Dracunculiasis -- Guinea-worm disease

 

"We think about President Carter's legacy [and his push to get to zero cases]." 

"These might not be seen as the No. 1 problems in the world, but they are the No. 1 problems for people that suffer from these diseases."

"So we continue to charge ourselves with his mission of alleviating as much pain and suffering as we can."

Adam Weiss, director, Carter Center Guinea worm eradication program 

 

"Dracunculus medinensis (D. medinensis), a type of parasitic worm, causes guinea worm disease. The larvae live in stagnant (nonmoving) water, like ponds or shallow wells. They infect copepods, bug-like crustaceans that are almost too tiny to see. Copepods are sometimes called water fleas."

"If you drink water that copepods live in, D. medinensis larvae can get into your stomach and intestines. They move through the walls of your insides to other parts of your body. Eventually (usually about a year later), an adult worm starts pushing its way through your skin. They need to get to the outside of your body to release eggs into water. Adults can grow up to 3 feet (1 meter), so it can take a long time for them to work their way out of your body."

Cleveland Clinic

 

 

In 2025, came the good news of a historic low in Guinea worm infections now seen only in three countries. Former U.S. President Jimmy Carter who established The Carter Center with its mandate to eradicate the dread disease with its launching in the 1980s, was said to have wanted to outlive its eradication, to enjoy the completion of a goal he had set. Back then in the mid 1980s, the parasite was known to afflict millions of people in developing countries.

 

In the year just passed, four human cases were reported in Chad, four in Ethiopia and two in South Sudan. Animals too can become infected and among animals infections continue to number much higher but have slightly declined in some countries. There were 15 cases of Guinea worm reported in 2024 in Angola, Cameroon, and Central African Republic while Mali reported zero cases two years running.

 

If and when Guinea worm is finally eradicated, it will join smallpox as the only two human diseases that medical science succeeded in freeing the world from. The worm's larvae are laid in water, so the contaminated water becomes the vector in infecting people and animals who consume that water. Once the larvae enters the body it grows for a year and can grow up to a metre in length, with the diameter of spaghetti.

 

Once the worm has reached maturity it seeks to exit the host body and it does this through the medium of a blister. Depending on the length of the worm, its exit can take a long time, during which time excruciating pain wracks the infected person. When infected people -- or animals -- who suffer from the condition immerse themselves in water in an effort to ease their pain, the worm takes the opportunity to deposit its larvae, in an ongoing cycle. 

 

Infections can also occur when people consume fish or amphibious creatures that have themselves consumed the larvae. The Carter Center specializes in educating the public, training volunteers, and distributing water filters in affected areas. No treatment exists for Guinea worm, although medication can be used to alleviate pain and suffering.

 

The development of diagnostic tests is next on the agenda for the Carter Center's eradication program. The benefits of testing before an infected person or animal becomes symptomatic are linked to minimizing or eliminating opportunities for the worms to continue infecting water sources with their larvae.  

A jar containing Guinea worms AP file

"Imagine drinking a simple sip of water and unknowingly setting a timer for one of the most bizarre and painful biological ordeals on the planet. Guinea worm disease, caused by the parasite Dracunculus medinensis, has haunted humanity for millennia. Its modus operandi is as unsettling as it is intricate. The story of its near-eradication, led by the heroic efforts of former U.S. President Jimmy Carter and a coalition of determined organizations, is a testament to what global cooperation can achieve—even without the aid of modern medical marvels like vaccines or miracle drugs."

"Guinea worm disease begins when someone in a rural, water-scarce region drinks from a stagnant pond teeming with tiny water fleas infected by Guinea worm larvae. Once ingested, these larvae migrate through the digestive tract, eventually pairing up for a little love in your body. While the male dies after its job is done (a grim version of “mate and die”), the fertilized female has big plans: she grows to about a meter long—yes, meter—and prepares to leave her host, which, unfortunately for us, involves excruciating pain."

"A year after infection, the female worm heads to the surface of the skin, creating a blister that feels like it’s on fire. Naturally, the victim seeks relief by submerging the affected body part in water. That’s the worm’s cue to release a soup of larvae, ensuring its species’ survival. The cycle begins anew, unless interventions like water filtration or behavior change interrupt it."

