In her front-page National Post article, “Baby by Stealth”, journalist Kathyrn Blaze Carlson, suggests that a Canadian statute is causing Canadians to break the law. Quoting some professionals whose income is derived at least in part from assisted human reproduction, Carlson writes that the Assisted Human Reproduction Act is “forcing a slew of prospective parents underground”.
The article suggests that Parliament is wrong to treat people who just want to be a mom or a dad like criminals. But the one-sided argument hardly helps advance debate on this complex issue.
Regulating human reproduction in Canada has not been easy, especially for politicians who face re–election by citizens who can disagree fundamentally on reproductive matters.
Not surprisingly, every Canadian effort at regulation has been controversial. The Ontario Law Reform Commission bravely tackled the matter in 1982. But that all-male body recommended that “surrogacy” deals be enforced, even by taking a breast-feeding infant from its mother.
Canadian women reacted by lobbying for the federal Royal Commission on New Reproductive Technologies. It reported in 1993, after spending $28 million hearing from individuals and groups throughout the country and commissioning volumes of original academic research.
Despite the cost and the effort, it would be eleven years before Canada’s Parliament enacted the Assisted Human Reproduction Act.
And then in June 2008, the Quebec Court of Appeal decided that Parliament acted unconstitutionally regarding many statutory provisions because they concerned health – a matter within provincial jurisdiction. The Federal Government appealed to the Supreme Court, whose decision we await.
Meanwhile, the Federal Government has, since January 2009, had a duty to review the existing statute. It is unclear whether Prime Minister Harper’s government has even commenced the statutorily-required task.
This history can perhaps unite all Canadians in agreement on two points: it is difficult to pass legislation in a federation about matters as sensitive as whether people can buy semen, ova and embryos; and some Canadians are bound to feel badly treated by everyone’s best efforts to regulate assisted human reproduction.
So maybe we should not ask, “How can we make everyone happy?” but rather, “Whom should we worry about the most?” Parliament admirably answered this question in 2004 when it recognized and declared that, “the health and well-being of children born through the application of assisted human reproductive technologies must be given priority in all decisions respecting their use”.
So what are the health and well-being interests of the children? Some reproductive technology providers say, “The children should be grateful to be alive.” In other words, they believe that the children’s interests are in being born and the consequences of the methods are irrelevant.
But many disagree. Some people conceived by third party gametes say that not knowing half of their identity creates a significant loss. Many claim that not only must they grieve this loss; they must defend the legitimacy of their grief – a double blow.
Some donor-conceived people compare themselves to adoptees whose loss is recognized. Adoptees are encouraged to seek their birth parents and are aided by government registries in their search. By contrast, parents who use third party gametes need not tell children the truth about their conceptions. Nor is anyone who knows the identity of the genetic parent required to disclose this fact to the child, even when the child becomes an adult.
Whilst the donor-conceived and adoptees arguably suffer similar losses in being separated from their genetic parents, adoptees can find resolution of the loss in the knowledge that the decision to surrender them for adoption was arrived at with great emotional difficulty, as a last resort. The donor-conceived, however, can find it much harder to find resolution of this deliberate separation of genetic and social parenting.
The donor-conceived can believe that their genetic parents were only interested in money, and gave no real thought to the children they were helping to create. They can be devastated by the full import of what their genetic parents did – that their parents were motivated by the money. A condition of the sale can be the promise of anonymity, but the donor-conceived can be severely affected by their inability to meet their genetic parents or even know their names.
Curiously, the National Post article seems to lament, “We see donors who originally thought they didn’t want to be very involved, but who then want increased involvement after the child is born.” How is parental involvement with his or her child a bad thing, even if it is inconvenient for the rearing parents? Children are usually glad to know and to develop a relationship with their genetic parents.
Parliament’s decision to ban the sale of semen, ova and embryos is bound not to make everyone happy. But insofar as it attempted to protect human reproduction from becoming a commercial enterprise, its motivation is honourable.
In the reproductive technology business, some people claim that adults have a right to have a child no matter what the cost. Parliament and Canadian legislatures have a moral duty to investigate the costs to prospective children and to take steps to reduce them.
