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Canada’s private COVID-19 testing industry is booming, but some experts say oversight is lacking

Whether you’re a traveller getting a mandated COVID-19 test at the airport, or a worker on a job site like a film set or food processing plant that requires a negative test, odds are it’s being done by a private company.

Businesses offering polymerase chain reaction (PCR) tests are now a crucial part of Canada’s pandemic response, allowing thousands of people to continue to travel, visit loved ones in long-term care, and stay on the job.

But some doctors and health experts are concerned about what they say is a lack of regulation in what has become a rapidly growing part of the health-care industry.

“Who’s doing the tests? What are the standards? How do we know that they’re doing it at the same sensitivity and specificity as those done in provincial labs or hospital labs?” said Dr. Anna Banerji, a physician and infectious disease specialist at the University of Toronto’s Dalla Lana School of Public Health.

Publicly administered PCR tests are free and are meant for people with symptoms of COVID-19. Private companies generally test people who are asymptomatic, and charge a fee for the service. Demand is soaring as many workplaces require on-site testing in order to stay operational.

The federal government and the Ontario government recently added to that demand when both declared international air travellers must have PCR tests when they arrive in Canada.

New entrants

A quick and non-exhaustive search by CBC News found 15 companies offering PCR tests for COVID-19 in Canada. Some, such as LifeLabs, which says it has conducted more than one million COVID-19 tests to date, and Dynacare, are well-known names in the specimen collection and diagnostic testing industry.

Others, such as Calgary’s Ichor Blood Services, pivoted to COVID-19 testing mid-pandemic.

Pure Lifestyle in Winnipeg offered fitness and medical services prior to launching its COVID-19 testing business just after Christmas.

Private companies across Canada are jumping in to meet the growing demand for COVID-19 testing. (Evan Mitsui/CBC)

In Toronto, HCP Diagnostics garnered attention last fall when it started offering in-home COVID-19 testing for $ 400 per test. One of the directors of HCP is James Blackburn, who also co-owns an event company that organizes large parties, and a nightclub in Toronto’s Entertainment District.

Blackburn, who declined the CBC’s interview request, told The Pal’s Podcast recently that he moved into COVID-19 testing because the pandemic had shut down his other enterprises.

“If the beast squashes your business, you might as well try to get into another business and try to fight the beast, right?” he said.

Blackburn’s partners include a registered nurse and a doctor.

HCP’s timing was good. The company incorporated in October, but its website actually went live a month earlier, the same week the Ontario government amended the Laboratory and Specimen Collection Centre Licensing Act in an effort to expand testing capacity.

The change allowed a wider range of people to get into the private testing business.

HCP is now providing on-site testing for film and TV production, construction sites, manufacturing and warehousing, as well as smaller businesses in Toronto’s downtown area.

In fact, HCP said it’s so busy, it had no time to talk with CBC News about its burgeoning business.

“Given the busy nature of our programs, I have been informed that our team will not be available,” HCP’s Emily Coles said in an email.

CBC News compared prices for PCR tests across the country and found they ranged from about $ 160 at Switch Health, which is also the company testing travellers at Pearson airport near Toronto, to as much as $ 400, the top price charged by GMF Sante Med Clinic in Toronto.

Lack of oversight, experts say

But as private testing’s role in the pandemic grows, so is concern among some that it’s largely unregulated.

“When you have people working privately in no man’s land, then you really don’t know, are the tests accurate? Are they doing the right infection control?” said Banerji.

“I think there needs to be a body that has some oversight.”

While public tests are generally done in health-care environments such as hospitals and clinics, private tests can be done anywhere from construction sites to homes. Companies must use equipment and tests approved by Health Canada, but there’s no regulatory body governing the cost private companies are charging for tests, and there’s no single external system beyond the companies themselves to deal with complaints.

Dr. Anna Banerji is a pediatric infectious disease specialist and associate professor of pediatrics at the University of Toronto’s Dalla Lana School of Public Health. She says she has concerns about the lack of oversight of the private testing industry. (Submitted by Mike Cooper)

There are different governing bodies in each province that regulate the collection and processing of medical samples. In Alberta, for instance, the province does not license or approve companies for private COVID-19 testing.

In fact, no government agency in Canada is tracking how many companies are offering the service or even how many tests they’re doing across the country.

A spokesperson for Health Canada and the Public Health Agency of Canada said because medical tests fall under provincial and territorial jurisdiction, the CBC would have to contact each province and territory individually and compile the numbers ourselves.

