Aid organization gives overseas hungry diet food: Diet giant Slim-Fast gets tax write-off for donating products

By David South

Now Magazine (Toronto, Canada), December 2-8, 1993

Doling out diet supplements to recipients of food aid may sound bizarre, but that’s what US diet giant Slim-Fast has been doing.

The company’s cans of powder have been distributed to the conflict-ridden former Soviet republic of Georgia and other parts of the collapsed Soviet Union by the aid agency Americares.

Critics say Slim-Fast is far from appropriate and is, at best, in bad taste. New York-based food-aid critic and writer Michael Maren says such contributions are simply the result of agencies being used as dumping grounds for tax write-offs.

As an example, he cites Somalia, where he recenly spent time researching an upcoming book critical of aid programs. Pharmaceutical firms, he charges, are dumping unnecessary drugs in that country.

“If you want to help people, give them what they need, not the crap we have around here. That a so-called aid agency would bring over Slim-Fast is absurd.

“The attitude that they should take any shit we give them – it’s arrogance,” says Maren, who believes many donors have a beggars-can’t-be-choosers attitude to people in need of help.

At Slim-Fast’s corporate headquarters in New York, Adena Pruzansky acknowledges that the donations are tax write-offs, but insists that their product is very nutritious. No one, she says, has complained about their contribution.

Powdered cure

“If you look at our powdered products, there is a lot of nutrition in there. Certainly for people who don’t have food, this is something that could be useful to them.”

A spokesperson for Connecticut-based Americares, which directs surpluses donated by 1,100 firms to relief operations in 80 countries, praises Slim-Fast.

“They are a fine group of humanitarians,” says Elizabeth Close.

“Americares was just written up in Money magazine as the most cost-effective nonprofit agency,” she says of the organization, whose donations consist of overstocked, discontinued or obsolete items.

“We only accept a product for donation when we know we have a home for it. So we are not giving something inappropriate,” she says.

Close provides no details, however, about Slim-Fast’s participation. “Without their permission, I’m not really supposed to go into any further description of what they donated,” she says.

But those who see the devastating effects of eating disorders on women say Americares exercises poor judgement when it accepts such diet supplements.

“I think it’s quite bizarre,” says Merryl Bear of the National Eating Disorder Information Centre. “Many of these diet plans are starvation diets. In many of the diets, the caloric intake is less than or equivalent to what the Nazi concentration camps delivered.”

Slim-Fast’s chocolate drink powder, for instance, is made of skim milk powder, sugar, whey powder, cocoa, fibre, calcium caseinate, corn oil, fructose, lecithin, salt and carrageenan. It relies on mixing with milk to gets its nutrition.

Lynne Martin of the Toronto Hospital’s eating disorder clinic says Americares is encouraging dieting among starving people who need calories first.

“Women need a minimum of 1,800 to 2,100 calories per day – to meet that requirement with Slim-Fast, you would need eight glasses per day,” she says.

Low calories

Martin say the low calories available in the supplement become even lower if recipients don’t have access to milk and try to mix it with water.

“The protein level isn’t given without the milk, so you don’t know how much is in the powder, but certainly the calories would change if one were to mix it with water.”

At food relief agency CARE in Ottawa, program officer Ivan Connoir says what “the hungry need isn’t Slim-Fast but what is called a human daily ration (HDR).

“It is prepared in the United States especially for emergencies. It has no pork, so it can go to any country,” he says. “It is a kind of lentil stew and vegetable soup – just add water and it’s ready to eat. You even find bread in it. It can last for years.

“Of course the best thing is family food parcels that last one month.”

"Aid organization gives overseas hungry diet food": Now Magazine, December 1993.

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Take two big doses of humanity and call me in the morning

By David South

The Toronto Star (Toronto, Canada), January 1, 1993

“Anybody going into medicine should read a whole bunch of good novels.” Dr. Alvin Newman isn’t kidding. The head of curriculum renewal at the largest English-speaking medical school in the world, the University of Toronto, feels strongly that doctors have been ill-prepared for their profession’s challenges.

