in the science of FASD; why are some children exposed to alcohol in utero less seemingly affected than others? Data has been collected from over 1,700 patients at diagnostic clinics cross country; 65 percent having received a diagnosis of FASD; 35 percent did not. "We want to know what's different about the brains of people who didn't get a diagnosis but still had prenatal alcohol exposure", Jocelynn Cook, chief scientific officer for the Society of Obstetricians and Gynecologists of Canada explained.

"Our parents with FASD kids are under more stress. If the caregiver is a biological parent, then they're also in the burden of guilt and shame and grief. And the kids who are adopted often those parents didn't sign up for FASD, so they deal with a whole other level of emotion and stress", is how Edmonton pediatrician Dr. Gail Andrew put it. Research has shown early intervention -- occupational and speech therapies, medication to address anxiety or attention-deficit behaviours, training caregivers on coping strategies -- can improve outcomes for children with FASD.

Fetal Alcohol Spectrum Disorder : Preventable

"Because of its social acceptance, we have lost sight of the fact that continued high rates of problematic alcohol consumption are [sic] leading to a wide-range of harms."
Dr. Theresa Tam, Chief Public Health Officer, Canada

"Too many physicians in this country still advise women that it's okay to drink a little bit during pregnancy."
"But what does it mean to drink a little bit? Or is that just an enabling statement that says, 'Oh I really don't have to change my lifestyle because I'm pregnant'."
Dr. Kwadwo Oheme Asante

Originally from Ghana, Dr. Asante came to Canada on a student visa to study science at the University of British Columbia. Following medical school in the 1970s he set up practise as a pediatrician in a large area of northwestern British Columbia and the Yukon, the only pediatric specialist in the region. His intention was to remain in the vast area long enough to pay off his medical training debt.

Soon he began seeing patients that he hardly expected to be confronted with; babies with small heads, thin upper lips, flat cheekbones. These were children missing critical developmental milestones and who would never 'catch up' to what other, normal children were achieving in their development, physical and mental. His initial thoughts were that these were children symptomatic of a chromosomal or metabolic disorder. Nothing existed in the medical literature to describe his cases.

A colleague in 1973 alerted him to a new paper published in the influential journal the Lancet produced by two pediatricians at the University of Washington, describing children exposed to alcohol in utero -- exhibiting symptoms that Dr. Asante recognized immediately. This was an era when doctors might prescribe alcohol for morning sickness, when hospitals made use of ethanol drips in the prevention of early labour. When beer was considered a nutritional drink for expectant mothers.



The medical community viewed this new information with shock since the uterus had been regarded as a protective barrier, impenetrable by harmful agents, a trust that was only shaken in the early 1960s with the advent of the anti-nausea drug prescribed for pregnant women called thalidomide which went on to produce grossly malformed limbs in babies whose mothers trustingly used the drug.

Dr. Asante set out with a team of doctors across the country for the purpose of ensuring that doctors and their patients, policymakers and the press became alerted to the risks of Fetal Alcohol Spectrum Disorder (FASD). Later studies definitively proved alcohol to pass from mother to foetus through the bloodstream, with the potential to deleteriously impact development of the central nervous system as well as sensory and immune systems, among others.

The first large-scale study on FASD surveyed over 2,500 seven- to nine-year-olds in the Greater Toronto Area was released last year, its conclusion suggesting that up to three percent of the general population could be victims of the disorder. FASD could turn out to affect greater numbers in the Canadian population than does autism and cerebral palsy together. This, at a time when social culture has changed, when more women drink, more frequently than ever.



The most recent national survey out of the Society of Obstetricians and Gynecologists of Canada estimates that 61 percent of women between ages fifteen and fifty have reported an unplanned pregnancy at a time when social drinking has been recognized as a symbol of female empowerment. A symbol that does not hesitate to lapse during pregnancy, as far as some women are concerned, resentful of being reminded that their social habit may harm their foetus.

A fifth of respondents to a survey of Canadian physicians on an online medical community, Figure 1, suggests that physicians may themselves be aiding in the normalizing of this reaction by women to alcohol consumption during pregnancy, by informing their patients that the occasional drink during pregnancy is safe. This, in startling contrast to the official position of Health Canada.