So we did, and found the picture is still unclear.

Every province requires companies to report positive test results. But many provinces don’t know how many tests are being done overall.

WATCH | Calls to test truckers for COVID-19: 

Commercial truckers who regularly cross the U.S. border as essential workers are increasingly worried about COVID-19 risks. Many are saying they want regular rapid testing and faster access to vaccines. 1:59

Of the nine provinces that responded, only Quebec and Nova Scotia provided a breakdown of the number of private versus public COVID-19 tests administered.

Saskatchewan and British Columbia say private tests are included along with public ones in a single number released to the public daily. But neither province could say what proportion of that daily number is private versus public tests.

Newfoundland, Ontario, Manitoba and Alberta don’t keep track of private testing data at all.

Apart from Quebec and Nova Scotia, none of the provinces that responded was able to provide a test positivity rate for private tests, a percentage that reflects how many of the total number of tests are coming back positive for COVID-19. 

Possible ramifications

Experts say the lack of an accurate count and positivity rate of private tests means we may not have an accurate picture of the overall positivity rate in Canada. 

“If the government is testing, say, 50,000 people and that gives us a positivity rate of four per cent, and the private sector is testing an additional 50,000 and they’re finding no cases at all, then in fact our test positivity rate is actually two per cent, not four per cent,” said Raywat Deonandan, an epidemiologist and associate professor at the University of Ottawa’s faculty of health sciences.

“That’s a big difference. The test positivity rate tells us two things: Are we testing enough? And how present the disease is in our population.”

University of Ottawa epidemiologist Dr. Raywat Deonandan, pictured here in Toronto, says reporting complete private testing data could have an impact on COVID-19 positivity rates. (Evan Mitsui/CBC)

CBC News also reached out to nearly a dozen companies to ask about the number of tests they conduct and the positivity rates they’ve observed.

Among those that responded was Quantum Genetix in Saskatchewan, which had been doing PCR testing on cattle prior to expanding to human COVID-19 testing late last year. Quantum Genetix said it has tested about 1,500 people and had a positivity rate of just under two per cent.

Another company, Dynacare, said it conducts between 5,000 and 10,000 PCR tests per day at its lab in Ontario. It said the positivity rate ebbs and flows, but over the past 30 days it has been near seven per cent. 

Problems with private testing

With companies often dealing with customer complaints internally, it’s difficult to know how the quality of private testing compares with that of the public system. 

The day before Christmas, Allan Asselin was visiting his 88-year-old mother, Mary, in her east end Toronto seniors’ residence when one of the nurses on staff walked into the room.

“She said, ‘Your mom has COVID. You have to leave,'” Asselin said.

“Needless to say, there were tears. She was shaking. She was just in a horrible state.”

Mary Asselin, 88, had two entries for results for a single COVID test from December, one positive and one negative. (Submitted by Allan Asselin)

Mary spent Christmas and several days afterward quarantined in her room, alone and scared.

Her COVID-19 test was processed in a private lab.

Three negative tests later, she was cleared. When Allen checked the Ontario government’s COVID-19 test results site, he found two entries for that first test back on Dec. 22, one positive and one negative.

“So did she have it or did she not have it?” he said.

In another case, a 34-year-old Montreal woman who pays $ 300 every two weeks to get tested to see her elderly father says she got a positive result in the mail with her name on it but the wrong date and location of the test, wrong home address, no health insurance card number, and the notification came a month after her test was performed.

“What good does it me, or the public, to get this information a month later, after walking around and hanging out with my family, [possibly] being unknowingly positive for a month?” said the woman, whom CBC News agreed not to identify for privacy reasons. 

Private testing necessary

The fact is, however, the economy would likely not be reopening nearly as quickly as it is without private testing, which epidemiologists say plays a vital role in Canada’s pandemic response.

“I approve of private testing, if done strategically, because it alleviates strain on the public health system that should be used for things like proper surveillance, that should be used for actual symptomatic people arriving at hospitals and things like that,” said Deonandan.

Private companies, he said, should be tasked with what he calls “reassurance testing.”

“That’s when you need a test to go back to work or to keep going to work or maybe to engage in some other activity,” he said.

“But even then, that requires some serious ethical oversight.”