History of Vaccines tribute to former President Jimmy Carter 

 

 

The Judgement of Solomon

Some critics are outraged that a person convicted of a violent crime would be awarded an organ that so many others so desperately need.  University of Maryland School of Medicine

 

"The key principle in medicine is to treat anyone who is sick, regardless of who they are."

"We are not in the business of sorting sinners from saints. Crime is a legal matter."

Arthur Caplan, bioethics professor, New York University

 

"Ed suffered. the devastation and the trauma, for years and years, that my family had to deal with."

"[Once Bennett was released from prison he] went on and lived a good life. Now he gets a second chance with a new heart -- but I wish, in my opinion, it had gone to a deserving recipient."

"He's being given another shot at life. But my brother Ed wasn't given a shot at life. Ed was given a death sentence."

Leslie Shumaker Downey, sister of Edward Shumaker

 

"I said, 'We can't give you a human heart; you don't qualify. But maybe we can use one from an animal, a pig. It's never been done before, but we think we can do it."

"I wasn't sure he was understanding me. Then he said, 'Well, will I oink'?"

Dr.Bartley Griffith, heart transplant surgeon, University of Maryland Medical Center 

"We have a legal system designed to determine just redress for crimes. And we have a health-care system that aims to provide care without regard to people's personal character or history."

Scott Halpern, professor of medical ethics, University of Pennsylvania

 

"[The Baltimore hospital provides] life-saving care to every patient who comes through their doors based on their medical needs, not their background or life circumstances."

"This patient came to us in dire need and a decision was made about his transplant eligibility based solely on his medical records."

University of Maryland Medical Center official statement

David Bennett was convicted of the 1988 bar stabbing of Edward Shumaker, an attack that resulted in the victim needing to use a wheelchair before having a stroke and dying. University of Maryland School of Medicine

The story originally began back in 1988, almost 34 years before David Bennett Sr. broke medical history by becoming the first human to receive a genetically modified pig heart, and with it the chance to live a little longer. Back then, in his 20s, he entered the Double T Lounge in Hagerstown, Maryland. And came into contact with 22-year-old Edward Shumaker who was drinking while speaking with Bennett's then-wife Norma Jean Bennett. The innocence of the encounter marred by Bennett's wife sitting on Shumaker's lap.

 

At the time, Bennett, 23 years old himself, attacked Shumaker while he was playing pool, stabbing him in his back. The immediate result was Shumaker losing feeling in his legs while he was stabbed repeatedly in the abdomen, chest and back, seven times in all. In the trial that followed Bennett was acquitted by a jury of intent to murder, but found guilty of battery and carrying a concealed weapon. Sentenced to ten years in prison, ordered to pay restitution of $29,824 to Shumaker.  

Until he died at age 41, the once-muscled, hale and social Shumaker was wheel-chair bound. His younger brother who was an EMT had dropped Shumaker off at the bar before reporting to his ambulance shift. Ironically, he was the first to respond to the scene. Shumaker's brother Eric struggled with guilt as his older brother endured staph infections, sepsis, bedsores. His brother cycled in and out of nursing homes and he blamed himself for driving him to the bar that night. He died at age 28 of an opioid overdose.

There are over 106,000 Americans on the waiting list for a transplant, 17 of whom die daily while awaiting a transplanted organ. Bennett's doctors proposed the experimental procedure once the man was considered to be ineligible for a normal human heart transplant as a result of heart failure and irregular heartbeat. What also made  him ineligible was his past as a patient where he failed to follow doctors' orders and was inconsistent about taking prescribed medications.

Before his admission to hospital Bennett lived in a duplex next door to one of his three sisters, worked as a handyman and spent time with his five grandchildren, and his dog, Lucky. At his admission to hospital and before the first-in-the-world pig heart transplant into a human chest he had been bedridden for weeks in the hospital; there was no therapy that might alleviate his dying heart. And then the implant took place with doctors on tenterhooks over his survival potential.

 

This Monday their patient was breathing on his own, still connected to a heart-lung machine. A day later doctors took him off the heart-lung machine. By Wednesday he was able to speak. His new heart appears to be working well, exceeding his doctors' expectation.

Bennett became the first person to ever successfully receive a genetically modified pig heart transplant. AP

"My intent here is not to speak about my father's past. My intent is to focus on the groundbreaking surgery and my father's wish to contribute to the science and potentially save patient lives in the future."

"My Dad has never ever in his entire life talked to me about that [the event that occurred in 1988]. I will not say anything about it."

