Are anticoagulants underused in Ontario?

In writing the following post, I came upon the paper How Can We Avoid a Stroke Crisis in Europe? If you do nothing more, read this paper. You found my blog because you were searching for information on anticoagulants, heart rhythm problems and risk of stroke. Read the linked paper. You may find it answers many of your questions.

When done, if you want to know more, read the rest of my post. There are also more links of interest.

Cheers,
Rockinon -- a patient with ongoing heart problems
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Are anticoagulants underused in Ontario? This is the question I asked myself upon learning that a friend in constant heart flutter was not taking an anticoagulant to lessen his chances of suffering a debilitating stroke.

I found an article in The American Journal of Medicine looking at this very question. I learned there are clear guidelines for managing atrial fibrillation and atrial flutter with recommendations for anticoagulation based on a patient's overall stroke risk. I also learned that the guidelines are not always being followed.

In a study of more than 170,000 patients in the States, less than 50% of high-risk patients were given anticoagulant therapy. The study concluded that the anticoagulation guidelines are not being routinely followed in clinical practice. The study did not conclude this was resulting in harm to untreated patients but decided another study, one looking at treatment outcomes, was warranted.

I can understand doctors being hesitant to immediately give anticoagulants to all patients with high CHADS₂ scores. Although I am now taking an anticoagulant daily, it was a tough call for my doctors.

I have microbleeding in the brain, discovered during an MRI scan. For a very good discussion of the significance of cerebral microbleeds read the article Cerebral microbleeds: a new dilemma in stroke medicine posted in the Journal of the Royal Society of Medicine. In my case, as in all cases, doctors must weight the risks vs. the benefits of various treatments. All too often the answer is a trade-off.

Clearly, a slightly elevated CHADS₂ score is not always enough to convince doctors anticoagulants are the best response. They see the risk/benefit ratio as not favouring the immediate use of a blood thinner (an inaccurate name for anticoagulants.) I don't envy doctors. They find themselves forced to choose between a rock and a hard place every day.

So, should more Ontario patients be on anticoagulants to protect them against stroke? It is hard to say for certain but the answer may well be yes. The Canadian doctors, like their American counterparts, may be too conservative, too timid. In steering their patients down a path that avoids the complications resulting from the use of blood thinners, their patients may be on the road to a stroke.

If you have a heart arrhythmia and are not on a blood thinner, you should ask your doctor why not. There may be good reasons for not giving you anticoagulant therapy but you should know what they are. To get a handle on your risk of a stroke, here is a link to a CHA₂DS₂-VASc Score calculator.

To better understand your risk of bleeding, here is a link to a HAS-BLED calculator. Taken together these two calculators point to the difficult decisions forced upon your doctor.

Lastly, not all abnormal heart rhythms are created equal. All arrhythmias do not result in equal risk of stroke. And atrial flutter, when occurring alone, does not carry the same increased risk of stroke as atrial fibrillation. That said, atrial flutter is often accompanied by periods of atrial fibrillation.

So, should my friend be taking an anticoagulant to lessen his risk of stroke? Maybe. He was on a blood thinner but stopped taking his medication on his own. Possibly his doctor senses his patient's fears and this tips the scales against recommending anticoagulants in the doctor's mind.

But atrial flutter is not benign. It is associated with an increase in overall mortality. According to a  posting on Patient.co.uk, persistent atrial flutter when left untreated can become chronic atrial fibrillation (AF). Even after treatment, I had my atrial flutter eradicated by undergoing an ablation procedure, I continue to take the powerful arrhythmia fighting drug sotalol to help insure my flutter does not return. I also continue to take Pradaxa, a blood thinner, twice a day.

Lastly, I wonder if the perceived dramatic increase in cost of anticoagulant therapy in recent years has influenced doctors, especially in the States. The old drug of choice, coumadin, is relatively inexpensive and safe. Unfortunately, it is also a fair amount of trouble. Regular blood work is necessary to insure the dosage is effective. The bothersome constant need for monitoring is one reason many patients quietly stop taking coumadin without consulting their doctors.

Newer drugs, like Pradaxa (dabigatran), cost more but do not require the expensive regular blood work. Some studies, such as one in Denmark, have found treatment with dabigatran only costs about 10% more than coumadin, with the increased cost of the medication the main driver of the added Pradaxa expense. I take Pradaxa to protect me against stroke while minimizing my chances of suffering a cranial bleed.

Minimizing the occurrence of strokes is a win-win situation. Both patients and society benefit from anticoagulant therapy in high-risk AF populations. A French study found the mean cost of a severe stroke was €34,809, and the risk of a severe stroke is what accompanies AF. The mean cost of a mild stroke in the study was €10,530. Clearly, dabigatran saves society money by preventing severe strokes in AF patients.

So, why do doctors shy away from prescribing blood thinners when the cost is not exorbitant and the benefits appear to be clear? One study pointed to a misplaced fear of bleeding, especially cranial bleeding. The fear of bleeding seems to trump the fear of stroke among medical professionals.

And so, in seeking treatment for heart rhythm problems there is one risk that is often overlooked: The risk that one's doctor has a personal aversion, an unsubstantiated fear, of the side-effects of the what should be one of the drugs of choice -- an anticoagulant.

NASA claims no ties to research paper

National Post: Tuesday, March 18, 2014

It was quite the story: A NASA-funded study predicted the end of the civilized world as we know it. The controversial report calculated that our global civilization is headed for annihilation. The sky may not be falling now but come back in a few decades and bring a hard hat.

The Independent: Sun., Mar. 3, 2014

The story, published by The Independent and The Guardian in Britain, was picked up by The Huffington Post and immediately went viral. The story was repeated by media outlets around the world. Even NASA entered the fray with a comment. This was not unexpected as scores of media outlets around the globe reported on the NASA-funded and oh-so-damning report.

Did the NASA statement contain any surprises? In a word, yes. For one thing, NASA called the media reports "erroneous." The soon-to-be released study "was not solicited, directed or reviewed by NASA. It is an independent study . . . ," NASA claimed.

NASA was in damage-control mode, distancing itself from the story. A Google search found a link to the scholarly paper. The authors write, "This work was partially funded through NASA/GSFC grant NNX12AD03A."

The National Socio-Environmental Synthesis Center (SESYNC), one of the sponsors of the paper, reports:

" [Safa] Motesharrei [one of the authors of the paper] received minor support from NASA to develop a coupled earth system model. Some of this funding was spent on the mathematical development of the HANDY model."

The paper is not only connected to NASA by some minor funding, one of the report's authors, Eugenia Kalnay, was branch head at NASA Goddard Space Flight Center prior to heading off to the University of Maryland.

The media reports may have overstated the NASA connection but the NASA press release underplays the connection the space agency has to this University of Maryland paper. The respected-research-patina conveyed by an association with NASA is certainly there. The reason for NASA's backpedaling is clear.

The study in question found that the ongoing economic stratification of society -- think of the one percenters and the rich-get-richer world endorsed by right wing capitalist Kevin O'Leary on CBC -- makes the collapse of civilization almost unavoidable. Major policy changes to reduce inequality are desperately needed, according to the authors.

