canada https://scienceblogs.com/taxonomy/term/156/feed en Canada moves to ban asbestos. Will Trump follow the lead of our neighbors to the north? https://scienceblogs.com/thepumphandle/2016/12/15/canada-moves-to-ban-asbestos-will-trump-follow-the-lead-of-our-neighbors-to-the-north <span>Canada moves to ban asbestos. Will Trump follow the lead of our neighbors to the north?</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>Canada's Minister of Science <a href="http://pm.gc.ca/eng/minister/honourable-kirsty-duncan">Kirsty Duncan</a> announced today that her country plans to implement a comprehensive ban on asbestos by 2018. The proposal includes:</p> <ul><li>Banning the import of asbestos-containing products such as construction materials and brake pads;</li> <li>Expanding the on-line registry of asbestos-containing buildings;</li> <li>Prohibiting the use of asbestos in new construction and renovation projects; and</li> <li>Improving workplace health and safety rules to limit the risk of contact with asbestos.</li> </ul><p>Duncan indicated that the Canadian government's action will involve several agencies. Foreshadowing that collaboration were attendees at today's press event: Health Minister <a href="http://www.healthycanadians.gc.ca/minister-ministre/jane-philpott-eng.php">Jane Philpott</a>, Public Services Minister <a href="http://pm.gc.ca/eng/minister/honourable-judy-m-foote">Judy Foote</a> and Environment Minister <a href="https://www.canada.ca/en/government/ministers/catherine-mckenna.html">Catherine McKenna</a>.</p> <p>Since the 1940's Canada has been a major <a href="http://www.ehatlas.ca/asbestos/trends/asbestos-production-canada-0">producer and exporter</a> of the deadly carcinogenic mineral. Only five years ago, the Canadian delegation to the Rotterdam Convention blocked efforts to include chrysotile asbestos on the treaty's list of hazardous chemicals in international trade. However, the political and economic winds have shifted since 2011. Canada's <a href="http://www.cbc.ca/news/business/asbestos-mining-stops-for-first-time-in-130-years-1.1103672">two major chrysotile mines</a>, which were located in the Province of Quebec, closed. Soon after, the government made a dramatic change in its official asbestos policy which was <a href="http://www.cpha.ca/en/about/media/asbestos.aspx">applauded by the Canadian Public Health Association</a>. The government announced it would ends its defense of asbestos mining and opposition to the addition of chrysotile to the Rotterdam Convention.</p> <p>Then, in November 2015, Justin Trudeau was elected as Canada's Prime Minister. A few months later, <a href="http://www.cbc.ca/news/canada/ottawa/asbestos-ban-canada-justin-trudeau-1.3576617">Trudeau told attendees</a> at a building trades union conference that the adverse health consequences of asbestos</p> <blockquote><p>"far outweighs any benefits that it might provide."</p></blockquote> <p>That was the first (and strong) indication that his administration would support an asbestos ban.</p> <p>The <a href="http://canadianlabour.ca/news/news-archive/canada%E2%80%99s-unions-celebrate-federal-asbestos-ban">Canadian Labour Congress</a> (CLC) reacted positively today to the Minister of Science's announcement. They would like the government's action to include a national registry, managed by the Centre for Occupational Health and Safety, of all workers diagnosed with asbestos-related diseases. The CLC president Hassan Yussuff emphasized the need to protect the First Nations peoples whose housing is "filled with asbestos-ridden vermiculite insulation.” [The <a href="http://anairthatstillkills.com/updated-book/">continued scourge</a> of W.R. Grace.]</p> <p>Anna Maria Tremonti with the CBC's <em>The Current</em> describes asbestos as part of "the fabric of Canadian life for the last 130 years." The announcement today of the ban "marks the beginning of the end of a long chapter." Tremonti's <a href="http://www.cbc.ca/radio/thecurrent/the-current-for-december-15-2016-1.3896671/thought-asbestos-was-fully-banned-in-canada-not-until-2018-1.3896765">audio reporting</a> includes voices of Canadians who have been touched personally by the "magic (deadly) mineral."</p> <p>Here in the U.S., asbestos is still legal. On hearing Canada's announcement, Linda Reinstein, executive director of the Asbestos Disease Awareness Organization (ADAO), <a href="http://www.asbestosdiseaseawareness.org/archives/42226">remarked</a></p> <blockquote><p>"As we celebrate this historic moment for Canada, the ADAO team remains dedicated to ensuring a U.S. ban on asbestos follows quickly. I look forward to a future where one day, asbestos exposure will be a thing of the past in North America and across the globe."</p></blockquote> <p>Reinstein's husband Alan, 66, died from pleural mesothelioma. It’s the quintessential disease associated with exposure to asbestos.</p> <p>Last month, the U.S. <a href="http://scienceblogs.com/thepumphandle/2016/11/30/epa-beats-congress-deadline-names-first-10-chemicals-for-action-under-new-law/">EPA announced</a> the first 10 ten chemicals about which it will conduct risk evaluations, as required under a new chemical safety law. Asbestos was one of the ten. We'll have to wait and see whether the Trump EPA will follow Canada's lead and move forward with a ban. I'm not holding my breath. Donald Trump <a href="http://m.motherjones.com/politics/2016/05/the-trump-files-asbestos-mob-conspiracy">says that asbestos</a> is "100 percent safe, once applied," and that it just "got a bad rap."</p> <p> </p> </div> <span><a title="View user profile." href="/author/cmonforton" lang="" about="/author/cmonforton" typeof="schema:Person" property="schema:name" datatype="">cmonforton</a></span> <span>Thu, 12/15/2016 - 10:36</span> <div class="field field--name-field-blog-categories field--type-entity-reference field--label-inline"> <div class="field--label">Categories</div> <div class="field--items"> <div class="field--item"><a href="/channel/policy" hreflang="en">Policy</a></div> </div> </div> Thu, 15 Dec 2016 15:36:55 +0000 cmonforton 62754 at https://scienceblogs.com Makayla Sault's mother: Racism, trust, and science-based medicine https://scienceblogs.com/insolence/2016/01/18/makayla-saults-mother-racism-trust-and-science-based-medicine <span>Makayla Sault&#039;s mother: Racism, trust, and science-based medicine</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>One of the recurring topics I write about is, of course, cancer quackery. It goes right back to the very beginning of this blog, to my very earliest posts <a href="http://oracknows.blogspot.com/2004/12/understanding-alternative-medicine.html">more than 11 years ago</a>. Over the years I've covered more cases than I can remember of patients relying on quackery instead of real medicine. In particular, tales of children with highly curable cancers being treated with quackery bother me most of all. Many have been the examples throughout the years: <a href="http://scienceblogs.com/insolence/2013/02/19/the-long-strange-case-of-abraham-cherrix-continues/">Abraham Cherrix</a>, <a href="http://scienceblogs.com/insolence/2006/06/05/update-on-katie-wernecke/">Katie Wernecke</a>, <a href="http://scienceblogs.com/insolence/2007/11/17/why-would-i-promote-a-hoax/">Chad Jessop</a>, <a href="http://scienceblogs.com/insolence/2009/06/15/danny-hausers-doing-well-and-as-usual-mi/">Daniel Hauser</a>, <a href="http://scienceblogs.com/insolence/2015/10/14/sarah-hershberger-cancer-free-and-proof-that-natural-healing-works-not-so-much/">Sarah Hershberger</a>, and teens like <a href="http://scienceblogs.com/insolence/2015/08/18/cassandra-callender-the-teen-who-refused-chemotherapy-speaks-out-to-a-quack/">Cassandra Callender</a>, who wanted to use quackery instead of medicine to treat their cancer.</p> <p>Most recently, I was depressed to learn how one of the quackiest quacks that I've ever encountered, a man named <a href="http://scienceblogs.com/insolence/2015/02/25/finally-the-state-of-florida-acts-against-brian-clement-and-the-hippocrates-health-institute/">Brian Clement</a>, who runs the <a href="http://scienceblogs.com/insolence/2015/02/11/brian-clement-and-the-hippocrates-health-institute-cancer-quackery-on-steroids/">Hippocrates Health Institute</a> in Florida, victimized two aboriginal girls in Canada, one named <a href="http://scienceblogs.com/insolence/2015/01/20/a-tale-of-two-unnecessarily-doomed-aboriginal-girls-with-lymphoblastic-leukemia/">Makayla Sault</a> and the other only known through <a href="http://scienceblogs.com/insolence/2015/04/27/j-j-has-a-chance-to-live/">court documents as JJ</a>. These two girls came to my attention because of a highly <a href="http://scienceblogs.com/insolence/2014/11/17/an-ontario-court-dooms-a-first-nations-girl-with-cancer/">misguided court ruling</a> that <a href="http://scienceblogs.com/insolence/2014/11/18/an-ontario-court-dooms-a-first-nations-girl-with-cancer-whos-to-blame-2/">JJ's parents could choose</a> "traditional medicine" over science-based medicine for their daughter's lymphoblastic leukemia. This ruling was made despite the fact that at the time of the ruling the other First Nations girl whose parents had fallen for Brian Clement's quackery (Makayla Sault) had already <a href="http://www.cbc.ca/news/aboriginal/makayla-sault-earlier-first-nations-child-who-refused-chemo-relapsed-doctor-1.2787249">relapsed</a>. Later, Makayla <a href="http://scienceblogs.com/insolence/2015/01/20/a-tale-of-two-unnecessarily-doomed-aboriginal-girls-with-lymphoblastic-leukemia/">died of her cancer</a>, and JJ relapsed. Fortunately, after JJ's relapse, her family came to a agreement that allowed her to begin treatment, and Ontario Court Justice Gethin Edward <a href="http://scienceblogs.com/insolence/2015/04/27/j-j-has-a-chance-to-live/">walked back his original ruling</a> that <a href="http://scienceblogs.com/insolence/2014/11/17/an-ontario-court-dooms-a-first-nations-girl-with-cancer/">put the rights of indigenous peoples over the welfare of the child</a>. Unfortunately, JJ's chances of survival were definitely hurt by the lapse in treatment.</p> <!--more--><p>It's now been about a year since Makayla Sault died, and her parents are speaking out. Unfortunately, what they're saying points to a problem when it comes to dealing with parents like them who are bound and determined to pursue quackery rather than science-based medicine. Over the weekend, there appeared in <em>The Hamilton Spectator</em> an interview with Makayla's parents entitled <a href="http://www.thespec.com/news-story/6235052--we-faced-a-lot-of-racism-mom-of-new-credit-girl/">‘We faced a lot of racism’: mom of New Credit girl</a>. As before, Makayla's mother is blaming chemotherapy for her death:</p> <blockquote><p> One year after the death of Makayla Sault, her mother's only regret is agreeing to treat the 11-year-old New Credit girl's cancer with chemotherapy at all.</p> <p>"I regret to this day…ever letting a drop of chemo touch her body," said Sonya Sault. "It ravaged her body."</p> <p>After a year that has "been the hardest to endure," the pastor is now fighting for the legacy of her daughter, who quit chemotherapy for traditional healing. </p></blockquote> <p>Look, I get it. I get it at least as much as a supporter of science-based medicine can. Chemotherapy is hard. It's toxic. It's incredibly difficult for parents to watch their child endure the toxicity of chemotherapy. Unfortunately, it's also the only treatment that had a chance of curing Makayla. It was a good chance, actually, at least 70%. Unfortunately Makayla's parents don't see it that way. Her mother clearly thinks that chemotherapy "ravaged her body" to the point of killing her. Remember, Makayla died of a stroke. Now a stroke can be a complication of advanced leukemia. As the white blood cell count skyrockets uncontrollably, the blood can become more viscous, leading to sludging in the blood vessels of the brain. Yet, even though it had been months since Makayla received any chemotherapy, her mother <a href="http://scienceblogs.com/insolence/2015/01/20/a-tale-of-two-unnecessarily-doomed-aboriginal-girls-with-lymphoblastic-leukemia/">blamed her stroke on it</a>, even though, from what we know, it is entirely plausible that, sadly, a stroke was the terminal event of Makayla's leukemia a year ago.