"This [his father as a private, selfless man, thinking of helping others] was something that made me proud as a son [to proceed with the transplant]. This tops everything, in terms of what makes me proud."

"He has a strong will and desire to live."

David Bennett Jr., physical therapist, North Carolina

 

Inspired to Discovery and Medical Treatments

"The value of my stake doesn't interest me." 

"We wanted to build up a firm similar to biotech giants like Amgen or Genentech. We want to create long-term value."

"That's what interests me."

BioNTech CEO Ugur Sahin, 55, Turkish-German biotech entrepreneur

Dr Özlem Türeci and Dr Uğur Şahin, who both have parents who came to Germany from Turkey in the late 1960s. Photograph: Biontech

The behind-the-scenes story of a married pair of bioengineers backstops the sensational report that Pfizer has announced an astounding 90% success rate in the early stages of its Third Stage human trials for their anti-COVID vaccine. Theirs is an immigrant-success story of quite considerable proportions. The pair is devoted to discovering whatever can be found to support the human immune system against dire threats to human life. Their primary focus has been to discover new drugs and therapeutic protocols in the battle against cancer.

They turned their focus temporarily to finding possible solutions to the enigma of the SARS-CoV-2 virus that causes COVID-19 whose complexity of assaults against the human body has caused great consternation among epidemiologists as it continues to sweep through the world community, wreaking unstoppable havoc. Unstoppable until such time as an effective, efficient and safe vaccine can be produced, distributed and inoculate as much of the world's population as possible with, to achieve that vaunted herd effect.

Pfizer and BioNTech, the first drugmakers to indicate that initial data from their large study spells success for a novel coronavirus vaccine have up to the present seen no indications of any serious safety concerns, and are confident that U.S. emergency use authorization will be on an early horizon.

 

BioNTech chief executive Ugur Sahin is the son of a Turkish immigrant who worked in Cologne, Germany at a Ford factory. The offspring of that factory worker in Germany is now among the 100 wealthiest Germans, along with his wife and BioNTech board member, Oezlem Tuereci, 53, who is also the firm's chief medical officer. 

 

Nasdaq-listed BioNTech, co-founded by the pair now stands at $21billion. A year ago its market value was $4.6 billion. BioNTech employs a workforce exceeding 1,300 people from over 60 countries, more than half of them science-qualified women

Matthias Kromayer, board member of venture capital firm MIG AG, backers of BioNTech since its 2008 inception, describes Ugur Sahin as a modest man: "Despite his achievements, he never changed from being incredibly humble and personable". Professor Sahin, he continued, typically attended business meetings in jeans, carrying his bicycle helmet and backpack.

The Turkish-German entrepreneur was faithful to his childhood dream to become a physician. His experience includes working at teaching hospitals in Cologne and the south-western city of Homburg, and it was there that he met his future wife during his early academic career. They were both wedded to medical research and oncology, as well as to one another.

For her part, Oezlem Tuereci's father is a Turkish physician who migrated to Germany. She and her husband have consistently focused on the human immune system hoping to be able to harness it in the fight against cancer as they attempted to address each tumour's unique genetic makeup. In 2001 they launched themselves as entrepreneurs, setting up Ganymed Pharmaceuticals for the purpose of developing cancer-fighting antibodies.

Professor Sahin never surrendered interest in research and teaching and served as a professor at Mainz University. MIG AG provided the funding they needed along with Thomas and Andreas Struengmann when Novartis bought out their generic drugs company in 2005. The couple looked to the future, building BioNTech in 2008 in pursuit of a broader range of cancer immuno-therapy tools.

 

 

What's Old is New Again

"It [psychedelic drug trials] raises the caution that the investigation of hallucinogens as treatments may be endangered by grandiose descriptions of their effects and unquestioning acceptance of their value."
"Timothy Leary was a research psychologist before he decided the whole world should 'Turn on, tune in and drop out'. It is best if some steps are not retraced."
Dr. Guy Goodwin, professor of psychiatry, Oxford University

‘Magic mushrooms’ contain psilocybin, a psychedelic substance. Jonathan Carmichael

"I was so depressed. I felt that the world had abandoned me that I'd lost the right to exist on this planet."
"I experienced this kind of unity, of resonant love [in a trial with a heavy dose of psychedelics], the sense that I'm not alone anymore. I felt welcomed back to the world."
"I think that trial was the single most effective thing I've done to manage my mental health, and I had tried almost everything."
Rachael Peterson, 29, Maryland, U.S.