How doctors become doctors is being hotly debated as Ontario’s five medical schools institute a potpourri of curriculum reforms. After a century of taking a back seat to scientific achievement, bedside manners and the art of medicine are in vogue again.

“Around the world, medical education is undergoing significant changes,” says Newman. “Medical schools must strike a balance between the incredible explosion of scientific knowledge and re-establish the role of the physician as wise counsel and empathic healer.”

It’s a role that many feel doctors have ignored. An American Medical Association poll, conducted between 1985 and 1988, found that fewer than 50 per cent of respondents said they thought doctors listened well and half believed doctors no longer care as much about patients as they used to.

In response to these criticisms, current reforms are shifting medical education away from reliance on the turn-of-the-century science-based approach, says Professor Jackie Duffin, a medical historian at Queen’s University who helped organize the new curriculum introduced there in 1991.

“In the old days doctors could probably make a diagnosis and tell people what was happening to them, but not do very much for them,” says Newman.

“Yet society had more trust and fondness for physicians than they do now. Much of the condemnation of the medical profession is because we have become the custodians of high-tech medicine.”

While the Ontario government embarks on the most sweeping reforms to health care since the 1966 introduction of comprehensive health insurance in Ontario and the founding of national medicare in 1968, many doctors feel their profession cannot afford to maintain the status quo.

The concensus at Ontario’s five medical schools – U of T, Queen’s, University of Western Ontario, University of Ottawa and McMaster University – has gelled around a belief that doctors need to be as comfortable dealing with people as they are with scientific medicine. To this end, revamped curricula supplement basic science and clinical medicine with emphasis on early exposure to patients, communication skills, psychological issues, medical ethics, medical literacy and health promotion.

These schools hope to produce new doctors to fit into a rapidly-changing health care system – one that many believe will rely far less on large hospitals.

Instead, many procedures will take place in the home or in the day clinics. Expanding community health care care centres will try to tackle extensive social and health problems. This preventive approach ot medical education was pioneered by Hamilton’s McMaster medical school.

Since its founding in 1967, McMaster has experimented with teaching methods that steer away from mass lectures to concentrate on the individual student. The evolution of McMaster’s curriculum has placed greater emphasis on communication skills, psychosocial aspects of medicine, community issues, and disease prevention and health promotion.

How do McMaster students rate against other medical students?

Last year they scored above the national average on licencing exams. A higher proportion of McMaster students enter research and academic medicine than their counterparts from other schools. One study comparing them to U of T suggested they were more motivated to be life-long learners.

Dr. Rosana Pellizzari practices the kind of medicine everyone is talking about these days. Working out of renovated church, Pellizzari’s practice at the Davenport/Perth Community Health Centre in westend Toronto serves a working class neighbourhood that has been home to generations of recent immigrants.

A member of the Medical Reform Group – which has long advocated significant reforms to health care – and trained at McMaster, Pellizzari can be seen to represent the doctor of the future: Sensitive, salaried and working in community health.

“McMaster’s curriculum attracts people with innovative ideas,” says Pellizzari, who was active in community health education before going to medical school. “It is a very supportive environment.

“I think the important question is: Who do we choose to be medical students? They should open up medical schools to those who know what it’s like to be a parent, a mother or disabled. Doctors should represent the population they serve. We are still getting mostly white, inexperienced young males as physicians. They aren’t going to practice the way that is necessary.”

In Ontario, many doctors see the 1986 doctors’ strike as a watershed for public opinion.

As a result of the negative fallout from the strike and perceived gap between physicians andhe public they serve, a five-year project entitled Educating Future Physicians for Ontario became a major advocate for reform.

Started in 1988, EFPO has examined fundamental issues in designing and implementing new medical school curricula. These issues include defining societal health care needs and expectations, faculty development and student evaluation. While each medical school has adapted reforms to its particular situation, EFPO hopes to prod further reforms.

“This is a unique venture in Canada, and could have implications far beyond Ontario if successful,” says Dr. William Seidelman, a key player in EFPO. “It captures the unique sense of the Canadian scene, and will build on the implied contact in the Canadian health system.”

