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Canadian doctors enter new era

The power relationship between patients and doctors fundamentally changed on Feb. 6, 2015, when the Supreme Court of Canada ruled that the Criminal Code prohibitions against physician-assisted suicide were unconstitutional. With its unanimous, compassionate and eloquent decision, the country’s top court recognized that competent adults who are suffering grievously should have the legal right to request medical help in ending lives that have become unbearable – a key stage in patient autonomy.

The SCC gave the federal government one year to introduce new legislation while reconciling the Charter rights of both patients and doctors. That step has proved troublesome largely because of the Harper government’s antipathy to physician-assisted dying and to the notion of working with the provinces and territories.

Less than two months before the SCC deadline, confusion reigns as the new Trudeau government flexes its constitutional and legislative muscles. Canada intervened in a Quebec court challenge this month to argue successfully that the province cannot implement its ground-breaking legislation (which will institutionalize extensive palliative care for dying patients and allow doctors to euthanize adult patients who meet strict criteria) until the federal Criminal Code prohibitions are lifted. Simultaneously, the federal government has asked the Supreme Court for a six-month extension to develop, debate and pass its proposed legislation replacing those very sections of the Criminal Code.

If the top court agrees, we are unlikely to have a law that protects the vulnerable and eases the afflicted before August – if at all. In the interim, will Quebec, which has constitutional jurisdiction over the administration of justice, refuse to lay charges against doctors who perform medical aid in dying? If our politicians fail to design a comprehensive legislative and regulatory framework, will physician-assisted dying, like abortion, become a patchwork of provincial guidelines with unequal access across the country and no national standards or oversight?

While we are in limbo, desperate patients are buying one way tickets to death clinics in Switzerland or resorting to violent, often inept and premature DIY suicide methods. That’s why physician-assisted dying will probably be the biggest national health story in Canada two years running. Sandra Martin

Dairy and red meat take heat

This year was a big one for upending conventional wisdom on what we eat. In February, a U.S. advisory panel reviewing the latest iteration of American dietary guidelines (to be released this month) decided to drop its caution against eating cholesterol-laden food. In April, a provocative book by Alissa Hamilton suggested that our overreliance on dairy as a source of calcium is the result of an industry- and financial-driven campaign, rather than what’s best for our health. In October, the World Health Organization categorized processed meat as a carcinogen and red meat as a probable one. (But just because something can cause cancer if consumed frequently and in large amounts doesn’t mean it will).

Most notably for me, though, was a major study in the September issue of the journal Alzheimer’s & Dementia that showed eating the right diet – one that’s plentiful in vegetables, berries, nuts, fish, and low in red meat, cheese, fast food and sugar – can have enormous benefits for our brain health. The research, conducted in nearly 1,000 community-dwelling older adults, found that these dietary considerations – coined the MIND diet by researchers from Rush University Medical Center in Chicago – could significantly reduce the risk of developing Alzheimer's disease.

So what’s the big takeaway from all of this? We need to stop fixating on single nutrients (e.g. cholesterol, fat) or single foods (e.g. milk, red meat) and, instead, consider our overall diet. Giving up red meat – or dairy – alone won’t ward off disease. It’s time to shift our focus to eating a variety of wholesome foods, many of them plants. Doing so will automatically prevent you from eating too many cheeseburgers. Leslie Beck

Genes are tweaked

Almost 15 years after the human genome was first sequenced, the practical applications and the mind-boggling potential are beginning to become clear.

In 2015, scientists, for the first time, used technology to alter the genes of an embryo and edit out a defect – and, along with it, a chronic health condition. So far, the gene-editing tool, known as CRISPR/Cas9 (short for Clustered Regularly Interspaced Short Palindromic Repeats associated protein 9, a reference to the gene’s structure) has been used only in the lab. But the field is advancing at such a dramatic pace that clinical application – such as editing out the cystic fibrosis gene at the embryonic stage – is a not-far-off prospect.

Meanwhile, the cost of sequencing is falling rapidly. It cost in excess of $3-billion (U.S.) to decode the first human genome, but now the $1,000 test is imminent, putting the technology within the reach of many. Practically, this means we are moving to an era in which medical treatments, and drugs in particular, are tailored to individuals based on their genetic makeup.

These advances, however, bring with them a host of ethical and economic challenges – in part, whether the new technologies and the benefits that flow from them, will be available equitably, to those most in need and not just those who can afford them.