When regulating assisted human reproduction, the health and well-being of children and prospective children must be given priority, even if commercial or other adult interests might incidentally be thwarted.
Dr. Juliet Guichon is Senior Associate in the Office of Medical Bioethics and a faculty member of the Department of Community Health Sciences in the University of Calgary Faculty of Medicine.
By Dr. Peter Craighead
For The Calgary Herald — March 18, 2010
Publicly funded health care is only sustainable by focusing on and providing what is needed by its constituents.
During the boom years, many Albertans and their health-care leaders assumed we could ask for whatever we wanted. The truth is that Alberta’s health-care system now is forced to balance the needs of our public against the wants of its health-care leaders, whether this is in the provision of surgical services for joint replacement, caring for stroke patients or funding expensive cancer treatment.
The Rolling Stones aptly describe this in their song: “You can’t always get what you want, but if you try sometime you just might find, you get what you need.” The recent flurry of discussions around a new cancer centre in Calgary forces us to ask whether this is a need or a want.
Almost one in two Albertans will develop cancer in their lifetime, and one in four will die from this disease. Another way of looking at this is to realize that there were 14,500 new cancer cases diagnosed in 2009, and there are an estimated 80,000 people living with cancer in our province. About 85 per cent of these cancer patients will be seen and treated at cancer centres around the province. The Tom Baker Cancer Centre in Calgary is one of two major centres in the province, currently sees 150,000 patient visits annually and is the major referral centre for cancer care in southern Alberta.
So what is it that Albertans need when it comes to cancer care, and how has the system responded to this? Albertans with cancer need to receive state-of-the-art treatments in a timely, respectful manner; they should have access to care as close to home as possible; and they should not suffer pain or emotional distress. We also believe that Albertans should have access to prevention strategies that reduce the incidence of cancer and screening that finds the disease at an early, curable stage.
Until the second half of the last decade, Alberta’s health system responded well to these needs. For example, by the early 2000s the province had built up a network of facilities across the province, was highly responsive to cancer drug treatment requests and supported the purchase of expensive radiotherapy equipment in Edmonton and Calgary. Alberta was considered one of the best places to receive cancer treatment, and the place to work if you were a cancer specialist. This was evidenced by the successful recruitment of medical specialists, researchers, nurses and other professionals.
The rapid growth of Alberta’s population, continued increase in cancer numbers, success in recruitment and the change in our health system have all contributed to a growing capacity problem for us. Facilities in Edmonton and Calgary have outstripped their space, leading to a significant impact on patient experience. Cancer care has worked with the province to identify solutions, including the distribution of radiotherapy to smaller cities, plans to expand buildings in Edmonton and Calgary, and using leased space to tide us over for the medium term. We are also improving efficiencies within our centres to increase patient throughput.
The TBCC responded by moving some functions off site, because there was no available expansion space at Foothills Hospital. Since 2003, we have completed two phases of renovations in leased space at the Holy Cross Hospital, and the space we are currently renovating will allow us to expand treatment facilities at the Tom Baker site, so we can sustain our comprehensive service to cancer patients for southern Alberta for at least another three years. A few years ago, we also relocated many of the day procedures that we previously performed within the TBCC to the Foothills, but it is apparent that the rest of the system has minimal capacity to accommodate any further growth. Finally, we are in discussion with South Health Campus planners to see whether that space will provide us options for dealing with our space crunch in the medium term.
How have these decisions affected patient experience in Calgary? As I write this, patients experience serious overcrowding in our facilities, are made to travel between sites for various parts of their clinical care and some of them have excessive wait times to get in to see oncologists.
Fortunately, the wait times for treatment other than surgery continue to fall within our guidelines of two weeks for chemotherapy and eight weeks for radiotherapy. But the fragmentation of services into two sites means patients cannot take advantage of all services at one time. A further complication of providing clinical services across the city is that our clinical staff becomes less efficient by having to include transit times into their day. Simply put, distributing the services of one cancer centre within a city provides a suboptimal patient experience compared with full-service cancer centres.
