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Similar Efficacy Among Second-Generation Antidepressants

Monday, December 05, 2011

Filed under:  Mental Health | Pharmacy | Psychiatry
Second-generation antidepressants show no evidence of differences in efficacy for the treatment of major depressive disorder in adults, but differ according to onset of action and adverse events, according to a meta-analysis published in the Dec. 6 issue of the Annals of Internal Medicine.

(HealthDay News) — Second-generation antidepressants show no evidence of differences in efficacy for the treatment of major depressive disorder (MDD) in adults, but differ according to onset of action and adverse events, according to a meta-analysis published in the Dec. 6 issue of the Annals of Internal Medicine.

Gerald Gartlehner, M.D., M.P.H., from Danube University in Krems, Austria, and colleagues reviewed available literature from 1980 to August 2011 to compare the benefits and harms of second-generation antidepressants for treating MDD in adult patients. Data were extracted on study design and conduct, participants, and interventions and outcomes. Efficacy was evaluated in 234 randomized trials of at least six weeks, and harm was assessed in observational studies with at least 1,000 participants. Meta-analyses and mixed-treatment comparisons were performed to study the response to treatment, and weighted mean differences in the depression rate.

The investigators found that there were no clinically relevant differences in efficacy or effectiveness for the treatment of acute, continuation, and maintenance phases of MDD. Patients with accompanying symptoms, or patients sub-grouped on the basis of age, gender, ethnicity, or comorbid conditions, also showed no differences in efficacy. Each drug differed on the basis of onset of action, adverse events, and some measures of health-related quality of life.

"Current evidence does not warrant recommending a particular second-generation antidepressant on the basis of differences in efficacy. Differences in onset of action and adverse events may be considered when choosing a medication," the authors write.

One of the study authors disclosed financial ties to Novartis and Takeda Pharmaceutical Company.

Comparative Benefits and Harms of Second-Generation Antidepressants for Treating Major Depressive Disorder
An Updated Meta-analysis

   1. Gerald Gartlehner, MD, MPH;
   2. Richard A. Hansen, PhD, RPh;
   3. Laura C. Morgan, MA;
   4. Kylie Thaler, MD, MPH;
   5. Linda Lux, MPA;
   6. Megan Van Noord, MSIS;
   7. Ursula Mager, PhD, MPH;
   8. Patricia Thieda, MA;
   9. Bradley N. Gaynes, MD, MPH;
  10. Tania Wilkins, MSc;
  11. Michaela Strobelberger, MA;
  12. Stacey Lloyd, MPH;
  13. Ursula Reichenpfader, MD, MPH; and
  14. Kathleen N. Lohr, PhD

+ Author Affiliations

      From Danube University, Krems, Austria; Auburn University, Auburn, Alabama; RTI International, Research Triangle Park, North Carolina; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and the Ludwig Boltzmann Institute for Health Promotion Research, Vienna, Austria.


Background: Second-generation antidepressants dominate the management of major depressive disorder (MDD), but evidence on the comparative benefits and harms of these agents is contradictory.

Purpose: To compare the benefits and harms of second-generation antidepressants for treating MDD in adults.

Data Sources: English-language studies from PubMed, Embase, the Cochrane Library, PsycINFO, and International Pharmaceutical Abstracts from 1980 to August 2011 and reference lists of pertinent review articles and gray literature.

Study Selection: 2 independent reviewers identified randomized trials of at least 6 weeks' duration to evaluate efficacy and observational studies with at least 1000 participants to assess harm.

Data Extraction: Reviewers abstracted data about study design and conduct, participants, and interventions and outcomes and rated study quality. A senior reviewer checked and confirmed extracted data and quality ratings.

Data Synthesis: Meta-analyses and mixed-treatment comparisons of response to treatment and weighted mean differences were conducted on specific scales to rate depression. On the basis of 234 studies, no clinically relevant differences in efficacy or effectiveness were detected for the treatment of acute, continuation, and maintenance phases of MDD. No differences in efficacy were seen in patients with accompanying symptoms or in subgroups based on age, sex, ethnicity, or comorbid conditions. Individual drugs differed in onset of action, adverse events, and some measures of health-related quality of life.

Limitations: Most trials were conducted in highly selected populations. Publication bias might affect the estimates of some comparisons. Mixed-treatment comparisons cannot conclusively exclude differences in efficacy. Evidence within subgroups was limited.

Conclusion: Current evidence does not warrant recommending a particular second-generation antidepressant on the basis of differences in efficacy. Differences in onset of action and adverse events may be considered when choosing a medication.

Primary Funding Source: Agency for Healthcare Research and Quality.

Depression Doubles Dementia Risk in Diabetic Patients

Deborah Brauser

Authors and Disclosures

December 5, 2011 — Depression coupled with diabetes has been linked to a significantly increased risk of developing dementia compared with diabetes alone.

A large study of more than 19,000 adults with type 2 diabetes showed that those with comorbid depression had a 2-fold higher risk of developing dementia over 5 years compared with their counterparts who did not experience depression.

In addition, younger participants with depression also had a significantly higher risk for dementia compared with patients who were older, whereas those who took insulin had a significantly lower risk compared with those were not on insulin.

