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BCTOX BC Toxicology News Monthly Bulletin

Dedicated to Toxicological Issues in Population and Environmental Health in British Columbia .

Contents

1. Hofstra Angela: A message from the President of the Society of Toxicology of Canada ………………….…..……… 409-410

2. Paul Hasselback; The return of the Blob. A case study in holistic ecology ……………………………………………….……… 411-412

3. Kay Teschke; Jobs, individuals, asbestos exposure, and doubt science ………………………………………………………... 413-414

4. Reza Afshari, Shifting pattern of biotoxins on the west coast of Canada Jan 2017 to Jan 2019 …………….……. 415-419

5. BCTOX’s Toxicology News Surveillance in BC Jan 2019 …………………………………………………………….……………...... 420-423

6. Reza Afshari, Solve the Mystery; Mercury Poisoning, Emperor Qin Shi Huang and Terracotta Army ……...… 424-428

7. Announcement;

7.1. “TOXIC”, The Oxford Word of the Year 2018! ………..429

7.2. Bio-monitoring; Lead and mercury are now report-able in BC …………………………………………………………………………….. 430

7.3. Bio-monitoring - Gagandeep Dhillon; Blood concentrations of lead and mercury in British Columbians (2009-2010) - A student report from the past …............... N/A

7.4. Bio-monitoring - Adriana Kanlic; Smoking increases blood cadmium in Canadians – A student report from the past …….……………………………………………………………….…....… N/A

Solve the mystery! --- Participate in our Chinese New Year “solve the mystery” and win a prize!

First, let us congratulate Dr Ray Copes Chief, Environmental and Occupational Health, Public Health Ontario, who won last month’s prize. BCTOX is thankful for his accurate description of the problem.

Second, First Emperor of China who unified the great wall and created the Terracotta Army was obsessed with mercury for the purposes of immortality!

--- Which physiological, psychological and behavioural profile of his can be explained by low dose long term mercury exposure?

--- Take a guess (or confirm the given manifestations), and email in your response to be entered into the BCTOX drawing for a $20 gift card (Deadline: Feb 15, 2019).

Enacts Reporting Information Affecting Public Health Regulation, effective January 1, 2019: Lab director must

report examinations for lead or mercury!

BC Toxicology Figure of the Month

Biomonitoring. Lead, 204-208Pb multicompartment kinetic model

Half-life of lead ranges from days and weeks in blood to years and decades in cortical and trabecular bones, respectively!

What is BCTOX?

While BCTOX is not official and not liable for reported news and views, it is BC-related, full of concise and inspiring information, handpicked and fun to read. BCTOX keeps you engaged with Toxicological Issues in Population and Environmental Health in British Columbia.

--- BCTOX is shared with a large number of health and environmental professionals in BC and beyond. It can increase the visibility of your work!

You may contribute to BCTOX by providing 1000 to 2000 word articles and commentaries on a toxicology-related environmental, public health or clinical problem or an initiative that you have taken! These commentaries are peer reviewed and can be referenced. To cite abstracts of the current issue: Authors’ surname, Initials, Title. BCTOX 2018; 3(1): Pages.

BCTOX is available online: https://blogs.ubc.ca/bctox2015/ and Google Scholar https://bit.ly/2SnZL1n

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BC Toxicology News Monthly Bulletin BCTOX 2019 Jan 1(4): 407-430

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..About Us

Aims and Scope

BC Toxicology News Monthly Bulletin (BCTOX) aims to popularise the knowledge of toxicology and expand use and the awareness of Toxicology News in British Columbia, Canada. It tries to engage health and environmental professionals with online published toxicology news, publicly available information, and by providing short communications. BCTOX mainly focuses on adapting or summarizing relevant toxicology news in BC. The Bulletin accepts and welcomes contributions from professionals and the public as long as they meet BCTOX standards.

How to access the original news items? If you click on the link related to each one of the provided stories, it will take you to the original site of the news.

Publication Frequency: BCTOX is published monthly in English by Reza

Afshari. Provided information in GRAY is not related to the current issue, but could

be of interest.

ISSN: 2560-645X

Policies:

Open Access Policy: This bulletin provides open access to all its content.

Fee: BCTOX is free-of-charge for readers, authors and contributors.

Copyright Statement

BCTOX’s content is currently prepared by Reza Afshari. The bulletin retains the copyright of their articles and will be able to archive pre-print, post-print, and publisher's versions.

This bulletin is not official and for the most parts is not peer-reviewed. It does not cover all the news, and is not liable for the accuracy of the news from media. It is, however, BC related, informative, handpicked and fun to read. The provided contents are not necessarily BCTOX’s views.

BCTOX has been modified since (BCTOX 2017 June 2(6)) issue. It is now accepting 400 words educational material, commentaries, and research abstracts (with data) as long as they are within the scope of the bulletin and meets our standards.

We are going to publish up to four short or full papers in each issue. This section of the journal is peer reviewed.

Archiving. Digital Archiving: In addition to indexing database this Bulletin utilizes digital archive as well as hard copies to guarantee long-term preservation and restoration.

Publication Ethics

This bulletin follows International Committee of Medical Journal Editors (ICMJE)’s Recommendations. Authors (i) must declare any conflict of interest in a given manuscript, and we utilize COPE workflow to transparently handle it, (ii) follow ICMJE definition of author and contribution, and (iii) accept the ethical policy including regulation and malpractice statement.

Guide for Authors

From June 2017 (BCTOX 2017 2(6)) we publish original research, mini reviews, short communications, letters, case reports, and case series as long as they are limited to 400 words and the content is British Columbia related. These publications are peer reviewed.

References

References should be given in the Vancouver style and numbered consecutively in the order which they are first mentioned in the text. Citation in the text should be in line with text in parenthesis with Arabic numbering style.

List of contributors of this issue Reza Afshari; Editor-in-Chief Yasi Afshari; Information gathering Michael Jonasson; Tissa Rahim; Editor of English language

Reviewers of this issue Reza Afshari

Contact Us To contribute to the next issues, provide your opinion or report a

mistake, please email us, your Feedback is greatly appreciated.

BC Toxicology News Monthly Bulletin could be reached at:

604 999 6185 BCTOX@yahoo.com

West 7th Avenue, Vancouver, V5Z 1C2.

BCTOX have a professional blog, thanks to the University of British Columbia. https://blogs.ubc.ca/bctox2015/

Google Scholar

https://scholar.google.ca/citations?user=uaHeNh8AAAAJ&hl=en

New subscribers will be added to the mailing list upon their request.

If this bulletin is not of interest to you, let us know please so we do not to fill up your mailbox in future.

Toxicology news in this month was focused on biomonitoring and climate change.

How to cite BCTOX’s articles:

AUTHOURS. TITLE, BCTOX 2017;2(8): PAGES.

Acknowledgment

BCTOX respectfully acknowledges that it is published on the ancestral homelands of the Coast Salish peoples, including the territories of the xʷməθkwəy əm (Musqueam), Skwxwu7mesh (Squamish), Stó:lō and Səl ilwətaʔ/Selilwitulh (Tsleil-Waututh) Nations.

Erratum from the previous issues None.

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Society of Toxicology of Canada - 2018 another great success!

Hofstra Angela; President of the Society of Toxicology of Canada. Angela.Hofstra@syngenta.com

Introduction

The Society of Toxicology of Canada Inc. (STC) was founded in 1964 as a non-profit association. Our membership, broadly representing industry, government and academic institutions across Canada, is comprised of individuals whose interests range from fundamental and basic to clinical and applied toxicology. Individuals with academic qualifications including M.Sc., Ph.D., D.V.M. and M.D. degrees forms majority of our members.

STC:

supports continuing education and excellence in research in the field of toxicology through its Annual Symposium.

promotes the acquisition, facilitate the dissemination, and encourage the utilization of knowledge in the science of toxicology.

provides a venue for members and international experts to present the latest advances in experimental and regulatory toxicology.

STC recognizes the universality of science and adheres to principles which affirm membership and free circulation of bona fide scientists in a non-discriminatory fashion.

By the end of 2018, the society has organised

2018 meeting - Novel Approach Methodologies

2018 meeting was another success!

We celebrated the STC’s 50th Annual Symposium December 10 to 12, 2018 in Toronto. The focus of this year meeting “What’s in a NAM (Novel Approach Methodologies)? Benefits/Limitations/Translation/Communication”, generated animated discussion among the more than 130 attendees.

Presentations

The intent of the symposium was met with the first seven speakers on Day 1 discussing the advances, benefits and limitations of novel approaches from lab bench to regulatory settings. The eight symposium speakers on Day 2 continued the theme discussing translation or lack thereof to human health or the environment of traditional and novel toxicology approaches, followed by presentations on how to assess and communicate the risk from toxicology findings.

Posters

Thirty-seven posters were presented, along with six exhibitors, with ample opportunity for authors and exhibitors to showcase their work at coffee breaks and lunch.

Symposium Day 1 ended with the annual business meeting and a graduate student hosted mentor/trainee workshop on alternative careers in toxicology.

The one room format

The one room format of the STC symposium meant that all registrants were able to attend the Gabriel L. Plaa Award of Distinction Lecture by Peter G. Wells of the University of Toronto, “A Novel Developmental Role for 'Tumor' Suppressor Genes in Protecting the Fetus From Reactive Oxidative Species”.

The one room format also allowed the opportunity for four graduate students, selected based on poster abstract submission, to give short presentations of their research to all attendees.

The STC annual symposium provides a unique opportunity for interaction between experienced and trainee toxicologists. The format of the symposium gives maximum visibility to speakers, poster presenters, exhibitors and sponsors. The complimentary, sponsor supported, welcome and President’s receptions allow additional opportunity for engagement in a relaxed setting.

You may find the detailed program from:

http://stcweb.ca/en/assets/Final_2018_STC_program.pdf

We also provide Annual Symposium Program Books. Please check:

http://stcweb.ca/en/assets/2018_What's_in_a_NAM.pdf

Why should you participate in our future meetings (2019 and 2020)?

Join us in Ottawa December 2 to 4, 2019 at the Shaw Centre and Les Suites.

