Wednesday, May 24, 2017

Dear Minister Ambrose: We at Dietitians of Canadai write to you to express our concern about recent public advocacy related to vitamin D. Paid advertisements by Pure North S’Energy Foundation, placed in newspapers across the country, have challenged definitions of sufficient serum vitamin D levels and have recommended daily vitamin D supplementation at doses of 6000–9000IU/day (more for individuals who are overweight or obese). These dosages are many times greater than amounts currently recommended by the Institute of Medicine (IOM) and Health Canada and exceed the current Tolerable Upper Intake Levelii of 4000IU/d for children over age 9 and adults. These recommendations are based on observational evidence – low-level evidence obtained from simple comparisons, not well-designed randomized controlled trials. What medical ethics board would approve a population-wide research protocol that sought to administer supplements far in excess of national reference intakes and upper limits, based on nothing more than observational evidence? In 2013, Dietitians of Canada raised concerns about scientific and economic interpretations of the Pure North initiative directly with the University of Calgary following its published commendation for public policyiii. We received no response. The recent public nature of Pure North’s generously-funded advocacy program and the publication of yet another public policy paperiv, however well-intended, now prompt us to be more public with our questions and concerns, recognizing the health of Canadians could be put at risk.

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The Pure North debacle is a classic case of political expediency resulting in a waste of public dollars in my opinion. You have folks with science backgrounds indicating that this program isn't productive and yet the Horne guy provides $10 million of our cash upfront to this dubious venture. Then you have the Hoffman agree with the Horne and send more money down the drain with $4.2 million dollars to a grand total of $14.2 million.
One has to wonder why the Health Ministers agreed to a project that became a program so as to evade ethical review that used vulnerable populations to do the study of the use of extra amounts of vitamins. It's simply unfathomable to any scientist that folks in government can make such dumb decisions that put the health of folks at risk when they're all in the Ministry that is supposed to protect the health of citizens. What the heck?

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and I know
that change does not
begin with government
nor end there
change begins in each of us
who decide to speak
instead of staying safely silent
we put ourselves out on the stage of politics
and declare ourselves
I guess this leads to problems
of the retribution sort
but then staying silent also has problems
of the fatality kind      the public health risks are acute 


and I know
that change does not
begin with government
nor end there
because I have waited like Ruth Adria has
for the bureaucrats and politicians to work for us
but instead we are betrayed over and over again
the truth lies in the distance with the humming of beetles
we're being duped and scammed
by the very folks we hire      and the truth is that we know this
and we don't know what to do about this
we've seen the masks on the faces
and the upraised hands beseeching us to believe in pseudo-science 



and I know
that change does not
begin with government
nor end there
it seems that we are here to witness only
the follies of too much money in the hands of these expedient folks
who understand power means access to the public bank
and free cheques for all concerned    but I wonder if the people of Alberta realize
that it is our hard labour that pays for all of this?
I wonder if the money we spend on the backs of our children is worth
the infrastructure games and the buttering up of the oil and gas industry or the debacle
of the Pure North program that has no evidence supporting its advertisements 
I wonder when it will all end this subversion of democracy and these public sector games

https://www.youtube.com/watch?v=SJbzlPRjC-0
Amelia Curran - In A Town
http://purenorth.ca/pure-north-program/

