Tag Archives: medicine

With sport, medicine worlds colliding, Hayley Wickenheiser spoke her truth to IOC

In what she calls “the final straw” moment, Hayley Wickenheiser had to clear her conscience and say something.

Confronted with two vastly differing scenarios playing out at exactly the same time, Wickenheiser found her two worlds — sport and medicine — colliding.

It’s her unique position of being a six-time Olympian, member of the International Olympic Committee Athletes’ Commission and doctor-in-training that allowed Wickenheiser to speak her truth with conviction and start a global movement, one she could have never imagined.

Since the beginning of January, Wickenheiser, an aspiring emergency room physician in her final year of medical school at the University of Calgary, has been inside Greater Toronto Area emergency rooms, seeing first-hand the escalation and severity of COVID-19.

It was in one of those hospitals, about two weeks ago, when she had a moment that moved her so profoundly.

“Being involved in a situation where a young airline pilot was severely hypoxic and had to be intubated,” Wickenheiser told CBC Sports, describing the process of a breathing tube being inserted in the patient’s throat.

“I just watched the anxiety of a lot of my supervising doctors try to grapple with how to keep themselves safe while having to deal with these patients coming in. I’m not treating these patients but I’m watching what’s happening. I feel like I’ve watched this pandemic from the front lines a little bit.”

She could feel the stress and fear rising within the hospitals she was training in — “a free-floating anxiety” in the words of a friend of Wickenheiser who has been an emergency doctor for 20 years.

WATCH | Hayley Wickenheiser explains why she had to speak out:

Canadian hockey great and current medical student Hayley Wickenheiser, wants Canadians to stick together, and be proud of the work being done to fight COVID-19. 1:30

The next morning after that very real and unsettling experience of being in the emergency room with the pilot, Wickenheiser read the International Olympic Committee headlines, insisting the Games in Tokyo would be going ahead as scheduled in July.

She couldn’t believe what she was reading.

“It was so incredibly tone-deaf. It wasn’t about the health and safety of the athletes. It was about everything else,” Wickenheiser said.

“The conflict that I had wasn’t about speaking up. It was how to do it in the lens that I sit, which was a foot in medicine and a foot in sport and what I had seen in the last few months and what I heard from my friends.”

Wickenheiser reached out to Canadian Olympic Committee president Tricia Smith, as well as Olympic champions Mark Tewksbury and Beckie Scott, both who have extensive experience with the IOC.

“I called Beckie. At the IOC level I always ask myself what would Beckie do when it comes time for conflict? I told her that,” Wickenheiser said. “I couldn’t have lived with myself if I let this go by another day. This was wrong. We talked about it and after I got off the phone, I knew exactly what I had to do.”

In what has become a now famous and movement-starting tweet, Wickenheiser sent out a message on her Twitter account.

“I think the IOC insisting this will move ahead, with such conviction, is insensitive and irresponsible given the state of humanity. We don’t know what’s happening in the next 24 hours, let alone the next three months,” she said.


In the hours and days that followed, the message traveled around the world. Wickenheiser quickly heard from IOC officials.

“They were not happy. They felt I needed to get approval from them before I spoke out. I countered with I didn’t know free speech had to go through the IOC,” Wickenheiser said.

“I wasn’t elected by athletes of the world to be told what to say. I think I have a very unique lens on this situation and felt quite confident I knew what I was talking about.”

Wickenheiser says it was remarkable to watch how the Canadian sport system rallied in the wake of her message, ultimately landing on pulling Team Canada from competing in the summer should the Games go ahead as scheduled.

Two days after the COC’s decision, the IOC announced it was postponing the Olympics until 2021.

“I’m so proud. I’m so proud of Canada,” she said.

“I will say it’s not the first time Canada took the lead. During the Russian doping scandal, it was Canada that led the charge there. I feel like many times Canada on the international stage is not afraid to say what needs to be said and do what needs to be done.”

On 276 occasions over her career Wickenheiser led Team Canada into battle on the ice — on the frontline for 23 years alongside her teammates, draped in the maple leaf. She recorded 168 goals and 211 assists during that time, earning her a spot in the Hockey Hall of Fame this past fall.

While all her golden moments bring great pride to the Shaunavon, Sask., native, it’s perhaps in this moment Wickenheiser finds herself most proud about what’s unfolding in her home country.

“As much as I was on a hockey team for my whole life, I feel like truly all of Canada, we are a team right now. We have to be caring for each other and pulling for each other,” she said.

“It’s personal to me. I love Canada and I feel there’s no other country in the world I would want to be going through this in. I’m just really proud our politicians to the grocery clerks who are trying their best. I really believe that.”

They were not happy. They felt I needed to get approval from them before I spoke out. I countered with ‘I didn’t know free speech had to go through the IOC.– Hayley Wickenheiser on IOC’s response to her tweet

Wickenheiser is doing everything she can to get the best information to her family, friends and even people she hardly knows during grocery store encounters.