It has been well understood for close to a half century that drinking during pregnancy is harmful. Given the current social climate, it is little wonder that eradication of FASD has failed. Some children diagnosed with FASD resulting from their pregnant mothers imbibing alcohol are born with visible physical features typifying their condition, while others suffer with impaired motor and sensory control.

Embryonic stem cells exposed to low levels of alcohol "led to the abnormal development of parts of the brain responsible for executive function -- critical for self-control, organizational skills and goal attainment" according to a 2010 study out of the Emory School of Medicine in Atlanta. Drinking appears to be most detrimental during the first three to eight weeks of gestation when cells are dividing to form the baby's organs.



And during the third trimester, alcohol consumption is similarly detrimental, at a time that the brain undergoes rapid development, and when specific organ functions are being determined. Research such as this with their definitive conclusions along with the dedicated work of campaigners like Dr. Asante have led most bars and liquor stores in Canada to post prominent signs outlining the risks of drinking during pregnancy.

In the United States, warning labels are mandatory by law to be placed on alcoholic beverages, informing and reminding women of the harms that drinking results in during pregnancy. Not all children of the estimated 10 percent of Canadian mothers who flaunt this cautionary advice are born with FASD. Many risk factors for the disorder -- genetics, maternal nutrition, exposure to other toxins, poverty and trauma -- also exist, but their influence is not settled.

Just exactly how much alcohol may cause FASD, or the type of alcohol -- 13 percent alcohol red wine as opposed to 70-proof tequila may make a difference in the threat, is also unclear. Leading, according to James Reynolds, professor of biomedical and molecular science at Queen's University to an impression that only "problem" drinking places a foetus at risk.

One Figure 1 user posted the statement that "I've known fellow medical professionals who are open about their own consumption during pregnancy".

A new report found up to three per cent of Canadians could have fetal alcohol spectrum disorder.   Ian Kucerak/Edmonton Sun

Curbing "Boutique" Psychiatrists

"[The ministry's data shows] that there are some physicians in Ontario who are providing a high volume of psychotherapy to a small number of patients for an extended period of time, with uncertain clinical benefit, while also limiting access for new patients."
Ontario Ministry of Health and Long-term Care report

"Any physician who cultivates dependence is not practising evidence-based care. This can be very problematic."
"There are a number of psychiatrists in the GTA [greater Toronto area] who, based on reports, see fewer than 30 or 40 patients per year."
"There are many patients who are being seen by psychiatrists who need more than 24 hours of care per year."
"If the government doesn't fund other human resources for those individuals, where will they go?"
"I think the problem with the current system is it's a bit of a wild, wild west. We haven't implemented quality metrics. We are funding lots of things that don't fall into that evidence-based category and yet evidence-based therapies are not funded."
Javeed Sukhera, president-elect, Ontario Psychiatric Association

Illustration by Joe Morse

Among those who think that the government of Ontario's proposed cuts to limit funding for psychotherapy could end up with a redistribution of psychiatric care in a more equitable way is Dr. Mario Elia, practising in London Ontario, who is also an adjunct professor at Western University. In his community, he stated, outpatient OHIP-funded psychotherapy is "almost impossible to access". None of the 76 psychiatrists practising in London accept referrals for ongoing psychotherapy.

The vast majority, he says from his perspective as a family physician, are "doing their utmost to see as many patients as possible, as efficiently as possible to save as many lives as possible". However, he comes across psychiatrists who it appears haven't accepted new patients in years. A situation Dr. Elia finds puzzling since he believes most evidence-based psychotherapy is limited to a defined period of time.

The situation he reflects upon is one where within a single city MD-psychotherapists can conceivably gather within an affluent area to provide ongoing, unlimited therapy sessions for a population that becomes very well-serviced, while other areas are left with an overwhelming need that cannot be responded to in the absence of psychotherapists willing to provide service there.

The glaring geographic and socioeconomic discrepancies between affluent Ontario communities with two to three psychiatry practices per 10,000 people sits in stark contrast to other communities or areas even within  single city where 0.6 psychiatrists per 10,000 people is the norm.Toronto alone has 3.5 psychiatrists in contrast, per 10,000 residents.

The new announcement of the government of Ontario's proposal to limit psychotherapy funding is generally viewed with a degree of alarm. The need for psychiatric counselling has never been greater, particularly among the young, yet there is a noted scarcity of medical professionals in the field and the need to schedule appointments with mental-health professionals results in frustratingly-long waits.

