IMS Magazine Winter 2022 by IMS Magazine

THINK. LEARN. DISCOVER.

WINTER 2022

Men’s Health

Autism Spectrum Disorder An “Extreme Male Brain” Condition?

The Big T Impact of Testosterone on Illness

Cutting into Endocrine Disease Dr. Pasternak on being a Clinician-Scientist Student-led initiative

IMSSA POSTER Co-presidents, Kayvan Aflaki and Serena Peck, would like to thank the outgoing executive team for their excellent leadership and support with transitioning roles to the new executive team

Meet the IMSSA Executives Kayvan Aflaki Co-President, MSc. Student Kayvan studies maternal mortality with the Ontario Coroner. His favourite snack is bananas with peanut butter and if he could have any superpower, it would be the ability to steal other people's superpowers.

Upcoming Events

February

Serena Peck Co-President, MSc. Student

3 Minute Thesis Competition (3MT) (February 10th)

Serena studies the cardiovascular health of women with breast cancer during and after treatment. Her favourite snack is chocolate covered pretzels and if she could have any superpower it would be to read minds.

Black History Month Documentary Screening (February 24th)

March Alex Boshart VP External Affairs, MSc. Student Alex studies kidney transplant rejection, focusing on antibody-mediated rejection. His favourite snack is flat pretzels from Costco with hummus. If he could have any superpower, it would be telekinesis so he could get food from the fridge while sitting on the couch.

IMSSA EDI Book Club (Date TBD) Are You Smarter Than a 4th Year Competition (Date TBD)

Isis So VP Internal Affairs, MSc. Student Isis studies brain recovery after traumatic brain injury. Her favourite snack is sour cream and onion chips. If she could have any superpower, it would be flying so she could beat traffic while commuting and because it would be so cool.

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IN THIS ISSUE Letter from the Editors................................... 4 Director’s Message........................................ 5 Contributors................................................... 6 Infographic..................................................... 8 Features....................................................... 10 BMC Showcase............................................ 16 Viewpoints................................................... 18 Faculty Highlights........................................ 26 Faculty Spotlight.......................................... 30 Diversity in Science..................................... 32 Past IMS Event............................................. 34 Virtual Travel Bite......................................... 35 Raw Talk 104th Episode................................ 36

MAGAZINE STAFF EDITORS-IN-CHIEF: Jason Lo Hog Tian Mikaeel Valli EXECUTIVE DIRECTORS: Stacey J. Butler Dorsa Derakhshan Elizabeth Karvasarski PHOTOGRAPHERS: Dorsa Derakhshan (Director) SOCIAL MEDIA TEAM: Sandy Lee DESIGN EDITORS: Amy Zhang (Director) Sherry An Amy Assabgui Yuejun (Mimi) Guo Abeeshan Selvabaskaran Michie (Xingyu) Wu

JOURNALISTS & EDITORS: S. Hussain Ather Vritika Batura Stacey J. Butler Dorsa Derakhshan Daniel Diatlov Sonja Elsaid Bahar Golbon Junayd Hussain Rehnuma Islam Paras Kapoor Sumiha Karunagaran Zahra Khan Carmen Li Nayaab Punjani Madhumitha Rabindranath Dorsa Rafiei Iciar Iturmendi Sabater Vaidhehi Veena Sanmugananthan Shu’ayb Simmons Lindsey Thurston Kyla Trkulja Sally Wu

FEATURE INFOGRAPHIC By Yuejun (Mimi) Guo, MScBMC Candidate (2T2)

Copyright © 2022 by Institute of Medical Science, University of Toronto. All rights reserved. Reproduction without permission is prohibited. The IMS Magazine is a student-run initiative. Any opinions expressed by the author(s) are in no way affiliated with the Institute of Medical Science or the University of Toronto.

COVER ART By Abeeshan Selvabaskaran, MScBMC Candidate (2T2) FOLLOW US ON SOCIAL MEDIA! www.imsmagazine.com @IMSMagazine @IMSMagazine IMS MAGAZINE WINTER 2022 MEN’S HEALTH |

LETTER FROM THE EDITORS

Letter from the

EDITORS

Photo Credit: Daniel Mitra

We hope you all had a restful and relaxing winter break and welcome you back to school despite yet another round of lockdowns. Given the difficult situation, we are ever more appreciative of the IMS Magazine team and the work that they put in to make this publication possible. This issue focuses on Men’s Health, an important and often under-researched issue that warrants more attention in the media. We highlight the work of IMS members Drs. Robert Hamilton, Mary Seeman, and Meng-Chung Lai who investigate prostate and testicular cancer, schizophrenia, and autism, respectively, all conditions that are of particular importance to Men’s Health. We also put the spotlight on IMS member Dr. Jesse Pasternak and his work as an endocrine surgeon. There are also Viewpoint articles touching upon key topics in Men’s Health. Read about the paternal brain and father-infant relations, the impact of testosterone on illness, and how stoicism in males may impact their health. We also include articles on what we need to do to further promote diversity in science and the challenges with the equitable distribution of PrEP and other treatments for people living with HIV. Lastly, we are excited to present a new type of article – a collaboration with our friends at Raw Talk Podcast based on the content of their recent episode on Science in Social Media. It has been a pleasure working on our second issue as Editors-in-Chief and we are excited to continue to learn and improve the magazine. Please enjoy reading the issue and we hope you all stay safe and healthy during these difficult times.

Jason Lo Hog Tian

Mikaeel Valli

Jason is a fourth year PhD student examining the mechanisms linking HIV stigma and health under the supervision of Dr. Sean Rourke.

Mikaeel is a fifth year PhD student. He works with Dr. Antonio Strafella’s lab that uses neuroimaging techniques to understand the underlying mechanisms in Parkinson’s disease with nonmotor complications.

@JasonLoTweets

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linkedin.com/in/mikaeel-valli/

DIRECTOR’S MESSAGE Photo Credit: Mikaeel Valli

DIRECTOR’S MESSAGE

n this frosty winter of 2022, I hope all our readers are keeping warm, safe from the Omicron wave, and having a productive time with their academic and research endeavours. I am thrilled to read another great issue produced by the IMS Magazine. Yet again, this issue showcases the wonderful work that is happening on the ground at IMS.

DR. LUCY OSBORNE Acting Director, Institute of Medical Science Professor, Departments of Medicine and Molecular Genetics

This Winter 2022 issue takes the opportunity to complement the Summer 2019 issue on women’s health by shifting focus to conditions that have a greater impact on men. Read the work by Dr. Robert Hamilton and his group that are finding ways to improve the quality of life for male patients suffering from prostate and testis cancer. In another feature, Dr. Mary Seeman explains the possible reasons why men develop schizophrenia earlier than women. Also read about the effort made by Dr. Meng-Chuan Lai and his colleagues in understanding whether autism is an “extreme male brain” condition. “Summer Undergraduate Research Program” (SURP) attracts many talented undergraduate and medical students to be involved in medical science research projects at IMS. This issue takes the opportunity to showcase the experience of a few out of the many bright students that participated in this program during the summer of 2021. The application for summer 2022 is underway and I cannot wait to see the great work that the participants of SURP 2022 will produce at the SURP Scientific Day. I extend my sincerest congratulations to the new faculty joining IMS and members that have been promoted within the ranks of IMS! Welcome to the IMS family and I am looking forward to your continued success in your research endeavors. I would like to thank the IMS Magazine’s Editors-in-Chief, Mikaeel and Jason, and all of the editors, journalists, social media, and design team for their excellent production of this issue. I hope you will find the work of my fellow IMS members inspiring as much as I did! Sincerely, Dr. Lucy Osborne Acting Director, Institute of Medical Science

IMS MAGAZINE WINTER 2022 MEN’S HEALTH |

CONTRIBUTORS

Contributors

Winter 2022

S. Hussain Ather is a first year PhD student working under John Griffiths at the Centre for Addiction and Mental Health (CAMH). He uses and develops computational modeling techniques to investigate the brain connectivity structures underlying neuropsychiatric disorders. He also likes cosplaying.

Dorsa Derakhshan is a MSc student at IMS investigating the cognitive effects of repetitive transcranial magnetic stimulation in treatment resistant depression under the supervision of Dr. Peter Giacobbe. She enjoys photography, painting, and working on creative projects in her leisure time.

Stacey J Butler is a third year PhD student at IMS, specializing in respiratory medicine and epidemiology, under the supervision of Dr. Andrea Gershon. Outside of academia, Stacey enjoys creative activities, board games and cooking hearty vegetarian meals.

Shu’ayb Simmons (they/them) is a first year MSc candidate working with Dr. Tripathy at the CAMH Krembil Centre for Neuroinformatics. Their research pertains to the biological crux of disparity, aiming to elucidate the molecular underpinnings of racial disparity in neuropsychiatric illnesses - using bulk RNAseq data. Shu‘ayb enjoys social activism, lyricism, and fashion in their free time.

Junayd Hussain is a first year MSc candidate at University of Ottawa’s School of Epidemiology and Public Health. His research interests lie in clinical epidemiology and health services research, specifically looking at new ways to employ large administrative databases and patient-reported outcomes to improve clinical management of chronic kidney disease. When not aggressively coding and cleaning datasets, Junayd is an avid runner, reader, and smartphone photographer.

Vritika Batura is a third year PhD student with Dr. Aleixo Muise at Sickkids Hospital. She is investigating the role of genetic aetiologies and targeting the associated signaling pathways in the pathogenesis of pediatric inflammatory bowel disease (IBD). She is using patient samples, including patient derived organoids, to understand the mechanism involved in the onset of patient IBD. Apart from research, she loves traveling with the incentive to explore new places, culture and food!

Iciar Iturmendi Sabater is a first year PhD student working with Dr. Meng-Chuan Lai at the Center for Addiction and Mental Health. Her research focuses on understanding how people with autism spectrum disorder cover-up or mask their social and communication differences, a process known as ‘camouflaging’. Iciar enjoys traveling, meeting new people, and spending time with family and friends.

Vaidhehi (Veena) Sanmugananthan is a second year MSc student under the supervision of Dr. Karen Davis at the Krembil Brain Institute, Toronto Western Hospital. Her research focuses on examining pain and attention interactions in people that suffer chronic pain. Outside of the lab, Veena loves to run, play squash, sketch, and challenge herself to learn new art mediums!

shuayb_neuro

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Nayaab Punjani is a second year MSc student at IMS working with Dr. Michael G. Fehlings. Her research is examining a preclinical drug treatment that aims to provide a multifaceted approach targeting neural regeneration and inflammation following cervical spinal cord injury. She enjoys watching action and mystery genre movies and TV shows, and loves sketching in her free time.

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iciar_itur

junayd_h27, shots_by_jh

StaceyBeePhD

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sanmugananthan

Graphic design by Amy Assabgui

CONTRIBUTORS

Bahar Golbon is a first year MSc student investigating the diagnostic study and surgical management of primary hyperparathyroid patients under the supervision of Dr. Jesse Pasternak. In her free time, you can find Bahar struggling to complete her millionth puzzle, and drinking coffee! BaharGolbon

gol_99

Carmen Li is a second year MSc student under the co-supervision of Dr. Thomas Eiwegger and Dr. Theo Moraes at SickKids Hospital. Her work focuses on utilizing flow and mass cytometry to understand the immunological mechanisms of oral immunotherapy in food allergic children undergoing treatment. In her spare time, you can catch her baking or reading in a coffee shop.