</p> <p>Now here's where things get disturbing. Here's where we discover how there might have been a possibility, however, small, of keeping Makayla's treatment science-based:</p> <blockquote><p> Sault spoke at a conference at Six Nations Community Hall Nov. 27 aimed at harmonizing traditional healing and the health-care system after a divisive court case over forcing treatment on aboriginal children made it clear there is a deep divide between the two philosophies of care.</p> <p>"From the very beginning of our time at McMaster, we wanted to use traditional medicines with Makayla and at the start, we were met with a flat out, 'No. No you can't use traditional medicines with chemotherapy,'" said Sault. "It angers me because I hear words like caring, respect, dignity and treating the child as a person but yet that was never shown to us. What Makayla said and what she wanted was never heard or respected." </p></blockquote> <p>As much as I hate to criticize the parent of a child who died, given that the death of a child is one of the worst things that any parent can endure, I do have to point out one thing here. Sault is being a bit disingenuous. The quackery to which she subjected her daughter had zero, zip, nada to do with traditional aboriginal medicine. I've described his quackery before. He's a white faux naturopathic quack (which is even worse than being a real naturopathic quack) who's apparently found a rich source of marks among the First Nations aboriginal people of Ontario. Yet what he does has virtually nothing to do with traditional aboriginal medicine. If you don't believe me, simply consider the major focus of Brian Clement's quackery: <a href="http://scienceblogs.com/insolence/2013/12/20/when-false-hope-leads-well-meaning-people-astray/">Wheatgrass enemas</a>. His Hippocrates Health Institute is basically <a href="http://scienceblogs.com/insolence/2015/02/11/brian-clement-and-the-hippocrates-health-institute-cancer-quackery-on-steroids/">cancer quackery on steroids</a>—white man's quackery.</p> <p>That being said, if true <a href="http://www.thespec.com/news-story/6235052--we-faced-a-lot-of-racism-mom-of-new-credit-girl/">this is not acceptable</a>:</p> <blockquote><p> "We were completely devastated at the news to think that our daughter had cancer in her body," said Sault with her husband, pastor Ken Sault, at her side. "Terrified and overwhelmed with the news that we had received, we consented to chemotherapy."</p> <p>But once treatment started, "We were never made to feel like we were real people," she added.</p> <p>She describes inappropriate comments by staff, the family's concerns about side-effects being brushed aside and more focus being put on enrolling Makayla in clinical trails than incorporating traditional healing into her care.</p> <p>"During our time at McMaster, we faced a lot of racism," said Sault. She recalled one health-care worker, saying,"'I know all about your people and your kind.' She talked about the high rates of diabetes, alcoholics and drug addictions and it didn't even have anything to do with what was going on with Makayla."</p> <p>Sault was equally disturbed by the absence of First Nations culture in the hospital.</p> <p>"We want somebody to talk to," said Sault. "First Nation social workers working in the hospital, the child-life specialists and it would be so awesome to have a room for First Nations people at the hospital where families can meet and come together and support one another."</p> <p>Makayla went through 11 weeks of what was supposed to be two years of chemotherapy before abandoning the treatment.</p> <p>"She begged us to take her off of the chemo, claiming that it was killing her body and she couldn't take it anymore and she didn't want to go that way," said Sault, who described "agonizing" over what to do. "I want to make it clear that Makyala made the decision. She said, 'Mom I will never return for chemotherapy. I don't care if it comes back.'"</p> <p>Sault said it was only after Makayla decided to quit chemotherapy that the hospital was willing to incorporate traditional healing into her treatment.</p> <p>"By then, it was too late," she said. "The damage was already done to her body and she couldn't continue anymore." </p></blockquote> <p>OK, point one: Makayla was a child. She wasn't even close to the age where a person is considered competent to make such decisions. It really wasn't up to Makayla. It was up to her parents, and her mother failed her. Harsh? Yes, but true. The reason parents are trusted with guardianship of their children is because children can't make decisions as portentous as this by themselves. Of course she didn't like the chemotherapy! Of course she wanted to stop. The same is true of pretty much any child with cancer undergoing chemotherapy. It doesn't matter what the child's race is. What a child undergoing chemotherapy needs is support, encouragement, and parents with a spine. No one ever said it was easy. Watching one's child suffer is more than many parents can bear. But a wise parent, who keeps her eye on the prize, makes sure her child gets through the necessary chemotherapy.</p> <p>That being said, if there had been First Nation social workers around, perhaps they could have persuaded the Saults. If there had been more support at the hospital for First Nation peoples, perhaps Makayla's mother, even given her apparent propensity for woo, might have stayed the course even though her daughter had had enough. If there hadn't been health care workers at McMaster who were openly racist towards First Nations people, maybe the Saults wouldn't have become so turned off on and hostile towards "Western" medicine.</p> <p>As much as some might find it hard to believe, I am not by any means dogmatic. I am a pragmatist. I keep my eye on the prize, which is to save as many lives as possible. If what it takes to keep a child like Makayla Sault receiving her curative chemotherapy in order to save her life is letting the parents also indulge in subjecting her to ineffective treatments with ties to the family's culture, then, as long as those treatments don't interfere with effective anticancer treatment, so be it. Let the family bring in their community's healer and let that healer do whatever it is that he believes will help. As is the case with reiki practitioners, I view this as little different than what pretty much all hospitals do now when they allow chaplains on the premises to see patients and provide comfort and reassurance.</p> <p>None of this absolves Sonya Sault for having sought out a quack like Brian Clement and having sold him as being "traditional healing" when he is nothing of the sort. Still, it's hard not to speculate that, had traditional healers been allowed to minister to Makayla and help her get through chemotherapy, it is quite possible that her mother and she might not have been taken in by the blandishments of the charlatan Brian Clement. Had Sault's mother not been subject to clear racism from health care professionals, maybe trust would not have been so irretrievably broken that mother and daughter embraced a white quack from Florida as "traditional medicine." Perhaps Makayla might have survived. Indeed, it is clear that there was more than a bit of cluelessness among hospital administrators over what was happening "in the trenches" in their own hospital. While it is quite possible that most of the doctors, nurses, and other health personnel behaved professional, clearly a <a href="http://www.thespec.com/news-story/6235052--we-faced-a-lot-of-racism-mom-of-new-credit-girl/">significant number did not</a>:</p> <blockquote><p> Hamilton Health Sciences CEO Rob MacIsaac was on hand to hear the no-holds-barred speech from Sault as well as two other moms who also say they faced racism within McMaster's walls.</p> <p>"It was very painful listening to their stories and a great motivation to continue to work hard to make the patient experience better," MacIsaac said. "I felt it was important for me to hear what the community was saying. There is no substitute for actually coming and listening." </p></blockquote> <p>There is a line, however. If the traditional medicine interferes with existing treatment (and, as far as I can tell, what was being proposed probably didn't, but I don't know enough about it to judge), then it would be irresponsible to allow it. More importantly, the hospital must not endorse medicine that science has not validated as though it were science-based. Hospitals allow chaplains in all the time without endorsing any specific religion; again, viewing these healers as similar to chaplains might be a way to overcome this issue. What we do not need is for McMaster Children's Hospital, for instance, to set up an aboriginal medicine program and start offering it to patients with the imprimatur of the hospital, the way that the Cleveland Clinic offers traditional Chinese medicine to its patients as though it were just another department or specialty, the same as science-based medicine.</p> </div> <span><a title="View user profile." href="/oracknows" lang="" about="/oracknows" typeof="schema:Person" property="schema:name" datatype="">oracknows</a></span> <span>Sun, 01/17/2016 - 21:00</span> Mon, 18 Jan 2016 02:00:54 +0000 oracknows 22221 at https://scienceblogs.com Maintaining blood sugar during fasting https://scienceblogs.com/lifelines/2015/09/29/maintaining-blood-sugar-during-fasting <span>Maintaining blood sugar during fasting</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><div style="width: 515px;"><img src="https://upload.wikimedia.org/wikipedia/commons/6/67/Branta_canadensis_4014.jpg" alt="" width="505" height="336" /> "Branta canadensis 4014" by Dori - Own work. Licensed under CC BY-SA 3.0 us via Wikimedia Commons - <a href="https://commons.wikimedia.org/wiki/File:Branta_canadensis_4014.jpg#/media/File:Branta_canadensis_4014.jpg">https://commons.wikimedia.org/wiki/File:Branta_canadensis_4014.jpg#/med…</a> </div> <p>A study published earlier this month examined how Canada geese (<em>Branta canadensis),</em> long-distance migratory birds, regulate their blood sugar levels during prolonged fasting. Dr. Jean-Michel Weber and <span class="name">Eric Vaillancourt (University of Ottawa, Ontario, Canada) were interested in understanding whether </span>the pancreatic hormone glucagon could alter blood sugar in the birds. In mammals, glucagon maintains glucose homeostasis during periods of fasting mainly by stimulating the production and release of sugar by the liver. It is also involved in the breakdown and mobilization of fats in birds. Prior to this study the authors knew that during long-distance migration, geese rely mainly on fats as opposed to sugars for flight. I found it surprising to learn that the role of glucagon had apparently not been examined previously in long-distance migratory birds.</p> <p>When the researchers administered glucagon to the geese, it increased the mobilization of glucose from the liver by 50% causing circulating glucose concentrations to increase by about 90%. In contrast, glucagon had no effect on fat mobilization. The increase in circulating glucose was not accompanied by a change in the utilization of glucose or fats, however. This suggests that the purpose of the increase in circulating glucose is simply to ensure that the animals do not develop low blood sugar.