Some physicians, however, claim to welcome cuts that could "curb boutique psychiatrists" with their focus on business and who "over-treat the worried well". Although the Ontario Ministry of Health has not formally announced planned funding cuts, they were included in a briefing document received by an arbitration board considering a contract dispute between the Ontario Medical Association and the ministry.

The suggestion included in the document is to limit OHIP funding to 24 hours of psychotherapy each patient per year to save an annual projected $13 million for the government. According to Dr. Mary Fernando, such cuts represent a "death sentence" for suicidal patients, precisely the concern expressed among Ontario psychiatrists and GP-psychotherapitsts.

The term "boutique psychiatrists" refers to mental health professionals who deign to see fewer than two new patients each month; they keep servicing the same patients over and over again, and are thus less likely to agree to see other patients, particularly poor patients, recent immigrants or patients who have recently been hospitalized for severe psychiatric illness.

A February study published in the Canadian Journal of Psychiatry found about one-third of Ontario psychiatrists accept less than two new patients on average each month. Those same psychiatrists have 1,041 sessions with 69 patients throughout the space of a year. While at the opposite end, 27 percent of psychiatrists take on a new patient each day, with 2,274 appointments with 680 different people yearly.

Since only medical doctors can bill to OHIP that leaves an insufficient number of psychiatrists to meet the public need. The majority of psychotherapy is performed in the province by clinical psychologists and licensed therapists, often with social work backgrounds who are funded either by private insurance or by out-of-pocket payment, hence the allure of situating in prosperous areas. This is the reality of a two-tier system for mental health care in the province.

Medical doctors can charge the province $160 per hour to do unlimited amounts of psychotherapy on any patient. The government wants to limit treatment to 24 hours per year

Hospital Infection Nightmare: Fungus Candida auris

"Typically, we have never really been concerned about fungi or yeast spreading from person to person."
"It seems to be acting a little bit differently. We haven't really thought about fungi this way before."
"It highlights that we are still vulnerable to infectious disease. We will not be able to rely on antibiotics forever."
"Should [Canadians] be worried? In Canada we are doing a pretty good job so far in containing it. We haven't had the same experience as is happening in the States."
"I would say from the community level, I would not worry about it. But it is a good thing to talk about."
Dr.Julianne Kus, clinical microbiologist, Public Health Ontario

File photo

In Winnipeg, a resident who had been to India became a patient in a local hospital in 2017. That 64-year-old is now recognized as Canada's Patient Zero, the first individual to bring back a new threat steadily emerging across the globe, hitting hospitals everywhere and placing them on high alert. Having undergone dental surgery in India, the individual became infected with a drug-resistant bacteria called Candida auris, a fungal infection found in the person's ear after being drained and tested.

This is an infection resistant to multiple drugs, one able to spread from patient to patient. Candida auris is able to live on skin, walls, curtains, handles, cellphone; virtually any surface. It poses little risk to healthy patients, but can colonize the skin of patients with seemingly no deleterious impact. They, in turn can communicate the bacteria to others with suppressed immune systems, causing a serious infection that can enter their bloodstreams and can result in lethality.

It flourishes in some countries as a now-common infection, and there mortality rates for people with invasive Canadida auris are above 50 percent with limited treatment options, making it a viral and often-deadly threat difficult to eradicate. Hospitals in particular view its impact with alarm, since it is there that populations of patients with suppressed immune systems congregate; undergoing cancer treatment or transplants, as an example.

To complicate matters even further, Candida auris is difficult to identify, diagnose, treat and contain; it is particularly persistent. "I think it is something that all hospitals are worried about", remarked Dr. Kus at Public Health Ontario. Thus far, Canada has recognized 19 cases of Candida auris. A cluster of cases in British Columbia, and five others in southern Ontario, although none of the cases surfacing in Ontario was multi-drug resistant.

Candida auris was identified first in 2009 in Japan. Since then it has morphed into a global threat, behaving differently than other infectious threats; its ability to cling to synthetic surfaces to form a biofilm makes it particularly difficult to eradicate. While humans are normally colonized with various strains of Candida which can sometimes cause infections like vaginal yeast and athlete's foot, those strains are considered a nuisance, rather than serious infections.