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CBC | Health News

AthletesCAN claims IOC lacking in empathy as Olympic debate heats up

As the debate continues over whether the Tokyo Olympics should proceed as planned, an internal letter from AthletesCAN – the organization that represents all of Canada’s national team athletes – is questioning the International Olympic Committee’s level of empathy, as the world deals with the COVID-19 pandemic.

CBC Sports obtained a copy of the internal email sent to all AthletesCAN members on Saturday afternoon.

Despite the growing spread of the novel coronavirus – that began in late 2019 in Wuhan, China, and that as of this writing has killed nearly 13,000 worldwide with over 300,00 confirmed cases – the IOC has repeatedly insisted that the Summer Games will open in Tokyo as scheduled on July 24, followed by the Paralympics on Aug. 25.

In recent days, the IOC’s insistence has started to draw heavy fire. What began with a few dissident voices has quickly grown into a swell. On Friday, USA Swimming called for a 12-month postponement —a move also backed by Swimming Canada.

And on Saturday, USA Track and Field said it also supported a postponement. Soon after, the Norwegian Olympic Committee echoed these sentiments, saying the Olympics should wait until the COVID-19 situation is under control.

Against this unnerving background, AthletesCAN – raised its own doubts over the single-mindedness of Olympic organizers, and the increasingly muddy qualifying schedule.

“While we desperately want to believe that health and safety of all involved in the Games is the utmost priority for the IOC, IPC (International Paralympic Committee) and TOC (Tokyo Organizing Committee), at times, the communication has lacked empathy in recognizing athletes as humans first, and athletes second,” AthletesCAN wrote.

The letter goes on to say, “We, as much as you, do not want to see the Games cancelled. However, we want to know that if push came to shove, no one’s safety would be sacrificed, and unbiased, transparent leadership would prevail.”

WATCH | Impact of COVID-19 on Tokyo 2020:

As of now the Games are still on, but is it only a matter of time until that changes? 4:15

With only 57 per cent of Olympics spots currently decided, and qualifying events falling like dominoes as the global pandemic continues to spread, many Canadian athletes remain in limbo.
With their Olympic dreams on the line, the internal letter suggests athletes are torn. The organization says they understand that “athletes are currently in a very unpredictable and difficult position. Especially as workout facilities and training centres around the country have been forced to close.

AthletesCAN writes that athletes are having to choose between listening “to public health authorities” and staying inside, or find a way to continue their training and “risk it for the sake of qualifying or doing well at the Games.”

WATCH | Canadian athletes weigh in on IOC’s continued preparations:

The IOC says it is moving forward with the Olympics in July, but some past and present athletes don’t agree. 1:06

“For those who are still working on qualifying for the Games, we understand the additional stress you must be feeling as you watch more and more opportunities to do so be cancelled or delayed.”

The organization, however, goes on to stress that “as athletes, we are role models for Canadians and youth across the globe. Let us act as role models in solidarity with our neighbours and health care workers to do everything we can to stop the spread of the virus. Flattening the curve is a collective exercise – we must all do our part.”

IOC attempts to ease athlete jitters

The IOC made a number of calls on Wednesday to reassure jittery partners, including one with more than 200 athlete-representatives from around the world.

“It was constructive in a way that everybody realized that we have still more than four months to go and we will address this action,” said IOC president Thomas Bach.

“We said we were going to continue to be very realistic in our analysis.” Bach said the IOC will continue to push toward Tokyo while “safeguarding the health of the athletes and contributing to the containment of the virus.”

As Canada’s athletes navigate these uncertain times, AthletesCAN also went on to echo Prime Minister Justin Trudeau’s comments on Friday regarding his “sincere appreciation for our health care workers on the front lines, especially those coming out of retirement.”

The letter closes by encouraging Canada’s athletes to be both resourceful and creative “in adapting your training and mindset to remain healthy and safe.” And a belief that “the next few weeks will bring a significant amount of clarity on not only the Games, but a lot of aspects of our daily lives.”

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CBC | Sports News

Hospital patients in Canada lacking English need access to interpreters, study says

Waking up with worsening pain had Surjit Garcha worried, but the red blisters on her stomach were so alarming that she went to her neighbour’s home to try to explain, in her limited English, that she needed help.

Garcha, who lives alone, doesn’t have the English skills to call her doctor’s office and felt more comfortable going to someone she trusts.

Her neighbour took her to the emergency department in Delta, B.C., where Garcha learned she had shingles, a viral infection that can include complications such as scarring and vision and hearing loss in older adults.