I find one of the most interesting features about this story is not how far and fast it spread but the limits to growth it encountered. Even the Club of Rome might find this interesting. I could find no evidence that Sun Media, Canada's right wing newspaper chain, featured the story at all.

Does U.S. educated reporter hate Canadian health care system?

The headline screams "Crohn's research at Robarts hits world stage." Is the headline true? Yes. Is it the whole story? Not by a long shot.

Dr. Brian Feagan is the director of Robarts Clinical Trials at the Robarts Research Institute in London, Ontario. Last year Feagan was among those awarded the 2013 Scientific Achievement Award by the Crohn’s & Colitis Foundation of America (CCFA). Feagan has long been known for, as they say, pushing the needle forward in the quest for cures to these diseases.

The man is amazing. A quick Google search shows he has been at the forefront of inflammatory bowel disease research since late in the last century at least. His latest work is, not surprisingly, a continuation and a validation of research which has attracted global interest for years. He is a longtime player on the world health care stage.

Londoners should be proud of medical scientists like Feagan and proud of the work being done at the Robarts Research Institute. Researchers like Feagan and their studies are among the reasons I have the institute on my short list for an annual charitable donation. Because of the work done there, I am increasing my donation this year.

If you have been reading the series of articles run by The London Free Press and carried by Sun Media across the chain, you would think that Canadians are receiving second rate health care when compared to what is available south of the border in the States. The story tells readers "many provinces won't pay" for an aggressive approach for treating Crohn's disease.

A quick Google search turned up this online post by a woman in Salt Lake City, Utah:

In November, my new gastroenterologist . . . started me on Humira. It's a biological medication to decrease inflammation that has been successful to treat some people's Crohn's disease. . . .

The insurance denied the claim when the the pharmacy tried to get payment, because after a couple of refills at a local pharmacy, it's only covered when it comes from a "specialty pharmacy," called Acredo. After three hours either talking with people at Acredo, the specialty pharmacy, or having my doctor's office or the University pharmacy techs talk with people at Acredo and the insurance company, I left without the medication.

The patient ended her tirade saying, "Sigh. I wish private enterprise wouldn't get between patients and treatment"

Yes, some provinces resist paying for aggressive and expensive treatments for Crohn's disease as the first line approach -- but so do many private insurance plans around the globe. These are often plans that the patients thought were excellent until they were denied coverage for a drug like Humira.

I will leave the last word to Beth, the lady with Crohn's disease that I quoted out of Salt Lake City.

"I shouldn't be surprised [at the denial of coverage], since Anthem Blue Cross is beholden to stockholders before patients. Private business, in my opinion, is NOT always the best way to get things done, especially when it comes to health issues."

The Free Press article wasn't wrong. It wasn't error filled. But it wasn't balanced either.

Where are the editors?

The Globe and Mail needs to hire some editors. They are running way too thin. A recent story was trying to be hip and cool by making reference to "Llewyn Davis, the vagrant folk singer imagined by the Cohen brothers, who opened a show for Elvis Presley."

The problem is that the movie making brothers are the Coens. No 'h'. And the movie, Inside Llewyn Davis, shows Davis appearing on stage immediately before Bob Dylan. Not Elvis Presley.

It just makes one want to scream: "Aaauuugghh!"

When the James Bond film franchise hit the 50-year mark, Heather Hiscox on CBC went on and on about her favourite Bond film, Goldfinger, in which Bond stops Auric Goldfinger from stealing gold stored in Fort Knox. She goes on and on about the amazing planned theft. Trouble is Goldfinger never planned to steal the gold. Too bulky. Too heavy. He was going to explode a dirty bomb in Fort Knox. This would contaminate the gold and leave it worthless.

When newspapers and high-paid news anchors cannot get facts right, facts so easily checked, how are we to be certain  they are getting their facts right about a situation like the one unfolding in Ukraine.

That's Ukraine and not the Ukraine. When I worked at The London Free Press an editor put me straight.

What the world can learn from India concerning health care

Today I read an interesting article in the Harvard Business Review on what is being done right in India when it comes to keeping health care costs in check. It makes an interesting counterpoint to the stories being run by the local paper. The London Free Press seems to have hate on for the Canadian single-payer health care system. The writers at the paper deliver criticism in spades, not that our system doesn't at times deserve it, but the paper fails to offer many detailed solutions.

If you are interested in the rising cost of health care,  read: India's Secret to Low-Cost Health Care. The article makes a number of interesting claims, but two that really stood out are:

1. The health care available in Indian hospitals is cheaper even when you adjust for wages: For example, even if Indian heart hospitals paid their doctors and staff U.S.-level salaries, their costs for open-heart surgery would still be one-fifth of those in the U.S.
2. When it comes to innovations in health care delivery, these Indian hospitals have surpassed the efforts of other top institutions around the world.

Plus ça change, plus c'est la même chose.

The idea that "the more things change, the more they stay the same" is a common one around the world. No doubt because it's true.

The late Horace Judson was a famous and well respected journalist. His most famous book was Eighth Day of Creation, a history of molecular biology. Published way back in 1996, I believe this book is still in print. Of course, the fact that his daughter Olivia Judson is the well known evolutionary biologist and popular writer also keeps his name current.

While reading a review of Horace Judson's book on heroin addiction, published in 1974, I was struck by how little the world has moved forward in the intervening forty years.

The reviewer, Gerald McLaughlin, Associate Professor of Law at Fordham University School of Law, wrote:

Apart from government moneys being spent on drug law enforcement, apart from the countless government research grants given academics every year, entire industries have begun to grow up around the drug cure business - methadone clinics staffed by private physicians have become booming business, drug analysis and urinalysis centers have sprung up to serve their needs, and private drug research firms have been created. Like the fabled "military-industrial" complex of the Eisenhower years, a "drug abuse-industrial complex" has been created. Once created, it is hard to dismantle. To put it another way, with so much money at stake, there is an incentive not to let the problem die or at least there is an incentive to push for one's own special treatment modality. The law enforcers want to keep their funds, so they push for new law enforcement programs to end the heroin traffic; the methadone maintenance advocates push for more money for more centres; sociologists and psychologists request further grants to test this or that theory of addiction. Quite often some of these diverse elements or the "drug abuse-industrial complex" lobby against new alternatives simply to prevent money from being siphoned off to fund new programs or approaches. Fiscal preservation is an age-old vice of man.

Of course, some things do change. I must add that in the years following the publication of Judson's book, Heroin Addiction in Britain - What Americans can learn from the English experience, the British government turned more and more towards the American model. The Brits even appointed a drug czar in 1998. 

The changes failed.

Kalydeco: What is the whole story?

The other night I caught a little foreign film in which the woman protagonist was one difficult lady to love. She had a young niece who was also damn difficult. Thrown into the mix was a boyfriend who had his own little, and so little, quirks. The movie ended on an upbeat note but with such a convoluted story it was difficult to know how all would play out in the end.

