Canada is usually associated with our long cold winter. To take advantage of the cold weather, we go out for skating, skiing, snowshoe hiking, ice fishing, snowmobiling, etc., tons of fun activities. Is there anything we can do at hospitals to make full use of the winter? Actually there is. Our hospitals have much essential medical equipment that requires cooling year around. Magnetic resonance imaging (MRI) is one example. It relies on deep cooling to maintain super-conductors inside to generate extremely strong magnetic field and radio waves to do very detailed scanning of patients. The temperature required is so low for super-conductors that they are submerged in liquid helium, which is about -270 °C (-454 °F).
With the first month of 2019 still fresh as a honeycrisp apple, we’re checking in on your good intentions (kinda like New Year’s resolutions, but without the pressure). Of the 19 options, these really hit home with you.
12. Repair my appliances, clothes and stuff that’s broken
Not the handiest or craftiest? There are Repair Cafés throughout Toronto and around the world.
As sure as the indigestion after a holiday meal, it would be wrong to end the year without a Best of 2018 rundown. And because you’ve already finished everything on your list (or because you’re studiously avoiding your list, we don’t judge), tuck in and enjoy. In no particular order, other than being in the top 18, (click on the pics to jump to the stories)…
To be clear, we’re talking about what’s on our plates, not about Canada’s newly legal and ubiquitous weed (granted, some clever chefs may have combined the two). Hot on the heels of Nicolette’s Drugs vs. “Bugs”: Antimicrobial Resistance and the Power of Stewardship, let’s shift gears from medicine cabinet to meal.
For the fantastic feasts and where to find them (Sorry, J.K Rowling), ’tis the season of plenty, whatever you celebrate. Unless you’re a vegan, there may be brisket at Hanukkah, or ham at Christmas, or goat biryani at Eid-ul-adah* … plus let’s not forget all the non-denominational festivities like New Years, Thanksgiving and Festivus (for the rest of us). The common theme here is a plentiful amount of meat. Let’s look at what happened before it got to our tables.
The not-so-well-kept secret in agriculture is that farmers can save money by raising more animals in less space. I remember the size of my first apartment … same goes for the COFAs (Confined Animal Feeding Operations). Less space means sanitary issues. Sanitary issues mean illness. Rather than wait for some animals to get sick and treat them, many farmers dose their herds with antibiotics (ABX) “preventatively” and regularly, and even use animal feed with ABX mixed in.
Surprisingly, antibiotics also make animals grow faster, so it takes less time (and money) to raise them. That’s such a tempting offer for farmers. Because of this “magical” ABX power, not surprisingly, about 82% of antibiotics used in Canada are in agriculture. Though some of it is necessary, just like when you or I develop an infection, a lot is what they call “indiscriminate” … preventative or for growth-enhancing purposes.
What farmers gain in efficiency, they lose to the “superbugs” they helped develop. Scientific evidence shows that bacteria are developing antibiotic resistance as a result of ABX use in animal agriculture. These bacterial “superbugs”, resistant to multiple types of antibiotics, can affect both humans and animals.
Antibiotic resistance is a major threat to human health … for decades we’ve been squandering one of our most precious medicine, our best weapon in the fight against deadly infections. If we continue our current misuse of antibiotics, we may soon enter a post-antibiotic era. What does that mean to you and me? For starters, transplants will be impossible, heart infections could be deadly, and giving birth will become a lot more dangerous.
So what can we do?
As individuals, look for “antibiotic free” if/when we buy meat. Make sure the meat says “antibiotic free”, and not a wishy-washy claim like “100% natural” (which sounds lovely but means nothing legally-speaking). Yes, it may be more expensive, but extremely worthwhile.
We’ve heard that 40% of all food gets wasted … so if we buy less-but-better meat, and make sure not to waste it, we might come out ahead. It couldn’t hurt to try more plant-based meals while we’re at it, not just for the antibiotics, but for the environmental impacts:
Carbon emissions per person for each diet type image credit: Shrink That Footprint
As nations, we can outlaw indiscriminate use. A lot already have … hello Europe! Sweden banned it for growth-enhancing purposes way back in 1986. And we have some promising news here in Canada …
As of December 1, 2018, all Medically Important Antimicrobials (MIAs) for veterinary use will be sold by prescription only. The responsible use of MIAs is intended to preserve their effectiveness and minimize the development and spread of antimicrobial resistance.
