La contraception chez les adolescents canadiens

Les adolescentes devraient choisir le stérilet avant la pilule, dit la Société canadienne de pédiatrie

Les craintes liées à l’utilisation du stérilet sont des vestiges du siècle dernier, expliquent les pédiatres.

Résumé

Chez les adolescents, la santé sexuelle et reproductive est un aspect important des soins de santé complets. Le présent document de principes fournit des conseils afin de sélectionner des contraceptifs à l’intention des adolescentes et de leur en prescrire, y compris les contraceptifs hormonaux courants (pilule, timbre, anneau et progestatif injectable) et les contraceptifs réversibles à longue durée d’action (CRLDA).

Tel qu’on les utilise habituellement, les CRLDA, qui incluent les implants sous-cutanés (non offerts au Canada) et les contraceptifs intra-utérins, sont beaucoup plus efficaces que les contraceptifs hormonaux.

Le présent document de principes recommande les CRLDA comme contraception de première intention chez les adolescentes canadiennes, tout en soulignant que les dispensateurs de soins doivent collaborer avec les jeunes dans le choix d’un moyen de contraception que celles-ci trouvent acceptable, sécuritaire, efficace et pratique. Des stratégies sont proposées pour éliminer les obstacles à l’adoption et au maintien de la contraception.

Référence. Interview HuffPost Québec. Image Ben White.

How can biomonitoring be used by communities impacted by fracking ?

Fracking and Health: Ask an Expert, with Dr. Elyse Caron-Beaudoin, 2018

Dr. Elyse Caron-Beaudoin, postdoctoral fellow in the University of Montreal School of Public Health gives practical tips for designing research studies to measure chemicals in the bodies of people living near fracking.

Dr. Elyse Caron-Beaudoin also discusses how biomonitoring data can support efforts to protect public health.

Abstract

Background
Northeastern British Columbia (Canada) is an area of intense hydraulic fracturing for unconventional natural gas exploitation. There have been multiple reports of air and water contamination by volatile organic compounds in the vicinity of gas wells. Although these chemicals are known developmental toxicants, no biomonitoring effort has been carried out in the region.

Objective
To evaluate gestational exposure to benzene and toluene in the Peace River Valley, Northeastern British Columbia (Canada).

Methods
Urine samples were collected over five consecutive days from 29 pregnant women. Metabolites of benzene (s-phenylmercapturic acid (S-PMA) and trans, trans-muconic acid (t,t-MA)) and toluene (s-benzylmercapturic acid (S-BMA)) were measured in pooled urine samples from each participant. Levels of benzene metabolites were compared to those from the general Canadian population and from a biomonitoring study of residents from an area of active gas exploitation in Pavillion, Wyoming (USA). Levels measured in participants from the two recruitment sites, and self-identifying as Indigenous or non-Indigenous, were also compared.

Results
Whereas the median S-PMA level (0.18 μg/g creatinine) in our study was similar to that in the general Canadian population, the median t,t-MA level (180 μg/g creatinine) was approximately 3.5 times higher. Five women had t,t-MA levels above the biological exposure index® proposed by the American Conference of Governmental Industrial Hygienists. The median urinary S-BMA level in our pilot study was 7.00 μg/g creatinine. Urinary metabolite levels were slightly higher in self-identifying Indigenous women, but this difference was only statistically significant for S-PMA.

Discussion
Urinary t,t-MA levels, but not S-PMA levels, measured in our study are suggestive of a higher benzene exposure in participating pregnant women from the Peace River Valley than in the general Canadian population. Given the small sample size and limitations of t,t-MA measurements (e.g., non-specificity), more extensive monitoring is warranted.

The New War on Cancer

50-Year War on Cancer: Can We Win?

The signing of the National Cancer Act by President Richard M. Nixon on December 23, 1971, was considered a declaration of war on cancer.

In a multi-part series, the National Post explores why we need a new war on cancer.