"Clinicians who treat diabetes, such as primary care doctors and endocrinologists, already realize that there are comorbidities and behaviors that can worsen risks," lead author Wayne Katon, MD, professor and vice chair in the Department of Psychiatry and Behavioral Sciences at the University of Washington Medical School in Seattle, told Medscape Medical News.

"Our study found that depression is an important comorbidity that needs to be screened for among diabetic patients and treated effectively. This might decrease the risk of developing a very serious complication, such as dementia," he added.

Dr. Katon noted that the finding that younger patients were more affected than older patients was also significant because past research has suggested that depressed people develop diabetes 5 to 6 years earlier than those who are not depressed.

"Given that depression is potentially modifiable, future studies are needed to further evaluate whether effective depression interventions reduce the risk of dementia and identify the mechanisms that may explain our observation," write the investigators.

The study was published online December 5 in the Archives of General Psychiatry.

Poor Glycemic Control

According to the investigators, there is a significant link between depression and diabetes that appears to be bi-directional. Not only can depression lead to an increased risk for diabetes, but adult-onset diabetes can lead to an increased risk for depression, they write.

Dr. Katon said that previous research suggests diabetes is also a risk factor for dementia, as is depression. However, to his knowledge, only 1 other study has looked at whether having both disorders may lead to an even greater risk for dementia.

In a cohort study of 3837 patients with diabetes, published in 2010 in the Journal of General Internal Medicine in 2010 and reported by Medscape Medical News at that time, Dr. Katon and colleagues found that patients with comorbid depression and diabetes were twice as likely to develop dementia as those who had diabetes only.

"That study included participants with limited diversity. So we wanted to do a much bigger study with a more diverse population that would also let us do some innovative things in our analysis, including examining interactions between depression and insulin treatment and controlling for health risk behaviors."

Dr. Katon noted that patients with comorbid depression and diabetes often have poor glycemic control and take worse care of themselves in terms of diet and not taking prescribed medications.

He added that this poor glycemic control, in addition to increased pro-inflammatory factors and increased cortisol levels often found in both disorders, could be factors contributing to an increased risk of dementia.

Risk Even Higher in Younger Patients

The Diabetes Study of Northern California (also known as DISTANCE) was created to assess patients living with diabetes, as found through the Kaiser Permanente Northern California Diabetes Registry. Baseline information was collected through surveys from May 2005 to December 2006.

The Diabetes and Aging Study is an ongoing cohort trial of DISTANCE, focusing specifically on medical issues experienced by DISTANCE's older participants. For the current analysis, the investigators evaluated data on 19,239 of the participants between the ages of 30 and 75 years (mean age, 58.8 years; 51% men; 22% white, 19% Latino, 17% black, and 12% each for Asian and for Filipino).

Depression symptoms were determined by a score of 10 or more on the Patient Health Questionnaire 8 (PHQ-8); a clinical diagnosis based on the International Classification of Diseases, Ninth Revision; and/or past-year prescriptions of antidepressants.

Dementia risk was determined according to a clinical diagnosis of the disorder given 3 to 5 years after the baseline assessments.

Results showed that 3766 (19.6%) of the participants had both depression and diabetes.

Of these patients, 2.1% received 1 or more diagnoses of dementia during the follow-up period compared with 1.0% of those with diabetes alone (incidence rates, 5.5 per 1000 person-years vs 2.6 per 1000 person-years, respectively).

After adjustment for age, sex, and other demographic factors, the participants who had a diagnosis of comorbid depression at baseline had a 2.02 greater risk of developing dementia (95% confidence interval [CI], 1.73 - 2.35) during the 3 to 5 years after baseline assessments than those without depression (P < .001).

In addition, patients who were younger than 65 years had a significantly higher risk for dementia associated with depression compared with those who were older (hazard ratios [HRs], 4.42 [95% CI, 3.11 - 6.29] vs 2.01 [95% CI, 1.65 - 2.45]; P < .001).

Finally, those who took insulin were at a decreased risk for dementia associated with depression compared with those who did not take this treatment (HRs, 1.59 [95% CI, 1.17 - 2.18] vs 2.82 [95% CI, 2.33 - 3.42]; P = .005).

Depression Not Prodromal

The researchers note that "insulin modulates levels of ß-amyloid in the brain" and that past research has suggested that insulin dysregulation may lead to pathophysiology of Alzheimer's disease (AD).

"Moreover, intranasal insulin may preserve memory and general cognitive abilities in patients with mild cognitive impairment or mild to moderate AD."

They write that overall study effect sizes were "quite robust" for both primary and sensitivity assessments, which included examining only diagnoses of dementia in years 4 and 5, or only including a score of 10 or more on the PHQ-8.

In fact, they note that sensitivity analyses showed an even higher risk for dementia in those with depression, "suggesting that these results are not due to depression being a prodromal phase of dementia or the depression definition."

"We were also able to control for factors such as smoking and obesity. And we expected that there would be some mediation on depression causing dementia because of these health risk behaviors that are associated with depression. But in fact, those behaviors had no effect on the risk at all," added Dr. Katon.

"So I think we can conclude that it is probably the psychobiological changes associated with depression that increased this risk more than health risk behaviors."

Equal to 5-Year Earlier Onset

"This study showed a very interesting relationship that we need to understand further," J. Wesson Ashford, MD, PhD, clinical professor (affiliated) of psychiatry and behavioral sciences at Stanford University in Palo Alto, California, told Medscape Medical News.

