Latest / Morning Medical with Dr. Chow / Colorectal Cancer, Myopia Insights, and Exercise for Osteoarthritis

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Colorectal Cancer, Myopia Insights, and Exercise for Osteoarthritis · Morning Medical with Dr. Chow

• 0:00
  Good morning!
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  Welcome to another episode of Morning Medical with Dr.
• 0:03
  Chow, where we bring you the latest in medical and health news from around the world.
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  I'm your host, Dr.
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  Chi-Ming Chow, a cardiologist based in Toronto, Ontario, Canada.
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  In addition to my work as the Director of the Echo Lab at St.
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  Michael's Hospital, I'm also a Professor of Medicine at the University of Toronto.
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  Today, we're diving into a critical update on colorectal cancer screening, which could impact
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  the way we approach cancer prevention in Canada.
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  Colorectal Cancer Canada is urging provinces and territories to lower the routine screening
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  age for colorectal cancer to 45 for average-risk Canadians.
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  This recommendation, announced in a recent press release, reflects a growing concern about
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  the increasing incidence of colorectal cancer among younger adults.
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  The current screening programs across Canada typically start at age 50, but with rising
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  rates of the disease in those aged 45 to 49, experts believe this change is urgently needed.
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  The American Cancer Society highlighted in a January report that colorectal cancer has
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  become the leading cause of cancer-related death among individuals under 50 in the United
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  States.
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  This trend is mirrored in Canada, where the Canadian Cancer Society noted that colorectal
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  cancer was expected to be the fourth most commonly diagnosed cancer in 2025 and the third
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  leading cause of cancer death for both men and women.
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  In numbers, it's estimated that 26,400 people in Canada will be diagnosed with colorectal
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  cancer, and 9,100 will die from it, accounting for 10 percent of all new cancer cases and
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  deaths.
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  Despite these concerning statistics, provincial screening programs still begin at age 50,
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  leaving a growing at-risk population without access to routine, organized screening.
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  Brandon Purcell, an advocacy manager at the Canadian Cancer Society, emphasized that
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  lowering the screening age could catch more cancers early, when they're easier to treat and
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  survival rates are higher.
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  Dr.
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  Harminder Singh, a gastrologist from Manitoba, also noted that while the rates in younger age
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  groups are lower than those in older ones, the trend is increasing and needs more attention
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  and awareness.
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  Singh pointed out that individuals with a family history of colorectal cancer require
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  more attention, as the detection rate among those with familial cancer syndromes remains
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  suboptimal.
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  Raising awareness about screening options is crucial, especially for those who may be at
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  higher risk due to their family history.
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  In a related effort, Health Minister Marjorie Michel announced a federal investment of $41
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  million into 19 new cancer research teams.
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  This initiative aims to explore new approaches to cancer prevention, including collaborations
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  with Japanese researchers to better understand the links between aging and early-onset
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  colorectal and pancreatic cancers.
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  Dr.
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  Singh believes that raising awareness about cancer screenings is an individual choice that
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  requires informed decision-making.
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  He stresses the importance of making people aware of the potential benefits and any risks,
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  however small, associated with early detection and screening options.
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  Let's delve into the latest discussion surrounding the Interim Federal Health Program,
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  which is reigniting debates across Canada.
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  This program provides crucial health care benefits to refugees and asylum claimants
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  residing in Canada.
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  Recently, it has become a focal point of contention between political parties, with the
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  Conservatives proposing significant cuts and changes to its structure.
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  Conservative Member of Parliament Michelle Rempel Garner, who serves as her party's
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  immigration critic, has been vocal about the need to curtail the costs associated with the
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  Interim Federal Health Program.
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  Her party has suggested that the program's expenses, which have surged from two hundred
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  twenty-six million dollars in two thousand twenty-one to eight hundred ninety-six million
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  dollars in two thousand twenty-five, need to be reined in.
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  The Parliamentary Budget Officer warns that without intervention, costs could skyrocket to
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  one point five billion dollars annually by two thousand thirty.
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  The Conservative Party's leader, Pierre Poilievre, has gone as far as to label some
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  benefits as 'deluxe' and claims that 'fake refugees' are exploiting the system.
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  His party's motion, which was put forward in the House of Commons, sought a full review of
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  the program and proposed that the federal government should only cover emergency
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  life-saving health care for those whose asylum claims are denied.