Cancer nation

Where you live could affect your odds of getting cancer or dying from it.

Interactive map: Cancer is an indiscriminate disease, affecting rich and poor, old and young. Still, Canadians’ odds of getting sick depend surprisingly on where they live.

Why we need a new war on cancer

Over-treating and over-screening is doing patients more harm than good

The issue: Advances in screening and diagnosis are sending some cancer patients down aggressive treatment paths that they shouldn’t be on.
The solution: A new war on cancer and a rethinking of resources.

Drug money

Some cancer treatments cost as much as $33,000 a month, but fall well short of being wonder cures

A Post analysis of 17 cancer drugs that cost between $4,700 and $33,000 a month reveals only three had evidence that they extended lives when approved by Health Canada.

Bankrupt by cancer

Cancer is not just a life-threatening disease ― but a financial disaster.

In Canada, a country that prides itself on looking after the sick, no matter their ability to pay, Canadians are declaring bankruptcy because of cancer.

The fundraising complex

Of the $2.7 billion that cancer charities spent in 2013, only 45 per cent went towards fighting cancer.

The Post’s analysis of cancer funding reveals the depth of inefficiencies in the sector. In 2013, more than half of total funds went to salaries and overhead.

Learning to live with cancer

As science gets better at controlling cancer for longer periods of time, it might be best to kill the battle rhetoric

Nowhere else in medicine is the battle rhetoric more entrenched than in cancer. And its defeating people. Who wants to go war with their own bodies?

Prevention as the ultimate cure

Prevention saves more lives than any cancer drug

However, in the multi-billion-dollar cancer business, efforts to stop people from contracting the illness account for as little as five per cent of what’s spent.

Glyphosate found in one third of food products in Canada

A third of Canada food samples tested contain residue of controversial pesticide

2017 Study Abstract

Introduction

Chemical hazards may occur in foods either from their deliberate use in food production (e.g. veterinary drugs, pesticides, food additives) or by accidental contamination from the environment, during processing, or due to the presence of natural toxins. Regardless of the source of the hazard, food producers, manufacturers and importers must ensure their products are safe to eat and compliant with applicable Canadian standards. The Canadian Food Inspection Agency‘s (CFIA) priority is to protect consumers by safeguarding Canada’s food supply. Testing foods for pesticides is one of the tools used by the CFIA to detect food safety risks and ensure that the food supply is safe.

Glyphosate Testing

Objective and Rationale
Glyphosate is an herbicide that is used to kill weeds and it can also be used to dry grains and legumes before harvesting. Health Canada has approved its use on a variety of crops and has set Maximum Residue Limits (MRL) for residues of glyphosate in foods which can be found in their MRL Database. The MRL is the amount of pesticide residue that is expected to remain in or on a food product when a pesticide is used according to the label directions and which will not be a concern to human health.

These testing activities were designed to:

  • generate information on the presence and levels of glyphosate residues in foods;
  • verify the safety of the food supply and compliance with Canadian standards.

Sample Collection
Testing for Glyphosate residues was added to the CFIA’s food surveillance program in 2015. In 2015-2016, 3188 samples of domestic and imported food products were collected and tested for glyphosate residues in three programs:

  • Testing of 482 samples of fresh and processed fruits and vegetables as part of the National Chemical Residue Monitoring Program (NCRMP);
  • Retail survey of 2497 samples of grains (barley, buckwheat, and quinoa), beverages, bean, pea, lentil, chickpea and soy products;
  • A survey of over 209 retail samples of infant foods as part of the 2015-2016 Children’s Food Project.

Limitations
Due to the low number of samples and products analyzed, care must be taken when interpreting these results. Regional differences, impact of product shelf-life, storage conditions, or cost of the commodity on the open market were not examined in this survey.
Samples were tested as sold; no inference can be made on the levels of glyphosate in foods as consumed.

