Lissages capillaires : attention au risque d’insuffisance rénale aiguë

Source: The Conversation – France in French (3) – By Pauline Guillou, Chargée de projet scientifique, Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail (Anses)

L’Agence nationale de sécurité sanitaire (Anses) a conclu, en janvier 2025, à un lien fortement probable entre la présence d’acide glyoxylique, un ingrédient utilisé dans certains produits de lissages capillaires, et la survenue de cas d’insuffisances rénales aiguës. En attendant une évaluation des risques au niveau européen, cette substance ne fait l’objet d’aucun encadrement ni restriction d’usage. Les consommateurs sont appelés à ne pas utiliser ces produits afin de limiter les risques pour leur santé.


Après plusieurs signalements de cas d’insuffisance rénale aiguë à la suite de la réalisation de lissages capillaires en France et à l’étranger, des études scientifiques ont montré qu’une substance contenue dans ces produits, l’acide glyoxylique, pouvait être à l’origine de ces effets.

Dans un avis rendu en janvier 2025, l’Agence nationale de sécurité sanitaire, de l’alimentation, de l’environnement et du travail (Anses) a confirmé un lien fortement probable entre cet ingrédient et cet effet indésirable et préconise une évaluation des risques au niveau européen.

Quelles recommandations pour la sécurité des consommateurs ?

Pour l’heure, les autorités sanitaires conseillent d’éviter d’utiliser des produits capillaires contenant de l’acide glyoxylique et d’être vigilant en cas de symptômes inhabituels après un lissage.

En attendant d’éventuelles mesures réglementaires, l’Anses émet les recommandations suivantes :

  • Ne pas utiliser de produits de lissage capillaire contenant de l’acide glyoxylique ;
  • En cas de symptômes inhabituels pendant l’application ou dans les heures suivant la réalisation d’un lissage capillaire (douleurs lombaires, fatigue, nausées…), que le produit contienne de l’acide glyoxylique ou non, il est recommandé de consulter un médecin ou de contacter un centre antipoison en indiquant la réalisation d’un lissage capillaire ;
  • Pour contacter un centre antipoison : se rendre sur le site Internet Centres-antipoison.net ou appeler le (33)1 45 42 59 59 ;
  • En cas de symptômes inhabituels pendant l’application ou dans les heures suivant la réalisation d’un lissage capillaire (douleurs lombaires, fatigue, nausées…), que le produit contienne de l’acide glyoxylique ou non, il est également recommandé de déclarer l’incident sur le portail de signalement des évènements sanitaires indésirables du ministère en charge de la santé : Signalement.social-sante.gouv.fr/

À noter que la vigilance doit être de mise pour des lissages capillaires réalisés chez le coiffeur, en salon ou à domicile, mais aussi directement par le consommateur. Les produits capillaires lissants susceptibles de contenir de l’acide glyoxylique (même si leur étiquetage ne le précise pas) sont en effet disponibles dans le commerce et peuvent être achetés directement par le grand public. Ces lissages sont parfois – mais pas systématiquement – présentés sous certaines dénominations (« lissages brésiliens », « lissages indiens », etc.).

Une première alerte auprès du dispositif de cosmétovigilance en France

En janvier 2024, l’Anses, nouvellement en charge de la cosmétovigilance en France, a reçu de la part d’un néphrologue le signalement d’un cas d’insuffisance rénale aiguë supposée en lien avec l’utilisation d’un produit de lissage capillaire. Ce signalement concernait une femme ayant connu trois épisodes d’insuffisance rénale aiguë en trois ans qui se sont déclarés systématiquement quelques heures après la réalisation d’un lissage capillaire. Le seul événement commun aux trois épisodes était en effet l’application d’un soin capillaire le jour du début des symptômes (La cosmétovigilance consiste à assurer une surveillance et, le cas échéant, à identifier des effets indésirables chez l’humain liés à des produits d’hygiène ou de beauté que l’on classe, selon la réglementation, dans la catégorie dite des « cosmétiques », ndlr.)

Lors des trois épisodes, les premiers symptômes étaient une sensation de brûlure du cuir chevelu durant toute la durée de l’application, puis l’apparition d’ulcérations du cuir chevelu. Une douleur lombaire apparaissait dans l’heure suivant le soin, suivie de nausées et d’asthénie le jour même. Les produits utilisés lors des deux premiers soins lissants n’ont pu être identifiés. Le troisième produit, lui, était connu.

Des effets indésirables graves qui suscitent l’attention

Les néphrologues ayant pris en charge cette patiente ont mené des recherches afin d’identifier l’origine de cet effet. Ils ont ainsi établi un lien de causalité entre l’insuffisance rénale aiguë et une substance contenue dans le produit utilisé lors du troisième soin, l’acide glyoxylique. Ces conclusions résultent, d’une part, de l’observation de la toxicité rénale de l’acide glyoxylique chez la souris et, d’autre part, de l’existence de cas humains similaires identifiés dans plusieurs pays, notamment en Israël.

L’acide glyoxylique est utilisé dans les produits de lissage capillaire en remplacement du formaldéhyde. Le formaldéhyde était utilisé dans les produits cosmétiques et notamment pour les lissages capillaires, mais a été interdit en 2019 du fait de son classement comme substance cancérogène en 2014 dans le cadre du règlement européen CLP. L’industrie a alors développé des alternatives, dont l’acide glyoxylique.

Au regard de ces éléments, l’Anses s’est autosaisie pour dresser un état des lieux des connaissances sur la toxicité rénale de l’acide glyoxylique présent dans les produits lissants et déterminer si un encadrement des conditions d’utilisation de cette substance était nécessaire.

En août 2024, deux nouveaux signalements d’insuffisance rénale aiguë chez des personnes s’étant fait lisser les cheveux ont été adressés à l’Anses. Ces signalements concernaient des femmes, ayant présenté des symptômes tels que des maux de tête, des douleurs lombaires, des nausées, de la fatigue, ou encore une soif excessive dans les heures suivant le soin. Leurs analyses de sang ont mis en évidence une augmentation significative des taux de créatinine, un marqueur biologique de l’insuffisance rénale. Aucune autre cause explicative n’a pu être identifiée. L’évolution de leur état de santé a été favorable, après une hydratation, voire une hospitalisation de plusieurs jours pour l’une d’elles.

Appliqué sur le cuir chevelu, l’acide glyoxylique peut pénétrer dans l’organisme

L’analyse de la littérature scientifique menée par l’Anses a permis d’identifier des données à la fois expérimentales et cliniques établissant un lien entre l’utilisation de produits lissants pouvant contenir de l’acide glyoxylique et la survenue d’une insuffisance rénale aiguë dans les heures qui suivent.

Concernant les 26 cas similaires survenus entre 2019 et 2022 en Israël, pour certains d’entre eux, des biopsies rénales ont révélé la présence des dépôts de cristaux d’oxalate de calcium. Ces derniers peuvent constituer des calculs rénaux qui altèrent le fonctionnement des reins de façon parfois sévère. Parmi ces 26 cas, 11 patientes ont été exposées à des produits de lissage à base de kératine affichant, dans leur composition, des « dérivés de l’acide glycolique ». Pour les autres, le type de produit lissant n’a pas été identifié.