Pure North Program

The Pure North team helps you feel your best

At Pure North we care about the health of Canadians. We know that when we feel our best we’re able to live our fullest life possible. When it comes to our health every Canadian, at any given time, is at a certain point on a health spectrum; at one end we are our healthiest version of ourselves while at the other end we are our sickest.
In Canada we have a great healthcare system to support us when we are at one end of the spectrum – when we get sick or injured. However, Canadians are chronically underserved when it comes to getting the support needed when we’re in the middle or closer to the healthier end of the spectrum.
At Pure North we believe everyone can benefit from additional knowledge about our bodies that helps us take measured steps to prevent chronic illness and disease and improve our overall health and wellness.
If you are interested in learning how you can improve your health, no matter where you fall on the health spectrum, Pure North can help. Every team member at Pure North is dedicated to helping you understand your body by arming you with knowledge – a scorecard of health. It is with this information that we are better able to track and measure your health improvement.
https://www.dietitians.ca/Downloads/Public/2015-02-19_letter_Minister_of_Health_vitaminD.aspx
Dietitians of Canada / Les diététistes du Canada TEL: 905.689.3864 480 University Avenue, Suite 604 FAX: 416.596.0603 Toronto, Ontario, Canada M5G 1V2 EMAIL: marsha.sharp@dietitians.ca www. dietitians.ca | www. dietetistes.ca February 19, 2015 The Honourable Rona Ambrose, PC, MP Minister of Health, House of Commons Ottawa, ON K1A 0A6 By e-mail: minister-ministre@hc-sc.gc.ca Dear Minister Ambrose: We at Dietitians of Canadai write to you to express our concern about recent public advocacy related to vitamin D. Paid advertisements by Pure North S’Energy Foundation, placed in newspapers across the country, have challenged definitions of sufficient serum vitamin D levels and have recommended daily vitamin D supplementation at doses of 6000–9000IU/day (more for individuals who are overweight or obese). These dosages are many times greater than amounts currently recommended by the Institute of Medicine (IOM) and Health Canada and exceed the current Tolerable Upper Intake Levelii of 4000IU/d for children over age 9 and adults. These recommendations are based on observational evidence – low-level evidence obtained from simple comparisons, not well-designed randomized controlled trials. What medical ethics board would approve a population-wide research protocol that sought to administer supplements far in excess of national reference intakes and upper limits, based on nothing more than observational evidence? In 2013, Dietitians of Canada raised concerns about scientific and economic interpretations of the Pure North initiative directly with the University of Calgary following its published commendation for public policyiii. We received no response. The recent public nature of Pure North’s generously-funded advocacy program and the publication of yet another public policy paperiv, however well-intended, now prompt us to be more public with our questions and concerns, recognizing the health of Canadians could be put at risk. As you know, the discourse of science continues to evolve, and population health recommendations must consider both the potential benefits for the majority and risks for vulnerable segments of the population. We understand your officials in Health Canada, together with the IOM, are analyzing evidence available from newer, more rigorous studies, as well as re-examining parameters leading to the IOM recommendations in 2010. Even in the face of intense advocacy from groups such as Pure North, we urge Health Canada to continue this due diligence, carefully considering the level of evidence, and ask that this analysis be made publicly available when completed. We recognize science is emerging with respect to the role(s) that vitamin D may play from pregnancy to old age, for health promotion, illness prevention and improvements in ill health. Nevertheless, we do not believe there is consistent, strong evidence at this point in time to recommend a broad clinical intervention for “health optimization”, using megadose supplements to change dietary intake targets for the Canadian population. Earlier claims and assertions based on observational evidence about other nutrients, e.g., vitamin E, betacarotene, and folic acid, are now recognized to have serious limitations in spite of what at first appeared to be convincing evidence. When randomized controlled scientific experiments were conducted with these vitamins as megadose supplements, there was no statistically significant evidence of substantial health benefit beyond prevention of vitamin deficiency and no additional roles were identified for these nutrients beyond healthy metabolism and body functions, as already established. Indeed, both vitamin E and beta-carotene supplements were found to increase ill health and risks: vitamin E increased mortalityv , and beta-carotene increased cancer rates among smokersvi. Vitamin D is the current ‘darling’ of the nutrition world. Hundreds of published peer reviewed papers report associations between apparently sub-normal/sub-optimal serum levels of 25-hydroxy-vitamin D and poor health conditions, including cardiovascular diseases, serum lipid concentrations, inflammation, glucose metabolism disorders, weight gain, infectious diseases, multiple