The 2019 Symposium will include discussions of: better models for predicting human toxicity; transgenerational effects; novel mechanisms of endocrine disruption; interplay between eco and human toxicity. Suggestions for speakers may be sent to the 2019 program chair: Ella.atlas@canada.ca

In 2020 join us in downtown Montreal. Suggestions for topics and

speakers may be sent to the 2020 program chair: joanne.wan@intertek.com

STC offers investigator, student poster awards and student travel

awards. Details at http://www.stcweb.ca/en/awards

We are looking for more participants from wsetern Canada and British Columbia in 2019. Join us to hear cutting edge science, interact with experienced and trainee toxicologists, and learn more what are sponsors and exhibitors have to offer.

Annual Awards

STC provides a range of awards for professionals and students including:

Gabriel L. Plaa Award of Distinction

The purpose of the STC Gabriel L. Plaa Award of Distinction is to honour those individuals who have made outstanding and sustained contributions to the science of toxicology in Canada and/or the Society of Toxicology of Canada. (Read more)

V.E. Henderson Award

The award is designed to honour an individual who has made a significant contribution to the discipline of toxicology in Canada. Toxicologists with less than 15 years’ experience are eligible to be nominated for the V.E. Hendersen Award. (Read more)

In addition, financial awards are available to graduate students for travel as well as two STC Intertek awards for best posters.

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STC Intertek Scientific & Regulatory Consultancy Student Awards

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There are two annual STC Intertek Awards of $500 each, one for the best poster presentation by an MSc student and the other for the best poster presentation by a PhD student. (Read more)

Student Travel Award

STC provides financial assistance for a limited number of student delegates presenting a poster at the Annual STC Symposium to encourage graduate students residing outside of Ottawa to attend and participate at the Annual Symposium. (Read more)

Postgraduate students are encouraged to apply for next year symposiums.

References

1. Society of Toxicology of Canada. http://stcweb.ca/en/index.shtml

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The Return of the Blob. A case study in holistic ecology.

Paul Hasselback MD. MSc. FRCPC. Island Health, BC, Canada. Paul.Hasselback@viha.ca

Introduction

Reminiscent of the 1958 indie horror file, the west coast of BC was attacked by “The Blob” in late 2013 and besieged the coast until it finally retreated in mid-2015. The Blob returned to reinvigorate its attack in mid-2018 and as of this writing in January 2019 its status is in limboi. A fascinating hydro-meteorological event of itself it has become known as the Blob as a large floating mass.

Many of us grappled with some of the environmental health impacts that it spawned, without necessarily linking the events together or recognizing their cause. As it returns, we need to ask if this is going to become a recurring event (like El Nino)? And what if any, is the relationship of the Blob as a current day manifestation of our changing climate.

Meet the Monster

The Blob is the descriptive term for a mass of warm water, which at its peak was over 3000 km in length and extended from Alaska to Mexico, with a width of some 2000 km and located off the Pacific coast. The warm water had a depth of 100-300 metres and temperatures within the Blob were often 2.5C warmer than historical averages and at times even warmer. A 2015 sea surface temperature graph shows both the “Blob” and El Nino. (Figure 1)

Figure 1. Sea surface temperatures from July 2015 demonstrating both The Blob and El Nino (Adopted from reference XIII (NOAA))

Meteorologists and hydrologists attribute the formation of the warm water mass to a persistent high pressure zone over the Bering Sea/Gulf of Alaska (with a less endearing name of the “Ridiculously Resilient Ridge”). The high pressure area resulted in reducing surface water churning and this led to the elevated surface water temperaturesii.

The root cause of the changes remain subject to speculation with theories related to a known cyclical change called the Pacific decadel oscillation which is an el Nino like fluctuation usually cycling at over a decade. It is notable that the first attack of the Blob was driven back by the El Nino of 2014-15 as warmer water flowed northward along the Pacific coast from the tropical oscillation event.

The Carnage left by the Blob

The mass of warm water had several immediate implications from the initial attack of the Blob. Air temperatures near the coast were

warmer throughout the year. Warmer air temperatures provide for higher moisture amounts. Higher precipitation during the winter months with notable intense wind and rain storms (is this sounding familiar to the 2018-19 storm season?), greater rainfall and lower snow pack formation in coastal regions.

The typically dry summers of the Pacific Coast were drier. Droughts were feared, drinking water systems were concerned about running short on water and the establishment of a provincial drought assessment systemiii and more harmonization of water conservation messaging (albeit confusion persists as the drought assessment levels do not correspond with conservation levels, and conservation levels may vary between adjacent jurisdictions and water systems).

The 2014-2015 drier summers led to a wildfire filled summers with smoke advisories and problems across the province and the two of the most impactful fire seasons on record. iv There are other factors contributing to the upward trends in wildfires, but the warmer water, warmer air and reduced summer precipitation expected in climate change modelling where all in play. Wildfires have become a regular occurrence, literally fueled by pine tree deadwood from pine beetle kills through much of the Interior of the province. The pine beetle infestation is itself a climate change manifestation due to warmer winters – and the combination of factors was synergistically detrimental and contributed to the widespread smoke exposure in addition to the direct damage associated with wildfires. Coastal BC as a rain forest is generally relatively protected from wildfires and yet in 2015 and again in 2018, there were notable wildfires in the area. (Figure 2)

Figure 2. Lizard Lake Fire August 2015 (Adopted from B.C. Wildfire Management Branch)

Warmer water led to changes in extent of algae blooms and species. With the blooms was an increase in domoic acid (cause of amnesic shellfish disease) identifications from harvest areas, and suspected as a factor in increased sea mammal wasting and deaths noted that year. Warmer air and water temperatures led to changes in locations where freshwater algae blooms were noted, and impacted drinking water systems and drinking water quality. The warmer marine waters (Figure 3) were also implicated in changes in salmon runs and harvest volumes. Sightings were made of warmer water species (eg thresher sharks and ocean sunfish) in new northern expansion of their historical ranges. Bleaching in Hawaiian corals was also partially attributed to the blobv and partially attributed to sun screen products entering the marine environmentvi.

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Figure 3. Sea Surface temperature 2014-15, Strait of Georgia.

(Adopted from BC centre for Disease Control, Resource Gallery)

2015 was notorious for a well-documented Vibrio parahemolyticus outbreak that had negative impacts on the shellfish and restaurant industries and has by some been attributed to warmer waters in the shellfish farm areasi . Those working in coastal environments became very familiar with the outbreaks of shellfish associated Norovirus in late 2016-early 2017 the sources of which remain a point of contention but widely impacted the shellfish industry againii .

Related or not has been the receding of the Arctic sea ice in the Bering Sea which has continued to recede over the past 3 decades with an overall reduction of 2.7% per decade. Ice pack melting, both sea ice and pack ice have been retreating, and is at the confluence of the northern extent of the warmer surface waters iii.

Perhaps unrelated, although some theories have been postulated to link to water temperatures, is the well documented and studies widespread sea star die off through the same areas of the west coast. Debate continues over the cause of the die off that also began in 2013/14iv. The consequences of the die off are allowing for an expansion of sea urchin populations. Sea urchins consume kelp v. Kelp is the incubator for many young fish in their development, at a time that sea temperatures may also be affecting fish stocks. In fairness to skeptics, the cycles of sea star wasting disease, sea urchin population explosions and kelp barrens have happened regionally before throughout the globe and may be unrelated. Their potential synergistic impacts of multiple assaults on the marine environment are less predictive based on past experiences.

Those interesting in monitoring progress of the sea surface temperature anomalies are recommended to follow the posted National Oceanography and Aerosmith Administration (NOAA) data reportsvi. Winter reductions in the surface temperature anomalies were being noted prior to the US partial government shutdown that has put a hiatus into data reporting.

Anticipating the Blob’s offspring

We are all obliged to more carefully integrate the data from the changing ecology in BC coastal waters as it impacts human wellbeing in all its manifestations. There is likely a strong role for citizen science in noting these impacts, in addition to augmenting existing research agendas.

We can also begin to ask the questions about whether we are asking the right questions. We have considerable strength in issues based surveillance and research in changes over time for issues like impacts on fish stocks, changes in sea mammal populations, even researchers focused on sea stars and plankton monitoring programs. We have strong research and monitoring in meteorology and some experience in monitoring the impacts of sea water changes through decades of El Nino/La Nina oscillations. Climate change research has focused on the expected future state conditions and possible single issue impacts. Where we have room to build is on monitoring and research of complex environmental changes and their human health impacts.

The Blob may be a passing anomaly unrelated to a changing global climate, it may be a recurrent local condition that has only been recently documented, or it may be a flagrant demonstration of what climate change has and will herald. In this respect it is a living laboratory. Optimistically, resilient marine environments may adapt as they have done innumerable times in the past and are a measure of a healthy environment. If the combined impacts have impacted ecological wellbeing, recovery may be prolonged or even unsuccessful. Irrespective, the changes to local ecology will carry with it changes to normal human patterns particularly in relation to harvesting of marine and traditional foods. On land, humans assert greater control over manipulation of the environment and will be challenged to adapt to changes in temperature, precipitation, drought and wildfires amongst other noted impacts.

Consider this a plea for holistic assessment of our ecological health. Complex/wicked problems will not be solved by simple solutions. Even in the absence of any solution, adaptation will require holistic approaches that consider the multitude of impacts as the regional ecology continues to be modified.