Treatment for fungal infections is limited, posing yet another complication with Candida auris. Aside from which antifungal drugs can be harmful, and this being the case, they must be judiciously used to avoid harm. Advice to physicians from Public Health Ontario is that rooms of patients or residents colonized with C.auris must be cleaned and disinfected on a daily basis; even twice daily -- with medical equipment used only on that patient, none others.

Ultraviolet light holds out hope as a treatment to eradicate its presence, and evidence exists that hydrogen peroxide vapour together with ultraviolent light can be capable of reducing levels of environmental contamination with C.auris. It is as yet unknown whether this will ultimately reduce transmission rates.

Stephanie Spoor, second from the right, is pictured here with her family. The Chicago woman died in February after contracting a drug-resistant superbug in hospital. (Submitted by Jason Spoor-Harvey.)
Stephanie Spoor, 64, died in February after contracting the fungal superbug Candida auris at Chicago's Northwestern Memorial Hospital while awaiting a lung transplant. She had lived with lupus for years, but the infection killed her within weeks.

 

That Other Eternal Search

"There’s currently a renaissance going on in psychedelic research with pilot trials and promising studies of full-dose MDMA (ecstasy) use for post-traumatic stress disorder and of psilocybin use within healthy populations or to treat depression and end-of-life anxiety. There hasn’t been the same research focus on microdosing. We didn’t have answers to the most basic epidemiological questions – who is doing this and what are they doing?"
"We wanted to ensure the results produced a good basis for future psychedelic science.Typical doses aren’t well established. We think it’s about 10 mcg or one-tenth of an LSD tab, or 0.2 grams of dried mushrooms. Those amounts are close to what participants reported in our data."
"Users engage in black market criminalized activities to obtain psychedelics. If you’re buying what your dealer says is LSD, it could very well be something else. We wouldn’t suggest that people microdose, but if they are going to, they should use Erlich reagent [a drug testing solution] to ensure they are not getting something other than LSD."
"With microdoses, there should be no ‘trip’ and no hallucinations. The idea is to enhance something about one’s daily activities, but it can be very difficult to divide a ½-cm square of LSD blotting paper into 10 equal doses. The LSD might not be evenly distributed on the square and a microdoser could accidentally ‘trip’ by taking too much or not taking enough."
"The goal of the study was to create a foundation that could support future work in this area, so I’m really excited about what these results can offer future research. The benefits and drawbacks data will help ensure we can ask meaningful questions about what participants are reporting. Our future research will involve running lab-based, randomized-control trials where psychedelics are administered in controlled environments. This will help us to better characterize the therapeutic and cognitive-enhancing effects of psychedelics in very small doses."
Thomas Anderson, PhD candidate, cognitive neuroscientist, Regulatory and Affective Dynamics (RAD) Lab, U of T Mississauga

Microdosers experiment with sub-hallucinogenic hits of acid and mushrooms in the hope of gaining some reprieve from depression, anxiety and other distractions. Brent Lewin/Getty Images

"What we found with microdosing is that people's negative feelings again were less. But they also had more positive feelings, which has never appeared on anti-depressant studies. People felt less bad, and more good."
"People indicate they have incredibly improved focus and attention. I remember one young man who said, 'I only use it [LSD] when I have a coding problem'."
James Fadiman, psychedelic researcher and psychologist, author The Psychedelic Explorer's Guide

LSD blotter tabs on top of a US quarter coin. Microdosers say they typically take about one- or two-tenths of a tab every three days or once per week. (Paul J. Richards/AFP/Getty Images)

"[Microdosing can induce a kind of] cognitive flexibility [one] that helps you reframe how you are seeing the world, what's salient to you, the kinds of connections you're able to make, the kinds of insights into problematic situations that you're capable of having." 
"[Psychedelics are about therapeutic or existential improvement], how to make sense of your environment and realize what's relevant to you."
"It's more about people trying to respond to the meaning crisis in culture [not the] tune in, drop [counterculture of the 1960s]."
John Vervaeka, assistant professor, cognitive psychology and cognitive science, University of Toronto

A new Canadian study digs into the little-researched subject of how and why people microdose psychedelic drugs, including so-called magic mushrooms, pictured above. (Evert-Jan Daniels/AFP/Getty Images)

There were 909 participants in one of the largest formal studies recruited online from 29 countries to focus on microdosing with psychedelics to assess the effects on mental health. Responses to the online questionnaire and having participants measure creativity allowed two University of Toronto PhD candidates to complete one of the first psychological profiles of a community that is growing, and identified by their commitment to microdosing; consumption of small amounts of LSD or "magic mushrooms".