Garcha, now 82, said the intense pain was bad enough, but not being able to understand what was wrong with her made her feel even more vulnerable.

“The employees who bring food to patients would leave it outside the door, because they could catch what I had and no visitors could come in my room,” she said in Punjabi about her experience three years ago.

Garcha’s only solace was that a nurse spoke Punjabi, but it wasn’t until her daughter arrived from Seattle the next day that she had any contact with a family member.

Interpreters trained in medical terminology are more often provided for patients in Canada’s larger centres, but a researcher from the University of Toronto said lack of access to interpretation could potentially result in unsafe health care through missed diagnoses and medical errors, suggesting language services should be a priority.

Dr. Shail Rawal, lead author of a study that includes data from Toronto General and Toronto Western hospitals, said patients with a chronic disease and limited English are more likely to return to the emergency room or be readmitted to hospital because of poorer understanding of discharge instructions and not taking medication as required, compared with those who are proficient in the language and were discharged with similar health concerns.

Toronto physician and researcher Dr. Shail Rawal is the lead author of a study published in the Journal of the American Medical Association suggesting hospitals across Canada provide professional interpreters for patients with limited English skills. (The General Medicine Inpatient Initiative/Handout via the Canadian Press)

The study was published recently in the Journal of the American Medical Association and includes data for all patients discharged from the two hospitals with acute conditions, pneumonia and hip fracture, and chronic conditions heart failure and chronic obstructive pulmonary disease, between January 2008 and March 2016, amounting to 9,881 patients.

“We saw that if you had heart failure and limited English proficiency you were more likely to come back to the emergency room to be reassessed in 30 days after you were discharged,” said Rawal, an assistant professor in the University of Toronto’s department of medicine and a staff physician at the University Health Network, which includes the two hospitals.

“Patients who had limited English proficiency and heart failure or chronic obstructive lung disease were more likely to be readmitted to hospital in the 30 or 90 days after discharge,” she said.

The quality of care or the level of access to interpretation … should not vary based on which hospital you happen to present at with your illness.– Dr. Shail Rawal

For those with pneumonia or hip fracture, the data showed no difference in return to hospital regardless of patients’ ability to speak English, Rawal said.

“Our thinking is that those are acute conditions that have a pretty standard treatment, whether it be surgery and then rehabilitation or a course of antibiotics, whereas the two chronic conditions require a lot of patient-centred counselling and patient management plans.”

Of the 9,881 patients:

  • 2,336 had limited proficiency in English.
  • Nearly 36 per cent spoke Portuguese.
  • Just over 23 per cent spoke Italian.
  • Cantonese, Mandarin and Chinese were the primary languages for about 14 per cent of patients.
  • Greek and Spanish were the least spoken languages.
  • 18.5 per cent of the study subjects’ languages were listed as “other.”

Rawal said patients at the two hospitals have around-the-clock access to interpretation in various languages by phone and in-person interpretation is also available but must be pre-booked and is typically offered during business hours.

“The quality of care or the level of access to interpretation, in my view, should not vary based on which hospital you happen to present at with your illness,” she said.

“Currently, that is the case, that depending on what hospital you go to in our city, in our province or across the country, you will have varying levels of access to professional interpretation services and I think that in a linguistically diverse country the language needs of patients and families should be met by institutions.”

The study included data from Toronto General Hospital. ‘The quality of care or the level of access to interpretation, in my view, should not vary based on which hospital you happen to present at with your illness,’ said lead author Shail Rawal. (David Donnelly/CBC)

Family members often step in to interpret and alleviate a patient’s anxiety but may end up having to rearrange their schedules while waiting for nurses, doctors or specialists to show up at the bedside, Rawal said.

However, she said previous research studies have shown that families are less accurate in their interpretation than professionals and sometimes may not wish to translate what a clinician is saying, perhaps to lessen the impact if the prognosis would be too upsetting.

Kiran Malli, director of provincial language services for the Provincial Health Services Authority in British Columbia, said patients in Vancouver and the surrounding area have access to 180 languages through interpreters who work at hospitals and publicly funded long-term care homes.

The top three languages are Cantonese, Mandarin and Punjabi, Malli said.

In-person and phone interpretation is provided without a pre-booked appointment. The health authority started a pilot project last year to provide services by phone to family doctors’ offices, she said.