“I was at the grocery store the other day and I walked in and there were these young girls at the cashier I see all the time. They looked at me and they had gloves on and they said, ‘are we going to be safe?'” Wickenheiser said.

The captain saw it as a teaching moment and right there in the middle of the grocery store gave a 10 minute tutorial on how to safely put the gloves on and take them off to protect themselves.

“I started crying in the grocery store. And then I went back two days ago and they had plexiglass up and they were wearing masks and gloves,” Wickenheiser said. “We all clapped our hands and had a cheer. The manager of the store was there too. They took extra measures.”

Wickenheiser says she’ll continue to be relentless in sharing important information and hope with as many people as she can during this global pandemic.

From instructing her parents, who two weeks ago returned from Hawaii to self-isolate, to her son who is safe and immersed in his university studies in Vancouver, to her friends and really anyone who will listen, Wickenheiser is once again taking up the call to lead a team.

“It’s incredibly emotional for me maybe because it is so personal. I have spent hundreds of hours in the emergency rooms with these people who are on the front lines, now putting their lives and families at risk to save other people’s lives,” Wickenheiser said.

And she’s doing all this while spending every waking moment outside of phone calls and messages to continue studying medicine, aware that at any moment she might be shoulder-tapped, this time without a stick but personal protective gear, to suit up and take up a frontline battle for Canada once again.

“I’m trying to learn medicine because who knows how long this is going to go on and when someone like me as a trainee might be called upon,” Wickenheiser said.

‘Obligation to be ready’

“Like what’s happening in Italy where they put 10,000 doctors out there without finishing their final exam. So I feel it’s an obligation to study every day and stay on top of everything just in case there’s a place I can be more useful.”

In the meantime, Wickenheiser says she continues to be so grateful for all the work being done by her friends and colleagues in the medical field who are working around the clock to save lives while protecting themselves.

“I have such respect. I know how much they care. Those frontline responders are the people I know. And that’s the life I have lived other than sport,” Wickenheiser said.

“If everybody truly heeds the advice of our medical people and wash their hands, I know we’re going to see the light.”

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CBC | Sports News

How one hospital tackles hallway medicine, starting in the emergency room

One Ontario hospital is trying to lessen its “hallway medicine” problem by forming a new team of health-care workers in its emergency room with the aim of reducing admission rates among seniors.

The “ED One Team” at Sunnybrook Health Sciences in Toronto launched in late October and is already showing evidence of success, according to figures provided by hospital officials that suggest a nearly five per cent drop in admissions.

The team brings together a social worker, a geriatric emergency medicine nurse, a physiotherapist, an occupational therapist, a community care co-ordinator, a psycho-geriatric case manager and staff from agencies that provide home-care services.

The team helps patients who come to the emergency room avoid being admitted to the hospital by ensuring adequate supports are available for them at home or in the community.  Its target group is those aged 70 and older who don’t need to be admitted, but who can’t otherwise go home safely straight from the emergency room. 

The team has helped Sunnybrook “reduce the number of patients who are in hallways in our emergency department, as well as the number of patients who are stuck in the waiting room,” said Dr. Aikta Verma, the hospital’s chief of emergency services. 


Dr. Aikta Verma is chief of the emergency department at Sunnybrook Health Sciences Centre. (Paul Smith/CBC)

“I’m really proud of the work that the team has been doing here,” Verma told CBC News. “This has really made a difference for us in terms of being able to lower our admissions.” 

Verma pointed to the recent case of an older patient who came to the emergency room with what the doctor described as a “very minor” foot fracture but was unable to walk. 

A year ago, said Verma, she would have decided that the patient needed to stay in hospital. Instead, Verma contacted the ED One Team, whose members taught the patient how to walk with support, got her the equipment she needed to be safe at home, and avoided admission. 

“This was better for the patient as well as for the system overall,” said Verma. 

Sunnybrook hopes the team’s efforts will help alleviate some of the demand for beds that has led to the “hallway health-care” trend on its wards and in hospitals across the province.

An investigation by CBC News last month revealed dozens of Ontario hospitals were filled beyond capacity for weeks at a time in 2019. The data showed Sunnybrook with a higher than 100 per cent occupancy rate on 47 days in the six-month period analyzed.


Members of Sunnybrook’s team meet every day to discuss the cases of emergency room patients who may need extra supports to make the transition home, rather than be admitted to hospital. (Paul Smith/CBC)

Premier Doug Ford has promised to end hallway medicine. The government’s statistics show a five-to-six per cent drop over the past year in the number of hospital patients in “unconventional spaces” such as hallways and storage rooms, but that still means some 950 patients are falling into that category every day. 

Sunnybrook’s ED One Team operates seven days a week from 8 a.m. until 11 p.m., working with the emergency department medical staff to identify patients who don’t need hospital admission, but need some form of extra care. 

That could include physiotherapy right in the emergency room, something that previously was only provided to patients who’d been admitted, unnecessarily taking up a hospital bed sometimes for days. 

Physiotherapist Belinda Wagner said the team typically sees patients who come to the ER with an injury or an illness that affects their ability to function safely at home but who don’t require a hospital stay. 