Microdosers scored lower overall on neuroticism and "dysfunctional attitudes" than their non-microdosing counterparts. They also had higher scores on a "wisdom" scale measuring certain perceptions such as "I am in touch with my feelings", or "I have a good sense of humour about myself". The microdosers appeared to be more open-minded, curious and creative, able to think of more unique and unusual uses for example, that a brick or a knife could be put to. They appeared to the researchers to be prime examples of outstanding mental health.

The two researchers, Thomas Anderson and Rotem Petranker, compared current and former microdosers against controls with no microdosing experience in their backgrounds. University of Toronto Centre for Psychedelic Studies, newly launched, and the two researchers are now preparing for a first Canadian study of a new randomized trial to compare placebos to measured psilocybin -- the principal psychoactive compound in certain types of fresh and dried mushrooms. According to Mr. Petranker, the associate director of the new centre, microdosing has assumed the proportions of a new religion.

Several trials have been conducted on the affects of taking LSD, but none on microdosing it. Photograph: PR

Microdosing subreddit alone has close to 40,000 using subscribers making it abundantly clear that tens of thousands of people have launched their personal experiments with sub-hallucinogenic hits of acid and mushrooms hoping to feel less depressed, to assuage anxiety, to become more focused; a practise likened to an "illicit, chemical form of yoga", according to The New York Times. It's a trend that saw its beginnings in Silicon Valley when biohackers in 2010 were looking for a competitive edge.

Psychedelic-guided therapy at the present is based primarily on a phenomenon known as "ego dissolution"; belief that a person's sense of self, distinct from the rest of the world, evaporates during a psychedelic experience, permitting a new sense of connections and "boundlessness" to be gained. Microdosing involves "sub-perceptual" hits, typically representing one-tenth of a recreational dose; ensuring that no altered states of consciousness ensue. There should be no visions, no wavering lights; less about feeling at one with everything, more about pulling through the day.

More than half of Canadians, according to a recent survey, believe depression and anxiety have reached "epidemic" proportions. "People are saying, at a grassroots level, what else can we possibly do?", said Petranker, given that antidepressants dispensed so commonly offer little help over placebo for mild depression, according to studies. Mr. Fadiman, of Sofia University in Palo Alto, California and Toronto clinical psychologist Sophia Korb report from their experience with microdosers, the end result is that there is less depression, better mood, less procrastination, more energy and more patience.

Researchers presented the findings at the Beyond Psychedelics conference in Prague in June. (Source: The Benefits and Drawbacks of Microdosing Psychedelics)

The Mystery of Life and Death

"We can then look at survivors and see if they can recall any of these stimuli, and when they were able to receive information, and how that relates to their brain resuscitation quality."
"What happened to this person's mind and consciousness, this sweet human being that I was talking to just a half an hour ago? Is he conscious? Is he able to see us, hear us? When did he lost it, if he did lose his consciousness?:
"Transcendental mystical or spiritual experiences close to death have been described for millennia. The problem with all those studies are that none of them are causative -- none of them show you how brain cells could possibly generate a thought, which is the fundamental problem of consciousness."
"Why would my brain cells, millions of them connected together, suddenly feel guilty, or have a sentiment of guilt, like if I were to throw a brick in my neighbour's window, or be rude to somebody or do something immoral?"
"Yet, paradoxically, what we started to see is that millions of people have now been resuscitated, and many of them have reported these very lucid, well-structured thought processes [able to to form memories, describe conversations and what people were wearing] Except that their brain has shut down and they've gone through death. Which is completely a paradox, it should not happen."
"We're all conscious, thinking beings. Everything we do starts with consciousness. Yet we don't know fundamentlaly where it comes from."
Dr. Sam Parnia, author, AWARE, awareness during resuscitation, resuscitation specialist, NYU Langone Medical Center

