Family doctors can no longer claim ritzy drug dinners as professional training

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Canadian family doctors can no longer earn educational credits for attending swanky drug dinners, where pharmaceutical companies wine and dine physicians at some of the country’s most upscale restaurants.

The change, part of larger efforts to protect the integrity of the continuing medical education doctors are obligated to take, is outlined in a new report released by the College of Family Physicians of Canada to its more than 38,000 members.

Although doctors can still choose to attend the dinners, they will not receive credits.

“Our view is that (the dinners) are basically marketing evenings,” said Dr. Jeff Sisler, who oversees medical education programming for the College.

“We’re trying in that decision to discourage members from that kind of learning, and remind them that it is not viewed by the College as appropriate continuing professional development.”

In Ontario, physicians are required to attend continuing medical education to keep their licence in good standing.

Read more:

Drug companies wine and dine family physicians

Critics have long said that in providing professional development, pharmaceutical companies are disguising a sales pitch as education, and doctors are encouraged to prescribe a sponsoring drug maker’s product over other options.

A 2016 Star investigation exposed questionable practices at some of these dinners, where everything from the speaker to the food and wine was bankrolled by the drug company. In Toronto, the soirees included a three-course meal at Sassafraz in Yorkville.

At more than one dinner, the Star found the speaker recommended a medication to treat certain conditions — the medication made by the same company that funded the event. In the days following a company-sponsored dinner lecture on managing symptoms of irritable bowel syndrome, a rep from the pharmaceutical company visited the clinic of one of the doctors who attended with samples of its latest product.

The new report reveals that the College’s professional development department received nearly $80,000 from the pharmaceutical industry in the 2017-2018 fiscal year. The money came from fees drug companies paid to have their educational programs reviewed and certified.

Since tightening the rules last year to no longer certify educational events put on by drug companies, the College expects that amount of direct revenue from industry to drop to zero, the report said.

“That’s been a big change for us,” one prompted by concerns of a “high risk (of bias),” Dr. Sisler said.

But that change does not mean medical education will be completely free of industry money.

Pharmaceutical companies can still give money to groups putting on the educational events, though new restrictions put in place by the College and other doctor organizations bar the sponsoring drug makers from participating in choosing a speaker or developing the presentation.

In 2017-2018, 31 per cent of the applications to have an event certified by the College declared some kind of funding support from drug companies, the new report said.

Dr. Sheryl Spithoff, a family physician at the Women’s College Hospital in Toronto, said the College needs to go further and not accredit any educational event put on by a group funded by industry.

“We know that when the pharmaceutical industry funds physician education, it leads physicians to prescribe drugs more often, and prescribe less appropriately,” Dr. Spithoff said

“What we really want to stop is to stop the influence,” she said. “The only way to change that appears to be stopping the funding.”

Dr. Sisler said the College, however, continues to support “a mixed model” of funding for professional development.

“There is no direction or intent at the moment to move to a time when pharma support is not permitted period. That isn’t the way things are moving at the moment,” he said.

Jesse McLean is a Toronto-based investigative reporter. He can be reached at jmclean@thestar.ca. Follow him on Twitter: @jesse_mclean

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Please sell responsibly: Ontario launches cannabis retail training

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It will take four hours of online training before employees can step behind the counter of a pot shop in this province.

That’s the average length of time a mandatory course known as CannSell will take prospective workers in Ontario’s forthcoming cannabis stores to complete, its builders say.

A grow room at Canopy Growth’s Tweed facility in Smiths Falls, Ont. For retail workers, a program has been set up in advance of the first stores, coming April 1.
A grow room at Canopy Growth’s Tweed facility in Smiths Falls, Ont. For retail workers, a program has been set up in advance of the first stores, coming April 1.  (Sean Kilpatrick / THE CANADIAN PRESS)

Created by the cannabis resource company Lift & Co. and MADD Canada, the program was announced this week by the Alcohol and Gaming Commission of Ontario as the sole certification program for all store employees.

“By law everyone that touches cannabis (in) retail essentially has to have this course,” said Lift and Co. head Matei Olaru.

“CannSell is meant to educate cannabis retail employees on the responsible sale of cannabis and their legal and regulatory obligations,” Olaru said.

The $49.99 (plus tax) course will be offered starting Feb. 25 and will have to graduate its first class in time for the scheduled April 1 opening of Ontario’s 25 initial brick-and-mortar shops.

Read more:

First store could be in Yorkville

Canada’s edibles could be much weaker than U.S.

Collective Arts craft brewer branches out to pot

Central to the self-guided program, said MADD Canada CEO Andrew Murie, is its focus on responsible sales.

“The drug presence in (road) fatalities is three times what it is for alcohol,” Murie said. “We’ve done an amazing job on alcohol so we need to applaud ourselves for that, but we still haven’t had the same rigour around cannabis.”

Murie said safety issues covered in the course will largely mirror those found in the Smart Serve Ontario training program, required of LCBO workers.

Most important, he said, are the program’s focus on the legal liability that stores could face; federal and provincial regulations surrounding pot; and the ability to recognize both cannabis and alcohol impairment.

“If you train people to know their jobs so they don’t serve minors, they don’t serve intoxicated people, that lowers the incidence of potential impaired driving,” Murie said.