“If they’re medically stable and they’re ready to leave this level of care but not necessarily go home safely, we as a team can put our brains together and figure out what is the best next place for them to go,” said Wagner.


The ED One Team operates seven days a week from 8 a.m. to 11 p.m. in the emergency department at Sunnybrook. (Doug Ives/Canadian Press)

 

Team member and social worker Valerie Soper says it’s “fantastic because we all come to the table with a different lens and there’s so many improvements that have been made in the emergency department.” 

Soper worked in Sunnybrook’s ER long before the formation of the team and said the change has meant each professional’s work gets done more efficiently, patients’ needs are being met in a more timely fashion, and discharges happen more quickly.

By working until 11 p.m., the team can set up home-care supports that typically only get arranged during the daytime.

“We’re able to see patients in the evening and facilitate a safe discharge home instead of having these patients stay overnight,” said occupational therapist Faith Gallant, one of the team members.

In its health-care reforms, the Ford government is encouraging hospitals to work more directly with outside agencies such as home-care providers with the aim of improving connections within the health system for patients. 

Sunnybrook’s ED One Team is putting that into practice in a range of ways:  

  • Doing physiotherapy or occupational therapy assessments in the ER makes it possible to refer patients directly to a physical rehab facility without the patient having to wait in the hospital. 
  • Home-care agencies involved in the team can arrange for a personal support worker to accompany the patient home.  
  • A psycho-geriatric case manager keeps tabs on patients at home after discharge to reduce the risk of re-admission. 

The emergency department has seen a 4.5 per cent reduction in admission rates among the team’s target caseload since the launch in October, according to hospital officials. That has meant 74 fewer patients admitted to the hospital’s already crowded wards. 

There’s also been a noticeable increase in patient satisfaction with the hospital experience, said Natalie Coyle, the team’s co-ordinator. 

“We’ve heard from some patients who have written in to say, ‘It was really great that someone followed up with me and was able to provide extra service and ensure that I was safe,'” said Coyle. 


Natalie Coyle is the co-ordinator of Sunnybrook’s ED One Team. (Paul Smith/CBC)

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CBC | Health News

Ontarians tell their hallway medicine stories

Every day, Ontario hospitals put nearly 1,000 patients in what the province’s health ministry calls “unconventional spaces,” such as hallways, meeting rooms and storage areas.

An investigation by CBC News last week revealed the most thorough picture yet of the extent of hallway medicine in the province. 

  • Have you experienced hallway medicine in Ontario? Email us and tell us your story.

Behind all those numbers are the patients affected by hospital overcrowding: waiting more than 24 hours in the emergency department before getting admitted to a bed, spending their hospital stay in a makeshift spot, such as a converted exercise room, or facing repeated delays for surgery because all post-op beds are full.   

Here’s what the experience was like for some of those patients. 

Jennifer Sabine

Food lodged in her esophagus sent Jennifer Sabine to the emergency department at Trillium Health’s Mississauga Hospital one Sunday night last April. She waited until the next afternoon for it to be removed by an endoscopy, and when she emerged from sedation, she was struck by how many patients were in the hospital hallways. 


Jennifer Sabine’s hallway medicine experience at Trillium Health’s Mississauga Hospital provoked concern for the lack of privacy for other patients in the hallway, some of whom she described as really ill. (Submitted)

“I was blown away. I’m walking down the hall and literally it’s just bed against bed against bed,” said Sabine in an interview. “Lined head to toe. It was just chaos. My heart broke for the nurses because it was just crazy.” 

While Sabine’s primary feeing was one of relief that the blockage had been removed, she recalls how she was not in a proper room but in a space divided from others like a cubicle. 

“I just felt really bad for everyone else who was there with more severe issues,” said Sabine. “The other patients in the hallway, some of them were really ill, but there’s just no privacy whatsoever. Some people were crying out in pain or discomfort. It looked not like something you’d see in North America.”

Sabine contacted the CBC to tell her story after seeing the data on hallway medicine last week.  

Rhonda McIntyre

Cobourg resident Rhonda McIntyre broke her arm in early January while ice skating. When it didn’t set properly in its cast, she was scheduled for surgery at Lakeridge Health’s Oshawa General Hospital, which CBC research found was one of the most frequently overcrowded hospitals in Ontario over in the first six months of 2019.


After breaking her arm while skating, Rhonda McIntyre faced repeated delays for surgery this month at Lakeridge Health’s Oshawa General, one of Ontario’s most frequently overcrowded hospitals. (Submitted)

The operation was originally scheduled for Tuesday, Jan. 21, and she was told to fast from midnight onward. The hospital called her at 10 a.m. to say it had to be rescheduled for a day later.

On Jan. 22, it took until 4:30 p.m. before she received a call to come for the operation. She made the 50-minute drive, waited more than three hours between the emergency room and the pre-op area, then was told the surgery wouldn’t happen that night either.

McIntyre was instructed to start fasting again from midnight and come back the next day.