À également été recensé en Suisse, et présenté dans une publication datant de 2024, le cas d’une femme d’une quarantaine d’années ayant développé une insuffisance rénale aiguë après un lissage des cheveux. La biopsie rénale avait également montré des dépôts de cristaux d’oxalate de calcium. La composition du produit utilisé reste cependant inconnue.

Par ailleurs, des tests expérimentaux menés sur des rongeurs ont confirmé le rôle néphrotoxique de l’acide glyoxylique lors d’une exposition par voie cutanée. Enfin, la formation de cristaux d’oxalate dans l’organisme à partir de l’acide glyoxylique a également été démontrée.

L’ensemble de ces données suggèrent donc que l’acide glyoxylique, lorsqu’il est appliqué sur le cuir chevelu, peut pénétrer dans l’organisme et se transformer en oxalate de calcium.

Une substance dont l’utilisation n’est ni encadrée ni limitée

À la suite de l’analyse de l’ensemble des données existantes, l’Anses a donc publié en janvier 2025 un avis qui conclut au rôle causal fortement probable de l’acide glyoxylique dans la survenue d’insuffisances rénales aiguës observées après l’application de produits lissants.

À ce jour, cette substance ne fait cependant pas l’objet de dispositions spécifiques dans le cadre du règlement cosmétique (en particulier selon les annexes II et III, qui correspondent respectivement aux substances interdites et aux substances faisant l’objet de restrictions). Son utilisation n’est donc ni encadrée ni limitée.

Comme l’interdiction ou la restriction d’une substance cosmétique ne peut se faire au niveau national, l’Anses recommande donc de réaliser une évaluation des risques au niveau européen afin de statuer sur la sécurité de l’utilisation de cette substance dans les produits de soins capillaires et, par voie de conséquence, sur la nécessité de telles mesures réglementaires.

De plus, l’Anses préconise qu’une attention particulière soit portée aux substances (présentes dans les produits capillaires et autres produits cosmétiques) pouvant se métaboliser en acide glyoxylique.

En mars 2025, l’Anses a présenté ses travaux devant le groupe de travail sur les cosmétiques organisé par la Commission européenne réunissant les États membres et les parties prenantes. À la suite de quoi, un appel à données a été lancé par la Commission européenne dans le but de compiler toutes les informations scientifiques disponibles afin d’évaluer la sécurité de cette substance dans les produits cosmétiques. Cet appel à données est ouvert jusqu’au 8 avril 2026.

Se mobiliser pour protéger le public en Europe et dans l’Union européenne

Il est à noter que, depuis octobre 2024, 15 nouveaux cas d’insuffisance rénale aiguë ont été signalés en France. Ces nouveaux cas ont, par ailleurs, montré que l’acide glyoxylique pouvait être présent dans les produits même si ce n’était pas mentionné sur l’étiquette.

En effet, parmi les six produits pour lesquels il n’était pas fait mention de la substance dans la composition, l’analyse de trois d’entre eux a confirmé qu’ils en contenaient. Deux nouveaux cas ont également été publiés dans la littérature scientifique en Tunisie et en Algérie.

Cet exemple démontre par ailleurs l’importance de signaler tout effet indésirable lié à ces produits et aux produits cosmétiques sur le portail de signalement des événements indésirables du ministère en charge de la santé. Ces signalements sont essentiels afin de mieux comprendre les risques et protéger les consommateurs.

The Conversation

Les auteurs ne travaillent pas, ne conseillent pas, ne possèdent pas de parts, ne reçoivent pas de fonds d’une organisation qui pourrait tirer profit de cet article, et n’ont déclaré aucune autre affiliation que leur organisme de recherche.

ref. Lissages capillaires : attention au risque d’insuffisance rénale aiguë – https://theconversation.com/lissages-capillaires-attention-au-risque-dinsuffisance-renale-aigue-275738

Violent aftermath of Mexico’s ‘El Mencho’ killing follows pattern of other high-profile cartel hits

Source: The Conversation – Global Perspectives – By Angélica Durán-Martínez, Associate Professor of Political Science, UMass Lowell

A soldier stands guard by a charred vehicle in Michoacán state, Mexico, on Feb. 22, 2026. AP Photo/Armando Solis

The death of a major cartel boss in Mexico has unleashed a violent backlash in which members of the criminal group have paralyzed some cities through blockades and attacks on property and security forces.

At least 73 people have died as a result of the operation to capture Nemesio Oseguera Cervantes, or “El Mencho.” The head of the Jalisco New Generation Cartel was seriously wounded during a firefight with authorities on Feb. 22, 2026. He later died in custody.

As an expert in criminal groups and drug trafficking in Latin America who has been studying Mexico’s cartels for two decades, I see the violent aftermath of the operation as part of a pattern in which Mexican governments have opted for high-profile hits that often lead only to more violence without addressing the broader security problems that plague huge swaths of the country.

Who was ‘El Mencho’?

Like many other figures involved in Mexico’s drug trafficking, Oseguera Cervantes started at the bottom and made his way up the ranks. He spent some time in prison in the U.S., where he may have forged alliances with criminal gangs before being deported back to Mexico in 1997. There, he connected with the Milenio Cartel, an organization that first allied, and then fought with, the powerful Sinaloa Cartel.

A red and white poster shows a man's face.
A wanted poster for ‘El Mencho.’
United States Department of State/Wikimedia Commons

Most of the information available points to the Jalisco New Generation Cartel forming under El Mencho around 2010, following the killing of Ignacio “Nacho” Coronel Villarreal, a Sinaloa Cartel leader and main link with the Milenio Cartel.

Since 2015, Jalisco New Generation Cartel has been known for its blatant attacks against security forces in Mexico – such as gunning down a helicopter in that year. And it has expanded its presence both across Mexico and internationally.

In Mexico, it is said to have a presence in all states. In some, the cartel has a direct presence and very strong local networks. In others, it has cultivated alliances with other trafficking organizations.

Besides drug trafficking, the Jalisco New Generation Cartel is also engaged in oil theft, people smuggling and extortion. As a result, it has become one of the most powerful cartels in Mexico.

What impact will his death have on the cartel?

There are a few potential scenarios, and a lot will depend on what succession plans Jalisco New Generation had in the event of Oseguera Cervantes’ capture or killing.

In general, these types of operations – in which security forces take out a cartel leader – lead to more violence, for a variety of reasons.

Mexicans have already experienced the immediate aftermath of Oseguera Cervantes’ death: retaliation attacks, blockades and official attempts to prevent civilians from going out. This is similar to what occurred after the capture of drug lord Ovidio Guzmán López in Sinaloa in 2019 and his second capture in 2023.

Violence flares in two ways following such high-profile captures and killings of cartel leaders.

In the short term, there is retaliation. At the moment, members of the Jalisco New Generation Cartel are seeking revenge against Mexico’s security forces and are also trying to assert their regional authority despite El Mencho’s death.

These retaliatory campaigns tend to be violent and flashy. They include blockades as well as attacks against security forces and civilians.

Then there is the longer-term violence associated with any succession. This can take the form of those who are below Oseguera Cervantes in rank fighting for control. But it can also result from rival groups trying to take advantage of any leadership vacuum.