Kyla Trkulja is a first year MSc student at IMS studying under the supervision of Dr. Armand Keating, Dr. John Kuruvilla, and Dr. Robert Laister at Princess Margaret Hospital. Her work focuses on novel cancer therapies for lymphoma. Outside of academia, Kyla enjoys reading, writing, road trips, and going for walks in nature

Sumiha Karunagaran is a first year MSc student at the Latner Thoracic Surgery Research Laboratories. Under the supervision of Dr. Stephen Juvet, she is investigating the role of B cells in lung transplant rejection using mouse models. On weekends, you can find Sumi working as a barista at Balzac’s on Market Street. Is there a better match than grad student + coffee? karunasumi

Rehnuma Islam is a PhD student at IMS under the supervision of Dr. Cindi Morshead. She explores the role of neural stem cells in promoting recovery after stroke. Her favorite pastimes involve painting, piano, or a good read.

Social Media Team

2T2 IMS Design Team

Sandy CheEun Lee is a fifth year PhD student under the supervision of Dr. Marianne Koritzinsky at the Princess Margaret Cancer Research Center. Her research focuses on characterizing a novel oxygen sensitive enzyme in the hypoxic tumour microenvironment. Outside of the lab, Sandy enjoys running and exploring new activities like rock climbing!

The 2T2 IMS Design Team is a group of second year MSc students in the Biomedical Communications (BMC) program. Turning scientific research into compelling visualizations is their shared passion, and they are thrilled to contribute to the IMS Magazine.

Amy Assabgui

amya_visuals amyassabgui.com

Mimi Guo

mimi.guo.art mimiguoart.com

Madhumitha (Madhu) Rabindranath is a first year MSc student at IMS who is supervised by Dr. Mamatha Bhat. Her research focuses on leveraging AI to non-invasively diagnose liver graft fibrosis in post-transplant patients. Outside the lab, Madhu likes reading a good book and exploring the city.

Amy Zhang

Sherry An

Abeeshan Selvabaskaran

Michie Wu

(Director) amykzhang.com

abeeshan.art

sher.i.an

michiewu michiewu.com

IMS MAGAZINE WINTER 2022 MEN’S HEALTH |

INFOGRAPHIC

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Compiled by Stacey J. Butler and Nayaab Punjani

INFOGRAPHIC

IMS MAGAZINE WINTER 2022 MEN’S HEALTH |

FEATURE

Improving Quality of Life for Patients with Male Cancers By Kyla Trkulja

ale cancers, specifically prostate and testicular cancer, pose a serious threat to men’s health– both physically and psychologically. While the outcomes of these cancers are more favourable relative to others,1 patients and survivors face a variety of challenges including mental health struggles and lessened quality of life.2 Dr. Robert Hamilton, a surgeon-investigator at the Princess Margaret Cancer Centre, is working to improve the quality of life for these men through both his clinical practice and research. His training included a medical degree (MD) and Urology Residency from University of Toronto, a Master’s Degree from University of North Carolina at Chapel Hill, and a Research Fellowship at Duke University. “I knew I wanted to have my career be more than just sitting in the office seeing the next patient and doing the next surgery,” he said, describing the curiosity that led him to pursue research. “When you’re the one asking the research questions, you quickly realize that you can affect more than just that one patient that’s in front of you.” Dr. Hamilton came to Princess Margaret Cancer Centre in 2012 after completing his Oncology Fellowship in New York City. “I was always interested in cancer, the biology, as well as the psychological or 10 | IMS MAGAZINE WINTER 2022 MEN’S HEALTH

psychosocial functional aspects of what the cancer did to people,” Dr. Hamilton explained. His interest in urology stemmed both from the favourable outcomes, which allows him to positively affect the patients, and from the deep personal interactions with patients due to the intrinsic nature of urological organs. “It’s incredibly rewarding that you can help [patients] in [the psychological] domain as well as conquer the cancer biology.” Dr. Hamilton has seized the unique opportunity to improve the quality of life of cancer patients and survivors both in and out of the clinic. He is currently the only physician in Canada to utilize minimally invasive robotic surgery for testicular cancer, which decreases the length of hospital stay compared to traditional surgery.3 The nerve-sparing small incisions promote a quicker recovery time and cause fewer post-operative complications, making this an innovative technique to improve the quality of life of testicular cancer patients and survivors. To tackle the mental health challenges of survivorship, Dr. Hamilton teamed up with Dr. Anika Petrella who was completing her PhD in health behaviour under the supervision of Drs. Catherine Sabiston and Andrew Matthew. Dr. Petrella started ‘The Ball’s in Your Court’

program in collaboration with the University of Toronto after noticing that the mental health burden on young men diagnosed with testicular cancer was a huge challenge. “These [15 to 35-yearold] men who get told they have testes cancer go from thinking they’re going to live forever to wondering if there’s a chance they could die relatively soon. It’s a fundamental uppercut to the ego, and that has profound implications.” In fact, Dr. Hamilton described this mental shock and denial as the biggest challenge impacting these patients. The unique life experiences and young age of the population meant that these patients could not be effectively integrated into existing survivorship programs. Thanks to Dr. Petrella’s research, a physician- and counsellor-led program was created to engage testicular cancer survivors with physical and group wellness sessions outside of the hospital, allowing them to make meaningful connections, and become more resilient. “You don’t think of yourself as a patient when you’re there,” Dr. Hamilton said. Dr. Hamilton’s translational research covers topics ranging from basic science to population health sciences. In prostate cancer, he focuses on chemoprevention, with an emphasis on statin medications to Graphic design by Amy Assabgui

FEATURE

DR. ROBERT HAMILTON MD, MPH, FRCSC; Clinician-Investigator at Princess Margaret Cancer Centre; University of Toronto Department of Surgery & Division of Urology Photo Credit: Dr. Robert Hamilton

lower cholesterol and improve outcomes after diagnosis. For testicular cancer, his main focus is on survivorship and identifying biomarkers associated with cancer susceptibility and patient prognosis. Before the COVID-19 pandemic, Dr. Hamilton was one of the leaders in utilizing virtual care for his patients to

improve their quality of life. In-person follow-up appointments usually require patients taking time off of work and travelling long distances for a brief appointment telling them that everything is normal. In Dr. Hamilton’s model, after an initial meeting with early-stage cancer patients to discuss diagnosis, staging, and expectations, the remainder of the patient’s visits were virtual unless there was something of concern. Importantly, the virtual care was asynchronous, allowing patients to view their results or ask questions at any time. Dr. Hamilton was also able to interpret test results and answer questions. The ultimate goal was to enhance the quality of life for patients, as well as their adherence to follow-up appointments. The phase one trial for this virtual care system showed promising results. Patient compliance and quality of life improved while clinic burden was reduced. Princess Margaret Cancer Centre was also able to expand its services to more patients in remote areas across Ontario. Even with virtual care becoming more popular as a result of COVID-19, Dr. Hamilton’s asynchronous and patientcentered approach remains unique, and he hopes that his methods will be used to shape the future of virtual healthcare.

him to make a tremendous impact on male cancer patients and survivors. Balancing it all can be a challenge but being able to positively affect people’s lives both in and out of the clinic is described by Dr. Hamilton as an honour and a privilege. “That’s the excitement of it, which I love. I wouldn’t do anything else.” References 1. Filippou, P., Ferguson, J. E., 3rd, & Nielsen, M. E. (2016). Epidemiology of Prostate and Testicular Cancer. Seminars in interventional radiology, 33(3), 182–185. https://doi.org/10.1055/s-0036-1586146 2. Schepisi, G., De Padova, S., De Lisi, D., et al. (2019). Psychosocial Issues in Long-Term Survivors of Testicular Cancer. Frontiers in endocrinology, 10, 113. https://doi.org/10.3389/fendo.2019.00113 3. Ray, S., Pierorazio, P. M., & Allaf, M. E. (2020). Primary and post-chemotherapy robotic retroperitoneal lymph node dissection for testicular cancer: a review. Translational andrology and urology, 9(2), 949–958. https://doi.org/10.21037/tau.2020.02.09

The multiple roles that Dr. Hamilton plays in research and as a physician have allowed IMS MAGAZINE WINTER 2022 MEN’S HEALTH | 11

FEATURE

Why do men develop schizophrenia earlier than women? Dr. Mary Seeman offers possible answers. By S. Hussain Ather

A Disease Marked by Difference

en develop schizophrenia earlier than women, usually by up to three to five years.1,2 Men are also more likely to show harmful symptoms and decreased social functioning, while women respond more rapidly to treatment. However, the reason for these differences is not clear. Researchers have searched for explanations for decades. They have raised potential answers from environmental, psychological, and neurobiological contexts, but the answers are far from straight-forward. Dr. Mary Seeman, Professor Emerita in the Department of Psychiatry at the University of Toronto has dedicated her career to exploring gender differences and disparities in psychiatric diseases. With over 12,000 citations, Dr. Seeman has made significant contributions to her field. In this interview, she sheds light on the complexities of gender and schizophrenia.

Lost in Causes and Conjecture Schizophrenia affects 20 million people worldwide.3 The disease is characterized by delusions and hallucinations, paranoia, and difficulty concentrating that change the brain’s wiring to alter the way we perceive the world. This creates 12 | IMS MAGAZINE WINTER 2022 MEN’S HEALTH

fundamental changes, not only in the way the nervous system reacts to the world around it, but in how patients with schizophrenia develop and construct their own identities. The disease results from a combination of interactions between genetic, psychosocial, and environmental factors. This means the search for the cause of the disparity between men and women depends on this complicated mix of factors. Dr. Seeman noted many possible reasons why men develop schizophrenia earlier than women. These can occur at any time during the life course, even as early as in utero with complications during pregnancy or delivery. Dr. Seeman noted, “all neurodevelopmental illnesses really are far more common in boys.” Early exposure to physical trauma could also expose boys to more neurobiological stressors that could cause the disease. Alongside this, in childhood, males tend to show greater communication problems than females, with a higher prevalence of speech disorders and slower language acquisition. These can contribute to difficulties with emotional expression associated with schizophrenia.4,5 The hormone hypothesis is another explanation for sex disparities in schizophrenia. Low levels of testosterone

in men have been associated with more severe symptoms of the disease. While female schizophrenia patients often have more severe symptoms in the low estrogen phase of their menstrual cycle.1 The gender disparities in schizophrenia may also stem from psychosocial causes. Adherence to traditional normative beliefs of male behaviour and masculinity, notably emotional repression and selfreliance, could be a contributing factor.6 These norms and beliefs discourage men from seeking help and treatment for mental illnesses. There are also important neurobiological components. Schizophrenia patients have deficits in intracortical myelin (ICM), myelin found in the gray matter of the cortex in the brain.7 Rates of myelination also differ between genders, with women showing a higher rate of increase in fiber density in associative white matter regions of the brain as they age.8 These regions consist of myelinated axons, responsible for communication between regions. The brains of patients with schizophrenia tend to have abnormalities in their white matter tracts.9 Dr. Seeman noted, these deficits could also be contributing to the gender differences.

Graphic design by Sherry An

FEATURE

Age of onset for the disease has been observed to be the same in others, and, for families with a history of schizophrenia, the difference in age of onset is typically eliminated, Dr. Seeman noted.

On ways to move forward

DR. MARY SEEMAN MDCM, FRCPC, DSc Professor Emerita in the Department of Psychiatry Photo Credit: Kenneth Chou

Dr. Seeman and other researchers have presented various answers to the question of why there exists a difference in expression and disease progress in men and women diagnosed with schizophrenia. The links between these answers and the disparity itself can be explored more thoroughly. It is still unclear how exactly these causes play out in the grand scheme of schizophrenia. Exploring the underlying etiology and pathophysiology of the disease through interdisciplinary research in psychiatry, epidemiology, and similar fields, could shed light on this relationship.