“They said to me, ‘There’s just not enough beds,'” McIntyre said in an interview. “‘The doctor can only do so many surgeries and we have to be able to find you a bed,’ that’s what they kept telling me.” 

On Jan. 23, it happened again. She got a call at 1:45 p.m. advising that the surgery would not happen that day either.

“I asked how long this could go on and she said, ‘Up to two weeks,'” McIntyre recounted. “I felt bad for the people who had to deliver all those messages because I could tell it was difficult for them.” 

That evening, McIntyre emailed the hospital’s patient experience team. 


This space at Southlake Regional Health Centre in Newmarket, Ont. used to be an exercise gym to help patients with physical rehab. Now it is permanently set up as an overflow patient ward, with a makeshift nursing station and beds separated by screens. (Aizick Grimman/CBC)

“I’m on day 3 of fasting and am cranky and have a headache,” she wrote.

“I get that there are always more pressing cases but would suggest the system at Lakeridge Health Oshawa is broken, and that this treatment is not at all in keeping with their four core patient experience principles of Dignity and Respect, Communication/Information Sharing, Collaboration and Participation.”

The next morning, Friday Jan. 24, she received an emailed apology from the hospital and a call to come for surgery. She went into the operating room around 4 p.m.

McIntyre says that’s when the surgeon asked when the fracture happened, and because it had been so long, had to change the type of surgery that was to be performed.

“They actually had to cut into my wrist, re-break my arm and use a plate and screw,” she said.  

“It’s definitely left me to have some concerns [about the hospital system],” said McIntyre.

“Is there a doctor or a bed shortage that needs to be addressed?”

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CBC | Health News

Nobel Prize in Medicine goes to 3 scientists for discovering how cells use oxygen

Two Americans and a British scientist won the Nobel Prize for Physiology or Medicine on Monday for discovering details of how the body’s cells sense and react to low oxygen levels, providing a foothold for developing new treatments for anemia, cancer and other diseases.

Drs. William G. Kaelin Jr., of Harvard University and the Dana-Farber Cancer Institute, Gregg L. Semenza, of Johns Hopkins University, and Peter J. Ratcliffe, at the Francis Crick Institute and Oxford University, won the prize.

The scientists, who worked largely independently, will share the 9 million kronor (about $ 1.2 million Cdn) cash award, said the Karolinska Institute in Stockholm.

They “revealed the mechanism for one of life’s most essential adaptive processes,” the Nobel committee said.

Cells can encounter lowered oxygen not only from situations like living at high altitudes, but also from things like a wound that interferes with local blood supply. Their response triggers reactions that include producing red blood cells, generating new blood vessels and fine-tuning the immune system.


The Nobel committee said scientists are focused on developing drugs that can treat diseases by either activating or suppressing the oxygen-sensing machinery. Such manipulation could help in attacking cancer cells, experts said.

Another payoff is pills to boost production of red blood cells in anemia, which can appear in people with chronic kidney disease. One such drug has been approved in China and Japan and a filing for approval in the U.S. is expected soon, Kaelin said.

Still other potential targets include heart attack and stroke, and a condition of reduced blood flow in the limbs that can lead to amputation, the researchers said.

‘A look of urgency’

Kaelin, 61, said he was half-asleep when the phone rang Monday morning with the news of his award.

“I don’t usually get phone calls at 5:00 in the morning, so, naturally, my heart started racing and I could see the call was from Stockholm,” he said. “And so I think at that point I almost had an out-of-body type of experience.”

Kaelin is paid by the Howard Hughes Medical Institute, which also supports AP’s Health and Science department.


William G. Kaelin Jr. holds a model of his work as he speaks at a news conference in Boston on Monday. (Elise Amendola/The Associated Press)

Ratcliffe, 65, said he learned the news after he was summoned out of a meeting this morning by his secretary, who had “a look of urgency.”

Trained as a kidney specialist, Ratcliffe said his research began when he and colleagues simply wanted to figure out how cells sense oxygen.

“I thought it was a definable problem and just thought we’d find out how it worked,” he said. It was about two years into their research program, which began in 1990, that they realized the discovery had much wider significance, Ratcliffe said.

“We saw that it wasn’t just cells in the kidney that know how to sense oxygen, but all cells in the body.… There are hundreds and thousands of processes the body uses to adapt to and regulate its oxygen levels.”


Scientist Peter J.Ratcliffe poses for photos in the laboratory at the University in Oxford, England on Monday, Oct. 7, 2019. (Frank Augstein/The Associated Press)

He said while some promising drugs have been developed, it will be years before it’s clear whether such discoveries are going to change the lives of tens of thousands.

In Baltimore, Semenza, 63, said he slept through the Nobel committee’s initial phone call. “By the time I got to the phone it was too late,” he said. He went back to sleep but was able to answer the second call from Stockholm.

He said kidney cancer may be the first malignancy in which a drug based on the prize-winning work might make chemotherapy more effective, and that he hopes many other cancers will follow.