"The complex relationship between depression and diabetes has been studied for a long time and I would say that the basis of it is not known. So when we're dealing with these complex epidemiological studies, you find relationships that might be important. But it's also important not to confuse them with cause-and-effects," said Dr. Ashford.

"It points you in a direction but it doesn't establish a path."

Still, Dr. Ashford, who is chair of the Memory Screening Advisory Board of the Alzheimer's Foundation of America and clinical editor of the Journal of Alzheimer's Disease, noted that clinicians should screen for this possible risk factor.

"A 2-fold increase of risk would be comparable to a 5-year earlier onset of incidence. This should lead to providing cognitive screenings 5 years earlier than when it otherwise would be started. In other words, screenings should probably begin annually at 60 years of age as opposed to 65 years of age," he said.

"These screenings can improve quality of care because having unrecognized dementia can be a disaster in someone with diabetes as medications are often missed or forgotten."

Insulin Debate

Concerns voiced included that the study did not say whether or not someone treated for depression would be less likely to develop dementia. In fact, because use of an antidepressant was one of the criteria for identifying participants with depression, Dr. Ashford said that it is a possibility that that treatment could have been a risk factor itself.

"So again, you have to be careful with the cause and effect. But it absolutely raises some questions in an area that has huge interest, said Dr. Ashford.

He also noted that there has been considerable debate in the field about whether insulin is good or bad for amyloid production.

"Overall, I'm hearing more and more about how pessimistic the whole field is about finding a treatment for Alzheimer's. There are billions of dollars that have been spent that has led to nothing. And it's been 10 years since anything beneficial has been found," said Dr. Ashford.

"An interesting question from this paper is: does this mean patients with diabetes and depression should be started on medications? There's no evidence that these medications prevent the development of Alzheimer's, so I would say no.

"But on the other hand, there is evidence that as soon as a person does develop dementia, they should be put on a cholinesterase inhibitor. And that does seem to have a long-term benefit in terms of delaying nursing home placement and delaying cognitive progression a little bit. So again, interesting questions have been raised," he said.

The study was supported by grants from the National Institute of Mental Health Services, the National Institute of Diabetes and Digestive and Kidney Disease, and by the Centers for Diabetes Translation Research. Dr. Katon reported board memberships for Eli Lilly and Wyeth and receiving lecture honoraria from both companies, plus Pfizer and Forest. Dr. Ashford reported having an interest in MemTrax, which is a screening test for AD.

Arch Gen Psychiatry. Published online December 5, 2011. Abstract

Association of Depression With Increased Risk of Dementia in Patients With Type 2 Diabetes

The Diabetes and Aging Study

Wayne Katon, MD; Courtney R. Lyles, PhD; Melissa M. Parker, MS; Andrew J. Karter, PhD; Elbert S. Huang, MD, MPH; Rachel A. Whitmer, PhD

Arch Gen Psychiatry. Published online December 5, 2011. doi:10.1001/archgenpsychiatry.2011.154

Context  Although depression is a risk factor for dementia in the general population, its association with dementia among patients with diabetes mellitus has not been well studied.

Objective  To determine whether comorbid depression in patients with type 2 diabetes increases the risk of development of dementia.

Design  The Diabetes and Aging Study was a cohort investigation that surveyed a racially/ethnically stratified random sample of patients with type 2 diabetes.

Setting  A large, integrated, nonprofit managed care setting in Northern California.

Participants  A sample of 19 239 diabetes registry members 30 to 75 years of age.

Main Outcome Measures  The Patient Health Questionnaire 8, International Classification of Diseases, Ninth Revision (ICD-9) diagnoses of depression, and/or antidepressant prescriptions in the 12 months prior to baseline were used to identify prevalent cases of depression. Clinically recognized dementia was identified among subjects with no prior ICD-9 Clinical Modification (ICD-9-CM) diagnoses of dementia. To exclude the possibility that depression was a prodrome of dementia, dementia diagnoses were only based on ICD-9-CM diagnoses identified in years 3 to 5 postbaseline. The risk of dementia for patients with depression and diabetes relative to patients with diabetes alone was estimated using Cox proportional hazard regression models that adjusted for sociodemographic, clinical, and health risk factors and health use.

Results  During the 3- to 5-year period, 80 of 3766 patients (2.1%) with comorbid depression and diabetes (incidence rate of 5.5 per 1000 person-years) vs 158 of 15 473 patients (1.0%) with diabetes alone (incidence rate of 2.6 per 1000 person-years) had 1 or more ICD-9-CM diagnoses of dementia. Patients with comorbid depression had a 100% increased risk of dementia during the 3 to 5 years postbaseline (adjusted hazard ratio, 2.02; 95% confidence interval, 1.73-2.35).

Conclusion  Depression in patients with diabetes was associated with a substantively increased risk for development of dementia compared with those with diabetes alone.

Author Affiliations: Department of Psychiatry and Behavioral Sciences, School of Medicine (Dr Katon), and Department of Health Services, School of Public Health (Drs Lyles and Karter), University of Washington, Seattle; Kaiser Permanente Division of Research, Oakland, California (Ms Parker and Drs Karter and Whitmer); and University of Chicago, Chicago, Illinois (Dr Huang).