References

I. Hamilton, Tyler. (Jan 4, 2019) The Blob Update www.theweathernetwork.com/news/articles/the-blog-winter-

forecast-windstorm-low-elevation-snow-risk-vancouver-victoria-british-columbia/120991

II. Bond, Nicholas A, Cronin, Meghan F, Freeland, Howard, Mantua, Nathan. (April 0, 2015) Causes and impacts of the 2014 warm anomaly in the NE Pacific

III. agupubs.onlinelibrary.wiley.com/doi/full/10.1002/2015GL063306

IV. Province of BC (2018) Drought Information www2.gov.bc.ca/gov/content/environment/air-land-

water/water/drought-flooding-dikes-dams/drought-information V. Province of BC (2018) Wildfire Averages

https://www2.gov.bc.ca/gov/content/safety/wildfire-status/about-bcws/wildfire-statistics/wildfire-averages

VI. Voice of America. (November 03, 2017) Scientists: Half of Hawaii’s Coral Reefs Bleached

www.voanews.com/a/hawaii-coral-reef- bleaching/4099707.html VII. Edwards, Judy. (April 1, 2018) Hawaii’s Coral Reefs and Reef Preservation

www.hawaiianairlines.com/hawaii-stories/adventure/hawaiis-coral-reefs-and-reef-preservation VIII. BC Center for Disease Control. (2019) Vibrio

www.bccdc.ca/health-info/food-your-health/fish-shellfish/vibrio IX. BC Center for Disease Control (2017) Norovirus (page 13)

www.bccdc.ca/resource-gallery/Documents/Statistics%20and%20Research/Statistics%20and%20Reports/Epid/Annual%20Reports/Norovirus.pdf

X. Hansen, Kathryn. (May 3, 2018) Historic low sea ice in the Bering Sea.

climate.nasa.gov/news/2726/historic-low-sea-ice-in-the-bering-sea/

XI. Milner, Melissa, Gaddam, Rani, and Douglas, Melissa. (January 7, 2019) Ecological Consequences and Juvenile Recruitment

www.eeb.ucsc.edu/pacificrockyintertidal/data-products/sea-star-wasting/ XII. Bland, Alastair. (October 10, 2017) Sea Urchins Are Laying Waste to Kelp Forests – and an Entire Ecosystem

www.newsdeeply.com/oceans/articles/2017/10/10/sea-urchins-are-laying-waste-to-kelp-forests-and-an-entire-ecosystem XIII. Office of Satellite and Product Operations (2018) Operational SST Anomaly Charts for 2018

www.ospo.noaa.gov/Products/ocean/sst/anomaly/

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Jobs, individuals, asbestos exposure, and doubt science

Kay Teschke, Professor Emeritus, School of Population and Public Health, The University of British Columbia. kteschke@mac.com

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Late career surprise

One of the biggest shocks of my career was to discover that a study of mine1 had been used for over a decade to assert that vehicle mechanics could not contract mesothelioma from their work.

I found out in a roundabout way. An occupational health physician wrote an “amicus brief”2 to the Michigan Supreme Court summarizing evidence that asbestos from brake linings can cause mesothelioma. A quote from the abstract gives a flavour of why the brief was written:

“This article outlines the evidence supporting the conclusion that asbestos from brakes can and does cause mesothelioma, and describes the defendants’ attempts to fabricate doubt about this conclusion.”

She asked for signatures from researchers who agreed with her summary. Little did I know that my signature would cause a stir in the mesothelioma legal world.

Getting involved with the law

I received a call from a lawyer shortly afterwards. He told me that our article “Mesothelioma surveillance to locate sources of exposure to asbestos”1 was being used in US courts as evidence against vehicle and brake mechanics with mesothelioma.

He was surprised that I had signed the amicus brief and wanted to know if I would explain why in a deposition for a mesothelioma case in which the defendants were brake manufacturers and large automobile companies. I agreed.

As indicated by the title of our article, our research was built on the well documented evidence that asbestos causes mesothelioma. We wanted to see if mesothelioma cases might lead us to identify BC occupations previously unknown to be asbestos exposed.

The study was modelled on one done in Italy, where rag workers with no known asbestos exposure were found to have elevated mesothelioma risk.

This led to the discovery that they baled their product in bags that had once contained asbestos. Our BC study examined mesothelioma by occupational groups and found a number with elevated risk, but not vehicle mechanics. This was the evidence being used to fight US compensation claims.

A simple solution: Explain the misinterpretation of our work

I explained that the question we addressed in our paper was not the same as the one that needed to be asked in compensation cases: Was this person with mesothelioma exposed to enough asbestos in his or her job to cause this cancer?

The risk ratio for mechanics in our study reflected the average exposure of all mechanics in the study. Many reported no brake repair work at all, and those who did, did it intermittently as part of a broad array of general duties at service stations.

Compare this with the exposure of the mesothelioma case whose claim I was asked to comment on: a brake mechanic for a major automaker, repairing and replacing brakes every day all day for 40 years, sanding brakes and using compressed air for cleaning. Compensation claims are about an individual’s exposure, whereas relative risks for a job reflect the average exposures of the group.

Educating the academic: There is no simple solution to doubt science

The lawyer told me that my testimony in this one case could be used in other cases, but unfortunately this was not the end of the story. A group of academics frequently employed to fight mesothelioma claims published a review article3 citing our paper1 – as a “tier 1” study in support of their argument.

I wrote a letter to the editor4 to make sure that the important distinctions above were in the public domain. I hoped that the following point would help make the difference between individual and group risk clear:

“Studies of chrysotile miners and textile workers have found elevated risks of mesothelioma, whereas studies of vehicle mechanics and brake repair workers typically have not. Does this mean that vehicle mechanics and brake repair workers are somehow immune to the effects of asbestos, that they are especially resistant, superhuman? No, they simply work in a job that has very varied exposures, so detecting occupation-disease relationships is difficult.”

Recently, I heard again from the lawyer who alerted me to the use of our research. He sent me text from a recent trial. It included this exchange:

Lawyer: Teschke goes on to say: “I do not normally accept legal work, but agreed to take part as an expert witness in one case to point out some problems in interpretation of epidemiological evidence such as ours in these cases.” And she also wrote this letter to the editor for the purpose of saying: I don't like what's happening here. Is that fair? Doubt scientist: Well, I don't think that that actually fully characterizes Dr. Teschke's letter. She doesn't want science to be used in court.

Sigh.

My respect for lawyers who have to fight these cases one at a time is huge. And I am thankful that in BC, mesothelioma compensation claims are rarely, if ever, denied.

Dr Kay Teschke (bio)

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Bio: Dr Kay Teschke is Professor Emeritus of the School of

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Population and Public Health at the University of British Columbia where she was on faculty for 33 years. Her work focused on exposure assessment for epidemiological research including studies of Parkinson’s disease, cancer, respiratory disease, gastrointestinal illnesses, back injuries, and more recently traffic injuries.

She helped develop and lead the Occupational and Environmental Hygiene Graduate Program, the Cycling in Cities Research Program, and the Strategic Training Program Bridging Public Health, Engineering, and Policy Research.

She currently serves on the Board of Directors of WorkSafeBC, BC Road Safety Strategy Working Committees, and the BC Road Safety Law Reform Group. She received her academic training at Trent University, BCIT, the University of California at Berkeley, and the University of Washington in Seattle.

References

1. Teschke K, Checkoway H, Spinelli JJ, Weiss NS, Morgan MS, Franklin G. Mesothelioma surveillance to locate sources of exposure to asbestos. Can J Public Health 1997;88(3):163-68

2. Welch LS. Asbestos exposure causes mesothelioma, but not this asbestos exposure: an amicus brief to the Michigan Supreme Court. Int J Occup Environ Health 2007;13(3):318-27

3. Garabrant DH, Alexander DD, Miller PE et al. Mesothelioma among motor vehicle mechanics: an updated review and meta-analysis. Ann Occup Hyg 2016;60:8-26

4. Teschke K. Thinking about occupation-response and exposure-response relationships: Vehicle mechanics, chrysotile, and mesothelioma. Ann Occup Hyg 2016;60(4):528-30

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BCTOX’s Marine Biotoxins Surveillance System in BC from Jan 2017-Jan 2019: shifting patterns of biotoxins on the west coast of Canada; Data from CFIA

Reza Afshari, School of Population and Public Health. Division of Occupational and Environmental Health, University of British Columbia. Reza.Afshari@bccdc.ca

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Public health surveillance is “the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice” according to WHO.

BCTOX is hopeful that this initiative will draw the attention of public health professionals to the changing patterns of marine biotoxins that may cause shellfish poisoning. The graphs could be predictive indices for what is going to come next month!

Bi-weekly marine bio-toxin monitoring in West Coast BC from Jan 2017 to Jan 2019

Domoic acid (DA)

Background Domoic acid, an excitatory amino acid is produced by diatoms that called Pseudo-nitzschiae, of which at least 14 strains are toxic;1 it accumulates in filter-feeding molluscs (as well as certain crustaceans and finfish). Acute exposure to DA is associated with amnesic shellfish poisoning (ASP), a syndrome characterized by both gastrointestinal and neurological manifestations and which led to three deaths in a 1987 Canadian Atlantic Coast outbreak.2 The U.S. Food and Drug Administration (FDA), the European Food Safety Authority (EFSA), and Health Canada promulgated regulatory limits for DA 34 based on assessment of that outbreak.2

Results Domoic acid (ug/g) that may cause Amnesic shellfish poisoning (ASP) among detected shellfish samples in BC (Jan 2017 to Jan 2019):

Very few positive cases detected (less than 1%) No case was above the regulatory limit of 20 ug/100g. Below regulatory limits Domoic acid levels were observed in summer

and fall of 2017 and fall of 2018.

Saxitoxin (STX)

Background Saxitoxin (STX)-group toxins are a group of closely related tetrahydropurines and mainly produced by dinoflagellates belonging to the genus Alexandrium such as Alexandrium tamarensis.

STX cause paralytic shellfish poisoning (PSP) in humans, characterised by a range of symptoms from a slight tingling sensation or numbness around the lips to fatal respiratory paralysis. In fatal cases, respiratory arrest occurs 2 to 12 hours following consumption of contaminated shellfish.5

Results Saxitoxin (ug/100g) that may cause Paralytic shellfish poisoning (PSP) among detected shellfish samples in BC (Jan 2017 to Jan 2019)

Positive cases were always detected (more than 99%) Above regulatory limit of 80 ug/100g was frequent Below regulatory limit Domoic acid levels were observed in summer

and fall of 2017 and fall of 2018.

Okadaic acid (OA)

Background OA-group toxins are usually produced by planktons in the sea, and can contaminate shellfish, notably bivalve molluscs such as oysters, mussels, scallops, and clams. Contaminated shellfish may cause diarrhetic shellfish poisoning (DSP). [Note: DSP can also be caused by other toxins, not only OA-toxins.]6

Results Okadaic acid (sum of okadaic acid and dinophysis toxins (DTX-1, DTX-2 and DTX-3) that may cause Diarrhetic Shellfish Poisoning (DSP) among shellfish samples in BC (Jan 2017 to Jan 2019):

Very few positive cases detected (less than 1%) Very few cases were above the regulatory limit of 0.2 ug/g. Below regulatory limits Domoic acid levels happened in summer and

fall of 2018.

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…

Other biotoxins. Data from WASHINGTON STATE Toxic Algae, Shifting pattern of biotoxins

Regulatory authorities in B.C. do not require routine environmental measurements for other marine biotoxins including Anatoxin-a, Cylindrospermopsin and Microcystin.