Sun Media is using the story to attack Ontario Liberals.

Now take the news. Everyday we read, hear and watch stories reported in the media. They are usually good tales with strong, neat story lines. Maybe too neat. I often have the feeling there is more to these stories than we are being told. Life is depicted by the media more as bad fiction than rich reality.

Take the story of the young Ontario girl taking the very expensive Kalydeco (ivacaftor) to treat a rare form of cystic fibrosis (CF). Sun Media reports it costs $348,000 annually in Canada for this unique drug. This is completely out of the financial reach of most people. At this point, the Ontario government is refusing to assist this young girl and her family as they struggle to cope with this massive expense.

The government has stated that it would like to help and to this end it and a number of other Canadian provinces are in negotiations with Vertex, the maker of the drug. At this point, the company and the provincial drug consortium in Ontario are at loggerheads over the price of the drug which is perceived by many to be outrageously expensive.

The kicker in this is that the genetic variation of CF the drug treats is rare. It is so rare that only about 20 people in the province would be helped by taking Kalydeco. The entire cost to the province would be less than $8 million.

Read the story at news.com.au.

What has the mainstream media left unsaid? Well to start, it is not just bureaucrats in Ontario balking when confronting the high cost of the Vertex drug. Health care bureaucrats around the world have choked when confronting the high cost.

A story similar to the one being played out in Ontario made headlines across Australia. Ellie Haikalis has the type of cystic fibrosis controlled by Kalydeco. Unfortunately, her family cannot afford the treatment and the Australian government refused to assist them.

Her mother, Rachelle, told the media  she and her husband had discussed selling their home but realized that even taking that drastic action would not raise the money demanded by the drug maker.

Almost thirty concerned American doctors banned together to pen a letter to Vertex. They wrote:

It is at best unseemly for Vertex to charge our patient's insurance plans (including strapped state medical assistance plans), $294,000 annually for two pills a day . . . This action could appear to be leveraging pain and suffering into huge financial gain for speculators, some of whom were your top executives who reportedly made millions of dollars in a single day (Boston Globe, May 29).

The dispute over the cost of Kalydeco is just one skirmish in a larger, ongoing war being fought in numerous countries scattered across the globe. But the Kalydeco story on its own is a good one. Many see the price charged for this drug as "unconscionable."

Read the fine Milwaukee-Wisconsin Journal Sentinel story.

A story in Medpage Today, Cystic Fibrosis: Charity and Industry Partner for Profit, points out Vertex developed ivacaftor (Kalydeco) "with the help of a $75 million investment from the Cystic Fibrosis Foundation -- as well as a hefty investment from taxpayers through grants from the National Institute of Health which underwrote the cost of early research."

It isn't just Yanks who have some skin in this game. There are Canadians at the table too, such as Lap-Chee Tsui and John R. Riordan of the Hospital for Sick Children in Toronto. The two research scientists, along with Francis Collins of the University of Michigan, led a team isolating the gene responsible for cystic fibrosis. Medical breakthroughs do not occur in a research vacuum.

On the upside, the drug cost isn't out of sight for everyone. Ian Smith, Vertex executive vice president and chief financial officer, exercised stock options to gross more than $60 million in one day, according to the Milwaukee-Wisconsin Journal Sentinel.

If Smith had the type of CF in question, he could live to be a hundred and never experience any difficulty in paying for his supply of Kalydeco thanks to his after tax profits from just that one day.

Of course, Smith does not have CF. The millionaire has no reason to worry. He can breath easy.

Comparing apples to oranges

Jonathan Sher, a Sun Media investigative reporter working for the chain's London, Ontario, newspaper has filed another story in a series examining health care in Ontario: Health ministry data on hospital overcrowding riddled with errors. From the tone of Sher's past articles and the frequent positive references he has made to the American health care system, one might surmise Sher is no fan of Canadian single-payer health care.

Sher, who may have been born an American citizen, is one bright fellow. After graduating from the University of Virginia with a B.A in history and foreign affairs he went on to earn his Doctor of Law from the University of Southern California in 1992. It has been reported he is a member of the New York State bar association. With his strong background in law, Sher knows how to build a strong argument.

I believe it is safe to say that when Sher slides an apples and oranges comparison into a story he does so knowing full well what he is doing.

Sher tells Sun Media readers:

Ontario has 2.4 hospital beds for every 1,000 residents, less than half the European average. Of 39 countries compared by the Organization for Economic Co-operation and Development, only three had fewer hospital beds: Mexico, India and Indonesia. 

This is not the first time that Sher has compared a Canadian province with the entire continent of Europe. He goes on to compare Ontario with 39 countries in an Organization for Economic Co-operation and Development list. I addressed this debating trick in an earlier post: Hospitals too full to be safe? Not in London, Ontario.

As I wrote in the earlier post:

Let's try comparing apples to apples: countries to countries. According to the most recent numbers released by The World Bank, Canada has 3.2 beds per 1000 people. Both The United States and Britain have a smidgen less at 3.0 beds per 1000. Sweden fared even worse with only 2.7 beds.

According to the newspaper article, Ontario has only 2.4 hospital beds per 1000. It sounds bad and it is bad but Ontario cannot lay claim to the worst numbers on the continent. For lower numbers look south. Ontario has more beds than almost 40% of the American states according to The Henry J. Kaiser Family Foundation. Oregon only has 1.8 beds per 1000 and California, Hawaii and Vermont have numbers that are little better.

Kudos to Sher for discovering that the overcrowding data compiled by the province had serious errors. Good work. (Here is a second link to the story.)

Overcrowding of hospitals is a serious global problem and not unique to Ontario. Many industrialized countries do attempt to keep occupancy rates at or below 85 percent, just as Sher claims. And many, many hospitals throughout the industrialized world fail at the attempt.

Cuts hammering journalists

The headline warns "Cuts hammering elderly." Oddly, the online picture accompanying the story shows a happy senior being patiently spoon-fed by a caring health care worker.

The image is jarringly inappropriate and, no surprise, it is phony. It is a staged, stock photo image — stock photos are cheap but they are not journalism. I'd say cuts are hammering journalists, too.

Recently I briefly traded tweets with a local reporter who was offended when I called the balance in one of his stories "faux."

I not only stand by my previous comments but I'd like to expand upon them. The media in general, it is not just the local paper, all too often seem to believe that a story is not complete until it is balanced. They believe this until the cost of balance, either in time or money, is deemed too high.

Which brings us to today's article. My guess is the journalist was instructed to write a story on the report "Pushed Out of Hospital, Abandoned at Home" released by the Ontario Association of Speech-language Pathologists and Audiologists (OSLA) and the Ontario Council of Hospital Unions (OCHU).

Before continuing, I want to make one thing clear: I am not claiming the report is error-filled. I am simply saying that a story as inflammatory as this one demands context, demands balance. How does what is happening in Ontario compare to what is taking place outside the province? Are these local problems or are they endemic in the health care approach embraced in a multitude of places?