But he said ongoing alcohol and gaming commission inspections must ensure that the rules taught in the online program are being enforced at shop doors and counters.

“If we can tighten up on that (responsible service) then that goes a long way to reducing the harms.”

The course will also delve into the risks, harms and responsible use of cannabis and provide an overview of the plant and its history. The latter aspect, Olaru said, will give store employees the grounding they need to build an expertise in cannabis products that consumers will demand.

Some 70 per cent of consumers rank a strong product knowledge among store staff as the top feature of a cannabis outlet, a 2018 industry report by Deloitte Canada found. Olaru said Lift could take the lead on further product education among store employees.

“CannSell is very much a foundation for you to even understand how to talk about products.”

The course will be taken individually online and students must score 80 per cent to pass. All retail managers and store owners must also be CannSell-certified under provincial rules. The program’s website, cannsell.ca, was to go live Thursday with an information package on the course.

A similar program is being offered by MADD and Lift & Co. in Nova Scotia, Prince Edward Island and by many private stores across Canada.

Murie said CannSell programs are modular and that they can keep up with a changing industry — one that will see edibles enter the market next October, for example.

“The training needs to keep up with the marketplace,” he said. “So we designed it on that flexibility so every teaching element is a single component in the training so it can be removed, can be updated and slotted back in — components come in come out.”

Murie said he does not know if employees will be on the hook for the course costs or if store owners will cover them.

He said many LCBO applicants take the Smart Serve course at their own expense to boost their hiring prospects.

Joseph Hall is a Toronto-based reporter and feature writer. Reach him on email: gjhall@thestar.ca

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Canadian soldiers suffer frostbite during winter training

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About 20 Canadian Armed Forces members suffered frostbite, and some required hospitalization, following a military training session near Petawawa, Ont., held earlier this month in extremely cold weather. 

On Jan. 17-18, nearly 120 soldiers with the Royal Canadian Dragoons participated in basic winter survival training while the temperature dropped to –31 C. 

The soldiers, part of the immediate response unit (IRU) vanguard, left in the morning on a 12-kilometre march and returned the next day after spending the night outside.        

Approximately 20 soldiers reported frostbite or minor hypothermia, and « a very small number » had to be hospitalized for more serious cold-related injuries, said public affairs officer Capt. Daniel Mazurek.

Mazurek said medical staff and ambulances were present during the training to provide care. The frostbite cases were treated immediately, he said, and soldiers with more pressing injures were taken to hospital. 

No amputations were necessary, Mazurek said, and all the soldiers sent to hospital have now returned home or are back at work.

Maj. Kevin Wong said he was given notice the winter survival training would be taking place only a few hours before it got underway. (Radio-Canada)

‘We must accept some risks’

Maj. Kevin Wong was one of the soldiers taking part in the training. He said it was a « no-notice exercise, » meaning they were only told it was taking place only a few hours beforehand.

« We do this more than once a year. » Wong told Radio-Canada.

« We train for the worst-case scenario [in] the harshest conditions, whether it’s cold or hot, whether it’s on land or near water. We have to be ready to respond to the needs of Canadians. »

Mazurek said that IRU soldiers are required to tackle emergencies like floods or ice storms « on a moment’s notice, » and therefore exercises in such extreme conditions, while difficult, are also necessary.

« Our job is to protect Canadians, regardless of the environment or situation, » he said. « To prepare for this incredible responsibility we must accept some risks. »

Some of the equipment that Canadian Armed Forces soldiers brought with them during the winter survival training exercise, which took place while the temperature dropped to –31 C. (Jeff Smith)

‘Serious lack of leadership’ 

Retired colonel Michel Drapeau, however, said he believes the soldiers were exposed to significant risk.

« It is a serious lack of leadership, and we should not put our young people at risk in this way, » he said. 

Nevertheless, Drapeau agreed that Canadian troops must be ready to operate and survive in Arctic climates, hence the importance of training in harsh conditions.

« Canadian soldiers are trained for this kind of exercise — and are much better equipped than the general population — but sometimes commanders want to push their troops, » Drapeau said.

« There is a fine line between pushing their soldiers … and abusing their power as commanders. »

Retired colonel Michel Drapeau said the soldiers who took part in the winter training exercise near Petawawa, Ont., were exposed to significant risk of frostbite. (Radio-Canada )

Richard Blanchette, a retired major-general and the chair of the Royal Canadian Legion’s defence and security committee, said that the injuries sustained by the soldiers during the training were not « normal. »

Blanchette said those types of injuries can occur when training conditions are extremely difficult — but also if the equipment wasn’t suitable for the situation. 

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Advocates welcome mandatory training for semi drivers

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Advocates are praising the decision to make training for semi drivers mandatory across Canada, but they say there’s still more work to do.

« I’m just very grateful the ministries have all met and are moving forward and agree that it needs to be federally regulated. That’s wonderful, » said Pattie Fair, whose petition calling for national rules for semi drivers attracted more than 2,100 signatures over the past week.

Federal and provincial transport ministers met in Montreal Monday. They said new training standards will be developed by the end of the year and will be mandatory in every province and territory shortly after that.

