More than 400 students in India told to retake language tests after Niagara College flags concerns

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An Ontario college has raised concerns over the validity of the scores of a popular international standardized language test submitted by students applying from India after a probe found “inconsistencies” in language proficiency.

Niagara College has contacted more than 400 students admitted to its January 2019 programs who had taken IELTS tests at locations in India, telling them they had to undergo a second English test or risk losing their offer of admission.

Niagara College flagged concerns with “inconsistencies” in the scores of English-language tests taken by students applying from India. It has asked 428 applicants to retake the test in India or risk having their offers of acceptance cancelled.
Niagara College flagged concerns with “inconsistencies” in the scores of English-language tests taken by students applying from India. It has asked 428 applicants to retake the test in India or risk having their offers of acceptance cancelled.  (Niagara College)

The International English Language Testing System (IELTS) is accepted by most Canadian academic institutions and is one of two major English language tests used by Immigration Canada as independent proof of an immigration or citizenship applicant’s language proficiency.

Steve Hudson, Niagara College’s vice-president of academic and learner services, said the school launched an investigation this fall after the number of first-year international students flagged by faculty for being “at risk academically” surged to 300 from an average of 150 in previous years.

Those students were made to take an in-house language test and the college found 200 out of that group were failing in their academic programs because their English was not at the required level. Further investigation found 80 per cent of them were from India and had taken their IELTS tests at locations run by Australia-based IDP Education.

Niagara College said officials alerted IDP Education with their findings shortly after the fall semester started and notified immigration authorities last week.

“Based on (our analysis), we felt we needed to be absolutely certain that applicants for our winter 2019 term have a level of English proficiency that will allow them to succeed, and we wanted to do this before they invested significant time and money to travel here to study,” Hudson said in a statement to the Star.

The IELTS test, which is jointly owned by IDP Education, the British Council and Cambridge Assessment English, is a three-hour exam that assesses candidates’ listening, reading, writing and speaking skills on a scale of 1 to 9. A score of 9 indicates the person is an “expert user” with full command of the language. But it is up to individual organizations to determine a pass score.

More than three million IELTS tests were taken in the last year by people around the world, according to IDP Education.

“The test is recognized for being fair to all test-takers regardless of nationality, cultural background, gender or special needs,” Warwick Freeland, managing director of IELTS/IDP Education, said in an email statement from Melbourne.

“IELTS is the leading English language test for international students in Canada,” he said, adding “results from all IELTS test centres, including all centres located in India, continue to be accepted for admission to Niagara College.”

In a followup email to the Star on Saturday, IDP Education raised questions about the value of the in-house test Niagara College gave to the Indian international students in the fall cohort, saying the college “used a low-stakes” test which is “not approved by Canadian education institutions or government to check their English language skills.”

Niagara College’s Hudson said the IELTS language test results submitted by the first-year at-risk students from India this fall were authenticated by IELTS and the school is treating the “inconsistencies” in their scores and language proficiency as a one-time anomaly. “We continue to believe IELTS is a good test for assessment of English proficiency,” he told the Star.

“We have been open to dialogue with IDP and have been communicating our interest in understanding (the) rationale for the larger number of students identified being at risk of failure,” Hudson said in a followup email on Saturday. “Academic quality and student success has always been and will remain at the core of Niagara College’s decision-making.”

An Immigration Department spokesperson said officials are looking into the matter.

There have been previous instances that have exposed the vulnerability of the administration of language testing around the world:

  • A Pennsylvania State University student from China pleaded guilty this year after paying someone to take the TOEFL English-language entrance exam for her.
  • In 2016, several people in Britain were convicted of running an immigration scam that paid fake “sitters” to take TOEIC language exams for non-EU students.
  • In Australia, an employee at Curtin University’s English Language Centre was found guilty in 2011 of accepting bribes and manipulating IELTS results through the centre’s computer system. The case triggered an investigation by Western Australia’s Corruption and Crime Commission.

Freeland, who said IDP Education partners with a range of organizations who administer IELTS in 140 countries, maintained “IELTS is a secure and valid indicator of a candidate’s ability.”