The shift to genomics-based (or personalized) medicine has the potential to revolutionize health care, but will also pose significant challenges to insurers and publicly funded insurance programs such as Canada’s medicare system in particular. André Picard

Overhaul sought for Home-care

Allowing the sick and the elderly to stay at home sounds like a winning idea. It’s what most people want and scarce health-care dollars can go further when people avoid expensive hospital and long-term care beds. As Canada’s population ages, getting home care right will be increasingly important, but solutions are far from simple. And when it fails, families and friends are usually left struggling to care for the sick and the elderly, often with few supports.

This year, numerous reports – including two from Ontario’s Auditor-General and a Globe and Mail investigation – showed how broken the system is for delivering care at home in Canada’s largest province, with long wait lists, inconsistent standards and rationing of service. Improving home care also gained some high-profile national champions. The Canadian Medical Association made a national seniors strategy a priority and support for seniors its No. 1 election ask. The new Liberal government campaigned on a promise to invest $3-billion into improving home care. The coming weeks will see a meeting of federal and provincial health ministers and a chance to glean more details on that promise. In Ontario, the provincial government is about to scrap its troubled home-care system, a move its critics hope will free up dollars for investment in front-line services. Elizabeth Church

The brain’s blood-brain barrier is breeched

There were no high-fives. No cheers. But all present were aware they’d just been a part of an historic moment when the research team led by neurosurgeon Todd Mainprize at Toronto’s Sunnybrook Health Sciences Centre became first in the world to temporarily and non-invasively break through the human blood-brain barrier. The November surgery is a major step toward treating some of today’s incurable and hardest-to-manage brain diseases, ranging from Alzheimer’s disease and certain types of depression to cancerous brain tumours.

The team used focused ultrasound waves and tiny air bubbles, called microbubbles, to mechanically create little holes in the protective coating around the blood vessels of patient Bonny Hall’s brain, which make up the blood-brain barrier. While this barrier is essential for keeping harmful substances in the bloodstream out of the brain, it has also prevented doctors from precisely delivering drugs and other treatments to targeted areas of the brain without putting the patient at risk of greater harm.

The research team has a long road ahead. They still need to test the procedure on several other patients to determine it can be safely replicated. But by actually proving it can be done, they’ve offered hope to those suffering from brain illnesses for which there currently is none. And that’s something worth cheering for, indeed. Wency Leung

The anti-vaccination movement loses steam

An outbreak of measles that began in Disneyland and spread to seven states, Canada and Mexico thrust the issue of vaccination into the spotlight and led to a push-back against the anti-vaccine movement in the first few months of 2015. While outbreaks of preventable illness have become more common as vaccination rates slip, the scope of the Disneyland incident – which eventually sickened more than 130 in Quebec (the vast majority of them unvaccinated) – caught the public’s attention. As did a Facebook post from a Toronto-area mother whose newborn had been exposed to the measles in a doctor’s waiting room. The post by Jennifer Hibben-White offered a swift and thorough dismissal of the trumped-up “dangers” of vaccines and placed direct blame for her son’s potential illness on those who choose not to vaccinate. It was shared more than 300,000 times and led to international media attention. Luckily, baby Griffin did not contract the illness. But the idea of Canadian children falling sick and possibly dying from completely preventable illnesses is perhaps why there was such a strong negative reaction when The Globe and Mail wrote about a University of Toronto professor who promoted anti-vaccine views in class. Or why there are growing calls on the federal and provincial governments to crack down on naturopaths, chiropractors and homeopaths – many of them regulated by provincial regulatory colleges – who continue to promote false views about the supposed dangers of vaccines. The anti-vaccination movement hasn’t gone away, but seems to be waning in popularity. Carly Weeks

Germs get their due

For more than a hundred years, germs were considered to be mainly our enemies, with a few exceptions, such as probiotics. But in 2015, that has all changed as we have finally witnessed how microbes can be used to improve our battle against chronic and infectious disease.

In March, a probiotic bacterium, Lactobacillus rhamnosus, was revealed to help cure peanut allergies. In July, an Ebola vaccine proved to be 100-per-cent effective. It was made from a virus known to infect pigs. Then in October, in a landmark moment, the first cancer-fighting virus was approved for use. What makes this even more incredible is the fact that the treatment was developed from a herpes virus.

These three discoveries have turned the page on the influence of germs in our lives. We can look beyond the illnesses and appreciate the potential of these microbes for use in therapies, vaccines and cures. In the future, we can expect even more microbial miracles. Viruses of bacteria, bacteriophages, may one day replace antibiotics. We may be able to provide bacteria to our young to prevent asthma. And certain cancers may be a thing of the past through microbial prevention.