"Now we have the core funding and infrastructure to really advance psychedelic science in a way that hasn't been done before."
"That [MEQ: 'mystical experience questionnaire'] was a significant branding mistake, because awe is not fun."
"There's something existentially shaking about these experiences."
Roland Griffiths, neuroscientist, Johns Hopkins

Johns Hopkins is launching a new Center for Psychedelic and Consciousness Research

 

 

 

 

Johns Hopkins Medicine launched its new Center for Psychedelic and Consciousness Research in the study of compounds such as LSD and psilocybin as experimental potential aids in dealing with a range of mental health problems, including anorexia, addiction and depression. As the first of its kind in the U.S., all eyes will be fixed on the new Center's progress. Johns Hopkins has been enabled to proceed with this ambitious and controversial project after having received a commitment to the value of $17 million from a foundation and private donors.

By no means is this  the first such center worldwide studying the potential benefits of psychedelics in the treatment of various mental illnesses. Imperial College London had launched the world's first center of its kind back in April, aided with $3.5 million from private funding sources. Both new centers are set to lead the way in "psychedelic medicine", an elusive but long-considered foothold with the acceptance of legitimacy in the scientific establishment. The exploration of the potential of psychedelics and other recreational drugs to aid in psychiatric problems dates to the early 2000s.

Two books and positive headlines were generated out of these early initiatives, attractive enough to researchers to inspire them to study the effects of psychedelics on people suffering from mental illness in a more organized and thorough manner. The anaesthetic and club drug ketamine and related compounds which cause out-of-body sensations used in the treatment of depression has garnered interest as well in therapeutic aids in mind-altering states used to correct for mental illness.

TIBER and REBUS models suggest which psychedelic-assisted therapy may be beneficial

While the evidence of these drugs' successful interventions is not yet convincing, causing many experts in the field to remain wary of their use, reports of improvements have yet to be standardized from the situation where it is not possible for trials with psychedelics to be 'blind'; simply put, participants, unlike most drug trials, are aware when they have been dosed. Acknowledging that situation, scientists at both centers feel the new infusion of funding will lead to clarity in identifying which drugs are useful to which patients, when the altered states are recognized as ineffectual, or where they become potentially dangerous.

Psilocybin, found in magic mushrooms, are among the first of the psychedelics chosen to take into trials for anorexia nervosa and psychological distress and cognitive impairment in early Alzheimer's disease. Since psychedelics can make people with a history of psychosis worse, they are excluded from participation in any trials. On the appointed day of treatment, the individual takes the drug while under continuous observation under the care of a therapist. In some trials, participants are given eyeshades and headphones, are instructed to lie down, and listen to music.

Thus far, the literature from such trials suggest that psilocybin looks promising as a protocol for chronic depression and addiction. And that M.D.M.A. (ecstasy) has the potential to help those with post-traumatic stress, veterans included. LSD and cannabis use in trials have brought in mixed results. What does appear universal in efficacy, is that positive effects are likelier to last longer should the participant experience an especially intense reaction to the psychedelics applied.

Stem Cell Infusion : Youthful Miracles

"[YouTube's one billion audience reaches more people than any television network] and presents a formidable platform to market unproven SCTs [stem cell therapies]."
"Providers often use misleading claims, hard sell promotional techniques, an base efficacy claims on patient testimonials."
New Study, published journal Stem Cell Reports

Terry Storm, shown in 2012, works in a Stanford University lab funded by the California stem cell program, which will soon come to the end of its $3 billion in state funding. (Paul Sakuma / Associated Press)

"[The power of the personal-story narrative] often overwhelms the data. It becomes very clear that patient testimonials, patient narratives, are a huge part of the marketing strategy."
"But despite all of the pop culture representations, despite all the excitement around these therapies, there are very few ready for the clinic. If  you see a stem cell therapy being marketed in your newspaper, on YouTube, it's almost for sure an unproven therapy and, at best, experimental."
"Of course testimonials are powerful, because there's a story being told."
"I think we need health-care professional organizations like the College of Physicians and Surgeons to stop their members from operation unproven stem cell therapies."
"Sometimes patients may see studies that have been done. These are generally observational studies, they're not well-controlled studies. So, they’re just asking patients, ‘how do you feel?’ You know placebo effect can play a big role. Especially when there’s a ‘placebo theater’ when there’s fancy technology and someone in a lab coat and people are paying a lot of money and we know that studies tell us, expensive placebos work better."
Timothy Caulfield, Canada Research Chair, professor of health law and policy, University of Alberta

