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Thursday, December 6, 2018

A bridge with a future

As the former owner of a heritage automobile, I was disappointed when Í first inspected the re-opened Blackfriars Bridge. When I expressed my disappointment and explained why the poor paint and lingering corrosion bothered me, my friends patiently explained it's an old bridge not an old car. It's been rehabilitated, not restored.

I thought for a moment. I recalled how my old Morgan was built in the days before seat belts. When I sold the roadster, the first thing the new owner did was install seat belts. This was an act of rehabilitation and something I should have done years ago. I had allowed myself to be seduced by the restoration mythology: if it wasn't there originally, it shouldn't be there. Period. And bunkum. Old or new, equipment must meet today's safety requirements. Anything else is stupid. I had been stupid.

I wonder about all the unpainted stuff that I found all over the Blackfriars Bridge. The corrosion would not have been acceptable on an old car, rehabilitated, restored, re-anythinged. Still, it is an old bridge and not an old car.

Those running the City of London should be proud. The continuing presence of the Blackfriars Bridge over the North Branch of the Thames River is remarkable. The fact it is also still carrying traffic is a rare achievement.

 If you had assumed a 143-year-old structure would not have been designed to meet today's demands, you'd have been right. (Heck, my Morgan was only 45 year old and it fell short.)

It is for some very good reasons that the Blackfriars Bridge of today is not, for the most part, the original structure. Instead, it is a ghost, an elegant reminder that the past is past, that times change and that stuff must change too or be left behind. The Blackfriars Bridge has changed. It has not been left behind.

This is not a restored structure but a rehabilitated one, and a somewhat repurposed one. It no longer carries horses pulling farm wagons but cars, albeit in only one direction, plus numerous pedestrians and cyclists.

Top detail of derelict Wrought Iron Bridge Co. bridge arch.
It was almost 70 years ago that the bridge load was restricted to five tons. A few years later it was necessary to do "significant work" to strengthen truss members and reduce vibration. By 1986, the load limit had to be reduced again. This time to only three tonnes.

Since that first "significant work", the bridge has undergone a lot of significant remedial work. I'd argue the bridge standing over the river today is a new bridge which incorporates the visual elements of the original bowstring-arch truss bridge.

I'm old enough to recall when hundreds, if not thousands, of wrought-iron bridges were still in use throughout both Canada and the United States. Almost all are now gone. Worn out, demolished, replaced.

Restoration: really?
I was disappointed by the new bridge because too many folk, often journalists, refer to the work as "the restoration of an historic gem." It isn't. It's better.

The myth of restoration is a killer. Structures have been demolished when found impossible to restore. Restoration can be an impossibly high bar to clear. Why? Because of what true restoration entails.

Restoration modifies an heritage structure to accurately reflect its appearance at a specific point in its past. This may involve the addition or the removal of structural material.

The engineers who rebuilt the London bridge to meet today's demands proclaimed quite openly that they were rehabilitating the structure. Rehabilitating is not restoring.

There is very little of the original bridge in this latest incarnation. This is as it should be if the goal is to keep the bridge in use. Once we get our heads around the truth that restoration is not the only way to honour the past, opportunities appear all around us. Think of Old Quebec. As I wrote in a previous post:

I am old enough to recall when many of the present "heritage" structures (in old Quebec) were not there. Many of these buildings were not restored but recreated. Much of the area's 18th century ambiance so loved by tourists is faux.

Once we accept that our new bridge is a glorious salute to the past, a glowing, functioning memory, we find it possible to openly ask, what is the best approach to preserving the illusion of heritage? To answer this, we must bring artists and historians into the rebuilding effort and not just engineers. Artists like Ted Goodden, who featured the bridge in his art, can bring a lot to the rehabilitation table.

Those who take the time to look will discover that the new Blackfriars Bridge is magic--a practical answer wrapped in romance and sentimentality. Gérard Morisset, the art historian behind the reclaiming of Old Quebec's heritage texture, argued it is completely acceptable to restore a structure "to a state of completeness that may never have existed."

A construction update picture posted by The City of London.
Make no mistake about it, the reopened Blackfriars is new bridge, a stronger bridge, a bridge with a future not just a past. This is not just a facade like the old roomless hotel pasted into the northeast corner the Budweiser Gardens. This is a working bowstring-arch truss bridge. Appreciate it.

Saturday, December 1, 2018

On my death, to my Indian friend, I leave my pacemaker.

So how dependable are pacemakers? Well, the University of Michigan has a program for recycling devices no longer needed by their original owners. Why are they no longer needed? Uh, the heart patient has died.

Pacemakers cannot make a heart beat that no longer has the strength to continue. There's no point in flogging a dead horse, as they say.

Tossing out perfectly good pacemakers with the cadavers is seen as a waste by the U of M folk. Working with funeral directors and crematorium staff, along with interested individuals, the U of M is recycling pacemakers that still have life in them, so to speak.

And who takes the old units. Why the third world. Many pacemakers are good for up to ten years today. Many folk die long before a decade has passed. Put these used units in the right patients and it it is a match made in heaven.

For more information, click the My Heart Your Heart link.

Thursday, November 29, 2018

Medical 'breakthroughs' hyped by media

This topic is tough to discuss. The danger is that one may come across as simply a defender of the medical device industry. I'm not.

Another danger is that one may come across as a media-hater. Again, I'm not. I worked at two newspapers and one television station and have great respect for many of the folk with whom I once worked.

Medical devices are often foreign objects surgically implanted into the human body -- a damn hostile environment for many materials. Corrosion is but one of the immediate threats.

Think about the discredited Liberation Therapy treatment proposed as a treatment for MS (multiple sclerosis). Doctors were slow to embrace the untested surgical treatment as it often involved the off-label use of a coronary artery stent being inserted in a vein in a patient's neck.

The media was quick to attack the doctors, government regulators and insurers for their reticence. The Post Media paper in London, Ontario, ran a story about a local woman unable to obtain government health care funding for the treatment.

When I looked into the wisdom of placing a stent in a patient's neck, I was told by the medical professionals questioned that they would not do it. Why? Too dangerous.