This information, however, is available from Washington State, which is the closest available information. The pattern is shown below (2018 Jan to Sep).

Phytoplankton’s - WASHINGTON STATE

(2018 Jan to Sep)[ n= 995]

Regulatory authorities in B.C. do not require routine environmental measurements of Phytoplanktons.

This information; however, is available from Washington State, which is the closest available information. The pattern is shown below (2018 Jan to Sep).

.

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.BCTOX’s Marine Biotoxins Surveillance System in BC Shifting pattern of biotoxins on the west coast of

Canada

1. Other Marine Miotoxins 1- Algae bloom are simple plants that do not have ordinary

leaves or roots. True algae (green algae) start to bloom in late spring and early summer in rather colder areas or near water.

--- They are the result of excess nutrients, particularly phosphates originating from fertilizers; other sources include excess carbon and nitrogen and catalyst residual sodium carbonate. --- Algae are short-lived, and decaying dead organic matter consumes dissolved oxygen in the water, resulting in hypoxia and die off of plants and animals in large numbers.

2- Harmful algae bloom (or red tide); involves toxic

phytoplankton such as dinoflagellates of the genus Alexandrium and Karenia, or diatoms of the genus Pseudo-nitzschia. Such blooms often take on a red or brown hue. They produce natural toxins.

--- Reappearance of blue-green algae at Elk Lake that are lethal to dogs is a constant concern for water quality, prompting a CRD advisory notice (2018-11-20).7

2-1- Saxitoxin

Dinoflagellate Alexandrium fundyense produces Saxitoxin that causes paralytic shellfish poisoning

2-2- Domoic acid

Pseudo-nitzschia diatom produces Domoic acid that causes amnesic shellfish poisoning.

2-3- Okadaic acid

--- Dinoflagellates Dinophysis produce Okadaic acid (sum of okadaic acid and dinophysis toxins (DTX-1, DTX-2 and DTX-3) that cause Diarrhetic Shellfish Poisoning (DSP)

2-4- Azaspiracid

Dinoflagellate Azadinium spinosum produces Azaspiracid (a phycotoxin) and analogues. Azaspiracid can result in severe acute symptoms that include nausea, vomiting, diarrhea, and stomach cramps.

EU and FDA regulatory limit is 160 µg/kg (reports from Europe).

--- No information is available online from BC

2-5- Brevetoxin Karenia brevis dinoflagellate produces brevetoxin that causes

neurotoxic shellfish poisoning (common in Florida and the Gulf of Mexico).

NSP is diagnosed through gastrointestinal and neurological symptoms: nausea and vomiting, paresthesias of the mouth, lips and tongue as well as distal paresthesias, ataxia, slurred speech and dizziness. Neurological symptoms can progress to partial paralysis and respiratory distress.8

--- No information is available online from BC

--- Officials in Florida say dolphins seem to be red tide’s latest victims as more than 20 have washed up dead. Scientists attributed the deaths to brevetoxin (2018-11-27).9

2-6- Cyclic imines

“The dinoflagellates Karenia selliformis and Alexandrium ostenfeldii / A. peruvianum have been implicated in the biosynthesis of gymnodimines and spirolides, while Vulcanodinium rugosum produces pinnatoxins and portimine.”10 11

--- No information is available online from BC.

2-7- Palytoxin and analogues

“Most incidents of palytoxin poisoning have manifested after oral intake of contaminated seafood. Poisonings in humans have also been noted after inhalation, cutaneous/systemic exposures with direct contact of aerosolized seawater during Ostreopsis blooms and/or through maintaining aquaria containing Cnidarian zoanthids.”12

“Common symptoms include numbness, paraesthesia and swelling around the site of exposure (cutaneous exposure), rhinorrhea, cough, dyspnea (inhalational exposure), perioral paraesthesia, dysgeusia (oral exposure) and eye irritation (ocular exposure)”13

2-7-1 Coral

Toxic coral in aquarium sends Quebec family to hospital - Zoanthid corals can be toxic, be aware when handling them. (Global News)14

The green type Zoanthid coral is a common feature of saltwater aquariums, but can contain palytoxin (photo adopted from (15 16))

--- Case report; Seven members of a family exposed to toxic Zoanthid coral (that may contain palytoxin) in their home aquarium. They bought the aquarium second-hand from a business where it had been on display and transported it with its contents to his home in Gatineau, Quebec. They experienced sneezing within minutes followed by chest pains, problems breathing, fever, shaking, and vomiting (2018-04-24).16 17

--- Case report; While cleaning his fish tank in Oxfordshire, U.K. an aquarium owner scraped the coral's surface (pulsing xenia), and inadvertently a particular kind of deadly toxin known as palytoxin was released into the air.

--- The family went to bed, but became deeply sick the following day, experiencing acute breathlessness, coughing and other symptoms. All six people in the house were hospitalized, along with four firefighters and two dogs (2018-04-07).18

--- No information is available online from BC.

2-8- Pectenotoxin

--- No information is available online from BC

2-10- Yessotoxin and analogues

Abalone photo adapted from reference (2014-02-08).19

.

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Lingulodinium polyedrum and Gonyaulax spinifera Dinoflagellates produced Yessotoxins that are related to ciguatoxins. Yessotoxins cause diarrhetic shellfish poisoning. 20

EU regulatory limit is 1 µg of YTXs per g (1 mg/kg).

--- Case report; Thousands of dead red abalone washed up on the beaches of Sonoma County in Northern California in August 2011. Later scientists from the University of California found that a harmful algal bloom was to blame: the causative agent was Yessotoxin (2014-04-17).21

--- No information is available online from BC

2-9- Tetrodotoxin and analogues

After ingestion of puffer fish. The flesh of the puffer fish (i.e. fugu) is considered a delicacy in Japan.

“Paresthesias initially affect the tongue, lips, and mouth and progress to involvement of the extremities. Gastrointestinal symptoms may be seen and include nausea, vomiting, and less often, diarrhea. Muscle weakness, headache, ataxia, dizziness, urinary retention, floating sensations, and feelings of doom may occur. An ascending flaccid paralysis can also develop.

Other reported effects include diaphoresis, pleuritic chest pain, fixed dilated pupils, dysphagia, aphonia, seizures, bradycardia, hypotension, and heart block. Death can occur within hours secondary to respiratory muscle paralysis or dysrhythmias.

Clinical effects in the mildest of cases resolve within hours, whereas the more severe cases may not resolve for days. Treatment is supportive; there is no specific antitoxin. Patients who have progressed to having generalized paresthesias, extremity weakness, pupillary dilation, or reflex changes should be admitted to the hospital for observation until peak effects have passed. Those with respiratory failure should be intubated and placed on mechanical ventilation.

Vasopressor support may be necessary for hypotension refractory to intravenous fluids. Atropine has been used for symptomatic bradycardia.”22

Image adapted from MedScape

Ciguatoxin Ciguatera fish poisoning (CFP)

Ciguatera is caused by eating contaminated reef fish. Symptoms include diarrhea, vomiting, numbness, itchiness, sensitivity to hot and cold, dizziness, and weakness. Onset can occur from half an hour to up to two days. Diarrhea may last four days. Certain symptoms typically remain for a few weeks to months. Heart difficulties such as a slow heart rate and low blood pressure may occur.23 --- Recreational exposure to cyanobacteria can cause GI, pruritic skin rashes and hay fever. 24

Scombroid Fish Poisoning: Histamine Poisoning

3- Cyanobacteria (blue green algae)

Cyanobacteria are aquatic and photosynthetic bacteria that live in the water, and can manufacture their own food.

Cyanobacterial toxins Cyanotoxin – not related to cyanide – contains neurotoxins,

hepatotoxins, cytotoxins, and endotoxins. It causes rapid death by respiratory failure.

--- No information is available online from BC.

Anatoxin-a Anatoxin-a is produced by cyanobacters and causes loss of

coordination, muscular fasciculations, convulsions and death by respiratory paralysis.

Cylindrospermopsin Microcystin BCTOXScope (CYANOscope)

BCTOX publishes your pictures of cyanobacteria samples found in BC with your name.

Email your image(s) to BCTOX@yahoo.com

--- Even if you are not sure that it is cyanobacteria, upload it please!

Make sure to include the date, geographical area and other relevant information.

Examples

Photo

Photo

.

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--- Algae gallery by Washington State. Toxic Alga is publicly accessible!

Decision Tree for Drinking Water: Cyanobacterial Toxins – Step Descriptions (No information is available online from BC)

STEP A: STEP A: Initial screening for suspected blooms: Examine the water for one or more of total nitrogen and phosphorus. Check for bloom formation.

STEP B: If yes to any of: nitrogen (N)>658 μg/L; phosphorus (P)> 26μg/L; an N:P ratio < 23; changes in secchi depth; or blooms observed, go to Step C. If no, return to Step A.

STEP C: Sample the raw water. Use a portable field kit to test for the presence of microcystins.

STEP D: If the presence of microcystins is detected (>1.0μg/L) with a field test kit, go to step E, and alert the health authority of a potential issue. If microcystins are absent, return to step A.

STEP E: Use a portable test kit to test the treated water supply for microcystins.

STEP F: If the portable test kit indicates microcystins are present (>1.0μg/L) in the treated water, send a sample to the lab for confirmation and immediately notify the health authority.

STEP G: If the lab results indicate the seasonal MAC of 1.5μg/L has been exceeded, immediately contact the health authority for consultation and decision making.

Others

---

References

1. Lelong A, Hégaret H, Soudant P, et al. Pseudo-nitzschia (Bacillariophyceae) species, domoic acid and amnesic shellfish poisoning: revisiting previous paradigms. Phycologia 2012;51(2):168-216.

2. Perl TM, Bedard L, Kosatsky T, et al. An outbreak of toxic encephalopathy caused by eating mussels contaminated with domoic acid. N Engl J Med 1990;322(25):1775-80.

3. EFSA. Scientific opinion. Marine biotoxins in shellfish – Summary on regulated marine biotoxins. Scientific Opinion of the Panel on Contaminants in the Food Chain (Question No EFSA-Q-2009-00685). Adopted on 13 August 2009 The EFSA Journal 2009;1306:1-23.