References 1. Li R, Ma X, Wang G, et al. Why sex differences in schizophrenia?. J Transl Neurosci. 2016 Sep;1(1):37. 2. Leung MD DA, Chue MRC Psych DP. Sex differences in schizophrenia, a review of the literature. Acta Psychiatr Scand. 2000 Jan;101(401):3-8. 3. James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 Nov 10;392(10159):1789-858. 4. Seeman MV. Care gaps in schizophrenia: male/female differences. The University of British Columbia: This Changed My Practice. 2013 Mar 18. 5. Seeman MV. Does gender influence outcome in schizophrenia?. Psychiatr Q. 2019 Mar;90(1):173-84. 6. Lanzenberger R, Kranz GS, Savic I. Sex Differences in Neurology and Psychiatry, 1st edition. Elsevier; 2020. 7. Tishler TA, Bartzokis G, Lu PH, et al. Abnormal trajectory of intracortical myelination in schizophrenia implicates white matter in disease pathophysiology and the therapeutic mechanism of action of antipsychotics. Biol Psychiatry Cogn Neurosci Neuroimaging. 2018 May 1;3(5):454-62. 8. Schmithorst VJ, Holland SK, Dardzinski BJ. Developmental differences in white matter architecture between boys and girls. Hum Brain Mapp. 2008 Jun;29(6):696-710. 9. Fields RD. White matter in learning, cognition and psychiatric disorders. Trends Neurosci. 2008 Jul 1;31(7):361-70. 10. Folnegović Z, Folnegović-Šmalc V. Schizophrenia in Croatia: age of onset differences between males and females. Schizophrenia research. 1994 Dec 1;14(1):83-91. 11. Jablensky A, Cole SW. Is the earlier age at onset of schizophrenia in males a confounded finding?: Results from a cross-cultural investigation. The British Journal of Psychiatry. 1997 Mar;170(3):234-40.

Finally, Dr. Seeman noted that the discrepancy between men and women could also hinge on issues of sampling, confounding variables, and the individuals studied. “There are many parts of the world where this conclusion may not apply.” In some countries, such as Croatia, no gender difference was observed.1⁰,11 IMS MAGAZINE WINTER 2022 MEN’S HEALTH | 13

FEATURE

Is autism an “extreme male brain” condition? A conversation about sex and gender variability in autism with Dr. Meng-Chuan Lai By Iciar Iturmendi Sabater

utism diagnoses are three to four times more common in men than women. Women are diagnosed with autism later than men. A growing number of concerns have been raised over ascertainment bias in autism. Does the male to female ratio in autism diagnosis truly range from 4:1 to 3:1? Or is it possible that a particular research focus on male samples has led to autism definitions solely drawn from the observation of autistic male characteristics?1 Dr. Meng-Chuan Lai’s scientific work lies at the center of this debate. Dr. Lai is an associate professor at the University of Toronto’s Institute of Medical Science (IMS), and a psychiatrist and O’Brien Scholar at the Centre for Addiction and Mental Health and the Hospital for Sick Children. As a Clinician-Scientist, he studies sex and gender variability in individuals with neurodevelopmental conditions, especially autism. A theory that may be associated with this ascertainment bias in autistic* women and explain sex and gender differences in prevalence rates is the “extreme male brain” hypothesis, proposed twenty years ago. It was derived from the observation that in the general population and at the group level, women are on-average better at understanding the world through a social or empathizing lens, whereas men are on-average better at grasping meaning from a more technical lens. Yet among the autistic population, autistic women 14 | IMS MAGAZINE WINTER 2022 MEN’S HEALTH

match their male counterparts’ higher systemizing abilities compared to their empathizing abilities. Thus, the extreme male brain hypothesis states that autistic women may show a shift towards ‘male’ profiles in these specific cognitive and behavioural characteristics.2

Before diving into this explanation, Dr. Lai emphasizes that “future autism research should differentiate sex and gender, and account for diverse gender identities.”

Dr. Lai calls for careful interpretation of this hypothesis, “the extreme male brain hypothesis, when misunderstood and mistaken as a fact, has led to the stereotype that autistic women should look like autistic men. As a consequence, lots of autistic women who do not show characteristics close to stereotypical autistic men would be perceived as not autistic. This negative impact was not intended based on my understanding of the hypothesis.” For Dr. Lai, the hypothesis was formulated from a cognitive and behavioural lens and confined in the domains of “empathising” and “systemising,” but it does not necessarily extrapolate onto the origins and neurobiological mechanisms underlying autistic cognition and behaviour.

First, studying sex and gender influences may point towards different sex- and gender related origins of autism. Population studies suggest that multiple genetic factors contribute to the development of autism, and that the genetic load required for autism to manifest is higher for female than male individuals. Beyond genetics, it is possible that male-specific factors make boys more prone to developing autism. For example, higher levels of prenatal sex steroid hormones relate to heightened autistic-like traits or autism diagnosis likelihood later in life.3 This link between sex-hormones and autistic characteristics could reinforce the idea that autism is indeed an extreme male brain condition. However, new research challenges the extreme male brain hypothesis by considering how biology and social factors relate to sex and gender differences in autism.3

There are three main reasons why it is important to go beyond the extreme male brain hypothesis of autism and study of sex and gender influences in autism, which Dr. Lai refers to as the “ABCs”: A for Aetiology (origin), B for Biological heterogeneity, and C for Clinical practice and care. At each level, research on sex and gender variability may reveal new information about the nature of autism.3

The idea of heterogeneity posits that the biological and developmental factors that lead to autism vary from one individual to another. That is, the different developmental pathways lead to autism and the adaptation of autistic individuals, like many roads lead to Rome. While many research efforts currently aim to unveil the sex and gender neurobiology that may differentially underlie autistic Graphic design by Michie (Xingyu) Wu

FEATURE

DR. MENG-CHUAN LAI, MD, PhD Staff Psychiatrist, Clinician Scientist and O’Brien Scholar at the Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health, Hospital for Sick Children, and University of Toronto. Associate Professor in the Department of Psychiatry, and Graduate Faculty at the Institute of Medical Science and Department of Psychology, University of Toronto. Honorary Visiting Fellow at the Department of Psychiatry, University of Cambridge. Adjunct Attending Psychiatrist and Assistant Professor of Psychiatry at the National Taiwan University Photo Credit: CAMH

characteristics, Dr. Lai pioneers research on social phenomena that may influence the manifestation of autistic features. Part of his work focuses on understanding so-called camouflaging behaviours used to manage the impression one causes on others with the aim to pass as ‘normal’.

Dr. Lai’s research suggests that autistic women are more likely to camouflage their autistic characteristics (social and communication differences, restricted interests, and repetitive behaviours) than autistic men. This observation has led to the hypothesis that recognizing autism may be easier and come earlier in boys and men since girls and women invest greater efforts in going unnoticed as autistic.5 This would mean that autism is not necessarily more common in boys and men, but rather that it is harder to acknowledge in girls and women. Future research is required to clarify how these differences in camouflaging are driven by biological, cultural, and developmental factors. As a psychiatrist, Dr. Lai became interested in understanding how differently people process and cope in social situations throughout his general psychiatric training early in his career. This takes us to the last level of importance in understanding sex and gender differences in autism: clinical practice and care. “My research ideas are not necessarily pre-defined, but more posthoc: they come after learning from clinical encounters and lived experiences shared by many autistic people,” Dr. Lai shares. In recent years, the autistic community has emphasized the need to make research in autism participatory. Autistic individuals should be included in the design, implementation, and interpretation of findings. Dr. Lai suggests that “it is not just about learning directly from autistic individuals, but also from their caregivers.”

In this way, Dr. Lai’s work at the IMS reconciles understanding sex and gender variability in autism from an aetiological, biological, and clinical practice lens. To achieve this, he highlights the importance of interdisciplinary collaboration and participatory research, “true collaboration should involve a commitment and discussion from the earliest stages when studies are being conceptualised and designed, rather than just receiving input on the interpretation of findings later on.” The interdisciplinary and collaborative products of Dr. Lai’s research on sex and gender influences in autism may help gain a better understanding of this condition in the years to come. * Identity-first language has been used throughout this article to fit evidence available on the language preferences of the autistic community.6 References 1. Mo K, Sadoway T, Bonato S, Ameis SH, Anagnostou E, Lerch JP, et al. Sex/gender differences in the human autistic brains: A systematic review of 20 years of neuroimaging research. NeuroImage Clin. 2021; 32:102811. 2. Baron-Cohen S. The extreme male brain theory of autism. Trends Cogn Sci. 2002;6(6):248–54. 3. Lai MC, Lombardo M V., Auyeung B, Chakrabarti B, Baron-Cohen S. Sex/Gender Differences and Autism: Setting the Scene for Future Research. J Am Acad Child Adolesc Psychiatry. 2015;54(1):11–24. 4. Lai M-C, Lombardo M V, Ruigrok AN, Chakrabarti B, Auyeung B, Szatmari P, et al. Quantifying and exploring camouflaging in men and women with autism. Autism . 2017; 21(6):690-702. 5. Kenny L, Hattersley C, Molins B, Buckley C, Povey C, Pellicano E. Which terms should be used to describe autism? Perspectives from the UK autism community. Autism 2016; 20(4): 442-62.

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BMC SHOWCASE

Master of Science in

Biomedical Communications

Clownfish in Sea Anemone by Livia Nguyen

Livia Nguyen

During undergrad, I found myself gravitating towards visual media when learning difficult scientific concepts and was propelled to explore the field of visual science communication further. I collaborated with professors to create visual learning aids for a course on global human health and illustrate figures for a textbook on metabolic bone disease. The sense of purpose and enjoyment I felt while working on these projects is what ultimately led me to apply to the BMC program. In the future, my goal is to work on projects related to game-based learning and explore the use of AR/VR in science communication.

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BMC SHOWCASE Before embarking in earnest on my journey into illustration and design, I studied at McGill University, completing an honours degree in environmental science and a minor in classical history. In my time there, I worked as a field assistant in an ecology lab, a bee surveyor in Panama, and a museum volunteer — all of which allowed me to see a host of different perspectives on the valuable role of art in science. It was there that I became inspired to pursue a career that allows me to use my artistic skills to further design and science communication among disparate communities.

Aimy Wang

Chagas Disease by Aimy Wang

“

Invasive species pose a major risk to the vibrant biodiversity of the Great Lakes ecosystem. Using data from the Great Lakes Aquatic Nonindigenous Species Information System (GLANSIS), I created this infographic to introduce the impact of non-native species and the measures we take to combat them.

Invaders from Distant Waters by Aimy Wang

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“

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Beyond the Oedipus Complex:

What we know about parent-infant relations and why research on the paternal brain may have lagged behind

By Iciar Iturmendi Sabater

Trapped in myth

n Greek mythology, the king of Thebes is warned by an oracle that his son, Oedipus, will slay him, take over the throne, and marry the queen, Jocasta (Oedipus’ own mother). Interestingly, the impact of this omen has reached beyond the ending of Sophocles’ Oedipus Rex, and has continued to inspire thinkers until today. In The Interpretation of Dreams (1899)1, Sigmund Freud (1886-1939) referred to this myth to represent a child’s unconscious desire to get rid of his father to remain merged to his loving mother, naming it the “Oedipus Complex”. From the start of the 20th century, psychology has carried the weight of the negative connotation of father-infant relations introduced by Freud. It may be time neuroscientific and psychological research on fathers raises its voice over this myth.