Veterans Deserve Better Access to Pain Care

TORONTO, April 19, 2012 /CNW/ - As our soldiers return home from Afghanistan, many will be requiring long term care to manage injuries sustained while on tour. Modern military medicine has led to an increased survival rate in combat zones. This is related to high tech body armour and improved delivery of battlefield medicine. Improved survival leads to increased complexity in managing pain both on and off the battlefield. Many servicemen and women still struggle with the treatment of their injuries once home. With the mission in Afghanistan complete, there have been over 2,000 sustained injuries since 2002, many of which are life changing, irreversible and result in chronic pain.i

While Canadians can wait up to five years to seek treatment from pain specialists and those living in remote communities have no access to pain care, members of the military face additional challenges. "Many soldiers are reluctant to report injuries or discuss conditions that can't physically be seen, like chronic pain," said Master Corporal Patrick Kelly, former Canadian Forces Aviation Systems Technician. "There is a fear any medical condition could restrict duty, impact promotion or even potentially lead to discharge from the service. I would personally go to work hurt because I was afraid to shed light on my chronic pain."

The US Army Pain Management Task Force has identified that the tough it out, no pain no gain philosophy needed in the heat of battle can actually have an adverse impact on every aspect of a warriors recovery and rehabilitation and recommends that pain must be recognized as a disease process. This task force has identified the need to "synchronize a culture of pain awareness" and education and proactive intervention.ii Canadian warriors deserve the same excellent level of care.

The Canadian Pain Society, in conjunction with the Canadian Pain Coalition, are requesting the federal government implement a National Pain Strategy to address the gap that exists in pain management and to minimize its burden on Canadians living with pain, their families and society. The National Pain Strategy will help to ensure that all doctors both military and civilian receive appropriate training in pain management, are aware of alternative treatment options and ensure that all Canadians have equal access to the medical attention they require. At present veterinarians receive five times more training in pain management than people doctors. It's time for Canadians to rise up against pain. Canadians should visit

"There are many non drug treatments that can help people suffering with pain but because of the lack of access to these treatments both veterans and civilians alike are frequently offered opioids as the only means to treat pain when other medication and non-medication options should be available," says Dr. Mary Lynch, a pain specialist from the Canadian Pain Society. "Pain in Canada is under recognized and poorly treated." Currently, one in five Canadians suffer from chronic pain,iii yet the total funding for pain research is only 0.25 per cent of that spent on health research,iv v this severely limits funding needed to answer questions critical to the better management of pain.

Chronic pain is associated with the worst quality of life when compared to other chronic conditions such as heart and lung disease. We owe it to our servicemen and women to give them the best that medicine has to offer not only on the battlefield but also after they have returned home.

About the National Pain Strategy
The first-ever Canadian Pain Summit will take place in Ottawa on April 24th, 2012. It is essential that Canada take a leading role in proceeding with a national pain strategy and that pain patients are part of the solution. Canadians are urged to visit and endorse the national pain strategy.

About the Canadian Pain Society
The Canadian Pain Society has been a chapter of the International Association for the Study of Pain since 1982. The aim of the CPS is to foster and encourage research on pain mechanisms and pain syndromes and to help improve the management of patients with acute and chronic pain by bringing together the basic scientists and health professionals of various disciplines and backgrounds who have an interest in pain research and management. /

About the Canadian Pain Coalition
The Canadian Pain Coalition (CPC) is THE National Voice of People with Pain. Incorporated in 2004 as a non-profit organization, the CPC is a partnership of pain consumer groups, individuals, health professionals who care for people in pain and scientists studying better ways to treat pain. CPC promotes sustained improvement in the understanding, prevention, treatment and management of all types of pain in Canada. CPC accomplishes this through pain education, awareness activities and advocacy initiatives. CPC obtained the Senate Declaration of National Pain Awareness Week in 2004.


i Canadian Forces' Casualty Statistics (Afghanistan) Fact Sheet. FS 12.002 - February 1, 2012.
ii Pain Management Task Force. Office of The Army Surgeon General. Final Report May 2010. Synchronize a Culture of Pain Awareness, Education, and Proactive Intervention. Section 4.4. Page 63.
iii Research funding for Pain in Canada. ME Lynch MD FRCP, Dalhousie University, Halifax, Nova Scotia, Donald Schopflocher PhD, University of Alberta, Edmonton, Alberta, Paul Taenzer PhD, University of Calgary, Calgary, Alberta ,Caitlin Sinclair BSc, Dalhousie University, Halifax, Nova Scotia
ivSchopflocher, D., R. Jovey, et al. (2011). "The Burden of Pain in Canada." Pain Res Manage: In Press.
v Moulin, D., A. J. Clark, et al. (2002). "Chronic pain in Canada, prevalence, treatment, impact and the role of opioid analgesia." Pain Res Manage 7: 179?184.
For further information:

or to schedule an interview, please contact:
Rob McEwan
Argyle Communications
(416) 968-7311 ext. 242

Steven Blaney interpellé au sujet de l'ex-militaire Pascal Lacoste

La députée du Nouveau Parti démocratique (NPD) Annick Papillon demande au ministre des Anciens Combattants, Steven Blaney, de tenir ses promesses à l'endroit de l'ex-soldat Pascal Lacoste.