A doctor at a stem cell clinic in Beverly Hills, Calif., collects fat from a patient's back as part of a stem cell procedure in 2014. The U.S. has experienced a boom in for-profit clinics marketing stem cells to patients for a wide range of ailments. Critics say they have flourished because of a lack of oversight. The U.S. FDA recently sent warning letters to two clinics and said it will take a firmer approach to stem cell clinics. (Raquel Dillion/The Associated Press)

Dr. Caulfield, who collaborated on this new study with American and Canadian colleagues, searched through YouTube to find videos relating to five medical conditions, focusing on ALS, cerebral palsy, multiple sclerosis and spinal cord injury, whose sufferers had sought out stem cell therapy, none of which would have been approved for therapeutic purposes. The study team focused on 159 videos for analytical purposes which (with the exception of three) were published by clinics whose therapies were unproven.

Most of the clinics, unsurprisingly were located in India. Next up, the United States and Mexico. Most of the people who sought out this type of stem-cell therapy were Americans -- the next largest groups were East Indians followed by Canadians. The videos featured people describing the process of injections with adult, bone marrow-derived umbilical, fat, placental or fetal stem cells. While effusively praising the therapy, mention of risks appeared an afterthought with merely ten percent of the videos speaking of downplayed risks.

One video alone has seen two-and-a-half million viewers watch an interview by comedian Joe Rogan of actor Mel Gibson, speaking about his 92-year-old father's miraculous regeneration following a double dose of stem cells extracted from umbilical cord blood injected into Gibson's father's hip. He began walking again, his eyesight improved, "cognition power" improved, his prolapsed heart valve healed -- according to Gibson -- in response to Rogan's skepticism. This one interview alone attracted more viewers than any other single YouTube topic.

The stem-cell clinics convincingly inform prospective clients that their therapies -- priced from several thousand at Canadian clinics to six thousand and steeper at those in the United States -- that an infusion of stem cells at their clinics can succeed in dramatically decreasing inflammation, and regenerate diseased or damaged organs and tissues. It's a sales pitch that people are eager to embrace, and to try out for themselves, envisioning an entirely changed self, a renewal of life's prospects in extending quality of life and a more enduring life.

At a Florida clinic, on the other hand, after stem cells were injected into the eyes of three women, the therapy left them blind. And while legitimate research scientists do believe in the potential of stem cells to grow new tissue -- replacing diseased or worn-out ones -- not all therapies are created equal, nor do they have the required experimental research to back up their quality and effectiveness claims. Some that do have papers to bolster their claims for success reporting improvements to some of those treated by them.

In Canada, although Health Canada has failed to involve itself in regulating the industry, it has issued warnings of unlicensed clinics offering unauthorized cell therapies, stating unproven claims that may in the final analysis pose serious risks to people anxious to give them a try. In videoed testimonials people are seen to describe their therapies and how their stem cell treatments have led them to increased appetite, strength, movement and flexibility. Some, on the other hand, also mention such changes to be of short duration.

Some claim to owe the new quality of their lives to the clinics treating them. Others speak of how swiftly the therapy's improvements in their function kicked in: "I started walking straighter. My energy came back and I'm amazed at how quick it happened." Dr. Caulfield is of the opinion that science must work harder at communicating both its promise and its limitations to people. That the same kind of communication strategies used by stem cell clinics who operate for profit, not science, would be useful in educating people.

"We need to use narratives, we need to use interesting videos in order to get across the good science. It's starting to happen. But we need more of it to fight this", he explained. Popularizing science in the field of health sciences so that people can have a more realistic understanding of just what it is they are so quick to submit their bodies to, in the hope that the therapy will work, because those selling it to them assure them it would.

"They are experimental [stem cell therapies]. We don't know if they work, and we don't know how safe they are."

"If a patient called me up to say they are thinking of getting the therapy from a practitioner offering it like this for a fee, I would say that I don't think that's wise."
"I don't think they know they are going to get any benefit. I think they are taking a potential risk, and all of these therapies should be offered within the context of a properly designed clinical trial."