Pellizzari sees the attitude of medical schools and teaching hospitals towards medical students as a significant factor in creating insensitive doctors. She recalls the high rate of suicide among medical students and the abusive work environment that forces doctors-in-training to work shifts unthinkable for other workers.

“The way we train doctors is inhumane,” she says. “We don’t expect other workers to put in 30-hour shifts. It creates in new physicians the attitude that they paid their dues and now society owes them.”

Many critics feel that changing training methods isn’t enough; the whole ethos and selection process must be changed. If doctors are to better serve the population, they must better reflect it.

“We are getting very close to gender equality and a laudable distribution of ethnic and racial backgrounds,” says Newman. “But students still come from a fairly narrow social spectrum,  very middle class kids. Their exposure to the extremes of society, to poverty, to homelessness and related illnesses have been very limited.”

Pellizzari found how out-of-date the medical profession was in her first year. One teacher wanted her to work till 10 at night. When told that she needed 24 hours notice for a babysitter, the teacher shot back that motherhood and medicine don’t mix.

“I was a mother before I was a physician. When I get a call at night from a mother, I understand this. With 30 per cent of visits to doctors having no biological basis – like depression due to unemployment – you can’t do anything unless you have experienced life.

“If we don’t address this, you can design the best training in the world, but things won’t change.”

But Newman also feels many factors outside of medical school discourage a more diverse student body.

“To go through medical school in the United States requires large indebtedness. That’s not true in Canada. You can calculate what a year of medical school costs in terms of a finite number of CDs, a leather jacket and ghetto blaster. So something is dissuading people from pursuing this career, and it isn’t money.”

While there is a concensus among academics that medical schools haven’t prepared doctors well enough, there is little support for a dramatic change in selection criteria. “I can’t muster a lot of support from colleagues for serious changes,” says Newman.

Dr. Jock Murray, the former dean of Dalhousie medical school in Halifax, recently told an EFPO meeting he doesn’t see any significant changes ahead.

“Physicians have a reputation for being conservative and self-serving,” says Murray. “If reform is going to be successful we have to be clear that it is about what is good for the people.”

Pellizzari believes life experience and empathy with social circumstances just can’t be taught.

“I grew up in this neighbourhood. I understand their powerlessness, the conditions. Doctors have to see themselves as a member of a team of health professionals, not as the top of the social and medical totem pole.”

U of T’s experience is a classic example of the hurdles ahead. Newman admits it has come as a shock to students loaded with society’s ingrained expectations.

“They spend half a day a week in the community seing things like drug rehab clinics and community health centres. But being out in the community doesn’t make the students feel comfortable. Their image of what they are going to do involves big buildings, chrome and steel, scurrying personnel and banks of computers.”

'Take two big doses of humanity and call me in the morning' was published in the Toronto Star in 1993.

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Study says jetliner air quality poses health risks: CUPE takes on airline industry with findings of survey

By David South

Now Magazine (Toronto, Canada), March 11-17, 1993

Canada’s troubled airline industry is about to face some more turbulence, as the union representing more than 6,000 flight attendents presses its concern that many of its members’ health problems are related to poor air quality in jets.

The Canadian Union of Public Employees (CUPE) says its locals have compiled data that paints a fairly stale profile of in-flight air quality and its relationship to altitude, passenger load and length of flight. As part of the survey, the union recorded flight crews’ complaints of chest pains and lack of oxygen, as well as other work-related problems like back injuries, hearing loss and high incidence of colds and flu.

Of more interest to frequent fliers might be the opinion of some experts that even the more common jet lag may be caused by excess carbon dioxide, ozone and radiation. More than half the air in many aircraft is recirculated, “stale” air that is high in carbon dioxide and may be carrying bacteria and viruses, according to some experts.

CUPE health and safety chair Tracy Angles says the union now has enough evidence to at least pressure the carriers to undertake more comprehensive air quality studies. CUPE represents workers at Air Canada, Canadian, Nationair, Air Transat and some smaller feeder carriers.

While the union’s study is the first of its kind in Canada, a survey by the US department of industrial relations found, among other things, that flight attendents had 20 times the expected frequency of respiratory illness.