For instance, the report by the unionized hospital workers and some therapists tells us "one in six patients has an unplanned readmission within 30 days." My response is to ask, "How does this compare to the readmission rate for seniors in other localities?"

A little searching discovers a report, The Revolving Door, on readmissions in the United States. This American report tells us:

The U.S. health care system suffers from a chronic malady — the revolving door syndrome at its hospitals. It is so bad that the federal government says one in five elderly patients is back in the hospital within 30 days of leaving.

Where this all gets interesting is newspaper report places the blame on underfunding. The answer from the union et al. is simple: Throw money at the problem. But the U.S. report puts the blame on its badly fragmented health care system. According to the American report, if patients get the right care the first time many return trips are prevented. Done properly, this costs less money, much less money, not more.

According to The Revolving Door report out of the U.S.:

The [U.S.] federal government has pegged the cost of readmissions for Medicare patients alone at $26 billion annually, and says more than $17 billion of it pays for return trips that need not happen if patients get the right care. This is one reason the Centers for Medicare & Medicaid Services has identified avoidable readmissions as one of the leading problems facing the U.S. health care system and now penalizes hospitals with high rates of readmissions for their heart failure, heart attack, and pneumonia patients.

As a senior, in what I hope is just the early stages of congestive heart failure, I read the news report with great personal interest but I was left with more questions than answers. I know the reporter who wrote The Free Press piece and I am sure that that reporter was also left with lots of unanswered questions. Sadly, neither the reporter's questions nor mine will be answered. I blame cutbacks, newsroom cutbacks.

Take the congestive heart failure example. I keep returning to CHF because the news story told of a patient with CHF who was sent home after being taken to ER. As there isn't enough information in the newspaper concerning this incident, I read the report itself.

It seems the gentleman in question was 89 at the time he was admitted to the ER suffering from pulmonary edema. The doctor in ER immediately gave the gentleman Ventolin. This is widely accepted as a good first response. The ER doctor then wanted to send the gentleman home but his daughter fought this decision.

In the end she was successful at having her dad admitted to the ICU and given morphine. Morphine is a traditional drug for dealing with pulmonary edema but is falling our of favour. According to University Hospital, Cleveland, morphine is no longer indicated to treat pulmonary edema.

The daughter was happy with the morphine but upset about the Ventolin. I don't believe the daughter is a doctor. I'm not sure how much weight to give to either the daughter's praise or to her criticism of her father's care.

Survival times for those 80 years or older are often measured in months rather than years. The gentleman in question lived to be 94. Clearly, something was being done right for this senior. Cuts did not seem to be hammering his man, at least not until he hit 94. The fellow died after undergoing an gastroscopy during which the doctor apparently perforated his esophagus. He died from an actual medical cut.

A link to: Le Monde diplomatique

“If you don’t give the people social reform, they will give you social revolution,” Quintin Hogg, a leading light in the Tory party, told the British parliament in 1943.

I read the above in Le Monde diplomatique in a piece by Benjamin Selwyn discussing what he calls "development by the elite for the elite." I can't say I agree whole heartedly with Selwyn but his views counter the capitalist-apologist arguments I often see published in my local paper, The London Free Press.

If interested, here's a link to: The Working Class Does The Job. 

Follow the above link if you agree that the world’s workers should be paid what they are worth and  countries left to develop free of condescending international meddling.

Capitalism: The best system?

I posted this some time ago. Recent business closures in London, and the responses claiming capitalism is still the best system bar none, have made its reposting appropriate.
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"Even Paul McCartney has admitted capitalism is the best system. And he was a big pinko back in the day." [source: Dan Brown of The London Free Press]

I groaned when I read Brown's claims and then I thought this could be a blog post — and it is.

Paul McCartney caused a stir in 1972 with his song "Give Ireland Back to the Irish." The song was banned on the BBC. I'm old enough to recall all sorts of silly stuff being said about the Beatles when they were at their peak, but I don't think Paul McCartney was ever a communist — but that's just my opinion. Go google this and get back to me. I did, and failed to find a solid connection.

But, I don't think McCartney's politics are really relevant. You might say this talk of his being a pinko is a bit of a red herring. The statement in which we're really interested is: "Capitalism is the best system." True or false?

This is a hard one to answer, especially for someone who is not an economist. I'll attempt answer, of sorts, but I'm going to come at the answer sideways. I'm not looking to get deep into an economic or political argument.

My first thought is that when I was young I would have agreed rather quickly with the statement. But with the passing of sixty some years I've changed and it is has not only me that has changed but capitalism. Capitalism today is not the capitalism of my childhood.

I believe the boosters of capitalism would say this is a strength of the capitalist system. It adapts to meet the demands of the day. This sounds good on the surface but what does that mean in reality? Have the changes I have experienced during the passing of some six some decades made capitalism better? If not, maybe the best system was some version of capitalism now adapted out of existence.

My grandfather was born on a farm in Princeton, Ontario. He was an outstanding student and I understand that at his graduation it was said he was the youngest pharmacist in the province of Ontario. It's hard to prove the truth of this statement as he graduated back in the early 1890s. Let's just agree that he was one very bright young man.

On graduation, he went to the States to work for Cunningham Drug Stores. This was an up and coming chain. My grandfather had a chance to get in on the ground floor, make big bucks, but he declined.

He moved back to Canada, to Brantford, Ontario, where he started his own independent neighbourhood drugstore. He didn't get rich but he did have a beautiful wife and he raised a fine family. He never owned a car; he didn't need one as he walked to work. He lived in the type of walkable neighbourhood that is today thought so desirable. It was a different world.

Today, a young man graduating as a pharmacist would have a difficult time starting his own independent corner drugstore. The large chains pretty well control everything in the pharmacy business.

The Cunningham's Drug Store chain, the one my grandfather snubbed, went on to become one of the major players in the American Midwest but a few decades ago it was taken out by another player in the capitalist game. A lot of people lost their jobs.

When I was a boy, my neighbourhood had a least three independent drugstores. Each one employed people in the neighbourhood while providing an important service. There were no big parking lots at any of these stores as big parking lots weren't necessary. Most people walked to these drugstores — even the staff.

I worked for one of those drugstores. It became one of the first Big V pharmacies. Big V was formed by a small group of independent Windsor, Ontario, pharmacists intent on saving the neighbourhood drugstore. A few years ago Big V was taken over by the giant Shoppers Drug Mart chain. In 2013 Shoppers was bought by Loblaws in a deal worth about $12.4B.

Capitalism, the best system? I'm not sure that my grandfather would recognize today's capitalism. And I honestly believe that he would tell you the system under which he started his business, a business that lasted him a lifetime, was better.

Found a neat site featuring documentary films

While searching for something I would have thought was quite unconnected, I discovered a site called Top Documentary Films. I would tell you more but, other than the fact that the posted documentaries are free, I know very little about the site or the videos posted there.

After I have viewed some of the videos, I may reopen this post and add some more information.

Cheers.