Gregg L. Semenza speaks during a news conference at Johns Hopkins Medicine Hospital in Baltimore on Monday. (Jose Luis Magana/The Associated Press)

Speaking at a news conference at Johns Hopkins University’s School of Medicine, Semenza paid tribute to his biology teacher, Rose Nelson, at Sleepy Hollow High School in Sleepy Hollow, N.Y., for inspiring his pursuit of medicine.

“She used to say, ‘Now when you win your Nobel Prize, I don’t want you to forget that you learned that here,”‘ he said. “It’s my great sadness that she is not still alive to share the moment because I know it would have meant a lot to her. She was my inspiration.”

“That’s the importance of teachers,” he added. “To make that kind of spark.”

Steven McKnight, of the UT Southwestern Medical Center, in Dallas noted that the process discovered by the three researchers is widespread in the animal kingdom, found even in the worm. He said the honoured work is “of a heroic nature.”

Last year, James Allison of the United States and Tasuku Honjo of Japan won the 2018 Nobel Prize for Medicine for their work in immunotherapy, activating the body’s natural defence system to fight tumors.

Physics prize next

Monday’s announcement kicked off this year’s Nobel Prizes. The physics prize will be handed out Tuesday, followed by the chemistry prize on Wednesday. This year there is a double-header for the Nobel Literature Prize — one each for 2018 and 2019 — which will be awarded Thursday. The Peace Prize will be announced on Friday.

The 2018 Nobel Literature prize was suspended after a sex abuse scandal rocked the Swedish Academy, the body that awards the literature prizes, so two prizes are being awarded this year.

The economics prize will be awarded next Monday. Officially known as the Bank of Sweden Prize in Economic Sciences in Memory of Alfred Nobel, it wasn’t created by Nobel, but by Riksbanken, Sweden’s central bank, in 1968.

The laureates will receive their awards at elegant ceremonies in Stockholm and Oslo on Dec. 10 — the anniversary of Nobel’s death in 1896.

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CBC | Health News

Nobel Prize in Medicine goes to 3 scientists for discovering how cells use oxygen

Two Americans and a British scientist won the 2019 Nobel Prize for Physiology or Medicine for discovering how the body’s cells sense and react to oxygen levels, work that has paved the way for new strategies to fight anemia, cancer and other diseases, the Nobel Committee said.

Doctors William G. Kaelin Jr. of Harvard University, Gregg L. Semenza of Johns Hopkins University and Peter J. Ratcliffe at the Francis Crick Institute in Britain and Oxford University will share equally the 9 million kronor (about $ 1.2 million Cdn) cash award, the Karolinska Institute said.

It is the 110th prize in the category that has been awarded since 1901.

Their work has “greatly expanded our knowledge of how physiological response makes life possible,” the committee said, explaining that the scientists identified the biological machinery that regulates how genes respond to varying levels of oxygen.

That response is key to things like producing red blood cells, generating new blood vessels and fine-tuning the immune system.


The Nobel Committee said scientists are focused on developing drugs that can treat diseases by either activating or blocking the body’s oxygen-sensing machinery.

The oxygen response is hijacked by cancer cells, for example, which stimulate formation of blood vessels to help themselves grow. And people with kidney failure often get hormonal treatments for anemia, but the work of the new laureates points the way toward new treatments, Nils-Goran Larsson of the Nobel committee told The Associated Press.

‘A bit surreal’

Reached at his home, Kaelin said he was half-asleep Monday morning when the phone rang. It was Stockholm.

“I was aware as a scientist that if you get a phone call at 5 a.m. with too many digits, it’s sometimes very good news, and my heart started racing. It was all a bit surreal,” he said.

Kaelin said he isn’t sure yet how he’ll spend the prize money but “obviously I’ll try to put it to some good cause.”

Ratcliffe told Sweden’s news agency TT on Monday that “when I started my research I also had no idea that it would result in this.”

He added the impact of oxygen on cells “has not always been a trendy area to research, and some people have doubted them during the journey.”

Last year, James Allison of the United States and Tasuku Honjo of Japan won the 2018 Nobel Prize for Medicine for their work in immunotherapy, activating the body’s natural defence system to fight tumours.

Physics prize next

Monday’s announcement kicked off this year’s Nobel Prizes. The Nobel Physics prize is handed out Tuesday, followed by the chemistry prize on Wednesday. This year’s double-header Literature Prizes — one each for 2018 and 2019 — will be awarded Thursday and the Peace Prize will be announced on Friday.

The economics prize will be awarded on Oct. 14.

The 2018 Nobel Literature prize was suspended after a sex abuse scandal rocked the Swedish Academy, the body that awards the literature prizes, so they are awarding two prizes this year.

Prize founder Alfred Nobel — a Swedish industrialist and the inventor of dynamite — decided the physics, chemistry, medicine and literature prizes should be awarded in Stockholm, and the peace prize in Oslo. He also designated the institutions responsible for the prizes: The Royal Swedish Academy of Sciences awards the Nobel Prizes in Physics and Chemistry; the Karolinska Institute is responsible for the Nobel Prize in Physiology or Medicine; the Swedish Academy picks the Nobel Prize in Literature; and a committee of five people elected by the Norwegian Parliament decides who wins the Nobel Peace Prize.