</p> <p>As noted by the authors, it would have been interesting if they had measured circulating levels of glucagon in the birds prior to administering it. An increase in fasting concentrations of glucagon would have helped to confirm whether it is normally elevated during fasting to protect the animals from low blood sugar.</p> <p><strong>Source:</strong></p> <p><span class="highwire-citation-authors"><span class="highwire-citation-author first article-author-popup-processed has-tooltip" title="" data-delta="0"><span class="nlm-surname">Vaillancourt E</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" title="" data-delta="1"><span class="nlm-surname">Weber J-M. </span></span></span>Fuel metabolism in Canada geese: effects of glucagon on glucose kinetics. <em><span class="highwire-cite-metadata-journal-title">American Journal of Physiology - Regulatory, Integrative and Comparative Physiology. </span></em><span class="highwire-cite-metadata-volume">309(</span><span class="highwire-cite-metadata-issue">5): </span><span class="highwire-cite-metadata-pages"> R535-R543, 2015. </span><span class="highwire-cite-metadata-doi"><span class="label">DOI:</span> 10.1152/ajpregu.00080.2015 </span></p> </div> <span><a title="View user profile." href="/author/dr-dolittle" lang="" about="/author/dr-dolittle" typeof="schema:Person" property="schema:name" datatype="">dr. dolittle</a></span> <span>Tue, 09/29/2015 - 10:41</span> Tue, 29 Sep 2015 14:41:00 +0000 dr. dolittle 150336 at https://scienceblogs.com In Alberta, Pigs Do Fly https://scienceblogs.com/gregladen/2015/05/06/in-alberta-pigs-do-fly <span>In Alberta, Pigs Do Fly</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>The Canadian Province of Alberta has been likened to the American State of Texas. Energy and cattle, energy barons and cowboys. But with mountains.</p> <p>Yesterday a relatively liberal party, the New Democratic Party (NDP), won a surprise victory in the provincial election, ousting the 44 year long reign of the Progressive Conservatives. From an American point of view, this is all very confusing because the Canadian political system is very different. Alberta has a Premier, and the premier will step down because of this election. The NDP formerly never held very many seats in the legislature, but now holds 55 out of 87, with the Progressive Conservatives ending up with an anemic 11. </p> <p>This is relevant to topics often discussed here because Alberta is where the famous Canadian Tar Sands, the bitumen from which would be carried on the famous Keystone XL Pipeline through the United States to points unknown, rest. This raises two questions. First, did the left-leaning victory arise in part (small or large) from the fight over tar sands exploitation? Second, will this change in government influence the future exploitation of this relatively dirty source of Carbon-based fossil fuel?</p> <p>People vote for a range of reasons. When a large and unexpected shift happens, in American politics, it is more often than not (IMHO) because voters are upset with those in power, and are "throwing the bums out." I think it is much more rare to see a smaller coalition blossom into a majority over issues pushed by that coalition. Also, even though the NDP is left leaning, just how "left" (meaning, in the context of these major issues, Climate Hawkish) are they? All you Canadian Politics experts need to provide your analysis in the comments below. I'm especially interested in John Irving's analysis. (John?)</p> <p>It is said that this is like a Democratic sweep/Republican trounce in Texas. Is it? Will it last? Is this a game-changer, a sea change? Some other appropriate Canadian metaphor? (Ice-out? Turning of the maple leaf?)</p> </div> <span><a title="View user profile." href="/author/gregladen" lang="" about="/author/gregladen" typeof="schema:Person" property="schema:name" datatype="">gregladen</a></span> <span>Wed, 05/06/2015 - 02:32</span> Wed, 06 May 2015 06:32:04 +0000 gregladen 33566 at https://scienceblogs.com J.J. has a chance to live! https://scienceblogs.com/insolence/2015/04/27/j-j-has-a-chance-to-live <span>J.J. has a chance to live!</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>Over the years I've written about a lot of topics. After all, I've been at this for more than a decade now, and I still grind out four or five posts per week, with only occasional breaks for vacations or medical or scientific meetings. Topics have included science-based medicine, antivaccine nonsense, topics of general skepticism, and of course medical quackery, among others. There's one type of recurrent story I've been commenting on periodically since 2005, when I began by discussing the <a href="http://oracknows.blogspot.com/2005/11/misguided-faith-in-alternative.html">case of Katie Wernecke</a>, and these include stories of children with cancer who do not receive the therapy that they need, usually because their parents balk at the toxicity and, more often than not, because the parents—and sometimes the child, too—are choosing quackery instead of effective medicine.</p> <p>The names of such children that I've blogged about started with Katie Wernecke but certainly did not end with her. For example, they include Abraham Cherrix, whose choice of quackery over effective treatment for his lymphoma inspired a truly awful law in Virginia known as <a href="http://scienceblogs.com/insolence/2006/08/31/the-abraham-cherrix-case-bad-medicine-ma-1/">Abraham's law</a> that allows children 14 and over with terminal illnesses to <a href="http://scienceblogs.com/insolence/2007/03/26/abrahams-law-bad-medicine-has-made-bad-l-1/">choose quackery instead of medicine</a> and that, when last I learned anything about him, had left him with <a href="http://scienceblogs.com/insolence/2013/02/19/the-long-strange-case-of-abraham-cherrix-continues/">recurrent lymphoma that keeps popping up</a>. Others include <a href="http://scienceblogs.com/insolence/2009/05/26/good-news-for-daniel-hauser/">Daniel Hauser</a>, J<a href="http://scienceblogs.com/insolence/2012/03/26/another-case-of-chemotherapy-refusal-for/">acob Stieler</a>, an Amish girl named <a href="http://scienceblogs.com/insolence/2014/03/12/reason-com-defends-the-medical-neglect-of-sarah-hershberger/">Sarah Hershberger</a>, and, most recently, a girl who was only identified as Cassandra C, who is being compelled against her mother's wishes to <a href="http://scienceblogs.com/insolence/2015/01/09/another-teen-refusing-chemotherapy-another-court-ruling/">undergo chemotherapy</a> for her Hodgkin's lymphoma and fortunately is <a href="http://www.people.com/article/teen-cassandra-c-forced-chemotherapy-hospital-court-ruling">doing well</a>. Many of these stories have a depressing similarity to them. A child is diagnosed with cancer and undergoes her first course of chemotherapy. The side effects alarm the parents—understandably. If the parents are woo-prone, that can lead to rejection of further chemotherapy, particularly if the tumor has gone into remission, given that it can be really hard to explain why prolonged courses of chemotherapy are needed. These stories usually either end with some agreement being reached that allows the child to pursue woo with conventional therapy.</p> <!--more--><p>Such was the case with a particularly thorny couple of cases that involved aboriginal rights in Canada, the confusion of parental rights with aboriginal rights, and some particularly troublesome history and political considerations. The first case was the case of JJ (the name used in the news stories), an aboriginal girl in Canada with lymphoblastic leukemia whose parents took her case to court to allow her mother to take her to undergo "natural healing" under the care of a man named Brian Clement, who runs the Hippocrates Health Institute (HHI) in Florida. Unfortunately, as I discussed, the HHI is a haven of <a href="http://scienceblogs.com/insolence/2015/02/11/brian-clement-and-the-hippocrates-health-institute-cancer-quackery-on-steroids/">cancer quackery on steroids</a>, much of it based on claims that wheatgrass (including wheatgrass enemas) has magical curative powers. Even though Clement's quackery had nothing to do with traditional aboriginal medicine, Ontario Court Justice Gethin Edward, who belongs to the same Six Nations band as JJ, ruled that the parents could <a href="http://scienceblogs.com/insolence/2014/11/17/an-ontario-court-dooms-a-first-nations-girl-with-cancer/">choose Clement's quackery instead of chemotherapy</a>, all in the name of "<a href="http://scienceblogs.com/insolence/2014/11/18/an-ontario-court-dooms-a-first-nations-girl-with-cancer-whos-to-blame-2/">aboriginal rights</a>." At the time, I characterized the decision as <a href="http://scienceblogs.com/insolence/2014/11/17/an-ontario-court-dooms-a-first-nations-girl-with-cancer/">ruling that the parents can let their daughter die</a>.</p> <p>So I believed at the time. I knew that after the brief course of chemotherapy that JJ had received, recurrence was virtually certain. Not surprisingly, almost right on schedule, JJ's lymphoblastic leukemia recurred. According to a recent news report, it <a href="http://www.cbc.ca/news/canada/hamilton/news/first-nations-chemo-case-ruling-amended-to-include-child-s-well-being-1.3048223">recurred in March</a>, and JJ is receiving chemotherapy again. I only hope it isn't too late. As I've explained before, a big part of the reason why I get so worked up over these cases. Besides hating the implicit assumption behind such rulings that <a href="http://scienceblogs.com/insolence/2014/01/28/once-again-caring-more-about-parental-rights-than-the-rights-of-the-child-being-subjected-to-quackery/">parents apparently own</a> their children <a href="http://scienceblogs.com/insolence/2013/10/29/children-are-not-their-parents-property/">when they do not</a>, I know that the first, best shot at curing a cancer—any cancer, but particularly childhood cancer—is the first shot. Pediatric oncologists learned this the hard way decades ago. Although you wouldn't know it from what the quacks say, pediatric oncologists don't treat children with multiple courses of chemotherapy over the course of up to over two years because they like torturing children with chemotherapy toxicity. They do it because they learned very quickly that, although a course of chemotherapy can often produce a complete remission rapidly, cancers like lymphoblastic leukemia would rapidly recur and kill the patient. Worse, recurrent leukemias are harder to treat, and the odds of success go down. Clearly, that's <a href="http://www.theglobeandmail.com/news/national/case-over-cancer-treatment-for-native-girl-is-resolved/article24101800/">what's happened with JJ</a>, but the good news is that she is likely still potentially savable.</p> <p>More interestingly, Justice Edward has, with the cooperation of all parties involved in his original ruling, has walked back its broadness, its putting aboriginal rights and parental rights over the rights of the child to <a href="http://www.cbc.ca/news/canada/hamilton/news/first-nations-chemo-case-ruling-amended-to-include-child-s-well-being-1.3048223">effective medical care</a>:</p> <blockquote><p> The clarification of a controversial court ruling that allowed the mother of an 11-year-old First Nations girl to pull her out of chemotherapy says the best interests of the child are "paramount," but traditional medicine must be respected.</p> <p>It is a "significant qualification" of Ontario court Judge Gethin Edward's November 2014 ruling, according to one legal expert, which means the child's well-being has to be balanced against rights to traditional medicine.