“All test centres are rigorously monitored to ensure they operate to the highest of standards,” he said.

The test, which costs about $215 in India, has two versions, one for higher-level academic purposes and a general version that measures a person’s ability to function in English.

Niagara College said the school will be responsible for covering the cost of retesting for the 428 students in India and the tests must be completed by Monday.

Gonzalo Peralta, executive director of Languages Canada, an association that represents more than 200 providers of accredited English and French language programs across the country, said maintaining the integrity of language tests is important to the international education sector.

“Language testing is one tool that tells everybody — the students, institutions, Immigration Canada and employers — with confidence that this person is ready to perform linguistically,” he said in an interview. “You can’t run international education without appropriate and good-quality testing. So much depends on it.”

Alarm Raised Over Validity of International Language Tests | Story Behind the Story

Peralta said test operators constantly update their security measures and have tight rules in place at local test centres, including requiring photo ID and banning cellphones.

When informed about the situation at Niagara College, Peralta said, “I’m concerned it impacts one of our good members, Niagara College. I’m also concerned for the students who have invested substantially to learn. I’m concerned about IDP, not knowing what has happened.”

According to the Canadian Bureau for International Education, there were 494,525 international students in Canada at all levels of study in 2017, a 17 per cent increase over the previous year. Some 123,940, or 25 per cent, of these students came from India, which made up the second largest contingent behind China.

At Niagara College, which has campuses in Welland and Niagara-on-the-Lake, 2,914 of a total 4,683 international students come from India. Tuition fees for international students average $13,500, more than triple the amount their Canadian peers pay.

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Hudson said the school received about 8,200 international applications for the winter 2019 term, of which 4,800 applicants were from India, where the school recruits through international education fairs. The college made 1,300 admission offers to Indian applicants; 428 of those students have been asked to retake the IELTS test or take the alternative Pearson Test of English.

“We recognize that this is stressful for these applicants and their families, but we want to ensure that before they make significant financial and emotional investments involved with travelling to Niagara College to study, that they have the opportunity to be successful in their studies,” said Hudson.

“We believe the hardship they would experience if they were to travel here and be unable to succeed in their program of study would be much more significant. We will continue to engage with the applicants and IDP throughout this process.”

Hudson said those “at-risk” students who are already attending the college have either been redirected to language programs or offered additional language and academic support.

Nicholas Keung is a Toronto-based reporter covering immigration. Follow him on Twitter: @nkeung

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Don’t use rapid tests to rule out strep throat, many pharmacists directed

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As efforts to bring $15 rapid strep tests to Canada’s pharmacies continue, the Nova Scotia College of Pharmacists says using them in the absence of a consultation with a physician or nurse practitioner does not meet the « standard of care » for diagnosing strep throat, especially in children. 

The Neighbourhood Pharmacy Association of Canada, a national association representing pharmacy business owners, says the rapid tests can help save patients with sore throats a trip to the doctor’s office and reduce unnecessary antibiotic prescriptions. That’s because many sore throats are caused by viruses, not bacteria, rendering antibiotics useless. 

The association’s members include Shoppers Drug Mart, which started providing the tests about three years ago through pilot projects in the three provinces: Nova Scotia, Alberta and British Columbia.

For the rapid tests, pharmacists take a throat swab and test for Group A streptococcus bacteria (which cause strep throat) on site within minutes. If it comes back positive for strep, they advise the patient to go see a doctor or nurse practitioner for an antibiotic prescription.

If the test comes back negative, the association says, the patient may be able to just go home and rest instead of braving crowded waiting rooms. 

But many pediatric infectious disease specialists say the in-pharmacy tests aren’t accurate enough to rule out strep throat on their own — and it’s risky to miss strep diagnoses in children, because they can suffer from complications.

The Nova Scotia College of Pharmacists shares that concern. In May, it instructed pharmacists in that province to stop doing the rapid strep tests for diagnosis.  

‘It needed to stop’

Rapid strep tests seemed like a good idea when they first arrived, said Beverley Zwicker, registrar of the Nova Scotia College of Pharmacists.