University of Manitoba professor Ahmed Shalaby lauded the federal and provincial ministers for making semi driver training mandatory, but said there is still more to do. (Leif Norman)

« Development of this national standard represents an important milestone for road safety in Canada, » an official in Federal Transport Minister Marc Garneau’s office said in an email.

Details of the new rules are unclear. Some had called for the federal government to take over, but it appears each province will still be responsible for semi driver training. It’s also unclear, for example, whether exceptions will be allowed in each jurisdiction. In Saskatchewan, for example, the previously announced rules allow farmers to bypass the training if they stay within provincial borders.

Fair, whose husband was killed in a 2017 crash with a semi, said mandatory training will make the roads safer. Trucking is the second most popular occupation in Canada, with an estimated 300,000 drivers on Canadian roads.

Crosses, hockey sticks and other items form a memorial at the site of the crash between a semi and the Humboldt Broncos bus. Calls for mandatory training for semi drivers have grown since the crash, and the changes were announced this week. (Omayra Issa/CBC)

University of Manitoba professor Ahmed Shalaby called it « a very important step. » He said the training needs to be evidence-based and data should be collected on which driving schools are producing the safest graduates. The United States is moving toward a rigorous national system of data collection, Shalaby noted.

« I’m very hopeful that will happen, » Shalaby said.

Shalaby praised Fair and the families of the Humboldt Broncos victims for their courage and advocacy. He said their voices were a powerful force in making policy makers aware of the situation.

At the moment, only Ontario has mandatory training. Saskatchewan and Alberta are set to implement it in the spring.

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Ontario corrections officers only get a week of training, London jury hears

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A former corrections officer at the Elgin-Middlesex Detention Centre told a London court that provincial jail guards only receive a week of training before starting their jobs and are not required to acknowledge changes to jail policy by their employer.

Greg Langford, 60, is a key Crown witness and has worked as a guard at the London jail for seven years. Before that, he worked for eight years at jails in Waterloo and Sarnia.

On Thursday, he testified that he warned his fellow former jail employees Stephen Jurkus and Leslie Lonsbary about « the distinct odour of alcohol » emanating from the cell inmate Adam Kargus shared with prisoner Anthony George on Halloween night in 2013.

George proceeded to beat Kargus to death in a violent frenzy in the cell that lasted for over an hour. George is now serving a life sentence for second degree murder.

The Crown alleges Jurkus and Lonsbary failed in their duty to protect Kargus from the deadly beating. Both men have pleaded not guilty.

Former EMDC supervisor Stephen Jurkus seen outside the courthouse in London, Ont. Jurkus and a colleague are accused of failing to provide the necessaries on life in connection with beating death of Adam Kargus. (Colin Butler/CBC)

Langford was initially charged along with the two men, but the charges were dropped after he testified at a preliminary hearing in May, 2015.

During cross-examination by Lonsbary’s lawyer Ron Ellis Friday, the jury heard how Langford described his training at all three jails as « non-existent. » 

« It was non-existent, your training? » Ellis asked.  « You’ve described it that way before. »

« Yes, » Langford testified.

Fomer EMDC guard Greg Langford seen here leaving the London, Ont. courthouse on Jan. 17, 2019 is a key Crown witness. (Colin Butler/CBC News)

Langford told jurors that his training consisted of courses in CPR, first aid, fire procedure and a week of shadowing a more experienced guard. 

He also received a copy of the standing orders, a provincial policy manual on how corrections officers should properly do their jobs.

However, he noted during testimony that when it came to actually dealing with the inmates on a day-to-day basis, guards largely have to figure it out themselves and often don’t perform their duties by the book. 

« So you can develop your own way with the inmates as long as you don’t break major rules? » Ellis asked. 

« Correct, » said Langford, noting that in his 15 years as a corrections officer at three provincial jails, he was never given in-service seminars or updates on proper correctional techniques.

Langford testified that the only training updates he received came in the form of paper handout. Even then, Langord said he was never required to acknowledge that he had received, read, or even understood them.

Langford testified that if the standing orders were followed to the letter, inmates would become uncooperative, causing delays, which would then upset the courts. 

« The place comes to a standstill, » he testified. « Inmates don’t get to court on time and everything goes bad. »

Adam Kargus was beaten to death by his cellmate on the night of Oct 31, 2013. (Deb Abrams) 

« The courts were upset? » Ellis asked. 

« Yes, » Langford testified.

Langford also told the court that in his time at the EMDC, the jail was often understaffed and overcrowded, with as many as three and sometimes four inmates squeezed into a cell that was only designed for two prisoners. 

On the day Kargus was killed, Langford recalled in front of the jury that he was frustrated because a staffing shortage forced a lockdown on Unit Six Left, where Kargus and George were housed because a number of guards had gone home early.

Ellis pointed out that while Langford claimed he had warned fellow guard Leslie Lonsbary and former supervisor Stephen Jurkus about a « possible brew, » Langford neither explicitly said anything about alcohol, nor did he tell them about Anthony George placing Adam Kargus in a chokehold earlier in the day.

In a surveillance video shown in court, George can be seen placing Kargus in a chokehold in the same room as Langford just hours before the murder. 

Anthony George was able to move the bloody mattress from his cell to another cell, all undetected by EMDC guards. (EDMC surveillance footage)

Langford told the jury that the chokehold was his first thought when he learned of Kargus’ death when he reported to work on November 1, 2013.