Flying mines

“Flight attendants have been equated with coal miners in terms of the bad air they have to breathe,” says Angles. “But this is not something the companies want to study.”

However, spokespeople for Air Canada and Canadian Airlines say they have not heard of such health problems. Jerry Goodrich of Canadian simply says, “It’s not an issue.”

However, while earlier-model jets supplied the cabin with 100 per cent fresh air, increasing fuel costs led to some modification. Modern jets mix fresh air – expensive to produce – with stale air from inside the cabin, which is passed through filters. The percentage of recirculated air in some aircraft, such as the popular Boeing 747-400, could be as high as 52 per cent, Boeing’s figures show.

Boeing’s Tom Cole says air circulation in Boeing’s jets is better than in an average office building, and that the passengers are “washed” with air to eliminate carbon dioxide and other hazards.

Critics like Georgia doctor William Campbell Douglass, publisher of the health newsletter Second Opinion, charge that the high rates of recirculated air, and the reliance on passengers’ own breath and perspiration to humidify the dry air, provide a perfect environment for bacteria and viruses. Douglass even speculates that planes could transmit serious diseases like tuberculosis. He suggests jet leg could be “nothing more than CO2 intoxification and oxygen starvation.”

“There is no doubt if you are in a confined space, you are at greater risk,” says University of Toronto microbiologist Eleanor Fish. “Aircraft filter systems aren’t sophisticated enough to filter out all the bacteria and viruses. But I’d be hard pressed to believe that you are at greater risk traveling on airplanes than on elevators.”

It is difficult for public health authorities to pin down the health risks of airplane travel because passengers disperse immediately after a flight. However, medical journals have documented two cases where virus transmission could be established because the passengers were easily traceable.

In 1977, 38 of the 54 passengers on a plane grounded in Alaska for four and a half hours came down with the same strain of flu.

“We consistently hear complaints about certain aircraft,” says Angles. “The Airbus320 is one of the worst” Angles says many airlines exacerbate the problem by over-crowding planes and flying them longer and farther than they were designed for.

Cut corners

“With deregulation, they have more people in there than was ever planned on. Nationair is a good example. A normal class Air Canada 747 carries about 420 people. In the all-economy configuration the load is upwards of 496.”

Angles also says airlines have been known to cut corners by turning down air flow to save money. In their 1990 book The Aircraft Cabin: Managing the Human Factors, Mary and Elwin Edwards cite a study indicating that 1 per cent saving on a fuel bill can be achieved by reducing the ventilation rate in a McDonnel-Douglas DC-10.

"Study says jetliner air quality poses health risks": Now Magazine, March 1993.

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More resources: 

Jetliner Cabins Are Quickly Cleared of Virus, Pentagon Says

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Filtration systems and rapid air-exchange rates mean that only about 0.003% of infected particles entered a masked passenger’s breathing zone, said the report, released Thursday."

Aircraft Air Quality – Protecting Against Contaminants, Association of Flight Attendants

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An outbreak of influenza aboard a commercial airliner, American Journal of Epidemiology, Volume 110, Issue 1, July 1979

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The Airliner Cabin Environment and the Health of Passengers and Crew.

"At the end of its review of health data in the 1986 report The Airliner Cabin Environment: Air Quality and Safety, the National Research Council (NRC) committee concluded that “available information on the health of crews and passengers stems largely from ad hoc epidemiologic studies or case reports of specific health outcomes [and] conclusions that can be drawn from the available data are limited to a great extent by self-selection…and lack of exposure information” (NRC 1986). This chapter reviews data on possible health effects of exposure to aircraft cabin air that have emerged since the 1986 report and the emergence of data resources (e.g., surveillance systems) and studies that have particular relevance for the evaluation of potential health effects related to aircraft cabin air quality. Selected earlier sources are also reviewed. The decision to ban tobacco-smoking on domestic airline flights in 1987 and on flights into and out of the United States in 1999 reduces the relevance of some studies of exposures and reported signs and symptoms that clearly could have been related to the products of tobacco smoke." 

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