Pharmacists « really saw this as providing a service to people, » she told CBC News. 

But as the tests became more widely available, the college began hearing concerns from children’s health-care providers. They included reports of pediatric patients showing up at a Halifax emergency department with positive strep tests from local pharmacies when they didn’t actually have strep throat, Zwicker said.

When the college looked into the issue further, it determined that having a pharmacist swab a child’s throat to test for strep without a complete medical examination was contrary to the clinical practice guidelines established by the Infectious Diseases Society of America, which are regularly used by health-care providers in Canada. 

Those guidelines say that for children, even a negative rapid strep test should be backed up by a throat « culture » test — which definitively confirms the presence of strep by seeing if it grows in a lab setting from the throat sample. That’s the test doctors routinely use when they suspect strep throat in kids.

So in May, the college « made it very clear to all pharmacists that conducting this test without the patient first having that physical assessment by a physician or nurse practitioner was inappropriate and that it needed to stop, » Zwicker said.  

The Nova Scotia College of Pharmacists issued this notice in May 2018. (Nova Scotia College of Pharmacists)

The point-of-care tests may still have a role to play if pharmacists work in conjunction with doctors and nurse practitioners, she said.

If a doctor examines a patient and believes they have strep throat, for example, they can send the patient to the pharmacy with an antibiotic prescription contingent on the result of the point-of-care test. If it’s positive, the patient can start antibiotics right away, instead of waiting for the results of a traditional « throat culture test, » which is sent to a lab and takes a couple of days.

It’s too early to tell whether doctors and nurse practitioners will use that option, Zwicker said, since the strep throat « season » has just begun.  

Pharmacists do ‘thorough assessment,’ association says

When asked to respond to the concerns expressed by the Nova Scotia College of Pharmacists, the Neighbourhood Pharmacy Association said it agreed « that an assessment of symptoms by a healthcare provider is required prior to determining the appropriateness of the point of care testing » and that pharmacists have « the training and the expertise » required. 

« Pharmacists are healthcare providers and we do perform a thorough assessment of the patient before determining whether to perform the test, » said Sandra Hanna, a practising Toronto-area pharmacist and the association’s vice-president of pharmacy affairs, in an email to CBC News.   

« Like any test there are always certain limitations and pharmacists use their professional judgment when determining whether the test is appropriate for a given patient, » Hanna said. 

« In some circumstances pharmacists would refer to a physician, and age is one of the criteria used in considering the appropriate care plan for a patient. »

But Zwicker told CBC News that the « assessment » Nova Scotia pharmacists were asked to use in conjunction with the rapid strep tests was a questionnaire about symptoms. The college concluded that was not an adequate replacement for the examinations conducted in a doctor’s or nurse practitioner’s office, she said. 

New guidelines for Alberta pharmacists

In Alberta and British Columbia, the colleges governing pharmacy practice have not issued similar directives to Nova Scotia’s. 

However, in an emailed statement to CBC News, Jeff Whissell, deputy registrar of the Alberta College of Pharmacy, said the college had completed new practice standards and guidelines on the use of point-of-care testing in pharmacies to take effect on Jan. 1.  

As consumer demand increases, pharmacists need to understand « the limitations » of rapid strep tests, « especially for children, » he said.  

« If a rapid strep test or any other point of care test produces a negative result, pharmacists should discuss the sensitivity limitations of the test with their patient, and provide appropriate information for the patient on the need for follow-up, including the possibility of consulting with their physician for further investigation. »

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‘There is no validity’: Unproven blood tests for food sensitivity widely offered in Canada

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Feeling fat, itchy or bloated? Got tummy trouble? Want to help your hair or fix your skin? Could what you’re eating be ailing you? That’s certainly the sales pitch from companies behind food sensitivity tests.

They’re often advertised as a quick solution to a range of health issues, including by two of Canada’s biggest labs — despite the fact the science behind these questionable tests has been discredited by medical groups around the world.

And consumers, including Laura Chapnick, are buying in.