La députée néo-démocrate de la circonscription de Québec veut que le ministre conservateur s'engage à rendre publiques les conclusions du comité chargé d'étudier la possible contamination de soldats à l'uranium appauvri.

Rappelons que l'ex-militaire a fait une grève de la faim en novembre dernier pour interpeller le gouvernement fédéral au sujet de sa situation. M. Lacoste plaide que lui et d'autres militaires ont été contaminés par de l'uranium appauvri lors de missions à l'étranger.

L'ex-militaire dit avoir été contaminé alors qu'il était déployé en Bosnie dans les années 90 et dit souffrir de problèmes neurologiques et de douleurs chroniques.

À la suite de cette grève de la faim, le ministre Blaney avait convenu de mettre sur pied un comité consultatif qui se pencherait sur la santé des Anciens Combattants et sur la question de la contamination à l'uranium appauvri.

Or, la députée Annick Papillon estime que Pascal Lacoste a été laissé à lui-même depuis le mois de novembre.

« Dès qu'ils (conservateurs) ont une patate chaude entre les mains, ils créent un comité ou un secrétariat [...] puis après ça, ils estiment justement que le dossier est réglé. Mais Pascal Lacoste, il continue de se battre pour cette cause-là, mais je vous dirais que plusieurs mois plus tard, il commence à être de plus en plus déçu », indique Mme Papillon.

Defence of Canada Medal Act (1946-1989)Bill C-354

From: Hugh Message
To: Hugh Message
Sent: Thursday, April 05, 2012 1:29 PM
Subject: Fw: Defence of Canada Medal Act (1946-1989)Bill C-354
5th of April, 2012
From the "message centre"
Thank you Ray.
We are being asked to support this motion.
Details below...


While most private members bills fail to become law, Bill C-354, the Defence of Canada Medal Act is one that AFP/AAC is encouraging members to support. Introduced by Carol Hughs, MP for Algoma-Manatoulin-Kapuskasing, the bill seeks to establish an award formally honouring individuals who defended Canada from within Canada to ensure the survival of the country's people and democratic way of life during the Cold War. It would retroactively recognize those who served in the regular and reserve forces, police forces, emergency measures organizations, as well as civil organizations, such as St. Johns Ambulance, all of whom were focused on protecting Canada from the threat posed by the countries behind the Iron Curtain. The Bill represents the hard work and vision of a constituent, says Hughs. "C-354 was brought to me as a complete proposal by Elliott Lake resident Ulrich Krings shortly after I was first elected. I introduced it in the 40th and 41st parliaments where it garnered interest from all over Canada as people recognize relatives, friends and others who would be suitable candidates for such an honour." Many people want to give something back to all those who worked to keep us safe and prepared in case of an attack on Canadian soil, she explains. "There is a great desire from people who have contacted me to recognize the contributions made by Canadians from all walks of life during the Cold War. Hopefully the Defence of Canada Medal proposal can help focus those desires into a tool that will allow Canada to do that." The Cold War lasted from 1946 when Sir Winston Churchill made his famous speech proclaiming " an iron curtain has descended across the continent," until the fall of the Berlin Wall in November 1989. This period in the history of Canada, and the world, shaped the lives of the many men and women who served the nation as a member of the Armed Forces and other organizations. The medal would be awarded by the Governor in Council to any Canadian citizen or permanent resident with a minimum cumulative period of three years of service in one or more of the specified organizations during the period commencing 1 June 1946 and ending on 30 November 1989. Anyone who would like to offer their support for this initiative can let their MP and others know about Bill C-354, says Hughs. "They can also write the Prime Minister, the Minister of Defence, and even the Governor General about the idea. I would certainly be glad to be copied on those messages and will use the information to keep interested parties in the loop when developments on the proposal occur." Contact your MP today to express your support for the private members bill. A list of contact details for all MP's is located on our website at

Canada spent $25 M bombing Gadhafi forces

By Jeff Davis and Lee Berthiaume, Postmedia News April 18, 2012 6:02 PM

Read more:

Two CF-18 pilots from Canadian Forces 425 Tactical Fighter Squadron in Bagotville, walk across the tarmac at the Birgi NATO Airbase in Trapani, Sicily, March 24, 2011 during their deployment to enforce the no-fly zone over Libya.

OTTAWA — Canada spent $25 million on the roughly 700 bombs the Royal Canadian Air Force dropped on Libya during last year's rebel uprising that deposed dictator Moammar Gadhafi.

Each bomb, the Department of National Defence told Postmedia News, cost between $34,000 and $43,000.

Canada deployed seven of its aging CF-18 fighter jets to participate in the NATO-led mission, which raged from February to October 2011. The squadron was based in Sicily, and participated in bombing runs against pro-Gadhafi forces and helped enforce the no-fly zone over Libya's skies.

All of the 695 bombs dropped by the RCAF in the course of conflict were so-called "smart bombs," which are guided into their targets as they fall.

About 98 per cent of bombs dropped were from the Paveway II family of laser-guided smart bombs, commonly used by the American military. Canada favoured the smaller 500-pound version of the bomb - dropping 495 - as opposed to the 2000-pound version, of which the RCAF dropped 188.

The RCAF also appears to have experimented with the Joint Direct Attack Munition family of GPS-guided smart bombs, dropping just 11 of the 500-pound versions and two 2,000-pound versions.