A Nobel Prize drawing attention to mothers Ten years after the publication of Freud’s The Interpretation of Dreams (1899)1, oxytocin was discovered by Sir Henry H. Dale (190 9). He found that this hormone, produced in the brain’s hypothalamus and released by the posterior pituitary gland, induced uterus contractions in a pregnant cat. Oxytocin is produced in higher concentrations in women than men. It was the first polypeptide hormone to be synthesised, which earned Vincent du Vigneaud the Nobel Prize for Chemistry in 1955. The discovery drew world-wide 18 | IMS MAGAZINE WINTER 2022 MEN’S HEALTH

attention and recognition to the power of medical research in unveiling the mechanisms of the maternal brain. Oxytocin (from Greek, meaning “sudden delivery”) is now used to induce labour, known to control lactation and to be involved in diverse reproductive functions in women, including the regulation of the menstrual cycle.2, 3 While knowledge on the functions of oxytocin in mothers kept growing throughout the second half of the 20th century, interest remained limited in understanding to what extent fathers shared oxytocin-related parental functions with mothers, or what alternative mechanisms may underlie the fatherinfant relationship.⁴

of emotion (let that be ceaseless crying and screaming), but she further works through these in her own mind and reflects them back to the infant in a digestible, more tolerable way. For example, the mother opens her eyes widely and slowly says: “I know why you are crying: you are hungry! Food is coming soon”. In this way, Winnicott argued, the mother provides ‘holding’ for the infant’s mental states, or a secure psychological base from which to make sense of one’s intense emotions and to begin exploring the outside world.⁵ It is possible to draw parallels from Winnicott’s work with later findings from neurobiological research.

Parents as mirrors

Metaphors for brain function

As the positivist emphasis of the 20th century propelled neurobiological research on the maternal brain, the development of psychological theories on the mother-infant relationship silently advanced in parallel.

Emotion regulation (provided by a mirroring and holding mother) is known to be mediated by top-down control of the brain’s highly evolved prefrontal cortex, which is in charge of executive control, over more primitive structures like the amygdala, a region highly reactive to emotional triggers.

Freud’s differentiation of the role of the mother and father in the psychological upbringing of their infant is arguably sexist as seen through today’s lens. Yet his work lit the spark for others to reflect upon the psychological processes through which the mother introduces a newborn infant to the world. British paediatrician Donald Winnicott (1896-1971) dedicated his life’s work to this matter. Winnicott studied in detail how the mother acts as a mirror for her infant’s intense emotions: not only is she receptive to the infant’s manifestations

Neuroimaging research finds that functional brain connectivity between the prefrontal cortex and amygdala is not yet established in infants and young children. However, when young children are exposed to the same stressful situation in the presence of their mother, connectivity between these regions is boosted, as if the mother was providing some type of stress buffering or holding their child’s emotions.⁶ This boost in connectivity is, in part, explained by the release of oxytocin, Graphic design by Sherry An

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stimuli are not as different from that of mothers as previously thought. From a theoretical perspective, psychologists have proposed that fathers promote interactions with the outside world and provide their children with discipline that sets limits to keep them safe.3

Children drawn by Winnicott. Winnicott resorted to drawings during his therapy sessions and to illustrate his theories on the mother-infant relationship. He called the drawings produced in the therapeutic process “squiggles”.8

Neurobiological discoveries about the maternal brain have historically advanced in parallel to the development of psychological theories on the motherinfant relationship. Perhaps, using psychological theories to guide medical research on father’s brains can accelerate our current understanding of the fatherchild relationship, and let it finally break free from the Oedipus Complex myth.

Source: Thinking About Children (R.Shepherd, J.Johns, H. Taylor Robinson (Eds.). 1996).

known to be triggered by social stimuli. In young children, this occurs especially in the presence of the mother. Over time, oxytocin further promotes the formation of social preferences and modulates attachment behaviours.⁶

mirroring functions? Current and future research is aiming to target this gap in the psychological and neuroscience literature.

Interestingly, prefrontal-amygdala connectivity increases with age. Adolescents can regulate their own emotions when the mother is absent, as oxytocin release becomes less specifically sensitive to mothers’ presence and generalizes to other social stimuli. Maternal presence no longer affects amygdala-prefrontal connectivity, and the individual becomes independent to regulate and hold their own mental states.⁷

The present theoretical and evidence-based research on the maternal brain clearly outweighs that of the paternal brain. Yet, promising lines of research are building to understand the brains of fathers.

Why wouldn’t this top-down connectivity also be supported by paternal holding and

The future of research on the paternal brain

Research on hormones and neurotransmitters beyond oxytocin (i.e., vasopressin, testosterone, endogenous opioids, norepinephrine, prolactin, GABA, serotonin) is providing novel insights into the parental brain. Neuroimaging studies are finding that fathers’ responses to their own infants’

References 1. Freud S, Strachey J. The interpretation of dreams. New York: Avon Books. 1965. 2. Dumais KM, Veenema AH. Vasopressin and oxytocin receptor systems in the brain: Sex differences and sex-specific regulation of social behavior. Front Neuroendocrinol. 2016 Jan 1;40:1–23. 3. Marazziti D, Baroni S, Mucci F, Piccinni A, Moroni I, Giannaccini G, et al. Sex-Related Differences in Plasma Oxytocin Levels in Humans. Clin Pract Epidemiol Ment Health 2019 Mar 27;15(1):58. 4. Swain JE, Dayton CJ, Kim P, Tolman RM, Volling BL. Progress on the paternal brain: theory, animal models, human brain research, and mental health implications. Infant Ment Health J. 2014 Sep 1;35(5):394–408. 5. Winnicott DW. The theory of the parent-infant relationship. Int. J. Psycho-Analysis. 1960;41:585–95 6. Gee DG, Gabard-Durnam L, Telzer EH, Humphreys KL, Goff B, Shapiro M, et al. Maternal buffering of human amygdala–prefrontal circuitry during childhood but not adolescence. Psychol Sci. 2014 Nov 20;25(11):2067. 7. Nelson EE, Panksepp J. Brain Substrates of Infant–Mother Attachment: Contributions of Opioids, Oxytocin, and Norepinephrine. Neurosci Biobehav Rev. 1998 May 1;22(3):437–52. 8. Winnicott DW. Selected Drawings. Collect Work D W Winnicott. 2016 Oct;279–88. 9. Winnicott, DW. A child psychiatry case illustrating delayed reaction to loss. Drives, Affects, Behavior. 1965; 2:341-368.

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The Big T

Is Testosterone a Key Player in Illness Disparities Seen Across Sex? By FirstName LastName

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By Shu‘ayb Simmons

Graphic design by Michie (Xingyu) Wu

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Introduction: Disparities in Illness Across Sex

isparities in disease incidence across males and females are well established. Here, the word ‘disparity’ serves to denote the unequal incidence of illness manifestation across sex. In general, males are more susceptible to infectious diseases whereas females are more prone to autoimmune diseases.1 There equally exist illnesses that affect only one sex or one sex in the majority. For example, only females attain certain autoimmune diseases, such as Turner Syndrome, and are more likely to manifest conditions such as Chronic Fatigue Syndrome (CFS).2 Males, on the other hand, are more likely to attain illnesses such as stomach cancer, abdominal aortic aneurysms, tuberculosis, esophageal cancer, and liver cancer. So why do these disparities in illness incidence occur across sex exist? They can be attributed mainly to variations in the immune system across sex due to factors like high testosterone levels and chromosomal differences.

A Key Distinction: Sex vs. Gender The operative words in this article are female and male (i.e., sex) and not woman and man (i.e., gender). Sex and gender are not analogous nor interchangeable. Sex denotes one’s biological chromosome makeup (male = XY, female = XX, etc.). Contrarily, gender refers to the social role one chooses to adopt. This is an important distinction to highlight as the crux of this article focuses on sex.

The Immune System & Sex Threats to one’s health are not few and far between; bacteria, toxins, and viruses can all cause illness and potentially death. So how exactly do we humans defend ourselves from these serious threats? The immune system is the first common biological defence that pathogens (i.e., illness-causing substances) meet. The immune system is incredibly complicated. In simplified terms, it is a series of cells that aim to conquer the threat (i.e., the antigen) to maintain the host’s health (i.e., the human). The immune system is

capable and consists of two components. The first is innate immunity, which can be considered the general immune response. The second is adaptive immunity and mounts a pre-programmed immune response to similar antigens that once invaded the host body, providing the host with a more specific immune defence. The immune system, however, is not infallible and proves virtually useless against specific predators like Naegleria fowleri (the braineating parasite). The immune system is also not universal, and its efficacy can be largely determined by the environment and the individual in question. Additionally, the human immune system is ‘sexually dimorphic,’ a million-dollar phrase meaning that the immune response is different across sex.

The Big T: Testosterone Hormones are chemical signals of the endocrine system and are secreted by the endocrine glands. Hormones can be divided into two broad classes: steroid or peptide hormones.3 Hormones and behaviour are bidirectional; hormones influence behaviour, and, in turn, behaviour influences hormones. Testosterone (The Big T) is a cholesterolderived steroid hormone and is one of four androgens. It is synthesized by the ovaries and adrenal glands in females and by the Leydig cells and adrenal glands in males.4 Testosterone is present in both females and males, although at a much higher quantity in males, and is critical for developing male characteristics.4 Testosterone also boasts immunosuppressive (i.e., immune system weakening)1 and analgesic (i.e., pain-relieving) qualities, indicating that it can lower the immune system’s efficacy and make pain more bearable. Granted, not all research supports this theory. Nowak and colleagues (2018) did not find a positive relationship between testosterone and immunosuppression.5 However, this finding was only significant when considering body mass index (BMI) and age as covariates in their model, suggesting that these are potential confounders. There has been an equal query as to whether testosterone promotes aggressive behaviour since it is marginally beneficial in bouts of human aggression,6 however, further research is

required to assess the robustness of this relationship due to the paucity of research on the matter.