Check it out,
Top Documentary Films

For lovers of French

As readers of this blog will know, I've been trying to learn French. Why? One, because I like the language, two because I find TV5, the French television network available on cable, is an excellent source of both movies and documentaries and three because my granddaughter is attending French public school. I wish to support the little girl in her effort to learn another language.

When it comes to reading French, I do fairly well. I often watch French movies and catch the gist of what is being said by turning on the French subtitles for the hearing impaired. Unfortunately, a lot of the newscasts are not subtitled.

What has me truly stymied is understanding spoken French. The words seem to fly by, merging together. To get past this hearing boondoggle, I have been listening to French songs and other sources of spoken French.

For my own education, I have posted a video of the French song Tu Trouveras sung by Natasha St. Pier. I have also posted the lyrics both in French and translated into English with links to the source on the Web. (I would appreciate any suggestions on improving the translations.)

If interested, listen to the song, check out the vocabulary and then take the test posted on Quizlet. Bonne chance! (Good luck!)




Lyrics to Tu Trouveras:                                         Lyrics to You Will Find:

Comme tout le monde j'ai mes défauts                  Like everybody I have my faults
J'ai pas toujours les mots qu'il faut                        I don't always have the right words
Mais si tu lis entre les lignes                                 But if you read between the lines
Tu trouveras dans mes chansons                           You will find in my songs
Tout c'que je n'ai pas su te dire                             All that I don't know how to say to you

Il y a des fautes d'impression                                There are wrong impressions
Des "Je t'aime" un peu brouillon                             Some "I love you's" a little muddle-headed
Malgré mes accords malhabiles                              Inspite of my clumsy chords
Tu trouveras dans mes chansons                            You will find in my songs
Tout ce que je n'ai pas osé te dire                          All that I haven't dared to tell you

{Refrain:}
Tu trouveras . . .                                                  You will find . . .
Mes blessures et mes faiblesses                             My wounds and my weaknesses
Celles que j'n'avoue qu'à demi-mot                        Those that I only say in a low voice
Mes faux pas mes maladresses                              My slip-ups, my blunders
Et de l'amour plus qu'il n'en faut                             And more love than is necessary
J'ai tellement peur que tu me laisses                      I'm so afraid that you are leaving me
Sache que si j'en fais toujours trop                        Know that if I'm always trying too hard
C'est pour qu'un peu tu me restes                          It's to make you stay with me a little
                                                                               longer
Tu me restes                                                          You stay with me.

Il y en a d'autres que tu aimeras                              There will be some others you will love
Bien plus belles, plus fortes que moi                        More beautiful, much stronger than me

[Je leur laisserai bien sûr la place                            Of course I'll give them my place       
Quand je n'aurai plus dans mes chansons                 When I don't have in my songs
Plus rien à te dire en face                                        Anything else to say in front of you
Le temps vous endurcit de tout                                Time makes you stronger
Des illusions, des mauvais coups]                             From illusions, from hard blows

Si je n'ai pas su te retenir                                        If I didn't known how to retain you
Sache qu'il y a dans mes chansons                            I want you to know that in my songs
Tout c'que je n'ai pas eu le temps de te dire             Is everything I didn't have time to tell
                                                                                 you

Le temps vous endurcit de tout                               Time makes you strong
Des illusions, des mauvais coups                             From illusions, from bad beats
Si je n'ai pas su te retenir                                        If I wasn't able to make you stay
Sache qu'il y a dans mes chansons                           I want you to know that in my songs
Tout c'que je n'ai pas eu le temps de te dire             Is all I didn't have the time to tell you

{au Refrain: x3}
Tu trouveras . . .                                                  You will find . . .
Mes blessures et mes faiblesses                            My wounds and my weaknesses
Celles que j'n'avoue qu'à demi-mot                        Those that I only say in a low voice
Mes faux pas mes maladresses                                My slip-ups, my blunders
Et de l'amour plus qu'il n'en faut                            And more love than is necessary
J'ai tellement peur que tu me laisses                     I'm so afraid that you are leaving me
Sache que si j'en fais toujours trop                       Know that if I'm always trying too hard
C'est pour qu'un peu tu me restes                         It's to make you stay with me a little
                                                                              longer
Tu me restes                                                        You stay with me.

[ These are Tu Trouveras lyrics on http://www.lyricsmania.com/ ]

The fable of the plant closure

Once upon a time there was a little widget factory operating in a not-so-little town. The factory made good widgets, not great ones, but they were good quality and the price was right. The business flourished.

The widget factory owner, his wife and all his children flourished. All the widget makers at his widget factory flourished. The little town, which had lots of little factories like this one, flourished. All was good.

Then one day the widget making factory owner was approached by a beautiful temptress. The factory owner fell for her charms and tumbled into bed with her. He had an affair. His wife discovered and she left him. What she didn't leave was her half ownership in the widget factory.

The factory owner had to face the shocking reality that he wasn't the sole owner. He and his estranged wife were co-owners. What was he to do?

The factory owner hired good lawyers -- good for him, bad for his wife. It was soon learned that in another city in a country not all that far, far away there was another widget maker. A greedy widget maker who grew his business by buying other widget factories that, for whatever reason, could be bought for a song.

The big widget maker was known as Mr. Acquisition because he had grown his business into one of the biggest in the entire world by buying one after another competing businesses. He had acquired dozens and dozens and dozens of both small and large widget-making plants.

The little widget factory operating in a not-so-little town was sold to Mr. Acquisition. The money paid was split between the divorcing couple. The husband opened another widget factory, a smaller one, and named it Widget Factory Two. The lawyers fashioned all this so that the cheating husband was able, as they say, to stick it to his wife one last time.

As for Widget Factory One, the little factory operating in a not-so-little town, well Mr. Acquisition continued on his buying spree until his business got too big and too complex. His prices were too high and his quality too low. The value of his company crashed. Mr. Acquisition was forced to close Widget Factory One.

Mr. Acquisition had taken a lot of his profit in shares in his once ever expanding business. This meant that as the share value of his Big Widget Company collapsed he lost millions. He began closing plants all over the world. His grossly inflated business had burst like an overfilled balloon. Workers and shareholders around the world were left, as they say, high and dry.

Mr. Acquisition, in trouble financially, was himself acquired -- or at least what remained of his widget business. But don't worry about Mr. Acquisition. The new owner gave the former owner a handsome golden parachute worth many millions of dollars. As you can tell, it wasn't really a parachute but it was handsome and it was golden and, as they say, two out of three ain't bad.

_____________________________________________________

This little fable was inspired by stories still being played out in the real world.

There's nothing here. It's just scribbling.

Rainbow by Fiona.

I have been amazed at the art done by granddaughter now four. I really like some of the stuff she has done. But others in the family have not been so kind. I have been mocked for my open enthusiasm. "It's is not art, Ken," I've been told.

The other day Fiona saw a water colour by another young child. Fiona looked at the painting on a large sheet of paper and she shook her head. "There's nothing here," she said. "It's just scribbling."

I shook my head in disbelief.

Hospitals too full to be safe? Not in London, Ontario.