Air-dropped bombs are no longer manufactured in Canada, since the SNC-Lavalin munitions factories in Quebec were sold to General Dynamics Ordnance and Tactical Systems-Canada Inc. in 2007.

Without a domestic supplier, the RCAF must look south of the border to buy bombs.

"The majority of the ordnance dropped by the CF-18 Hornet is procured from American sources," Josee Hunter, a spokeswoman for DND said.



Bomb Type — number dropped — unit cost — total cost

GBU 12 Paveway II — 500 lbs. — 495 x $35,000 = $17,325,000

GBU 10 Paveway II — 2000 lbs. — 188 x $37,500 = $7,050,000

GBU 38 JDAM — 500 lbs. — 11 x $34,000 = $374,000

GBU 31 JDAM — 2000 lbs. — 2 x $43,000 = $86,000
© Copyright (c) Postmedia News

Dead veteran's benefits allegedly collected for 8 years

CBC – Tue, 17 Apr, 2012

A Richmond, BC man is accused of defrauding Veterans Affairs by collecting eight years worth of benefits on behalf of his dead father-in-law.

Alan David Lexier is scheduled to make a first appearance in provincial court next month on four charges including fraud and theft in excess of $5,000.

Court documents obtained by the CBC say the director general of finance for Veterans Affairs Canada contacted RCMP in 2009 after an internal investigation suggested the department had paid more than $125,000 in pension benefits to a dead man.

Details of the case are laid out in information sworn to obtain production orders for financial records.

According to the documents, Benjamin Dewberry was admitted to George Derby Centre, a Veterans Care home, a few months before his death on January 24, 1998.

But the department received a benefit declaration signed in Dewberry's name in 1999. The form also indicated a change in his address to a location that later turned out to be a mailbox rental outlet.

"I infer by this that there was a wilful misrepresentation of Benjamin Dewberry as living and eligible to receive his pension," the investigator writes.

Veterans Affairs allegedly made several attempts to contact the deceased in the eight years that followed, sending out questionnaires in 2004 and 2006. According to the sworn information, forms were completed and signed in Dewberry's name.

Bank records for the eight years following Dewberry's death allegedly show monthly deposits totalling more than $125,000 in disability pensions and $3,400 worth in pension payments.

"On March 24, 2009, the account balance was $656.52," the investigator wrote.

Lexier didn't respond to a call from the CBC. According to the court documents, he told investigators that he thought his wife was getting a survivor's benefit.

"[Lexier] couldn't figure out why Veterans Affairs did not know that Benjamin Dewberry had passed away; He never phoned Veterans Affairs Canada 'cause we filled out all the documentation...' for such things as Canada Pension," the document reads.

"Money was received from Canada Pension to pay for the funeral and given the fact that Benjamin Dewberry had lived in a Veterans hospital [Lexier] couldn't understand why Veterans Affairs Canada did not know Benjamin Dewberry had died."

The accused allegedly told investigators his wife "knew nothing about 'anything that went on.' He said he "might've" signed the benefit declaration card and asked if criminal charges would still be forwarded if restitution was made.

Lexier's lawyer Vincent Michaels said his client is not likely to plead guilty when he makes a first appearance on May 1.

"We have not yet had our first appearance in court. When we do we'll get the Crown's disclosure package. What I can say is that we'll be reviewing the evidence very closely and I don't expect that Mr. Lexier is intending to plead guilty at this point," said Michaels.

"Veterans Affairs Canada takes the issue of fraud very seriously. The department has operational controls in place to protect the integrity of public funds, including processes to confirm the continued eligibility of benefit recipients. These are reviewed regularly."

In a written statement, Veterans Affairs said the department identified 10 cases of fraudulent claims for benefits totalling $781,000 in 2010/11.

The total budget is $3.56 billion and they pay benefits out to more than 215,000 people.

None of the allegations contained in the information to obtain the production order have been proven in court.

Medical - Médicale / B.C.'s quit smoking program hits 100,000 mark
« on: April 18, 2012, 05:33:36 PM »
B.C.'s quit smoking program hits 100,000 mark

By Cindy E Harnett, April 18, 2012 2:14 PM

Read more:

Orders for a program that helps smokers kick their habit has hit the 100,000 mark, the government announced Wednesday.

Since B.C.’s smoking cessation program launched six months ago, 104,736 orders have been placed through HealthLink B.C.

Vancouver Island residents have the third highest uptake — at 21,058 orders — after the Fraser Health region at 34,373 orders and Interior Health at 23,639.

“The program supports British Columbians who wish to improve their health and recognizes that quitting smoking is one of the best ways to improve our health and reduce the health risks associated with chronic diseases like cancer, heart disease and asthma,” said Health Minister Mike de Jong, in a news release.

The program is accessed by calling 8-1-1. It assists with the cost of smoking cessation aids.

Each year, B.C. residents who are enrolled under the Medical Services Plan are entitled to PharmaCare coverage. According to the rules of your plan, you are entitled to a single continuous course of a prescribed smoking cessation drug —varenicline (Champix) and bupropion (Zyban) — or a free 12-week supply of over-the-counter nicotine replacements —either Thrive nicotine chewing gum or Habitrol nicotine patches , according to the government.

The program is not available to people who are not residents of B.C. or who are otherwise covered under similar federal programs — such as those in the Canadian Forces the RCMP.