While waiting for other blood tests and an ultrasound in a Dynacare clinic, Chapnick saw an ad stating that 45 per cent of people suffer from food intolerances. Desperate for answers to her ongoing stomach problems, Chapnick later asked to take the $325 food intolerance test.

She said she « genuinely believed that doing … the blood test was going to give me absolute factual answers that I needed. »

Laura Chapnick decided to ask for an IgG blood test for food sensitivities after seeing an ad in a Dynacare clinic. She was there for other blood tests and an ultrasound. (CBC)

Within weeks, she received a report outlining 26 foods she should reduce or eliminate altogether. Many were foods she had been eating regularly, including corn, potatoes, peanuts, wheat, milk and eggs.  

« These tests scared the crap out of me, » she said. « These food tests scared me into believing that whatever I put in my mouth was toxic. »

Grocery shopping and eating quickly became a challenge. « I felt like a prisoner in my own head almost, » Chapnick said, « and became very obsessive, trying to figure out what can I eat. »

  • Also on Marketplace this week: Investigating the rise of ‘tech abuse’ and the truth about popular (and pricey) ‘teatoxes.’ Watch at 8 p.m. Friday on CBC TV or online.

Chapnick is not alone. The value of the global food allergy and sensitivity industry is expected to hit a whopping $24.8 billion US by 2020. And with food sensitivity tests specifically ranging in cost from more than $100 to nearly $400, companies are cashing in on the craze.

Two of Canada’s biggest labs, Dynacare and LifeLabs, promote and offer something known as IgG food tests at their labs, marketed as a way to test for food sensitivities.

But medical experts, including the Canadian Society of Allergy and Clinical Immunology (CSACI), call IgG tests for food sensitivities « unvalidated, » and more than two dozen organizations warn about the misuse of such tests.

The reports being generated by the IgG test taken by Chapnick and countless others are being grossly misinterpreted, critics say.

Food sensitivities are different from food allergies. An allergy is an immediate, immune response, and foods like nuts and seafood are often known to cause allergic responses that can be life-threatening.

Sensitivities or intolerances, on the other hand, are not related to the immune system and often take hours, if not days, to take effect — and are therefore very difficult to diagnose.

Exposure not intolerance

Dr. Douglas Mack, a pediatric allergy, asthma and immunology specialist, argues the results of an IgG test are an indication that you had exposure to the foods — not an intolerance of them.

IgG tests measure levels of an antibody known as Immunoglobulin G — or IgG, for short.

« It should be used to track whether a patient actually is developing tolerance, not intolerance, » he said.

Dr. Douglas Mack is a pediatric allergy, asthma and immunology specialist. (Dave MacIntosh/CBC)

Interpreting the test otherwise is not only incorrect, but potentially hazardous to your health, Mack argues. By unnecessarily eliminating foods, he says he sees « kids that are coming in with nutritional deficiencies, with failure to grow very well. »

Removing foods from your diet could also lead to development of a food allergy, especially in children, says Mack. One young patient of his developed a milk allergy after eliminating it from his diet when a food sensitivity test suggested he had a milk intolerance.

« If these tests result in the harm of a child, we really gotta think twice about whether or not these labs should be offering these, » he said.

Putting the test to the test

To test the accuracy of these food sensitivity tests, Marketplace ran several different kinds on host Charlsie Agro, including drawing blood for the IgG tests offered by Dynacare and Rocky Mountain Analytical, which is owned by LifeLabs.

Both tests require a requisition from a naturopathic doctor or licensed physician. LifeLabs’ test is typically offered through naturopaths or other health outlets, however, while Dynacare’s food intolerance test is advertised and promoted directly to the consumer in its clinics.

The results from the Rocky Mountain Analytical test reported intolerances to 52 foods, while Dynacare reported 30 intolerances.

The tests offered by both Dyancare and Rocky Mountain Analytical require a requisition from a naturopathic doctor or licensed physician. (Tyana Grundig/CBC)

Before taking the tests, Agro had tracked what she was eating. Yet both tests reported intolerances to foods she regularly consumed, with absolutely no adverse reactions.