Additional Key Players & Conclusion Testosterone is not the only key player in the sexual dimorphism of the immune response and its consequent effect on the immune system. Factors such as one’s genetic makeup also play a role. Males possess XY chromosomes, whereas females have XX chromosomes. The haploidy (i.e., the singular appearance of X) of the male chromosome is costly; it renders males more susceptible to infectious diseases and diminishes immune system efficacy. Experimental studies in autoimmune encephalitis mice assessing the effect of sex chromosomes on illness have found that mice with XX chromosomes experienced worsened disease progression compared to XY mice.1 Difference in lifestyles across sex (e.g.., differences in engaged behaviour, thus changing one’s environment) is another potential key player in the disparities of the immune system between sex. Although–immunologically speaking– the Big T may sometimes cost the win, it’s a fascinating hormone with a fascinating immune system interplay. I doubt anyone could imagine a world without testosterone. References 1. Klein, S. L., & Flanagan, K. L. (2016). Sex differences in immune responses. Nature Reviews. Immunology, 16(10), 626–638. https:// doi.org/10.1038/nri.2016.90 2. Faro, S. et al. (2016). Gender Differences in Chronic Fatigue Syndrome. Reumatología Clinica (Barcelona), 12(2), 72–77. https://doi. org/10.1016/j.reumae.2015.05.009 3. Simmons, S. (2021). Diurnal Variation in Male White-Faced Capuchin (Cebus imitator) Faecal Glucocorticoids, Testosterone and Dihydrotestosterone [Unpublished Undergraduate Thesis]. York University. 4. Jordan-Young, R., & Karkazis, K. (2019). Testosterone: An Unauthorized Biography (pp.1-23). Harvard University Press, https://doi. org/10.4159/9780674242647 5. Nowak, P. et al. (2018). No evidence for the immunocompetence handicap hypothesis in male humans. Scientific Reports, 8(1), 7392–11. https://doi.org/10.1038/s41598-018-25694-0 6. Book, S. et al. (2001). The relationship between testosterone and aggression: a meta-analysis. Aggression and Violent Behavior, 6(6), 579–599. https://doi.org/10.1016/S1359-1789(00)00032-X

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How Stoicism could lie at the root of men’s health issues

By S. Hussain Ather

en are less likely than women to wear face masks and find themselves at greater risk of being infected with COVID-19, but for what reasons? According to a recent study, it is not socially desirable to be seen wearing a face mask.1 Being conditioned not to show fear in light of the pandemic, these men have embraced a form of masculinity that can interfere with their personal health. These tough, “macho” behaviors rely on never showing weakness, suppressing one’s emotions, and remaining self-reliant. Through “Stoicism,” a philosophical school of thought for dealing with distress and anxiety, these men find answers. With the popularity of websites like “Daily Stoic” and books like “Meditations,” a series of personal writings in which Stoic philosopher Marcus Aurelius journaled his own self-improvement as he sought peace, Stoicism has offered insights into behavior, attitudes, and lifestyles that could influence to this day. These new attitudes towards life could also bring differences in health outcomes. The ideas and beliefs of Stoicism could lie at the root of many mental health issues men face. Indeed, upon examining the attitudes of Stoic philosophers, it is evident how the philosophy might encourage men to deny or minimize health-related issues. 22 | IMS MAGAZINE WINTER 2022 MEN’S HEALTH

A Doctrine against Disaster When Greek philosopher Zeno of Citium founded Stoicism, it was a school of thought that emphasized wholesomeness and peace of mind. Upon finding himself in the disastrous face of a shipwreck, Zeno needed to find the answers to some of life’s deepest questions. By studying the works of Socrates and Marcus Aurelius, he conceptualized Stoicism, a term borrowed from the Greek phrase “stoa poikile”, meaning “The Painted Porch,” where Zeno taught his students. At the heart of the system of belief lies an aversion to fear and pleasure, alongside an emphasis on reason (i.e., logic), sometimes described using the Greek word logos. Stoics used the phrase seminal logos (“logos spermatikos’’) to refer to the law of generation in the universe. As in, by the divine law of logos, reason had the power to work and create all things in the universe. If the universe were a computer, then logos would be its operating system. Orthodox stoicism comprised a set of principles that embodied features commonly used to describe “harmful masculinity”. These include, but are not limited to, behaviours such as hypersexuality, aggression, homophobia, and limited expression of one’s emotional

range. In the 17th century, Neostoicism emerged as an amalgam of Stoic and Christian ideas and principles. When upholding this ideology, one can overcome unwanted emotions through reason while also maintaining the Christian ideal that God’s suffering should be endured. This form of Stoicism still retained the ideas or methods of how, through analyzing one’s own judgements, one could find peace from any sort of negativity. This would later evolve into contemporary Stoicism.

Men vs. Reason What ties the toxic, harmful forms of masculinity that prevents men from seeking treatment to the ideals and principles of contemporary Stoicism? Professor Emerita of Sociology and gender theorist Raewyn Connell describes that when practicing or embracing ideals of emotional restraint and hiding vulnerability, men may refuse or remain averse to seeking treatment for mental health issues.2,3,4 And, in some ways, Stoicism was meant to be a philosophy for men. As the Historian of Medicine Ludwig Edelstein described, “The difference between the Stoics and other philosophers, Seneca says, is the difference between men and women; those who have chosen the Stoa have chosen the manly, the heroic Graphic design by Amy Assabgui

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- Epictetus

“

Man is not worried by real problems so much as by his imagined anxieties about real problems.

outcomes vary by socioeconomic status.9 The risk for hypertension, for example, goes down with increasing levels of education. There’s an irony in how a philosophical doctrine meant to guide men to peace through a reason-derived approach to their emotions may serve as a detriment to their health. Could a healthier, more positive form of Stoicism emerge from the struggles men face? Stoic emotional repression, as it plays out, can’t be ignored. References

Can we improve our health through reason alone? Stoicism offers a tough solution to men’s problems. Illustration by: Amy Assabgui

cause.”5 In response to these stiff, rigid norms, men don’t reach out for help, much like a Stoic might refuse to do so as well.6

Expressions among Ethnic Groups

When performing research, four quantities (stoic taciturnity, stoic endurance, stoic serenity, and stoic death indifference) can be measured to determine how “stoic” one is.7 Although, from here, it is still not clear how differently men and women score in terms of stoicism. While one study showed that about 30% of men had “strongly endorsed stoicism” compared to about 20% of women, another study showed similar scores for both men and women.8

For men of color, emotional stoicism within cultures can also disrupt health outcomes. For example, the high-effort masculinity-informed method of coping observed among Black men, known as John Henryism, hinges wholly on emotional stoicism. While this form of “high effort” coping in response to the psychosocial stressors of racism may provide relief for certain psychological distresses in temporary contexts, in the long-run, health

1. Capraro V, Barcelo H. The effect of messaging and gender on intentions to wear a face covering to slow down COVID-19 transmission. PsyArXiv. Preprint posted online May. 2020;11. 2. Connell, R. W. Masculinities. Polity, 2005. 3. Connell, R. W., and James W. Messerschmidt. “Hegemonic Masculinity.” Gender & Society, vol. 19, no. 6, 2005, pp. 829-859. 4. Javaid, Aliraza. “Hegemonic Masculinity, Heteronormativity, and Male Rape.” Male Rape, Masculinities, and Sexualities, 2018, pp. 155-193. 5. Edelstein L. The meaning of stoicism. Harvard University Press; 1966. 6. Moore, Andrew, et al. “Troubling stoicism: Sociocultural influences and applications to health and illness behaviour.” Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, vol. 17, no. 2, 2012, pp. 159-173. 7. Pathak, Elizabeth B., et al. “Stoic beliefs and health: development and preliminary validation of the Pathak-Wieten Stoicism Ideology Scale.” BMJ Open, vol. 7, no. 11, 2017, p. e015137. 8. Murray, Greg, et al. “Big boys don’t cry: An investigation of stoicism and its mental health outcomes.” Personality and Individual Differences, vol. 44, no. 6, 2008, pp. 1369-1381. 9. James S.A. John Henryism and the health of African-Americans.

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We need to do more to promote diversity in science By Madhumitha Rabindranath

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Graphic design by Amy Zhang

s part of my graduate seminar series, I recently attended a lecture on “diversity, equity and inclusion (DEI) in scientific research”. It was refreshing to see the issue tackled directly but I could not help but think that it is about time! With increasing public pressure catalyzed by the Black Lives Matter movement, various academic institutions are taking more active approaches to show their support.1 Some recent examples include land acknowledgments during presentations, department-specific DEI committees and representatives, new initiatives to attract diverse talent through fellowships, and scholarships. Although these measures are a step forward, the question remains if they are effective or merely tokenistic. Current policies tend to re-affirm the universities’ commitment to diversity which often includes trying to increase representation in their faculty and student body.1 This is crucial since representation greatly matters in any form. Whether it is providing funding for under-represented students or hiring professors with diverse backgrounds and identities, these measures reinforce a sense of belonging. A recent study showed that approximately 54% of minority individuals comprised of mostly female respondents stated that interacting with gender and ethnicitymatched STEM professionals provided sufficient encouragement to pursue the associated professions.2 The exposure does not necessarily have to be direct interaction, as 56% of participants in the same study stated that increased media exposure of gender and ethnicity-matched STEM professionals (e.g., Instagram influencers) also provide a similar effect. This supports the policies that universities are enacting in hiring diverse role models in high academic positions and starting mentoring opportunities which can foster recruitment to academia. Newly hired academics from an ethnic minority, in turn, can become mentors themselves, continually increasing the representation of minority groups in science.3 Ultimately, increasing the number of individuals from various backgrounds in academia through institution-led DEI policies can help attract minority populations to these fields. Low representations of minorities in academia can also present challenges in

VIEWPOINT safeguarding DEI. Although dismantling the barriers to academia should be a priority for every member of an institution, the few minority professors or scientists hired at universities are often expected to tackle this behemoth alone.4 Known as “cultural taxation”, these professors are often asked to participate in DEI committees, mentoring upcoming scientists with similar backgrounds or any DEI-related commitments. Interestingly, most of these responsibilities are often under-recognized and uncompensated even though many universities proclaim their commitment to DEI.4 This “tax” infringes on the paid protected time that is required to complete research-related activities, including publishing articles especially in high-impact journals, which are particularly important for acquiring funding. This issue may further exacerbate the discrepancies in research funding awarded to minority-ethnic scientists. For example, African-American scientists are 10% less likely to receive funding from the US National Institute of Health.4 This disparity shifts the efforts of promoting DEI to tokenism as minority faculty members are seen as “representatives” of their associated ethnicity, gender, sexual orientation, and disabilities. These individuals should not be expected to carry the sole responsibility for changing the current scholarly climate which requires the collaboration of privileged allies and a conscious effort by institutions to tackle structural biases.

Some of these biases are so entrenched in academia that certain groups are often excluded such as scientists with medical conditions or disabilities.6,7 Ranging from inaccessible lab spaces and equipment to lack of support and mentoring, upcoming scientists with disabilities feel discouraged from pursuing graduate work or often fail to complete their degrees.7 This again illustrates that issues with DEI in science are not primarily about representation; tailored support systems need to be in place to adequately help minority students, faculty, and scientists. These past two years have shown that biases perpetuate systemically, and thus, to promote DEI in academia, sufficient time and effort must be invested to create a truly inclusive environment. Universities, professors, scientists, and students must play an active role, which can include participating in DEI training and advocating for their peers.

Although some of the challenges faced by academic minorities can be overcome by increasing numbers, the promotion of DEI in academia should not be confined to this objective. Surprisingly, increasing exposure and individuals from a particular background may not lead to significant changes in the culture of their respective fields. A study published in JAMA Surgery found that male physicians tend to refer their patients to male surgeons while this effect was not seen with female physicians.5 The authors present a harsh reality that even with increasing females in this field, these biases will continue to exist as their results show no changes in over-referrals to males during the study period. This example further supports the idea that we cannot simply increase the number of individuals from a particular group; institutions need to do more.

1. Forrester N. Diversity in science: next steps for research group leaders. Nature. 2020;585:S65–7. 2. Kricorian K, Seu M, Lopez D, et al. Factors influencing participation of underrepresented students in STEM fields: matched mentors and mindsets. Int J STEM Educ. 2020;7:16. 3. Fadeyi OO, Heffern MC, Johnson SS, et al. What Comes Next? Simple Practices to Improve Diversity in Science. ACS Cent Sci. 2020;6:1231–40. 4. Gewin V. The time tax put on scientists of colour. Nature. 2020;583:479–81. 5. Dossa F, Zeltzer D, Sutradhar R, et al. Sex Differences in the Pattern of Patient Referrals to Male and Female Surgeons. JAMA Surg [Internet]. 2021 [cited 2021 Nov 23]; Available from: https://doi. org/10.1001/jamasurg.2021.5784 6. Brown E. Disability awareness: The fight for accessibility. Nature. 2016;532:137–9. 7. Bayer GSM Skylar. Our Disabilities Have Made Us Better Scientists [Internet]. Scientific American Blog Network. [cited 2021 Nov 27]. Available from: https://blogs.scientificamerican.com/voices/our-disabilities-have-made-us-better-scientists/

Ultimately, the current DEI policies and measures put forth by various institutions are a starting point. They seem to predominantly focus on increasing the number of diverse faculty and mentors but as illustrated, it is not enough. Measures need to be put in place to ensure that all individuals are well supported. Primarily allocating seats at the academic table for individuals from minority backgrounds is insufficient; institutions are also responsible for ensuring they thrive. References

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FACULTY HIGHLIGHTS

Promoted IMS Faculty Promoted to MEMBER EMERITUS

Promoted to ASSOCIATE MEMBER

Promoted to FULL MEMBER

Dr. Mike Wiley is Professor Emeritus in the Division of Anatomy of the Department of Surgery. He has served as Graduate Coordinator of the Department of Anatomy and Cell Biology and Chair of the Division of Anatomy. He is the recipient of numerous teaching awards including the Aikins Award, the Graduate Course Director Award of the Institute of Medical Sciences, the Teaching Award of the Ontario Council of University Faculty Associations, and the President’s Teaching Award of the University of Toronto.