2015 has been an incredible year and the lessons we have learned about the goodness of germs will hopefully one day make us a healthier society. Jason Tetro

Autism gets reimagined

Of all the medical studies, health books and interviews I combed through this year, the one I can’t get out of my head is journalist Steve Silberman’s remarkable book, NeuroTribes: The Legacy of Autism and the Future of Neurodiversity. Silberman uncovered a startling truth: Our conception of autism as a modern disorder in desperate need of a cure is based on the junk science of the late child psychiatrist, Dr. Leo Kanner, who helped bury an earlier and more enlightened understanding of autism. Before the Nazis invaded Austria in 1938, Viennese clinician Hans Asperger worked with dozens of children with autistic traits. In addition to their obvious challenges, he observed that many of these children possessed unique gifts. Asperger proposed that autism had always existed and that people with the disorder may have played an unappreciated role in the evolution of culture. Years later in the United States, however, autistic kids were still being labelled “mentally deficient” and locked up in institutions. Silberman says it’s time to make peace with autism and view it as a lifelong disability that deserves support, through employment initiatives for adults with autism and help for their families. His book was released shortly before my interview with Christian Aquilini, the 20-year-old son of Paolo and Clara Aquilini, co-owners of the Vancouver Canucks. NeuroTribes was crucial to my understanding of the hardships and triumphs that Christian, diagnosed with autism at 19 months, had experienced on the road to adulthood. I’d say it’s required reading for anyone who knows anybody with a connection to autism – in other words, everyone. Adriana Barton

Fairy-tale romance gets a reality check

As a sex researcher and therapist, I am exposed to the most intimate aspects of people’s lives, and little surprises me when it comes to sex. However, the general reaction of horror and indignation to the millions of people caught in the Ashley Madison scandal this summer illustrates how judgmental we are when it comes to sex. For me, it was a blatant reminder of how deep-seated our beliefs are about what constitutes “normal” versus “deviant” behaviour.

The hack’s ensuing firestorm was rooted in the societal belief of soul mates who match perfectly and unwavering commitment once the bond is secured. But these notions of sex and relationships are not only misleading (science tells us that the desire to engage in extramarital relations is strong), they are also problematic because they suggest that cheating is always a symptom of an unhappy relationship and can only be resolved with divorce. Sometimes, people seek extramarital affairs not to find another, but to find themselves. With effort, affairs can be a catalyst for change and growth in the primary relationship. Lori Brotto

We stand up to sitting

Sitting habits became a hot topic this year. While researchers have been sounding the alarm about sedentary behaviour for years, recent reports suggesting that smokers and “prolonged sitters” share common health risks seem to have changed the conversation.

What many scientists now believe is that sitting more than six hours a day elevates the risk of heart disease, diabetes, cancer and other conditions, in large part due to the body downshifting into a dormant mode that compromises our ability to break down fats and sugars. There is also mounting evidence that even if you meet the recommended levels of daily exercise, you may still be at risk if your sitting-time approaches the average (unfortunately, we continue to spend close to 40 per cent of our day in a chair).

So, if your employment places you behind a desk, look for opportunities to interrupt your sitting. Drop your daily sit-time under six hours. By bringing movement into your day, you give the body a chance to “reset.” Each extra step becomes important and builds on the last. For example, if you enjoy the rest of this article while standing, your heart rate will increase by around 10 beats per minute, which will burn about 50 calories more an hour versus sitting. Over a year, this habit will burn 30,000 more calories or eight pounds of fat. Dwight Chapin

Infants nibble solid food earlier – and that’s okay

Long gone are the days when parents were urged to start their baby on solid food after the age of 1. New guidelines released this year by Health Canada, the Canadian Pediatric Society and the Dietitians of Canada (among other expert groups) now recommend introducing all foods (save for honey) by six months of age – including allergens such as nuts, eggs and wheat.

Five years ago, when I began feeding my son solids at four months of age, I felt like I was being a bad mom. Everyone around me told me “exclusive breastfeeding till six months.” But he seemed hungry and cried out when we ate, so I started him young. I’m a pediatrician, but like many new parents, I worried that he might have a reaction, belly pain or become constipated. I didn’t even tell our own pediatrician I had started solids. The experience went well of course and was liberating. It wasn’t scary after all and was quite fun, as food should be!

This winter, with our youngest baby, we followed the same principle and started solid food when he was ready, around four months of age. It was fun, and better yet, we now understood that research shows that introducing allergenic foods early can help to lower your baby’s chance of developing allergies. Double win. Dina Kulik