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Medical journal corrects two flawed articles by Dr. Gideon Koren

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A medical journal that for more than 20 years published advice about drug safety for pregnant women has issued a rare correction related to two questionable articles by the column’s lead author.

Canadian Family Physician (CFP), the official journal of the College of Family Physicians of Canada, published the correction in its January 2019 edition outlining concerns with the articles co-authored by Dr. Gideon Koren, former head of the SickKids’ Motherisk program and director of its discredited lab.

Former head of Motherisk program under investigation by medical regulator

The 177-word correction comes after a Star investigation that exposed flaws in medical publishing, including the inability and unwillingness of journals and research institutions to correct and preserve the integrity of the scientific record.

Corrections, the Star found, routinely take years to be published, if they happen at all.

The Star investigation prompted the Hospital for Sick Children to announce in December it will conduct a wholesale review of Koren’s vast body of work. In its review of 1,400 articles co-authored by Koren over 30 years, the Star identified what appear to be problems in more than 400 of his papers, including nearly 200 published in Canadian Family Physician.

The problems include inadequate peer review, failures to declare, perhaps even obscure, conflicts of interest and, in a handful of cases, lies about the methodology used to test hair for drugs. We identified just 18 instances in the 400 studies flagged by the Star where it appears journals have taken action, in the form of a correction or clarification.

The two articles being corrected by CFP, Nausea and vomiting of pregnancy. Evidence-based treatment algorithm and Treatment of nausea and vomiting in pregnancy. An updated algorithm, were not properly peer-reviewed, according to the correction, and failed to disclose a conflict of interest.

The correction also said the articles “did not provide satisfactory evidence that would have justified the recommendation” to prescribe Diclectin, a combination of antihistamine and vitamin B6, as a first-line of defence.

That recommendation was among the guidelines to treat morning sickness that were developed by Motherisk and endorsed and published by The Society of Obstetricians and Gynaecologists of Canada.

The journal withdrew its endorsement of the guideline in 2017, acknowledging in an editorial that it hadn’t subjected these regular articles to double-blind, peer reviews because of its “long-standing relationship with Motherisk.” The journal published regular articles under the title “Motherisk Update” from 1995 to 2016.

Until now, the two articles stood uncorrected in the literature.

Dr. Nav Persaud, a researcher and family physician at St. Michael’s Hospital, who co-authored a paper five years ago that questioned the recommendations in these two articles, said the medical profession in Canada has failed pregnant women with nausea and vomiting during pregnancy by issuing and recommending the faulty guideline. He said the two papers are not reliable and should be removed from the literature.

“I hope that this is a temporary measure on the road to doing what needs to be done,” Persaud said. “The fact that this is the second time that Canadian Family Physician has addressed this issue indicates that they should deal with it definitively.”

Visitors to each of the articles, which are still published on CFP’s website, are met with a note directing them to the correction. The correction guides them to a 2017 commentary written by Dr. Nick Pimlott, CFP’s scientific editor, that describes several concerns the journal had found with Koren’s work.

Neither Koren nor his lawyers responded to the Star’s request for comment.

Pimlott told the Star that the journal’s Editorial Advisory Board decided several months ago that these two articles did not meet criteria for retraction which he said is “commonly defined as conclusive evidence of scientific fraud or misconduct.”

“The Board felt that it would be important to provide clarification of the issue for CFP readers,” he said. “For this reason, a decision was made by the (board) to publish a correction.”

CFP’s correction says that for the two articles there was an undisclosed conflict of interest with Duchesnay, the manufacturer of Diclectin.

The articles, published in 2002 and 2007, were among 270 articles that the Star found referenced, in some way, “The Research Leadership for Better Pharmacotherapy during Pregnancy and Lactation.” This was not an actual fund, SickKids has said, but a name Koren created to describe “unrestricted funding he had available at different points in time.”

In 2015, SickKids said that the primary donor in the years leading up to the Motherisk scandal was Duchesnay. The hospital has said that in some cases where Koren used the “Research Leadership” name, he did not acknowledge funding from that drug company.