Dr. Paul R T Kuzyk (BSc(Eng), MD, MASc, FRCSC) is an orthopaedic surgeon at Mount Sinai Hospital with clinical focus on complex hip surgery and cartilage transplant surgery. He has published over 90 peer-reviewed articles and received multiple grants for research on hip replacement surgery and fresh osteochondral allograft transplantation for hip and knee cartilage defects.

Dr. Moumita Barua is a Senior Scientist at the Toronto General Hospital Research Institute and an adult nephrologist. She is also Associate Director of the Hereditary Kidney Disease Clinic at TGH. Her internationally recognized research program focuses on identifying genetic causes of kidney diseases which are further studied in clinically relevant models. The Barua lab has contributed new disease genes, changed the paradigm of understanding genetic causes and advanced mechanistic understanding. Their work is currently supported by CIHR and the Alport Syndrome Foundation.

Dr. Reg Gorczynski (PhD, MD, FRSM (UK), Fellow Polish Academy Scientist) now retired, is an Emeritus Professor in the IMS and UofT still actively engaged in research and supervision of graduate students, along with Editorial Board duties for 6 journals. He has published over 390 peer-reviewed articles and has trained over 40 Masters and PhD students. His interests include many facets of immunoregulation in oncology, infection, allergy and autoimmunity, and transplantation.

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Dr. Rodrigo Mansur is a psychiatrist at the University Health Network (UHN). His research focuses on the role of metabolic mechanisms in the etiopathology of mood disorders, and the development of mechanistically novel interventions for these conditions. Dr. Mohammad Ali Shafiee is an Associate Professor and a Clinician Teacher at Toronto General Hospital, University of Toronto. He is interested in basic physiology-oriented studies using Simulation, Extended Reality, and AI to improve Medical education besides patients’ care.

Dr. Masoom Haider (MD, FRCPC) is a Clinician Scientist and Professor in the Joint Dept of Medical Imaging at Sinai and UHN. He is the Head of the Radiomics and Machine Learning Lab at the Lunenfeld Tanenbaum Research Institute and Director of the Research MRI facility at Sinai Health System. Dr Haider holds a Chair in AI, Imaging Biomarkers and Radiomics at Mount Sinai Hospital. He has conducted extensive research in the field of Body MRI and in particular prostate MRI as well as Abdominal CT. He has supervised graduate students in IMS and multiple postdoctoral fellows in Machine Learning and MRI. He has held positions as the Head of Abdominal MRI at UHN and Chief of Dept at Sunnybrook Health Sciences Center. Graphic design by Amy Zhang

FACULTY HIGHLIGHTS

Dr. Lihi Eder is ClinicianScientist at Women’s College Research Institute and Associate Professor of Medicine, University of Toronto. Her research focuses on clinical outcomes of psoriatic arthritis and cardiovascular morbidities in rheumatic diseases.

Dr. Shreejoy Tripathy aims to understand brain cell type diversity, bridging genetics and gene expression with cell and circuit physiology. His long-term goal is to better understand the cellular changes that underlie psychiatric and neurological disorders.

Dr. Robert M Hamilton is a heart rhythm/ inherited arrhythmia specialist at SickKids. His interests are translational research around gene and novel biomarker discoveries that improve diagnosis, understanding and therapy of these life-threatening disorders.

Dr. Seema Mital (MD, FACC, FRCPC) is Professor & Staff Cardiologist in Heart Failure/ Transplantation, and Head of Cardiovascular Research at the Hospital for Sick Children. She is a Clinician-Scientist, PI of the Ontario-wide Heart Centre Biobank (theheartcentrebiobank.com), and Scientific Lead of the Ted Rogers Centre Cardiac Precision Medicine Program (tedrogersresearch.ca).

Dr. David Barron is Division Head of Cardiac Surgery at Sick Kids and Professor of Surgery at University of Toronto. He came to Canada in 2019 after 20 years at Birmingham Children’s Hospital, UK. He has a doctorate from Imperial College, London in cardiac bioassistance. He currently supervises a MSc and a PhD student at UofT.

Dr. Meng-Chuan Lai (MD, PhD) is a psychiatrist at CAMH and an Associate Professor at the Department of Psychiatry. As a CIHR Sex and Gender Science Chair, his work focuses on how sex- and gender-related factors act as modulating mechanisms for the presentation and adaptation, clinical recognition, neurobiology and etiologies of neurodevelopmental and co-occurring mental health conditions.

Dr. Tereza Martinu obtained her Medical Degree from McGill University and subsequently completed specialty medical and research training at Duke University. In 2014, Dr. Martinu joined the Toronto Lung Transplant Program as lung transplant respirologist and clinician-scientist and as assistant professor at the University of Toronto. In her clinical time, Dr. Martinu cares for lung transplant patients and candidates. In her research time, she studies immunological and cellular mechanisms of chronic lung allograft dysfunction in humans as well as in animal models.

Dr. Maryam Faiz is an Assistant Professor in the Department of Surgery. She received her PhD from the Autonomous University of Barcelona (Spain) and then trained with Dr. Milos Pekny (University of Goteborg, Sweden), and with Dr. Andras Nagy (Lunenfeld-Tanenbaum Research Institute, Toronto). She started her lab in 2017, which is interested in astrocyte heterogeneity and how it is established, the roles of astrocytes in the injured/diseased brain, and how this knowledge can inform future therapeutic interventions for brain injury and disease.

Dr. Marco Battaglia (MD) is a Professor of Psychiatry at the University of Toronto and a Clinician Scientist at the Centre for and Addiction and Mental Health. He studies both general population and clinical samples by developmental, geneticallyinformative designs (e.g. twin cohorts, families, developmental cohorts) via the adoption of quantitative intermediate phenotypes. He also investigates early parental separation in man and rodents: how this type of early adversity influences basic systems for harm detection, including suffocation, pain, and fear. IMS MAGAZINE WINTER 2022 MEN’S HEALTH | 27

FACULTY HIGHLIGHTS Dr. Abha Gupta is an associate professor in the Department of Pediatrics at the University of Toronto, crossappointed as a staff oncologist at the Hospital for Sick Children and Princess Margaret Cancer Center.

New IMS Faculty Dr. Ahmed N Hassan is a psychiatrist and a clinician scientist at the Center for Addiction and Mental Health. He has a particular research interest in the biopsychosocial aspect of addictions, improving the care for patients with concurrent disorders.

Dr. Abhishek Pratap leads an artificial intelligence and digital health group (www.aid4mental. health) at the Krembil Center of Neuroinformatics, CAMH. The group focuses on understanding what kind of tech-enabled solutions work for whom, when, and for how long.

Dr. Katharine Dunlop is a Scientist (St. Michael’s Hospital) and an Assistant Professor of Psychiatry (UofT). Her research uses TMS, neuroimaging and multivariate methods to develop biomarkers of treatment response and suicide risk in depression.

Dr. David Langelier is an Assistant Professor and Clinical Investigator of Medicine. His research focuses on improving functional impairments and quality of life in cancer survivors and increasing exercise participation in individuals with cancer.

Dr. Rinat Nissim is a psychologist and the co-director of the Caregiver Clinic at the Department of Supportive Care of the Princess Margaret Cancer Centre, and an assistant professor in the Department of Psychiatry at the University of Toronto.

Dr. Abigail Ortiz is a psychiatrist and Lead of the Bipolar Integrated Care Pathways at CAMH. Her research focuses on characterizing clinical trajectories and forecasting episodes in mood disorders using nonlinear techniques and wearable devices.

Dr. David Castle is the Director of the Centre for Complex Interventions (CCI) at CAMH. He has wide clinical and research interests, including schizophrenia, bipolar disorder, cannabis and methamphetamine, OCD spectrum disorders and disorders of body image.

Dr. Barnett-Tapia studies what outcomes are relevant for people with neuromuscular disease and neurofibromatosis, and how these can be integrated into clinical decision-making and trials. She has experience with quantitative and qualitative methods.

Dr. Luka Milosevic’s lab studies deep brain stimulation, plasticity, and patho-physiology in neurological disorders. Techniques include intracranial human brain recordings, signal processing, brain machine interface, machine learning, modelling, and more.

Dr. Raymond Kim (MD/PhD) is a medical geneticist specializing in hereditary disorders, clinical genetics and genomics. His research interests include whole genome sequencing, liquid biopsy in cancer early detection, and patient registries.

Dr. Damien Gallagher is an assistant professor of Psychiatry and staff geriatric psychiatrist at Sunnybrook Health Sciences Centre. His research focuses upon cognitive dysfunction in depression & strategies to prevent cognitive decline in later life.

Dr. Catharine Walsh is a clinician scientist SickKids and an Associate Professor in IMS, IHPME and Department of Paediatrics. Her research examines factors that influence the acquisition and assessment of clinical skills amongst health professionals.

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Graphic design by Amy Zhang

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Healthcare Behind Bars

Let’s Talk Grad School

100 Years Later: Insulin and Beyond

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Refugee Healthcare in Canada

Vaccines: Making History

IMS MAGAZINE WINTER 2022 MEN’S HEALTH | 29

FACULTY SPOTLIGHT

Cutting into Endocrine Disease with Dr. Jesse Pasternak

By Bahar Golbon

urgery is a unique medical field where science meets art. It is an area suited for trailblazers and those who can stomach a challenge. Dr. Jesse Pasternak is one such individual working as an Endocrine Surgeon at the University Health Network and as an Assistant Professor in the Department of Surgery at the University of Toronto. His clinical specialty is surgical intervention for patients with endocrine gland tumors. Endocrine surgery meshes the complexity of the endocrine system with the precision and innovation of oncologic surgery. Dr. Pasternak primarily operates on the thyroid, parathyroid and adrenal glands, focusing on minimally invasive and targeted therapy. Surgical treatment of endocrine disease has evolved substantially over the past couple of years, hence evidence-based results are necessary to appropriately guide diagnosis and treatment regimens. Currently, Dr. Pasternak’s research focuses on optimizing health outcomes for patients with endocrine disease by improving treatment guidelines. He develops innovative approaches to remove tumors; some surgical innovations include performing scarless thyroid surgery and using special dyes and light frequency to visualize essential blood networks in the neck during surgery. Additionally, he uses large datasets describing demographic, preoperative, surgical, and postoperative data to understand trends. He describes, “We have a high-volume specialized practice, so with adequate collaborations 30 | IMS MAGAZINE WINTER 2022 MEN’S HEALTH

we are able to generate large sets of past patient data to answer clinical questions.” He continues, “Being a clinician-scientist allows you to ask impactful questions. You’re using your clinical knowledge and experience to generate those questions and from there, using your scientific knowledge to answer them sufficiently.” Dr. Pasternak collaborates with national and international colleagues in the clinical research and teaching spheres. His work is a true testament to the importance of collaboration and its necessity in gathering a holistic understanding of endocrine disease in varying geographic regions, ethnicities, and cultures. “The Institute of Medical Science (IMS) provides a large network of local, international students, and clinical researchers to fuel academic partnerships. It brings people that have an academic research interest into the clinical world to bridge the gap.” As a newer member of the IMS, Dr. Pasternak is thrilled to join this renowned faculty. Dr. Pasternak entered the medical field with the goal to specialize in endocrinology due to personal family experiences with chronic endocrine disease. However, after becoming involved in surgery during a medical elective, he discovered his fascination with the field. “The ability to work with my hands and combine medical knowledge to cure disease instantaneously was amazing”, Dr. Pasternak recounts. During his journey, he was mentored by Canadian leaders in endocrine surgery, including Drs.