Results
The overall compliance rate for these surveys, based on Canadian Maximum Residue Limits (MRL), was 98.7 %. No samples of fruits and vegetables, soy products, or infant foods were found to contain residues exceeding Canadian limits. Most samples found with levels of residues exceeding Canadian limits were predominantly associated with grain products.

Summary
In 2015-2016, the CFIA tested a total of 3,188 food samples for glyphosate. Glyphosate was found in 29.7% of samples. Glyphosate residues above MRLs were found in only 1.3% of samples. This data was evaluated by Health Canada and no human health concerns were identified.

Sources and More Information

  • Safeguarding with Science: Glyphosate Testing in 2015-2016, CFIA- Science Branch Survey Report, Food Safety Science Directorate, Canadian Food Inspection Agency, 04.2017.
  • Nearly a third of food samples in CFIA testing contain glyphosate residues, CBC News, Apr 13, 2017.

Stilbestrol for veterinary use

0.5 mg and 1.0 mg DES tablets manufactured by Ormond Veterinary Supply Inc., Canada

image of stillbestrol
Stilbestrol Tablets manufactured by Ormond Veterinary Supply Inc., Canada.

DES was sold under many names including Distilbène®, Stilbetin®, Stilboestrol-Borne®, Benzestrol®, Chlorotrianisene®, Estrobene® and Estrosyn® to name just a few.

Many different companies manufactured and marketed this drug under more than 200 different brand names.

These Stilbestrol tablets – 0.5 mg and 1.0 mg – are manufactured at Ormond Veterinary Supply Inc. facility, Canada.

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Deadly prescription opioid epidemic must be stopped

By Dr. David Juurlink, Professor and head, Division of Clinical Pharmacology, University of Toronto

This post content is published by Troy Media – an editorial content provider to over 1,800 print and online media outlets within Canada.

An estimated 10,000 to 20,000 Canadians have died from opioids since 1995, and an untold number now suffer from addiction. Image Javier Maria Trigo.

By Dr. David Juurlink, Professor and head, Division of Clinical Pharmacology, University of Toronto

Dear Minister Jane Philpott,

Congratulations on your appointment as minister of Health. As an experienced physician, you bring valuable perspective to the post. While there are many contentious matters before you, including a new health accord, physician-assisted dying and marijuana legalization, few could be more pressing than the prescription opioid epidemic. It is an issue all but ignored by your predecessors but it is the greatest drug safety crisis Canada has ever faced.

When you returned to Canada in 1998 after nearly a decade of practice in Africa, you witnessed the seeds of this epidemic being sown, with strong painkillers like OxyContin prescribed liberally for chronic back pain, arthritis and fibromyalgia. You heard experts say these drugs worked well for chronic pain, that the risk of addiction was low, and that doctors who resisted prescribing them were “opiophobic.” Perhaps you even began prescribing opioids for chronic pain, as did I and thousands of our colleagues, unaware that what we had been told was untrue.

It’s clear now that we were objects in an elaborate marketing effort. Cloaked as it was in the virtues of compassion and beneficence, it was a remarkable success – until, that is, we considered our patients. Today, doctors’ offices are inundated with people who have been harmed more than helped by these drugs. Thousands more are dead. No demographic has been spared. And yet the marketing continues, with pain specialists and advocacy groups opposing moves to curtail opioid prescribing, their efforts financed by the very companies that make these drugs. These forces, coupled with the societal expectation that pain be medicated, threaten every community in this country.

An estimated 10,000 to 20,000 Canadians have died from opioids since 1995, and an untold number now suffer from addiction. The federal government must take the lead in dealing with this crisis, rather than offloading responsibility to the provinces. I propose several concrete measures to that end. Some are squarely within your purview; others will require provincial co-operation.

We must quantify the toll of the epidemic. In the United States, more than 16,000 people die of opioids each year; remarkably, there are no corresponding data for Canada. We can’t fix what we don’t even measure. The Public Health Agency of Canada should work with provinces to develop mechanisms to quantify opioid-related deaths. These numbers should be public.