The front page headline warned: " Hospitals too full to be safe." A follow up online story delivered the second punch to the gut: Overloaded wards likely contributing to spread of dangerous superbugs, says head of infection control for London hospitals. On reading the story I was surprised to learn infection rates have not been on the rise generally in London hospitals and in some cases rates have actually declined. A concerted effort at infection control led by Dr. Michael John is credited for the surprisingly good numbers.

Maybe it's just me and my personal bias when it comes to London hospitals and health care in Canada but I thought the newspaper missed the story. Many experts believe hospital acquired infections (HAI) increase when bed occupancy rates climb above 85 percent. Rates in London have surpassed 100 percent at times, and yet there has not been a corresponding increase in HAI rates.

Dr. John revealed to the paper that "beds have been fitted with hygienic liners that can be disposed, new disinfectants kill spores and patients who can’t be isolated are given separate commodes." Chalk up a win for Dr. John and the health care staff in London.

For some reason, the reporter seemed intent on focusing on the shortage of hospital beds. By comparing the number of hospital beds per thousand in Ontario to the average number available in Europe, a huge mix of countries, the reporter made the shortage seem even more dire: A classic "comparing apples and oranges" error.

Let's try comparing apples to apples: countries to countries. According to the most recent numbers released by The World Bank, Canada has 3.2 beds per 1000 people. Both The United States and Britain had a smidgen less at 3.0 beds per 1000. Sweden fared even worse with only 2.7 beds.

There are more than 50 countries listed by The World Bank with fewer beds per 1000 than Canada. Admittedly, for the most part, having bed numbers that are better than these 50 is not a surprise. Still, Canada can take solace in the fact that Norway has only  3.3 beds per 1000 or a mere .1 more beds than Canada. Norway has some excellent health care numbers despite having a low bed number.

According to the newspaper article, Ontario has only 2.4 hospital beds per 1000. It sounds bad and it is bad but Ontario does not sport the worst numbers on the continent. For lower numbers look south. Ontario has more beds than almost 40% of the American states according to The Henry J. Kaiser Family Foundation. Oregon only has 1.8 beds per 1000 and California, Hawaii and Vermont have numbers that are little better.

A more telling number is the percentage of Americans reporting that in the past 12 months they failed to see a doctor despite needing one because of cost. In some regions of the States the number of people who have stopped seeking medical help despite needing it is more than 1 in 5. That is downright frightening. The link provided takes one to a page with some very conservative numbers.

Researchers with The Commonwealth Fund in the United States calculated a much higher number. 37 percent of Americans in the Commonwealth survey went without recommended health care, not seeing a doctor when ill, or failing to fill prescriptions because of costs.

The number of hospital beds per thousand has been dropping all over the globe for years. As can be seen by the number in London, the medical profession is trying to rise to the challenge, and it is a tough challenge.

Recently I had an ablation procedure performed at University Hospital in London. After being sedated by an anesthetist, a heart specialist threaded thin, flexible wires from my groin up through my body to my heart. The surgeon guided the wires into my heart where heat was used to destroy the heart muscle causing my cardiac problem.

Today this procedure is often done as day surgery. My procedure was done in the morning and I was home for dinner. One way to cut down on hospital acquired infections is to get the patient out of the hospital quickly. My recovery bed was my own.

Are more hospital beds needed? Of course, there's no argument there, and the shortage is neither new nor news. The big story is how well those in the health profession in Canada are delivering some damn fine health care despite facing some pretty daunting problems.

We may be short of beds and our ER departments may take far too long to see all patients, but in the end the important numbers are good. For instance, we live longer, healthier lives than our neighbours to the south.

I tip my hat to the fine Canadian doctors and nurses without whom I would not be here today. I truly owe them my life. Thank you.

She said, he said: A lame excuse for balance

It was a small post. A reporter at the local paper claimed to have balanced his coverage of a political speech by seeking out and publishing the comments of a well known political adversary of the speaker.

Did the reporter question the speaker's statements? Did the reporter think the claims being made were simply bold-faced political puffery? Why did the reporter not simply report what was said and move on? Considering the source for the alternate point of view, I really don't know the answer. The reporter consulted Joe Fontana, the present Mayor of London, Ontario, a man who needs no introduction, as they say.

In my original post, I called the balance obtained by contacting Fontana an example of faux balance. A more accurate label of what was done might be "she-said-he-said-journalism." How does this work?

• Take a public statement and create a dispute.
• Conflicts make news; The created dispute will be newsworthy.
• Make no attempt to assess validity of claims, claims which are the very essence of the story.
• The symmetry of two sides provides the necessary faux balance.

And how do reporters respond to criticism like the above? They attack the messenger. Newspaper reporters believe this is good journalism. It is balanced.

Balanced? I am left shaking my head in disbelief.

Faux balance unbalances news stories

Without realizing it, reporter Patrick Maloney made a confession in the daily newspaper. Without grasping the true importance of his words, he admitted that The Free Press committed the common media blunder of faux balance.

It seems that some years ago, feeling the need to balance its coverage of Mayor Anne Marie DeCicco-Best's state of the city address, the daily paper chased down Joe Fontana vacationing out of town in the sunny south. According to Maloney, "Fontana ripped his old rival with unexpected vigour."

Unexpected vigour? Really? Fontana's vitriol-laced words were unexpected? I humbly suggest the newspaper sought out Fontana hoping to get some good quotes, and Fontana delivered.

It is interesting to note that the original story, as posted to the Web, makes no mention that Fontana was chased down by the paper, that he was not even at the event but was instead on vacation. The omission was not for lack of space. Fontana dominates from 40 to 50 percent of the first story, depending upon how one approaches the calculation.

Journalists have forgotten how to report straight-news straight. Faux balance does not add accuracy or objectivity. What it does add is risk, and one of those risks is the risk of being used by the person chosen as a counter-balance. Fontana welcomed the opportunity to grab some front page attention. He criticized his former opponent and took full advantage of the moment to further his own political ambitions.
_________________________________________________________________________

Personal Twitter attack by the reporter who wrote both stories mentioned in the above post.

 
Interesting response to my post. What makes it interesting, at least to me, is that it is but another in a long list of rude reactions from a reporter at The London Free Press, the newspaper at which I worked for thirty some years. While working at the paper I was mainly a staff photographer but I also wrote two weekly columns -- one on photography and another, Celebrating the Thames, on the river that flowing through London.

I have kept the letters and e-mails from these journalists but I don't publish them as the writers usually request that I not publish their thoughts on my blog. I respect their wishes. I have attacked financial advisers and others but the only rude responses I have received are from reporters. Other than reporters, I don't recall anyone else attacking me on a personal level. Some of the reporter e-mails have not only been rude in content but rude in form -- written in screaming solid caps in very large, bold fonts.

I have been disappointed by the responses from professional reporters. When I worked at newspapers I believed journalists had thick skins. And they did back in the '70s when I got into the profession. Not so today.