</p> <p>Nick Bala, a law professor at Queen's University, says the clarification "walks back" the original ruling that put First Nations constitutional rights as the major factor to be considered in the care of the child.</p> <p>The clarification, read in a Brantford, Ont. court Friday afternoon, comes with news the child restarted chemotherapy in March when the cancer returned after a period of remission. </p></blockquote> <p>From my perspective, this is the sort of compromise that could have and should have been arrived at the first time around. Why it wasn't, I still don't understand. Regardless of my distaste for non-science-based treatments that will not affect the outcome of a patient's cancer, if what it takes to get the parents to have JJ undergo effective chemotherapy that reportedly had about a 75% chance of eliminating her cancer for good, then I swallow hard and let it happen. Unfortunately, although I'm not a pediatric oncologist, JJ's chances of long term survival are now probably significantly less than 75% because she didn't continue her chemotherapy after the initial course put her into remission and has now relapsed.</p> <p>It still irks me that the first time around the judge seemed to conflate Brian Clement's quackery with aboriginal medicine in his decision in that his decision was that JJ's family had the right to use aboriginal medicine, not that they had the right to fly to Florida and subject JJ to the quackery of a man whose wheatgrass enema treatments have about as much to do with aboriginal culture as Eminem. Yet almost no one that I saw from the aboriginal community actually pointed out that basic fact, so intent were they to claim this decision as a victory for native rights. The other thing that still irks me is how little consideration was given the first time around for the good of the child. All the highfalutin rhetoric notwithstanding, what the case came down to was the right of the child to effective medical care versus aboriginal rights and parental rights? Guess which one? It was the same as it almost always was: Parental rights trump the rights of the child in Canada, just as they almost always do here in the US. Only this time, there was the ugly history of oppression, particularly the history of residential schools to which aboriginal children were sent after being taken away from their families in order to assimilate them into Canadian culture, overlaid on the usual battle between parental rights and the rights of the child.</p> <p>Still, at least JJ has a chance, and it's better late than never, I suppose, that Justice Edward and other parties in the case other than McMaster Children's Hospital and the Ontario Attorney-General finally realized that the JJ's right to effective medical care matters enough to trump the right to choose quackery:</p> <blockquote><p> Bala called it a "significant clarification" that recognized the earlier decision had not referred to the child's rights as being paramount.</p> <p>He said this decision makes it more of a balancing act between the child's best interests and aboriginal rights, and that courts "very rarely" clarify decisions.</p> <p>"The aboriginal rights are one factor to be considered, but not the only factor," Bala said. "This is a significant qualification of the prior decision."</p> <p>Paul Williams, the lawyer for the First Nations family, said the clarification prevented the previous ruling from being interpreted as an "absolute" that only aboriginal rights would be considered. </p> <p>"The right to use traditional medicine is part of the child's best interests. That was clarified, it wasn't changed," Williams said. "I think it was a fear of absolutism. I think it was clear that nothing was absolute." </p></blockquote> <p>Well, duh. Justice Edward's ruling was "interpreted" as an absolute that only aboriginal rights would be considered because <a href="http://www.thestar.com/news/canada/2015/04/24/jj-is-thriving-no-thanks-to-courts-belated-clarification-dimanno.html">that's how it was written</a>:</p> <blockquote><p> What Edward did was add a crucial “clarification,” on consent of all counsel, that indigenous does not take precedence over conventional and scientific. “Implicit in this decision is that recognition and implementation of the right to use traditional medicine must remain consistent with the principle that the best interests of the child remain paramount. The Aboriginal right to use traditional medicine must be respected and must be considered among other factors in any analysis of the best interests of the child, and whether the child is in need of protection.”</p> <p>Edward had never stated, in November, that the family shouldn’t pursue chemo if they chose. But he did say they didn’t have to do so, a conclusion that sparked intense controversy.</p> <p>Now Edward tells us that he always knew, instinctively, the parents would do what was best for J.J. He took that comforting view from the testimony of an intake manager with the Brant child welfare agency, in which she quoted the child’s mother as saying, “I will not let my baby die."</p> <p>Edward told court yesterday: “Implicit in those seven words was that, regardless of what this court said or did, or anyone else for that matter, what was paramount for the mother was what was in her daughter’s best interest.” </p></blockquote> <p>This is a manifestly dumb argument—one of the dumbest I've ever heard in a case like this. Virtually <em>every</em> mother who refuses chemotherapy for her child has the best interests of the child at heart. Every mother who refuses chemotherapy loves her child and wants her child to live. That's not the point in cases like this. The point is that what the mother was <em>doing</em> was clearly not in the child's best interest by any reasonable standard, no matter what her motivation might have been. Heck, parents who belong to religious orders that eschew all medical care to the point of allowing children die preventable deaths of <a href="http://scienceblogs.com/insolence/2008/04/02/relying-on-prayer-instead-of-medicine/">diabetic ketoacidosis</a> or <a href="http://scienceblogs.com/insolence/2013/06/27/responsibility-versus-antivaccine-activists/">treatable pneumonia</a> believe they are doing what was in their children's best interest. The end result is still dead children. If JJ's parents and Edward hadn't finally seen the light, that would have been the end result for JJ. It might still be.</p> <p>Edward's ruling was a ruling that delayed effective treatment for JJ for five months and allowed her cancer to relapse. Never mind that JJ wasn't being treated by aboriginal healers at all, but rather a white quack from Florida! If JJ ultimately dies, it will have been the ruling that let that happen. After all, we've already seen what happened when a parent stuck with Brian Clement's quackery to treat her daughter's lymphoblastic leukemia. I'm referring, of course, to the case of Makayla Sault, whose mother took her to HHI and who <a href="http://scienceblogs.com/insolence/2015/01/20/a-tale-of-two-unnecessarily-doomed-aboriginal-girls-with-lymphoblastic-leukemia/">died in January of her leukemia</a>, very likely unnecessarily given that she had a good chance of long term survival with proper treatment. It's a good thing that Justice Edward was given the opportunity to "walk back" his ruling. It's not a good thing that it apparently took JJ's relapse to do it.</p> <p>But what of Brian Clement? As glad as I am that JJ now has a fighting chance, I don't recall having mentioned the bad news about Brian Clement here on this blog. I was optimistic a couple of months ago when the State of Florida finally did something about HHI, <a href="http://scienceblogs.com/insolence/2015/02/25/finally-the-state-of-florida-acts-against-brian-clement-and-the-hippocrates-health-institute/">ordering Brian Clement to stop practicing medicine</a>. Unfortunately, it didn't last long. By mid-March, the State of Florida had backed down, and <a href="http://www.wptv.com/news/local-news/investigations/unlicensed-activity-complaint-dropped-against-hippocrates-health-institute-director">dropped its case against Brian Clement</a>, who is free to continue to ply his considerable quackery on unsuspecting desperate cancer patients, just as he had been doing for more than two decades before. Truly, Florida is a good place to be a quack.</p> <p>No doubt Clement has already visited Canada again to try to recruit the next JJ and Makayla Sault.</p> </div> <span><a title="View user profile." href="/oracknows" lang="" about="/oracknows" typeof="schema:Person" property="schema:name" datatype="">oracknows</a></span> <span>Mon, 04/27/2015 - 01:00</span> Mon, 27 Apr 2015 05:00:14 +0000 oracknows 22037 at https://scienceblogs.com A tale of two unnecessarily doomed aboriginal girls with leukemia https://scienceblogs.com/insolence/2015/01/20/a-tale-of-two-unnecessarily-doomed-aboriginal-girls-with-lymphoblastic-leukemia <span>A tale of two unnecessarily doomed aboriginal girls with leukemia</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><a href="/files/insolence/files/2015/01/SickKidsHospital.jpg"><img src="http://scienceblogs.com/insolence/files/2015/01/SickKidsHospital-450x297.jpg" alt="SickKidsHospital" width="450" height="297" class="aligncenter size-medium wp-image-9268" /></a></p> <p>I'm depressed and angry as I write this.</p> <p>The reason for this is simple. I hate it when cancer quacks claim the lives of patients with cancer, particularly patients who were eminently treatable for cure. It's happened again, and it makes me sad. Florida cancer quack Brian Clement <a href="https://www.tworowtimes.com/news/makayla-sault-ojibwe-child-refused-chemo-dies-stroke/">has claimed the life of Makayla Sault</a>, an 11 year old Ojibwe girl with leukemia:</p> <blockquote><p> The entire community of New Credit is in mourning today, following the news of the passing of 11 year old Makayla Sault.</p> <p>The child suffered a stroke on Sunday morning and was unable to recover. Friends and family from across the province travelled to New Credit First Nation today to offer condolences, share tears and pay their respects. </p></blockquote> <p>I first <a href="http://scienceblogs.com/insolence/2014/11/17/an-ontario-court-dooms-a-first-nations-girl-with-cancer/">discussed the case of Makayla Sault</a> in the context of the story of a First Nations girl with cancer, whose fate was almost certainly sealed when a Canadian judge ruled that she could pursue "traditional" treatment in lieu of curative chemotherapy for her lymphoblastic leukemia, even though what she and her family were choosing had nothing to do with traditional aboriginal healing. Rather, instead they took the First Nations girl to Brian Clement, a quack who isn't even a physician but somehow has been treating patients with cancer at <a href="http//hippocratesinst.org" rel="nofollow">Hippocrates Health Institute</a> in West Palm Beach for many years now with his "<a href="http//hippocratesinst.org/life-transformation-program/life-transformation-program" rel="nofollow">Life Transformation Program</a>" that includes:</p> <!