4. National Shellfish Sanitation Program (NSSP) Guide for the Control of Molluscan Shellfish. From the U.S. Food and Drug Administration website http://www.fda.gov/Food/GuidanceRegulation/FederalStateFoodPrograms/ucm2006754.htm In: U.S. Department of Health and Human Services, ed.: Public Health Service, Food and Drug Administration,, 2017 Revision.

5. Scientific Opinion. Marine biotoxins in shellfish – Saxitoxin group. Scientific Opinion of the Panel on Contaminants in the Food Chain (Question No EFSA-Q-2006-065E) Adopted on 25 March 2009 The EFSA Journal 2009;1019:1-76.

6. EFSA. Marine biotoxins in shellfish – okadaic acid and analogues. Scientific Opinion of the Panel on Contaminants in the Food chain (Question No EFSA-Q-2006-065A) Adopted on 27 November 2007 The EFSA Journal 2008 589:1-62.

7. Mirror SN. Algae bloom at Elk Lake prompts CRD advisory notice. https://www.sookenewsmirror.com/news/algae-bloom-at-elk-lake-prompts-crd-advisory-notice/ (acessed Nov 28, 2018). 2018-11-20.

8. Watkins SM, Reich A, Fleming LE, et al. Neurotoxic Shellfish Poisoning. Marine Drugs 2008;6(3):431-55.

9. CityNews. Officials: Red tide suspected as dead dolphins wash ashore. https://www.660citynews.com/2018/11/27/officials-red-tide-suspected-as-dead-dolphins-wash-ashore/ (accessed Nov 28, 2018). 2018-11-27.

10. Molgo J, Marchot P, Araoz R, et al. Cyclic imine toxins from dinoflagellates: a growing family of potent antagonists of the nicotinic acetylcholine receptors. J Neurochem 2017;142 Suppl 2:41-51.

11. Visciano P, Schirone M, Berti M, et al. Marine Biotoxins: Occurrence, Toxicity, Regulatory Limits and Reference Methods. Frontiers in Microbiology 2016;7(1051).

12. Patocka J, Gupta RC, Wu QH, et al. Toxic potential of palytoxin. J Huazhong Univ Sci Technolog Med Sci 2015;35(5):773-80.

13. Thakur LK, Jha KK. Palytoxin-induced acute respiratory failure. Respiratory Medicine Case Reports 2017;20:4-6.

14. GlobalNews. Toxic coral in aquarium sends Quebec family to hospital. https://globalnews.ca/video/4175960/toxic-coral-in-aquarium-sends-quebec-family-to-hospital 2018-04-29.

15. CBCNews-2018-04-25. Toxic coral in home aquarium blamed for making Gatineau family sick. http://www.cbc.ca/news/canada/ottawa/toxic-coral-blamed-for-sickening-gatineau-family-1.4633810.

16. CBC. Toxic coral in home aquarium blamed for making Gatineau family sick. https://www.cbc.ca/news/canada/ottawa/toxic-coral-blamed-for-sickening-gatineau-family-1.4633810 (accessed Nov 25, 2018). 2018-04-24.

17. Global News. How toxic coral in your aquarium could send you to hospital. https://globalnews.ca/news/4167774/toxic-coral-aquarium/ (accessed Nov 23, 2018). 2018-04-25.

18. The Weather Network. Toxin almost kills family and pets after fish tank cleaning. https://www.theweathernetwork.com/news/articles/coral-toxin-almost-kills-family-in-britain-during-fish-tank-cleaning/98938 (accessed Nov 28, 2018). 2018-04-07.

19. The Press Democrat. New rules reduce abalone season, trim catch. https://www.pressdemocrat.com/news/1855752-181/new-rules-reduce-abalone-season (accessed Nov 29, 2018). 2014-02-08.

20. Paz B, Daranas AH, Norte M, et al. Yessotoxins, a Group of Marine Polyether Toxins: an Overview. Marine Drugs 2008;6(2):73-102.

21. Phys.Org. Scientists solve the case of the red abalone die-off using forensic genomics. https://phys.org/news/2014-04-scientists-case-red-abalone-die-off.html (accessed Nov 03, 2018). 2014-04-17.

22. Lawrence D, McLinskey N, Huff JS, et al. CHAPTER 4 - Toxin-Induced Neurologic Emergencies. In: Dobbs MR, ed. Clinical Neurotoxicology. Philadelphia: W.B. Saunders, 2009:30-46.

23. Stewart I, Seawright AA, Shaw GR. Cyanobacterial poisoning in livestock, wild mammals and birds--an overview. Adv Exp Med Biol 2008;619:613-37.

24. Stewart I, Webb PM, Schluter PJ, et al. Recreational and occupational field exposure to freshwater cyanobacteria--a review of anecdotal and case reports, epidemiological studies and the challenges for epidemiologic assessment. Environ Health 2006;5:6.

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BCTOX’s Toxicology “News Surveillance” Jan – 2019

Reza Afshari*, Environmental Health Services, BC Centre for Disease Control, BC. Reza.Afshari@bccdc.ca

Public Health & Environmental Toxicology: What is BCTOX & why?

Health professionals (HP) including policymakers, health educators and researchers need to be regularly updated on environmental toxicology issues to keep up with rapidly evolving toxicology information, emerging health risks from environmental chemicals and to manage issues that are locally highlighted in the popular press and news media.

Environmental toxicology training is limited during education, and when HPs enter the field, they lack information on the responsibilities for regulation and risk communication among local, provincial and federal agencies, as well as their relations to international organizations, scholarly articles, and private sectors, including industry 1. All of these factors lead to avoidable confusion.

BCTOX acts as a local up-to-date resource to answer current toxicology issues. The business model of BCTOX is flexible in order to maximise its applicability. BCTOX is also still developing, and will be determining its future directions along the way.

BCTOX acts like a pendulum. It mobilises your interventions to other places where they can also be used, and also back-translates the health activities that have had a “life outside of the health system” and have made societal impacts.

While BCTOX is not official and not liable for the reported news from media, it is BC-related and full of concise information that is handpicked and fun to read. BCTOX keeps you engaged with toxicology news in BC. BCTOX is full of inspiring ideas dedicated to B.C!

Monthly major toxicological statistics

Mortalities In total, around 700 premature deaths could be attributed to toxic exposures in BC in May including:

ACUTE exposures; [estimated]≈ ≈ 110 due to Illicit drug overdose ≈ 10 due to suicides (CO, drugs and alcohol)

CHRONIC current and past exposures; [estimated] ≈ 500 due to smoking and tobacco use, 81 (air pollution), 11 (radon) 7 (asbestos)

These are equal to overall 15*10-5 population toxic exposure-induced deaths in March alone, including 2.4*10-5 acute and 13*10-5 chronic toxicities (estimations are subject to assumptions and limitations, and overlaps are possible (see BCTOX 2(8): 103)).

Morbidities Around 2200 calls were made to BC-DPIC (estimated from August 2017)

Sola dosis facit venenum Only the dose makes the poison!

Paracelsus (1493 – 1541 CE)

Dilemma of the pipelines in B.C. from a population health perspective

Since early January, a few checkpoints are blocking access to TransCanada’s $4.7-billion Coastal GasLink pipeline that is a 670-kilometre line that is meant to deliver liquefied natural gas (LNG) from Dawson Creek to a planned facility near Kitimat (Figure). 1

RCMP arrested 14 B.C. pipeline protesters. A B.C. Supreme Court injunction will allow police (or TransCanada) to remove camps and checkpoints set up by the Wet’suwet’en First Nation.2 Protesters would have to obey the injunction to end the blockade.3

While economically this pipeline makes sense, First Nations populations, activists and environmentalists are concerned about the potential ancestral land, environmental effects and pollution. With regards to public health this pipeline project faces a dilemma similar to what is at stake for another pipeline in B.C; the trans mountain Kinder Morgan project. While jobs and in turn income will increase as a result of industrial development that in turn contributes to improving population health, they are at odds with related pollution and potential spills, traffic, etc. (Figure) Oil spills involve toxicological health risks for people participating in the cleanup operations and coastal inhabitants.2

The extent of contradictory effects is not clear, and is a matter of judgment as well as science! --- What do you think?

The majority of scientific works are focused on environmental effects of spills and to a lesser extent cultural issues.3 4 There is no study following the problem in a holistic approach deducting the beneficial effects of industrial developments from negative impacts. --- What do you think? To what extent one direction of the effects are more important?

…

1 https://vancouversun.com/news/local-news/rcmp-expected-to-break-up-northern-b-c-first-nations-pipeline-check-points 2 https://vancouversun.com/news/local-news/rcmp-expected-to-break-up-northern-b-c-first-nations-pipeline-check-points 3 https://www.theglobeandmail.com/canada/british-columbia/article-bc-pipeline-protesters-say-theyll-obey-injunction-to-end-blockade/

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PROVINCIAL HEALTH OFFICER’S ANNUAL REPORT

released on Jan 2019

--- Toxicology Related issues

The office of the provincial health officer has released a provincial health officer’s annual report entitled “Taking the pulse of the population. An update on the health of British Columbians.” 5

--- B.C. is doing well in reducing diabetes and Hep C, but needs to improve on mental health and infant mortality according to Dr. Bonnie Henry, B.C.’s health officer.6

Toxicology related targets

Among the targets, toxicology related issues including

mental health and substance use, environmental health response to public health emergencies

were highlighted. The report points to the opioid crisis and its impacts on mental health and death rates. In addition, determinants with indirect impact on toxicology related issues such as poverty reduction, addressing homelessness and action on climate change were promoted in the annual report.

According to BC’s Guiding Framework for Public Health, the goal statement is: “Environments that optimize and support good health. This includes monitoring the built environment in which people live, and potential routes of environmental exposures, such as soil, air, food, and water supplies; and the living environment of people who attend or reside in licensed community care facilities.”

Recommendations to meet the 2023 targets

The report centered on and around improving equal health support across the province. --- “Compared to other parts of the world, BC has good drinking water quality and air quality, and a generally safe food supply.”

Acute Toxicities

Illegal Drug Overdose Emergency

Their activities under the direction of the Joint Task Force, task groups worked on a coordinated response to the emergency included

Expanding access to naloxone. Increasing access to overdose prevention and supervised

consumption services. Increasing access to opioid agonist treatment. Establishing enhanced surveillance and early-warning and

monitoring systems. Reaching and engaging those who are using drugs alone. Launching and maintaining a comprehensive social marketing

campaign to raise awareness of issues related to the emergency.