For example, Agro had a smoothie, which included flax seeds, for breakfast daily. Yet both tests suggested Agro is intolerant to flax. She also ate vegetable soup — containing barley, kidney beans and corn — without problem. Both IgG tests again claimed Agro is intolerant to these foods.

Both sets of lab results also showed Agro is « intolerant » of egg whites, all milks, wheat and gluten — all foods she eats regularly without issue.

What the results say

IgG is really a memory antibody, says Dr. David Stukus, an associate professor of pediatrics with the allergy and immunology department at the Ohio-based Nationwide Children’s Hospital.

« Measuring specific IgG levels merely detects that the person has eaten it at some point in the past, » he said. « It is a normal physiological response to eating. »

Stukus also said it wasn’t surprising that foods Agro hadn’t consumed in the weeks leading up to her blood tests showed up in her results.

One set of Charlsie Agro’s test results showed flax was a problem food for her. Yet she puts flax seed into her morning smoothie daily and has never felt negative effects. (John Lesavage/CBC)

Some foods « have cross-reactivity, » he said, meaning the proteins in one food are similar to the proteins in another.

« So it is possible that [the test] is picking up the memory antibody of other similar foods that have been eaten in the past, » Stukus said.  

He points to peanuts as a common example: If you’ve eaten peanut butter, your results might suggest you are intolerant to other legumes, like soy or other beans.

Serious side effects

More than 25 leading health organizations from around the world have warned about the misinterpretation of IgG tests, including a Health Canada scientist who wrote « these tests are not reliable and should not be recommended as a single diagnosis tool. »

Position papers from international medical communities have called the IgG blood test for food sensitivities « irrelevant, » « unvalidated » and « inappropriate, » warning that the test provides « false diagnoses » and that « the test should not be performed » for such a purpose.

There can also be adverse effects to drastically limiting your diet, including malnutrition and disordered eating patterns, says Stukus.

Chapnick said her eating patterns changed significantly after she got her IgG test back, which was done by Dynacare. So she turned to registered dietitian Elke Sengmueller to develop a diet she was comfortable with based on those results.

But Sengmueller says the radical changes the test was calling for would put Chapnick’s already compromised health in jeopardy.

« Because she had drastically cut down her foods already, because of her symptoms and her pain and not getting any answers, she was afraid to eat, » she said. « If she were to continue this … for an extended period of time, given her medical history I could see it … possibly leading to death. »

Registered dietitian Elke Sengmueller said the radical changes outlined in Chapnick’s IgG food test results made her client ‘afraid to eat.’ (CBC)

Mack says he is especially troubled by the IgG claims being made by LifeLabs and Dynacare through its marketing, as these are two of Canada’s largest blood labs, conducting millions of tests annually for everything from cancer screening to workplace drug testing.

« These are labs that we send patients to to get their bloodwork done for their iron, or to see if they have cancer, or to see whatever, » he said. « But in the same place, these labs are now offering a test for which there is no validity. »

Sengmueller echoes that concern.

« I’m surprised that an organization as reputable as Dynacare would be offering this to their clients, especially while they’re waiting to get their blood work done — they’re kind of a captive audience. It’s disappointing. »

Answering for IgG

When Marketplace asked the Ontario Ministry of Health about the manner in which IgG tests are being marketed in the province, a spokesperson said that labs are « operating as private businesses … and are allowed to provide a variety of tests that they are licensed to perform. »

Health Canada told Marketplace it has issued medical device licences for some IgG tests, but that none are « intended to be a single tool to be used for diagnosis of food intolerance. »

In its response, Dynacare said that « debate exists » about the use of the tests for food sensitivities, but  « peer-reviewed articles support the use of the food IgG test as an additional source of information. »

And the company said it « relies on the expertise of the ordering health professional to determine the appropriateness of a particular test for a particular patient. »

LifeLabs, the parent company of Rocky Mountain Analytical, also said that « numerous studies in peer-reviewed journals have shown the health benefits of removing IgG-reactive foods, » and that « a test does not need to be diagnostic to be clinically relevant and useful. »

Dynacare and LifeLabs provided those peer-reviewed studies to Marketplace, which were then analyzed by clinical epidemiologist and biostatician Jason Busse, DC, PhD. He found that « all of the studies were very problematic, » and said he was « amazed that many of them were published. »

If you’re worried about how the food you’re eating might be affecting you, health professionals say the best place to start is by keeping a detailed food and symptom diary, tracking what you’re eating and how it makes you feel. It’s important to visit a registered dietitian or family physician before starting any kind of elimination diet, they say.

