How ironic that Québec, the most Roman Catholic province in Canada, is proposing progressive legislation for Alzheimer’s patients.
It’s time for other Canadian provinces and American states to show similar humanity.
Québec’s Health Minister, Christian Dubé, has tabled Bill 38 that would allow patients with severe Alzheimer’s disease to receive an assisted death by allowing written consent to be given before they are mentally and physically incapable of doing so.
Under the proposed rules, a doctor would have to be certain that the patient was requesting death without pressure from any other people. Moreover, patients would be able to reverse this request at any time including at the time of the procedure.
To provide extra precaution, the patient must choose a trusted third party to act on their behalf at the appropriate time.
As long-time readers know, this column has been fighting for a more common-sense approach to MAID (medical assistance in dying) for years.
Current laws across North America ignore so much suffering. The Canadian law is so poorly conceived that it is hard to imagine how it has lasted so long without revision. It allows Alzheimer’s patients to ask for MAID while being mentally coherent and to sign the needed legal documents. But as the disease progresses and patients lose capacity, the request become void.
Any reasonable person would acknowledge the inadequacy.
Alzheimer’s patients need an advanced directive or an advance request for MAID that will be legally valid after their health has deteriorated.
Readers can understand the frustration for Alzheimer’s patients who wish to access MAID. But despite extensive efforts by the medical community and advocates, Canada’s elected Members of Parliament and Senators have not resolved the issue.
Those having read this column for years may recall the suggestions that the Government of Canada be replaced by taxicab drivers, garbage collectors, or veterinarians! The people in these professions have ample common sense. They would change the law in 24 hours.
But it is not only politicians that have fought against access to MAID for Alzheimer’s patients. Ethicists, moralists, and religious people who believe that “only God can decide on life and death” are also responsible. While 80 percent of the population agrees with proposed changes to the legislation, the minority conspire to block access by any and all.
Yet the concerns of this minority can be addressed. First, to be clear, MAID is only an option for those who actively request it. It cannot be imposed on anyone. But if those who are opposed would like to do so, they are free to sign an affidavit stating that they wish never to participate in MAID. But instead, they blow bullhorns. And those in need of assistance languish.
There is something lost in today’s digital society when decisionmakers lack connection to the people. Gone are the days when readers responded to a call for better legislation with thousands upon thousands of handwritten letters. But it is impossible to forget reading those personal stories of anguish on stationary where tear marks lingered. And politicians had to respond when one such campaign, for the legalization of heroin to ease the pain of terminal cancer patients, resulted in 40,000 letters on the health minister’s desk.
Now it’s time for the rest of Canada to replicate this same Quebec legislation.
Congratulations to Québec’s Minister of Health, Christian Dubé and to Dying with Dignity Canada for continuing efforts to achieve access to MAID. For Alzheimer’s patience wishing MAID, let’s facilitate the dignity of a peaceful end of life, just as the law now allows for others.
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The short answer is yes – cancer and other health problems too. Artificial Intelligence (AI) is a game-changer. Not only can this rapidly advancing technology improve the speed and accuracy of disease diagnosis and treatment, it has enormous potential to predict health problems, allowing for far more effective prevention programs that target at-risk populations.

Take, for example, children born with congenital heart defects. This fate currently falls to about 40,000 babies born in the U.S. each year, and about 1.35 million newborns worldwide. What causes defective heart structures in the developing embryo is open to debate. But genetics, diet, environment, medications, and smoking are all on the list.

But what if AI could analyse vast quantities of data and learn from patterns to predict a problem pregnancy even before conception? Neonatal cardiac surgeons are studying this possibility, in hopes of putting themselves out of a job. Instead of time in operating rooms, they are designing educational programs and delivering nutritional supplements to would-be mothers most as risk.

What exactly is AI? And how does it work?

Artificial intelligence refers to computer programs, or algorithms, that use data to make decisions or predictions. To build an algorithm, scientists instruct computers to follow a set of rules in the analysis of data. In machine learning (ML), an algorithm teaches itself how to analyze data and interpret patterns. With exposure to vast amounts of data, learning and interpretation improves.

The question becomes, to what extent can the decisions being made be trusted?
 
Dr. Hugo Aerts, Director of the Artificial Intelligence in Medicine Program at Brigham and Women’s Hospital in Boston, says, “AI can automate assessments and tasks that humans currently can do but take a lot of time.”

Scientists are developing AI tools that use screening images like mammograms to predict risk of developing cancer. To date, doctors used such images to detect if cancer is already present. Due to variation in the skill-level and experience of radiologists, results are highly subjective.

Aerts notes that relying on “a human making an interpretation of an image—say, a radiologist, a dermatologist, a pathologist —that’s where we see enormous breakthroughs being made.”

In 2018, an AI tool hit the news by outperforming 58 international dermatologists in the diagnosis of skin cancer, missing fewer melanomas and misdiagnosing fewer benign moles. AI models have shown impressive precision in identifying lung, breast, thyroid, prostate, and blood-related cancers.

With AI, medical professionals can cut costs, expedite clinical decision-making and significantly reduce wait times.