Actual and Projected Percentage of Households on Municipal Water Supplies That Boiled Water in Order to Make it Safe to Drink,

BC, 2007 to 2023

Notes: Survey data reflect households on municipal water supplies that boiled water in the last 12 months in order to make it safe to drink. This excludes respondents who did not indicate whether they treated their water prior to consumption. See Appendix B for more information about this data source. Source: Statistics Canada, Households and the Environment Survey, 2015. Extracted from CANSIM Table 153-0123. Prepared by Population Health Surveillance and Epidemiology, BC Office of the Provincial Health Officer, BC Ministry of Health, January 2017.

(Read more)

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....

Inside the changes to Canada's food guide,7 8

Environmental-clinical Toxicology related issues, 01-2019

The newest version of Canada’s Food Guide was realised on Jan 23, 2019.

1. General issues

Canada’s Food Guide recommends that your plate should be divided neatly into:

one-half vegetables and fruits, one-quarter whole-grain foods, and one-quarter assorted protein-packed foods.

This is a big change from the past. It focuses on meal planning, cooking and healthy choices:

Planning, buying and cooking healthy food, Eating well plate and recipes, Eating on a budget, Food waste and the environment,

In addition, it works on

Healthy eating at home, at school, at work, in the community, when eating out

Life stages; Nutritional needs and healthy eating habits, children, older adults

Other Points:

No one ever eats enough fruits and vegetables The majority of protein section consists of beans, nuts and

pulses, although some space is occupied by chicken, beef, fish and dairy

There is no milk or fruit juice in the newest version of the guide, which now describes water as the “beverage of choice”. --- “We’re not telling Canadians not to eat dairy products or not to eat meat products. What we are telling Canadians, however, is to look at the variety of foods that are available out there”.

...

History of Dietary Advice in Canada, A picture is worth a thousand words! (photos adapted from references 7and

8)

1944 1949 1977

1992 2007 2019

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…

The produce section does include frozen peas and carrots, as well as canned tomatoes (cheaper).

2. Toxicology related issues

2.1. sugar substitutes

The guide stresses that sugar substitutes are not needed for healthy eating, but they can be replaced sugar. Information can be found by reading the ingredient list that may include:

xylitol lactitol isomalt mannitol erythritol saccharin aspartame sorbitol and sorbitol syrup maltitol and maltitol syrup stevia extract and steviol glycosides

2.2. Healthy eating and the environment

One should be aware that the food choice they make impacts

Their health Their environment Buying and eating foods Use and disposal of foods

The impact that foods can have on the environment is influenced by the type of food, where it comes from and how it is produced, packaged, processed and transported.

2.3. Food waste

Store properly, prepare enough (to avoid leftovers) and do not shop impulsively.

2.4. Make environmentally-friendly choices

choose plant-based foods carry a reusable water bottle use reusable grocery bags use reusable containers to store food and pack lunches look for ways to reduce food packaging in what you buy buy food that can be transported home in your own re-fillable

container keep perishable foods in their original packaging when you

store them to extend freshness

** Some parts of this summary are pasted from the references 7 and 8.

References.

1. Liverman CT, Ingalls CE, Fulco CE, et al. Toxicology and Environmental Health Information Resources: The Role of the National Library of Medicine. Institute of Medicine (US) Committee on Toxicology and Environmental Health Information Resources for Health Professionals; Washington (DC): National Academies Press (US). 1997.

2. Laffon B, Pasaro E, Valdiglesias V. Effects of exposure to oil spills on human health: Updated review. J Toxicol Environ Health B Crit Rev 2016;19(3-4):105-28.

3. Bejarano AC. Critical review and analysis of aquatic toxicity data on oil spill dispersants. Environ Toxicol Chem 2018;37(12):2989-3001.

4. Li P, Cai Q, Lin W, et al. Offshore oil spill response practices and emerging challenges. Mar Pollut Bull 2016;110(1):6-27.

5. Office of the provincial health officer. Taking the pulse of the population. An update on the health of British Columbians. Provincial health officer’s annual report. https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/reports-publications/annual-reports/pho-annual-report-2019.pdf (accessed Jan 28, 2019). Jan, 2019.

6. Abbotsford-News. B.C.’s health officer releases annual report on health targets. https://www.abbynews.com/news/b-c-s-health-officer-releases-annual-report-on-health-targets/ (accessed Jan 30, 2019). 2019-01-25.

7. Health-Canada. Canada’s Food Guide. https://food-guide.canada.ca/. Jan 2019.

8. CTV News. What's on your plate? Inside the changes to Canada's Food Guide. https://www.ctvnews.ca/health/what-s-on-your-plate-inside-the-changes-to-canada-s-food-guide-1.4265399 (accessed Jan 24, 2019). 2019-01-23.

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Mercury Poisoning, Emperor Qin Shi Huang and his Terracotta Army

Reza Afshari, School of Population and Public Health, University of British Columbia, Canada. Reza.Afshari@bccdc.ca

Abstract: Emperor Qin Shi Huang (259 BCE - 210 BCE) was the founder of the Qin dynasty, and the first emperor of a unified China. His impact on Chinese society

was enormous and ranged from unification of diverse state walls into a single Great Wall of China, developing a massive new national road system and creating a city-sized mausoleum guarded by the life-sized Terracotta Army.

Throughout his adulthood, Emperor Qin sought immortality and sent explorers to find the secret to immortality from different corners of the world. It is documented that he continuously consumed mercury pills for immortality. Emperor Qin ran a tyrannical government with strict discipline, which intensified as he aged. He used to scrutinize every petty detail and occasionally suffered from overworking himself. Some of his clinical findings are consistent with mercury-induced neurotoxicity. His successor Qin Er was mentally ill, and murdered his older brother, to seize the thrown. He executed 12 princes, 10 princesses and many generals; he ordered for the city walls to be lacquered and uprisings not to be reported to him as they made him sad. It is plausible that his mental judgment was impaired as a result of low dose mercury poisoning; a practice that he presumably followed as it was his father’s immortality recipe. When his underground mausoleum was examined by modern archeologists in 1970s, high concentrations of mercury, some 100 times the naturally occurring rate, confirms the credence of the historical account.

Mercury poisoning and Emperor Qin Shi Huang’s life and death are intertwined in mystery and reality. Mercury pills did not bring him immortality in physical terms and perhaps just the opposite, contributed to his sudden premature death at the age of 49. However, he achieved immortality through his works and with acknowledging the toxic effects of mercury! Even after millennia we are talking about it. His army still stands under his discipline with horses and carriages intoxicated with mercury to trap their souls.

Introduction

The history of toxicology is mesmerizing and a highly effective source for medical and health education.1-3 What if we could use it to improve health litracy4 5, to change the attitude of professionals and the public6, and to persuade others to act more socially responsible 7 as well as incorporate historical events into medical and health curricula?8

We have already discussed a few examples.4 9-16 Here is another one; The world was stunned when the Terra Cotta Army was discovered in the 1970’s in China ….

Who was Emperor Qin Shi Huang

Qin Shi Huang (259 BCE - 210 BCE) was the founder of the Qin dynasty, and the first emperor of a unified China with a truly centralised bureaucratic system. His charisma and power has never been mimicked in Chinese history. He first became the king of the small State of Qin at the age of 13. He built a formidable fighting machine by mobilising the whole population. The territory that he governed extended from Mongolia to Hong Kong, as large as the whole Roman Empire at its peak. After his successful campaign, he declared himself “Qin Shihuangdi” or First Devine Emperor of the Qin.17 He died at the age of 49.

China's multiple States were diverging prior to his reign, and it is even plausible to say that China would not exist without Qin Shi Huang.18

The legacy of the First Emperor of China

Unification of diverse State walls into a single Great Wall of China

Developing a massive new national road system

Building a city-sized mausoleum guarded by the life-sized Terracotta Army

Developing a standard for weights and measures, a single currency and a universal writing system

Banning and burning many books and executing scholars

Emperor Qin’s Personality

Emperor Qin ran a tyrannical government with cruelty and strict discipline. He used to scrutinize every petty detail and occasionally suffered from overworking himself. His brutality intensified as he

aged. He is also acknowledged in history for his decisive actions and for his monumental achievements through resilience and ruthlessness.

Qin was paranoid and feared “the inkbrush as much as the sword”. He executed 400 scholars and intellectuals for not being subjective to his ideas or for talking behind his back.

Figure 1.Terracotta Army – Photo Courtesy of Pixabay

Qin’s ultimate charisma is unique throughout human history, a feature that never faded away until his death. He was innovative, a visionary, courageous and passionate for the work that allowed him to exercise absolute influence and authority over his people.

He repeatedly defied the odds in social sciences. It is technically proposed that relationships between charismatic personality and leader effectiveness is like a double-edged sword (curvilinear or inverted U-shaped), meaning that up to a point charismatic personalities facilitate social development, a trend that would not persist if charisma continuously increases.19 Emperor Qin is a clear figure in defiance of this theory. His extraversion, impulsivity, dominance, confidence and reactivity remained solid as it is obvious from his monumental works. He remained strategically, judgmentally and operationally in control for his entire life.

It is difficult to conceptualise Qin’s social-cognitive model of behaviours. His reign came with dramatic increases in sophistication and customised mass production, which is evidently portrayed by constructing the Terracotta Army mausoleum.

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It became clear that Chinese imperialism was going to end if he really died. He did not train or introduce a successor. He executed scholars, influential figures and commoners to an extent that the

reflect their impressive personalities and give everyone a sense of superiority. --- No visitor forgets the powerful atmosphere of the mausoleum. The Terracotta Army has become a part of the human

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Empire ran out of man power and was left in limbo and chaos. I wonder if he himself wanted it that way, or he really believed that he is going to last for 10,000 generations. Even biblical figures Adam and Noah did not live that long!

Unfortunately, his strong personality was devoid of good human qualities, moral values or compassion. He never fought for happiness or freedom of his subjects or pressured them to be “good” citizens, instead valuing submission above all. He was harmful to society and the livelihood of his people.

What was the Terracotta Army

When archaeologist Zhao Kangmin was notified that local farmers had found life-size pottery heads and several bronze arrowheads near the city of Xian in central China in April 1974, he would have never thought that he was on the verge of discovering the tomb of China's first emperor, Qin Shi Huang. Eventually 8,000 (1300 soldiers) soldiers, including horses and chariots, were discovered in this site (Figures 1 and 2).20

Qin Shi Huang’s mighty tomb was guarded by the Terracotta Warriors in a site 200 times bigger than Egypt’s Valley of the Kings. His huge mausoleum was supposed to protect the emperor in the afterlife.