Before this switch, farmers could buy as many antibiotics as they wanted and use them whenever. Now no one can buy ABX without a veterinarian’s prescription, and vets can’t prescribe to promote growth. Though some farmers may have stockpiled, this will help future herds, and the future effectiveness of antibiotics for all. That’s definitely something to celebrate.
Cheers and happy holidays!
Lisa
*Though Eid-ul-adah is technically in August this year, it is included for its major focus on meat. Eid-ul-adah translates as ‘Feast of the Sacrifice’ (thanks Farzana for the consultation!). People give one third of the animal to the needy; another third to relatives and the final third for home.
Many traditional feast dishes in Buddhism and Hinduism are already vegetarian (and delish!), so not included here.
When you’re sick you take drugs… right? And by taking those drugs, like say antibiotics when you have the flu, you get better… right? Wrong, very very wrong! The flu is actually a viral infection, meaning that along with getting plenty of rest the flu can only be treated with an antiviral! I sat down with Dr. Andrew Morris, an infectious disease specialist and Director of the Sinai Health System-University Health Network Antimicrobial Stewardship Program (ASP) to get to the bottom of the do’s and don’ts when it comes to taking antibiotics and to learn a bit more about the emerging global health threat of antimicrobial resistance (AMR).
Infectious disease specialists, you guessed it, identify and treat infections. Specialists use a wide range of antimicrobial agents (e.g. antibiotics, antivirals, etc.) to treat symptoms– but, as Dr. Morris describes, overuse and improper use of antimicrobials (ahem taking antibiotics when you have the flu) coupled with few antimicrobials on the market has contributed to the emerging global health crisis known as antimicrobial resistance.
Dr. Morris defines antimicrobial resistance as “when antibiotics don’t work because the germs have outsmarted the antibiotics”. Smart germs? Well, not so much brain capacity, more of a real-world example of survival of the fittest courtesy of our friend Charles Darwin. When bacteria (for example) are exposed to an antibiotic, only the resistant survive and spread. This problem intensifies when people are unnecessarily prescribed antibiotics. These redundant, repeat exposures are like bacteria boot camp, training whole populations of bacteria to resist antibiotics, so these treatments become ineffective in the future. Imagine dying from an ear infection?!
Thankfully, we here at Mount Sinai and University Health Network have Dr. Andrew Morris and his SHS-UHN Antimicrobial Stewardship Program (ASP) team. Composed of physicians, pharmacists, nurses, and data analysts, the interprofessional team directly interfaces with prescribers, coaches others in the healthcare team, analyzes data, and conducts research to identify best practices when it comes to treating patients like you and me! Exposed to the tragic consequences of antimicrobial resistance early in his medical career, when a young patient under his care died from an otherwise treatable pseudomonas infection, Dr. Morris yearned to improve how antibiotics were used, effectively launching his career in antimicrobial stewardship.
The SHS-UHN ASP Team: Standing (left to right): Sophia Virani, Sarwat Abbasi, Margot Renshaw, Dr. Linda Dresser, Dr. Chaim Bell, Linda Jorgoni, Dr. Shahid Husain, Dr. Lianne Jeffs, Dr. Warren McIsaac, Janice Takata-Shewchuk Seated (left to right): Dr. Sandra Nelson, Dr. Andrew Morris, Yoshiko Nakamachi, Dr. Miranda So, Dr. Mark McIntyre, Lopa Naik.
The ASP team takes a research-based approach to arrive at their recommendations, using both their successes and failures to inform decision-making on how to proceed further. And they have been pretty successful at doing just that. For example, after noticing gaps in practice for treating patients with Staphylococcus aureus bacteremia were related to high mortality, they decided the way to fill this gap was for patients to be seen by an infectious disease specialist – an easy fix which lead to a 30% drop in mortality!
According to Dr. Morris, the hardest task is to understand the cause of the problem, he explains that there are many drivers of behavior, like cultural factors, a lack of knowledge, or emotional factors so the first step is to figure out problems and then identify ways to tackle them. I stopped him there – medicine and emotions? How could they possibly be related? Dr. Morris then asked what happened when I got sick when I was little, I responded that my parents would give me medication. He then asked why… why? To make me feel better of course, which is exactly where the problem lies!
Sometimes you need medications to get better, but many times you would have healed on your own, but since you had medication, you think that’s why you got better.