Liberation Therapy is no longer bandied about as a miraculous cure for MS. The doctors and clinics that were so quick to provide the treatment should be ashamed. Patients died having this surgery. It was a high-risk-no-reward treatment. And the press should be ashamed of the role it played in advancing this quackery.

So, is there a problem with medical devices? Yes. But it is a complex problem and the breathless reporting of patient-recipient horror stories, as I've encountered on CBC, is not the adult discussion needed.

Wednesday, November 28, 2018

Thank you, Medtronic.

My heart doesn't beat well. At least, it doesn't beat well on its own. I have a one hundred percent heart block. This a problem with my heart's electrical system and not a problem with my arteries. I'm not concerned about having a heart attack. What threatens me is heart failure. You see, on its own my heart would beat only about 30 times a minute, maybe even less. Without my pacemaker, my ankles would swell, fluid would gather in my gut and surround my heart. My lungs would fill with fluid and I'd have a difficult time breathing. Within days I'd be dead.

My pacemaker is an implanted medical device attempting to partially correct my heart's electrical system failure. It is not a perfect solution and there are problems associated with having one implanted. How anyone could think that having a chunky metal box inserted into one's chest and attached to one's heart by 26-inches of wire could possibly be risk-free puzzles me.

CBC is reporting that tens of thousands of medical devices distributed worldwide — like pacemakers — were approved for sale with little scientific evidence . . . 

CBC claims devices such as pacemakers are suspected of having played a role in more than 14,000 reported injuries and 1,416 deaths. This number is so large because it includes problems associated with a number of devices, of which pacemakers are but one.

Digging deeper I discovered CBC posted an interactive medical device database of associated incidents. I typed pacemaker into the device category field.

I discovered 157 deaths and 1,291 patient injuries are associated with pacemakers. This is not all that surprising when the complexities of the system and the all-too-clear dangers are considered.

Simply making a pocket in a patient's chest and inserting a metal box is fraught with danger: infection, blood clots,  stroke and the list just grows. And, if a problem does arise, the solution may well demand another operation. Surgery is never risk free.

What did surprise me were some of the incidents that made the list. I admit to cherry picking but this is my point. Don't just take the numbers and other bits of information at face value.

The CBC encourages us to question the motives of the device makers. The manufacturers may be driven by a need for profit. I suggest the CBC, and all news folk, should face questions as well. Journalists may have their own demons driving them forward. Think viewers, readers, awards and even think profits. I like to think it's the demand to tell a good story that blinds them.

So what were the surprising incidents that made the pacemaker incident list? Here are a few:

  • patient piloting air ambulance involved in plane crash died. no evidence to support a device-related cause for the event.
  • generator and associated leads were removed due to infection. source of infection unknown. patient died from liver cirrhosis.
  • patient died due to acute coronary artery disease. device tested and functioned properly and within specification. patient was 85.
  • pacemaker implanted for heart block. developed non-ischemic cardiomyopathy with ejection fraction diminishing. root cause was physiological.

Now maybe a good time to read the CBC fine print:

  • CBC has not verified the accuracy of the data. 
  • Reports might have been filed to Health Canada with inaccurate or incomplete information. 
  • There is no certainty that the medical device caused the reported reaction. 
  • A given reaction may be the result of an underlying disease, process or another coincidental factor. One report may be tied to multiple parts of the same device and multiple reactions may be connected to a single patient. 

The data does not reflect any CBC assessment of association between the health product and the reaction(s).

I'm on my second pacemaker. I got seven years out of my first unit before the battery failed. I apparently suffered no infection from the replacement surgery. My luck seems to be holding. But, I cannot be completely certain I escaped the threat of infection until a full year has passed.

My original lead, the 26-inch wire connecting my pacemaker to my heart, was retained and reused. It has now been operating in a very hostile environment, the human body, for eight years. How long that lead will last is anyone's guess. The electricity-conducting wire could corrode or succumb to metal fatigue. Leads do fail and the frequency increases with time. And, of course, there is always the threat of manufacturing defects and recalls.

Just living carries risks. I simply live with a few extra risks. But risks in life are often nicely balanced by rewards. I believe the risk/reward ratio associated with my pacemakers are weighted heavily in favour of my pacemakers.

Thank you Medtronic.

Despite the scary tone of some of the CBC reporting concerning pacemakers, the ICIJ stories, the source for the ongoing CBC reports, is often not as frightening. The ICIJ is actually fairly reasonable. The following is from the ICIJ report titled: Frequently asked questions and resources for readers.

Do all medical devices have problems?

No. For example, pacemakers and implantable cardioverter defibrillators (ICDs) have revitalized and saved millions of lives.

I'm not keen on having man-made stuff implanted into my body. I've had car problems, microwave breakdowns and expensive camera battery failures. Stuff fails. It is a fact of life. Sadly, sometimes stuff fails because of poor design or shoddy workmanship. This is not acceptable in any situation but it is a worst case scenario when it involves the failure of a medical device. The ICIJ is doing us all a service.

The ICIJ asks who is watching the medical device makers? I wonder who is watching the journalists?

Sunday, November 4, 2018

Who's really endangered? Answer: Newspaper editors.

This opinion piece contains many questionable numbers. In the old days it would've been spiked.

"Who's really endangered?" My answer may surprise you: Newspaper copy editors.

A quick reading of the opinion piece written by Elizabeth Nickson left me asking, "Where is a copy editors when you need one?" Copy editors are an important and respected part of every newsroom — or, at least, were in the not-so-distant past. These talented, well educated, team players fixed grammar, corrected spelling and checked both usage and style for agreement with the newspaper's in-house style guide. (This post would look quite different if I had a copy editor.)

Copy editors acted as proofreaders, fact checkers and polishers of dull prose. Exceedingly knowledgeable, copy editors had solid backgrounds in journalism. Some of the best were first-rate reporters before moving to the desk.

Sadly, copy editors are a dying breed. Many have been given early retirement, their jobs declared redundant by the giant media conglomerate owners.

The opinion piece written by Elizabeth Nickson, a fellow at the right-wing Frontier Centre for Public Policy, often called a right-wing think tank, is a good example of writing in need of a skilled copy editor.