Although this site is widely recognised as a Chinese national treasure these days, his discoverer Zhao Kangmin who died in 2018 at the age of 81 remained underappreciated according to a BBC report.

Surprisingly, three of the original seven farmers who reported the site died under terrible circumstances.21 Was this site a curse for those who revealed it similar to the discoverers of the Egyptian mummies?

Figure 2. Terracotta Army – Emperor Qin’s mausoleum. RA©

Qin magnified his personal charisma with a stable professional charisma demonstrated by his Terracotta Army. He promised not only a blissful afterlife, but also a tangible manifestation of immortality in the shape of individual human sized personas. In his followers’ eyes, Qin was definitely a healer to cure death.

--- The Terracotta Army is another example of his long lasting charisma, manifested both in his private and professional life. The construction of this mausoleum was a visual confirmation of his charisma. --- Which one of his inner circle could have not been mesmerised by being involved in developing or even witnessing this mausoleum. He promised what were seen as immortal clay statues that would trap and keep alive their souls and last for millennia!

The warriors’ faces are solid and their bodies still. At 185 to 194 centimetres, they are modestly taller than ordinary people to

psyche!

In pursuit of immortality

Throughout his adulthood, Emperor Qin was hungry for immortality, and seriously searched for it. In the absence of contemporary scientific information on balanced diet and exercise to elongate his life, he was actively seeking advice from all scholars and physicians and even sent explorers to find the secret to immortality from different corners of the world. It is highly controversially claimed that some of his methods were inspired by ancient Greek influence.22 Historic writings show that a herb that was collected from an auspicious local mountain was suggested to him for immortality.20

In the pursuit of immortality, he was delusional. He viewed death as an absolute failure, and eventually misled himself that he is going to last for 10,000 generations. Even today, many people believe that he is going to come back and run an Empire that extends beyond his homeland geographical Empire, China. --- Did you enjoy watching the action-adventure fantasy film directed by Rob Cohen, “The Mummy: Tomb of the Dragon Emperor”? Be honest, do you want to be the devil who brings him back or the hero who defeats him? People are fascinated with the concept of immortality, in particular if the dead is going to come back to life.

In his quest for immortality, Emperor Qin eventually fell in love with mercury and started consuming mercury pills that were prepared by his alchemists and court physicians for this purpose.23

How could mercury cause immortality?

In my view, the “theory” behind using mercury for immortality was based on first, the observation that “mercury was able to absorb gold and silver from ores.24 Elemental mercury, even today, is used in artisanal and small-scale gold mining. In this process, mercury is mixed with gold-containing materials, forming a mercury-gold amalgam. The combination is then heated, by which mercury is vaporized leaving the gold and silver behind.25

--- Second, in the case of death, it was presumed that the soul, the most precious element of beings, is separated from the body and goes to heaven somewhere in the sky according to the dominant belief prior to and around Qin’s era. The physical body was then buried. Creating the heavenly bodies was a land mark of his thoughts. Taking both factors into account, they were looking to keep the soul in the body after death. Perhaps having mercury in the body would prevent the golden part of being, the soul, to leave the body, and therefore immortality may happen and last for 10,000 generations as he promised. This is my theory, anyway.

Emperor Qin and his over Terracotta Army made up of 10,000 warriors, highly contaminated even today (see below), kept the place secret as it was the location that their souls were trapped. They were so efficiently secretive that no one new such an Army even existed for over 2,000 years until the mausoleum was discovered by accident in 1970s.

Emperor Qin regularly consumed low dose mercury and gradually intoxicated himself with this element. He died suddenly at the age of 49, which is alleged to be related to mercury poisoning. In addition to pursuing immortality, other evidence exists supporting mercury’s involvement in his life.

Evidence from ancient texts

100 years after the he died, the great historian Sima Qian wrote that his tomb mound had a stockpile of treasures in an imitation of the universe, mercury representing the rivers and oceans and gems on the ceiling representing the stars.26 But Sima Qian did not mention

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the place of his tomb and if such an army exists. --- Apparently, secrets of the Emperor’s and his army’s mausoleum were sealed.

Evidence from archeological studies

When his underground mausoleum was discovered in 1974, archeologists inserted probes deep into and tested the tomb mound for heavy metals. Their study revealed unusually high concentrations of mercury some 100 times the naturally occurring rate, which confirms the credence of the historical account (Figure 3).27 Later extensive geochemical studies also confirmed abnormally high concentrations of mercury in his mausoleum (Figure 4).28 29 30

The actual tomb is still sealed (untouched) due to its conditions, which according to rumors is protected with many tricks and supra-natural curses!

Figure 3. Sample layout and mercury content over the tomb mound of Emperor Qin Shi Huang. Adopted with modification from reference (28).

Archeological studies confirmed the ancient texts. Mercury was in fact used in constructing his mausoleum to simulate the heavenly rivers and streams in his territory. Diamonds and pearls were used to replicate the sun, the moon and other stars.31

Figure 4. Variation of Hg-content in soil along the Lishan mountain-Fish Pond line. Adopted with modification from reference 28).

Evidence of mercury poisoning from the Emperor’s clinical manifestation

What is mercury?

Mercury (Hg, quicksilver) exists both naturally and anthropogenically, and is a sliver colour liquid under room temperature (Figure 5).

Figure 5. A drop of liquid mercury under room temperature.

Manifestations of chronic low dose mercury toxicity include gastrointestinal, renal and neurologic complications. Neurologic symptoms related to chronic inorganic mercurialism are varied and include:

mercurial tremor (a central intention tremor that is abolished during sleep),

neurasthenia (fatigue, depression, headaches, hypersensitivity to stimuli, psychosomatic complaints, weakness, and loss of concentration),

erethism (easy blushing and extreme shyness of the afflicted, anxiety, emotional liability, irritability, insomnia, anorexia, weight loss, and delirium, and

a mixed sensorimotor neuropathy, ataxia, concentric constriction of visual fields (tunnel vision), and anosmia.

In cases of mercury poisoning violent behaviour, assaults and hallucination has also been reported.32

Emperor Qin was an apprehensive person and extremely afraid of death. Maghazaji (1974) scientifically reported a case of mercury poisoning with intense fear of dying, so perhaps the Emperor's fear was potentiated by his mercury use.33 Qin was irritable and an insomniac. He suffered from exhaustion related to work overload and fatigue. He was a brutal version of Alice in Wonderland! Everything amazed him. He was ambitious with lots of ideas and inspirations.

His unstable emotional state manifested through his exaggerated changes of mood. He used to scrutinize every petty detail.

--- Psychologically speaking, his symptoms fit into chronic mercury poisoning! Research has shown that abnormal performance on neuropsychological tests persists over a prolonged period of time following mercury poisoning, and may be irreversible.32

In general, it is plausible that mercury contributed to his behaviour and death, which makes his case the earliest recorded death as a result of mercury poisoning.34

Having said that, mercury poisoning and, in particular, severe cases are presented with a wide range of clinical manifestations. We have no way today to see if he suffered from those symptoms or not. Judging a poisoning by psychological symptoms alone is farfetched.

Evidence from the Emperor’s successor

Due to Qin’s brutality, he left behind a large kingdom which was short of scholars and man power, and a paranoid family. Following his unexpected death, an old version of the bloodbaths reminiscent Game of Thrones happened, and eventually, one of his many sons, Qin Er Shi [Huhai] and Premier Li Si, Chief Eunuch Zhao Gao conspired to murder the Emperor’s oldest son [Fusu] and the presumed heir to seize the throne. Fusu was ordered to commit suicide using a forge letter from his late father.

He was too weak to fill his father’s shoes, and his family’s dynasty that was supposed to last for 10,000 generations lasted just three years before he was brutally overthrown and forced to commit suicide. The young Emperor was mentally peculiar and ill.

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He executed 12 princes, 10 princesses and many generals. He astonishingly ordered to lacquer the city walls and to not report uprisings; those who did were punished for making him sad. --- What if his mental judgment was impaired as a result of mercury poisoning? His strange behaviours were more consistent with low dose mercury poisoning; a practice that he presumably followed after his father’s immortality recipe.

Reliability of the report

Revisiting a 2000 year old cold case through a scientific lens is very difficult. I tried to evaluate the strength of evidence regarding the reliability of toxic attribution of this event, which are summarised in Table 1.

First, we know for sure that Emperor Qin was regularly consuming mercury pills from the ancient Chinese historical documents in pursuit of immortality. Second, recent archeological and environmental toxicological studies confirm his obsession and high exposure to this element. As a result to both independent evidence (historical documents and archeological toxicology tests), the myth of Emperor Qin's high mercury exposure is scientifically reliable.

Table 1. Strength of evidence and reliability of toxic attribution of events.

Type of evidence* Strength

Documentation of high exposure +++

Environmental laboratory findings +++

Psychological and clinical findings +*

His son’s behavioural profile ++

Suspicious Circumstances +

Human laboratory findings -[?] **

Reliability of attributing to toxic exposure Confirmed

- No evidence (improbable), + weak evidence (possible), ++ moderate evidence (probable), +++ strong evidence (confirmed).

* Differential diagnosis including personality disorders is highly plausible (++)

** His body is to be exhumed and tested for mercury by Chinese authorities.

Third, his peculiar psychological and behavioural profile to some extent could be justified by low dose mercury poisoning. His era was filled with suspicious circumstances. Although he escaped many assassination attempts, we know with high degree of certainty that he died of mercury poisoning after all. His successor that presumably follow his father’s recipe for immortality from childhood, showed more representative clinical manifestation.

In summary, the Emperor’s behaviour could be in part attributed to mercury toxicity, although the extent of which may never be known. --- Let’s assume that only 30% of his extraordinary behaviour was attributed to mercury toxicity. What would have been mercury’s effects on the unification and building the Great Wall, development of the national road system and his mausoleum that is still guarded by the life-sized Terracotta Army? All of which are wonders and pride of humanity even after two millennia.

If he was not exposed to mercury, the course of history could have been changed for better or worse. At least we know with a high degree of certainty that mercury’s effects that led to his premature death terminated his extraordinary contribution to human development. On the dark side of it, so many scholars would have been saved if he was not obsessive, paranoid and picky.