Predictions tell us that by 2013, when the breathing room provided by Holy Cross will have been exhausted, we can expect to be seeing six to eight per cent more new cases, and to be treating 10 per cent more patients. Although the opening of Lethbridge radiotherapy facilities will help us deal especially with radiotherapy referrals, and the increase in throughput initiatives will gain some efficiencies in chemotherapy treatments, it is predicted that we will be facing severe shortages in Calgary by 2013. Given the budgetary pressures facing Alberta Health Services, it will take significant focus on our part to see a co-ordinated strategy for cancer in the next 12 months. The short-and medium-term solutions we have employed have allowed us to provide excellent care, albeit of a somewhat fragmented nature.
AHS has made efforts to respond to cancer patients’ needs in the short term, but we now must challenge ourselves to move away from a “building the new system” mode into focusing on how to address the longer-term needs of patients, including the particular needs of cancer patients in Calgary.
As a medical leader within AHS Cancer Care, I am ready to support any planning process that ensures that future patients in Calgary are provided a superior experience, and that we are able to address their need to receive timely, quality care.
Peter Craighead, MD FRCPC, is senior radiation oncologist and director of the Tom Baker Cancer Centre.
By Glen D. Armstrong, PhD, Thomas Louie, M.D., and John Conly, M.D., Faculty of Medicine, University of Calgary and The Calvin, Phoebe, and Joan Snyder Institute of Infection, Immunity, and Inflammation.
Although there appears to be a lull in the number of serious H1N1 cases appearing in our hospitals, now is not the time to let our guard down. The H1N1 virus has resulted in severe infection with respiratory failure and increased numbers of intensive care unit admissions. And this is before the typical influenza season peaks in February or March. There is still plenty of time to get vaccinated. Now would be the perfect time to visit a vaccination clinic because of the significantly reduced wait times.
We want to remind people of one irrefutable fact; the incredible freedom we all now enjoy from once devastating infectious diseases because of safe effective vaccines. A short list includes smallpox, polio, mumps, measles, rubella, meningitis, whooping cough, diphtheria, tetanus, and hepatitis A and B. We cannot overemphasize that these are all diseases that no longer kill or severely disable millions of youngsters and adults every year in the developed world, thanks to safe and effective immunization programs.
We openly acknowledge that none of these vaccines is 100 per cent safe. We have learned from experience that in any mass vaccination program, a very small proportion, less than one in a million people, will experience a severe adverse reaction to the vaccine. Such rare reactions may lead to lifelong physical or mental disabilities. In this regard, the H1N1 vaccine is no different than any of other.
The anti-H1N1 vaccination proponents are misleading and distorting the facts around the vaccine being distributed. They are making the minimal risks appear much greater than they really are. If you carefully read the articles the anti-vaccine proponents quote in their fear-mongering campaigns, the H1N1 vaccine is no more dangerous or different in formula or action than any of the other vaccines routinely and safely used for decades to prevent deadly infections from spreading in human populations.
With the exception of a minority of older individuals, our population has no natural immunity to the H1N1 virus. Unlike the typical seasonal flu strains, the H1N1 virus affects young and old, healthy, pregnant, or sick individuals in a capricious and unpredictable manner. The H1N1 virus also has more potential to cause societal hardship, and loss of income to families and businesses due to employee absenteeism. So why not get vaccinated to protect ourselves, our family members, friends and society at large?
After all, the H1N1 vaccine is provided free of charge to all Canadians in order to protect themselves and probably more importantly, others around them. The societal benefits of vaccination far outweigh the risks. Despite the impression the H1N1 pandemic may be over, we still strongly encourage all Canadians to be vaccinated against H1N1. Now is not the time to let our guard down.
By Kyle Glennie
Posted December 4, 2008
Researchers working jointly for the University of Calgary and Alberta Health Services have discovered a way to help stop aggressive brain tumours from spreading by using an existing drug that is being tested for Alzheimer’s patients. The findings are published in the scientific journal Public Library of Science Biology.
Dr. Peter Forsyth, and Donna Senger, PhD, along with their colleagues identified a “switch” that enables brain cancer cells to journey outwards from the primary tumour. They first discovered the switch in August 2007, which is a mechanism that allows brain tumours to invade and spread within the brain. Their research focused on malignant gliomas-highly invasive tumours that are extremely resistant to conventional treatments such as radiation and chemotherapy.