Persaud and co-authors had re-analyzed a 1997 Koren paper that underpinned his views of Diclectin and led to the guideline to prescribe the drug.

SickKids has confirmed some of Persaud’s findings, including that Koren’s 1997 paper overstated the number of subjects involved in that study. SickKids also said that an independent reviewer, hired by the hospital to assess the paper, concluded that its claim that the antihistamines in Diclectin have a protective effect against major malformations was not supported by the data. Antihistamines, the reviewer concluded, are neither protective nor harmful.

Pimlott said CFP is reviewing all Motherisk articles it has published.

Michele Henry is a Toronto-based investigative reporter. Follow her on Twitter: @michelehenry

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Nostalgia and much more with Starburst XXXtreme

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Get a taste of adventure with Starburst XXXtreme based on the legendary NetEnt Game. The nostalgic themes are sure to capture fans of the classic version as they get treated to higher intensity, better visuals, and features. The most significant element of the game is its volatility. Patience will not be an essential virtue considering the insane gameplay, and there is a lot of win potential involved. It retains the original makeup of the previous game while adding a healthy dose of adrenaline. 

Starburst Visuals and Symbols

The game is definitely more conspicuous than before. The setting happens over a 5-reel, 3-row game grid with nine fixed win lines, which function if a succession from the left to the right reel is present. Only those players that that attain the highest win per bet line are paid. From a visual standpoint, the Starburst XXXtreme slots illustrates lightning effects behind the reels, which is not surprising as it is inherited from the original version. Available themes include Classic, Jewels, and Space. The game is also available in both desktop and mobile versions, which is advantageous for players considering the global pandemic. According to Techguide, American gamers are increasingly having more engaging gaming experiences to socialize to fill the gap of in-person interaction. Starburst XXXtreme allows them to fill the social void at a time when there is so much time to be had indoors. 

Starburst XXXTreme Features

Players get to alternate on three features which are Starburst Wilds, XXXtreme Spins, and Random Wilds. The first appears on reels 2,3, or 4. When these land, they expand to cover all positions while also calculating the wins. They are also locked for a respin. If a new one hits, it also becomes locked while awarding another respin. Starburst XXXtreme offers a choice between two scenarios for a higher stake. In one scenario with a ten times stake, the Starburst Wild is set on random on reels 2,3, or 4, and a multiplier starts the respin. The second scenario, which has a 95 times stake, starts with two guaranteed starburst wilds on reels 2,3, or 4. it also plays out using respin game sequence and features. The game also increases the potential with the Random Wilds feature to add Starburst Wilds to a vacant reel at the end of a spin. Every Starburst Wild gives a random multiplier with potential wins of x2, x3, x5, x10, x25, x50, x100, or even x150.

The new feature is sure to be a big hit with the gaming market as online gambling has shown significant growth during the lockdown. AdAge indicates the current casino customer base is an estimated one in five Americans, so Starburst XXXtreme’s additional features will achieve considerable popularity. 

What We Think About The Game

The gambling market has continued to diversify post-pandemic, so it is one of the most opportune times to release an online casino-based game. Thankfully Starburst XXXtreme features eye-catching visuals, including the jewels and space themes. These attract audience participation and make the gameplay inviting. The game also has a nostalgic edge. The previous NetEnt iteration featured similar visuals and gameplay, so the audience has some familiarity with it. The producers have revamped this version by tweaking the features to improve the volatility and engagement. 

That is characterized by the potential win cap of 200,000 times the bet. Starburst XXXtreme does not just give betting alternatives for players that want to go big. The increase of multipliers also provides a great experience. If the respins in the previous version were great, knowing that multipliers can go hundreds of times overtakes the game to a new level. 