 Nickson immediately stakes out the territory she is attempting to control: The sixth great extinction. "Unlike climate change, the notion of the sixth great extinction is not contested vigorously . . .," she claims, moving quickly to a full frontal attack on Paul Ehrlich, whom she derisively calls "the godfather of extinction science."

Unfortunately, it seems Nickson got her godfathers mixed and predictions as well. She tells us that Ehrlich predicted 27,000 extinction a day by 2000. He didn't. It was Edward Wilson, the father of sociobiology and a champion of biodiversity, who made that prediction, sort of. He predicted 27,000 extinction a year.

That's more than 70 a day, an amazingly high number until you understand the professor is talking about the destruction of the world's rainforests, the most biologically diverse places on Earth. He is not talking about black-tailed prairie dogs in the west or caribou in Canada's distant north. He does not restrict his prediction to large mammals and birds and this should come as no surprise; Wilson is the world’s leading authority on ants.

Ehrlich's and Wilson's ideas have attracted a lot of opposition over the years. It's a rich, complex world and, just as one would expect, not every biologist studying endangered species agrees with either man. Nickson would be in good company if her facts were correct but they aren't.

Nickson does no better reporting on the black-footed prairie dog situation in Colorado. Numbers are again the Frontier Centre writer's downfall. I won't go so far as to say Nickson is wrong but there is no doubt that her writing lacks clarity. People familiar with the situation in Colorado were puzzled by the Nickson numbers.

Nickson claims 12 million acres was demanded to protect to the black-tailed prairie dog. "In court, the state's scientific rigour won, hands down," she says.

Tina Jackson, Species Conservation Coordinator with the Colorado Department of Natural Resources , wrote me, "I am not sure where they got that information about black-tailed prairie dogs in Colorado." Neither Jackson nor James Baker, also with the DNR, was aware of this ever being taken to court.

Elizabeth Nickson was good enough to share some of her research links with me for this article. Reading through the links, and links to links, she sent me I found the following:

The earliest published estimate of prairie dog occupied acreage in the state (Colorado) is from C.P. Gillette in 1919 . . . (Gillette believed) prairie dogs inhabit about 12 million acres in the State . . . [Is this the source of the 12 million number?]

A good editor will tell a newspaper writer to deliver the goods before the turn. Break a newspaper story into two parts and a large number of readers won't make the turn. Editors keep stories short, interesting and accurate.

Today, a great number of people are failing to even pick up the paper, let alone make it past the turn. If newspapers want to bring back the readers, bring back the copy editors.

Black day for the blue pencil

Monday, October 15, 2018

CBC earns an incomplete for seat belt story

The CBC is making a big deal of its investigation into the need for seat belts in school buses. I can see the argument. I often accompany my oldest granddaughter on school outings. I sit in the school bus with the children and I feel weird not wearing a seat belt. It has never felt right and so I did some research.

Finding the definitive answer is not a quick search. It turns out this is a complex problem and a lot of folk have given it a lot of thought. Heck, even the researcher quoted this morning in the CBC report was once featured in a New York Times piece carrying the headline "Study Rejects Requiring School Bus Seat Belts."

Kathleen Weber, the researcher quoted by the CBC, told the Times that all the members of the committee examining the question of seat belts use in school buses were in agreement: the benefits of requiring seat belts were sufficiently small, and the problem itself sufficiently small, that the committee could not justify the cost.

I don't like that answer. If seat belts work, put them in the school buses. Period. End of discussion. Surely, cost does not enter into the equation. We are talking seat belts. How much can seat belts cost? The present system of making school buses safe, compartmentalization, cannot be cheap.

No, the question is: do seal belts work? Or more accurately, do standard seat belts work with little children? Think carefully before answering. If you do, you'll realize little children do not ride in the backseat of the family car restrained only by the three-point seat belts provided. By law a booster seat is required. Why? For safety.

In Canada, over a two-year period, 28 children were reported to have sustained injuries consistent with seat belt syndrome; seven of these children remained paraplegic. Among the 16 injured children eight years of age and older, four were properly restrained with three-point seat belts.

Booster seats are an attempt at preventing maladjusted seat belts from causing serious injuries and even death to improperly restrained children. Ill-fitting seat belts are a big safety concern. Studies show children are especially vulnerable to suffering a seat belt caused injury. Transport Canada has some well founded concerns.

As I mentioned, I have grandchildren. I own two types of booster seats: one a booster cushion and the other a high-backed booster seat that installs using the Universal Anchorage System (UAS/Latch). Both are legal in Canada but not everyone in the world agrees. The use of booster cushions is restricted to older children in Great Britain and Europe. In those places, my grandchildren would be breaking the law by using booster cushions.

Whenever possible, I use the high-back booster seats which attach firmly to the car's UAS system. I leave the booster cushions at home in the garage. My gut feeling is that the high-backed, anchored boosters deliver improved protection. I think the Europeans are making the right decision. I'd like to see this style of booster seat, paired with properly designed seat belts, used in school buses.

The Fifth Estate did one thing right. They found IMMI in Indiana. This is a company developing innovative seat belts for school buses. One product features a five-point system that appears to deal with the biggest dangers posed by traditional three-point seat belts. Kudos to the Fifth Estate for finding the IMMI company and bringing it to our attention.

An independent study of the IMMI product or products may be necessary but surely it could be done quickly. Let's make school buses, already remarkably safe, safer still.

Lastly, one-sided attacks, like the one launched by the CBC, make for attention-holding television but such attacks don't encourage folk to come to the table for an adult discussion. I'm not surprised the minister refused to meet with the CBC Fifth Estate reporter. It appears on the face of it that the CBC folk had an agenda and it wasn't getting at the whole truth and nothing but the truth. It was attacking a government bureaucracy. It was in telling a good story.

When writing a post for my blog, an immense amount of information must be found and read. I admit it may overwhelm me. A better system would be for journalists to work together and to work longer, ignoring self-imposed, artificial deadlines, to deliver accurate information. Below, is just a very small sample of the info found and examined.

Sixteen passengers died and 13 were injured in the Humboldt Broncos bus crash. The charter bus company involved in the crash had already installed seat belts without a federal rule, but none of the players were wearing one.