« I thought about the chokehold, it’s the first thing that came to my mind, » he said.

« Is it fair to say that you thought ‘oh my goodness, I should have seperated them? » Ellis asked. 

« Yes, » Langford said. 

Langford was fired from his job at the London jail in connection with Kargus’ death. 

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Judge certifies $600-million class-action lawsuit on behalf of former residents of Ontario’s training schools

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An Ontario Superior Court judge has certified a class-action lawsuit seeking $600 million in damages against the Ontario government on behalf of former residents of the province’s training schools.

The certification order, signed by Justice Danial Newton in Thunder Bay and released Tuesday, defines the class as all individuals who resided at 13 of the province’s training school facilities between Jan. 1, 1953, and April 2, 1984.

A look at what is left of Pine Ridge Training School in Bowmanville, Ont. The provincially-run training school operated in the 1970s. On Tuesday, a judge certified a $600-million class-action lawsuit against the Ontario government on behalf of former residents of the province’s training schools.
A look at what is left of Pine Ridge Training School in Bowmanville, Ont. The provincially-run training school operated in the 1970s. On Tuesday, a judge certified a $600-million class-action lawsuit against the Ontario government on behalf of former residents of the province’s training schools.  (Randy Risling / Toronto Star file photo)

“This is an important milestone for the boys and girls from the training schools,” said lead plaintiff Kirk Keeping in a statement issued by Koskie Minsky, the law firm representing him and other class members. Keeping alleges he was sexually, physically and psychologically abused while attending Pine Ridge Training School in Bowmanville in 1968 when he was 15.

“We have all lived with this for years and we are glad this case is moving forward,” he said.

Training schools were institutions set up and operated by the provincial government to house and educate thousands of children between the ages of 8 and 16 who were deemed by the courts to be “incorrible” or “unmanageable.” Children sent to training school need not have committed any crimes; transgressions such as petty theft, truancy, or running away from home could land a child in training school. Many children sent to the institutions came from abusive or poverty-stricken homes.

A Star investigation published last year revealed that the provincial government has secretly settled more than 200 individual lawsuits launched by former training school residents who alleged horrifying treatment at the hands of school employees. Former students interviewed by the Star alleged they were raped, beaten and put in solitary confinement by staff members, among other abuses they say they suffered.

The Star’s investigation also revealed that provincial officials warned the government — in one case as early as the late 1960s — that students were being mistreated at the institutions, but that these warnings appeared to have been ignored. The last training school closed in 1984.

“The allegations of abuse by the province are quite frankly shocking,” Jonathan Ptak, a partner at Koskie Minsky and the lead lawyer for the class, said in a statement Tuesday. “We are pleased that the case now has been certified as a class proceeding, so that we can now litigate this case on the merits. We will continue to push forward as quickly as possible and to seek access to justice for the thousands of survivors of the Ontario training schools.”

The next step in the case, he said, will be to return to court to determine how to provide notice to class members that the action is proceeding. Class members will then have the opportunity to opt out if they wish. Ptak said records filed by the province in the case show there were about 21,000 former residents of training schools.

The lawsuit, which seeks $500 million in damages for negligence, breach of fiduciary duty and vicarious liability, as well as $100 million in punitive damages, was certified in Thunder Bay, where lead plaintiff Keeping lives.

Among Keeping’s allegations in the statement of claim, which was filed in Dec. 2017, were that he was sexually abused by two Pine Ridge training school employees: a female kitchen worker who allegedly took Keeping, who was a virgin, into a large cooler and had sex with him; and a male employee working at the school’s dairy farm who allegedly performed oral sex and “simulated sex” on Keeping.

It also alleges he was put in a locker by staff members and hit with running shoes when he misbehaved.

“The children who resided (in training schools) were vulnerable and powerless and due to the Crown’s systemic failure, were subjected to a toxic environment in which physical, sexual and psychological abuse was widespread,” reads the statement of claim.

As of publication time, the Ministry of the Attorney General had not responded to a request for comment.

Kenyon Wallace is a Toronto-based investigative reporter. Follow him on Twitter: @KenyonWallace or reach him via email: kwallace@thestar.ca or phone 416-869-4734

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He started as a tiny preemie at Sick Kids. He beat the odds and now he’s back at the hospital — as a doctor in training

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Adam Shehata has been inside the Hospital for Sick Children hundreds of times in his 36 years.

First, as an infant, struggling to survive in the hospital’s NICU after being born 16 weeks too early and on the threshold of life.

Adam Shehata, 36, is a third-year medical student who came late to the field but says it’s a long-held dream to be a pediatric surgeon.
Adam Shehata, 36, is a third-year medical student who came late to the field but says it’s a long-held dream to be a pediatric surgeon.  (Rick Madonik / Toronto Star)

Then, as a child, during weekly visits for his many follow-up appointments.

And later, as an adult, Shehata found himself back at Sick Kids for an unexpected visit, during which he and his wife learned their longed-for first pregnancy would have a devastating end.

But this week, Shehata entered the hospital, not as a patient or a parent, but as a doctor-in-training, a step toward fulfilling his long-held dream of becoming a pediatric surgeon at the renowned hospital.