But despite these successes and benefits, there is reason to be skeptical about early computer models as stand-alone tools for screening cancers or predicting the onset of other diseases. One model, for example, was found to raise alarms not in accordance with the patients’ conditions but with the location where imaging equipment was used.

Yet, scientists are honing the instructions given AI tools by validating results against well known, trusted data. For example, the Framingham Heart Study has been collecting data from a large population cohort for over 70 years. This data provides an opportunity to assess AI findings against established records.

Will the technology become so astute that oncologists and pathologists become obsolete?

Not according to Dr. Olivier Michielin of University Hospital of Lausanne, Switzerland. “AI will enable oncologists, pathologists and other stakeholders to work more efficiently, it will not replace them,” he says.

But AI is undeniably improving the practice of medicine by having computers do what humans cannot – crunching huge amounts of data to expedite diagnosis and treatment. To what extent AI can help prevent disease remains to be seen.

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The global formula milk industry is huge and growing rapidly, at about US$55 billion and projected to reach US$110B by 2026. Aggressive and deceptive marketing by manufacturers is driving this growth. The World Health Organization (WHO) is ringing alarms. It charges the industry with using new digital marketing tactics to target pregnant women and new mothers with “personalized social media content that is often not recognizable as advertising.”
The Internet and smart phones are wonderful tools. But they can also be dangerous. Women have breastfed babies since the beginning of time. Animals thrive without Big Pharma. Human babies do too.
The WHO says the digital onslaught by industry reaches 2.47 billion people. The intention is to plant concerns in the minds of new mothers that their natural breastmilk is insufficient. They set out to convince new mothers that they’re nutritionally uneducated and irresponsible if they choose traditional breast milk.
Dr. Francesco Branca, Director of the WHO Nutrition and Food Safety department, goes on the offence. He says, “The promotion of commercial milk formulas should have been terminated decades ago.” He adds, “That formula milk companies are now employing even more powerful and insidious marketing techniques to drive up their sales is inexcusable and must be stopped.”
What are the natural benefits that breast milk has always given babies? For one, mother’s milk transfers antibodies to build immunity against infection.
Ameae Walker, Professor of Biomedical Science at UC Riverside School of Medicine, explains that copies of these cells will provide immunity to the baby for life. Breastfeeding protects mothers as well by reducing risk of breast and ovarian cancer, type 2 diabetes, and high blood pressure.
Apart from conveying immunity, extensive research shows that breastmilk offers increased long-term protection from a host of diseases. Breast-fed babies have less chance of developing ear, respiratory, and urinary infections. They are more resilient against bacterial meningitis, a serious condition that can lead to death. Breastfeeding decreases the risk of obesity, type 1 and type 2 diabetes, Crohn’s disease, ulcerative colitis, high blood pressure and heart disease.
While antibodies in breastmilk adjust to a growing baby’s evolving needs, manufactured formula is unchanging and has no antibodies. Instead, manufacturers add ingredients designed to foster good gut bacteria. This may help protect babies from illness, but not to the same degree.
It has also been found that vitamins and minerals added to manufactured milk cause increased gas in babies and more constipation. Bottle feeding affects mother-child bonding. And formula fed babies have an increased risk of sudden infant death syndrome.
Expectant mothers have reason for confidence, not trepidation, in their abilities to breastfeed babies. At best, it should be deemed unethical to market misleading information about baby formula. At worst, given the lifelong health consequences at stake, and the duty to care for society’s youngest and most vulnerable members, such marketing should be criminal.
There are, of course, circumstances in which formula is the right choice. These mothers should be supported, not shamed. It’s an obvious fact that many babies raised on formula have fared just fine. There are geniuses, concert pianists, gold-medal athletes, doctors, lawyers and every other professional among them.
But the economics of the formula milk industry is the problem. This industry should not be allowed to profit at the expense of parental confidence and children’s health – yet profit is precisely the boardroom mandate of these companies. Looked at another way, the total cost of formula feeding is estimated to be US$900-$3,000 per year. Those funds would be better spent other ways.
It’s the WHO’s boring reports versus deceptive digital marketing. Not a good match up.
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John Travolta and Olivia Newton-John sang about romance in “Summer Nights”, the opening song in the hit movie, Grease. But now, at 68, he, more so than she, may want to watch out for a different kind of summer heat. New research shows that warm summer nights increase the risk of heart-related death among men in their 60s.

The study involved analysis of 39,912 deaths due to cardiovascular disease in England and Wales between 2001 and 2015. After controlling for other factors, a rise of 1° Celsius (1.8° Fahrenheit) in summer nighttime temperature was associated with a 3.1% increase in the risk of death due to cardiovascular disease among men aged 60 to 64 years.

Replicating research results helps validate findings, and so a similar analysis was undertaken in a county within Washington State in the U.S. Here too, an increase of one degree in nighttime temperature resulted in a 4.8% increase in risk of heart-related death among men ages 60 to 64 years, although not older men above 65 years.

The research findings are concerning because they show an increase over recent years in the incidence of cardiovascular-related death occurring at nighttime rather than during daytime summer temperatures.