Cornelia Li for National Post

"If you take that organ [the brain] away or kill that organ or that organ dies, you cannot be conscious. [While there is no identified conscious centre of the brain, nothing to point to and claim] 'there, that's where it all happens."
"And I know of no case in the literature of a brain dead patient coming back."
Adrian Owen, neuroscientist, Western University

"Serotonin in particular was very high [in dying brains]. We know that the serotonin is associated with hallucinations and other mental functions."
"But the part that is at least partly responsible for conscious information processing is actually increased tremendously in the dying brain [for 30 seconds at least]."
Jimo Borjigin, associate professor, University of Michigan Medical School

Dr. Parnia believes that human consciousness may very well go on even after our heart stops beating for an undetermined period of time. He has taken the testimony of many people whose detailed descriptions of their out-of-body-at-death experience he gives credence to. A man, for example who suffered a cardiac arrest, and his brain "flatlined", with no sign of brain activity of any meaning. He described someone beckoning to him from the ceiling, and then the next second, "I was up there, looking down at me", a corpse, surrounded by doctors, nurses.

He witnessed his blood pressure being taken, a doctor placing something down his throat, saw a nurse pumping on his chest. He described the people, the sounds and the events of his eventual "resurrection". The man experienced conscious awareness for three to five minutes in the absence of detectable brain activity, "When no human experience should be happening whatsoever", stated Dr. Parnia, who cited the case in his study published in 2014 called AWARE.

According to Dr. Parnia, who has made himself an expert on the phenomenon, evidence from AWARE along with other related studies brings in the possibility that the mind or consciousness; the psyche, the "self", the spirit that reflects our uniqueness may not originate after all in the brain as popularly imagined as reality, but may rather reflect a separate, as yet-undiscovered scientific entity. Modern science at the present time lacks the tools required to demonstrate this, that when we die, what we name consciousness or the self does not become "immediately annihilated".

Dr. Parnia is not religious, he is not looking for proof of an afterlife; he and others who believe as he does are attempting to discover improved methods whereby the brain can be saved to avoid "disorders of consciousness", such as that which afflicted a Florida woman who suffered massive brain damage which resulted in a permanent vegetative state following a cardiac arrest. He is also searching for a method whereby he can test the accuracy of fantastical claims of near-death experiences with the use of objectively scientific approaches.

He plans to measure, second by second, oxygen levels inside the brain through a planned study of 1,500 people in cardiac arrest when a "code" is called so participating researchers, once alerted can dispatch themselves to resuscitation rooms with backpacks carrying portable brain oxygen monitoring devices. A portable EEG will measure whether the brain is functioning, and patients will be fitted with wireless headphones where random words and sounds will be transmitted and images beamed upwards as people undergo CPR.

The ultimate goal is to understand the optimal brain oxygen levels to be targeted by doctors during cardiac arrest and CPR to be able to optimize survival and bring a whole person back from cardiac arrest, with intact brain and mind and full functionality for their living future. This reflects advances in resuscitation where death can be reversed in those who have lacked a pulse for hours. Even greater numbers of people could be brought back across the death threshold, believes Dr. Parnia, if more hospitals implemented advanced techniques; chilling bodies to protect the brain, or using automated mechanical devices for chest compressions beyond what a human could perform.

Most people ultimately die of cardiac arrest, irrespective of how it has come about; the drop of blood pressure, the heart's inability to pump sufficient blood to supply the body, the heart eventually stops, respiration stops, electrical activity to the brain stops, and the brain flatlines. Studies suggest that six to 23 percent of cardiac arrest survivors report having clear memories fitting the parameters of a near-death experience. From a functional perspective, the moment the heart stops, the brain shuts down, said Dr. Parnia; even so, people become resuscitated, they form memories, describe conversations, "Except that their brain has shut down and they've gone through death".

The notion of a soul or mind existing separate from the body, charge his detractors is absurd. "I thought to myself, we can probably figure this [conundrum of brain-mind and near-death phenomenon] out in, like, a year, year-and-a-half of research", muses Dr. Parnia. He's still struggling with it after twenty years, with no end in sight, but opportunities to conduct further research, looking for that elusive "eureka!" moment of discovery.