--more--><ul><li><a href="http://hippocratesinst.org/life-transformation-program/fine-longevity-cuisine" rel="nofollow">Superior nutrition</a> through a diet of organically-grown, enzyme-rich, raw, life-giving foods</li> <li>Detoxification</li> <li>Wheatgrass therapies, green juice, juice fasting</li> <li>Colonics, enemas, implants</li> <li>Exercise, including cardio, strength training and stretching</li> <li>Far infrared saunas, steam room</li> <li>Ozone pools, including: dead sea salt, swimming, jacuzzi and cold plunge</li> <li>Weekly massages</li> <li>Bio-energy treatments</li> <li>Med-spa &amp; therapy services</li> </ul><p>I described it all in an old post in which I had <a href="http://scienceblogs.com/insolence/2013/12/20/when-false-hope-leads-well-meaning-people-astray/" rel="nofollow">first encountered Clement</a>. In particular, Clement seems to have a thing for treating people with wheatgrass enemas. Wheatgrass, according to Clement, can increase red blood cell count, decrease blood pressure, cleanse the blood, organs and GI tract of “debris,” stimulate the thyroid gland, “restore alkalinity” to the blood, “detoxify” the blood, fight tumors and neutralize toxins, and many of the usual other things quacks like Clement claim. He even offers the infamous "<a href="http://hippocratesinst.org/mindbody-therapies/specialized-healing-therapies/aqua-chi-ionic-footbath" rel="nofollow">detox footbath</a>," plus <a href="http://hippocratesinst.org/mindbody-therapies/specialized-healing-therapies/iv-therapies" rel="nofollow">intravenous vitamin therapy</a>, <a href="http://hippocratesinst.org/mindbody-therapies/specialized-healing-therapies/cranial-electrotherapy-stimulation" rel="nofollow">cranial electrotherapy stimulation</a>, <a href="http://hippocratesinst.org/mindbody-therapies/specialized-healing-therapies/infrared-waves-plus-oxygen-therapy" rel="nofollow">combination infrared waves plus oxygen</a>, <a href="http://hippocratesinst.org/mindbody-therapies/spa-treatments/acupuncture" rel="nofollow">acupuncture</a>, <a href="http://hippocratesinst.org/mindbody-therapies/spa-treatments/colon-hydrotherapy" rel="nofollow">colon hydrotherapy</a> (apparently with or without wheatgrass) and <a href="http://hippocratesinst.org/mindbody-therapies/specialized-healing-therapies/lymphatic-drainage-plus-oxygen-therapy" rel="nofollow">lymphatic drainage</a>. There's even a bit of quackery hilariously called <a href="http://hippocratesinst.org/mindbody-therapies/spa-treatments/acupuncture" rel="nofollow">colorpuncture</a>, in which various colors are applied to acupuncture points.</p> <p>You get the idea. Brian Clement's clinic has nothing to do with <a href="http://doubtfulnews.com/2014/05/culturally-appropriate-alternative-medicines-for-leukemia-may-mean-death/">Ongwehowe Onongwatri:yo</a> (<a href="http://www.tworowtimes.com/news/physician-tells-ojibwe-family-anyone-who-says-that-traditional-medicine-works-should-be-thrown-in-jail/#comment-54098">indigenous medicines</a>) and everything to do with good, old-fashioned European-American quackery focused mainly on wheatgrass, raw vegan diet, and "detoxification."</p> <p>Unfortunately, another child who very well might have been saved and lived to a ripe old age is dead, her whole life ahead of her having been thrown away pointlessly, because her family relied on quackery instead of effective medicine. Once more, a cancer quack has claimed a very salvageable life. The saddest thing about this is that this outcome didn't have to be. All reports indicate that Makayla's tumor was a treatable variety. In fact, it was the same kind of cancer the First Nations girl whose case I discussed has, lymphoblastic leukemia, although it wasn't as favorable a variety. Pediatric oncologists estimated that Makayla had a <a href="http://news.nationalpost.com/2014/06/06/makayla-saults-parents-say-they-have-no-regrets-over-girls-decision-to-opt-for-holistic-cancer-treatment/">70% chance of surviving five years</a>, because the cancer had the Philadelphia chromosome. So, yes, it's quite possible that Makayla could have been treated with the very best drugs modern medicine has to throw at lymphoblastic leukemia and died anyway, nearly a one in three chance. However, by abandoning chemotherapy and choosing Clement's quackery instead of Makayla's best shot at a cure, Makayla and her family reduced her chances of survival from 70% to zero.</p> <p>To be honest, after the descriptions of how her condition was deteriorating in November when I originally <a href="http://scienceblogs.com/insolence/2014/11/18/an-ontario-court-dooms-a-first-nations-girl-with-cancer-whos-to-blame-2/">wrote my posts about the First Nations girl</a>, I'm a little surprised that she lasted two whole months more. From the news reports, she sounded as though she was in bad shape in November. But last she did.</p> <p>Now Makayla's parents have suffered the worst loss a parent can suffer. They are, no doubt, suffering intensely, as is Makayla's entire family and tribe, over the loss of their beloved. I do not blame either Makayla or them; I blame Brian Clement for duping them. Unfortunately, as is often the situation in these cases, the Sault family is not accepting that the cancer killed Makayla. They're blaming—you guessed it!—the chemotherapy. In a <a href="http://www.tworowtimes.com/news/makayla-sault-ojibwe-child-refused-chemo-dies-stroke/">statement</a>, they said:</p> <blockquote><p> Makayla was on her way to wellness, bravely fighting toward holistic well-being after the harsh side effects that 12 weeks of chemotherapy inflicted on her body.</p> <p>Chemotherapy did irreversible damage to her heart and major organs. This was the cause of the stroke.</p> <p>We continue to support Makayla’s choice to leave chemotherapy. At this time we request privacy from the media while we mourn this tragic loss.” </p></blockquote> <p>Yes, as happens so often in these cases, it's not the quack's fault that the child died. It's the fault of those evil "Western" doctors and their poisonous chemotherapy. Always. Unfortunately, a stroke is a known <a href="https://www.medlink.com/medlinkcontent.asp">complication of leukemias</a> due to either cancer-related coagulopathy or complications of treatment. It's <a href="http://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home/Support/Support/Asked+and+Answered/What+to+Expect+with+Various+Illnesses/Cancer/What+can+be+expected+as+leukemia+progresses_.aspx">one way that patients with end stage leukemia die</a>. Given that Makayla hadn't been treated in months, her stroke was almost certainly due to her cancer. Such strokes can be a hemorrhagic (for example, if the platelet count falls very low), or it can be a thrombotic stroke (clot) if the white blood cell count goes too high. Either way, it's not <a href="https://answers.yahoo.com/question/index?qid=20090427110800AAYHxfM">particularly surprising</a> that Makayla, with untreated leukemia, suffered a fatal stroke. It was almost certainly end stage cancer the killed her, not the side effects of the chemotherapy.</p> <p>In a way, I can't blame the Saults for believing that it was the chemotherapy that killed their daughter. I really can't. It's completely understandable. If they stopped believing that, then they would have no choice but to accept that it was the choice to abandon chemotherapy that doomed their daughter. That's just not something that any parent is likely to be able to admit.</p> <p>Unfortunately, I see this happening to another child in the not-too-distant future. Remember, there is still another aboriginal girl with lymphoblastic leukemia who has abandoned chemotherapy, with the blessing of her tribal chiefs and family, in favor of the quackery peddled by a Yankee in Florida. We don't know her name due to <a href="http://scienceblogs.com/insolence/2014/11/17/an-ontario-court-dooms-a-first-nations-girl-with-cancer/">privacy concerns</a> enforced during her <a href="http://scienceblogs.com/insolence/2014/11/18/an-ontario-court-dooms-a-first-nations-girl-with-cancer-whos-to-blame-2/">court case</a> but we do have an <a href="http://metronews.ca/news/canada/1263684/girl-at-centre-of-controversial-aboriginal-medicine-ruling-cancer-free-family-says/">update about her condition</a> to juxtapose with the death of Makayla Sault. Not surprisingly, due to the usual misunderstanding that families who abandon chemotherapy for quackery for hematologic malignancies nearly always have, her family believes she is doing well because her latest tests have failed to find residual cancer:</p> <blockquote><p> The 11-year-old at the centre of a controversial ruling on aboriginal medicine tested negative for signs of cancer, her family says, months after she was pulled out of chemotherapy early in favour of natural therapies.</p> <p>According to a published statement, the family credits the alternative treatment for the remission. But oncologists say it may be the result of the two weeks of chemotherapy the girl underwent at McMaster Children’s Hospital in August before her mother pulled her out. </p></blockquote> <p>There's no "may" about it. It's almost certainly the result of the chemotherapy that the girl underwent in August. I've explained this concept several times of late. For hematologic malignancies like this, there are several phases of chemotherapy, starting with the induction phase. The induction phase is designed to put the patient rapidly into remission. However, as pediatric oncologists (not to mention adult oncologists who treat hematologic malignancies) learned the hard way decades ago, it requires sustained courses of chemotherapy to prevent leukemias from rapidly recurring. Basically, it's often easy to get a patient into remission, but keeping the patient in remission is harder.</p> <p>One good thing about this <a href="http://metronews.ca/news/canada/1263684/girl-at-centre-of-controversial-aboriginal-medicine-ruling-cancer-free-family-says/">article</a> is that the reporter interviewed some actual oncologists who explained this concept rather well:</p> <blockquote><p> “From my perspective, there’s lots that traditional healing can offer in terms of symptom management and support, but based on my scientific training I think it’s exceptionally unlikely that traditional medicine has cured her of her disease,” said pediatric hematologist and oncologist Dr. David Dix, a clinical professor at the University of British Columbia.</p> <p>“It is quite possible that she went into remission after the first two weeks of chemotherapy,” he said. Dix said the likelihood of the cancer returning is “100 per cent” and that any return of the cancer will be more difficult to treat. </p></blockquote> <p>And, later in the article:</p> <blockquote><p> The typical course of treatment for lymphoblastic leukemia involves four weeks of intensive chemotherapy which puts “99.9 per cent” of people into remission, Dix said. That is normally followed by about six months of heavy chemotherapy, then about two years of maintenance chemotherapy.</p> <p>“Achieving remission, even with a short duration of chemotherapy, is expected,” said Dr. Kirk Schultz, professor of pediatrics at the University of British Columbia. “The whole focus of chemotherapy in children with acute lymphoblastic leukemia is to get a curative outcome, that they cure the disease and it never comes back.” </p></blockquote> <p>And the conclusion of the article:</p> <blockquote><p> “Any pediatric oncologist would tell you that the likelihood of her disease recurring or relapsing is 100 per cent, that she’s at very high risk of recurrence for her disease,” said Dix. “When she does relapse it becomes more difficult then to get her back into remission. It’s very much better to get her back into chemotherapy as soon as possible.” </p></blockquote> <p>So what we have in this second girl is the same story as Makayla's, probably delayed by several months or maybe a bit longer, given that this girl's cancer is not quite as nasty as Makayla's was. Her cancer will eventually recur, probably within the next year or two at most, and at that point it will be much more difficult to eradicate than it would have been if the girl had only undergone standard-of-care chemotherapy and completed the full course. She didn't.