DR. JESSE PASTERNAK with his adorable children! MD, MPH, FRCSC Division of General Surgery, Sprott Department of Surgery – University Health Network Assistant Professor of Surgery, Temerty Faculty of Medicine – University of Toronto Associate Member, Institute of Medical Sciences – University of Toronto Photo Credit: Dr. Jesse Pasternak

Graphic design by Sherry An

FACULTY SPOTLIGHT issue in 2005 and continues to be a success to this day, highlighting dozens of undergraduate researchers. Today, Dr. Pasternak mentors multiple graduate students who have come to work with him from universities across the world. He remarked that his “proudest academic accomplishment was when he awarded his first student a PhD.” That student is now an academic surgeon, teaching and mentoring their own students. “This is the idea behind academic surgery, you may help one person in an operating room theater, but you help many by teaching someone how to perform that operation,” this seems to be his motto on surgical education. Within the world of research, he believes this idea applies even more dramatically. “If you can provide students with an approach to ask and answer questions, the potential for discovery to help save and improve patients’ lives is endless.” Dr. Pasternak is a dedicated researcher who volunteers much of his time to the professional development of his trainees. To conclude, he shares a curious aspect to his story: “I did not have a clear vision of my career early on. I wanted to be an innovator and make an impact in the field, so I think putting those ideas together are what carried me through to the place that I am today and hopefully will continue to guide me as I move through my career.”

Dr. Jesse Pasternak conducting endocrine surgery alongside a team of healthcare professionals at a University Health Network affiliated hospital. Photo Credit: Dr. Jesse Pasternak

Adrienne Melk, Lorne Rotstein and Janice Pasieka who have made impactful contributions in this field. He has also been trained by endocrine surgery pioneers at University of California San Francisco. His work there involved understanding the fine meticulous operations and the complex medical feedback mechanisms, critical to treating patients in the field of surgical endocrinology. Dr. Pasternak has also completed his graduate studies at Harvard University in clinical epidemiology and biostatistics.

Aside from his clinical work, Dr. Pasternak spends much of his time within his research program. He was first interested in research as a high-school student working in a genetics lab at SickKids hospital. During his undergraduate career at McGill University, he realized that it was difficult to highlight early career researchers in established peer-reviewed journals. This inspired him to co-found the McGill Science Undergraduate Research Journal with his fellow students. The journal published its first IMS MAGAZINE WINTER 2022 MEN’S HEALTH | 31

DIVERSITY IN SCIENCE

PrEP-ing for HIV

By Rehnuma Islam

pproximately 62 000 Canadians are living with the Human Immunodeficiency Virus (HIV).1 In fact, roughly two thousand Canadians are diagnosed with HIV every year, and around 13% are unaware of their HIV positive status.1 HIV diagnosis involves testing for antibodies against the virus and viral components (e.g., antigens or nucleic acid) in blood samples. More recently self-testing was approved for use within Canada.2 HIV is contracted following exposure to vaginal fluid, semen, blood or breast milk and often manifests flu-like symptoms.2 As the disease progress into a chronic HIV infection, it can be asymptomatic.2 Left untreated, HIV enters a phase where the immune system is severely damaged, ultimately favouring opportunistic infections.2 This phase of the disease is termed Acquired Immunodeficiency Syndrome (AIDS) and the viral load is high. Without treatment, the estimated survival within this phase is around three years.2

University of Toronto; “We have this relatively underutilized but really […] blockbuster intervention which is PreExposure Prophylaxis (PrEP). So, a lot of my research program involves working on PrEP, which is a hugely effective and safe intervention that we don’t utilize well enough in Canada, unfortunately.”

There are numerous preventative measures one can take to avoid contracting HIV. Some of which include frequent status testing, discussing one’s status among partners, practicing safe sex, and not sharing needles. According to Dr. Darrell Tan, a clinician-scientist at St. Michael’s Hospital and associate professor at the

PrEP is given to individuals that are HIV negative to reduce the risk of contracting HIV. Previous research has highlighted the efficacy and safety of PrEP. However, even after a decade, individuals at risk of contracting HIV are seldom prescribed PrEP due to a lack of education and conversation surrounding its use.

32 | IMS MAGAZINE WINTER 2022 MEN’S HEALTH

Dr. Tan was elected as a governing council member of the International AIDS Society and is a Canadian Research Chair in HIV prevention and STI Research. While completing his BSc at McGill University in Microbiology and Immunology and International Development Study, Dr. Tan was interested in the biological and societal impacts of HIV, particularly its devastating effects within the LGBTQ2+ community. Dr. Tan’s passion to continue studying HIV led him to complete his MD and residency training in infectious disease, and PhD in clinical epidemiology at the University of Toronto, where he continues his mentorship and research.

Currently, Dr. Tan’s research investigates the implementation of PrEP as an intervention against HIV. Past projects with PrEP implementation have helped clinicians learn about and prescribe PrEP.3 Other projects have helped link different parts of the health care system to identify individuals that could benefit from PrEP services when visiting a clinic.4 There is currently a study aimed at identifying barriers and facilitators in an individual’s choice to use or not use PrEP.5 These vital questions surrounding the efficacy and usefulness of PrEP will improve sexual health and wellbeing within the gay and lesbian communities, while efforts are being made to reach racial minorities, genderqueer individuals, and various other subjugated groups. Dr. Tan acknowledges that there remain many hurdles to improve the public discourse around PrEP use and emphasizes the problem stems from the top down; “It’s a failure of our public health and health system that everybody does not know about it because, obviously knowledge is power and is the first step to getting people access to something that is extremely effective and safe. Frontline clinicians do not always know about the product. I speak to clinicians all the time including primary care providers who could be potentially prescribing this to patients in Graphic design by Amy Assabgui

DIVERSITY IN SCIENCE

DR. DARRELL TAN Clinician-scientist at St. Michael’s Hospital, Associate professor at the University of Toronto

Photo Credit: Dr. Darrell Tan

the clinic, but sometimes just do not have the information, they just don’t know about it.” Dr. Tan acknowledges that even on a personal level, an individual’s use of PrEP is not common conversation among social circles, further perpetuating the concerning lack of knowledge about HIV preventative measures among the public. HIV treatment has come a long way from treatments with side effects to relatively safe treatments that rely on a pill a day

and pose minimal long-term side effects. Dr. Tan discusses recent improvements in treatment, such as the long-acting injection (lasting two months) which boasts improved safety profiles and gives individuals more freedom to live their daily lives. Dr. Tan notes that there are not only treatments for symptoms, but also treatments can prevent the spread of HIV; “the treatment of folks who are living with HIV is associated with not only benefits for that person, but also reduction in the risk of them transmitting HIV to their partners. We can actually reduce that risk, right down to zero - that is an important difference, it’s not a really low risk it’s zero risk, which completely revolutionizes how people can think about their sex lives or partners – it helps undo stigma.” And while more improved treatments are being developed, Dr. Tan recognizes that “we need to do much more in terms of equitable distribution of all these tools”. Outside of his research, Dr. Tan also acts as a Department of Medicine’s LGBTQ2+ ambassador and hopes that the program will improve engagement with and visibility of the LGBTQ2+ community across healthcare and educational institutions. Recent data suggests that half of HIV patients on drug treatments reported avoiding HIV services because of stigma and discrimination.1 Dr. Tan’s

role as an ambassador involves breaking the code of silence against all forms of discrimination, specifically those against sexual minorities. Sexually transmitted infections are a reality many Canadians live with, however, individuals such as Dr. Darrell Tan are improving the narratives in our living room and in our physician’s office. The future is promising for pre- and post-treatment options of HIV, the next step is to begin removing the stigma surrounding HIV. References 1. Government of Canada / Gouvernement du Canada [Internet]; 2021 [cited 2022Jan7]. Available from: https://www.canada.ca/en/ public-health/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90. html 2. About HIV/AIDS [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2021 [cited 2022Jan7]. Available from: https://www.cdc.gov/hiv/basics/ whatishiv.html 3. Sinno J, Doria N, Cochkanoff N, et al. Attitudes and practices of a sample of Nova Scotian physicians for the implementation of HIV pre-exposure prophylaxis. HIV/AIDS - Research and Palliative Care. 2021;Volume 13:157–70. 4. Sharma M, Chris A, Chan A, et al. Decentralizing the delivery of HIV pre-exposure prophylaxis (prep) through family physicians and Sexual Health Clinic Nurses: A dissemination and implementation study protocol. BMC Health Services Research. 2018;18(1). 5. Cox J, Apelian H, Moodie EEM, Messier-Peet M, et al. Use of HIV pre-exposure prophylaxis among urban Canadian gay, bisexual and other men who have sex with men: A cross-sectional analysis of the engage cohort study. CMAJ Open. 2021;9(2).

IMS MAGAZINE WINTER 2022 MEN’S HEALTH | 33

PAST EVENTS

The SURP Research Day: Expansion of Academic Horizons By Dorsa Derakhshan

he Summer Undergraduate Research Program (SURP) at the Institute of Medical Science (IMS) connects Bachelor of Science undergraduate and medical students without a graduate degree to distinguished researchers who span diverse domains of research such as cognitive science and bioethics.1 The SURP Research Day is held annually, most recently held virtually on August 11, 2021, where students presented their summer research, networked with faculty, and shared their experience in the program with IMS Magazine. Origin of Research Interest For some students, such as Sophia Farcas, their long-time inspiration in research came from family and friends involved in research who motivated her to connect to distinguished faculty members in their desired field. Others found their passion for research had bloomed from academic courses, such as Vaneeza Moosa, who discovered a newfound interest in neuroscience and physiology. On the other hand, Michelle Weller witnessed a family history of a rare type of cancer, which propelled her interest in pursuing research in the field of surgical oncology and cancer survivorship. Moreover, prior research experience and future career aspirations served as a key inspiration for Melika Dastgheib, who previously had the opportunity to interact with transplant recipients and studied the dynamics of patient communication in medicine. Expectations & Experience Students had hopes of a novel research experience with SURP, distinguished from previous volunteering and work-study positions. In fact, as Melika confirmed, it was found to be exactly that: the one-onone supervision students received from their mentors rendered the research process more real than ever before. Similarly, for Sophia and Michelle, SURP was a comprehensive academic experience with weekly seminars, graduate speaking panel and networking opportunities. Additionally, direct hands-on experience and exposure to the more practical aspect of research

34 | IMS MAGAZINE WINTER 2022 MEN’S HEALTH

Sophia Farcas

Michelle Weller

McMaster University

Queen’s University

Program: Bachelor of Health Sciences Year of Study: 4

Program: Bachelor of Science, Specializing in Life Sciences Year of Study: 2021 Graduate