No one working at the paper should be surprised at the tone of my posts. When I saw stuff with which I didn't agree while working at the paper, I was known to walk into the publisher's office or the editor-in-chief's office and voice my disapproval. I vented, they listened and that was it. I was never able to spur anyone into taking any action. (I believe, if asked, Paul Berton, a former editor-in-chief at the Free Press, would confirm this statement.)

Writing a blog is far more satisfying that making futile noises as an employee at a paper. I have had more than 164,000 hits and the number keeps growing. I vent and someone listens and another and then still another. Right now my most popular post has been hit more than 12,500 times.

If you are a journalism junkie, please read the story that inspired my post: London mayor hints at re-election platform with promise to keep taxes at 1% a year and then read the "balanced" story done at the time of Anne Marie DeCicco-Best's state of the city address: Mayor's race replay?

A writer for The Economist's Democracy in America blog wrote:

"Balance is easy and cheap. In political journalism, a vitriolic quote from each side and a punchy headline is all that is needed to feed the news machine."

Seeing the anger my posts generate, I try to be careful when discussing errors made by local journalists. Still, newspapers are too important to be above criticism. I've decided to be careful but at the same time to be true to myself and to continue to openly discuss my unease with some aspects of how the media operates. An open, free media is a pillar of our way of life.

Discussion is called for, not personal insults.

That's not an argument.

I have some friends who like to argue. An evening spent with this group can be expected to deliver at least one example of toe-to-toe of verbal sparring. I'm ashamed to admit that in the past I've been sucked into the maelstrom, but I'm learning to keep my lips buttoned.

I decided to start clamming up after I mentioned that the insulating blinds installed in my kitchen are causing a thick build up of ice to form at the bottom of the windows. The ice, and resulting water, are damaging the wooden sills.

I thought the blinds were an example of an incomplete understanding of how insulation interacts with water vapour in a home. Buildings are facing an increasing number of problems with black mould and I believe the causes are insulation and moisture combined with ignorance.

My statement found no agreement at the table. In fact the fellow beside me said I was failing to credit these new, insulating blinds with delivering great energy savings during hot, summer nights.

Soon I found that no matter what I said I was going to be contradicted. I felt like I was entering the world of Monty Python -- and I was right. I had entered the Argument Clinic.



Part of the pleasure of this sketch is derived from the undeveloped meta-argument put forth. Meta-argument: An argument about an argument.

Embracing the meta-argument position, one soon understands not even getting into an argument in some situations is the rational thing to do. More to the point, arguing strenuously with others whom have all gathered to enjoy a fine dinner is simply bad manners. (I hang my head in shame for my role in the minor dinner table brouhaha.)

Emily Post suggested on try to change the subject the minute a discussion feels like it is escalating into an argument. (Now, how do I get my friends to read this post?)

Being rich isn't bad -- but being a leech is.

Kevin O'Leary has made a career out of pulling the chains of Canadians, especially those who watch CBC. Recently The Lang & O'Leary Exchange touched on an Oxfam report: Working for the Few. The report reveals that the 85 richest people on earth have a combined wealth equal to that of the entire bottom half of the world’s population. According to Oxfam: "Wealthy elites have co-opted political power to rig the rules of the economic game, undermining democracy."

O'Leary's unthinking, by rote response was to applaud the news. "What can be wrong with that," he asked. The small time business man, but big time self-promoter, went on to say it was wonderful to see this happening. It encourages people to work hard, to get ahead.

Mr. O'Leary doesn't seem to realize many of those in the third world already work damn hard. Many possibly harder than Mr. O'Leary. Millions of children in the Third World are Born To Work. This is the title of a book by GMB Akash, a Bangladeshi photographer.

It should be noted that the percentage of people living in dire poverty around the world has been declining over the past decades. It must also be noted that, contrary to O'Leary's statement, in countries with the greatest income inequality an expanding GDP does less to alleviate poverty than the same growth in a country with a more equal distribution of wealth.

Amanda Lang mocked O'Leary as she imitated a Third World worker getting up in the morning. I can get ahead, thinks the worker: "I just need to pull up my socks. Oh wait, I don't have any socks."

At least, Ms. Lang gets it. For instance, some 10,000 people, including over 2500 women and 1000 children, earn a living collecting stone and sand from the Piyain River in Bangladesh. The average wage is less than $2 US a day. Times may be tough for these folk while they are working but for four months a year it gets even worse. Work is suspended during the annual rainy season. Click on the link and check the pictures. Lang is right. Many of these workers don't have socks.

Falls from beds injure children

I'm a bit of a worrier, even my granddaughter thinks so. When she has a sleep-over at our home, I worry. The guest bed is about 80cm off the hardwood floor. That's a long drop in my estimation. We push the bed against the wall and then I insist that someone sleep with the 4-year-old, keeping her sandwiched between the wall and a sleeping adult (usually mommy.)

The other night the little girl slept over. She was excited. Sleep-overs are fun. She climbed onto the bed and rolled back and forth in glee. I moved in close to the edge of the bed, warning her that what she was doing was dangerous.The words were hardly out of my mouth when she had rolled too close to the edge of the bed. She was sliding off and could do nothing to stop it. Her face filled with fear -- and then relief. I had reached out and caught her in mid-air.

"Gaga!" You caught me!" This was not the first time I've been in the right place at the right moment to catch the very active little girl. I've been told that I can't always be there. This makes me smile. She won't always need me to be there. She's four. It won't be long until the falls will be, for the most part, out-grown. I'm not putting a six-year-old in a shopping cart seat.

But my relatives seem to be sending me an underlying message: She should fall. It would do her good. She'll  learn a lesson. Kids don't get hurt falling, I am always being assured. Kid are resilient. I'm not convinced.

It didn't take a lot of research to confirm my worst fear: The proportion of kids injured by short falls is small but the extent of the injuries among those children injured is major. Knowing the exact proportion of children injured is impossible. Children who are not harmed in any way are not taken to the hospital and therefore there is no record of these incidents. But among the relatively small number of children taken to emergency, the number of injuries is surprisingly large and the extent of the injuries frighteningly major.

In one study involving 104 children, there were eight skull fractures among those children who fell less than 60cm. When the child fell more than 60cm but less than 120cm, the number of skull fractures jumped to 23. When all factors were accounted for, the researcher concluded:

• It is common for children to suffer fractures from falls.
• Significant, but not life-threatening injuries, are common in short falls.
• Children tumbling from low heights can suffer unexpectedly severe injuries.
• The greater the height of the fall, the more common it is to suffer a skull fracture.

Threats:

• Stairs
• Beds, especially bunk beds
• Playground equipment
• Shopping carts (Store floors are often hard, non-energy-absorbing surfaces)
• Wooden floors are more dangerous than carpeted floors

One last, sad note. The figures may be skewed by child abuse. Sometime the injuries don't mesh with the details surrounding the incident and the care-givers are suspect. For this reason, I didn't go into too much detail with numbers and links, etc.

Source: Cincinnati Children's Hospital Medical Center

Big isn't bad; Bad is bad.