"It is kind of scary because there is theoretical risk that there could be tumours that form. There is a theoretical risk of blood vessels forming where you don't want them to form — for instance, the back of the eye or other places, so all of these things could happen."

Dr. Duncan Stewart, scientific director, Ontario Institute for Regenerative Medicine

Researchers examined the training background of clinicians at 166 companies advertising unproven stem cell therapies in California, Florida, and Texas. (Spencer Platt/Getty Images)

MAID: Medical Assistance in Dying and Organ Harvesting

"If we accept people can make decisions to end life, and we accept the idea of cardiac death being sufficient for organ donation, t his should be acceptable."
"The concern that comes up is, could the decision for one drive the decision for the other?"
"There's a lot riding on this. If somebody has organs that would be appropriate to donate, you'll never get better organs than you would by this process [harvest post-] MAID."
Dr. James Downar, co-chair, Canadian Blood Services committee organ donation guidelines

"This [feeling compelled to pursue decision] is a theoretical possibility. Imagine a situation where the workup is done -- people have gone out and done the medical tests and found the recipients and set everything up. And then you change your mind."
"One wonders if perhaps that might create pressure to continue with the MAID. It would be very important in these scenarios to make it very clear to people that they can change their mind at any time -- that someone shouldn't stick with MAID just because they feel an obligation, having set the process in motion."
"I'm torn between a sense of, is it any harm to let people know [the donor died by assisted death]? After all, if it really bothers them, there will be someone else who will benefit greatly from this donation. They will just bypass the person who objects and go to the next."
Jennifer Chandler, professor, centre for health law, policy and ethics, University of Ottawa

"I think it's really important we keep the public's trust, in all of this."
"We have to be transparent. And it has to be clear that the two must be kept separate, that there is no pressure to go for MAID to procure organs [for transplantation]."
"[The terminally ill] may feel they would better serve society by dying and saving other people's lives." 
Dr. Marie-Chantal Fortin, transplant nephrologist, Centre hospitalier de l'Universite de Montreal

Medical team performing surgery on patient who had undergone medically assisted suicide. Getty Images

The conventional major source of transplant organs has been people who have been declared "brain dead", where patients are removed from ventilators and similar life support mechanisms meant to keep hearts and lungs functioning. Live-donor donations have more recently become another means to produce organs for transplant, when people decide to voluntarily donate pieces of their liver or a lung out of a sense of public duty and charity sometimes related to a specific patient, sometimes altruistically.

The Canadian medical community has recently adopted a practise of urging organ donation after cardiac death involving people on life support for whom the chance of recovery is medically dim. When life support is withdrawn and the heart stops beating, a five- to 10-minute "no touch" period ensues, after which the organ/s can be harvested. Because death takes its time; up to two to three hours; vital organs such as the heart and lungs begin deteriorating, resulting from lack of blood flow and oxygen.

When assisted dying is involved, organs have the potential of being retrieved swiftly once the heart stops within two to three minutes of the injection. What troubles ethicists, however, is the coupling of assisted death and organ donations. What is also to be considered is whether those organ recipients whose moral or religious objections to euthanasia entitles them to be informed that the organ offer has come from someone who chose an medically assisted death. In most instances cause of death is not routinely revealed, such as in the case of suicide, barring a valid medical reason for disclosure.

Even so, the pool of organs to be transplanted from those undergoing medically assisted dying is not a large one, given that most patients requesting assisted dying are suffering from advanced stages of cancer, making their organs transplant-unsuitable. Those, however, suffering from neurological disorders such as multiple sclerosis, have organs that are good candidates for transplant. Over 4,500 people were awaiting an organ donation in Canada in 2014, and from among them 278 died, while waiting for a transplant that never materialized.

So far, in Ontario, 26 people who chose to die by lethal injection have been donors of tissue or organs since decriminalization was passed last June. Since that time, 338 people have died through medical assistance altogether, in the province. Tissue donations represent eyes, skin, heart valves, bones and tendons. Experts feel that those who qualify for aid in dying could gain a sense of psychological comfort in the knowledge they have, through donating their organs, saved someone else's life.

And that comes up hard against those concerned that organ donation decisions might place pressure on those who qualify for assisted death. The issue appears to be, should someone agree to donate their organs, would they feel compelled by those circumstances involving the health and life of other people, to continue the procedure of assisted dying even though they may have decided they would prefer not to proceed?