Research link: http://www.who.int/roadsafety/projects/manuals/seatbelt/seat_belt_manual_module_1.pdf

The three-point lap and diagonal seat-belt used by adults is not designed for children’s varying sizes, weights, and the different relative proportions of children’s bodies. For example, a smaller portion of a child’s abdomen is covered by the pelvis and rib cage, while a child’s ribs are more likely than an adult’s to bend rather than break, resulting in energy from a collision being transferred to the heart and lungs.

Consequently three-point lap and diagonal seat-belts may lead to abdominal injuries among children, and will not be optimally effective at preventing ejection and injury among them. Appropriate child restraint systems are specifically designed to protect infants and young children from injury during a collision or a sudden stop by restraining their movement away from the vehicle structure and distributing the forces of a crash over the strongest parts of the body, with minimum damage to the soft tissues.

Child restraints are also effective in reducing injuries that can occur during non-crash events, such as a sudden stop, a swerving evasive manoeuvre or a door opening during vehicle movement.

Seatbelt Syndrome in Children: This is an interesting paper. Seat belts are good but, when it comes to their use with children, proper booster seats are an excellent addition to increase safety. It should be noted that there are a number of opinions on what exactly constitutes a proper booster seat. For instance, look up what is demanded in Great Britain.

http://www.roadsafetyobservatory.com/HowEffective/vehicles/child-restraints (The researchers found that abdominal injuries mainly occurred in children using only a seat belt, emphasising the need for belt-positioning boosters. (Jakobssen, 2005))

(The main system for safely restraining occupants in vehicles is, of course, seat belts. However, seat belts do not fit children properly, and do not fit babies at all. This means they are less effective in protecting children, and in some circumstances, could even cause injury.

Children are not simply smaller adults; they are proportioned differently, their bones are not fully formed and their skeletal structure does not cover and protect their internal organs in the way it does in adults. All of these things change as children grow older, meaning that the type of restraint system they use also needs to change, until they reach the point where the seat belts can provide the same protection as for adults. (Burdi and Huelke, 1969, WHO, 2009))

Child Car Restraints Compared with Seatbelts
A USA study of 2 to 3 year old rear seat child passengers in crashes that resulted in at least one vehicle being towed away between 1998 and 2004 concluded that the odds of injury were 81.8% lower for toddlers in child seats than for toddlers wearing seat belts. (Zaloshnja, 2007)
Another American study comparing the use of child restraints with seat belts by 2 to 6 year old children involved in vehicle crashes between 1998 and 2003 found that compared with seat belts, child restraints (when not seriously misused) were associated with a 28% greater reduction in the risk for death in children of that age group. When including cases of serious misuse, the effectiveness was slightly lower, at 21%. (Elliot, 2006)

A study of crashes in 15 states in America between December 1998 and May 2002 involving 1,207 children aged 12 and 47 months, seated in the rear of vehicles, found that the risk of serious injury was 78% lower, and the risk of hospitalisation was 79% lower, for children in forward facing child restraints than for those in seat belts. (Arbogast, 2004)

A study of 17,980 children under 16 years old involved in crashes in 15 states between December 1998 and November 2002 found that the risk for inappropriately restrained (defined as using a seat belt rather than a child safety seat or booster seat) children was almost double that of appropriately restrained children. (Durbin, 2005)

An analysis of fatal car accidents in the USA between 1982 and 1987 estimated that children in child safety seats were 50% less likely than unrestrained children to be killed, but those using the car’s adult seat belts were only 36% less likely to be killed. (NHTSA, 1998)

When these estimates were updated in 1996, the estimates for the effectiveness of seat belts on their own had increased to 47% in cars and 48% in light trucks or vans. The effectiveness of child restraints had also increased from 69% to 71% for under one year olds and from 50% to 54% for one to four year olds. (NHTSA, 1996)


Thursday, September 27, 2018

The Crisis of Living

I was directed to the Globe and Mail opinion piece by a tweet by a journalism professor. The piece? The Crisis of Living Too Long.

He was right. It was a good piece of writing but a bit too maudlin for my liking. The author tells us that she and her husband aim to "stockpile sleeping pills" as they get deeper into their senior years. I suppose today suicide is an option for those finding life too tough. But it wasn't always so.

When my dad died, suicide was not a good way to leave this world of blood, sweat, toil and tears. For one thing, killing oneself left one's life insurance in question. It left one's spouse and children possibly in a tougher-than-need-be financial crisis.

My dad had a poor heart but excellent doctors. He endured coronary after coronary and after a stay in the hospital he was back home, gulping nitroglycerin pills and waiting for the next major heart attack, the next trip to the hospital and the trip home.

After his last attack, life threw him a changup. He suffered a stroke instead of a heart attack. He lost the sight in one eye, all was a blur. He found himself forced to have one lens of his glasses completely frosted. If he wasn't wearing his glasses, he wore an eye patch. He took no pleasure in his new I'm-a-pirate look. I believe he felt humiliated.

He sold his car. His first new car in decades. It was a small, four-door, Vauxhall with leather seats. It broke his heart to part with that car. But the stroke that damaged his vision also left him slightly paralyzed on one side. The car had to go. In one sense, it was not a big loss as he no longer had a job. The car had become just an expense, a drain on the family finances.

One morning my dad appeared at the breakfast table in his best blue suit. He wore a bright, almost jaunty, tie held firmly in place by a fancy, gold clip. His white shirt was pressed with just the right amount of sleeve extending below the cuffs of his suit jacket. His patent leather Oxfords were perfectly polished. Not a scuff to be seen.

His bald head glistened from the Wildroot used to slick back the dozen or so long hairs he carefully tended. Those hairs were all that protected him from facing the fact he was bald. The world saw him as bald; he saw himself as thinning.

Dad had his usual bacon and eggs breakfast with two pieces of well-buttered toast. He mopped up the dark orange-yellow yolk with a scrap of toast, downed the last dregs of his peculator-brewed coffee, kissed both me and my mother good-bye and walked out of our home and out of our lives.