The details behind the study tell an interesting story. Why even think to study nighttime heat in mid-latitude settings? Is it not the soaring daytime heat shocks in places known for scorching sun that deserve attention?

Haris Majeed, a PhD student with the Institute of Medical Science, Temerty Faculty of Medicine, at the University of Toronto, is the study’s lead researcher. His motivation was both academic and personal. As an early-career academic, he was poring through his textbook readings when he noted that although heart attacks occur at any time of day, most take place in the early morning hours while people are still in bed. Over the course of the year, the warmest months of June and July contain the highest rates of death from cardiovascular disease.

Majeed looked at places like Wales and Washington State because these places have strong seasonality. In effect, people in these places need to cope both with cold winters and hot summers. In these regions, too, many residents may not have air conditioning.

Why would men face a higher risk of heart attack with an increase in nighttime temperatures, and not women? Majeed speculates it might be due to men being more exposed to daytime heat, sweating more, and becoming dehydrated. This can lead to lower blood volume and increase the risk of blood clotting.

On the personal side, Majeed’s father recently underwent a bypass surgery and remains at high risk for health trouble when air temperatures go up. Contributing to the body of science that will help his father is a motivator like little else.

Majeed will need to do more work to test his theories.

In the meantime, as the northern hemisphere heads into the summer season, it would be prudent for people with cardiovascular concerns to take simple precautions. Keep well hydrated. Stay out of the sun during the hottest part of the day. Cool down with a quick cold shower before bed. And use a fan during the night when the heat is oppressive.

Going to sleep on a hot summer’s night should not be the most dangerous thing one does. But this research is highlighting two firm facts. One, cardiovascular disease is continuing to hold its place as a major killer. And two, air temperatures matter to human health.

Bottom line: keep cool when things heat up, especially at night.

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Tracing the medical history of nostalgia involves a sharp U-turn. Centuries ago, it was considered a psychopathological disorder. Still today, nostalgia can be associated with negative feelings and sadness. But researchers are reaching new conclusions about the health benefits of wistful affection for the past.
We recently witnessed the medicinal effects firsthand on a special family trip. A full seventy years later, we returned to the majestic Manoir Richelieu, a historic hotel northeast of Quebec City on the shores of the St. Lawrence River. As the former hotel doctor-in-residence, and the accompanying story-seeking family, we were treated to a wonderful walk down memory lane.
It was hard not to notice the spring in our steps, the smiles, and the upbeat mood.
Nostalgia comes from the Greek root “nostos” meaning “home” and “algos” meaning “pain”. Distinct from “homesickness”, which strikes when far from home and justifiably induces sadness, loneliness, and other depressing feelings, nostalgia can swing either way. One can be sad to recall “the good ole days”, or nostalgia can stimulate reward pathways in our brains.
Many studies have demonstrated the way memories make us feel good.
A study published in Psychological Science found that nostalgia boosts perceptions of social support and that highly resilient people use nostalgia as a tool to beat back loneliness.
Another study published in the journal Appetite examined how nostalgia influences attitudes about food. Experiments showed that people consumed more and reported more favorable attitudes towards healthy food when feeling nostalgic. Nostalgia also diminished the consumption of unhealthy food.
Another interesting study linked nostalgia to creativity. Two groups of students were invited to write for five minutes. One group was instructed to think about an ordinary experience while the other was asked to think about something nostalgic. The latter group produced far more creative writing.
Organizational effectiveness gurus took note. A report in the Harvard Business Review recommended employers use nostalgia to make workers feel socially supported, energized, and confident, noting how this leads to more workplace creativity.
But watch the pocketbook, because other research points to the effect of nostalgia as a trigger for charitable giving, built on an abundance of empathy that comes along with happy personal associations.
Count on Shakespeare to have a take. He wrote in Othello, “To mourn a mischief that is past and gone is the next way to draw new mischief on.”
Dr. Constantine Sedikides, Professor of Social and Personality Psychology at the University of Southampton in the U.K., has spent his career studying nostalgia. He would agree with Shakespeare’s recommendation to move on to new mischief.
Dr. Sedikides says he has adopted strategies for increasing nostalgia in his own life. “I don’t miss an opportunity to build nostalgic-to-be memories,” he says. “We call this anticipatory nostalgia.”
Our recent visit to the Manoir Richelieu helped our family connect with the past and share experience across generations. But you don’t have to travel to achieve the same benefit.
Try taking ten minutes to reflect on a special place or time. Look back into your past and recall an occasion when you achieved a goal, when you first met a special friend, or even something recent that you enjoyed. Then, having immersed yourself in the memory, check to see how you feel. You should notice a sense of happiness.
Another technique is to meander through the pages of an old photo album.
Need motivation? A study of people who regularly thought about past positive experiences observed the added benefit of leaving them better able to cope with the inevitable stresses in life.
Readers interested in more about Dr. W. Gifford-Jones’ nostalgic trip to the Manoir Richelieu should sign-up at www.docgiff.com to receive our weekly e-newsletter. For comments, contact-us@docgiff.com. Follow us on Instagram @docgiff and @diana_gifford_jones