Patients at Vancouver General Hospital and surrounding areas have access to 180 languages through interpreters who work at hospitals and publicly funded long-term care homes. (Evan Mitsui/CBC)

Another pilot on video-remote interpreting at hospitals, which Malli said would greatly benefit patients needing sign language — which is already being provided — will also start soon and benefit those living in isolated parts of the province.

A few scattered grassroots programs were available in B.C. in the 1990s but the current standardized one didn’t start until 2003, she said.

“It was getting pretty evident that we needed to do something a little more than just pulling up any bilingual person or calling on the overhead paging [system] to say ‘If anybody speaks Cantonese could you please come to emergency,”’ Malli said of the current program’s genesis.

“Research shows us that as people get older, even if you know English when you’re younger, you tend to revert back to your mother tongue as you age,” she said, adding elderly people in medical distress tend to forget the English skills they have.

“I do think we are seeing more elderly patients for that reason,” she said.

It’s unfair for health-care staff to expect family members to act as interpreters because, just like English-speaking patients’ relatives, their role should be to support their loved ones and not to be burdened further, Malli said.

“If we are looking at equity, as family I should just be there to support my family member through whatever it might be rather than act as their language conduit,” she said.

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CBC | Health News

Privacy review finds personal information protections lacking at B.C. medical clinics

Medical clinics throughout British Columbia need to do more to protect the often highly sensitive personal information in their possession, according to a new report from the Office of the Information and Privacy Commissioner.

The OIPC report, looking at how nearly 2 dozen B.C. medical clinics are meeting their legal obligations under the Personal Information Protection Act, found that privacy protections are lacking.

OIPC auditors examined 22 clinics and found gaps in privacy management programs at several clinics, including the absence of a designated privacy officer, a lack of funding and resources for privacy and a failure to ensure that privacy practices keep up with technological advances.

Privacy Commissioner Michael McEvoy said the report raises concerns about patient privacy that are relevant throughout the province.

“Medical clinics were chosen for this review for two reasons: the amount and sensitivity of the personal information they collect, some of the most sensitive personal information out there,” McEvoy said.

“Doctors and staff at clinics not only owe it to their patients to do their utmost to build and maintain strong privacy programs, but they are also legally obligated to abide by privacy legislation.”

Report recommendations

The report makes several recommendations including that clinics build robust privacy management programs that consider how personal information inventories and privacy policies are created, ensure adequate funding and resources for effective privacy management programs and that each clinic designates a privacy officer and establishes and communicates clear internal reporting structures on privacy issues.

The Office of the Information and Privacy Commissioner provides independent oversight and enforcement of British Columbia’s access and privacy laws.

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CBC | Health News

Canada Soccer, Vancouver Whitecaps lacking accountability over allegations against coach, soccer legend says

A Canadian soccer legend says the Vancouver Whitecaps and Canada Soccer failed the teenaged players on the combined under-20 Women's National Team and Whitecaps women's team in 2008, when the two organizations quietly parted ways with a coach following allegations of inappropriate behaviour.

In a statement, Andrea Neil, former captain of the Canadian Women's National Team and Whitecaps, says a decade later, some players "still carry the scars of their experiences to this day."

Neil says she wants to add her voice to that of former Whitecaps player Ciara McCormack, who published a blog last month alleging sexual harassment and inappropriate behaviour from a coach in 2008.

In the blog, McCormack refers to the man as "Coach Billy." She has since confirmed with CBC that his real name is Bob Birarda.

Birarda held the dual positions of head coach of the women's Whitecaps and U-20 Women's National Team head coach in 2008, in charge of a group of female players who were between 17 and 19 years old.

Mutual parting of ways

He was let go by Canada Soccer and the Whitecaps in October 2008 in what was described at the time as a "mutual decision."

His replacement, Ian Bridge, told CBC that Birarda's departure was due to "inappropriate communication with the players."

"My information was that things weren't working out and that there was some inappropriate communications," said Bridge.   

Hired to coach girls at club level

Soon after leaving Canada Soccer and the Whitecaps, Birarda was hired as the under-18 girls coach at Coastal Football Club in South Surrey, a position he held until his suspension last month when McCormack's blog went viral. 

Neil said that in September 2008, one year after she had retired from playing, she started hearing stories from players on the Whitecaps and U-20 national team.

Andrea Neil (centre, sitting) was inducted into the Canadian Sport Hall of Fame in 2011. (Jeff McIntosh/Canadian Press)

"Concerned about the seriousness of the allegations, I contacted a high-performance coach within Canada Soccer and alerted him to the issue," said Neil in her statement. 