The economics prize — officially known as the Bank of Sweden Prize in Economic Sciences in Memory of Alfred Nobel — wasn’t created by Nobel, but by Riksbanken, Sweden’s central bank, in 1968. It is the Royal Swedish Academy of Sciences that was tasked with selecting the winner.

The laureates will receive their awards at elegant ceremonies in Stockholm and Oslo on Dec. 10 — the anniversary of Nobel’s death in 1896.

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CBC | Health News

3 get Nobel Medicine prize for learning how cells use oxygen

The 2019 Nobel Prize for Physiology or Medicine has been awarded to scientists William G. Kaelin, Jr, Peter J. Ratcliffe and Gregg L. Semenza for their discoveries of “how cells sense and adapt to oxygen availability,” the Nobel Committee announced Monday.

The discoveries made by the three men “have fundamental importance for physiology and have paved the way for promising new strategies to fight anemia, cancer and many other diseases,” said the Karolinska Institute.

The trio — Kaelin and Semenza are Americans, and Ratcliffe is British — will share equally the 9 million kronor (around $ 1.2 million Cdn) cash award. It is the 110th prize in the category that has been awarded since 1901.

Kaelin works at Harvard, Semenza at Johns Hopkins University and Ratcliffe is at the Francis Crick Institute in Britain.

In announcing the prize, the Nobel Committee said the work by the three laureates has “greatly expanded our knowledge of how physiological response makes life possible.” The Committee said that Semenza, Ratcliffe and Kaelin found “the molecular switch for how to adapt” when oxygen levels in the body vary, noting that the most fundamental job for cells is to convert oxygen to food and that cells and tissues constantly experience changes in oxygen availability.


Thomas Perlmann, the secretary of the Nobel Committee at the Karolinska Institute, said he was able to call all three laureates Monday. But he reached Kaelin via his sister who gave him two phone numbers — the first one was a wrong number.

“He was really happy,” Perlmann told a news conference.

The announcement kicked off Nobel week. The Nobel Physics prize is handed out Tuesday and the following day is the chemistry prize.

This year’s double-header Literature Prizes — one each for 2018 and 2019 — will be awarded Thursday and the Peace Prize will be announced on Friday.

The economics prize will be awarded on Oct. 14.

The 2018 literature prize was suspended after a scandal rocked the Swedish Academy. The body plans to award it this year, along with announcing the 2019 laureate.

Prize founder Alfred Nobel — a Swedish industrialist and the inventor of dynamite — decided the physics, chemistry, medicine and literature prizes should be awarded in Stockholm, and the peace prize in Oslo.

He specifically designated the institutions responsible for the prizes: The Royal Swedish Academy of Sciences awards the Nobel Prizes in Physics and Chemistry; the Karolinska Institute is responsible for the Nobel Prize in Physiology or Medicine; the Swedish Academy picks the Nobel Prize in Literature; and a committee of five people elected by the Norwegian Parliament decides who wins the Nobel Peace Prize.

The economics prize — officially known as the Bank of Sweden Prize in Economic Sciences in Memory of Alfred Nobel — wasn’t created by Nobel, but by Riksbanken, Sweden’s central bank, in 1968. It is the Royal Swedish Academy of Sciences that was tasked with selecting the winner.

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Family doctors want term ‘family medicine’ protected legally


This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.


Family physicians are concerned that terminology associated with their profession — such as “family medicine” — could be misused by people who are not medical doctors, according to the results of an informal internal poll by the College of Family Physicians of Canada.

The CFPC, which represents about 38,000 physicians who practise family medicine, solicited feedback from its members in April and received approximately 4,400 responses.

The poll found 92 per cent of respondents support legally protecting such terms, and 89 per cent want the college to put its time and resources into doing so.

The college was prompted to investigate how widely that sentiment was shared after its executives were presented with a petition by some members who were concerned that certain terminology was being misused by some complementary health practitioners, such as naturopaths or people who work for “virtual medicine” apps.

Naturopathy enjoys popularity among people who seek an alternative to conventional medical care, but its critics say it is not supported by evidence-based science. Naturopathy is a combination of practices that predate modern medicine, such as homeopathy, acupuncture and traditional Chinese medicine, along with new treatments that are often not covered by provincial health plans, including intravenous vitamin therapy and nutrition counselling.

According to the Canadian Association of Naturopathic Doctors, naturopaths must complete a four-year, full-time program at an accredited institution. There are two such schools in Canada, both of which are private. The association says more than 2,400 naturopaths practise in Canada.

There are no consistent rules across the country about what naturopaths can call themselves.

In B.C., the naturopathic college stipulates they can only refer to themselves as a “doctor” or “physician” if the word is preceded with “naturopathic” each time. The rules in Ontario are less explicit. The profession is not regulated in Quebec or Atlantic Canada. 