My dad died in the Prince Edward Hotel.
That was the last either of us saw my dad. Apparently, he took the bus downtown, checked into the Prince Edward Hotel and died. His heart pills, mostly nitroglycerin, were found sitting on the dresser on the other side of the room from the bed in which he was found.

It appeared my dad had died shortly after leaving home but we'll never know for sure. His body was found by the hotel cleaning staff. The hotel called the police, the police, using the information on his pill bottles, called his heart doctor and he, in turn, called us. His doctor identified the body, filled out all necessary forms, and contacted the funeral home.

My dad had a closed coffin, as he wished. Neither my mom nor I ever saw my dad's dead body. His death was from natural causes, a major coronary event unmitigated by medication. His doctor claimed that his death had come so suddenly, so quickly, with such power he had been unable to reach his pills left on the side of the room from where he had stretched himself out seeking relief from the pain.

My dad's death is a story that could be told as I've told it and then left, but to do so would be to tell an incomplete story. My dad died the way he had lived. He was born ill. His mother blamed a sick cow used to provide all the milk given the newborn. In his twenties he had three fourths of his stomach removed: ulcers. In his thirties had had hernias: numerous hernias. He had gall bladder, appendix, bowel operations and more. His health issues in old age, if dying in one's early 60s is old age, were a continuation of health problems that plagued him his whole life.

I'm ending this with a wonderful bit of advice from Monty Python's Life of Brian. And yes, I have considered the jarring note added by this song written by Eric Idle. But, please trust me, as a fellow alive only thanks to my second pacemaker I take great pains to smile. I see no hotel room in my future.

Saturday, September 22, 2018

It's NOT Baby Aspirin; it's low-dose.

As children stopped taking Aspirin, Reye's syndrome almost disappeared.
Reye's syndrome posed a danger to children when I was young. It was rare but lethal. Today? We rarely hear of Reye's. Why? The relationship between Aspirin (ASA), its use in children and Reye's syndrome was recognized.

The orange-flavoured chewable labeled Baby Aspirin disappeared from drugstore shelves. The powerful drug is now known as low-dose Aspirin.

And yet, today, we still encounter folk using the former name. Even doctors are known to fall into the trap, referring to low-dose Aspirin by it now out-dated-for-a-reason moniker. What puzzles and appalls me is that journalists, those purveyors of truth and accuracy constantly get the name wrong. Where are the editors? In forced retirement, I'd guess.

Aspirin is a drug, a powerful drug and, as with all powerful drugs, taking it comes with risks as well as rewards. If one is healthy, taking even a low-dose Aspirin once a day has always been a questionable practice. As they say: "If it isn't broken, don't fix it."

That said, if you get your medical knowledge from the main-stream media, you might be forgiven for thinking otherwise. The media has a history of presently the taking of low-dose Aspirin as relatively innocuous, almost risk free. To underscore this point, the media often refer to low-dose Aspirin as Baby Aspirin. What could be safer?
This is NOT news. The recent report simply confirms common concerns.

The media should not link babies and Aspirin for the same reason that Bayer changed the name: it was found that parents, especially new parents, thought the low-dose product was made for use by children and infants. It's not. Not today.

I take low-dose Aspirin and it  frightens me. As the Harvard Medical School pointed out:

If taking Aspirin was risk free, it might make sense for everyone worried about heart disease to take it. But Aspirin does have risks.

It can potentially lead to hemorrhagic stroke (bleeding inside the brain). In the stomach, Aspirin can aggravate bleeding ulcers. Severe gastrointestinal bleeding can be lethal.

Aspirin is NOT for babies nor children no matter how low the dose. Nor is taking Aspirin completely risk free even for healthy, adult folk. It's a powerful drug and deserves to be treated as one.

I knew that. How? Because my doctors made the risks associated with taking a daily low-dose Aspirin very clear to me. Why doesn't my daily newspaper, and the rest of the MSM, get the story right? It's not difficult and it would lessen the danger of children mistakenly being given low-dose Aspirin.

Sunday, August 5, 2018

I don't understand. This story left me confused.

A young Londoner came down with a illness that left his doctors stumped. And according to The London Free Press, this "experience is all too typical in a country in which Lyme disease has grown to epic proportions, a crisis that neither doctors nor public health officials have adequately addressed..."

One problem: The young boy did not have Lyme disease. A Maryland specialist discovered the boy had Bartonella, commonly called Cat Scratch Disease. According to the CDC (Centers for Disease Control and Prevention in the States) people get CSD from the scratches of domestic cats, particularly kittens. The disease occurring most frequently in children under 15. The boy in the story was 12 when he came down with his illness.

Which bring us to my second problem: The CDC and many other official sources claim ticks may carry some species of Bartonella bacteria, but "there is currently no convincing evidence that ticks can transmit Bartonella infection to humans."

The young man had an illness that went undiagnosed. Why? The story does not give us enough information to understand why this terrible thing happened.

I sense a bias against the Canadian healthcare system in this story. If it was simply the shoddy Canadian system at fault, why did the boy have to travel to Maryland, a nine hundred kilometre trip. If the American system is so great, why didn't the boy simply cross the border and immediately get help? There are a lot of American doctors closer to London, Ontario, than the specialist in Maryland.

I can feel for this young man. I had a somewhat similar experience. I had a V-tach event while vacationing in California. After running up a bill approaching $30,000, the American heart specialists found nothing to explain what had happened. I was released from the hospital to drive to Vancouver and on home to London, Ontario.

Although one should wait six months before getting behind the wheel after such a cardiac event, I drove some fifty six hundred kilometres immediately after having my heart reset by two paddles pressed tightly to my chest to deliver a jolt of 200 joules. Unlike my Canadian doctors, the American ones failed to discuss driving after being released from the hospital.

When it came to finding a cause for my V-tack event, my London doctors didn't fare much better than their American counterparts but the Canadians persevered, discovered I had a relatively rare form of heart disease and installed a pacemaker/ICD in my chest. I'm now on my second pacemaker/ICD. Thanks to the Canadian system, I have a life. (And thanks to my granddaughters, I have a good life.)

Should the American doctors with all their sophisticated testing equipment have been so easily stumped by my heart disease. I don't know. But what I do know is that I owe my life to my Canadian doctors.
To keep the above post short I did not examine the newspaper's criticism of the Canada's supposedly out-of-date approach to testing for Lyme disease, but, if interested, read the following.