Prescription monitoring programs should connect pharmacies in real time, in part to identify the small but important subset of patients seeking prescriptions for misuse or resale. These systems can also identify physicians whose prescribing falls afoul of good practice or, in some instances, the law. In an era when teens on different continents play video games in real time, it’s absurd that pharmacies in the same town operate in isolation.

Some measures involve specific drugs. Eliminate non-prescription codeine products from Canadian pharmacies. These are poor analgesics prone to abuse at high doses, resulting in deaths from acetaminophen and ASA toxicity. Revoke approval for generic OxyContin tablets, which are easily crushed and disproportionately benefit the dealers who sell them. The popular painkiller tramadol is increasingly abused and should be reclassified as a controlled substance, as its pharmacology demands and as Health Canada contemplated in 2007 before being lobbied by Purdue Pharma. Finally, treatment with fentanyl – an especially dangerous drug – should be restricted to patients willing to return used patches for new ones.

People with opioid addiction need more support and less marginalization. They require greater access to addiction specialists and medications like buprenorphine, along with supervised injection sites for those who choose this path. These save lives, as does the antidote naloxone, which should be freely available to anyone who wants it. Health Canada’s review of naloxone, inexcusably glacial, must be accelerated.

Finally, the government should introduce legislation akin to America’s Sunshine Act, illuminating the financial relationships between pharmaceutical companies and doctors, specialty organizations and advocacy groups. The money here flows in one direction, its sole purpose to increase drug sales. This initiative, sure to be opposed, will necessitate provincial co-operation.

Some of these suggestions are more easily implemented than others, but all warrant your consideration. With more than a hundred Canadians dying every month, there is no time to waste.

© 2015 Distributed by Troy Media

Class-action lawsuit in Canada about Zofran morning sickness drug use in pregnancy

Woman, whose daughter died at 14 months, sues GSK over drug she took while pregnant

Zofran image
Woman, whose daughter died at 14 months, sues GSK and Novartis over Zofran drug she took while pregnant.

Nov 27, 2015 – CALGARY – The makers of an anti-nausea drug prescribed to pregnant women for morning sickness are being sued for $11-million by an Alberta woman whose daughter died 10 years ago.

In 2012, the US Department of Justice announced that GlaxoSmithKline, maker of Zofran, would pay more than $1 billion to settle claims that it illegally marketed Zofran and other medications for off-label, unapproved uses. Specifically, GlaxoSmithKline allegedly “promoted certain forms of Zofran, approved only for post-operative nausea, for the treatment of morning sickness in pregnant women.” Although doctors are free to prescribe Zofran for off-label use, it is illegal for a drug company to market its medications for unapproved uses.

Sources and more information

  • Woman, whose daughter died at 14 months, sues GSK over drug she took while pregnant, cnews, Nov 27, 2015.
  • Zofran Birth Defects, lawyersandsettlements, Feb-3-15.

Maternal and fetal exposure to pesticides associated to genetically modified foods

Toxic pesticides from GM food crops found in unborn babies

Pesticides-associated-to-genetically modified foods image
Toxic pesticides which are implanted into genetically modified food crops have lodged in the blood of pregnant women and their unborn babies, 2011 research showed. The research suggested the chemicals were entering the body through eating meat, milk and eggs from farm livestock which have been fed GM corn. The findings appeared to contradict the GM industry’s long-standing claim that any potentially harmful chemicals added to crops would pass safely through the body.

2011 Study Abstract

Pesticides associated to genetically modified foods (PAGMF), are engineered to tolerate herbicides such as glyphosate (GLYP) and gluphosinate (GLUF) or insecticides such as the bacterial toxin bacillus thuringiensis (Bt). The aim of this study was to evaluate the correlation between maternal and fetal exposure, and to determine exposure levels of GLYP and its metabolite aminomethyl phosphoric acid (AMPA), GLUF and its metabolite 3-methylphosphinicopropionic acid (3-MPPA) and Cry1Ab protein (a Bt toxin) in Eastern Townships of Quebec, Canada. Blood of thirty pregnant women (PW) and thirty-nine nonpregnant women (NPW) were studied. Serum GLYP and GLUF were detected in NPW and not detected in PW. Serum 3-MPPA and CryAb1 toxin were detected in PW, their fetuses and NPW. This is the first study to reveal the presence of circulating PAGMF in women with and without pregnancy, paving the way for a new field in reproductive toxicology including nutrition and utero-placental toxicities.