Players should get excited about this offering. All of the features can be triggered within a single spin. Whether one plays the standard game or takes the XXXtreme spin route, it is possible to activate all of the features. Of course, the potential 200,000 times potential is a huge carrot. However, the bet size is probably going to be restricted and vary depending on the casino. It is also worth pointing out that a malfunction during the gameplay will void all of the payouts and progress. Overall, the game itself has been designed to provide a capped win of 200,000 times the original bet. 

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‘We’re back’: Montreal festival promoters happy to return but looking to next year

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In downtown Montreal, it’s festival season.

In the city’s entertainment district, a musical act was conducting a sound check on stage Friday evening — the second day of the French-language version of the renowned Just For Laughs comedy festival. Tickets for many of the festival’s free outdoor shows — limited by COVID-19 regulations — were sold out.

Two blocks away, more than 100 people were watching an acoustic performance by the Isaac Neto Trio — part of the last weekend of the Festival International Nuits d’Afrique, a celebration of music from the African continent and the African diaspora.

With COVID-19 restrictions continuing to limit capacity, festival organizers say they’re glad to be back but looking forward to next year when they hope border restrictions and capacity limits won’t affect their plans.

Charles Décarie, Just For Laughs’ CEO and president, said this is a “transition year.”

“Even though we have major constraints from the public health group in Montreal, we’ve managed to design a festival that can navigate through those constraints,” Décarie said.

The French-language Juste pour rire festival began on July 15 and is followed by the English-language festival until July 31.

When planning began in February and March, Décarie said, organizers came up with a variety of scenarios for different crowd sizes, ranging from no spectators to 50 per cent of usual capacity.

“You’ve got to build scenarios,” he said. “You do have to plan a little bit more than usual because you have to have alternatives.”

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MELS new major movie studio to be built in Montreal

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MONTREAL — MELS Studios will build a new film studio in Montreal, filling some of the gap in supply to meet the demand of Hollywood productions.

MELS president Martin Carrier said on Friday that MELS 4 studio construction will begin « as soon as possible », either in the fall or winter of next year. The studio could host productions as early as spring 2023.

The total investment for the project is $76 million, with the Quebec government contributing a $25 million loan. The project will create 110 jobs, according to the company.

The TVA Group subsidiary’s project will enable it to stand out « even more » internationally, according to Quebecor president and CEO Pierre Karl Péladeau. In the past, MELS Studios has hosted several major productions, including chapters of the X-Men franchise. The next Transformers movie is shooting this summer in Montreal.

Péladeau insisted that local cultural productions would also benefit from the new facility, adding that the studio ensures foreign revenues and to showcase talent and maintain an industry of Quebec producers.

STUDIO SHORTAGE

The film industry is cramped in Montreal.

According to a report published last May by the Bureau du cinéma et de la télévision du Québec (BCTQ), there is a shortage of nearly 400,000 square feet of studio space.

With the addition of MELS 4, which will be 160,000 square feet, the company is filling part of the gap.

Carrier admitted that he has had to turn down contracts because of the lack of space, representing missed opportunities of « tens of millions of dollars, not only for MELS, but also for the Quebec economy. »

« Montreal’s expertise is in high demand, » said Montreal Mayor Valérie Plante, who was present at the announcement.

She said she received great testimonials from « Netflix, Disney, HBO and company » during an economic mission to Los Angeles in 2019.

« What stands out is that they love Montreal because of its expertise, knowledge and beauty. We need more space, like MELS 4, » she said.

There is still not enough capacity in Quebec, acknowledged Minister of Finance, the Economy and Innovation Eric Girard.

« It is certain that the government is concerned about fairness and balance, so if other requests come in, we will study them with the same seriousness as we have studied this one, » he said.

Grandé Studios is the second-largest player in the industry. Last May, the company said it had expansion plans that should begin in 2022. Investissement Québec and Bell are minority shareholders in the company.

For its part, MELS will have 400,000 square feet of production space once MELS 4 is completed. The company employs 450 people in Quebec and offers a range of services including studio and equipment rentals, image and sound postproduction, visual effects and a virtual production platform.

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