sclerosis, mood disorders, declining cognitive function, impaired physical functioning, and all-cause mortalityvii. In contrast, results of randomized controlled trials are just beginning to be published, and these reports are not consistently supporting the early findings from observational studies. Some studies suggest that blood levels of 25- hydroxy-vitamin D decrease as a marker of illness, rather than poor vitamin D status, thereby providing no data to support changes in vitamin D requirements as currently understood. Sensational and often contradictory reporting in public media can add to consumer confusion. A recent vitamin D study provides content analysis of 294 newspaper articles published between 2009-2014 – findings included enthusiastic linkage of vitamin D to a host of health conditions, with recommendations to supplement, underplaying the lack of conclusive evidence and omitting or downplaying any risks associated with supplementation. The researchers concluded there is a need for “good, independent and reliable sources of health information that present a more nuanced and contextualised picture of the relevant science”viii. We believe it is important that Health Canada proceed with caution before any recommendation is made for substantial vitamin D supplementation and/or pervasive vitamin D fortification of foods/beverages intended for the Canadian population. Any changes to public health policy must be based on a better understanding of potential roles for vitamin D, as well as potential risks from high vitamin D intakes. Health Canada’s guidance must pay heed to both the potential risks and benefits, lest our food supply itself becomes a population health experiment the next generation may regret. New science on vitamin D is currently being published at a rapid rate. New data on vitamin D levels of Canadians from the Canadian Health Measures Survey (CHMS) will no doubt also inform decisions. We urge you to continue to support the scientific process within Health Canada. The ‘cherry-picked’ evidence championed by some, including Pure North, must not be used to support premature recommendations for substantial vitamin D supplementation and/or vitamin D fortification of foods and beverages. Furthermore, given the aggressive and public nature of this debate, we recommend issuing a public advisory to protect the public and provide interim guidance for confused consumers. Thank you for your consideration of our concerns and suggestions. If you have any questions please contact Pat Vanderkooy (pat.vanderkooy@dietitians.ca) or Jayne Thirsk (jayne.thirsk@dietitians.ca), who would be pleased to provide additional information and response. Sincerely, Marsha Sharp, CEO Dietitians of Canada cc. Samuel Godefroy, Director General, Food Directorate, Health Canada William Yan, Director, Bureau of Nutritional Sciences, Food Directorate, Health Canada Hasan Hutchinson, Director General, Office of Nutrition Policy and Promotion, Health Canada i Dietitians of Canada (DC) is the professional association representing 6000 dietitians (regulated health professionals) across the country. DC promotes evidence-based best practice in dietetics, to advance the profession’s unique body of knowledge of food and nutrition and supports members in their diverse roles in health and wellness. ii A Tolerable Upper Intake Level (UL) is the highest level of continuing daily nutrient intake that is likely to pose no risk of adverse health effects in almost all individuals in the life-stage group for which it has been designed. ULs are based on evaluations conducted using the Dietary Reference Intakes: A Risk Assessment Model for Establishing Upper Intake Levels for Nutrients adopted in 1998 for the DRI process by the Institute of Medicine. The risk assessment model was designed specifically to address the potential for adverse effects from overconsumption of nutrients.” (From Health Canada website: The DRI values – definitions. Available from: http://www.hc-sc.gc.ca/fnan/nutrition/reference/dri_ques-ques_anref-eng.php#a5a iii Emery JCH, et al. The Fiscal, Social and Economic Dividends of Feeling Better and Living Longer. SPP Research Papers, Vol 6, Issue 20, June 2013, University of Calgary. http://www.policyschool.ucalgary.ca iv Dutton DJ, Emery JCH, et al. Bending the Medicare Cost Curve in 12 Months or Less: How Preventative Health Care Can Yield Significant Near-Term Savings for Acute Care in Alberta. SPP Research Papers, Vol 8, Issue 2, January 2015, University of Calgary. http://policyschool.ucalgary.ca/ v Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev. 2012 Mar 14;3:CD007176. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22419320 vi Cortés-Jofré M, Rueda JR, Corsini-Muñoz G, Fonseca-Cortés C, Caraballoso M, Bonfill Cosp X. Drugs for preventing lung cancer in healthy people. Cochrane Database Syst Rev. 2012 Oct 17;10:CD002141. doi: 10.1002/14651858.CD002141.pub2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12804424 vii Autier P, Boniol M, Pizot C, Mullie P. Vitamin D status and ill health: a systematic review. Lancet Diabetes Endocrinol. 2014 Jan;2(1):76-89. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24622671 viii Caulfield T, Clark MI, McCormack JP, Rachul C, Field CJ. Representations of the health value of vitamin D supplementation in newspapers: media content analysis. BMJ Open. 2014 Dec 31;4(12):e006395. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281532/
http://www.cbc.ca/news/canada/edmonton/carl-amrhein-pure-north-unproven-alberta-1.4068844
CBC INVESTIGATES