Two countries that have long since legalized medically assisted death requests -- Belgium and the Netherlands -- appear to have solved the dilemma of their own concerns relating to the issue, and have long harvested organs after euthanasia. Infamously, China operates a thriving organ transplant/tourism 'business' in organs harvested from prisoners who have somehow died while incarcerated. The country stands accused of harvesting organs from still-living prisoners, as well.

“MAID (medical aid in dying) has the potential to provide additional organs available for transplantation. Accepting to procure organ donation after MAID is a way to respect the autonomy of patients, for whom organ donation is an important value. Organ donation after MAID would be ethically acceptable if the patient who has offered to donate is competent and not under any external pressure to choose MAID or organ donation”. Julie Allard and Marie-Chantal Fortin, bioethicists at the University of Montreal

No Victimless Crime

"For somebody with no criminal record at all, and who seems otherwise rehabilitated, a mother of a young child, it's a heavy-duty sentence."
"She was devastated."
"It's like an occupational hazard to get addicted. It's like a kid in a candy store for a health-care professional who has ready access to this kind of stuff."
Mark Ertel, lawyer 

"To absolve someone of something like that, I find very difficult."
"Those individuals have to make some kind of restitution, have to accept the consequences of their behaviours ... It's much like somebody who drinks alcohol and assaults somebody or gets into a car accident."
Dr. Harry Vedelago, addictions physician, Homewood Health, Guelph, Ontario

Glenn Lowson For National Post    Dr. Harry Vedelago treats many nurses an other health professionals for their addictions to narcotics

It is, in fact, much, much more serious, when a health-care professional takes advantage of proximity to stored drugs meant to alleviate pain in patients undergoing care or post-surgery pain management, to procure for themselves a store of drugs to feed their own addiction. In the process sometimes falsifying records to indicate that the painkillers were dispensed to those patients when they were not, when the drugs were stolen by the health-care professional for their own use.

Which is precisely what occurred with a nurse working at Sunnybrook Health Sciences Centre in Toronto. She chose to steal opioid painkillers along with other drugs over a seven-year period before being caught out. During that time she falsified patient records in the effort to protect herself from discovery. Her case is not an isolated one since it is well known that up to ten percent of nurses and other health-care practitioners, including doctors, succumb to the lure of such drugs and become addicted.

Often pressures related to the work they do, allied with the easy availability of drugs taken illicitly from storage units at the workplace are cited as contributing factors. But the issue is that these are people who for whatever reason make a deliberate choice to use drugs, and to procure them any way they can. The pilfering of narcotics in the workplace setting of a hospital has spotlighted a nationwide occurrence in Canada.

Many of these hospital employees return to work after having taken steps to rehabilitate themselves while others have undergone discipline-related consequences and others still have lost their jobs, or faced criminal prosecution. In the case of the Toronto nurse who made it a regular habit to steal hydromorphone (Dilaudid) along with sedatives of other types from the Holland orthopedic centre at Sunnybrook, the thefts were screened by charting the drugs being administered to surgically recovering patients.

Although denying that she had caused patients to be deprived of needed painkillers post-surgery, Sunnybrook dismissed her from staff. The union that represented her filed a grievance. A psychiatrist called by the hospital agreed that most experts believe addiction is an illness but he spoke of addiction as a choice, not a disease. Viewed as a disability, the nurse who lost her position arguably faced discrimination based on her 'illness', in contravention of the human-rights code.

Ingram Publishing/Ingram Publishing/Getty Images

In another instance in Kingston, Ontario, a nurse stole hydromorphone for over two and a half years, pilfering supplies meant for dying patients at St. Mary's of the Lake Hospital. This nurse took to replacing what she had taken with a saline solution, and altered patient records. Having done so she must most certainly have been aware that she was doing great potential harm to patients who would then receive a painkilling solution that had been weakened in strength and potent effect through dilution.

In Alberta, the provincial supreme court decided in 2012 to uphold the discipline meted out to two drug-stealing nurses on the basis that not taking this practise seriously enough, and excusing it based on 'addiction' could result in "far-reaching" consequences. That view is not universally held, however. Most regulatory agencies overseeing nurses view their goal as aiding addicted, drug-purloining employees, to assist them to return to work.