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  However, this motion was met with strong opposition from Liberal Members of Parliament,
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  including Yasir Naqvi, who argued that the Conservative rhetoric was divisive and
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  reminiscent of sentiments seen south of the border in the United States.
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  The motion was ultimately defeated, with Members of Parliament from the Liberal, Bloc
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  Québécois, and New Democratic Party voting against it.
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  This debate brings back memories of a similar controversy in two thousand twelve when Stephen
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  Harper's Conservative government reduced coverage provided by the Interim Federal Health
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  Program.
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  Back then, the changes were met with widespread objections from refugee advocates, medical
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  professionals, and some provincial governments, leading to a legal challenge.
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  The Federal Court eventually ruled that those changes were 'cruel and unusual,' particularly
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  impacting vulnerable children, and violated the Canadian Charter of Rights and Freedoms.
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  Dr.
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  Meb Rashid, director of the Crossroads Clinic in Toronto, has highlighted the importance of
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  maintaining comprehensive health care for refugees, noting that the costs of basic
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  services are often less than the expenses incurred from untreated illnesses.
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  He argues that the government's portrayal of policy changes as mere co-payments masks the
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  reality that such costs could make essential services inaccessible to those who need them
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  most.
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  While the Conservatives argue that their current proposals are more moderate than those
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  in two thousand twelve, it's crucial to consider the potential real-world impacts of
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  policy changes on the health and lives of vulnerable populations.
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  The debate underscores the need for careful scrutiny of any proposed reforms to ensure they
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  do not disproportionately harm those seeking refuge in Canada.
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  In recent years, the landscape of organ donation has shifted significantly.
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  Traditionally, most organ donations came from individuals who were brain-dead.
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  However, there's been a notable increase in donations from those who died when their heart
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  stopped beating, a process known as donation after circulatory death, or DCD.
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  This method has become increasingly prevalent, accounting for forty-nine percent of all
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  deceased donors in the United States last year, compared to just two percent in the year two
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  thousand.
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  Advancements in technology have played a crucial role in facilitating the use of organs
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  from DCD donors by preventing the organs from deteriorating as the heartbeat ceases.
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  This shift is particularly important as the nation grapples with a dire shortage of organs,
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  with more than one hundred thousand people on the transplant waiting list and thousands dying
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  each year while waiting for a transplant.
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  Despite the overall rise in DCD, there is a significant variation in its prevalence across
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  different regions in the United States.
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  According to specialists from New York University Langone Health, donation after
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  circulatory death is more common in some parts of the country than others.
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  This disparity suggests that better education for the public and local hospitals about this
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  donation option could increase access to life-saving transplants.
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  The findings, reported in the medical journal JAMA, come amidst concerns about the transplant
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  system's integrity.
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  There have been rare but alarming reports of potential donors showing signs of life, which
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  have shaken public trust.
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  In response, both federal officials and organ procurement organizations are developing
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  additional safeguards to address these concerns and improve the system.
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  Donation after circulatory death involves complex procedures.
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  Typically, it is considered when someone has a non-survivable injury, but their brain function
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  has not completely ceased, and the family decides to end life support.
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  After the heart stops, there's a mandatory waiting period—usually five minutes—to ensure
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  it won't restart before a doctor declares death.
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  It's important to note that organ retrieval teams are not involved in the decision to end
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  life support and are not present when life support is withdrawn.
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  The process of DCD requires significant coordination and education among hospitals.
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  Smaller or rural hospitals may not be as familiar with the necessary steps involved,
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  which can lead to variations in the use of this method.
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  Additionally, some hospitals have adopted new technologies, such as normothermic regional
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  perfusion, which temporarily restores blood flow to the organs in the chest or abdomen
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  after death is declared, improving the quality of the organs for transplantation.
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  Ethical questions have been raised about temporarily restoring blood flow after death,
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  but these advancements have enabled the use of organs from older and sicker donors.
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  The Health Resources and Services Administration in the United States is
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  preparing new national policies to enhance safeguards for DCD.
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  These include proposals for pausing preparations if there are questions about a
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  potential donor's condition and ensuring hospitals perform appropriate neurological
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  exams.
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  The Association of Organ Procurement Organizations emphasizes the importance of
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  withdrawing life support in critical care units, rather than operating rooms, to prevent
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  public confusion about the timing of death and the involvement of organ procurement teams.
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  This distinction is crucial in maintaining public trust and ensuring ethical practices in
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  organ donation.
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  Let's turn our attention to a new study on exercise therapies for hip osteoarthritis.