Cornelia Li for National Post

Tyrannosaurus rex : King of the Dinosaurs

"In the last thirty years, the number of tyrannosaurs has increased threefold."
"The golden age of paleontology is right now."
"We have as much evidence that T.rex had feathers as we do that Neanderthals had hair."
Mark Norell, curator, fossil amphibians, reptiles and birds, American Museum of Natural History, New York

"It took evolution a long time to make T.rex."
"For most of the time they [early tyrannosaurs] were second- or even third-tier predators."
"People who study non-dinosaurs say dinosaurs get all the attention. People who study dinosaurs say theropods get all the attention."
"People who study theropods, say, oh, tyrannosaurs get all the attention."
Stephen Brusatte, paleontologist, University of Edinburgh, Scotland

Tyrannosaurus rex, by the very indisputable fact that it is the largest land predator that has ever existed, does, quite, 'get all the attention', focusing peoples' minds on their incredible size, ferocity, temperament and appetite. It was named the world's most charismatic megafossil, after T.rex was described in 1905. That first fossil, and its monumental size was thought to be an anomaly, that another would likely never be disinterred.

Yet for over a century, T.rex has added extraordinarily to the study of dinosaurs with the pace of discovery recently ramped up with many of the new findings about T.rex along with other tyrannosaurs recognized as its relatives. Now, T.Rex: The Ultimate Predator, a new exhibit at the American Museum of Natural History is slated to showcase that ancient monster of size and appetite. The Smithsonian National Museum of Natural History in Washington is set to reopen its hall of fossils with its own T.rex in a new stance, in June.

According to Dr. Mark Norell, curator at the American Museum of Natural History, T.rex has been an enormous assist in fostering a surge of interest in dinosaur paleontology given the rising number of researchers and new fossil discoveries thanks to the increase in the sophistication of new study techniques. "The golden age of paleontology is right now", stated his co-curator of the new show, Gregory Erickson, a paleobiologist at Florida State University.

"There were probably only six of us in the world who were paid" to study dinosaurs exclusively, explained Phillip J. Currie, paleobiologist at the University of Alberta. "Right now, there's maybe 150", he said, in light of the explosion in the field. The first discovery of T.rex created a sensation, and now each new skeleton or partial skeleton find has been met with the same kind of enthusiasm. The Field Museum in Chicago attracts international attention with its T.rex skeleton.

That skeleton, discovered in 1990, turned out to be the largest, most complete T.rex ever, which the museum paid $8.3 million for. Another giant skeleton discovered shortly afterward is set to be unveiled at the Royal Saskatchewan Museum in Regina, in May. Few finds are 90 percent intact as was the Chicago skeleton. Studies, with the use of CT scans, chemical analyses and new microscopic techniques illuminate behaviour, evolution and sensory capacities of T.rex.

The skull's musculature indicated that T.rex had a bite strength of 3,540 kilograms, deemed sufficient to cleave bones of other massive dinosaurs. Bone growth rings' studies led to a determination of how old individuals dinosaurs were and how swiftly they grew to maturity. T.rex, it appears, gained over two kilograms daily in its teenage years, living to age 30, at most. Judging by fossilized footprints of a dinosaur grouping, T.rex was held to be a social animal, one that likely hunted in groups.

Its brain was large even for its size, leading to the conclusion that its intelligence level was higher than other dinosaurs'. T.rex had excellent vision, with ears adapted for hearing low-frequency sounds and its brain case suggests that T.rex's olfactory capacity was superb. Feathers? It had feathers, more in its younger years, but likely had a tail plume at maturity though no T.rex fossil has been found indicating the presence of feathers.

According to Dr. Norell, considering what is known about other tyrannosaurs, related dinosaurs and the course of evolution, scientists are confident in asserting that T.rex had feathers growing out of parts of its hide.

There are over two dozen other dinosaurs dating back 100 million years before T.rex came on the scene, included in its superfamily of tyrannosaurs. The early tyrannosaurs for the most part were small; some chicken-sized while many were the size or dogs or deer. They were not the top predators for most of the 100 million years of their existence.

Then came the emergence of T.rex close to the end of the age of dinosaurs, swiftly becoming the dominant predator in North America. A reputation that draws some irritation from researchers of other early creatures that evolved aeons ago.