The story informs readers that in Ontario "doctors won't use a test well-established in the United States and Europe, a Western Blot test, unless patients first test positive using a method known to miss many cases, an Elisa (sic) test."

This would be very damning if it were true. But, it isn't. The CDC (Centers for Disease Control and Prevention) in the States recommends performing an ELISA, or similar EIA test, first and a Western Blot test second. If the first test is negative, no further testing of the specimen is recommended. The American CDC approach and the Canadian one are in agreement. (The respected Mayo Clinic also agrees with the Canadians and the CDC.)

Furthermore, the two steps should be done as designed. The CDC does not recommend skipping the first test and just doing the Western blot. The CDC warns, "Doing so will increase the frequency of false positive results and may lead to misdiagnosis and improper treatment."

Since writing this, I've encountered some criticism. I've decided to post some info from the Mayo Clinic in the States.

Lab tests to identify antibodies to the bacteria can help confirm the diagnosis. These tests are most reliable a few weeks after an infection, after your body has had time to develop antibodies. They include:
  • Enzyme-linked immunosorbent assay (ELISA) test. The test used most often to detect Lyme disease, ELISA detects antibodies to B. burgdorferi. But because it can sometimes provide false-positive results, it's not used as the sole basis for diagnosis. This test might not be positive during the early stage of Lyme disease, but the rash is distinctive enough to make the diagnosis without further testing in people who live in areas infested with ticks that transmit Lyme disease.
  • Western blot test. If the ELISA test is positive, this test is usually done to confirm the diagnosis. In this two-step approach, the Western blot detects antibodies to several proteins of B. burgdorferi.
The above has a reference date of May 16, 2018. The above is not stale-dated information.

Saturday, June 30, 2018

In hot weather, should we drink copious amounts of water even if we're not thirsty?

Even without considering the scientific evidence related to this essential question, one would have to believe it remarkable that the human species would exist if thirst were inadequate to guide drinking during exercise. Martin D. Hoffman M.D., et al.

It may seem like a small matter: who cares if one drinks too much water to avoid dehydration? No one ever died from too much water, right? Wrong. But there's more going on here: if drinking a lot of water during hot weather is not a good idea, if it can, in some cases be dangerous, why are so many reporters getting the story wrong?

I read newspapers and watch television news to learn. And I expect the stuff that I learn to be right, to be checked for accuracy by professional reporters, professional fact-gatherer. When I discover a reporter did little more than unquestioningly repeat what he or she had been told, possibly because it was a good story, I feel cheated. Information in newspapers should be vetted; it should be accurate; it should be right.

There are lots of myths out there. There's even a successful television program based on questioning these stories. It's amazing how many stories are revealed by MythBusters to be just that: stories.

Which bring us to the question of how much and of what should we be drinking during hot spells. Do you believe the news stories? Do you drink a lot of water without waiting until you feel thirsty. Do you try to belt back eight glasses of water a day?

If you question the accepted story, a reporter might respond by sending you a link to Oregon Occupational Safety and Health. The OOSH claims in a hot environment one should drink water frequently, even when not thirsty.

It may seem straight forward but wait. In response, you can site the Loyola Stritch School of Medicine:

In recent years, at least 14 deaths of marathon runners, football players and other athletes have been attributed to exercise-associated hyponatremia, a condition that results from drinking too much water or sports drinks.

But there’s an easy way to prevent hyponatremia, according to Loyola University Medical Center sports medicine physician James Winger, MD. Drink only when you’re thirsty.

Whom do you believe? And why should you even have to ask? Some years ago, I got very ill during a trip to the Sahara desert in southern Tunisia. I followed all the hydration advice. I made sure I drank even when not thirsty. And I got damn sick. When I got home my doctors told me I may well have had hyponatremia or water intoxication.

Since then, the doctors I have talked to have told me much of the advice surrounding the drinking of fluids during heatwaves is wrong. The media reports are often urban myths, I'm told. My doctors have warned me, excessive water intake can be dangerous for folk like, folk with a heart condition.

They remind me that I get water from many sources. Vegetables are often mostly water. For instance, cauliflower is about 92% water. If you drink coffee, I like a brew made from a mix of caffeinated and
decaffeinated, then each cup of coffee is equal to a eight ounces of water. And yes, the warning about not drinking coffee during hot weather is another myth but I'll leave that for another post.

Drinking to quell thirst is the correct way to go in almost all situations. A conference in California found there was an overemphasis on high fluid consumption. Athletes should be advised of the risks associated with over drinking. Decreasing the number of fluid stations at long distance running events might be counter intuitive but it might be necessary to reduce the number of incidences of exercise associated hyponatremia (EAH).

And here is where it gets interesting: dissemination of appropriate drinking advice alone has been shown to reduce the incidence of EAH. It's time journalists spent some time getting this story right. It should not be that hard for a professional fact-gatherer, professional story detective, a finder, a discerner and teller of truths.

And then these journalists can employ these investigative methods, honed tracking down the truth when it comes to water consumption during heatwaves, to uncovering the truths going unrevealed in other, more important, stories. Look out Donald Trump question-asking journalists could soon be on your trail.
Would you like to read more? Try this article:  Is Drinking to Thirst Adequate to Appropriately Maintain Hydration Status During Prolonged Endurance Exercise? Yes.

Do you need to drink 8 glasses of water a day?

Saturday, April 21, 2018

Journalists should not be storytellers

Recently, I read a tweet from a former newspaper editor who now expounds on journalism to students taking his class at a nearby college. He tweeted that he was training young people to be storytellers. I replied: Journalists are not storytellers but reporters.

He disagreed. A story lies at the heart of what a reporter tries to convey, he tweeted. Who's right?

According to Lee Wilkins, professor and communications department chair at Wayne State University in Detroit, faculty emeritus and curator’s teaching professor at the University of Missouri:

Journalists are not storytellers but reporters.

According to Wilkins, a local government reporter before she began teaching: "When we started thinking of ourselves as storytellers was when we ran into a problem." The problem? Journalism changed from an "objective process" to one focused on "storytelling." Wilkins believes this emphasis on story over reporting entered American newsrooms in the 1980s. And I concur.