Meanwhile, the Canadian Association of Naturopathic Doctors has trademarked the slogan “Medically trained. Naturally focused,” though it is now effectively illegal for a naturopath to say this in New Brunswick.


Dr. Michelle Cohen at her practice office in Brighton, Ont. Cohen said the call from her fellow family physicians to prevent misuse of terms such as ‘family medicine’ is ‘overwhelming’. (Submitted by MIchelle Cohen)

Dr. Michelle Cohen, a family physician in Brighton, Ont., says the call for CFPC to take action is “overwhelming.” She is part of a grassroots group of family doctors across Canada that is active on social media and has filed complaints against those who they feel misrepresent themselves as medical doctors.

“I do feel like [the CFPC has] been dragging their heels just a little bit. But I’m hopeful that with their understanding that this is important to the membership, that they’re going to push forward on it,” she said.

Cohen and other members of the group are credited with a complaint that led to a New Brunswick court ruling against a group of naturopaths who posted advertisements using such words as “family medicine practice,” “medical centre,” “family doctor” and “medically trained,” among other descriptions.

The New Brunswick College of Physicians and Surgeons was granted an injunction in the province’s Superior Court to stop the naturopaths there from using the terms. Naturopathy is not a regulated profession in New Brunswick.

In his ruling, Justice Hugh McLellan said naturopaths “are in some ways close and similar to the work of all sorts of other people, like wellness coaches or fitness gurus or health consultants … But they are not practising medicine.”

Nicole Basque, a naturopath in Moncton, N.B., was among those ordered to stop using “family medicine” to describe her practice. At the time, she defended her use of the term by saying it referred to the fact that she treats people of all ages, “from a newborn to an elderly person,” not that she is “a general practitioner or an MD.”

CFPC executive director Dr. Francine Lemire acknowledges that co-ordinating a common set of rules protecting the terms associated with family medicine in different provincial and territorial jurisdictions will be challenging.

But what defines a family physician is not open to interpretation, she said. “It’s a general physician who’s got an MD degree and got defined postgraduate training in the discipline of family medicine.”

The CFPC is consulting all the provincial and territorial colleges of physicians and surgeons and aims to come up with a set of recommendations in 12 to 18 months, Lemire said.


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American caravan arrives in Canadian ‘birthplace of insulin’ for cheaper medicine

A self-declared “caravan” of Americans bused across the Canada-U.S. border on Saturday, seeking affordable prices for insulin and raising awareness of “the insulin price crisis” in the United States.

The group called Caravan to Canada started the journey from Minneapolis, Minn., on Friday, and stopped in London, Ont., on Saturday to purchase life-saving type 1 diabetes medication at a pharmacy.

The caravan numbers approximately 20 people, according to Nicole Smith-Holt, a member of the group. Smith-Holt said her 26-year-old son died in June 2017 because he was forced to ration insulin due to the high cost. Type 1 diabetes often develops in childhood or early adulthood.

This is Smith-Holt’s second time on the caravan. Caravan to Canada trekked over the border in May for the same reasons, with a group smaller than the one this week, Holt-Smith said. She said Americans have gone to countries like Mexico and Canada for more affordable medications in the past and continue to do so.

CBC News reported in May that Canadian pharmacists have seen a “quiet resurgence” in Americans coming to Canada  looking for cheaper pharmaceuticals.

Insulin prices in the United States nearly doubled to an average annual cost of $ 5,705 US in 2016 from $ 2,864 in 2012, according to a study in January.

On the way to Banting House

Quinn Nystrom, a leader of T1International’s Minnesota chapter, said in May that the price in the U.S. of insulin per vial was $ 320 US, while in Canada the same medication under a different name was $ 30.

T1International, a non-profit that advocates for increased access to type 1 diabetes medication, has described the situation in U.S. as an insulin crisis.

“We know that many people couldn’t make this trip because they cannot afford the costs associated with travelling to another country to buy insulin there,” said Elizabeth Pfiester, the executive director of T1International in a press release.

An itinerary states the caravan will stop at the Banting House in London later in the day.


Sir Frederick Banting, seen here in a 1921 photograph, is one of the co-discoverers of insulin with Charles Best, then a student at University of Toronto. (Sir Frederick Banting House)

Banting House is where Canadian physician and scientist Frederick Banting, who discovered insulin with fellow Nobel laureate Charles Best, lived from 1920 to 1921, and is called the “birthplace of insulin,” according to the Banting House website. Much of the experimentation that led to effective treatment took place at University of Toronto and the Banting Institute is in Toronto.

Smith-Holt said she hopes for long-term solutions in the United States like price caps, anti-gouging laws, patent reform and transparency from pharmaceutical companies.

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FDA approves $2M medicine, most expensive ever

U.S. regulators have approved the most expensive medicine ever, for a disorder that destroys a baby’s muscle control and kills nearly all of those with the most common variant of the disease within a couple years.

The treatment is priced at $ 2.125 million US. Out-of-pocket costs for patients will vary based on insurance coverage.