</p> <p>The hard part will come when this girl's leukemia, as is almost inevitable now, recurs. What will the parents do? Will they admit that the combination of "traditional" medicine and Brian Clement's quackery didn't work and finally let their daughter be treated with state-of-the-art chemotherapy? At this point, that is probably the best outcome that can be expected, because they're clearly never going to bring her back to have her leukemia treated correctly as long as she is tumor-free, even though that would be the course of action that would maximize their daughter's odds of survival. The problem, of course, is that this honeymoon period probably won't last very long. The clock is ticking.</p> <p>Unfortunately, I fear that when this girl's cancer does recur, the parents will not change course. After all, this is what the <a href="http://www.cbc.ca/news/aboriginal/makayla-sault-girl-who-refused-chemo-for-leukemia-dies-1.2829885">girl's mother has said</a>:</p> <blockquote><p> In an interview with CBC News, her mother said, “This was not a frivolous decision I made. Before I took her off chemo, I made sure that I had a comprehensive health-care plan that I was very confident that was going to achieve ridding cancer of her body before I left the hospital. This is not something I think may work, this is something I know will work.” </p></blockquote> <p>Unfortunately for this woman's daughter, it is doubtful that she will be able to admit that this "something" didn't work, even after the leukemia recurs. Then we'll have a second Makayla Sault, another dead girl.</p> <p>It's so sad, and so preventable.</p> </div> <span><a title="View user profile." href="/oracknows" lang="" about="/oracknows" typeof="schema:Person" property="schema:name" datatype="">oracknows</a></span> <span>Mon, 01/19/2015 - 21:27</span> Tue, 20 Jan 2015 02:27:32 +0000 oracknows 21970 at https://scienceblogs.com A cancer cure testimonial for "traditional healing" of leukemia https://scienceblogs.com/insolence/2014/12/04/a-cancer-cure-testimonial-for-traditional-healing-of-leukemia <span>A cancer cure testimonial for &quot;traditional healing&quot; of leukemia</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><div align="center"> <a href="http://scienceblogs.com/insolence/files/2014/11/First-Nations1.jpg"><img src="http://scienceblogs.com/insolence/files/2014/11/First-Nations1-450x253.jpg" alt="First-Nations1" width="450" height="253" class="alignnone size-medium wp-image-9182" /></a> </div> <p>Cancer cure testimonials due to alternative medicine have been a staple of this blog since <a href="http://oracknows.blogspot.com/2004/12/understanding-alternative-medicine.html">its very inception</a>. Unfortunately, another staple of this blog since <a href="http://oracknows.blogspot.com/2005/11/misguided-faith-in-alternative.html">very early on</a> has included stories of children with cancer whose lives have been endangered when their their parents refuse effective cancer therapy for their cancer, in particular chemotherapy. The most recent such story is a particularly depressing one that cropped up last month in Canada. It was the story of an <a href="http://scienceblogs.com/insolence/2014/11/17/an-ontario-court-dooms-a-first-nations-girl-with-cancer/">11-year-old First Nations girl</a> whose parents opted for what they called "traditional" medicine instead of effective chemotherapy for her highly treatable and curable leukemia, acute lymphoblastic leukemia. Unfortunately, the judge who ruled in the case seemed not to understand that what the parents had chosen for their child had nothing to do with traditional medicine. In fact, they chose to let a white quack from Florida <a href="http://scienceblogs.com/insolence/2014/11/18/an-ontario-court-dooms-a-first-nations-girl-with-cancer-whos-to-blame-2/">subject their daughter to all manner of quackery</a>.</p> <p>I understand that, at its core, this case raised a number of issues, in particular issues of how much autonomy native tribes have and whether the Canadian government can compel treatment of a minor, with echoes of the horrible treatment the Canadian government and its predecessors treated native peoples hovering over the case like a black cloud of ill will. Unfortunately, the leaders of First Nations, instead of putting the life of the girl first and urging her parents to get her effective treatment (yes, chemotherapy), they glommed onto the case and, ignoring that what they were fighting for had nothing to do with aboriginal traditional medicine, used it cynically to push for more rights for their tribes.</p> <p>Yes, a girl is very likely to die at the hands of a quack named Brian Clement, and this is somehow being sold as a victory for aboriginal rights.</p> <p>It doesn't help that now, two weeks later, we're seeing stories like <a href="http://www.cbc.ca/news/canada/thunder-bay/cancer-cured-by-medicine-man-first-nations-man-says-1.2852376">this</a>:</p> <!--more--><blockquote> An Anishnawbe man from northwestern Ontario says traditional healing practices "got rid" of his leukemia, and he's concerned recent controversy over the treatment of two First Nations girls in southern Ontario will rob others of a cure. <p>On Nov. 14, an Ontario judge dismissed an application from McMaster Children's Hospital in Hamilton that would have forced chemotherapy on an 11-year-old First Nations girl. Earlier this year there were concerns that children's aid would intervene in the case of another First Nations girl after her family withdrew her from chemotherapy.</p> <p>"People who [were] trying to take the child away, they're just close-minded about the possibilities of traditional healing," said Daryl Archie. "I'm alive and well and a good example that it does work." </p></blockquote> <p>As I read the beginning of this article, I was quite confident that I could predict what was coming. These stories are depressingly familiar and based on a misunderstanding of cancer treatment. There are two basic forms these alternative cancer cure stories usually take. The first involves not understanding the difference between primary curative treatment of a solid cancer and adjuvant treatment of cancer, most commonly (or at least the stories I see most often) for breast cancer. Basically, the patient usually undergoes surgery, but eschews chemotherapy and and sometimes radiation therapy too. The key to understanding these testimonials is to understand that surgery cures most early stage breast cancer, with the radiation decreasing the chances of the tumor recurring in the breast and the chemotherapy decreasing the chances of the tumor recurring elsewhere. It's a sort of testimonial I've explained many times, beginning with <a href="http://oracknows.blogspot.com/2004/12/understanding-alternative-medicine.html">Suzanne Somers</a> and, later, <a href="http://scienceblogs.com/insolence/2010/09/28/the-testimonial-of-hollie-quinn-the-huff/">Hollie Quinn</a>. Notably, these stories tend not to turn out so well when the woman rejecting chemotherapy didn't undergo surgery first, as was the case with <a href="http://scienceblogs.com/insolence/2010/12/08/a-tale-of-two-victims-of-breast-cancer/">Kim Tinkham</a>.</p> <p>The second variety tends to include stories just like this First Nations girl, as well as children like the Amish girl <a href="http://scienceblogs.com/insolence/2014/03/12/reason-com-defends-the-medical-neglect-of-sarah-hershberger/">Sarah Hershberger</a>. These cases rest on the misunderstanding of the rationale for such long courses of chemotherapy in pediatric malignancies. For most pediatric tumors it takes a lot more than just a round or two of chemotherapy, a lesson painfully learned by pioneering pediatric oncologists back in the 1960s and 1970s. For the type of tumor that, for example, Sarah Hershberger has, lymphoblastic lymphoma, the duration of one standard <a href="http://www.cancer.gov/cancertopics/pdq/treatment/child-non-hodgkins/HealthProfessional/page7#Reference7.1">treatment</a> is <a href="http://www.ncbi.nlm.nih.gov/pubmed/10627444">two years</a>. For chemotherapy for pediatric hematologic malignancies, there are at least three phases. The induction phase is designed to put the patient into remission. <a href="http://www.wisegeek.com/what-is-consolidation-chemotherapy.htm">Consolidation chemotherapy</a> is given to patients who have gone into remission and is designed to kill off any residual cancer cells that might be present, thus increasing the chance of complete cure. <a href="http://www.cancer.net/all-about-cancer/cancernet-feature-articles/treatments-tests-and-procedures/explaining-maintenance-therapy">Maintenance chemotherapy</a> is the ongoing, longer term use of chemotherapy to lower the risk of recurrence after a cancer has gone into remission. It's basically lower-dose chemotherapy given for two to three years to help keep the cancer from returning. In the case of the First Nations girl, who has lymphoblastic leukemia, the treatment <a href="http://www.cancer.gov/cancertopics/pdq/treatment/childALL/HealthProfessional/page4">would have involved at least three phases</a>: remission induction, consolidation/intensification, and maintenance lasting a similar amount of time.</p> <p>But what about Daryl Archie? What kind of story is his? Let's see if you can figure it out before I explain it:</p> <blockquote><p> Archie, a 47-year-old from Big Grassy River First Nation, was diagnosed with leukemia when he was 19 years old. He was sent to Winnipeg for chemotherapy where he said doctors gave him a 50/50 chance of survival. (Doctors for the 11-year-old in southern Ontario said she had an 80 to 85 per cent chance of survival with chemotherapy.)</p> <p>"Some of those medical treatments they do are pretty painful. They stick a big needle into your hip bone for marrow with no pain killers at all," Archie said, recalling that the chemotherapy drugs made him feel "antsy and anxious."</p> <p>"Eventually I got tired of the drugs and all those needles."</p> <p>After about six months of what he called unsuccessful treatments, Archie left Winnipeg. "I guess I felt like I'd just go home and, I don't know," he said, his voice trailing off. "I wondered why is this happening to me?" </p></blockquote> <p>First of all, it's important to note that this was 28 years ago, and that chemotherapy for leukemia in the 1980s was not as effective as it is now. Second, Archie had six months of chemotherapy. He called them "unsuccessful," but it's unclear what he meant by that. Was the tumor still present? We don't know. Was the treatment unsuccessful because it caused side effects that Archie had problems dealing with it? Again, we don't know. However, if you listen to the interview accompanying this story, you'll learn that Archie described himself as being tired of the chemotherapy and tired of the needles, as well as depressed. So he left and went home without telling his doctors that was his plan.</p> <p>Most likely what happened, though, is that Archie had undergone the first part of his chemotherapy, had a good response, and was one of those fortunate enough not to recur after incomplete chemotherapy without consolidation therapy. Then, as so many breast cancer patients do after surgery and as Sarah Hershberger did after only induction chemotherapy, about a month after he went home Archie undertook ineffective "alternative" treatment, in his case, a traditional medicine man healer named Eddie Two-Teeth. This healer, according to the article, told him Archie that there was a 100% chance that he could cure his leukemia. Not bad, eh? Particularly when conventional medicine, if Archie's story is to be believed, only offered an approximately 50% chance of survival. So this is what happened:</p> <blockquote><p> He travelled to Roseau River First Nation in Manitoba and took part in traditional Anishnawbe ceremonies like the sweat lodge and shaking tent and was introduced to a healer named Eddie Two-Teeth from Montana. Two-Teeth conducted more ceremonies and Archie travelled with him to the United States.