Canada Soccer and the Whitecaps responded by hiring an independent investigator to look into the allegations.

But Neil said she has since learned from talking to players who were on the teams that the investigator did not interview "a vast majority of the players, some of whom were central to the allegations."

"The soccer community deserves to know why the Whitecaps and Canada Soccer chose to conclude [the investigation] as quickly as they did," said Neil in her statement.

'Could not manage… the power imbalance'

Neil also claims "[the investigator] told me that she would be informing the organizations that the staff member at the centre of the investigation should avoid future roles such as coaching, as she felt that he could not manage what she called the power imbalance between his role as a coach and his relationship with the players." 

CBC asked Birarda to comment but did not hear back.

The Whitecaps and Canada Soccer issued statements.

"As we have said from the outset, we took the allegations brought forward very seriously, hired an independent expert in the industry to thoroughly investigate all the information she could gather, and based our actions on her recommendations," said the Whitecaps. 

The statement from Canada Soccer reads: "Canada Soccer immediately responded to the concerns raised by participating in a thorough review with an independent ombudsperson in association with the Vancouver Whitecaps.  Upon conclusion of the investigation, the coach ceased to have any involvement with the national team program and the ombudsperson had no recommendations for further action."

Neil represented Canada in four World Cups and is in the Canadian Sports Hall of Fame and Canadian Soccer Hall of Fame.

She says as the accrediting body for soccer coaches across the country, Canada Soccer has "the responsibility to ensure that the people who coach at any level are fit to do so."

Neil and McCormack say they would like to see an investigation into what happened in 2008.

CBC has not independently verified Neil or McCormack's claims.

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CBC | Soccer News

Canada's young core shines amidst lacking result at Las Vegas Sevens

There's no 'i' in team. We all know that. There is, however, one in Hirayama, and another in Braid.

What would Team Canada do without the considerable influence of its dynamic duo? The respective performances and understanding of Nathan Hirayama and Connor Braid in Las Vegas were a brief highlight as the Canadians prepare to come home.

The next stop on the World Rugby Sevens Series takes teams to Vancouver beginning Mar. 9. The entire tournament will be streamed live on CBCSports.ca.

On a weekend that presented a legitimate passage to the Cup quarter-finals, Canada failed to find a way. A bizarre tie with Spain and a narrow loss to Samoa sealed the Canadians' fate, leaving them to contest the minor placings at the USA Sevens. Canada would finish 13th overall.

Hirayama is a captain others covet. Fleet of foot and swift of mind, he's engineered for rugby sevens. He's not only Canada's best player and leading points scorer; he is among the best there has ever been in this abbreviated version of thrill-a-minute rugby.

He takes responsibility as matter of course. Hirayama's decision-making elevates him above most of his peers. He is not the quickest, nor the bravest – but that's not his job. His ability to think his way out of danger areas and fluently bring others into offensive plays represent his hallmark qualities.

Then there are the stats. He's fourth all-time in points — let that sink in. During the weekend, Hirayama became the fourth man to break through the 1,600-point barrier, helping himself to 5 tries and more than 50 points.

Braid, Thiel continue growth

I would not pick an argument with Connor Braid. When it comes to the intimidating Canadian forward, what you see is what you get. A fiery redhead, with unwavering commitment to match, Braid is a one-man battering ram.

And he's so much more. You'll never see Braid shirk a tackle – his energy and fearlessness in Las Vegas was plain to see. His enthusiasm is infectious and his appetite in general support play means he's often in the thick of the action.

WATCH | The entire match between Canada and Samoa

Watch Canada battle Samoa at the World Rugby Sevens Series in Las Vegas, Nevada. 22:43

In full flight, Braid is a tough man to stop. Not only can he tackle, but he can carry the ball all day long. What he may lack in finesse, he more than makes up for in brute force and sheer determination.

There's another 'i' in Thiel. Far less experienced than his compatriots, Jake Thiel is still learning his trade. We are beginning to witness the fruits of his rugby education.

At just 21 years old, the youngster from Abbotsford, B.C., is a boy playing a man's game. He is still trying to establish himself as a regular member of the Canadian roster, but he appears to be heading in the right direction. He's quick and alert, so much so that Canadian rugby icon Gareth Rees described Thiel as the "find of the tournament".