That exemption had also applied to Veterans Affairs Canada but after at least one veteran complained he wanted to quit but was unable to access the B.C. smoking cessation program, the province changed its rules.

The province now allows veterans to register through its program and go directly to a pharmacist in order to immediately access either smoking cessation drugs or nicotine replacements. The province is reimbursed by the federal government.

More than half of the orders for smoking cessation assistance were first-time orders, according to the government.

Nicotine replacement therapies are sold over-the-counter medications that contain nicotine and work to reduce withdrawal symptoms.

Through the Smoking Cessation Program, PharmaCare covers the prescription drugs varenicline (Champix) and bupropion (Zyban). These drugs do not contain nicotine, but work on the brain to manage withdrawal symptoms and cravings and reduce the urge to smoke.

B.C. residents can also access QuitNow Services, which is operated by the BC Lung Association.

HealthLink B.C. staff can transfer callers directly to Quit Now Services and QuitNow has received more than 15,800 new web, text and telephone registrants since the Smoking Cessation Program began.

At the end of this month, QuitNow services will offer a live-chat coaching — from 9 a.m. to 9 p.m., Monday to Friday and from 9 a.m. to 5 p.m. on weekends and holidays — for online members to help support their efforts in quitting tobacco.

For more information:

• call 8-1-1 or visit:

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Antimalaria (mefloquine or Lariam) / Mefloquine (Lariam®)
« on: April 17, 2012, 03:39:41 AM »
Mefloquine (brand name: Lariam®) is a drug that has been given to military personnel, including those serving in Somalia, Iraq, and Afghanistan, for protection against malaria. Malaria is an infectious disease transmitted by mosquitoes. Mefloquine is also used for travelers visiting areas where malaria is found, based on recommendations from the Centers for Disease Control and Prevention.  Mefloquine was approved by the FDA in May 1989.

If you are concerned about mefloquine use or long-term side effects from taking mefloquine, talk to your health care provider or local VA Environmental Health Coordinator.

Mefloquine side effects
Hand holding a foil blister pack with small white pills

Most people who take mefloquine do not experience side effects. For those who do, symptoms are usually mild and do not last long because the drug quickly leaves the body after the medication is stopped. People with liver problems, or those who drink alcohol or take medications that affect the liver, may take longer to eliminate mefloquine.

Occasionally, mefloquine may cause more serious side effects. Examples include psychiatric symptoms such as anxiety, paranoia, depression, mood changes, hallucinations, agitation, and unusual behavior. Other uncommon side effects may include muscle weakness, irregular heartbeat, and lung problems such as pneumonitis (inflammation of lung tissue). Rare cases of suicidal thoughts have been reported.

If you are thinking about suicide, seek appropriate care immediately.  Contact the Veterans Crisis Line at 1-800-273-8255 (press 1) or through online chat.*†

Health concerns?

If you are concerned about mefloquine use or long-term side effects from taking mefloquine, talk to your health care provider or local VA Environmental Health Coordinator. Veterans not enrolled in the VA health care system, find out if you qualify for VA health care.

VA benefits

Veterans may be eligible for VA disability compensation benefits and health care benefits for health problems associated with mefloquine use during military service.

More on malaria and mefloquine

    Malaria* (Centers for Disease Control and Prevention)
    Mefloquine* (U.S. Department of Defense Deployment Health Clinical Center)
    Mefloquine (Lariam®)* (U.S. Department of Defense Force Health Protection and Readiness)*

Military dropping anti-malaria drug

By THOMAS WATKINS, Associated Press – 28 minutes ago

LOS ANGELES (AP) — Almost four decades after inventing a potent anti-malarial drug, the U.S. Army has pushed it to the back of its medicine cabinet.

The dramatic about-face follows years of complaints and concerns that mefloquine caused psychiatric and physical side effects even as it was used around the globe as a front-line defense against the mosquito-borne disease that kills about 800,000 people a year.

"Mefloquine is a zombie drug. It's dangerous, and it should have been killed off years ago," said Dr. Remington Nevin, an epidemiologist and Army major who has published research that he said showed the drug can be potentially toxic to the brain. He believes the drop in prescriptions is a tacit acknowledgement of the drug's serious problems.

Over the past three years, the Army slashed by almost 75 percent the amount of mefloquine it prescribes, even as it sent thousands more soldiers to malaria-prone Afghanistan.

The decrease in doses followed two orders from military and Pentagon leaders in 2009. One, from the Army's surgeon general, ordered the branch to limit its use to specific circumstances. Other branches, however, continue to favor mefloquine.

"We are constantly looking to ensure we are taking care of (soldiers) the best we can," said Army Col. Carol Labadie, the service's pharmacy program manager. "If that means changing from one drug to another because now this original drug has shown to be potentially harmful ... it is in our interests to make that change."

Army researchers started developing mefloquine toward the end of the Vietnam War and began using it widely after it was licensed by Roche Pharmaceuticals under the brand name Lariam in the early 1990s.

It gained support among the fighting forces because it works in areas where mosquitoes developed resistance to an earlier treatment, chloroquine, and requires just one tablet a week, not the daily dose needed with other medications.

For years, the Army downplayed veterans' criticism of the drug and insisted its protection against malaria easily outweighed the small risks.