Alberta Health deputy minister's relationship with private foundation 'not professional': expert

Carl Amrhein endorsed and participated in Pure North alternative health program

By Jennie Russell, Charles Rusnell, CBC News Posted: Apr 13, 2017 7:00 AM MT Last Updated: Apr 20, 2017 9:48 AM MT
Deputy health minister Carl Amrhein participated in Pure North S’Energy Foundation’s alternative health program.
Deputy health minister Carl Amrhein participated in Pure North S’Energy Foundation’s alternative health program. (CBC)
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Photo of Charles Rusnell, Jennie Russell
Charles Rusnell, Jennie Russell
Investigative reporters
Charles Rusnell and Jennie Russell are reporters with CBC Investigates, the award-winning investigative unit of CBC Edmonton. Their journalism in the public interest is widely credited with forcing accountability, transparency and democratic change in Alberta. Send tips in confidence to cbcinvestigates@cbc.ca. @charlesrusnell @jennierussell_

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Alberta Health deputy minister Carl Amrhein personally endorsed, and participated in, an unproven alternative health program offered by a private foundation that recently received a multimillion-dollar grant that he signed on behalf of the ministry.
A CBC News investigation has uncovered a years-long relationship between Amrhein, the Pure North S'Energy Foundation of Calgary, and its founder Allan Markin that an expert in public governance said was clearly unprofessional.
"The essence of a professional relationship with a client, or with an organization that is seeking money, is called arm's length," University of Alberta political scientist Jim Lightbody said.
"You have a job and you are not, as a public servant — particularly if you are a senior public servant — at the beck and call of some private interest, no matter how well financed," he added.
Jim Lightbody
University of Alberta political scientist Jim Lightbody said the close relationship between health deputy minister Carl Amrhein and Pure North was “not professional.” (CBC)
"This is not a professional relationship," Lightbody said after reviewing internal Alberta Health and University of Alberta documents obtained by CBC News through freedom of information.

Disclosed Pure North participation

Amrhein declined interview requests. But the health ministry issued a statement that simply said: "Amrhein's involvement with Pure North was fully disclosed to the ethics commissioner when he became deputy minister. All records indicate that subsequent decisions regarding funding for Pure North followed the advice of external and departmental experts."
Ethics commissioner Marguerite Trussler told CBC News that when Amrhein became deputy minister in August 2015, he disclosed to her office that he was a participant in Pure North's alternative health program.
But she refused to say whether Amrhein had disclosed anything more about his relationship with the health foundation, saying she was bound by provincial legislation and only had permission from Amrhein to reveal he had disclosed his participation in Pure North's health program.
Trussler said she questioned Amrhein about his signing of an October 2016 grant, worth $4.2 million, for a nurse-practitioner-led clinic for Pure North. She said Amrhein told her the decision was made elsewhere and he merely signed the agreement in his capacity as deputy minister, after the minister had signed off.
The ethics commissioner said her questioning of Amrhein took place "recently." But she could not say whether it was after CBC News published stories on Pure North last week.
Health Minister Sarah Hoffman's press secretary, Tim Wilson, did not respond to questions from CBC News about whether Amrhein had disclosed his prior relationship with Pure North to the minister, and to his senior staff.
Sarah Hoffman
Health Minister Sarah Hoffman refused to say whether deputy minister Carl Amrhein had disclosed his previous relationship with Pure North to her. (CBC)

Deputy minister arranged to have blood drawn

The internal government and university documents detail a close relationship between Amrhein, Markin and Pure North dating back years to when Amrhein was provost of the university, to which Markin was a major donor.
Most disturbing for Lightbody were documents that show Amrhein, while deputy health minister, and his wife planned to become participants in the Pure North program.
Emails from early January 2016 show Markin wanted a personal meeting with Amrhein that would require Amrhein to drive to the Edmonton airport late on a Sunday afternoon.
"The smaller the group the better I think," Amrhein wrote in an email to Wendy Paramchuk, Pure North's executive director, from his official government account. "I assume that the discussion will be high level since I do not manage operating details."  
Amrhein also told Paramchuk he planned to bring his wife to the meeting, hopefully so they could have their blood taken. Pure North collects blood from its participants to determine individual treatment plans, often involving high doses of supplements such as vitamin D.
"We will set up to have our nurse practitioner there to take both your and [your wife's] blood and do a medical intake," Paramchuk replied in an email written the day before the Jan. 3 meeting.
"If possible, if you could both fast for eight hours that would be ideal," Paramchuk continued. "If not, that is okay; we will still take your blood."
"Dear Wendy, okay, I copied [my wife] on this note," Amrhein replied.