“I’m fortunate for so many reasons, and much of it has to do with the care I received at Sick Kids,” Shehata says. “And now it’s a really nice feeling to know I can start to give back.”

Shehata, a third-year medical student at the University of Toronto, started his six-week pediatrics rotation at Sick Kids on Monday, Nov. 26.

That morning, during his subway commute to the hospital, Shehata found himself reflecting on what it meant to go back to the place that once saved his life. This time, and against the odds, he would be the one helping children.

Shehata hadn’t planned on making his thoughts public. But once he saw the big, illuminated Sick Kids sign towering above the main entrance, Shehata snapped a photo of the building’s facade and posted it on Twitter, along with several tweets briefly outlining his health journey.

His Twitter thread, which includes the following statement — “We can never truly know the impact we will have on other people’s lives” — has since been ‘liked’ more than 2,000 times and has generated dozens of comments. This is a lot of online attention for Shehata, who has roughly 350 Twitter followers.

“I think it’s the kind of story that people are longing for,” he says. “People are always rooting for the underdog. And though I don’t see myself in that position now, I certainly was an underdog when I was a baby, born at 24 weeks, with such long odds for survival.”

At 36, Shehata is a bit late to medical school; many of his classmates are in their early 20s.

But Shehata, who applied five times to med school before being accepted by the University of Toronto in the spring of 2015, knows he brings a host of skills.

Shehata is a professional pilot with a university degree in aviation business management. He also has a law degree from Osgoode Hall Law School at York University.

While in his 20s, Shehata focused on his passion for aviation, earning his Class I Flight Instructor rating, which allowed him to teach commercial pilots how to fly, and then acquiring his airline transport pilot licence, which is needed to captain large commercial airliners.

Adam Shehata, 2 months old, in an incubator at Sick Kids. The Polaroid photo was taken Aug. 7, 1982.
Adam Shehata, 2 months old, in an incubator at Sick Kids. The Polaroid photo was taken Aug. 7, 1982.  (Supplied)

But in 2010, at age 28, Shehata decided to become a doctor after a lifechanging experience that took place with his wife, Christina.

The pair, who had married the previous year, had been referred to Sick Kids after learning their unborn baby — their first pregnancy — had a severe heart defect. Shattered by the news, the couple were comforted by a pediatric cardiologist, who spent two hours helping them understand what it meant for a baby to have such a condition.

“We ended up losing that pregnancy,” Shehata says. “But that conversation with that physician inspired me to consider a career in medicine. He didn’t make the situation medically better for us, but the time he took and the way he explained things to us and his kindness … I knew I could be that person someday.”

Within months of their loss, Shehata was acquiring the high school and university credits needed to get into medical school. But despite top grades and his extensive aviation experience, Shehata didn’t make the cut at various schools.

Adam Shehata as a happy, healthy 4-year-old on his first soccer team.
Adam Shehata as a happy, healthy 4-year-old on his first soccer team.

Shehata then turned his attention to the law, another profession he believed had the power to change people’s lives.

He excelled in his studies at Osgoode Hall and was called to the bar in 2016. But still, he could not let go of his dream of being a doctor.

Shehata applied one last time to medical school. The same month that he was offered a job in aviation law at a downtown Toronto firm, he was admitted to the U of T’s faculty of medicine.

Three years later, and starting his pediatrics rotation at Sick Kids, Shehata knows he’s on the right path.

Shehata’s mother, Mona ElSayeh, is proud of her son and remains in awe of his success given the grim outlook at birth.

ElSayeh, who is executive director of a small Toronto charity called Access Community Capital Fund, recalls her and her husband’s fear in the moments after Shehata’s birth on June 7, 1982. Her son, born at 24 weeks and weighing just 660 grams (one pound, seven ounces) was unbelievably tiny and frail, his skin nearly translucent.

Doctors at Mount Sinai Hospital rushed the baby to Sick Kids, where doctors in the neonatal intensive care unit did everything they could to save his life.

Shehata, who initially relied on a ventilator to help him breathe, spent more than 120 days in hospital, and faced multiple health crises, including one remedied by a lifesaving blood transfusion.

Each day of his stay, ElSayeh or her husband made the hour-long trek from their home in Pickering to visit their son.

ElSayeh, who was heartbroken every time she had to say goodbye to Shehata, sleeping in his incubator, believes the constant care from the NICU staff has helped her son thrive — not just as a baby but throughout his life.

“Even though I was there every day, I couldn’t be with him 24/7. But I knew the nurses would take him out and cuddle him and treat him like any baby wants to be treated. I think that went a really long way in his development.”

After four months, Shehata went home on Thanksgiving weekend with his parents and older brother, Kareem.

Through much of Shehata’s childhood, ElSayeh continued to take her son to Sick Kids for weekly appointments with specialists to monitor his hearing, eyesight and growth and development. Doctors warned ElSayeh that Shehata would likely have physical disabilities and serious developmental delays due to his prematurity.

Adam Shehata, 1, in his Pickering backyard.
Adam Shehata, 1, in his Pickering backyard.

But though he needed extra help for some tasks, especially with his fine motor development, and did have to repeat third grade, Shehata surpassed everyone’s expectations.