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  This research, led by Dr.
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  Yareni Guerrero from the University of Sydney, sheds light on how we can better assess the
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  effectiveness of non-surgical and non-drug interventions for managing hip osteoarthritis.
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  The study emphasizes the importance of determining clinically meaningful benefits,
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  rather than just statistically significant changes, to guide clinical management
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  effectively.
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  Historically, thresholds for what constitutes a clinically meaningful benefit in osteoarthritis
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  therapies have concentrated on surgical or drug-based interventions.
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  However, these thresholds might not be applicable to physical therapies like exercise,
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  due to differing patient expectations and outcomes.
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  This study provides estimates of 'minimal important change' and 'minimal clinically
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  important difference' values, which are essential for interpreting pain and functional
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  ability improvements following exercise therapies in hip osteoarthritis.
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  Common tools such as the Western Ontario and McMaster Universities Osteoarthritis Index, or
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  WOMAC, are often used to quantify osteoarthritis severity and track changes over
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  time.
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  But using these tools to determine definite symptom improvement or worsening has been
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  challenging.
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  This new study aims to address that challenge.
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  The researchers reanalyzed data from a randomized clinical trial to establish minimal
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  important change for individual patients and minimal clinically important difference between
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  groups for pain and physical function.
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  They focused on WOMAC scores and 10-point numeric pain ratings for patients undergoing
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  physical therapy for hip osteoarthritis.
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  Notably, at three months, the minimal important change for numeric pain ratings was 2.1 points,
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  increasing slightly to 2.4 points at nine months.
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  For WOMAC pain, the minimal important change was 2.8 points at three months and 3.0 at nine
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  months.
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  The functional ability scores showed a minimal important change of 8.7 at three months,
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  slightly decreasing to 8.3 at nine months.
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  The study also provided minimal clinically important difference estimates, which were
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  identical for numeric pain ratings and WOMAC pain.
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  For WOMAC function scores, the minimal clinically important difference was set at 9.2
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  points at three months and 8.3 at nine months.
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  These findings offer context-specific values that enhance clinical interpretation and set
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  empirically supported parameters for future exercise-based trials.
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  The authors of the study observed that previous research concentrated on surgical or drug-based
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  therapies, where clinical improvement magnitudes are typically greater than those
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  expected from exercise-based interventions.
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  This is often due to differing patient expectations that can lead to a placebo effect.
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  Consequently, applying those minimal important change and minimal clinically important
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  difference estimates to exercise therapies might underestimate the benefits considered
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  clinically important by patients.
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  The study drew data from a trial known as PHOENIX, which compared resistance exercise
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  alone with an added aerobic component for treating hip osteoarthritis.
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  Approximately 200 patients were randomized into two groups, and their efficacy was assessed
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  using a 10-point numeric rating scale and WOMAC pain and function scoring.
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  Patients were also queried about perceived changes in pain and functional ability using a
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  7-point Likert scale, which helped correlate their responses with numeric and WOMAC scores.
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  The study participants appeared typical of the early-to-moderate osteoarthritis population in
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  Australia, with a median age of 62, two-thirds being women, most having overweight but not
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  severe obesity, and a median hip symptom duration of three years.
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  At baseline, the median numeric pain rating was 5, and WOMAC pain was 8 on its 20-point scale,
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  with a median WOMAC function score of 22 out of 68.
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  The researchers noted that replication of their study is necessary, given their relatively
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  small sample size, its Australian setting, and the focus on two specific exercise regimens
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  that may not represent the full range of physical therapies for osteoarthritis.
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  These findings, however, are a valuable step towards understanding the role of exercise in
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  managing hip osteoarthritis and tailoring interventions to meet patients' expectations
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  and needs.
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  A recent study from the State University of New York College of Optometry has uncovered a
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  potential link between the type of lighting used in Americans' homes and the increasing
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  rates of nearsightedness, or myopia.
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  The World Health Organization has projected that nearly half of the global population will
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  be affected by myopia by the year 2050.
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  While excessive use of digital devices like smartphones and computers has already been
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  associated with a higher risk of developing myopia, this new research suggests that dim
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  indoor lighting may also play a significant role.
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  Nearsightedness occurs when the eyeball elongates from front to back, causing light to
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  focus in front of the retina instead of directly on it.
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  This makes distant objects appear blurry.
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  The American Optometric Association explains that this physical change in the eye can be
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  triggered by various factors, including the lighting conditions in which close-up tasks are
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  performed.