Reference letter for Pure North

Pure North is a privately run, non-profit foundation established by Markin that claims it can prevent chronic disease and improve health through its alternative treatments, which include high doses of vitamin D and other supplements and the removal of heavy metals from the body.  
The foundation focuses its work on vulnerable populations such as seniors, the homeless and drug users, and has for years sought a financial partnership with the provincial government. It also funds nutrition and health research at universities.
With donations of more than $20 million, Markin is one of the University of Alberta's biggest donors. Before Amrhein became deputy minister, he was provost at the University of Alberta and documents show he met personally with Markin several times dating back to 2011.
'The essence of a professional relationship with a client, or with an organization that is seeking money, is called arm's length ... this is not a professional relationship.'- Jim Lightbody, political scientist, University of Alberta
In July 2014, as provost, Amrhein wrote a letter of support for Pure North and Markin that lauded the research data — and financial support — Pure North had given his university's academics.
"It has been a privilege to be able to work with Mr. Allan Markin and the Pure North S'Energy Foundation and we look forward to seeing all the program outcomes analyzed in a rigorous manner that meets the highest scientific standards," Amrhein wrote. "If I can supply any further information regarding this outstanding supporter of research, please do not hesitate to contact me directly."
Internal Alberta Health documents show Pure North used Amrhein's letter in September 2014, and again in December 2014, to bolster funding requests to the Progressive Conservative government.

Foundation seeks government funding

In November 2014, Amrhein left the university to become official administrator of Alberta Health Services (AHS). Five days before he left AHS to become deputy minister of health in August 2015, Paramchuk sent an email to two faculty members in the University of Alberta's School of Public Health.
"We have asked the [health] ministry to financially support our program to be delivered to the vulnerable population of Alberta," she wrote in the email.
"This suggestion came from Carl Amrhein," Paramchuk said, and asked the faculty members to review information that Pure North intended to submit to the ministry in support of its funding request.
Duff Conacher of Democracy Watch, a non-partisan watchdog organization, said he believes Amrhein's reference letter in support of Pure North belies bias and creates a potential conflict of interest.
Conacher
Duff Conacher of Democracy Watch said health deputy minister Carl Amrhein should not have been involved in any decisions related to Pure North. (CBC)
"He stated it; that he favours the foundation," Conacher said. "It adds to that conflict of interest if he is actually taking part and receiving the services from the foundation.
"And combined together, I think it clearly crosses the line in both the [provincial Conflicts of Interest] Act and the Code [of conduct for ministers' staff], and he should not have been taking part in any decisions that affected the foundation, that the government was making," he said.
Pure North had previously received public funding. As CBC News reported earlier this month, Alberta Health gave Pure North a $10-million grant in December 2013 to expand its existing seniors program — against the advice of senior ministry officials who said the foundation's alternative treatments were not adequately supported by science and could pose a health risk to participants.
A subsequent review by three independent experts found Pure North couldn't prove its program produced any of the health or economic benefits it claimed.
CBC News also reported that senior Alberta Health Services officials were informed in July 2013 of a serious potential health risk that provincial dietitians believed could have been caused by Pure North's lax distribution of high-dose supplements at the Calgary Drop-In Centre.
When the NDP assumed power in 2015, Health Minister Sarah Hoffman refused, based on advice from her officials, to extend funding to Pure North for its seniors program beyond the $10 million provided by the previous government.

Multi-million-dollar grant agreement

But internal documents show Pure North then began requesting changes to health-care policy that would directly benefit the foundation and further its aims. On several occasions, Markin and Paramchuk communicated directly with Amrhein.
Amrhein directed his staff to research several policy changes requested by Pure North, including making vitamin D an insured drug and allowing nurse practitioners to bill for primary care services provided by the foundation.
None of the policy changes were implemented, although the documents reveal senior ministry officials expended significant resources researching them and dealing directly with Markin. Conacher said Amrhein should not have been involved in any decisions related to Pure North, given his previous support of the foundation.
'He stated it; that he favours the foundation ... it adds to that conflict of interest if he is actually taking part and receiving the services from the foundation.'- Duff Conacher, Democracy Watch
In a Jan. 15, 2016 email, Markin expresses frustration to Amrhein that progress on several policy changes requested by Pure North had been "stymied" by ministry officials.
"As an ally for preventive care, I am calling on you to intervene immediately and send direction to your officials to urgently pursue solutions that will deliver preventive care for our province's most vulnerable citizens," Markin told Amrhein.
Pure North did, however, eventually receive support from the NDP government. In October 2016, Alberta Health finalized a grant agreement — signed by Amrhein — with Pure North to provide the $4.2 million over several years for the nurse-practitioner-led, primary-care clinic in Calgary.
Earlier this month, Hoffman told CBC News she was unaware of any previous public-health safety concerns related to Pure North. She also said the clinic's funding would be jeopardized if it was found to offer any alternative health treatments.
If you have any information about this story, or for another story, please contact us in confidence at cbcinvestigates@cbc.ca.

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