And, in the Toronto case, an arbitrator concluded that such serial thefts, motivated by addiction, fed a disability. And as such, the dismissed nurse was due human-rights protection, overturning the woman's dismissal. In her favour, the arbitrator cited the nurse seeking professional help, was currently in remission and when she returns to work as he had decreed, a set of conditions protecting Sunnybrook will define her ongoing tenure.

Chatting With Ludwig

"How people construct sentences, what words they choose to use, and even very microscopic fluctuations in their voice are very indicative of changes to their cognition."
"It [robot attendant] waits for you to talk, and when it figures out you've stopped talking, it sends the audio to speech-recognition [technology]."
"There's a very clear link between someone's expressive ability with language and the progress of Alzheimer's disease, generally. People who work with individuals with Alzheimer's disease ... could use a little bit of extra help, which is what we're trying to build."
Dr. Frank Rudzicz, assistant professor, University of Toronto/scientist, Toronto Rehabilitation Institute

Ernest Doroszuk/Postmedia Network   Dr. Frank Rudzicz with Ludwig.

"Based on [Ludwig's] analysis, we can tailor-make and customize the care the individual receives."
Isaac Weinroth, executive director, One Kenton Place, Toronto long-term care residence

According to the Alzheimer Society of Canada, 564,000 Canadians live with some form of dementia. This is a figure that will likely rise to 837,000 people afflicted with Alzheimer's or other dementia within the next fifteen years. The society states that after age 65 the chance of an individual suffering from dementia doubles every five years. Memory is the first function to begin to lapse, and after that, verbal language skills.

Dr. Rudzica felt it was time to use his skills in medical engineering and computing to produce a specialty robot whose intervention and usefulness would be invaluable to Alzheimer's care-givers. Five years ago he built a robot almost life-sized with a white case, in appearance resembling an early version of the beloved iPod. This robot was geared to following dementia and Alzheimer's patients in their homes, instructing them in basic tasks.

That robot's programming lacked the capacity to listen to the patients and interpret what they had to say. So he launched into the production of a follow-up robot, reducing the original five-foot size to only two feet, and named it Ludwig, in memory of Ludwig Wittgenstein the Austrian-British philosopher whose special interest was language and the meaning of words.

Ludwig is a new innovation to help in the care of the cognitively impaired. He resembles the physical characteristics of a boy with a high-pitched 'voice', wearing brown, unruly hair. And he is programmed to speak and interact with dementia patients, to ask them leading questions, and then 'consider' their responses, whereupon reports are provided to caregivers.

Ludwig is set to be involved in a practical trial test of its capabilities at One Kenton Place in Toronto.
As the robot stands before a patient, a picture appears on a screen, asking the patient to describe what it is they see before them. Ludwig notes his interpretation of the patient's response; whether they are conversationally engaged, seem happy or anxious, and how they're behaving in comparison to previous similar exchanges.

There are three components whose use is the recording of audio and video resulting from conversations. Ludwig has microphones in his ears, a camera in his eyes, and a sensor in his feet. The patient's gaze is tracked as well as body movement, vocal intonation and word choice. This interchange gives Ludwig the opportunity to assess the cognitive health of a patient.

The potential inherent in this little robot's functioning was a year's investment in planning and construction, all achieved at a building cost of $3,000 to produce Ludwig.

Laura Pedersen/National Post   Elizabeth Graner, a resident of long-term care home One Kenton Place, talks to Ludwig the robot.

Ludwig's home for the near future and some time after that will be in a common room at the Toronto care residence, where a television, card tables and other socializing apparatuses function to engage the residence's patients. He can be approached by residents on their own initiative to engage with him in casual conversational exchange.

Dr. Rudzicz plans to refine the technical capacity of the robot. To program it more precisely on how it will choose to respond to a patient's answer, to ensure that its assessment of the condition of the patient accurately reflects reality, before it reports back to staff who care for the patients. And bureaucratic regulatory considerations must also be addressed; whether to classify Ludwig as a medical device.

The robot is clearly not a game, but a device with a defined and critical purpose as an aid to caring for cerebrally-impaired patients. A device that is meant to change the game of looking after the needs of such patients.

Laura Pedersen/National Post    One Kenton Place resident Florence Sherman chats with Ludwig.

Blood Transfusion Outcomes

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

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

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

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


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

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

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

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

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