</p> <p>"He gave me some medicine, it was a small tree and he told me to wrap it in a circle (it was about six to eight inches across) and to boil that and drink the water from there and to drink it for 30 days," Archie said.</p> <p>The healer told him to keep a positive attitude and when the 30 days were up to go to a doctor for a blood test.</p> <p>"So I did and my doctor, after the test came back, he told me my blood was just as good as his," Archie said. "So that told me I was rid of the leukemia." </p></blockquote> <p>So did Eddie Two-Teeth cure Daryl Archie? Almost certainly not. Prayer and sweat lodges do not cure leukemia, nor is it likely that any plant products used by a healer like Two-Teeth would cure leukemia. Again, what most likely happened is that chemotherapy cured Archie, and that, as do so many people who choose quackery after an incomplete course of conventional therapy actually cured them.</p> <p>What is truly annoying and disturbing is how this story was written; i.e., with complete credulity:</p> <blockquote><p> Archie said he has remained healthy in the decades since he was cured.</p> <p>He's not sure why traditional medicine worked for him when chemotherapy didn't.</p> <p>"I did believe in the traditional ways, because Eddie Two-Teeth gave me a 100 per cent chance of survival from leukemia. He gave me confidence and hope that Western medicine didn't," he said.</p> <p>"With traditional medicine, it's with the help of the Creator and with Western medicine it's all just all chemicals and drugs that they put into your body. With the ceremonies, the Creator is right there. They don't even talk about that in the hospital." </p></blockquote> <p>Nowhere in the article is any significant challenge to Archie's claims. The closest the author comes is to mention the First Nations girl who was at the center of the legal action last month and <a href="Makayla Sault">Makayla Sault</a>, another First Nations girl treated by Clement who has since relapsed and, at last report, was in bad shape. Jody Porter, the woman interviewing Archie, even asked him, as above, "Why do you think traditional medicine worked for you when Western medicine didn't?" That is, of course, completely the wrong question to ask, because there is no convincing (or even mildly compelling) evidence in Archie's story that traditional medicine did anything for his leukemia. It's yet another example of someone who chose woo instead of real medicine after having undergone considerable treatment with real medicine and attributed his good fortune of surviving to the woo instead of the conventional medicine.</p> <p>Even worse, this story serves as an intentional bit of propaganda for traditional healing for cancer. Near the end of the article, at least, Archie acknowledges that <a href="http://scienceblogs.com/insolence/2013/12/20/when-false-hope-leads-well-meaning-people-astray/">Brian Clement</a>, the <a href="http://scienceblogs.com/insolence/2014/11/17/an-ontario-court-dooms-a-first-nations-girl-with-cancer/">quack who is treating the First Nations girl</a>, is <a href="http://scienceblogs.com/insolence/2014/11/18/an-ontario-court-dooms-a-first-nations-girl-with-cancer-whos-to-blame-2/">not using traditional medicine</a>. So he makes a pitch to the family to give up Clement's quackery and turn to the "healing" he used:</p> <blockquote><p> Archie is also concerned about the path the girls' parents have chosen.</p> <p>"I wish the parents would find and take their children to a real Anishnawbe traditional healer, not someone like this," he said. "I fear the children and others will die..."</p> <p>Archie said he felt confident about Eddie Two-Teeth's skills as a healer from talking to the people in Roseau River and hearing stories about people who were healed.</p> <p>"That kind of reinforced my belief in him," he said. </p></blockquote> <p>He's right. The First Nations girl whose case was decided last month, and particularly Makayla Sault, will almost certainly die of their disease because their parents chose quackery instead of effective medicine, and the tribal leadership who supported their decision and, indeed, used their decision to win a political victory against the government of Canada, will be complicit in their deaths. As I've explained many times before, I can understand why parents, seeing their children suffer through chemotherapy, can so easily be seduced by the lure of vile quacks like Brian Clement, who promise a cure without the side effects of chemotherapy. However, someone in the tribal leadership should have known better.</p> <p>Actually, I wouldn't be surprised if we see some more of these cases of aboriginal people with stories similar to that of Daryl Archie popping up in the media. The cases of this First Nations girl and Makayla Sault shined a bright, unflattering light on the quack chosen by their parents, Brian Clement, and how her case was used politically. The case of Daryl Archie is thus useful because it gives the impression that traditional medicine can actually cure leukemia, even though it can't. I'm sure Archie believes that it was the traditional medicine, and not the evil, poisonous "Western" chemotherapy that cured him. People who reject conventional therapy and choose alternative medicine are virtually always true believers, a belief that, thanks to their misunderstanding of what really cured them, seems to them to have been validated by their survival.</p> <p>That's the problem. Brian Clement might be a real quack preying on people under stress from dealing with their children's serious illness and struggle to get through chemotherapy, but those who promote these stories really do believe. That only makes them seem more credible to most people who don't understand cancer.</p> </div> <span><a title="View user profile." href="/oracknows" lang="" about="/oracknows" typeof="schema:Person" property="schema:name" datatype="">oracknows</a></span> <span>Thu, 12/04/2014 - 02:30</span> Thu, 04 Dec 2014 07:30:03 +0000 oracknows 21940 at https://scienceblogs.com The top of the Earth burns, makes Global Warming Worse https://scienceblogs.com/gregladen/2014/07/18/the-top-of-the-earth-burns-makes-global-warming-worse <span>The top of the Earth burns, makes Global Warming Worse</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><a href="http://scienceblogs.com/gregladen/category/climate/global_warming/">AGW</a> -&gt; <a href="http://scienceblogs.com/gregladen/2013/06/04/linking-weather-extremes-to-global-warming/">AA</a> -&gt; <a href="http://scienceblogs.com/gregladen/2013/09/28/global-warming-and-extreme-weather-climate-agw/">QR</a> -&gt; <a href="http://scienceblogs.com/gregladen/2013/09/28/global-warming-and-extreme-weather-climate-agw/">WW</a> -&gt; <a href="http://scienceblogs.com/gregladen/2013/06/13/is-global-warming-causing-more-and-bigger-fires-in-colorado/">WF</a> -&gt; <a href="http://climatecrocks.com/2014/06/22/dark-snow-project-why-we-are-here/">DS</a> -&gt; <a href="http://www.skepticalscience.com/earth-albedo-effect.htm">A-</a> -&gt; <a href="http://scienceblogs.com/gregladen/category/climate/climate_change/">AGW</a></p> <p>The great cycle of climate change. Anthropogenic Global Warming has resulted in a relatively increased warming of the poles, which changes the dynamic of jet streams forming thus causing quasi-ressonant (stuck in place) <a href="http://scienceblogs.com/gregladen/2013/09/28/global-warming-and-extreme-weather-climate-agw/">Rossby Waves</a> (curvy slow moving jet streams) which then fuels <a href="http://pauldouglasweather.com/just-thought-2014-couldnt-get-stranger-sweatshirt-weather-next-week/">Weather Whiplash</a> (or Weather Weirding if you prefer) which at the moment is causing unprecedented wild fires especially in Western Canada and Siberia, which causes a darkening of glacial surfaces in Greenland (Dark Snow) which decreases albedo which then contributes to both Arctic Amplification and Global Warming.</p> <p>It's happening now at your local planet. </p> <p>Here's some information about the fires, some older, some newer:</p> <li><a href="http://www.cnn.com/2014/07/18/us/washington-wildfires/index.html?hpt=hp_t2"><strong>Wildfires drive residents from homes in Washington state and Canada</strong></a></li> <li><a href="http://robertscribbler.wordpress.com/2014/07/17/polar-jet-stream-wrecked-by-climate-change-fuels-unprecedented-wildfires-over-canada-and-siberia/"><strong>Polar Jet Stream Wrecked By Climate Change Fuels Unprecedented Wildfires Over Canada and Siberia</strong></a></li> <li><a href="http://www.rawstory.com/rs/2014/07/17/forest-fires-in-canada-confirm-predictions-of-unprecedented-wildfire-activity/"><strong>Forest fires in Canada confirm predictions of ‘unprecedented’ wildfire activity</strong></a></li> <li><a href="http://www.rferl.org/content/siberian-forest-wildfires-triple-within-three-days/25398654.html"><strong>Siberian Forest Wildfires Triple Within Three Days</strong></a></li> <p>_________<br /> Photo from <a href="https://www.facebook.com/102519276560938/photos/pb.102519276560938.-2207520000.1405624912./503488213130707/?type=1&amp;theater">here</a>. </p> </div> <span><a title="View user profile." href="/author/gregladen" lang="" about="/author/gregladen" typeof="schema:Person" property="schema:name" datatype="">gregladen</a></span> <span>Fri, 07/18/2014 - 06:38</span> Fri, 18 Jul 2014 10:38:36 +0000 gregladen 33249 at https://scienceblogs.com Physician Administrative Costs in the US vs. Canada https://scienceblogs.com/thepumphandle/2011/08/12/physician-administrative-costs <span>Physician Administrative Costs in the US vs. Canada</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>The <a href="http://www.kff.org/insurance/snapshot/OECD042111.cfm">US spends far more per capita on healthcare</a> than any other developed country -- $7,538 per person, compared to $3,129 in the UK, $4,079 in Canada, and $5,003 in Norway (the second-biggest spender), according to 2008 totals compiled by the Kaiser Family Foundation. One contributor to our high healthcare costs is high administrative costs, which is the natural consequence of having hundreds of different insurance plans with different policies, networks, and rates. A <a href="http://content.healthaffairs.org/content/30/8/1443.abstract">new study in the journal Health Affairs</a> focuses on one aspect of administrative costs: the time physician practices spend interacting with payers. They surveyed US and Ontario practices and quantified just how much time and money the US proliferation of payers costs physicians.</p> <p>Canada has a single-payer system, while the US has a wide variety of insurance plans (as well as a large uninsured population). In theory, the proliferation of insurance plans fosters competition that can improve price and quality for plan members as the plans adjust benefit design and cost-sharing requirements. To control members' healthcare costs, plans often do the following kinds of things:</p> <!--more--><ul><li>Establish networks of physicians and negotiate payment rates with them</li> <li>Limit the number of visits covered in a calendar year (e.g., one physical per year, 40 therapy sessions, etc.)