This is like a placebo effect but with real medicine. Dr. Morris explains that the link between receiving antibiotics, feeling better, and associating antibiotics with making you feel better creates an attachment to antibiotics for the rest of your life. The same goes for doctors who also receive a natural feedback when they see their patients get better after they’ve administered medication. This dynamic is hard to overcome, which is why audits and coaching by the ASP team are essential for success.
And if we continue to travel down this path, of treating anything (and everything) with pills, we are going to be in big trouble. Already we are seeing the consequences of antibiotic resistance from overuse in our agricultural system, where antibiotics that are used to boost animal growth end up in our food systems or groundwater networks from manure fertilizer run off. These instances create additional opportunities for bacteria to develop resistance and for humans to be exposed. Additionally, the lack of regulation and shortage of antibiotics in low income countries, coupled with drug resistance contributes to the crisis observed. Soon enough, easily treatable infections will become life threatening, hence my ear infection example, because we no longer have medication that can effectively clear these simple infections!
So what can YOU do? Always talk to your doctor before taking antibiotics and take them as prescribed, try to look for antibiotic free meat products, and keep up proper hygiene and sanitation practices to avoid getting sick! While there is no easy solution or silver AMR bullet, it starts with better coordination … infection prevention and control, research and development, innovation, epidemiology and surveillance of antibiotics and antibiotic resistance. In Ontario, and especially here on University Avenue, we see the positive effects of stewardship on patient experiences and population health, so at least you can find comfort in knowing Dr. Morris and the ASP team at SHS-UHN have your back!
Originally, this was just going to be a quick piece about the changes to the TTC VIP program, but then something bigger happened. So that we’re covered, the TTC VIP program, the crowning jewel in our sustainable transportation crown, with over 2.6 thousand UHN participants, is coming to a close. The TTC has chosen to end this particular bulk purchasing plan in December 2018 (or, um, now).
Before I shake my fist in the air, it turns out the TTC hasn’t so much ended this as switched it to PRESTO. If you are on UHN’s or another workplace VIP program, you may even get a complimentary PRESTO card. This make the whole program a lot easier, and with some sweet savings. This version also requires a 12-month commitment, costs $134 per month and provides the same unlimited travel. More here.
Or skip the commitment, load your PRESTO card with cash and pay individual fares. The upside here is you can use the 2-hour transfer … hop on and off the system within a 2-hour period without being charged another fare.
OK, you talked transit, what’s the bigger picture?
COP24 is the nickname for the 24th Conference of the Parties to the United Nations Framework Convention on Climate Change (UNFCCC). Image Credit: COP24
COP24 is happening this very minute in Katowice, Poland! Reps from around the world are meeting to talk (and act) on climate change on a global scale (gotta be global since climate change doesn’t really get the whole national or provincial borders thing). You probably remember COP21 in Paris, and the landmark Paris Agreement? All the more relevant now.
Why are you talking about COP24 on a TTC post?
Because the biggest cause of climate change is us humans burning fossil fuels. And the biggest burn source in Ontario comes from transportation. And when people switch from driving gas-burning SOVs (Single Occupancy Vehicles) to cleaner substitutes like public transportation, that’s a major win for our climate, health and future. It’s also a win for Toronto’s soul-crushing congestion problem.
There’s the Climate Transparency Report which works for “Ambitious climate action through country comparisons”. This really appeals to the competitive side of human nature. I hope it works as (spoiler alert)Canadians generate the most pollution-per-person in the G20 … triple the average GHG emissions for G20 countries. Not a proud moment.
And if you look Stateside, they’ve released the National Climate Assessment (even if their leader doesn’t buy it).
Is there a nutshell version?
Livin’ the COG-life (Coal, Oil & Gas, my fancy new acronym) creates the emissions that cause and worsen climate change. When Ontario closed coal plants 5 years ago, that took a big juicy chunk out of our emissions (and out of our smog days, which haven’t happened since). Yay! But we will stall on climate progress unless we look beyond electricity. Transportation is the next big hurdle.
Image Source: my mashup of graphs from the ECO 2018 Greenhouse Gas Progress Report
After canceling Cap & Trade, Ontario has a new proposed Environment Plan. It looks strangely similar to what they did in Australia (which unfortunately saw more pollution, not less). The comment period is open until January 28, 2019.
OK, this is too big for me to deal!
There’s help out there, especially if you join a Green Team. Or go even further with Carbon Conversations, starting up again in February, with a January taster session! Put the cherry on the sundae and get there with your PRESTO card. 🙂