ElSayeh says she knows he will make a good doctor, just as he is already a good son, husband and father. Shehata and Christina have a 7-year-old daughter, Amelia, who ElSayeh calls “the apple of my eye.”

After his first week of training at Sick Kids, Shehata is even more sure of his dream of being a pediatric surgeon at the hospital that once saved his life.

He knows it is a longshot. Once he completes medical school, Shehata faces at least seven more years of training and stiff competition for the handful of pediatric surgery spots in Canada.

But he also knows that he has beaten the odds once before at Sick Kids. And that he’ll be helped by his personal experience — as a patient and then as a parent at the hospital — coupled with his technical skills honed while a pilot and a lawyer.

It’s time, he says, for him to start paying forward all the kindness and care he has received in his life. And he wants to start at Sick Kids.

Megan Ogilvie is a Toronto-based data reporter. Follow her on Twitter: @megan_ogilvie


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Why is Shoppers Drug Mart training doctors to prescribe medical cannabis?

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This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.

« Shoppers Drug Mart presents: ‘Medical Cannabis: The Future is Now.' »

That was the notice sent to Canadian doctors who were invited to register for « an exciting educational event » that would give them tools « to capably and confidently authorize medical cannabis for your patients. »

Interested doctors could sign up for one of four sessions being held across Canada.

Why is Shoppers Drug Mart holding education sessions for doctors on how to prescribe cannabis for their patients?

« Somebody has to do it, » said one family doctor on his way into the Vancouver event on Thursday evening. « On the whole for me I am confused. Who do I listen to? Who do I send my patients to, because I know I do not have adequate knowledge? »

Who should train doctors on prescribing medical cannabis?

But Toronto family doctor Sharon Cirone questions whether this medical education should be offered by a drug store chain that wants to get into the business of selling medical cannabis.

« It’s not appropriate and it’s not necessary » she said, adding that there are resources being developed by the College of Family Physicians of Canada, and other medical associations that don’t have a vested financial interest in cannabis.

The issue brings into sharp focus two increasingly controversial questions — how should a product that has not been approved through the normal drug approval process be used in medical practice? And who should be selling it?

Some doctors say they have no idea how to properly prescribe a product patients ingest though smoking. (Livia Manywounds/CBC)

Right now, pharmacies are not allowed to dispense medical cannabis. Instead patients must get it through the mail, after first getting authorization from a doctor and then registering with a licensed producer.

(Last week CBC News reported that medical cannabis users are facing supply disruptions in the first rush to supply newly legalized recreational market.)

National pharmacy chains are lobbying for legislation that would let them sell medical cannabis.

« This is basically the only product for medicinal purposes that does not go through a pharmacy, » said Justin Bates, CEO of The Neighbourhood Pharmacy Association of Canada which represents major drugstore chains and large retailers with in-store pharmacies.

The Canadian Pharmacists Association (CPhA) said patients would be better served if pharmacists were the ones dispensing medical cannabis.

« Typically the patients who are using cannabis for medical purposes are not using it as first line, » said CPhA spokesperson Shelita Dattani. « They’re on other medications which may have drug interactions with cannabis, they may be experiencing adverse effects, and we’d like to make sure we’re helping to keep patients safe. »

Lack of evidence still a concern, says CMA

But the professional pharmacist licensing agencies are not as keen for their pharmacists to jump into the medical cannabis field. The National Association of Pharmacy Regulatory Associations outlines that hesitation in a position statement.

There is similar hesitation from the Canadian Medical Association about doctors embracing cannabis use in their practices.

« The CMA remains concerned about the lack of clinical research, guidance and regulatory oversight for cannabis as a potential medical intervention, » the CMA states on its website.

« Physicians [are] being asked to prescribe something that is not approved, and that is largely ingested by smoking, » said Cirone. « Physicians have never been put in the position to prescribe a smoked product before and expose the lungs to disease. »

Right now, some doctors avoid dealing with the problem and instead direct patients to the recreational cannabis market, even though medical users might have different medical cannabis needs, such as achieving pain relief without getting high.  

Canada has two separate cannabis markets— recreational and medical. (CBC)

Is there a conflict of interest?

« Now with it being legal, many patients are going forward and getting a product and asking afterwards for guidance on how to use it, » said Winnipeg oncologist Dr. Paul Daeninck. He routinely gives talks to doctors about his experience using cannabis to treat cancer pain and other palliative conditions. He’s one of the panelists involved in the Shoppers Drug Mart seminars.

Is there a potential conflict of interest?

« I feel that a company or a group that’s providing education and trying to do it in an unbiased manner is really doing the right thing, and bringing in experts to talk about it is important, » Daeninck said. 

This is the first step in our journey to provide medical cannabis to our patients, »– Catherine Thomas, Loblaw Companies Limited

« The sessions, developed and presented by key opinion leaders from top Canadian universities and hospitals, cover the most up to date information about research into medical cannabis, including its use for a variety of disease states, » said Catherine Thomas, spokesperson for Loblaw Companies Limited, which owns the Shoppers Drug Mart chain.

In September, Shoppers Drug Mart received a licence from Health Canada to purchase and store pre-packaged cannabis products from existing licensed producers.

« This is the first step in our journey to provide medical cannabis to our patients, » Thomas said in an email.