The level and duration of violence depend on a few factors, such as whether there was a succession plan and what kind of alliances are in place with other cartels. But generally, operations in which a cartel boss is removed lead to more violence and fragmentation of criminal groups.

Of course, people like Oseguera Cervantes who have violated laws and engaged in violence need to be captured. But in the long run, that doesn’t do anything to dismantle networks of criminality or reduce the size of their operations.

What is the current state of security in Mexico?

The upsurge in violence after Oseguera Cervantes’ killing occurs as some indicators in Mexico’s security situation seemed to be improving.

For example, homicide rates declined in 2025 – which is an important indicator of security.

But other measures are appalling. Disappearances are still unsettlingly high. The reality that many Mexicans experience on the ground is one where criminal organizations remain powerful and embedded in the local ecosystems that connect state agents, politicians and criminals in complex networks.

Criminal organizations are engaged in what we academics call “criminal governance.” They engage in a wide range of activities and regulate life in communities – sometimes coercively, but sometimes also with some degree of legitimacy from the population.

In some states like Sinaloa, despite the operations to take out cartel’s leaders, the illicit economies are still extensive and profitable. But what’s more important is that levels of violence remain high and the population is still suffering deeply.

The day-to-day reality for people in some of these regions is still one of fear.

And in the greater scheme of things, criminal networks are still very powerful – they are embedded in the country’s economy and politics, and connect to communities in complex ways.

How does the El Mencho operation fit Mexico’s strategy on cartels?

The past two governments vowed to reduce the militarization of security forces. But the power of the military in Mexico has actually expanded.

The government of President Claudia Sheinbaum wanted a big, visible hit at a time when the U.S. is pushing for more militarized policies to counter Mexico’s trafficking organizations.

But this dynamic is not new. Most U.S. and Mexican policy regarding drug trafficking organizations has historically emphasized these high-profile captures – even if it is just for short-term gains.

A burned car is seen on a street.
Violence has flared in Mexico’s Jalisco state since the death of Nemesio ‘El Mencho’ Oseguera Cervantes.
Arturo Montero/AFP via Getty Images

It’s easier to say “we captured a drug lord” than address broader issues of corruption or impunity. Most of the time when these cartel leaders are captured or killed, there is generally no broader justice. It isn’t accompanied with authorities investigating disappearances, murders, corruption or even necessarily halting the flow of drugs.

Captures and killings of cartel leaders serve a strategic purpose of showing that something is being done, but the effectiveness of such policies in the long run is very limited.

Of course, taking out a drug lord is not a bad thing. But if it does not come with a broader dismantling of criminal networks and an accompanying focus on justice, then the main crimes that these groups commit – homicides, disappearances and extortion – will continue to affect the daily life of people. And the effect on illicit flows is, at best, meager.

The Conversation

Angélica Durán-Martínez has received funding from the Harry Frank Guggenheim Foundation, the Social Science Research Funding and the United States Institute of Peace.

ref. Violent aftermath of Mexico’s ‘El Mencho’ killing follows pattern of other high-profile cartel hits – https://theconversation.com/violent-aftermath-of-mexicos-el-mencho-killing-follows-pattern-of-other-high-profile-cartel-hits-276728

One of the biggest stars in the universe might be getting ready to explode

Source: The Conversation – Global Perspectives – By Sara Webb, Lecturer, Centre for Astrophysics and Supercomputing, Swinburne University of Technology

ESO / L. Calçada, CC BY

One of the largest known stars in the universe underwent a dramatic transformation in 2014, new research shows, and may be preparing to explode.

A study led by Gonzalo Muñoz-Sanchez at the National Observatory of Athens, published in Nature Astronomy today, argues that the enormous star WOH G64 has transitioned from a red supergiant to a rare yellow hypergiant – in what may be evidence of impending supernova.

The evidence suggests we may be witnessing, in real time, a massive star shedding its outer layers, shrinking as it heats up, and moving closer to the end of its short life.

A very special star

WOH G64 was first discovered in the 1970s as as star of interest in the Large Magellanic Cloud, a dwarf galaxy orbiting the Milky Way.

It turned out the star was not only extremely luminous, but also one of the biggest ever discovered: more than 1,500 times the radius of the Sun.

In 2024, WOH G64 was the first star beyond our galaxy ever photographed in detail, thanks to the Very Large Telescope Interferometer. The image showed a clear dusty cocoon around the central giant star, which confirmed it was losing mass as it aged.

From supergiant to hypergiant, big is big

WOH G64 is a young star in the grand scheme of the cosmos, with an estimated age of less than 5 million years old. Unlike our Sun (currently about 4.6 billion years old), WOH G64 is destined to live fast and die young.

WOH G64 was born big, forming from a huge cloud of gas and dust collapsing until the pressure made it ignite. Like our Sun, it would have burned hydrogen in its core by nuclear fusion.

Later it would have expanded and burned helium, becoming what is called a red supergiant.

Not all supergiants become hypergiants. It’s been theorised that hypergiants form when very large stars quickly burn and evolve from burning hydrogen to burning helium.

During this transition, these stars start to shed their outer layers, while their cores begin to shrink inwards. Once a star becomes a hypergiant, it is destined for a quick death in the fiery explosion of a supernova.

What has caused this change seen in WOH G64?

So what happened to WOH G64 in 2014? The new study proposes that a large part of the original supergiant’s surface was ejected away from the star.

This may have been due to interactions with a companion star, which the authors have confirmed exists by looking at the spectrum of light from WOH G64.

Another theory: the star is getting ready to explode. We know stars this big will inevitably go kaboom, but exactly when it will happen can be hard to determine in advance.

One possible scenario is that the transition we’re seeing is due to a pre-supernova “superwind” phase. This is theorised to occur due to strong internal pulsations as the fuel in the core is spent quickly.

Only time will tell

Most stars live for tens of millions or even tens of billions of years. It was never a given we would witness and be able to document so much transformation in a star, let alone one outside our galaxy.

If we are lucky, we will see the death of WOH G64 in our lifetimes – not only providing an incredible intergalactic spectacle but also helping scientists complete the puzzle of this fascinating star.

The Conversation

Sara Webb does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

ref. One of the biggest stars in the universe might be getting ready to explode – https://theconversation.com/one-of-the-biggest-stars-in-the-universe-might-be-getting-ready-to-explode-276519

Can blood tests really detect cancer?

Source: The Conversation – Global Perspectives – By John (Eddie) La Marca, Senior Research Officer, Blood Cells and Blood Cancer, WEHI (Walter and Eliza Hall Institute of Medical Research)

Westend61/Getty Images

If you’re feeling worn out or have suddenly lost some weight, your doctor might send you for a blood test.

Blood tests are a common way health-care professionals detect, diagnose, and monitor a range of medical conditions.

But can they help us detect more serious conditions such as cancer? Let’s dive into the research.

How do blood tests work?

Blood tests are a technique used in the field of pathology, which is the study of the nature and causes of disease.

Blood tests assess what cells, proteins, and molecules are present in the blood. Health-care professionals use them to monitor things like organ health, nutrition levels, immune system function, and the presence of some infections.

To test for anaemia, for example, you would take a blood test and count the number of red blood cells in that blood sample. Another example is blood sugar testing, which is used to measure the glucose levels of a patient with diabetes.

What can blood tests tell us about cancer?