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  The researchers at SUNY College of Optometry propose that the low-light environments typical
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  of indoor settings may contribute to the growth of the eyeball.
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  When a person focuses on close objects such as books or digital screens indoors, the pupil
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  constricts not due to brightness but to sharpen the image.
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  In dim lighting, this can significantly reduce the amount of light reaching the retina,
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  potentially signaling the eye to continue growing.
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  In contrast, spending time outdoors has been shown to slow the progression of myopia.
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  Outdoor light is much brighter than indoor light, ensuring that even when the pupil
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  constricts to focus on a nearby object, the retina still receives sufficient stimulation to
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  maintain healthy eye development.
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  Urusha Maharjan, a doctoral student involved in the study, noted that in bright outdoor
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  settings, the pupil constricts to protect the eye while still allowing ample light to reach
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  the retina.
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  This high-intensity natural light prevents myopia by providing enough retinal stimulation
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  to override the "stop growing" signal that might be triggered in dim indoor conditions.
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  The study also highlighted some limitations, such as the small subject group and the
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  challenges in directly measuring changes within the eye's internal lens during the experiments.
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  Nonetheless, the findings suggest that increasing indoor brightness during close-up
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  work could be a simple and effective strategy to combat the growing myopia epidemic.
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  Jose-Manuel Alonso, a senior author of the study, emphasized that while this is not a
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  definitive solution, the research offers a new perspective on how visual habits, lighting, and
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  eye focusing interact.
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  The study was published in the journal Cell Reports, and it opens the door to further
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  research on how modifying indoor lighting can help preserve vision health.
• 18:59
  In a significant move, Instagram has announced plans to alert parents if their teens
• 19:04
  repeatedly search for terms associated with suicide or self-harm.
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  This initiative is part of Instagram's ongoing efforts to enhance the safety and well-being of
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  young users on its platform.
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  However, it's important to note that these alerts will only be sent to parents who are
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  enrolled in Instagram's parental supervision program.
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  Instagram, which is owned by Meta, already blocks such harmful content from appearing in
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  search results for teen accounts and directs users to helplines instead.
• 19:35
  This new feature aims to provide an additional layer of protection by keeping parents informed
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  about their children's online activities, particularly when it involves sensitive topics
• 19:44
  like mental health.
• 19:47
  The timing of this announcement is notable, as Meta is currently facing two high-profile
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  trials related to the alleged harm its platforms cause to children.
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  One trial in Los Angeles questions whether Meta's platforms are designed to deliberately
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  addict and harm minors.
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  Another trial in New Mexico is examining whether Meta has failed to protect children
• 20:10
  from sexual exploitation on its platforms.
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  Thousands of families, school districts, and government entities have filed lawsuits against
• 20:20
  Meta and other social media companies.
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  They claim these platforms are deliberately designed to be addictive and fail to protect
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  young users from content that can lead to mental health issues such as depression, eating
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  disorders, and suicide.
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  Meta's executives, including CEO Mark Zuckerberg, have consistently disputed these
• 20:42
  claims, arguing that there is no conclusive scientific evidence proving that social media
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  causes mental health harms.
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  During a recent trial in Los Angeles, Zuckerberg reiterated this stance, highlighting
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  the ongoing debate about the impact of social media on mental health.
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  The alerts to parents will be sent via email, text, or WhatsApp, depending on the contact
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  information available, as well as through a notification on the parent's Instagram account.
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  Meta emphasized that the goal is to empower parents to intervene if necessary, while also
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  ensuring that notifications are not sent excessively, which could reduce their
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  effectiveness.
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  In addition to this initiative, Meta is also developing similar notifications for parents
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  regarding their children's interactions with artificial intelligence.
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  These new notifications will alert parents if a teen attempts to engage in conversations
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  related to suicide or self-harm with Meta's AI systems.
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  Meta has stated that this is important work and plans to share more updates in the coming
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  months.
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  As these developments unfold, it's crucial for parents, educators, and health professionals to
• 21:54
  stay informed about the evolving landscape of social media and its implications for youth
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  mental health.
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  By fostering open communication and vigilance, we can better support our children's well-being
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  in the digital age.
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  That's all for today's episode of Morning Medical with Dr.
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  Chow.
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  Thank you for tuning in, and I hope you found our discussions insightful and
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  thought-provoking.
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  Join us again tomorrow for more updates on the latest in medical and health news.
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  Until then, take care and stay healthy.