</li> <li>Require varying co-payments and/or co-insurance from patients, depending which providers they visit </li> <li>Establish drug formularies and/or tiered pricing structures that encourage the prescribing and purchasing of certain drugs and not others</li> <li>Limit coverage to visits and services based on the patient's diagnosis</li> <li>Require prior authorization for certain services and procedures</li> </ul><p>In some cases, these policies can actually contribute to the quality of patient care. Research has found that providers don't always deliver care that follows clinical guidelines; for instance, a <a href="http://www.nejm.org/doi/full/10.1056/NEJMsa022615">2003 study by Elizabeth McGlynn et al</a> examined medical records from consenting participants in 12 metropolitan areas and found that 11.3% of the participants "received care that was not recommended and was potentially harmful." If your physician is prescribing a drug or procedure that's not appropriate for your condition and has the potential to harm you, it might not be such a bad thing for someone to be denying coverage for it. Sometimes, of course, an insurer will deny something that might seem inappropriate to a non-expert with limited information, and the provider will then have to spend time going back and forth with the insurer to explain why it is, in fact, appropriate. (And getting these things resolved may take <a href="http://scientopia.org/blogs/thusspakezuska/2011/05/24/still-here-sort-of/">weeks of frustration</a>.)</p> <p>Insurance plans can also encourage the use of high-value care and discourage the use of low-value care through what's called <a href="http://www.sph.umich.edu/vbidcenter/award.html">value-based insurance design</a> -- basically, varying cost-sharing requirements based on how much a particular kind of care is likely to contribute to your health. For instance, a plan could reduce co-payments for hypertension or diabetes medication to encourage patients to control these conditions, and charge higher co-payments for MRIs ordered within the first six weeks after the onset of back pain. (Many cases of back pain resolve within six weeks, so MRIs aren't recommended until the pain has lasted beyond that time frame, unless there are other problematic symptoms like problems with urination.) </p> <p><strong>Interactions between physicians' offices and payers</strong><br /> In exchange for the potential cost-containment and quality benefits of having many different insurance plans, patients and providers pay for the complexity inherent in such a system. Many physician practices pay multiple staff people to do nothing but bill insurance companies and go back and forth about denials and authorizations. When providers want to prescribe a drug, give a referral, or order a test or procedure, they have to think about what the patient's insurance will cover and whether all the necessary requirements have been met. For instance, some insurers will only cover a branded drug or experimental treatment if a patient has tried other generic or standard therapies without success. If all the paperwork isn't filled out correctly, claims will be denied and someone from the doctor's office -- as well as the patient, in many cases -- will have to spend more time going back and forth with the insurer about it.</p> <p>Back in 2009, Lawrence Casalino and colleagues published <a href="http://content.healthaffairs.org/content/28/4/w533.abstract?ijkey=dd8f3e0321baaeb104c58ce41df102723889bb7e&amp;keytype2=tf_ipsecsha">a study in Health Affairs that quantified the cost</a> -- in both hours and dollars -- of physician practices' interactions with insurance plans. They surveyed physicians and administrators from physician practices of different sizes (excluding HMOs, hospital physicians, and those, like plastic surgeons, with many self-pay patients) about the minutes per typical day the practice's physicians, nursing staff, and clerical staff spent on specific categories of interaction with health plans: authorization, formulary, claims/billing, credentialing, contracting, and quality data. They excluded extreme outliers from their analysis, and to ensure that the survey was not capturing time spent interacting with Medicare and Medicaid they both asked respondents to report only time spent interacting with health plans and reduced the claims/billing time estimates by 38% (the percent of charges attributable to those payers).</p> <p>Their analysis of 895 completed surveys found the following average time spent interacting with health plans:</p> <ul><li><strong>Physicians:</strong> 43 minutes per day, or 3 hours per week (median: 28 minutes per day, 1.9 hours per week)</li> <li><strong>RNs, MAs, LPNs:</strong> 3.8 minutes per practice physician per day, or 19.1 hours per physician per week (median: 1.8 hours per day, 9.1 hours per week)</li> <li><strong>Clerical staff:</strong> 7.2 hours per physician per day, or 35.9 hours per week (median: 5.9 hours per day, 29.8 hours per week)</li> </ul><p>The large differences between the mean and median values suggests that several (fewer than half) of the respondents reported very large time expenditures, which increased the overall average but not the median -- and this was after extreme outliers had been trimmed. The authors note that average time expenditures were higher for primary-care physicians than for specialists, and physicians in solo or two-person practices spent significantly more time interacting with health plans than did their counterparts in practices with ten or more physicians.</p> <p>The authors converted that time into dollars and arrived at an average of $68,274 per physician per year interacting with health plans (median value: $51,043). They estimate that this works out to $31 billion each year spent on physician practices' interactions with health plans ($23.2 billion if you use the median value rather than the mean). This doesn't include other overhead costs (phone, fax, etc.) related to the interactions. More importantly, it doesn't include the health-plan-interaction costs of hospitals, which account for around 30% of US healthcare expenditures.</p> <p>Fast forward to 2011. Casolino and a slightly different group of colleagues (Dante Morra et al) have just published <a href="http://content.healthaffairs.org/content/30/8/1443.abstract">another study</a> in Health Affairs. They surveyed office-based physicians and administrators in Ontario (again, excluding hospital physicians and those with large numbers of self-pay patients) about how much time they spend interacting with payers. For comparability with the US results, they "report adjusted Canadian costs as if the Canadian physicians and staff were paid at US rates." They also created new estimates of US physician practices to include time spent interacting with Medicare and Medicaid, which were excluded from the 2009 results. Here are there results (only means were reported):</p> <ul><li>Canadian physicians: 2.2 hours per week</li> <li>US physicians: 3.4 hours per week</li> <li>Canadian nursing staff: 2.5 hours per week</li> <li>US nursing staff: 20.6 hours per week</li> <li>Canadian clerical staff: 15.9 hours per week</li> <li>US clerical staff: 53.1 hours per week</li> </ul><p>When the researchers adjusted Ontario costs to US salary rates, they concluded that <strong>Ontario practices spend $21,335 per physician on interacting with payers, compared to $82,975 in the US</strong>.</p> <p>In both articles, the authors point to some limitations, including the fact that the data come from surveys rather than from direct observation, and that the practices that chose to respond to the surveys might have been those who spent more time on payer interactions. It's possible that the gap between US and Canadian practices' time spent interacting with payers is smaller than what this study found -- but it's also possible that it's larger. </p> <p>Are the actual and potential benefits of having many competing health insurance plans worth spending nearly four times as much Canada's single-payer system does on this one component of administrative costs alone?</p> <p><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.jtitle=Health+Affairs&amp;rft_id=info%3Adoi%2F10.1377%2Fhlthaff.2010.0893&amp;rfr_id=info%3Asid%2Fresearchblogging.org&amp;rft.atitle=US+Physician+Practices+Versus+Canadians%3A+Spending+Nearly+Four+Times+As+Much+Money+Interacting+With+Payers&amp;rft.issn=0278-2715&amp;rft.date=2011&amp;rft.volume=30&amp;rft.issue=8&amp;rft.spage=1443&amp;rft.epage=1450&amp;rft.artnum=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fdoi%2F10.1377%2Fhlthaff.2010.0893&amp;rft.au=Morra%2C+D.&amp;rft.au=Nicholson%2C+S.&amp;rft.au=Levinson%2C+W.&amp;rft.au=Gans%2C+D.&amp;rft.au=Hammons%2C+T.&amp;rft.au=Casalino%2C+L.&amp;rfe_dat=bpr3.included=1;bpr3.tags=Health">Morra, D., Nicholson, S., Levinson, W., Gans, D., Hammons, T., &amp; Casalino, L. (2011). US Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers <span style="font-style: italic;">Health Affairs, 30</span> (8), 1443-1450 DOI: <a rev="review" href="http://dx.doi.org/10.1377/hlthaff.2010.0893">10.1377/hlthaff.2010.0893</a></span></p> <p><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.jtitle=Health+Affairs&amp;rft_id=info%3Adoi%2F10.1377%2Fhlthaff.28.4.w533&amp;rfr_id=info%3Asid%2Fresearchblogging.org&amp;rft.atitle=What+Does+It+Cost+Physician+Practices+To+Interact+With+Health+Insurance+Plans%3F&amp;rft.issn=0278-2715&amp;rft.date=2009&amp;rft.volume=28&amp;rft.issue=4&amp;rft.spage=0&amp;rft.epage=0&amp;rft.artnum=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fdoi%2F10.1377%2Fhlthaff.28.4.w533&amp;rft.au=Casalino%2C+L.&amp;rft.au=Nicholson%2C+S.&amp;rft.au=Gans%2C+D.&amp;rft.au=Hammons%2C+T.&amp;rft.au=Morra%2C+D.&amp;rft.au=Karrison%2C+T.&amp;rft.au=Levinson%2C+W.&amp;rfe_dat=bpr3.included=1;bpr3.tags=Health">Casalino, L., Nicholson, S., Gans, D., Hammons, T., Morra, D., Karrison, T., &amp; Levinson, W. (2009). What Does It Cost Physician Practices To Interact With Health Insurance Plans? <span style="font-style: italic;">Health Affairs, 28</span> (4) DOI: <a rev="review" href="http://dx.doi.org/10.1377/hlthaff.28.4.w533">10.1377/hlthaff.28.4.w533</a></span></p> </div> <span><a title="View user profile." href="/author/lborkowski" lang="" about="/author/lborkowski" typeof="schema:Person" property="schema:name" datatype="">lborkowski</a></span> <span>Fri, 08/12/2011 - 04:00</span> <div class="field field--name-field-blog-categories field--type-entity-reference field--label-inline"> <div class="field--label">Categories</div> <div class="field--items"> <div class="field--item"><a href="/channel/medicine" hreflang="en">Medicine</a></div> </div> </div> Fri, 12 Aug 2011 08:00:49 +0000 lborkowski 61343 at https://scienceblogs.com Not Leaving the US, Waiting to Be Annexed https://scienceblogs.com/casaubonsbook/2010/11/30/not-leaving-the-us-waiting-to <span>Not Leaving the US, Waiting to Be Annexed</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>This morning four guys in camo and rifles were walking up my road at 6am, which means one of two things. Either it is Deer Season, or Canada has invaded. And that's the real reason I'm not leaving the US - I've pinned my hopes on the conquest of upstate New York by Canada, who will ruthlessly impose national health care and better beer upon us.</p> <p>Of course, back in the 1990s, Saturday Night Live already speculated on what a nation called "Amerida" might look like. (H/T to Edson for the video!)</p> <object style="height: 390px; width: 640px"><param name="movie" value="http://www.youtube.com/v/qGQuRDjo7TI?version=3" /><param name="allowFullScreen" value="true" /><param name="allowScriptAccess" value="always" /><embed src="http://www.youtube.com/v/qGQuRDjo7TI?version=3" type="application/x-shockwave-flash" allowfullscreen="true" allowscriptaccess="always" width="640" height="390"></embed></object><p> I'm there already in my mind!</p> <p>Sharon</p> </div> <span><a title="View user profile." href="/author/sastyk" lang="" about="/author/sastyk" typeof="schema:Person" property="schema:name" datatype="">sastyk</a></span> <span>Tue, 11/30/2010 - 05:16</span> Tue, 30 Nov 2010 10:16:49 +0000 sastyk 63542 at https://scienceblogs.com