Mental toughness

Canada finished a lowly 13th in the Nevada desert, but there are some positives. Hirayama's team was not outplayed by any of its opponents – not even the mighty New Zealand All Blacks. Samoa emerged from Canada's pool, making it all the way to the gold-medal game.

Yes, there were errors and missed tackles – but everyone makes mistakes. The fact that the Canadians had the reserves of energy and mental toughness to finish strongly, albeit against weaker opposition, demonstrates their resolve to compete professionally and respect the national jersey.

WATCH | The entire match between Canada and France

Watch Canada battle France at the World Rugby Sevens Series in Las Vegas, Nevada. 22:40

Now they can return home and, for a few days at least, sleep in their own beds.

And when they awake they can relish the prospect of fervent home support at the Canadian Sevens in Vancouver. It's a rugby festival always enjoyed by players and fans alike.

Indeed, there is no 'i' in team. But without the likes of Hirayama and Braid, there may very well be no Canadian team in the elite core of World Sevens Rugby at all.

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Research lacking on medical marijuana, new prescription guideline suggests

A new guideline for medical marijuana, developed by Edmonton researchers, warns family doctors that the risks may outweigh the benefits for the vast majority of patients.

The guideline, published Thursday in the Canadian Family Physician journal, suggests the benefits of medical cannabis may be overstated, and research on it’s medicinal properties is sorely lacking.

Canadian doctors should think twice before prescribing the drug, said Dr. Mike Allan, who led the research team.

“While enthusiasm for medical marijuana is very strong among some people, good quality research has not caught up,” Allan, the director of evidence-based medicine at the University of Alberta, said in a statement.

The guideline was based on a review of clinical trials involving medical cannabis.

The document will be distributed to 30,000 physicians across Canada, and is intended as a new protocol for doctors to use when deciding whether or not to prescribe marijuana.

‘In general we’re talking about one study, and often very poorly done.’– Dr. Mike Allan

Thousands of Canadians are already prescribed medical marijuana, and that number is expected to rise after marijuana is legalized this summer.

Family doctors face increasing pressure from patients asking for medicinal pot. But the study authors suggest there is little data for physicians to rely on before making that decision.

Guideline authors found that, in most cases, the number of randomized studies involving medical cannabis was extremely small.

In the rare instances where research did exist, the studies were narrow in scope or poorly executed, said Allan.

“In general, we’re talking about one study, and often very poorly done,” Allan said in a statement.

“For example, there are no studies for the treatment of depression.” 

There was also only one study on anxiety and it was unscientific, said Allan. In that trial, half of the 24 patients involved received a single dose of cannabis derivative and scored their anxiety doing a simulated presentation.

“This is hardly adequate to determine if lifelong treatment of conditions like general anxiety disorders is reasonable,” said Allan.

Proven treatments

Researchers concluded there is adequate evidence for the use of medical cannabinoids to treat a handful of specific medical conditions, including nerve pain, palliative cancer pain, muscle tightness associated with multiple sclerosis or spinal cord injury, and nausea from chemotherapy.

Even in those specific cases, the benefits were found to be generally minor, said Allan.

“Medical cannabinoids should normally only be considered in the small handful of conditions with adequate evidence, and only after a patient has tried a number of standard therapies,” Allan said in a statement.

“Given the inconsistent nature of medical marijuana dosing and possible risks of smoking, we also recommend that pharmaceutical cannabinoids be tried first before smoked medical marijuana.”

While the researchers found limited evidence supporting the use of medical cannabinoids, the side-effects were common and consistent. Common side effects included sedation, dizziness and confusion.

‘Better research is definitely needed’

Allan acknowledged the guideline may prove controversial, since the debate over medical marijuana is divisive.  

“This guideline may be unsatisfactory for some, particularly those with polarized views regarding medical cannabinoids,” Allan said.

“Better research is definitely needed — randomized control trials that follow a large number of patients for longer periods of time. If we had that, it could change how we approach this issue and help guide our recommendations.”

The research was overseen by a committee of 10 medical professionals, including doctors, pharmacists, nurses and patients, and was peer-reviewed by 40 others.

Medical colleges have released some general guidelines for primary-care providers and have cautioned physicians against prescribing marijuana.

A trio of advisories prepared by the Alberta College of Family Physicians in 2017 summarized the scientific literature, or lack thereof, that dealt with medicinal marijuana.

Documents released by the colleges of physicians and surgeons in both British Columbia and Alberta cite the absence of reliable evidence to demonstrate the effectiveness of cannabis as medication.

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