Health Canada confirmed that Shoppers Drug Mart pharmacies cannot sell cannabis even through the mail, until the company receives a second Health Canada licence.

« There is no licence under the Cannabis Regulations that would allow Shoppers Drug Mart, or its subsidiary companies, to sell cannabis in its stores, »  Health Canada spokesperson Tammy Jarbeau said in an email.

With files from Manjula Defresne in Vancouver.

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Former employee sues MPAC alleging workplace ‘violence’ following Trump-themed training video

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A former employee of the Municipal Property Assessment Corporation has launched a lawsuit alleging she was traumatized by a “violent” dressing down over an in-house staff video that satirized soon-to-be U.S. president Donald Trump, and then let go while on medical leave.

Darlene Rich is seeking $340,000 in damages for wrongful dismissal from MPAC, the not-for-profit corporation that assesses all properties in Ontario, and $150,000 in damages from Linda Hall, MPAC’s vice-president of communications and marketing.

In a joint statement of defence filed last week, MPAC and Hall deny nearly all of Rich’s allegations and allege she was fired for cause after failing to meet a deadline to provide medical documents. They also allege Rich’s “performance often fell below accepted standards.”

Rich’s allegations, contained in a statement of claim filed in Toronto last month, and those made by MPAC and Hall have not been proven in court.

Both MPAC and Hall declined to answer specific questions from the Star.

A spokesperson for MPAC, which is funded by municipalities and employs 1,700 people across the province, said it “takes matters relating to the health and safety of its employees very seriously and is committed to fostering a climate of collegiality and mutual respect.”

In July 2015, according to her statement of claim, Rich was hired as a media relations specialist in MPAC’s public affairs branch, which is headquartered in Pickering, after previously working as a senior communications adviser in four Ontario government ministries.

According to her statement of claim, Rich was hired to “help improve” MPAC’s public reputation, which had been “suffering for years.”

“By all accounts, (Rich) was on track to have a successful career at MPAC,” her suit states, until she was “violently verbally assaulted” by Hall, a supervisor, and ultimately fired.

During the summer of 2016, a director of valuation for the corporation created a video “satirizing” Trump in which members of the communications department were asked to participate, including Rich, according to her statement of claim.

Rich told the Star through lawyer Hendrik Nieuwland that she’s never seen the video, but said it was meant to be a “parody” training video, with the director dressed as Trump saying, “Let’s make assessing great again!”

“I assume it was an attempt to use humour to motivate people,” she said through her lawyer.

The video was briefly posted internally when, according to her statement of claim, it drew a complaint from a female employee who called it “discriminatory against women because Trump is a misogynist.”

Following the complaint, on Oct. 20, 2016, Rich’s suit alleges Hall called Rich into a closed-door meeting and, standing between her and the door, “furiously” screamed “What the f— were you thinking?!” over and over again.

“Shocked and very afraid” and feeling blocked from leaving, Rich’s suit says she was confused by Hall’s anger until she realized it was over the video, at which point she “repeatedly” explained she had nothing to do with creating it and had felt she had no choice but to comply with the request to participate.

Hall, the suit alleges, continued to “violently” berate Rich, referred to her co-workers as “total f—ups” and said they would “get their’s (sic) too.”

Rich’s suit says she felt “intimidated, frightened, humiliated and trapped” and left the meeting feeling ill with her heart “pounding.”

In their statement of defence, MPAC and Hall tell a different version of that day, saying Rich was free to leave a pre-arranged meeting in which she was an “active participant” in a 15-minute conversation.

In their statement, MPAC and Hall say the meeting was about a “potential reputational risk and public relations issue” and deny Hall swore or engaged in any coercion or violence.

The statement also alleges Rich later admitted to “yelling” at Hall in the meeting, “displayed a deep animosity toward” her and “used threatening language.”

In her suit, Rich says she is a survivor of historic verbal abuse related to family and has struggled with anxiety and depression, a fact she alleges Hall knew about from when the two briefly worked together at Metrolinx.

Hall’s “misconduct” in the meeting, she alleges, was “calculated” to cause harm.

In her suit, Rich says she is suffering from “severe depressive disorder” and post-traumatic stress disorder as a result of the meeting.

In the statement of defence, Hall states she was unaware of Rich’s mental health issues.

According to her suit, Rich filed a workplace complaint the day after the meeting, tried to work from home and did not return to work.

In January, following an external investigation, MPAC’s human resources director her Hall had violated the corporation’s “Workplace Discrimination, Harassment and Violence Prevention Policy” but would not say if she had been disciplined, according to the statement of claim.

Then, to Rich’s “surprise and dismay,” the HR director insisted Rich return to work, sit in an office next to Hall’s and continue to report to her, Rich’s suit alleges.

In their statement of defence, MPAC and Hall say the investigation findings “confirmed that there was no aspect of violence” in the interaction.

Rich next went on sick leave.

In her suit, Rich says her doctor completed a required medical form on April 17 but, through an “administrative oversight,” failed to submit it on time, leading MPAC to cut her short-term disability payments. The form was delivered about a month later and described a number of reasons, including panic disorder and panic attacks, why Rich could not function at work, her suit states.