Currently, we can’t reliably diagnose most cancers using a blood test. One major reason is it’s often difficult to distinguish between cancer cells and normal, healthy cells. This is especially true when it comes to early-stage tumours.

But blood test results can give us clues about whether certain cancers are present in the body. So how do they do this?

1. By revealing abnormalities in your blood

Blood cancers will often cause clear changes in the number and types of cells in the bloodstream. We can measure these changes using a complete blood count, also known as a “full blood examination”.

This type of blood test counts all the different types of cells present in the blood: red blood cells, white blood cells, platelets, and more. Blood cancers arise when your body produces an abnormal amount of any type of blood cell. White blood cells, which fight infection, are the most common example. So a high number of one or more of these cell types may suggest the presence of a blood cancer.

But complete blood counts aren’t enough to make a conclusive diagnosis of blood cancer. We need to perform other tests to confirm whether the problem is a cancer or a different disease. These tests may include a biopsy or imaging techniques such as an MRI, CT scan, or X-ray.

2. By identifying “tumour markers”

We can also use blood tests to detect specific proteins which cancer cells often produce in greater numbers. These proteins are known as “tumour markers”.

One example of a tumour marker is prostate-specific antigen. This antigen is a protein made exclusively by the prostate gland. A healthy male will have only a small amount of prostate-specific antigen in his blood. In contrast, a male with prostate cancer will often produce abnormally high levels of this antigen. In this way, the prostate-specific antigen can serve as a “marker” of prostate cancer.

There are many different tumour markers used to identify different cancers. However, measuring tumour markers is not a foolproof solution. This is because they can be influenced by other factors. For example, an injury to or inflammation of the prostate gland could cause prostate-specific antigen levels to increase. So your doctor may perform additional tests to confirm if a person has cancer.




Read more:
Do I have prostate cancer? Why a simple PSA blood test alone won’t give you the answer


3. By locating rogue cells

For other types of cancer, blood tests can look for circulating tumour cells. Circulating tumour cells are produced when cancer cells break off from the original tumour and then enter the bloodstream. This usually only happens when a cancer reaches a more advanced stage and is metastatic, meaning it has spread to other parts of the body.

But this type of test is usually prognostic, rather than diagnostic. This means we can only use it to monitor the progression of a cancer which has already been diagnosed. So if a blood test does identify circulating tumour cells, it is best to conduct additional tests before proceeding with treatment.

So, are we close to creating a cancer-detecting blood test?

Unfortunately, we are yet to find a way to detect cancer with a single blood test. It’s a very difficult task, but researchers are making progress.

Circulating tumour DNA is a current topic of interest. These DNA molecules have mutations which distinguish them from healthy cells and can give information about the cancer they came from.

In one 2025 trial, Australian researchers measured the amount of circulating tumour DNA in 441 people with colon cancer to determine which patients would respond to chemotherapy. Another study from 2025 used circulating tumour DNA to monitor how 940 patients with lung cancer responded to different treatments.

One test did claim to successfully use circulating tumour DNA to detect more than 50 types of early-stage cancer. It’s known as the “Galleri test” and was first trialled in the UK in 2021. However, some experts have since raised concerns about the test’s effectiveness.

Researchers are also exploring other ways of using blood tests. In one 2025 study, Australian researchers adapted an existing test to use blood instead of tissue samples to identify known markers of ovarian cancer.

Another Australian study from 2025 investigated whether molecules other than proteins could serve as cancer markers. It found certain fats in blood can indicate if a patient with advanced prostate cancer will respond to treatment.

So, it looks like we’re still a while away from creating a cancer-detecting blood test. But with some time, effort, and robust research, it could be a possibility.

The Conversation

John (Eddie) La Marca receives funding from Cancer Council Victoria. He is affiliated with the Olivia Newton-John Cancer Research Institute and the Walter and Eliza Hall Institute of Medical Research.

Cameron Lewis receives funding from the University of Melbourne as part of a PhD scholarship. He is employed by Austin Health as a clinical haematologist.

Sarah Diepstraten receives funding from the National Health and Medical Research Council, Cure Cancer Australia and My Room Children’s Cancer Charity.

ref. Can blood tests really detect cancer? – https://theconversation.com/can-blood-tests-really-detect-cancer-269906

We studied primary care in 6 rich countries – it’s under unprecedented strain everywhere

Source: The Conversation – Global Perspectives – By Felicity Goodyear-Smith, Professor of General Practice and Primary Health Care, University of Auckland, Waipapa Taumata Rau

Getty Images

Primary care – the kind delivered by general practice (GP) clinics – is the backbone of every health system. When it works, we barely notice it.

It keeps people healthy, detects problems early, coordinates care and keeps people out of hospital.

But across many high-income countries, despite very different health systems, primary care is under unprecedented strain.

Our recently published paper presents case studies from the United Kingdom, the Netherlands, Canada, the United States, Australia and New Zealand.

All show governments are leaning on primary care to solve increasingly complex health needs. At the same time, bureaucracies are demanding more documentation, compliance, performance metrics and administrative work.

However, very little new investment is going into the four parts of primary care that matter most:

  • continuity: seeing the same health provider over time, rather than pinballing from one specialist to another

  • comprehensiveness: getting the whole family’s physical, mental and social health care from one place

  • coordination: ensuring all the different people and services involved in a patient’s care work together smoothly, information is shared and roles are clear, so patients don’t fall through the cracks

  • first-contact care: being able to get an appointment with a doctor or nurse you know, when you need it.

Ballooning administrative burdens

These are the core functions of effective primary care, and they are what reduce hospital visits. But across many countries, the GP workforce is shrinking or stagnating just as populations are ageing and multi-morbidity is increasing.

Medical graduates are turning away from general practice, citing high workloads, lower pay relative to other specialities, and the emotional weight of increasingly complex care.

Many GPs who stay in practice are reducing their hours, not because they lack commitment, but because the amount of unpaid work required outside of the consulting room makes full-time practice untenable.

Administrative burdens have ballooned. Electronic health-record systems generate endless inbox tasks. As hospitals push chronic care back into the community, GPs absorb more responsibility without receiving the resources to match.

The result is predictable: practices stop enrolling new patients, waiting times blow out, and people who cannot get timely care turn instead to emergency departments.

These alternatives are often far more expensive, lack continuity, and do not offer the long-term relationships that help detect disease early and manage chronic conditions effectively.

Quick wins, long-term losses

Many of the countries facing these problems spend less than 6% of their total health budget on primary care. For example, the US spends 4%, New Zealand 5.4% and Australia 6%. But how the money is allocated is as important as the amount itself.

Funding models in many countries fail to support team-based care – a collaborative, coordinated model of healthcare delivery in which multiple health professionals work together with patients and their families.

Governments often finance new roles – for example, physician assistants – in isolation, without ensuring practices have the infrastructure to integrate them safely and effectively. This creates inefficiencies and fragmentation.

Poorly designed “pay-for-performance” measures can make things worse. So, when funding is linked to disease-specific indicators rather than the core functions of high-quality primary care, clinicians end up spending more time on documentation and less on patients.

Continuity and comprehensiveness, the strongest predictors of better health outcomes, remain largely unmeasured and unrewarded.

The benefits of primary care investment accumulate slowly – fewer hospital admissions, better management of chronic disease, reduced premature mortality. But political cycles reward quick wins. Governments are tempted to fund initiatives that reduce waiting lists in months, not strengthen foundations for decades.

The result is a proliferation of short-term “solutions” that crowd out the long-term reforms primary care actually needs. The system that prevents downstream costs is neglected because its benefits are not immediately visible.

Toward a sustainable health system

Primary care is relationship-based. That continuity – knowing patients, their histories, their families and the context of their lives – is what allows efficient decision-making and prevents unnecessary interventions.

When investment flows into standalone or narrow services instead of strengthening general practice, care becomes episodic. This can result in poor followup and patients bouncing between providers who are working without shared information.

This fragmentation increases costs while reducing quality, even though each individual initiative may look beneficial in isolation. Once the foundation cracks, the entire system becomes more expensive to maintain but less effective.

The solutions are clear, and are strikingly consistent across countries. A whole-of-system approach is needed to:

  • set explicit investment targets for primary care

  • align funding, workforce planning and service delivery

  • invest in true multidisciplinary teams, not piecemeal roles

  • prioritise continuity, comprehensiveness, and first-contact access in funding models

  • and create long-term accountability structures that survive election cycles.

Countries that have strong primary care systems will spend less overall on health, have better population health outcomes, and enjoy greater equity. Those that neglect primary care pay for it many times over in hospital pressures, workforce burnout and widening inequities.

Strengthening primary care is not just another reform. It is the only path to a sustainable health system. Countries that fail to recognise this are already seeing the consequences.

The Conversation

Felicity Goodyear-Smith has received funding from the NZ Health Research Council, the Bill and Melinda Gates Foundation, the Ministry of Business, Innovation & Employment, and other NZ research funding bodies.

ref. We studied primary care in 6 rich countries – it’s under unprecedented strain everywhere – https://theconversation.com/we-studied-primary-care-in-6-rich-countries-its-under-unprecedented-strain-everywhere-276617

A viral monkey, his plushie, and a 70-year-old experiment: what Punch tells us about attachment theory

Source: The Conversation – Global Perspectives – By Mark Nielsen, Associate Professor, School of Psychology, The University of Queensland

David Mareuil/Anadolu via Getty Images

A baby macaque monkey named Punch has gone viral for his heart-wrenching pursuit of companionship.

After being abandoned by his mother and rejected by the rest of his troop, his zookeepers at Ichikawa City Zoo in Japan provided Punch with an orangutan plushie as a stand-in mother. Videos of the monkey clinging to the toy have gone viral worldwide.

But Punch’s attachment to his inanimate companion is not just the subject of a heartbreaking video. It also harks back to the story of a famous set of psychology experiments conducted in the 1950s by US researcher Harry Harlow.

The findings from his experiments underpin many of the central tenets of attachment theory, which positions the bond between parent and child as crucial in child development.

What were Harlow’s experiments?

Harlow took rhesus monkeys from birth, and removed them from their mothers. These monkeys were raised in an enclosure in which they had access to two surrogate “mothers”.

One was a wire cage shaped into the form of a “mother” monkey, which could provide food and drink via a small feeder.

The other was a monkey-shaped doll wrapped in terry towelling. This doll was soft and comfortable, but it didn’t provide food or drink; it was little more than a furry figure the baby monkey could cling to.

A monkey rests snuggled up against its cloth surrogate mother.
The wire ‘mother’ and the soft ‘mother’ in Harlow’s experiment.
Harlow, H. F. (1958). The nature of love. American Psychologist, 13(12), 673–685.

So, we have one option that provides comfort, but no food or drink, and one that’s cold, hard and wiry but which provides dietary sustenance.

These experiments were a response to behaviourism, which was the prevailing theoretical view at the time.

Behaviourists suggested babies form attachments to those who provide them with their biological needs, such as food and shelter.

Harlow challenged this theory by suggesting babies need care, love and kindness to form attachments, rather than just physical nourishment.

A behaviourist would have expected the infant monkeys to spend all their time with the wire “mother” that fed them.

In fact, that’s not what happened. The monkeys spent significantly more time each day clinging to the terry towelling “mother”.

Harlow’s 1950s experiments established the importance of softness, care and kindness as the basis for attachment. Given the opportunity, Harlow showed, babies prefer emotional nourishment over physical nourishment.

How did this influence modern attachment theory?

Harlow’s discovery was significant because it completely reoriented the dominant behaviourist view of the time. This dominant view suggested primates, including humans, function in reward and punishment cycles, and form attachments to whoever fulfils physical needs such as hunger and thirst.

Emotional nourishment was not a part of the behaviourist paradigm. So when Harlow did his experiments, he flipped the prevailing theory on its head.

The monkeys’ preference towards emotional nourishment, in the form of cuddling the furry terry towel-covered surrogate “mother”, formed the foundation for the development of attachment theory.

Attachment theory posits that healthy child development occurs when a child is “securely attached” to its caregiver. This is achieved by the parent or caregiver providing emotional nourishment, care, kindness and attentiveness to the child. Insecure attachment occurs when the parent or caregiver is cold, distant, abusive or neglectful.

Much like the rhesus monkeys, you can feed a human baby all they need, give them all the dietary nourishment they require, but if you don’t provide them with warmth and love, they’re not going to form an attachment to you.

What can we learn from Punch?

The zoo was not conducting an experiment, but Punch’s situation inadvertently reflects the controlled experiment Harlow did. So, the experimental setup was mimicked in a more natural setting, but the outcomes look very similar.

Just as Harlow’s monkeys favoured their terry towelling mother, Punch has formed an attachment to his IKEA plushie companion.

Now, what we don’t have with the zoo situation is the comparison to a harsh, physically nourishing option provided.

But clearly, that’s not what the monkey was looking for. He wanted a comforting and soft safe place, and that’s what the doll provided.

Were Harlow’s experiments ethical?

Most of the world now recognises primates as having rights that are, in some cases, equivalent to human rights.

Today, we would see Harlow’s experiments as a cruel and unkind thing to do. You wouldn’t take a human baby away from its mother and do this experiment, so we shouldn’t do this to primates.

It’s interesting to see people so fascinated by this parallel to an experiment conducted more than 70 years ago.

Punch the monkey is not just the internet’s latest animal celebrity – he’s a reminder of the importance of emotional nourishment.

We all need soft spaces. We all need safe spaces. Love and warmth are far more important for our wellbeing and functioning than physical nourishment alone.

The Conversation

Mark Nielsen receives funding from the Australian Research Council.

ref. A viral monkey, his plushie, and a 70-year-old experiment: what Punch tells us about attachment theory – https://theconversation.com/a-viral-monkey-his-plushie-and-a-70-year-old-experiment-what-punch-tells-us-about-attachment-theory-276625

3 ways Canada can navigate an increasingly erratic and belligerent United States

Source: The Conversation – Canada – By Charles Conteh, Professor of Public Policy and Administration, Department of Political Science, Brock University

The United States Supreme Court recently struck down President Donald Trump’s sweeping global tariffs imposed under the country’s International Emergency Economic Powers Act. The court stated that the law, intended for national emergencies, does not grant the government the authority to impose tariffs.

In early 2025, Trump invoked the act to impose tariffs on Canada, along with Mexico and China, claiming the countries failed to stop illicit drug trafficking into the United States.

The ruling is the latest episode in a political dust-up between Canada and its neighbour to the south which recently involved the Gordie Howe International Bridge linking Ontario and Michigan.

More than steel or stone, the bridge is a symbol of a shared destiny that both respects and transcends differences. Despite their historical, institutional and political differences, Canada and the United States have bonded economically as neighbours, generating shared prosperity over the past two centuries.

In 2023, I wrote a book chapter Canada and the United States: A Symbiotic Relationship or Complex Entanglement? In that chapter, I posed a question: What if the United States becomes more aggressive and even less open to working co-operatively with Canada? To answer that question, Canada can draw lessons from its centuries-long coexistence with an often erratic neighbour to successfully navigate the economic volatility of the present era.

While the recent Supreme Court ruling presents a setback for Trump, it is unlikely to stop him from using U.S. economic and military might as leverage against Canada and other countries. As Canada navigates this belligerent U.S. government, a lingering question is whether this history of interwoven reciprocity is deteriorating into a complex entanglement of vulnerability.

Two neighbours, different worlds

In the book chapter, I describe the Canada-U.S. relationship as a complex picture of deep interdependence, marked by significant power imbalances, and the creative ways Canada has learned to adapt and prosper.

The economic and political interests of the two countries have diverged and converged in undulating waves over the past 200 years. The two economies are inextricably intertwined across a range of sectors, from natural resources and agriculture to advanced manufacturing. Around 70 per cent of Canadian exports go to the U.S., and the share of Canada’s merchandise imports from south of the border was around 59 per cent in 2025.

But for Canada, the relationship is more than just economic interdependence. The U.S. has a population of about 342 million and a gross domestic product about 10 times larger than Canada’s. That sets the stage for an asymmetrical relationship whose threads are woven into the fabric of trade and geopolitics.

For Canada, this can sometimes feel like vulnerability. And that vulnerability is increasingly being exploited by the U.S., creating a general feeling of existential crisis and entrapment.

Nevertheless, Canada can draw from its centuries-long experience to navigate the current headwinds. While the smaller of the two neighbours, it is not entirely dependent on the U.S. for influencing global events or harnessing international opportunities.

Canada has been, and still is, an influential power on the international stage. As a G7 nation, Canada is one of the key pillars in the scaffolding of the global economy. This global standing and international influence give it some room to manoeuvre.

Navigating an existential crossroads

First, in the international arena, Canada must diversify economically and geopolitically to build strategic resilience. Prime Minister Mark Carney is already moving on this front by agreeing to ease mutual tariffs with China. With negotiations to renew the Canada-U.S.-Mexico Agreement (CUSMA) slated for this year, a diversified trading economy will give Canada much greater leverage to navigate the vulnerabilities of asymmetry.

Second, Canada should draw from its record of championing a rules-based order. In recent years, the country has had to skilfully navigate the crossroads of projecting and defending its global and liberal-democratic values during periods of U.S. flirtations with populism, isolationism and anti-international rhetoric. As a middle power, it derives its strength from the rule of law and by presenting a united front with like-minded nations. A wider set of partners means more buffers against trade policy whiplashes and geopolitical shocks from the U.S.

Third, domestically, loosening inter-provincial trade flows, updating anachronistic regulatory frameworks and pursuing digital data sovereignty strategies should be high priorities to fire the full engine of the economy.

Similarly, as I’ve previously argued, Canada should use its comparative advantages in natural resources to create a strong, well-connected critical minerals supply chain. This would give it significant strategic leverage in the global economy as the world shifts to electrification and renewable energy.

Over the past two centuries, Canada has mastered the complex dance of asymmetry. However, the current crisis takes on an existential proportion that will require new agility, courage and decisiveness. It is an inflection point that will mark a consequential shift for the next generation.

Canada’s nimbleness and agility in navigating this political moment could be an model for other countries that must manoeuvre a world where the old rules no longer apply. It can serve as an example for small and middle powers who must navigate a world where great powers are increasingly belligerent.

The Conversation

Charles Conteh receives funding from the Social Sciences and Humanities Research Council of Canada.

ref. 3 ways Canada can navigate an increasingly erratic and belligerent United States – https://theconversation.com/3-ways-canada-can-navigate-an-increasingly-erratic-and-belligerent-united-states-276035

Cameos in ‘Marty Supreme’ ask audiences to dig deeper

Source: The Conversation – Canada – By Joceline Andersen, Assistant Teaching Professor in Communication and English, Thompson Rivers University

In the lead-up to Oscar season, Josh Safdie, the director of Marty Supreme, has been elaborating on the many cameos in his film that build on real-world associations to create a rich cast of characters.

While usually cameo publicity is all about the director’s vision, Marty Supreme’s director of casting, Jennifer Venditti, has also made appearances in press for the film, amid increased recognition for the art of casting.

Marty Supreme is up for nine Oscars, including for casting, the first year this category will be awarded, and Venditti is nominated.

In Marty Supreme, Timothée Chalamet stars as an ambitious table tennis champion running away from his life as a shoe salesman in a largely Jewish slice of 1950s New York. Alongside this star are many other recognizable faces playing cameos.

Finding a famous face in an unexpected place is strangely thrilling. As some of my research has examined, this recognition is the allure behind cameos — small roles where famous and celebrated people play versions of themselves on screen. Cameos are full of contradictions: audiences are taken aback by famous people appearing in front of the camera. They proudly pick out celebrity faces in a crowd.




Read more:
A brief history of celebrity cameos, from ‘Sunset Boulevard’ to ‘Eurovision Song Contest’


Robert Pattinson, Pico Iyer

At a January screening, Safdie clued in London audiences to a Robert Pattinson voice cameo. In the film, Pattinson voices an announcer at the British Open for table tennis.

Pico Iyer, the travel writer Safdie knew from his 2019 TED Talk about ping pong, wrote in the New York Times in January about his own small role. This cameo began with a formulaic query email and Zoom call with Safdie and Venditti.

Writer Pico Iyer’s 2019 Ted Talk: What ping pong taught me about life.

While classic cameos like Jerry Lewis’s appearance in It’s a Mad, Mad, Mad, Mad World (1963) were filmed as cutaways that made for a flexible shooting schedule and assembly-line production, Iyer’s role involved shooting on two continents.

Safdie includes Iyer as a fastidious table tennis official, even though Iyer’s talk argues that ping pong transcends competition as the ultimate model for good diplomacy. Iyer’s TED Talk also sketches out the source material for an unusual minor character arc in Marty Supreme. Between the cameo, the New York Times article and the TED Talk, Safdie creates a maze for the viewer to follow outside of the viewing experience.

Stunt casting

Safdie is no stranger to stunt casting. He and his brother’s 2019 drama Uncut Gems starred Adam Sandler as a jeweller, and featured cameos from non-actors such as musical star the Weeknd and former NBA player Kevin Garnett.

The Hollywood Reporter recently detailed allegations about inappropriate behaviour by a non-actor on the Safdie brothers’ 2017 film Good Time that neither brother has commented publicly on. These allegations in the lead-up to the Oscars may have dampened excitement for casting that blurs acting and reality.

In Marty Supreme, many cameos highlight local colour. John Catsimatidis, New York grocery tycoon and former mayoral candidate, plays a well-to-do speculator bankrolling a line of table tennis balls, the Marty Supreme, that gives the film its title.

Kevin O’Leary

Kevin O’Leary, the wealthy Canadian reality-TV investor angel of Dragon’s Den and Shark Tank fame, appears in a supporting role as the sadistic wealthy husband of a faded movie star played by Gwyneth Paltrow. Surrounded by an entourage of sycophants, he bribes Marty to throw a match to the reigning champion as part of a promotional event for his company.

As O’Leary expressed in Vanity Fair, Safdie was looking for an “asshole,” and he knows how to play that.

Drawing on his savage TV persona, and inviting comparison with
U.S. President Donald Trump’s own reality-TV stardom, O’Leary’s performance relies on the audience to do the heavy lifting of association. Canadian viewers may recall that O’Leary’s 2025 “asshole” moves include supporting Trump’s bid to make Canada the 51st state.

As a supporting actor who plays a pivotal plot role in Marty’s return to grace, O’Leary is hardly a cameoist. And yet, in his first acting role, O’Leary’s persona never fully disappears into the character of the cutthroat mid-century businessman.

Marty Supreme could be an episode of Dragon’s Den, with O’Leary sizing up another hopeful contestant for humiliation or a dream come true. The audience sketches out much of O’Leary’s performance from our own memories of similar viewing experiences, just like we do for other celebrities and movie stars.

Casting against type

After Kevin O’Leary’s appearance, the audience’s second cry of recognition at my local screen was for Marty’s mom: Fran Drescher, best known as the brash, colourful New Yorker from the 1990s sitcom The Nanny. During the filming of Marty Supreme, Drescher was the president of SAG-AFTRA, the union that represents screen actors in the U.S.

Spinning a familiar story of cameo happenstance and friendly connection that is as old as Bob Hope and Bing Crosby’s star-studded 1950s Road movies, Drescher told People that the union brought Safdie and Drescher together when he called her for regular updates during the 2023 actors’ strike.

Safdie’s cameos were to feature people with what Drescher called the right “background”: New Yorkers, many of them Jewish, with local accents. According to Drescher, Safdie intrigued her with a promise to showcase her depth demonstrated during calls explaining labour negotiations. Like Iyer, Drescher was cast in this cameo against the type of her superficial sitcom character.

Labour, cultural contexts also shape cameos

Many cameos of the 1920s and 1930s relied on labour conditions where stars and former stars signed to restrictive contracts could be pulled out of the studio canteen to appear as little more than extras.

This wasn’t because extras were in short supply: according to Kate Fortmueller, who has researched film and TV labour histories, almost three per cent of Los Angeles residents in the 1920s were registered as extras. The unionization of movie actors emerged from a desire to give order to the wannabe actors flooding Hollywood.

Comparable concerns were behind the 2023 SAG-AFTRA strike — a key issue was compensation for actors as streaming media changed where audiences watch screens and convenient AI technology threatens real performers.

Marty Supreme commits to depicting the real New York through cameos that recreate the accents, dialects and unfiltered faces of famous New York actors, and these resonances beyond the screen are part of the film’s allure.

The Conversation

Joceline Andersen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

ref. Cameos in ‘Marty Supreme’ ask audiences to dig deeper – https://theconversation.com/cameos-in-marty-supreme-ask-audiences-to-dig-deeper-273762

Countries in the Americas can act to protect the environment without the United States

Source: The Conversation – Canada – By Alexandra R Harrington, Visiting Scholar, McGill University Faculty of Law, Centre for Human Rights and Legal Pluralism, McGill University

The United States federal government recently revoked a landmark scientific ruling by the Environmental Protection Agency that stated greenhouse gases are a threat to public health. U.S. President Donald Trump said the ruling was a “disasterous” policy that “severely damaged the American auto industry and massively drove up prices for American consumers.”

The revocation is the latest move by a U.S. administration that has framed action to tackle climate change as hampering the U.S. economy. In this context, trade has become a buzzword over the past year. With the focus on tariffs, it is easy to overlook the impacts of U.S. trade policies on the environment and the organizations tasked with bridging the two.

My areas of research focus on international law, specifically environmental law and the intersections between trade and international organizations.

In January, Trump indicated that the U.S. will withdraw from the NAFTA/CUSMA-linked Commission on Environmental Cooperation and the process for dealing with claims that Canada, Mexico or the United States are shirking their environmental commitments — the submission on enforcement matters (SEM) process.

The U.S. withdrawal highlights the importance of these issues at the regional level. It also provides an opportunity for other countries in the Americas to take action on climate change without the United States.




Read more:
Three ways Canada can navigate an increasingly erratic and belligerent United States


What are SEMs?

In 1994, Canada, Mexico and the U.S. adopted the North American Free Trade Agreement (NAFTA) along with two side agreements. One of these was the North American Agreement on Environmental Cooperation (NAAEC), establishing the Commission on Environmental Cooperation and the SEM process.

When NAFTA was renegotiated in 2018, the SEM process was incorporated into the Canada-United States-Mexico Agreement (CUSMA), and the NAAEC was replaced by the Agreement on Environmental Cooperation.

The Commission on Environmental Cooperation is charged with overseeing this agreement, while SEM is the process for dealing with claims that Canada, Mexico or the U.S. are not living up to their environmental commitments.

That process can lead to the creation of a “factual record”; an investigative report detailing the commission’s findings. Although not a legal decision, the factual record is a powerful evidentiary and fact-finding tool to generate reforms.

Reporting on derelict environmental commitments through the SEM process remains a vital tool. It has provided important factual records on leakage from Alberta tailings ponds and failures to protect species such as the loggerhead turtle, North Atlantic right whale and vaquita porpoise, among other issues.

The SEM model was replicated in U.S. trade agreements with Central American states, Colombia, Panama and Peru. In each of these agreements, however, the U.S. was exempted from SEM jurisdiction because it was already under the jurisdiction of CUSMA.

Given the U.S. decision not to provide the core funding needed for these entities to function, it would be possible for the Central American states, as well as Colombia, Panama and Peru, to enter into a separate agreement regarding SEMs. The same would be true for Canada and Mexico under CUSMA.

A new generation of environmental accountability

The U.S. was a driving influence in the creation of the SEM process. And the U.S. retreat could be accepted as a way to end systems that have brought significant issues in national enforcement of environment law to light.

Examples include the failure to properly monitor implementation of environmental laws and standards, ranging from those intended to protect communities living near pollution discharge points to those intended to protect species on the edge of extinction.

Other countries in the Americas now have an opportunity to create a larger environmental oversight mechanism. This would demonstrate their ability to step into the governance gap left by the U.S. and generate stronger regional alliances. This would not only benefit the Americas. It would also provide a model for other international organizations as they face the loss of a powerful member state.

This alternative would entail creating a new SEM process, along with an equivalent to the Commission on Environmental Cooperation to oversee it, linking all members of the impacted agreements and any other interested countries in the Americas. The most comprehensive way to do this would be to negotiate a new multilateral agreement similar to current regional agreements but without the emphasis being on trade.

Similar to the current SEM process, individuals and groups could make submissions claiming that a member state is failing to fulfill its environmental obligations. Once a submission is received, the SEM unit would determine whether it meets basic requirements. If so, the submission would move on and, ultimately, a factual record could be developed.

This alternative framework would demonstrate the collective commitment of countries across the Americas to environmental protection. It would reflect the reality that the Americas face significant shared environmental threats that are also increasingly threats to national security and economic interests.

Such an agreement could mainstream the SEM process, building on provisions established in NAFTA, NAAEC and CUSMA. Existing regional offices could be maintained to ensure strong connections on the ground, and the procedures used could largely be unchanged.

At a time when many countries seem to be focusing on narrow self-interest and military spending rather than the environment, this is a challenging proposition.

However, integrating the SEM process into a new, broader, collective effort would allow American countries to assert hemispheric leadership without having to reinvent the wheel. It would also allow citizens the continued ability to bring claims and to have some accountability.

As the U.S. government withdraws from its international obligations, reconceiving international organizations that are under existential threat is now a necessity. Reconfiguring SEMs throughout the Americas would serve as a model for other organizations and as a way of shifting international organizations to be less dependent on any one state.

The Conversation

Alexandra R Harrington does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

ref. Countries in the Americas can act to protect the environment without the United States – https://theconversation.com/countries-in-the-americas-can-act-to-protect-the-environment-without-the-united-states-275994

Canada is a global leader in obesity care guidelines, so why are Canadians still waiting months for treatment at home?

Source: The Conversation – Canada – By Muhammad Ilyas Nadeem, PhD Candidate in Obesity & Diabetes | Public Scholar (2024-2025), Concordia University

Canada is recognized globally for its world-leading obesity care guidelines — yet Canadians continue to struggle to access the very treatment plans we’ve developed. Meanwhile, the same model of care is now the one the World Health Organization (WHO) is urging other countries to adopt.

The WHO recently released its first ever guideline on anti-obesity medications, reinforcing a chronic disease model of care that Canadian experts have championed for years.

WHO’s stance mirrors the Canadian framework laid out in 2020 clinical guidelines: obesity is a chronic, relapsing disease that requires comprehensive, lifelong care — the kind that includes timely diagnosis, trained providers, co-ordination among the various health professionals involved, mental-health support, and — when appropriate — pharmacotherapy and bariatric surgery.

Despite Canada’s leadership in shaping this global shift, progress at home remains slow and uneven. More than one in four adults now live with obesity and wait times for specialist care have soared to a record high of 30 weeks in Canada. What’s more, in high-income countries, obesity and related chronic diseases tend to disproportionately affect people facing social and economic disadvantage.

When will Canadians see this research put into practice?

Either directly or indirectly, all Canadians are affected by obesity. Obesity remains largely framed as a willpower problem solvable through lifestyle change alone, despite decades of evidence showing it is a complex chronic disease shaped both by biology and environment. It is linked to more than 200 health problems worldwide and contributes to more than 3.7 million deaths annually.

Most health-care systems, including Canada’s, still rely on fragmented, weight-centric guidelines rather than holistic, chronic disease approaches. Even clinicians and clinics that want to follow these evidence-based models often find themselves constrained by limited resources, training, inconsistent insurance coverage and a system that still doesn’t put comprehensive obesity care at the forefront.

Canada has invested millions of dollars in obesity research, leading to the development of forward-thinking, science-backed approaches to obesity care, but system-wide implementation remains painfully slow.

The Canadian paradox: world-class guidance, patchy access

Here’s the bright side: Canada has quietly become an unexpected leader in global obesity care guidelines. Over the past five years, Canadian clinicians, researchers and people with lived experience have helped rewrite the international rulebook for treating obesity.

The 2020 adult guideline was a turning point that reframed obesity. It moved beyond using BMI as the main compass, and reorganized care around what matters to patients: quality of life, function and reduction of related complications, not just kilograms lost. That patient-centred, stigma-free model, along with Canada’s guideline process itself, has since been adapted in Ireland using the ADAPTE framework and in Chile through an international pilot. Several other nations are also integrating elements of the Canadian approach into their own guidelines.

In 2025, two major updates pushed the model further. A pediatric guideline in Canadian Medical Association Journal emphasized multicomponent, family-centred support that addresses mental health, quality of life and cardiometabolic risk, while considering medications or surgery for selected adolescents through shared decision-making.

An adult pharmacotherapy update called for long-term, individualized use of modern anti-obesity medicines — including semaglutide and tirzepatide — and urged clinicians to focus on abdominal obesity and complications rather than BMI alone.

Access to care

Yet a paradox remains: while the world begins to follow Canada’s lead on paper, most Canadians living with obesity still cannot access the level of care these very guidelines envision. Public coverage for anti-obesity medications remains limited and inconsistent across provinces, and private coverage reaches only a minority.

Training gaps compound these access issues. Medical education in Canada has historically overlooked obesity care, leaving many clinicians unprepared to treat patients in line with the guidelines.

Bariatric surgery capacity has been sharply constrained, with reported wait times varying from 1.5 years to nearly nine years, and historic analyses documenting stark interprovincial inequalities. These bottlenecks make it almost impossible to deliver the very guidelines we’ve poured time and funds into.

So far, policy signals are mixed. In March 2025, Alberta became the first — and still only — province to formally recognize obesity as a chronic disease, a move that can unlock more comprehensive coverage and care options. The federal government is reviewing applications for generic GLP-1 drugs which could improve access down the road. But no pan-Canadian policy framework exists, leaving most patients navigating a patchwork system.

In Québec, more bariatric surgeries have been performed relative to need than most provinces but waits remain substantial and public drug coverage for anti-obesity medicines is limited.

Improving the system

Ultimately, before we can improve the lives of our people, we need to improve the system that is supposed to care for them.

The first crucial step would be for more provinces to follow suit with Alberta to recognize obesity as a chronic disease nationwide. Recognition is the gateway to coverage and comprehensive care.

A co-ordinated federal-provincial-territorial framework implementing our guidelines on behavioural/psychological support, pharmacotherapy and surgery should be applied for obesity care in Canada. Make quality of life, mental health, functional capacity and obesity-related complication reduction core performance indicators.

Finally, similar to diabetes care, public and private plans should cover anti-obesity medications where clinically indicated. The absence of coverage continues to hinder access as international guidance embraces modern, chronic-care models for obesity management.

Canada’s impact on modern obesity care is commendable, with countries like Ireland and Chile adapting our model. WHO now supports this same chronic-care approach with its stance on GLP-1 medicines. But if Canada’s own guidelines are not practically applied within our health-care systems, many lives will continue to be at stake, and obesity numbers will continue to climb, as they have for the last several decades.

The Conversation

Muhammad Ilyas Nadeem receives funding from Fonds de recherche du Québec (FRQ)-Santé.

Jessica Murphy has received funding from Fonds de recherche du Québec (FRQ)-Santé.

Sylvia Santosa receives funding from CIHR, NSERC, MITACS, CFDR.

Cristina Sanza does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

ref. Canada is a global leader in obesity care guidelines, so why are Canadians still waiting months for treatment at home? – https://theconversation.com/canada-is-a-global-leader-in-obesity-care-guidelines-so-why-are-canadians-still-waiting-months-for-treatment-at-home-273361