“I found that perseverance and believing in myself is very important. Because you know, if you put your mind to it, you can really do whatever it is that you want” – Sophia Farcas

Rose Yakubov McMaster University

Melika Dastgheib

Program: Bachelor of Health Sciences Year of Study: 3

University of Toronto

Vaneeza Moosa

Program: Double Major in Physiology and Psychology Year of Study: 4

“I realized that I have to keep things simple and take things one step at a time” – Melika Dastgheib

was a particular highlight for Vaneeza. Rose Yakubov also emphasized that the welcoming environment of the lab was conducive to developing strong mentorship relationships as well as friendships. Newfound Knowledge & Challenges A consistent theme among students was that SURP provided them with an instrumental environment for professional and personal growth. Sophia considered the practical experiences of SURP as surreal, since just a year ago, she could not have anticipated being capable of performing surgery on mice now. Likewise, Rose was encouraged to explore new domains of science, such as artificial intelligence and computer science. Melika mentioned the challenges associated with the restrictions due to COVID-19, such as adhering to lab capacity and scheduling responsibilities, which on a positive note, helped improve her time management skills. Employing effective communication

University of Toronto

Program: Honours Bachelor of Science; Neuroscience Specialist and Physiology Major Year of Study: 3

skills was crucial, as emphasized by Michelle, especially in the era of Zoom meetings and virtual collaborations. Future Steps SURP students expressed their future directions and highlighted the importance of lifelong learning. Pursuing a career in medicine was a particularly pronounced professional goal, especially in conjunction with being involved in clinical research. With the culmination of SURP, it seemed that students were more solidified in their future directions with regards to their education and career aspirations. References 1. Institute of Medical Science. Summer Undergraduate Research Program (SURP) [Internet]. University of Toronto. [cited 2022 Jan 11]. Available from: https://ims.utoronto.ca/surp

Graphic design by Sherry An

TRAVEL BITES

Going Virtual for the 2021

CCRA CCRA Conference Conference

The virtual lobby of the CCRA Conference welcomed everyone with a photo booth, live chat, and overview for the events being held at that moment in time.

By Kyla Trkulja

s a result of the COVID-19 pandemic, all conferences were moved online for the past two years. I had never attended a conference before and, as a first-year Master’s student, I thought that the virtual environment was a great way for me to become familiar with what presenting at a conference entails. I was so excited that my abstract for the Canadian Cancer Research Alliance (CCRA) 2021 Conference was accepted and on the morning of Day 1, I made my way downstairs to my office with my coffee and got ready for my first-ever conference experience. Dozens of topics were covered throughout the conference, including the role of artificial intelligence (AI) in cancer research, research in Indigenous communities, health services and policy, impacts of COVID-19, and novel discoveries and therapies for different types of cancer. Speakers included students and scientists from institutions and organizations across Canada: from the University of British Columbia to Dalhousie and Canadian Breast Cancer Network to the National Research Council. It was incredible to hear about the speakers’ perspectives on all aspects of cancer research, from patient involvement to the advancement of clinical trials to better methods to screen for and diagnose early cancer. The posters reflected these topics as well, and I spent hours throughout the four days

reading the incredible findings that were discovered over the course of the past two years. In each presenter’s virtual booth, I was able to view their poster, information about the presenter, their organization, their contact information, and social media handles if they provided any. I also had the option to message them privately if I wanted to chat. The same applied for my booth, as I was able to view personal and contact information for everyone that visited and connect with them. I was hoping that there would be the option to video chat, but unfortunately, connections were limited to direct messages. The virtual conference experience was definitely different than what I would expect from an in-person conference. It was an excellent way for me to learn about what a conference was like, and made me feel more prepared for attending and

presenting at future events. However, as someone at the beginning of their research career, I would have appreciated more ways to connect with people and network. While I was able to make almost 100 connections on LinkedIn, I did not actually get the chance to talk to anyone. It felt weird for me to message someone saying, “Hi, I like your booth!” and I am guessing my lack of messages received— despite receiving 200 booth visits meant others felt the same way. Having the option to video chat with the exhibitor while I was in the booth would have allowed conversation to flow more naturally, and may have allowed me to meet more people in a meaningful way. But overall, my experience at the conference was very enjoyable and educational, and made me so much more excited for attending in-person conferences in the future!

My virtual booth for the CCRA conference contained my abstract, downloadable poster file, and social media handles for both myself and the organization I was representing. I was able to view other booths and posters using the navigation toolbar to the left of my booth.

IMS MAGAZINE WINTER 2022 MEN’S HEALTH | 35

RAW TALK PODCAST

Can misinformation and censorship in the media be effectively managed? By Vaidhehi Veena Sanmugananthan, Junayd Hussain, Sumiha Karunagaran

icture this: you’re going about your day when you suddenly hear your phone go off. A shocking news notification about the number of people dying from vaccines draws you in. Alarmed, you forward the story to all your friends and family to warn them about this new revelation on vaccines. The next day, you are scrolling through your feed, and come across a well-known scientist debunking yesterday’s vaccine story you recently shared. However, by this point the falsified information has been spread to your network and there’s no way of taking it back. This is the sad reality of how quickly misinformation travels today. Social media has made it very easy to spread news widely. According to a report published by the Social Media Lab at Ryerson University in 2020, 94% of Canadian adults sampled from over 1500 survey responses had at least one account on a social media platform.1 This highlights the dense online interconnectivity that exists among Canadian adults today. Despite its convenience, the above anecdote illustrates how social media can catalyze the spread of unsubstantiated facts and sensationalized news quickly. How can we regulate and stop this spread? More importantly, is it even possible to do so in such an interconnected digital environment? This article, and the accompanying Raw Talk Podcast episode #104, “Science on Social Media”, aims to explore this question with insights from 36 | IMS MAGAZINE WINTER 2022 MEN’S HEALTH

media researchers and scientists that are active on social media. Firstly, what is misinformation? Misinformation is false or inaccurate information that has been spread without intent to deceive others. Dr. Eric Merkley, an assistant professor in Political Science at the University of Toronto, and Dr. Anna Blakney, an assistant professor in Biomedical Engineering at the University of British Columbia, shared their insights on this topic. Dr. Merkley spoke about how social media can accelerate the propagation of misinformation throughout the public: “Historically, when people viewed the news, they cared a lot about source credibility…but now, through social media algorithms, people can kind of ignore the brand and…look at who in their social network is sharing this information as an alternative signal of credibility… scholars call this a credibility cascade”. Dr. Merkley also notes that spread of misinformation can stem from prominent figures like politicians or celebrities: “If you’re going to share misinformation, especially if you’re an elite voice, you got to do your due diligence…whatever they do, propagates much more fully through the media ecosystem. With great power comes great responsibility”. Current efforts to manage misinformation dissemination do exist within social media platforms and external organizations. For example, the Canadian Government runs initiatives that provide funding for creating

workshops and learning materials that improve media literacy.3 Twitter launched a pilot initiative called Birdwatch that allows users to write notes about Tweets that could be misleading.4 Clearly, there are existing initiatives being run to tackle misinformation dissemination. However, misinformation remains a persistent problem in society. Are the current efforts at slowing this spread effective or are there still improvements to be made? Given the complexity of this issue, the episode team decided to discuss their opinions on the idea of regulating misinformation on social media platforms. Junayd Hussain, a Science Writer on this episode, shared his insight on the topic of flagging potentially misinformed tweets on Twitter: “What these warnings are effective at is getting people to pause for a second, and to really think…about the implications of if they shared something that might be inaccurate or might be sort of harmful”. Jason Lo Hog Tian, a Show Host on the episode, addressed the concern of introducing biases through regulation implemented by social media platforms themselves: “We have to remember that…there are companies behind these platforms. And just like in traditional media, they can regulate however they like. So that introduces some bias potentially”. Regulation can be biased towards company interests and can affect what information is shared. The concern of censorship inevitably arises too, where opinions may be canceled to Graphic design by Michie (Xingyu) Wu

RAW TALK PODCAST

maintain harmony on platforms. Sumiha Karunagaran, a Content Creator on the episode, shared her concerns regarding censorship on social media: “I don’t know if anyone is truly capable of playing God… my biggest concern here is freedom of speech”. As Sumiha states, it is important to question whether any individual or organization is knowledgeable or objective enough to filter what people share online. With that being said, there are always limitations in exercising the principle of freedom of speech.5 Ultimately, we agreed that there needs to be a more effective way to prevent misinformation spread to those who are vulnerable. What ways can we improve the current dilemma regarding effectively managing misinformation on social media? Both Dr. Merkley and Dr. Blakney suggest that partial accountability needs to be taken by the consumers and producers of information on social media. Dr. Merkley believes that communities should have more skepticism overall, when consuming this information. Simultaneously, source checking should be implemented more frequently by platforms to ensure information is accurately represented. Finally, scientists who conduct research that are often addressed in sensationalized news and social media, should find ways to improve how they share their scientific findings to lay audiences in a clearly understandable way. Science communicators like the STEAM Sisters (IG: @steam.sisters), are working towards

promoting better science communication in the scientific community through their outreach and digital-social media presence. They stated: “communicating the process of science is a part of building trust with the general public…demystify to avoid mistrust”. Rampant misinformation in social media can be complex to deal with. Tackling the issue of misinformation dissemination requires collective efforts by all parties involved; consumers and producers included. There may not be a clear solution in sight to stop misinformation dissemination completely, but there needs to be more cohesive efforts and accountability shared among different members of our society.

resources the team has compiled in the episode’s show notes on the Raw Talk Podcast website.

References We would like to acknowledge the efforts and ideas of the rest of the episode #104 team: Jenna, Jason, and Dennis were Show Hosts on the episode. Sumi helped with the episode and article content. Jesse and Noor are our Co-Executive Producers. To learn more about the impact of social media on misinformation and the dissemination of science on public platforms, we invite you to listen to episode #104 of Raw Talk Podcast, titled “Science on Social Media”. Also, check out our references for more information on the bolded topics, as well as some interesting

1. The State of Social Media Report: Gruzd A, Mai P. The State of Social Media in Canada 2020 [Internet]. Scholars Portal Dataverse; 2020 [cited 2021 Dec 20]. Available from: https://dataverse.scholarsportal.info/dataset.xhtml?persistentId=doi:10.5683/SP2/XIW8EW 2. Misinformation Definition: Desai S. Research Guides: “Fake News,” Lies and Propaganda: How to Sort Fact from Fiction: What is “Fake News”? [Internet]. [cited 2021 Dec 20]. Available from: https://guides.lib.umich.edu/c. php?g=637508&p=4462356 3. Online disinformation Canadian Government Initiatives: Heritage C. Online disinformation [Internet]. 2021 [cited 2021 Dec 20]. Available from: https://www.canada.ca/en/canadian-heritage/ services/online-disinformation.html 4. Birdwatch: About Birdwatch on Twitter [Internet]. [cited 2021 Dec 20]. Available from: https://help.twitter.com/en/using-twitter/birdwatch 5. Freedom of Speech: Government of Canada D of J. Charterpedia - Section 2(b) – Freedom of expression [Internet]. 1999 [cited 2021 Dec 20]. Available from: https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/check/ art2b.html

IMS MAGAZINE WINTER 2022 MEN’S HEALTH | 37

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IMS Magazine Winter 2022

Articles inside

Raw Talk 104th Episode

Virtual Travel Bite

Past IMS Event

Diversity in Science

Contributors

Letter from the Editors

Director’s Message

Faculty Spotlight

Features

Viewpoints