Mercury in this case has changed the course of history as it targeted the most powerful man on earth at the time.

Conclusion

Emperor Qin motivated people around through both love and fear of this world and afterlife. He effectively engaged with his subjects and was able to raise societal awareness to rationalise his views, and reconstruct the culture and the Empire by imposing social changes. Are you familiar with Nietzsche’s favorite, Zarathustra brought the news; God is dead! He undermined Christian moral appeals but also created a new set of values to avoid ethical vacuum and banish nihilism. Do you see the similarity with Emperor Qin?

--- He was the earthly incarnation of Friedrich Nietzsche’s Übermensch (Superman).

The world was all about him. He did not share his leadership, but his team's effectiveness remained high. He never cared about peoples’ suffering, but only pursued his own charismatic needs. In my view his absolute power originated through three sources. First, as it was known from the antiquity, he discovered the power of fear among the elites and commoners.

Second, he promised afterlife, which at his time was the dominant belief in China. Both of which, however, existed in many other contemporary disciplines and religious ideologies.

What has separated him from all other rulers, however, is what he put in front of the eyes of his subjects in this world, in a tangible near future. Prior to him, relatives and close acquaintances of a deceased influential figure were buried with him to serve him in afterlife.

Emperor Qin broke gloriously this frightening tradition. Imagine how impressive this act would have been among the families of the elites; an ultimate display of charisma! Wives, administrative folks, servants, etc. should have loved him.

--- Instead of being slaughtered, they were now supposed to serve him. He created an Army of Clay Statues resembling his acquaintances to be buried with him, not the real people. This honorable act is unique and has not repeated in history.

While capturing the minds of his subjects through constructing the Terracotta Army, he used the mysterious power of mercury in cementing their loyalty and devotion through their potential immortality. Similarly to mercury’s ability to separate gold and silver from ore, it was formulated that it can keep the soul not to be separated from the clay if remains there. As a result, he unleashed an enormous social energy not only by the power of fear and promising afterlife, but by bringing distinctively the heaven to the earth.

His top warriors were able to see the immortality buy their own eyes or what he promised, a 10,000 generation glorious Empire. The afterlife was no longer an empty promise, but a tangible reality! In addition, you would have been killed if you did not join him after all!

His long term low dose ingestion of mercury pills did not bring him immortality, and perhaps just the opposite contributed to his sudden premature death at the age of 49. However, he achieved immortality through his works and by celebrating mercury. We still acknowledge his work a couple of millennia after his death. Although he died 2000 years ago, in reality he still rules his 56 square kilometres -that is right 56 square kilometres - tomb complex proudly and firmly.

His army still standing under his discipline with horses and carriages intoxicated with the mercury that has trapped their souls. --- Viva mercury!

Declaration and acknowledgement

This article has been written in Celebrating the Chinese New Year 2019.

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2. Afshari R. Chronicle of Datura Toxicity in the 18th and 19th Century. Asia Pacific Journal of Medical Toxicology 2017;5(4):101-06.

3. Afshari R. The Chronicle of Arsenic Poisoning in the 19th Century. Asia Pac J Med Toxicol 2016;6(2):36-41.

4. Afshari R. Historic Perspective (Ferdowsi); Scholarship of Teaching. Future of Med Edu J 2012;2(3):1.

5. Yahaghi MJ, Afshari R. Education and Health in Shahnameh (National Epic of Iran, Ferdowsi (1010 CE): Mashhad University of Medical Sciences Publishing Group, Iran, 2012.

6. Afshari R, Zavar A, Alidoust M, et al. Knowledge and Attitude of Health Network Staff towards Illegal Drug Use. Addiction and Health 7(1-2):96-98.

7. Afshari R, Bellinger DC. Socially Responsive Toxicology; Looking Outside the Windows of Medical Wards: A Tale of Lead Exposure Asia Pac J Med Toxicol 2015;4(3):95-96.

8. Afshari R. Incorporation of medical research and education in Asia Pacific region. Future of Medical Education Journal 2015;5(4):3-4.

9. Afshari R. The “Voice” and Execution of Socrates. BC Toxicology News Monthly Bulletin (BCTOX) 2018;3(3):439-241 https://bit.ly/2CPMPNY.

10. Afshari R. Mithridatium (Universal Antidote), Mithridatism and Mad Honey Chemical Warfare. https://bit.ly/2L5DPZA. BC Toxicology News Monthly Bulleti (BCTOX) 2018;4&5(3):264-66.

11. Afshari R. Use of Chemical Warfare Agents in Ancient History: The case of Persians and Romans in Dura-Europos, Modern Syria in 256 CE. Asia Pacific Journal of Medical Toxicology 2018;7(3):54-59.

12. Afshari R. Gustav III's risk assessment on coffee consumption; A medical history report. Avicenna J Phytomed 2017;7(2):99-100.

13. Afshari R. Fall of Easter Island Civilization and Toxic Prion Exposures. Asia Pacific Journal of Medical Toxicology 2018;7(2):29-32.

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17. Carelli F. The terracotta army. London J Prim Care (Abingdon) 2008;1(1):56-7.

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19. Vergauwe J, Wille B, Hofmans J, et al. The double-edged sword of leader charisma: Understanding the curvilinear relationship between charismatic personality and leader effectiveness. J Pers Soc Psychol 2018;114(1):110-30.

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The Oxford Word of the Year 2018 is…

“TOXIC”

Congratulation to All Toxicology Popularisers! It is important for us

to keep engaged people with health concerns. Preventive toxicology would be successful if people show more interest in toxic concerns.

Oxford English dictionaries, as a global leader in language select annually a word or expression that has attracted a great deal of interest over the last 12 months. Selfie, Vape, “face with tears of joy” emoji, and youth quake in the past few years. The Oxford Word of the Year 2018 is “toxic”! as they observed a 45% RISE in the number of times “toxic” has been looked up on oxforddictionaries.com.

The Oxford Word of the Year 2018 is… “TOXIC”.1

#Etymology; what does toxic mean? 2

Toxic means poisonous that borrowed from Latin #toxicum originated from Greek toxikon pharmakon “τοξικός φάρμακο”that means poisonous bow (arrows).3

Toxic collocates in 2018 --- Toxicological; Oxford English dictionaries have announced that

toxic’ collocates in 2018 by absolute frequency were #chemical, #masculinity (#metoo movement), #substance, gas, #environment, #relationship, culture, #waste, #algae and air. Nerve agent #poisoning (assassination of ex Russian spy in UK), toxic chemical #stockpiles and toxic waste in the wake of hurricanes and businesses burning toxic waste and #plastics lead to increased importance.

--- Metaphorical; Toxic workplace environments and toxic relationships

Google Trends© shows a similar pattern for Canada! For detailed information please visit Oxford English Dictionaries

https://bit.ly/2OL4bx3

References. 1. Oxford English Dictionaries. Word of the Year 2018 is... toxic.

https://en.oxforddictionaries.com/word-of-the-year/word-of-the-year-2018 (accessed Dec 05, 2018). 2018.

2. Afshari R, Monzavi SM. AFSHARI’S Clinical Toxicology and Poisoning Emergency Care. 6th ed. Mashhad: Mashhad University of Medical Sciences Publishing Group. ISBN 978-964-5944-47-4. P 410, 2017.

3. Afshari R, Monzavi SM. AFSHARI’S Clinical Toxicology and Poisoning Emergency Care. 6th ed. Mashhad: Mashhad University of Medical Sciences Publishing Group. ISBN 978-964-5944-47-4. P 410, 2017.

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Province of British Columbia Order of the Lieutenant

Governor in Council. Reporting information affecting

public health regulation. Order in Council No. 427

(adopted from 1)

Laboratory director must report examinations for lead

or mercury - 6

(1) Lead and mercury are prescribed as hazardous agents for

the purposes of the Act if present in a manner that may cause the

lead or mercury to enter the body of a person exposed to that

lead or Mercury.

(2) A laboratory director who performs a diagnostic examination on

a blood or urine sample for the purpose of detecting lead or mercury

must, if the diagnostic examination is a, benefit within the

meaning of the Laboratory Services Act,

(a) report the results of the diagnostic examination, regardless of

whether lead or mercury was detected, and

(b) include in the report personal information identifying the

person

(i) from whom the blood or urine sample was taken, and

(ii) who requested the diagnostic examination.

(3) A report must be made to the provincial health officer in

the format and manner required by the provincial health officer.

(4) A medical health officer who receives, under section 12 (2)

[reports must be made available to health officers], a copy of a report

made under this section

(a) may request the person who requested the diagnostic

examination to disclose

(i) personal information identifying the person from

whom the blood or urine sample was taken,

(ii) any relevant signs or symptoms exhibited by the person

from whom the blood or urine sample was taken, and

(iii) all relevant diagnostic examinations that were done,

and the results, and

(b) must report back to the provincial health officer under

section 12 (1) the information received in response to a request made

under paragraph (a) of this subsection.

(5) Section 14 of the Act applies for the purposes of a request made

by a medical health officer under subsection (4) (a) of this section.

Province of British Columbia Order of the

Lieutenant Governor in Council. Reporting

information affecting public health regulation.

Order in Council No. 427 (adopted from 1)

Persons responsible must report toxic spills 7

In addition to Satisfying all requirements imposed under the

Environmental Management Act, a person who causes or

permits the discharge of a substance that is a health hazard or

hazardous agent; whether onto land or into the water or air,

must do all of the following:

(a) take immediate action to stop the discharge, remove

and mitigate all hazardous effects and prevent all further

hazardous effects;

(b) promptly report to a medical health officer, in person or

orally,

(i) the matters set out in section 11 of the Act, and

(ii) the time, duration and quantity of the discharge;

(c) report again to a medical health officer, in writing and

within the time required by the medical health officer, the

matters referred to in paragraph (b).

Reference

1. Province of British Columbia Order of the Lieutenant

Governor in Council. Reporting information affecting public

health regulation. Order in Council No. 427. Part 2- Duty to

report - Division 1, General duty to report, Laboratory director

must report examinations for lead or mercury 6, and Persons

responsible must report toxic spills. Effective January 1, 2019,

http://www.bclaws.ca/civix/document/id/oic/oic_cur/0427_20

18, July 27, 2018:13. [Text adopted from the reference]