More information
  • Maternal and fetal exposure to pesticides associated to genetically modified foods in Eastern Townships of Quebec, Canada, NCBI PMID: 21338670, 2011 May.
    Full study PDF.
  • GM food toxins found in the blood of 93% of unborn babies, MailOnline, 20 May 2011

Dr Frances Oldham Kelsey: 20th-century American heroine for her role in the Thalidomide case

Frances Oldham Kelsey, F.D.A. stickler who saved U.S. babies from Thalidomide, dies at 101

Dr-Frances-Oldham-Kelsey
Dr Frances Oldham Kelsey, the Canadian doctor who played a central role in preventing the drug thalidomide being distributed in the US, has died at 101. Image of Kelsey with President John F. Kennedy signing the 1962 Drug Amendments (FDA051) by the The U.S. Food and Drug Administration.

A Londoner who’s kept the scourge of thalidomide out of the United States has died, leaving behind a legacy of achievement that made her a heroine south of the border.

In 1962, President John F. Kennedy awarded Kelsey the highest honour given to a civilian in the U.S., the President’s Award for Distinguished Federal Civilian Service. Kelsey was only the second woman to receive the award. The new laws would pass and Kelsey would play a leading role giving them force.

Dr Frances Kelsey spent her final years here with family after a trail-blazing career that once led the Baltimore Post-Examiner to call her America’s greatest living heroine.

Sources and more information
  • Frances Oldham Kelsey, F.D.A. Stickler Who Saved U.S. Babies From Thalidomide,
    Dies at 101
    , NYtimes, AUG. 7, 2015.
  • Frances Oldham Kelsey – a true American hero turns 100,
    Baltimore Post-Examiner, July 26, 2014.
  • America’s Greatest Living Heroine Frances Oldham Kelsey – 98 and forgotten,
    Baltimore Post-Examiner, February 11, 2013.
  • Thalidomide and the 1962 Kefauver-Harris Drug Amendments, FDA.
  • About the life and work of Dr. Kelsey: Autobiographical Reflections, FDA.

B.C. Ministry of Health hires back fired UBC Drug Researcher

BC Ministry of Health re-hires consultant on evidence-based evaluation. A two-year controversy that derailed pharma safety probes sees partial resolution

A two-year controversy that derailed pharma safety probes sees partial resolution

BC Ministry of Health re-hires consultant on evidence-based evaluation. A two-year controversy that derailed pharma safety probes sees partial resolution.
image via Province of British Columbia

The B.C. Ministry of Health took a step today towards resolving an independent drug research controversy by announcing the re-appointment of Dr. Malcolm Maclure, Professor and B.C. Chair of Patient Safety in the Department of Anesthesiology, Pharmacology and Therapeutics at UBC, as a research consultant.

  • Compensation unknown
  • Safety research put on hold
  • Access remains dismal: investigator
  • More accountability needed: experts
  • Ministry responsible for data breaches: report

Read Fired UBC Drug Researcher Rehired, Drops Lawsuit,
by Paul Webster, TheTyee, News, 18.07.2014.

More Information
  • B.C. Health Ministry hires back fired drug researcher,
    Times Colonist, News, July 18, 2014.
  • Ministry of Health hires consultant on evidence-based evaluation,
    Gov.BC, NewsRoom, July 17, 2014.
  • Research Stopped by Ministry Might Have Cut Big Pharma Profits,
    TheTyee, News, 8 Sep 2012.