The gene therapy, developed by Novartis, treats a rare condition called spinal muscular atrophy, which strikes about 400 babies born in the U.S. each year.

The U.S. Food and Drug Administration on Friday approved the drug, called Zolgensma, for all children under age 2 who are confirmed by a genetic test to have any of the four types of the disease.

The therapy, a one-time infusion that takes about an hour, will be available within two weeks.

Novartis said it will let insurers make payments over five years, at $ 425,000 per year, and will give partial rebates if the drug doesn’t work.

The one other treatment for the disease approved in the U.S., called Spinraza, is not a one-time injection. Instead, it must be given every four months after initial treatment. Biogen, Spinraza’s maker, charges a list price of $ 750,000 for the first year and then $ 350,000 per year after that.

In patient testing, babies with the most severe form of the disease who got the treatment within 6 months of birth had limited muscle problems. Those who got the treatment earliest did best.

Rebecca Van Fraassen’s family is just one many advocating for government help in paying for treatments for rare diseases, some of which can reach above $ 1 million per year. 2:47

Babies given Zolgensma after six months stopped losing muscle control, but the medicine was unable to reverse damage already done.

Novartis has been working with states to get genetic testing for newborns required at birth and expects most states will have that requirement by next year.

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Privacy: A hole in the virtual medicine cabinet


This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven't subscribed yet, you can do that by clicking here.


It's personal information that can't get any more personal: your medical conditions, symptoms you've searched and lists of medication you take.

If you happen to have entered that information into popular prescription drug-tracking Android phone apps, some of it might be shared with data giants like Google, Amazon and Facebook.

Those are the findings from an international team of researchers who analyzed the data traffic of each of the 24 medication apps they downloaded from the Google Play store.

The apps, which include Drugs.com, Medscape and Epocrates Plus, have been downloaded by millions of users. They're popular among doctors and patients because they not only keep track of the user's prescription drugs and medical conditions, but they're also a quick search tool for all medications on the market and even offer a possible diagnosis of symptoms.

The findings published in the BMJ this week found that sharing all this data with third parties is routine. Even the lead author, Quinn Grundy of the University of Toronto’s school of nursing, admitted she was surprised at how freely the data was being passed on to other companies, given the nature of the information. 

"We'd hoped that health data would be treated as personal and sensitive and I think we're disappointed to see that the kind of sharing going on was really 'business as usual' as for any other kind of app."

'Dangerous' permissions

During the installation process, users are required to grant app developers permission to start collecting personal information. Grundy and her colleagues from the University of California and the University of Sydney in Australia set up fake user profiles to track the flow of data.

In all cases, the type of permission granted was considered "dangerous" by Android's own security standards for developers. (The research was restricted to Android apps, so it's unknown whether the iPhone versions of these apps shared data differently).

  • The most commonly collected information by apps was about:
  • The devices they were downloaded on.
  • The operating system.
  • Browsing activity.
  • List of drugs entered by the user.

In a few cases, extremely sensitive data was also scooped up, such as the name of the user's doctor and pharmacy, as well as "feelings" they were experiencing.

In most cases, app developers aren't actually selling the data to third parties for money. Instead, it's a free trade, whereby third parties like Google, Crashlytics and Apptimize retain the right to collect user data in exchange for providing app developers services such as cloud storage. These arrangements are sometimes called '"freemium services."

A few medication apps can link with users' Facebook accounts, creating another avenue for personal data to be connected and shared. In most cases, the data is anonymized.

But users shouldn't be confident in thinking they won't be identified. The data-sharing often doesn't end with third parties if that third party happens to be Google, for example.

Google shares data with what Grundy refers to as "fourth parties" — business partners that have the ability to perform sophisticated data analysis.

"And so we could see user data kind of traveling through this mobile ecosystem and these big players at the centre of it able to aggregate and potentially re-identify users," she said.

Grundy added, although users consent to sharing data, and none of the activity is illegal, users are likely unaware of what happens to that information after it's passed along to third parties and beyond. The same goes for app developers.

Canada's 'lax' data laws

The research team's findings don't surprise to Sharon Polsky who has written privacy policies for organizations. She's now an advisor with the Privacy and Access Council of Canada, a non-profit advocacy group.

Polsky said however responsible an app developer's privacy policies sound, users kick the floodgates open once they give their consent. "It's carefully worded fuzzy language that essentially allows wide latitude for an organization to use the information."

Polsky said there are only a few examples of governments trying to reign in what she calls "surveillance capitalism." In 2018, the state of Vermont passed new regulations requiring data brokers to register and maintain basic data security standards.

Polsky said the European Union's General Data Protection Regulation (GDPR) is a "good start" but should go further, while referring to Canada's data privacy laws as "lax."

In a separate commentary published in the BMJ, health information professor Claudia Pagliari of the University of Edinburgh credited Grundy's research for providing some sobering context amid the excitement surrounding digital health.

Pagliari also wrote there is a "good news story hidden in this work," referring to the fact that companies were more transparent about their data-sharing arrangements after the GDPR came into effect.


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