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Small group of Ontario family MDs orders too many unnecessary tests, study finds

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A small group of Ontario family doctors is responsible for ordering a disproportionate amount of unnecessary screening tests on patients, new research shows.

A paper published Friday in JAMA Network Open found that 441 primary care physicians in the province order nearly 40 per cent of tests considered “low-value.”

This subset of the province’s 11,448 family doctors demonstrates “a general pattern of overuse,” according to the study by researchers at the Institute for Clinical Evaluative Sciences (ICES) and Women’s College Hospital.

Lead author Dr. Sacha Bhatia said the findings are relevant because they can help better target future efforts to reduce low-value care.

“The reality is that most doctors don’t get a lot of feedback on how they’re doing. But if we know who needs this the most, we can make big strides to improve the care patients get and save much needed health-care dollars in the process,” he said.

Researchers looked at the ordering rates of four low-value screening tests between 2012 and 2016. They correctly hypothesized that physicians who frequently order one of these tests are more likely to frequently order at least one of the others as well.

The four tests studied are:

  • Repeat bone density tests, formally known as dual-energy X-ray absorptiometry (DXA) scans. This kind of screening is done to look for conditions such as osteoporosis. Evidence shows there is little value in having more than one of these scans within a two-year period.
  • Electrocardiograms (ECGs) for patients 40 and older who are considered at low risk of cardiovascular disease.
  • Chest X-rays for patients at low risk for cardiopulmonary disease.
  • Pap tests on women younger than 21 and older than 69, a demographic considered at low risk for cervical cancer.

These four tests were studied because of an abundance of evidence showing they are overused and that there is much variation in how often doctors order them.

They have been identified as low-value by Choosing Wisely Canada, which is part of an international clinician-led campaign, running in 20 countries, aimed at reducing the frequency of low-value care.

Bhatia, a cardiologist, is the evaluation lead for Choosing Wisely Canada. He is the director of the Women’s College Hospital Institute for Health System Solutions and Virtual Care. Bhatia is also an adjunct scientist with ICES

He explained that low-value tests are not particularly helpful in diagnosing or treating disease. They also include tests for which the harms of undertaking them outweigh the benefits. For example, patients may be unnecessarily exposed to radiation.

Bhatia noted that it costs only about $5 to do one ECG. But the concern, he said, is that unnecessary ECGs are being done in large numbers and can result in patients getting even more tests they may not need. This is because screening tests can cause false positive results that require some further testing to rule out real disease. But this additional testing may be more invasive and expensive.

A report released last year by the Canadian Institute for Health Information and Choosing Wisely revealed that Canadians have more than 1 million potentially unnecessary tests, treatments and procedures annually.

The report found that 30 per cent of selected tests, treatments and procedures are potentially unnecessary. They waste health system resources, increase wait times for patients in need and can lead to patient harm.

The JAMA study was a retrospective one, which saw researchers pore over data on health-care claims held by ICES.

They identified 2,394 Ontario family doctors who see the most patients and order the most tests.

Researchers found that 18.4 per cent of this group — or 441 doctors — orders 39.2 per cent of all of the low-value tests.

“When you look at the overall trends on how doctors order these tests, most actually practise reasonably well. But for the minority who order these tests unnecessarily — the one in five — we can see clearly where there is a big opportunity for change,” Bhatia said.

Doctors with increased odds of frequently ordering low-value tests are male, further removed from medical school graduation (meaning they are older), and receive much of their income by billing OHIP on a fee-for-service basis. They are also more likely to be graduates of Canadian medical schools.

Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle

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