Two days later, on May 17, MPAC fired Rich, “paid no severance” and cut her benefits, the suit states.

Rich is seeking damages for wrongful dismissal, discrimination based on disability, lost short-term disability payments, discrimination on the basis of disability, bad faith and conduct causing mental distress. From Hall, she seeks damages for “intentional infliction” of mental distress.

MPAC says it continued to fund short-term disability payments to Rich even after repeated attempts to get required documents and, after a warning to return to work, fired her for reasons “completely unconnected to any disability she may have had.”

Rich, her suit states, received no severance, had her benefits cut off and “has been unable to obtain reasonable alternative employment.”

Nieuwland, Rich’s lawyer, told the Star by email that employees with “mental illness continue to struggle for understanding and acceptance in the workplace,” and he hopes Rich’s lawsuit “reminds all employers of their obligations in dealing with persons under a disability.”

Jim Rankin is a reporter based in Toronto. Follow him on Twitter: @Jleerankin

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These Products Get Sam Anderson Through Marathon Training | Healthyish

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On top of running the wine and beverage program at Wildair, Contra, and Una Pizza Napoletana, Sam Anderson is logging up to 80 miles a week. Yes, 80. That’s because he’s training for his fifth consecutive New York City Marathon. Which means between pouring you a glass of frizzante skin contact wine and making a new spritz recipe, he’s probably downing water and taking electrolyte pills so he can run 15 miles the next day. So how does someone whose career revolves around wine and alcohol manage to work until midnight then get up the next morning and hit the pavement? Well, for starters, by avoiding the hot dogs during family meal. Here, Anderson talks to us about the five things that help get him through training season. (Yes, natural wine is one of them.) — Rachel Karten

Maurten Energy Drink

I use this sports drink religiously. It is an extremely high carbohydrate drink mix that has been used by nearly all the world’s top marathoners including Eliud Kipchoge, who just set the world record, and Mo Farah, who just set the European Record with his win at Chicago. Maurten is unique because it delivers so much carbohydrates but these carbohydrates are encapsulated in pectin, which controls the rate that the nutrients are absorbed by the digestive system. This keeps you from getting stomach cramps or digestive issues. I mix it with some matcha tea powder, and that’s basically my training juice.

Kettl Matcha

I am a huge proponent of tea—it’s one of the healthiest ingredients we can put into our system but I really love the gentle caffeination it provides when I mix it into my Maurten fuel. Additionally, it has very high levels of theanine, which is one of the few amino acids which can cross the blood-brain barrier and has a great ability to reduce stress and promote a sense of well-being. It’s simultaneously relaxing, but also energizing. As a result, the mind is better suited to keep the body relaxed and performing freely. If you’re stressed out about running 22 miles, your body is going to tense up. Anything you can do to promote a state of relaxation and peacefulness, be it meditation or a tea ingredient, is definitely important.

Angela-Dimayuga-14

Photo by Alex Lau

Ashwagandha fresh from Furnace Creek Farm.

Ashwagandha and Arjuna

Ashwagandha is the lion of all roots. It is incredibly powerful in its ability to reduce inflammation, lower cortisol (stress) levels and improves brain function and ability to focus. Arjuna, which in Sanskrit means “shining,” is a tree bark that is the ancient herbal hero of the cardiovascular system, increasing the efficiency of heart contractions. When these two ingredients are taken together systematically and regularly, they have been shown to greatly enhance endurance athletes VO2 max and cardio-respiratory performance. When I’m dosing with these, I make a tea with ashwagandha, arjuna, cinnamon, lemon, and honey and drink about two liters of the tea daily. I get my ashwagandha in whole root form from Furnace Creek Farm at the Grand Army Plaza Farmers’ Market. Arjuna is available online from herbalists.

Honey ambrosia

Honey ambrosia is basically a mixture of bee pollen, honey, propolis, and royal jelly. And it’s all mixed together into this crazy paste. This stuff is like the fountain of youth. It’s sourced from just outside of NYC, so it has a great effect on your immune system, cardiovascular system, and keeping your lungs healthy.

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Photo by Alex Lau

This Château de Béru Côte aux Prêtres is made by Athénaïs de Béru.

Beer and natural wine

I drink alcohol very sparingly when I am training heavily. I will have some wine or beer on the weekends, but I don’t drink during the week at all. Evil Twin « Race Day » is a beer that I designed with my good friend and fellow runner Jeppe Bjarnit-Bjergso of Evil Twin with post-race refreshment in mind. It’s a sour IPA brewed with pineapple and aloe-salt, which is a natural full-spectrum electrolyte replacement. Additionally, I designed the label, which is a racing track.

Recovery also definitely involves plenty of natural wine the day after Saturday training. I’m tasting wine all day long for work but I don’t actually drink during the week. As a wine director, it’s easy to have pick of tons of delicious natural wines, but I tend to favor wines that are fresh, bubbly, and balanced. And made by producers who farm and make their wine transparently—not adding anything or taking anything away. My favorite producers at the moment are: Tom Lubbe of Matassa, Baptiste Cousin, __ Athénaïs de Béru__, René and Agnès Mosse, Nacho González, Envínate, Christian Tschida, Laurence Manya Krief, Le Coste, Cantina Giardino…this list could probably go for miles.

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