Visitors to T. rex: The Ultimate Predator will encounter a massive life-sized model of T. rex with patches of feathers—the most scientifically accurate representation of T. rex to date.
D. Finnin/© AMNH

Tracking Food Disclosures

"[It's likely AquaBounty] production will be ramped up in Canada."
"It's a huge advantage for AquaBounty to be allowed to produce this salmon in Canada."
Sylvain Charlebois, director, agri-food analytics, Dalhousie University

"Will there be a disruption in the ... entire salmon market? We hope not. But I will say if that's a possibility, then the response will be: somebody has to label."
"We are reviewing it. We recognize the United States is moving forward with mandatory labelling, as is the European Union."
"Does it make sense from a trade perspective to align more closely with our major trading partners?"
"Who bears the burden of that transparency? I don't think it should be our producers because we're not the ones putting the new product into the market."
Tim Kennedy, executive director, Canadian Aquaculture Industry Alliance

The salmon are engineered to grow much faster. Both these salmon are the same age. (AquaBounty)

"We take biosecurity and sustainability seriously, and our state-of-the-art recirculating aquaculture system (RAS) design includes multiple and redundant physical barriers to escape."
"With this final regulatory approval now obtained, we anticipate hiring more people from the community on Prince Edward Island to ramp up commercial production."
AquaBounty CEO Sylvia Wulf

"More GM salmon means more risk to wild Atlantic salmon. That is the science."
"This decision is the first step in a dangerous expansion of GM fish production. We need a national consultation on improving regulation before new GM animals are approved."
Mark Butler, spokesman, Ecology Action Centre, Nova Scotia

"The lack of genetically modified food labelling is just the most obvious transparency issue undermining public trust."
"Canadians are also asking for more transparent regulation of genetically modified organisms and opportunities for public engagement."
Lucy Sharratt, co-ordinator, Canadian Biotechnology Action Network

AquaBounty is prepared to begin stocking its Rollo Bay facility off the waters of P.E.I. "as soon as possible". The company, based in Maynard, Massachusetts, has genetically modified salmon for the singular purpose of having the fish reach adult size faster, by inserting DNA from Chinook salmon to create a more affordable product, taking less time to come to maturity, enabling the company to put the new genetically altered fish on the market with its initial AquAdvantage harvested salmon.

What the producers of non-GM-fish-farmed salmon are concerned about is differentiating their product from the GM-modified product in light of the fact that Canada's federal Health Department feels there is no need to impose mandatory labelling to identify genetically modified fish. Consumers, as far as the department is concerned, need not concern themselves over the presence of GM-altered fish on supermarket shelves.

Environment Canada having given its certification approval, Canadians can expect to see the GM fish for sale toward the end of 2020. Environmental groups assertively oppose such modified food, arguing the risk to wild Atlantic salmon -- should there be an escape of GM-modified fish. A large unknown, however, is how the availability of such fish on the Canadian market will be met by consumers; taken up with confidence -- or rejected.

As far as the Canadian aquaculture alliance is concerned, its members have no interest whatever in  researching, farming or selling such fish. According to executive director Tim Kennedy, the industry is prepared to consider setting up a label similar to labelling of organic foods, to identify their products as non-genetically-modified.

The Health Department relayed its considered opinion to the Canadian Biotechnology Action Network, an opponent of GM salmon, that it would rely on "industry-led initiatives such as voluntary standards"; that "the government of Canada intends to maintain its current approach". This is interpreted by Mr. Kennedy as indifference over where a labelling initiative will find its funding.

AquaBounty is prepared to ship directly to markets, specifically, processors for the GM salmon, to be used in products such as sushi, pies and pates. The U.S. Food and Drug Administration has assented to AquaBounty production in Indiana, but it will be required to disclose its GM status. A coalition of consumer, environmental and fishing groups hopes to block the sale of GM fish through a pending lawsuit.

The GM-modified fish opponents take exception to the American labelling system which uses the term "bioengineered", which may throw people off who are not familiar with the phrase which is synonymous with "genetically modified".

This handout photo provided by AquaBounty Technologies shows two same-aged salmon, a genetically modified salmon, rear, and a non-genetically modified salmon, foreground. As trangenic salmon raised in Prince Edward Island are poised for the leap to Canadian grocery shelves, traditional producers are pondering how to set their farmed fish apart.
THE CANADIAN PRESS/HO-AquaBounty Technologies