Sadly, when a journalist puts the story first, all too often it means facts become subservient to the story. I can give a solid example of this but, if I do, I risk losing you. You will immediately know I am wrong because you have seen and heard the story on television, maybe on 60 Minutes, or CBC Marketplace. You have read it in your local paper and in magazines. You know the truth. You know the story. And I will have a damn near impossible time changing your mind.

The story? The threat posed by the urea formaldehyde foam insulation or UFFI was created by the media. Before you quit reading, think about this:

Source: The London Free Press, Saturday Homes Section

When homes with UFFI were tested, the tested homes were found, on average, to have formaldehyde levels only slightly less than that of homes of similar age without UFFI. Also, there was no UFFI caused damage to house framing nor were other UFFI-caused defects found.

Why was the true story not told until years after the damage had been done? Because stories, good stories have legs and when told by good storytellers, by journalists, such stories are hard to resist. I believe it was 60 Minutes in the States that originally broke the erroneous scare story. Then CBC's Marketplace, not to be outdone, did their take on the same story. And the UFFI wildfire was lit and fanned. Newspapers across North American felt forced to run UFFI stories as well.

I covered a lot of UFFI stories and I am ashamed of the part I played in promoting that story. I met a lot of people, many seniors, who had massive amounts of their life savings tied up in their homes and the media-spread myth destroyed much of the equity that had accumulated in the family home. All too sad. Now, there is a story. Will it displace the mythical stories? I doubt it. Marketplace is still bragging about their major contribution to the original UFFI coverage.

Marketplace is proud of the part it played in the banning of urea formaldehyde foam insulation.

As I edited this, I wondered if scare stories involving UFFI were still being printed. It took but a moment to turn up this story from the Cornwall-Standard Freeholder on "toxic spray foam insulation."

I shake my head and a feeling of shame washes over me. I had a hand in pushing this story and the story is still influencing decision making. This is despite the fact that, and this is from the Freeholder story, "Canada is one of the only countries in the world that bans the use of UFFI . . . it (is) being used widely in many other countries including the United States."

If the reporter every decides to focus on that last sentence and explain why a "toxic" foam is only toxic in Canada, the reporter might have an award winning story and an easy one to tell.

According to CMHC, "UFFI is not a source of over-exposure to formaldehyde . . . Houses with UFFI show no higher formaldehyde levels than those without it."

So, are high levels of formaldehyde ever found in homes in Canada today? Not often but, again according to CMHC, "in new or other well-sealed houses, significant indoor formaldehyde levels may still occur (thanks to) new carpets." If the folk in the justice building are worried, maybe they should concentrate on new carpeting and not decades-old insulation.

Sunday, March 4, 2018

How not to report a story: The Current goes for false balance with negative overtones

Weight Watchers promotes healthy eating. The accent is not on weight loss.
The Current on CBC radio, featuring host Anna Maria Tremonti, recently claimed to be examining the offer of six weeks of free Weight Watchers memberships to teens between the ages of 13 and 17 this summer..

It was not much of an examination. To learn more, I googled the offer, but I failed to find the original announcement. It would have been nice if CBC had thought to post a link.

Weight Watchers apparently stated right up front that this offer was not about dieting and not about weight loss. No, Weight Watchers was offering to help teens develop the healthy eating habits so necessary at there time of life. And let's make one thing clear: today, this is very important. There is a serious problem with how our kids are learning to eat.

For the most part, the CBC and Anna Maria Tremonti ignored this very important and very believable claim by WW. I can understand why; there was a time that I, too, believed Weight Watchers was just a dieting program, a weight loss program.

Then, in 2010 I had a heart event that changed my life forever. I suffered a V-tach event, my heart went into overdrive hitting 300 beats per minute and I was rushed to the hospital. There, doctors placed defibrillator paddles on my chest and jolted my heart back into sinus rhythm. I now have an ICD/pacemaker in my chest. ICD stands for implantable cardioverter defibrillator. If my heart rate heads for the stratosphere again, and it has, my ICD shocks it back into its proper rhythm.

Roasted Madras Curry Cauliflower with Raita
I take oodles of meds and watch my diet carefully. At one point, I weighed almost 220 pounds. Not good. My doctors told me to get my weight down. Something under 170 pounds would be a fine goal.

My stroke doctor gave me a package of recipes and told me not to think of this not as a diet but as a whole new way of eating and quite possibly a better, more enjoyable, way of eating.

Coincidentally my wife was starting Weight Watchers at the same time. It was immediately clear that her diet and mine were quite similar. We embarked on the Weight Watchers approach to dining well together.

We counted points, don't ask, and slowly we lost weight. It took a lot of months, more than a year, but I got down to 165 pounds and I've stayed close to this weight ever since. And this success is, in no small measure, thanks to the Weight Watchers program. We didn't feel we had to cutback on our food but instead we expanded our food choices. We learned to eat wisely and well.

Following my doctors' and Weight Watchers instructions, we have discovered  a whole new way of eating, just as promised. I wish I'd been offered this program when I was a teen. I've always loved food and I find our new approach to dining is for food lovers.

So, how did CBC handle this story. Well, the broadcaster almost immediately cut to an interview with a holistic health coach, trained at the Institute for Integrative Nutrition. And what exactly is the IIN? I googled it and learned many call the online school a diploma mill.

The accusations must be awfully common as the IIN defends itself by stating clearly online that they are not a scam. They point out that much of the criticism of the school is of the strawman variety. Their health coach graduates are not registered dietitians and do not claim to be. A search of the U.S. Dep't of Education database confirms the IIN is telling the truth: its graduates are not registered dietitians.

There is a story here. The Weight Watchers offer deserves examination. That said, I don't find the debate, if not manufactured by the CBC, certainly promoted by it, to be the correct angle. Journalists can do better. I know. I worked for almost four decades in the media.

This is an important matter and our public broadcaster let us down. Just today I saw an article in The Harvard Gazette: a "comprehensive national strategy (is needed) across all relevant segments of society to prevent a looming public health disaster." This was written for Americans but the problem is also prevalent in Canada. In my lifetime, obesity among the young has increased two, possibly even three fold in Canada.