Some users complained the pill caused varying degrees of psychiatric symptoms ranging from nightmares, depression and paranoia to auditory hallucinations and complete mental breakdowns. Army literature says such symptoms occur at a rate of between one per 2,000-13,000 people. Critics, including Nevin, contend the number is far higher.

Family members have even blamed the drug on their loved ones' suicides.

Retired Navy Capt. Gary Foster said he cut his career short in part because of the effects of taking mefloquine in 2008 and 2009.

"I began to suffer short term memory loss, not able to recall what I had done earlier," he wrote in an email. "I also had more bouts of anxiety, and I cannot for the life of me tell you why."

In February 2009, Army Surgeon General Eric Schoomaker sent a policy memo to doctors saying it should be used only if soldiers could not tolerate doxycycline, a general antibiotic effective at preventing malaria.

In September 2009, Ellen P. Embrey, who at the time was deputy assistant secretary of defense overseeing health affairs, sent a letter similar to Schoomaker's. This time, it was directed across all military branches.

A small but vocal group of anti-mefloquine campaigners seized on the memos as vindication.

"I was stunned," said retired Navy commander Bill Manofsky, who said he sustained permanent damage to his sense of balance after taking Lariam in Kuwait in 2002 and has been a persistent critic of the drug.

"It's like you scream into a hurricane until you are hoarse," he said. "We knew we were right."

Roche says it stopped selling Lariam in the U.S. in 2008 because of the availability of generics and alternative therapies.

Roche spokesman Christopher Vancheri said in an email he could not comment on the military's stance on mefloquine, but noted that the drug continues to be available in over 50 countries.

In 2008, the Army dispensed 8,574 courses of the drug. In 2010, it fell to 2,054. At the same time, the Army increased fivefold the number of doxycycline prescriptions — to more than 80,000 — reflecting the increasing number of soldiers deployed to Afghanistan.

Spending followed a similar pattern, with the Pentagon buying almost $1.8 million of mefloquine in 2009, enough for about 10,000 yearlong courses. The amount dropped to $1.5 million last year. So far this year, the military has only spent about $50,000.

It's not clear how many of the tablets have been dispensed.

The Navy and Marine Corps have actually slightly increased their mefloquine prescriptions over the past three years, from about 1,200 in 2008 to nearly 2,000 last year. Numbers could be higher still because prescriptions filled overseas are frequently not counted.

The Air Force, which has long banned its pilots from using the drug, has been decreasing its usage over the past two years.

Capt. Christopher Clagett, who directs the Navy's Department of Preventive Medicine, said his service's view is mefloquine remains one of his best tools to prevent malaria. He said it is much cheaper than the most effective drug, Malarone, and can often work better than doxycycline.

"It would be imprudent and would place our personnel at the far greater risk of malaria to abandon an effective anti-malarial due to unsubstantiated allegations of chronic effects," Clagett wrote in an email, "than to continue the judicious and selective use of an imperfect, but nevertheless effective and valuable medication."

In August, Sen. Dianne Feinstein, D-Calif., wrote to the secretaries of Defense and Veterans Affairs, urging them to strengthen safeguards for the use of the drug. The VA last month stripped mefloquine from the advice section on its website while it reviews recent research into the drug's side effects.

Nevin, the Army doctor, has riled superiors with public attacks on mefloquine, calling it "probably the worst-suited drug for the military." He noted that its side effects can closely mirror symptoms of stress disorders related to combat, making diagnosis of neurological problems difficult.

"It is a story of the military bureaucracy gradually and reluctantly coming to terms with a tragic, possibly catastrophic, decades-long series of errors and missteps," Nevin said.


Mefloquine is a relatively new anti-malarial drug, first made generally available to the Canadian public in 1993.1 It is used both to prevent malaria (that is, as a prophylactic) and to treat malaria. Mefloquine is used in areas where the local strains of malaria have developed a resistance to other anti-malarial drugs. Somalia is one such area.

The suggestion was made to us that mefloquine caused severe side effects, including abnormal and violent behaviour, among some Canadian Forces (CF) personnel in Somalia. We were not able to explore fully the possible impact of mefloquine. This would have required additional hearings dedicated specifically to the issue, which time did not permit. However, we report here our general findings about mefloquine and its possible impact on operations in Somalia. Readers will see readily that further investigation is warranted before any firm conclusions about the role of mefloquine can be drawn.


La méfloquine est un antipaludique relativement nouveau, auquel le public canadien a accès depuis 19931. Elle sert à prévenir (c'est-à-dire en tant que prophylactique) et à traiter la malaria. Elle est utilisée dans les régions où les souches locales de malaria ont développé une résistance aux autres médicaments antipaludiques. La Somalie est une de ces régions.

On nous a laissé entendre que la méfloquine a causé de graves effets secondaires, dont un comportement anormal et violent, chez certains membres des Forces canadiennes (FC) en Somalie. Il nous a été impossible d'examiner tous les effets possibles de la méfloquine. Cela aurait nécessité d'autres audiences consacrées à cette question, mais nous étions à court de temps. Nous voulons toutefois noter ici nos conclusions générales sur la méfloquine et son incidence possible sur les opérations en Somalie. Mais il va de soi qu'il faudrait faire une enquête plus approfondie pour pouvoir tirer des conclusions solides sur le rôle de ce médicament.

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Ste Anne Protest Union and CVA 15 Dec 2011




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