Forsyth and Senger found the switch is activated by a protein that is already present in the brain. Now, with the laboratories of Stephen Robbins, PhD, a member of the Alberta Cancer Research Institute and Samuel Weiss, PhD, the Director of the Hotchkiss Brain Institute at the Faculty of Medicine, they’ve found a way to stop this protein from activating the switch.
“We’ve basically found this switch is turned on when it is cut by “a pair of scissors” found in our brains. What’s exciting is that we’ve discovered there is a family of drugs that block these scissors from cutting the protein and it’s already being tested in Alzheimer’s patients,” says Forsyth. “We’ve also found this process is present in cancer stem cells which many believe accounts for failures of our treatments in many patients.”
With these drugs already in clinical testing, Forsyth and Senger are optimistic they will be able to further their effectiveness on malignant gliomas in their own clinical trials much faster.
“A lot of background work has been done with these drugs already in terms of understanding their dose and side effects, so we’re hopeful that we can move this rapidly into the clinic,” says Forsyth.
Partnerships made it possible
Ken Hughes, chair of the Alberta Health Services Board, says the research demonstrates the value of partnership between universities and health care. “It’s exciting to see these researchers planning to take discoveries like this to clinical trial here in Alberta, where Alberta patients can be the first to benefit.”
“One of my ministry’s priorities is bringing technology to market, and technology often starts with research” said Doug Horner, Minister of Advanced Education and Technology. “In the coming years, Albertans will hear more about our province’s leadership in research and innovation, including research to create new drugs to treat cancer, new devices to diagnose it and, as in this case, new ways to repurpose today’s medical advances for tomorrow’s patients.”
The next step for the researchers is two-fold: to find a specific drug within the drug family to test in a clinical setting, and to make the drug as effective and as safe as possible. They also have another funding grant in place that allows them to try and redesign these drugs to better suit their purpose, something they are also investigating.
Patient says the treatment gives new hope
Rob Evans was not part of the study but as someone who was diagnosed with a cancerous brain tumour 15 years ago he says the research provides patients with new hope and the potential of less invasive treatment. Evans’ treatment regiment included surgery, radiation and chemotherapy. “Any time you can do reduce the stress for someone dealing with cancer and provide a better chance of survival you’ve hit a home run.”
While the team’s research focused on brain tumours, the findings could also have an impact on the treatment of other types of cancers. Skin cancer is also spread through the activation of a switch by this type of protein, and Forsyth would like to try this new approach on melanoma.
“It’s an interesting idea that you can use a drug to block the invasion of cancer cells into normal human tissue, but to have that drug already being used in clinical trials is a dream come true,” he said.
Dr. Peter Forsyth is a professor in the departments of Oncology, Clinical Neurosciences, and Biochemistry & Molecular Biology at the Faculty of Medicine. He is also the southern Director of ACRI (the Alberta Cancer Research Institute), the Associate Director of Research at the Tom Baker Cancer Centre, and is a former director of the Clark H. Smith Brain Tumor Centre.
Donna Senger, PhD, is a research assistant professor in the department of Oncology at the Faculty of Medicine, and has been a part of Dr. Forsyth’s research group since 2000. Senger has contributed regularly to numerous studies and publications that are directly focused on increasing our understanding of brain tumour progression and therapeutic intervention.
Stephen Robbins, PhD is an associate professor in the departments of Oncology and Biochemistry and Molecular Biology at the Faculty of Medicine. He is a scientist of the Alberta Heritage Foundation for Medical Research (AHFMR) and currently holds a Canada Research Chair in the Cancer Biology.
Samuel Weiss, PhD, is a professor in the department of Cell Biology and Anatomy at the Faculty of Medicine. He is the Director of the Hotchkiss Brain Institute and is a scientist of the AHFMR. Weiss was a recent recipient of the very prestigious Gairdner Award for his discovery of neural stem cells.
Their work is supported in part by a generous donation from the Clark H. Smith family, the Canadian Institutes of Health Research (CIHR), Alberta Health Services–(Alberta Cancer Board) and the Alberta Cancer Foundation.
A copy of the study can be downloaded at: