Moncton neurologist asked for help, but alleges was instead threatened with discipline
Internal government documents offer insight into decision to review Dr. Alier Marrero's patient files
On Thursday, Public Health Agency of Canada confirmed its two epidemiologists will work under the supervision of New Brunswick Public Health next month and conduct a "three-day scoping exercise that will include an on-site review of patient records that have been collected to date" by Dr. Alier Marrero.
In a statement, the New Brunswick Department of Health said Marrero has "struggled to fulfil his legally required notification duties under the Public Health Act, and as a result, the department is deploying resources to support him." It is not reopening the investigation into a mystery neurological illness, it said.
Marrero is on vacation and could not be reached for comment, but government emails and letters obtained through right to information requests show he asked the province for help with the required paperwork on May 11.
At that time, he had completed the forms for two patients. Each one was nearly 50 pages and took him a combined six hours, he said.
"Given the significant commitment of time involved in completing these questionnaires, and my busy clinical practice, I would ask for your assistance in completing these forms, as is usually the case when I report cases to the [Canadian Creutzfeldt-Jakob Disease Surveillance System]," Marrero wrote.
Instead, he claims he received a letter from a Vitalité Health Network lawyer about two weeks later "threatening discipline," and accusing him of not respecting the requirements of the Public Health Act, according to the 183 pages of documents.
Cases prompted increased requirements
Under the act, "unusual illnesses" are considered notifiable diseases and medical professionals must report them to Public Health by filling out a special form.
In October 2021, when the province appointed an oversight committee to look into a cluster of 48 of Marrero's patients experiencing neurological symptoms, primarily in the Moncton and Acadian Peninsula regions, it added a requirement that any patients identified as having a progressive neurological syndrome of unknown etiology would require the sign-off of two specialty physicians.
On March 29, 2023, Dr. Jennifer Russell, the province's chief medical officer of health, reminded Marrero of the requirements, as communicated to all provincial physicians in a memo from acting deputy chief Dr. Yves Léger on Oct. 26, 2021, and to Marrero personally in a letter from then-health minister Dorothy Shephard on April 8, 2022.
"Staff have indicated that you have followed the provincial requirements of reporting such cases in only two instances since late 2021," she wrote.
Dr.
Jennifer Russell, the province's chief medical officer of health,
repeatedly reminded Marrero of his obligation to report unusual
illnesses to Public Health by filling out the required paperwork. (Ed Hunter/CBC)
"It is with consternation that I read your letters dated January 30 and March 23, 2023," in which Marrero indicated he had been following the cases of 147 patients, aged 17 to 80, some with "very advance evidence of neurodegenerative diseases," including dementia, severe pain syndrome, brain and muscle atrophy, and some near death.
He also warned that some patients' blood work showed elevated levels for compounds found in herbicides such as glyphosate, and said more testing should be done to rule out environmental toxins, including the neurotoxin BMAA, which is produced by blue-green algae.
"I would ask that you follow this legal requirement," Russell wrote in bold letters.
"The province is not able to make any sort of assessment as to the significance of your findings due to the very limited information provided in your letters.
"We are reliant on you to report these cases to us so that we may gather further information from you that would allow us to determine the relevance of your findings and identify any additional work or scientific and clinical investigation that may be required."
Difficult to obtain second opinions
On April 1, Marrero said he understood the October 2021 directive meant that any unusual illness should be reported to Public Health when the second opinion from another physician had been obtained.
"As I am sure you understand, we are simply not in a position, given the scarcity of resources in our health care system, to obtain timely second opinions for all patients with progressive neurological decline with no known diagnosis."
He claims he made arrangements in 2020-21 for "subject-matter experts" to travel to New Brunswick to evaluate patients, but the province "chose not to avail itself of this invaluable expertise."
On May 5, Russell reiterated the legal obligation of health professionals to report the occurrence of a disease, infection, or condition they reasonably believe could be a risk to the health of the population.
"Attached please find an enhanced questionnaire created to capture the information we are requesting on each patient you have referenced in your letters," she wrote, adding that if Marrero was having issues obtaining needed resources, it was his professional duty to bring this to the attention of his medical department head or other senior clinical and medical leads of Vitalité.
'Extraordinary hurdles'
By the end of May, Marrero's office had completed forms for eight patients, each between 46 and 188 pages, according to the documents. Two of the patients had since died — one within six months of symptom onset, he said, while several other patients' conditions were "rapidly advancing," and some were near death.
"I am certain you can appreciate how difficult it has been for me to advocate for my very sick patients given the extraordinary hurdles that have been imposed on me since May 2021," wrote Marrero.
At that time, he was instructed by Public Health not to report any new cases, he said.
"Shortly thereafter, all scientific work that had been done to investigate the cause or causes of disease in patients was put to a stop, after years of extensive effort."
"Months later, I was directed by government officials not to report cases until I obtained a second opinion from a specialty physician," he said.
Then, in July 2022, he was "suddenly and unexpectedly excluded" from the MIND Clinic, set up to investigate neurodegenerative diseases.
I sometimes sense that my efforts to help my patients are being sidelined with attempts to dismiss my concerns and my pleas and create hurdles, where everyone's priority should be protecting the health and safety of patients and the population of New Brunswick.
- Alier Morrero, neurologist
More recently, Marrero alleges his correspondence to provincial and federal public health officials was forwarded to Vitalité.
He was subsequently summoned to an "urgent" meeting with Vitalité's administration, he said — even before he received an acknowledgement of receipt or response to the Jan. 30, 2023, letter, in which he raised concerns about elevated levels for compounds found in herbicides such as glyphosate.
"Considering this, I sometimes sense that my efforts to help my patients are being sidelined with attempts to dismiss my concerns and my pleas and create hurdles, where everyone's priority should be protecting the health and safety of patients and the population of New Brunswick," he wrote.
Vitalité will "fully collaborate with the exercise undertaken by the New Brunswick Ministry of Health, with the support of the Public Health Agency of Canada," Dr. Anick Pelletier, assistant vice-president of medical affairs, said in an emailed statement.
The additional support provided within the notification process will allow for a thorough review of patient medical records, she said, noting Marrero's schedule will be adjusted to allow him to devote more time to this task.
"It will be up to the Ministry of Health to determine any additional actions that may be necessary," she added.
Methinks the buck stops with Russell N'esy Pas?
David Amos
Glyphosate report not final word, says N.B. health officer
Despite report, acting Chief Medical Officer of Health 'uncertain' on safety of using Roundup
Stephanie Sirois · CBC News · Posted: Aug 02, 2016 4:22 PM ADT
David Wilson
Roughly translated this means that even though you are clearly identifying an ongoing serious health issue you have given us an out to ignore it.
David Amos
Content Deactivated
Reply to David Wilson
Dr. Eilish Cleary studying glyphosate when put on leave
Chief medical officer of health 'surprised and upset' by leave from provincial government
Jacques Poitras · CBC News · Posted: Dec 02, 2015 1:12 PM AST
"Pohl, who is a member of the Council of Canadians, says Cleary responded quickly when she first contacted her about glyphosate. "She was very interested in the issue.
"I'm concerned there might be some corporate or political pressure put on [Cleary] for her to stand aside."
Pohl says Dr. Jennifer Russell, the acting chief medical officer of health, told her on Nov. 9 the glyphosate study was still going ahead, and the office's action plan would be complete before the 2016 spraying season.
Health Minister Victor Boudreau told reporters Cleary's leave "is a personnel matter. It's not something we can comment about. It has nothing to do with the office per se, or the independence of the office. It's an HR issue and I won't comment anymore."
David Amos
Content Deactivated
The plot thickens
"He also warned that some patients' blood work showed elevated levels for compounds found in herbicides such as glyphosate, and said more testing should be done to rule out environmental toxins, including the neurotoxin BMAA, which is produced by blue-green algae.
"I would ask that you follow this legal requirement," Russell wrote in bold letters.
Reply to David Amos
*That's* the thing you got out of the article? Missed the part about bluegreen algae?
David Amos
Content Deactivated
Seems that everything is missing now
jay lett
Regulations, eh?
Keeping healers from healing, educators from educating, farmers from growing, builders from building, employers from employing…
It’s amazing that we can pause reality for 2+ years on a moments notice, but we’re helpless to deal and dispose of the nonsense that’s grinding our nation to a halt?
David Amos
Reply to jay lett
Methinks we get the governments we deserve when apathy rules the day N'esy Pas?
Raymond Leger
The Provincial Health Minister should resign!
David Amos
Reply to Raymond Leger
Yup
This story pushes several buttons which have attracted the attention of many readers, some of whom may be inclined to conspiracy thinking. Unfortunately this article does not describe what efforts have been made to double check Dr. Marrero's work which seems to me to be a big oversight in researching this story. Are there any respected neurologists wo have examined Dr. Marrero's work and if not why not, and if so what were their opinions? A February 4, 2022 report by CBC indicated that "an oversight committee made up primarily of neurologists from New Brunswick" examined Dr. Morrero's contention and found "The oversight committee has unanimously agreed that these 48 people should never have been identified as having a neurological syndrome of unknown cause and that based on the evidence reviewed, no such syndrome exists." Additionally, Dr. Howard Njoo, the deputy chief public health officer with the Public Health Agency of Canada, said the federal agency "supports the investigation's findings that this cluster does not represent a neurological syndrome of unknown cause."
It would seem that Dr. Morrero does not have much if any expert support for his hypothesis.
Brian Hughes
Reply to Brian Hughes
The reference for the quotes above is: ( https://www.cbc.ca/news/canada/new-brunswick/nb-mystery-illness-final-report-1.6362700)
Arthur Seamon
Reply to Brian Hughes
Don’t know if you all understand how New Brunswick works
Michael Cain
Reply to Brian Hughes
There are more than 200 case since then
Susanne Smith
Reply to Brian Hughes
In his interview from June 2023 titled "New Brunswick neurologist Dr. Alier Marrero speaks to CANADALAND about what he sees as an ever-widening mystery in his province"..
"The majority of my patients, first of all, the great majority of my patients, show exposure well beyond detection levels to one or more of these substances [glyphosate, AMPA, glufosinate, and 3-MPPA] and sometimes very high. I’m talking people who are not professionally exposed. They are not working in these industries in any way, and this is the winter time. And this happens to be concentrated in some communities or areas more than others.”
“If you go through the studies, international studies, you don’t find this number of young-onset cases of neuro-degeneration, other than in an epidemic condition, like, for instance, it happened in the United Kingdom with the variant CJD.”
He also says he's rarely the only specialist seeing these people. “In the great majority of these cases, I’m seldom the only specialist who saw them. And the documents I’m providing to public health right now prove that, because they request [information about] what doctors they see, when they see them, and so on and so forth, what tests they have taken. By making me the point, the attention is distracted away from the patients and communities.
Steve Mercer
Reply to Brian Hughes
Seems to most people that you are closing your eye and plugging your ears, much like the college of physicians seems to be doing.
What's the difference between a conspiracy and having it proven as fact? After covid, about 6 months now.
David Amos
Content Deactivated
Reply to Arthur Seamon
Would you like to try to tell me something that I don't already know?
Anybody know who that lawyer is???
"He also warned that some patients' blood work showed elevated levels for compounds found in herbicides such as glyphosate, and said more testing should be done to rule out environmental toxins, including the neurotoxin BMAA, which is produced by blue-green algae.
"I would ask that you follow this legal requirement," Russell wrote in bold letters.
"The province is not able to make any sort of assessment as to the significance of your findings due to the very limited information provided in your letters.
"We are reliant on you to report these cases to us so that we may gather further information from you that would allow us to determine the relevance of your findings and identify any additional work or scientific and clinical investigation that may be required."
If it weren't for documentarians, we'd know nothing about what's obviously a real medical issue, just the implausible denials of the Higgs government.
Because they didn't want to deal with it.
Dr. Eilish Cleary studying glyphosate when put on leave
Chief medical officer of health 'surprised and upset' by leave from provincial government
Dr. Eilish Cleary wrote to a Kent County resident in August that her office would be "developing a plan to further explore" the herbicide, which is used in New Brunswick by forestry company J.D. Irving Ltd. and by NB Power.
This is not a situation where I requested a personal leave.
- Eilish Cleary, chief medical officer of health
Cleary confirmed in an email to CBC News Wednesday that "This is not a situation where I requested a personal leave."
She said she was not allowed to discuss the reasons for the leave.
"I was surprised and upset when it happened. The whole situation has caused me significant stress and anxiety. And not being able to talk about it makes it worse."
WHO deems glyphosate probably carcinogenic
The International Agency for Research on Cancer, a branch of the World Health Organization, deemed glyphosate "probably carcinogenic to humans" earlier this year.
In a letter to Bass River resident Ann Pohl in August, Cleary said she and her staff concurred with the IARC finding and would look into it.
Pohl provided a copy of the letter to CBC News.
Health Canada said earlier this year that the federal Pesticide Management Regulatory Agency would re-evaluate glyphosate, but pending that review, it wasn't considered harmful to human health.
'I'm concerned there might be some corporate or political pressure put on [Cleary] for her to stand aside.'
- Ann Pohl, Bass River resident
If Health Canada found action was needed, Cleary wrote in her August letter, "please be assured that I will take proactive action to ensure that public health in New Brunswick is protected."
Pohl, who is a member of the Council of Canadians, says Cleary responded quickly when she first contacted her about glyphosate. "She was very interested in the issue.
"I'm concerned there might be some corporate or political pressure put on [Cleary] for her to stand aside."
Pohl says Dr. Jennifer Russell, the acting chief medical officer of health, told her on Nov. 9 the glyphosate study was still going ahead, and the office's action plan would be complete before the 2016 spraying season.
Health minister says 'personnel matter'
Health Minister Victor Boudreau told reporters Cleary's leave "is a personnel matter. It's not something we can comment about. It has nothing to do with the office per se, or the independence of the office. It's an HR issue and I won't comment anymore."
In 2012, Cleary wrote a report on what she considered the "social and community health risks" of shale gas development, a report the then-Progressive Conservative government considered keeping secret.
The PCs eventually allowed it to be released.
"I think I have had to re-affirm my right and my ability to speak," Cleary later said about the episode.
Pohl says she admired Cleary's work on shale gas "and we were really hoping she'd do the same thing with the glyphosate spraying issue."
'She's an action hero for us'
"She's an action hero for us in New Brunswick," Pohl says.
"We have so many of these environmental health issues and so many things that we need to be thinking about."
The Liberals, who accused the PCs of trying to "muzzle" Cleary on shale gas, promised in their 2014 election platform to "ensuring the independence of the medical officers of health."
The platform also said any decision on fracking would "follow recommendations of the Chief Medical Officer of Health."
ABOUT THE AUTHOR
Moncton neurologist asked for help, but alleges he was threatened with discipline instead
Internal government documents offer insight into decision to review Dr. Alier Marrero's patient files
Bobbi-Jean MacKinnon · CBC News · Posted: Aug 11, 2023 9:52 PM ADT
"He also warned that some patients' blood work showed elevated levels for compounds found in herbicides such as glyphosate, and said more testing should be done to rule out environmental toxins, including the neurotoxin BMAA, which is produced by blue-green algae.
"I would ask that you follow this legal requirement," Russell wrote in bold letters.
Glyphosate report not final word, says N.B. health officer
Despite report, acting Chief Medical Officer of Health 'uncertain' on safety of using Roundup
Stephanie Sirois · CBC News · Posted: Aug 02, 2016 4:22 PM ADT
Glyphosate report not final word, says N.B. health officer
Despite report, acting Chief Medical Officer of Health 'uncertain' on safety of using Roundup
The glyphosate report released to the public on Friday won't be the last word until Health Canada has weighed in, according to the acting Chief Medical Officer of Health, Dr. Jennifer Russell.
The report on glyphosate uses in New Brunswick began shortly after a branch of the World Health Organization declared glyphosate "probably carcinogenic to humans" in May of 2015.
- The Glyphosate Report
- Critics, industry respond to glyphosate report
- Glyphosate report shows no increased health risk: Dr. Jennifer Russell
"When we contacted Health Canada to find out where they were at with their assessments and find out what we should expect and when we should expect those results from their findings, they said March 2017 so that's what we're waiting for," said Russell on CBC Fredericton's Information Morning.
Glyphosate is a herbicide marketed by the Monsanto corporation, under the trade name of "Roundup" which is used for killing weeds and controlling undergrowth.
The currently released report suggests that while other jurisdictions tend to use the herbicide 90 per cent in agriculture, N.B. uses 60 per cent in its forestry industry with aerial spraying.
Roundup is sold by the Monsanto Corporation as a weedkiller and a way to control undergrowth. (Catherine Harrop/CBC)
She said the report currently released now was never meant to be public, but was made so in the effort to be transparent.
"It was an internal, very technical internal document to provide us with the information that we needed to make decisions about what the risks were for New Brunswickers again, based on usage that currently we are seeing here."
Effects not determined yet
Russell said she had no answer yet what effects other possible compounds regularly mixed with the spray formula could have on humans.
She said the department is waiting on the report Health Canada has promised will be ready by March 2017.
The
report released was intended to be a "technical internal document to
provide us with the information that we needed," says Russell. (CBC)
No precautionary measures suggested
Quebec banned the use of glyphosate on their public forests in 2001 to eliminate the use of chemicals, sometimes referred to as a precautionary measure.
"In certain situations where there is scientific uncertainty, it would be something to undertake, to be erring on the side of caution," said Russell.
Information Morning - Fredericton 15:03 There have been no precautionary measures against glyphosate taken in New Brunswick as of yet, but Russell says the department will continue to actively monitor the status of the herbicide.
"We're very concerned about this as well and we want to make sure we're doing our very best to make sure that the public health of New Brunswickers is protected."
Wow!
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