The CBC should have sent reporters to numerous Weight Watcher centres across the country. They could have learned whether or not a consistent approach is going to be taken by all WW leaders. As the Harvard article points out:

We have deep knowledge of the biological drivers of obesity, which include:

  • poor diet quality
  • excessive sedentary time
  • inadequate physical activity
  • stress
  • leep deprivation
  • perinatal factors
  • and probably environmental endocrine-disrupting chemicals

What is lacking is an effective strategy to address these drivers with sufficient intensity, consistency, and persistence, according to David Ludwig, professor in Department of Nutrition at Harvard T.H. Chan School of Public Health and founding director of the Optimal Weight for Life program at Boston Children’s Hospital.

CBC had a chance to be part of the solution; they chose to be part of the problem.

Monday, January 29, 2018

Fake News (Tweets) and CBC Ontario Morning

Donald Trump likes to call the mainstream media "fake news." He's wrong but that doesn't mean the MSM can ignore his charge. Those in the media must take those words to heart and attempt to never lend any credence to Trump's accusation.

Sadly, almost all of us have had a contact with the media that went poorly. I have often met folk who have told me that a story with which they were closely associated was reported incorrectly. They may have even talked directly to the reporter behind the story. By the time the reporter condensed the story to a sound bite for television or radio, or boiled the information down to an eight-inch story in the daily paper, the story was corrupted, changed, shaded with error.

Check out this tweet from CBC Ontario Morning:

It makes the claim that giving a child "a taste" or "even a sip" of alcohol is "not a good idea." It is important to note the shortness of this tweet. No attempt has been made to convey the complexities of the story.

This is a story that has been reported in the past and sometimes it has been reported very poorly. That said, let's cut right to the chase.

New Orleans magazine reported on this story. Allow me to quote a paragraph from that article.

“First sipping isn’t an early indicator of issues that would be of concern to parents,” wrote one of the psychologists in an August 2014 press release about an updated look at the same group of children. They showed that taking the first sip before age 12 correlated with a family’s permissiveness towards alcohol rather than predicting that a child was slated for abuse problems in young adulthood. There is no evidence that earlier sippers have more alcohol dependence, delinquent behavior, marijuana smoking, misuse of other illicit drugs, risky sexual behavior, car crashes or interruption of planned schooling than the late sippers."

If you want to stop reading now, you can. But, for those who want to read more, please, read on as I take a look at what some of the studies actually say:

For instance: adolescents who have consumed at least a full glass of alcohol or more are significantly different from adolescents who have simply had a sip of alcohol. And one might ask what the researchers define as a sip. But the important point is that adolescents benefiting from greater parental discipline, living with better rule enforcement and more comprehensive monitoring and enjoying positive family relations are less likely to have consumed a full glass of alcohol. 

And just how extensive is the problem of children consuming full glasses of wine, similar what is shown in the picture accompanying the tweet? According to the studies I found, it is not as extensive as we might expect. Many children consume no alcohol at all: almost 40% at 11 years of age have never tried alcohol and almost 60% have had only a sip or less. The little girl shown represents a little more than 2% of 11 year olds. If she is less than 11, she represents an even smaller proportion of children from her age group. Perhaps we should pity the little girl pictured. She appears to need improved parental monitoring. Going by the studies that I have found, there is a good chance her parents are not even aware she is engaging in a toast.

Screen grab: story discusses taking an early sip of alcohol.
So, if sipping, and only sipping, has not been implicated in future dangerous behaviour, why are we even discussing sipping. The answer is simple: the children who have had only a sip of alcohol and those who have had a full glass or more, have been combined in some reports into a single category. The whole issue has been muddied.

It appears there may be only one study explicitly investigating sipping of wine and beer in early adolesecence and that is Children’s Introduction to Alcohol Use: Sips and Tastes. And what was the conclusion of this study?

A young child’s sipping/tasting of alcohol . . . appears NOT to be an early indicator of the likelihood of future problem behavior.

It actually appears that parents are doing a fine job of keep alcohol away from their kids. There may well be no problem here. Most children only get to sip alcohol but once or twice, implying that this was opportunistic behavior rather than an attempt by parents to introduce their children’s to alcohol use. It may not be the sip that is the problem but the parental attitude.

Bolstering this interpretation is this fact: fully a third of the mothers and over half of the fathers did not even know that their child had ever had a sip or a taste of alcohol. Most sippers either sneaked their solitary sip when their parents were not watching or were given the single sip on the sly by someone such as an older brother or sister.

The public deserves better than this tweet. Our media must take advantage of every one of the 280 characters Twitter tweets offer. Teenage abuse of alcohol is a problem. The link between a young child having had a taste or a sip and having problems as a teen with alcohol is a link that researchers are still disputing.

Lastly, here is a link to the Lancet article that has been causing the recent stir. Association of parental supply of alcohol with adolescent drinking, alcohol-related harms, and alcohol use disorder symptoms: a prospective cohort study.

The Lancet article has a lot of negative things to say about parents supplying drinks to their children and this should come as no surprise. What is interesting is that the article reports under "Findings":

"Parental supply of alcohol was not significantly associated with the odds of reporting symptoms of either alcohol abuse or dependence, compared with no supply from any source."

I have to admit, I found the above statement out of place in the context of the Lancet article considered in its entirety. Putting all the info together is the job of the media, the job of the journalist. Sadly, all too often, the media handles complexity very poorly. (I would guess that Ontario Morning did not spend a number of days, possibly weeks, putting together their take on the research into underage drinking. It's an interesting story and I bet that it was sent to air as quickly as possible.)

Maybe in a future broadcast, Ontario Morning can investigate the role of the media in underage drinking. Yes, in researching this post I came across research claiming the depiction of alcohol in movies, on television and in social media can be linked to early alcohol abuse. This sounds like a great scare story. 

I can see the tweet now: "Let your child watch CBC dramas? We reveal why this is not a good idea, not even a glimpse. Research shows it could lead to alcohol abuse."

The above is a screen grab from the Huffington Post, Australian Edition.