When I was a boy jams, jellies, pickles and other assorted products were made by small, family-owned producers. Today, not so much.

When Heinz announced the closure of their plant in Leamington and Free Press columnist Larry Cornies wrote an apology for big business, I decided I had had enough. Cornies wrote about "The deal we make with them [Big Business] in the free-market system."

Cornies was wrong, in my opinion, about the deals we make but he did start me thinking. I don't want to make deals with big companies. Before Heinz announced the closure of its Leamington operation, I thought of Heinz as a pretty fair company with which to do business. Now that has all changed.

The headline above the Cornies column read: Answer lies in understanding, not boycotting. Cornies tells his readers to understand the pressures facing big business, to clearly understand the issues facing departing manufacturers — rather than reflexively boycotting certain brands.

I feel these companies are breaking the free-market deal I personally have with these businesses. Cornies may not agree but he sees the world differently than I do.

I'm not exactly boycotting big brand name food products, but I try not to buy them. Think of Kraft cheese. It's O.K. but I like Brights or Thornloe better. I always try to pick up some Brights Cheese when passing through Bright, Ontario, on the way to my sister's in Wellesley. Closer to home, I buy Thornloe cheese from Angelo's Italian Bakery and Market just a short drive from my London home. The Thornloe aged chedder is wonderful. Far more flavour than the Kraft product.

As I began writing this, I began wondering just whom I was supporting. I looked into the stories attached to a couple of the companies. I learned, Brights Cheese has a history going back to 1874 when a group of dairy farmers began working together to make cheese. Brights is still a cooperatives today.

Thornloe is also owned by a farmer-owned cooperative. Five years ago a global dairy producer, Parmalat, announced it was closing what is now the Thornloe operation. A local dairy farmer led the move to save the plant. Today some 3 million litres of milk runs through the plant annually.

I looked through my fridge and checked out the kitchen pantry. No Smucker's jams and jellies in my home. Smuckers bought Bick's pickles and moved production from Dunnville, Ontario, to Ohio. I now buy pickles made by Lakeside Packing Co. Ltd. located in Harrow, Essex County, Ontario. For a treat I love to pick up some Kosher dill pickles from Moishes Kosher Foods, Montreal.

It is interesting to note that to buy the Moishes I must go to Costco. Costco may be big but it is a fair employer. They pay their staff well and offer decent benefits. Do I have anything purchased from Walmart? No, I have nothing. Big is not necessarily bad. It is bad that is bad.

The truth is Mr. Cornies, we all make our own deals with Big Business. The deal that I have struck seems to be quite different from yours.

Sadly, all too often we are not given the option of not buying from Big Business. When I moved to London, kitchen ranges were still being made in town. Today I have no choice. My stove, fridge and dishwasher all come from Mexico.

The other truth, Mr. Cornies, is that all too often we do not make any deal with Big Business. Big Business dictates the terms and we have no choice but to go along with whatever is offered.

Urban sprawl: A worldwide problem

Homes, Isle of Wight, garages at front but off to the side. Google Street Views.

Sprawl is a global problem. Cars are popular the world over. Garages forward or off to the sides of a homes are everywhere. Years ago I was in Tunisia in a town on the edge of the Sahara desert. I saw a new home under construction. The home had a very traditional look, it fit right in with the older residences, except for one thing: It had a garage forward design with the garage jutting out from the home toward the street.

The continuing sprawl that surrounds London is sad but it is not unique. It is sadly all too common everywhere.

What is sad about London, and so many other towns throughout Southwestern Ontario, is that there are spots in the world that are experimenting with solutions to sprawl. These place are not common but there are a lot of them. Sadly, I know of no examples of London developers thinking way outside the box -- be it a fancy suburban box with its garage forward or a highrise box, a filing cabinet for people.

Warning: Insulated blinds can cause damage in winter

These blinds are causing condensation problems in an Ontario home.

When my wife and I bought new blinds for our kitchen, we bought ones which trapped a pocket of insulating air when lowered. This style of blind, ours are Duette by HunterDouglas, insulate our large kitchen windows when lowered each evening.

Thick ice at bottom of window after an extremely cold night.

By insulating the windows, the temperature of the inside surfaces of the kitchen window glass is now much colder than in previous winters. This is causing condensation to form at the bottom of each window. Last night the cold dropped into record low territory. In the morning we discovered condensation had turned into thick ice at the bottom of each kitchen window.

Some of the paint has already been damaged and is flaking off. The windows are almost thirty years old and are of the older wooden variety. They are not plastic. This constant soaking threatens to rot the wood surrounding the windows, especially the wooden sills. We may need replacement windows sooner than expected.

An unintended consequence of using insulating blinds is the condensation problem.

Homes are getting to be quite complicated. According to an architect I know, modern builders and renovators are not really up to speed on the pros and cons of the newly designed and redesigned stuff they are installing in homes. Water resulting from condensation is not just a problem on cold windows but often forms unnoticed deep within walls and ceilings, according to this architect.

"Keep the heat" in has become almost a mantra but the research, backed by good science, needed to accomplish that goal is sadly lacking. You may be keeping the heat in but also trapping structure damaging moisture at the same time. In many cases, "keep the heat in" should be accompanied by the words "let the moisture out."

A disease that needs no torquing

One of the world's most beautiful spots, the Orkney Islands, is Ground Zero for MS.

When I worked at the local paper I can recall one reporter getting into a heated discussion over the torquing a story. An editor at the top of the newsroom pecking order insisted the reporter rewrite a story to give it the expected, and now demanded, impact. This pumping up of a story was called torquing.

Multiple sclerosis (MS) is not a disease that needs to be torqued. Yet, this is exactly what a recent front page article in The London Free Press did. The reporter wrote:

It's a disease that strikes down adults at their prime -- and it's found Ground Zero in Canada.

Is the above true? Maybe; maybe not. There are those who would argue that the present Ground Zero, based on the latest figures, may be the Orkney Islands and the Shetland Islands off the north coast of Scotland. Studies of the island populations indicate an MS rate possibly as high as 402 per 100,000 inhabitants in the Orkney Islands. The Shetland Islands come in lower with only 295 per 100,000 but both rates are higher than Canada's reported rate of 291.

Declaring a country, especially a country as large as Canada, the global hot spot for MS is difficult. The disease is certainly all too prevalent in Canada but not uniformly so across the country. The frequency of occurrence varies across the country with folks in the Prairies suffering from MS at a rate running at about twice that of Canadians living in Quebec.

Why does the rate dip in Quebec only to rebound in Nova Scotia? Some theorize some of this may be the result of genes. The gene pool in Quebec is different that of the gene pool in Alberta.

Even the global Ground Zero for MS does not report a homogeneous rate for the small islands. According to Dr Wilson, of Edinburgh University’s Centre for Population Health Sciences, "We saw within Orkney and Shetland there were hotspots and cold spots. Some isles and parishes and villages had a much increased rate and in other parts there were hardly any residents who had it."

Damning Canada as the global Ground Zero for MS makes a good lede but a poor beginning for a story.