THINK. LEARN. DISCOVER.
SPRING/SUMMER 2020
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Behind every discovery, there’s a story. New episodes available every other Wednesday.
Raw Talk is a graduate student-run podcast at the University of
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Maternal Health
Homelessness and Health
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IN THIS ISSUE Letter from the Editors............................... 4 Director’s Message.................................... 5 Faculty Highlights...................................... 6 Contributors............................................... 8 Infographic............................................... 10 Letter: CEO of the Nurse Practitioners Association of Ontario............................. 12 Commentary............................................. 13 Features................................................... 14 BMC Showcase........................................ 22 Viewpoints............................................... 24 Faculty Spotlights.................................... 32 Student Spotlight..................................... 34 Diversity in Science................................. 36 Book Review............................................ 39 Travel Bite................................................ 40 IMSSA Poster........................................... 41
MAGAZINE STAFF EDITORS-IN-CHIEF:
JOURNALISTS & EDITORS:
Jonathon Chio Krystal Jacques Mikaeel Valli
Mashal Ahmed Laura Best Nadia Boachie Sonja Elsaid Krystal Jacques Jason Lo Hog Tian Natalie Simonian
PHOTOGRAPHERS:
DESIGN EDITORS:
Beatrice Ballarin Natalie Osborn EXECUTIVE EDITORS:
Krystal Jacques (Director) Mikaeel Valli Kenya Costa-Dookhan Nathan Chan SOCIAL MEDIA TEAM:
Sandy Lee (Director) Serina Cheung Cindy Ha Stephanie Hulme
Roxanne Ziman (Director) Hang Yu Lin Janell Lin Chloe Ng Su Min Suh Jennifer Barolet Ingrid Barany Katrina Hass Colleen Paris Ava Schroedl
12 FEATURE INFOGRAPHIC By Hang Yu Lin, MScBMC
COVER ART
Copyright © 2020 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.
By Su Min Suh, MScBMC
FOLLOW US ON SOCIAL MEDIA! www.imsmagazine.com @IMSMagazine @IMSMagazine IMS MAGAZINE SPRING/SUMMER 2020 BEDSIDE TO BENCH
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LETTER FROM THE EDITORS
T
his issue has seen all members of our team adjusting to the new COVID-19 era. To be honest, it has been a period of much stress, isolation, and fear for the future. All of our classes and research projects were interrupted, putting our abilities to pivot and readjust to the test. Even the process of creating this issue was affected – our meetings and interviews became virtual, our photographers could not take photos of their subjects, and we were unable to release the issue at the IMS Scientific Day, which was cancelled and moved online. Nonetheless, this issue is a testament to the continued passion of the many IMS students who volunteer their time, even in a pandemic, to write about the projects and people in the department who continue to inspire us all.
Our team decided, for the first time, that this issue should feature students of the IMS. Specifically, a special subgroup of our large student body: those who have previous professional experience in healthcare, and decided to return to school to solve the real world problems they encountered on the job. Those who went “from the bedside to the bench”, to apply their professional expertise to create research projects informed by first-hand knowledge. This issue starts with a one of a kind letter from the CEO of the nurse practitioners of Ontario. Dr. Dawn Tymianski worked as a nurse for many years and then discovered a desire to go “down into the rabbit hole” and learn more about research. She obtained a PhD at the University of California Santa Barbara and for the past years has been representing the nurses of Ontario at a governmental level to make real, practical improvements. In our Feature section you can read how a Clinical Pharmacist, a Psychologist, a Paramedic, and a Registered Nurse are leveraging their work expertise to answer important research questions in healthcare. Our viewpoints discuss controversial topics such as the role of misinformation in the media on our reactions to covid-19 and gender bias in the awarding of the Nobel Prize. In this issue we highlight Dr. Marianne Koritzinsky, our new graduate coordinator, and Dr. Ewan Goligher, who’s research on the effects of mechanical ventilation on respiratory function has become even more critical in the pandemic. Since travelling has been restricted, don’t miss the travel bite to the lovely Montreal for the Canadian liver meetup. And as usual if you are looking for a good book, Maybe you should talk to someone is our latest review. As Co-Editors in Chief we’d again like to acknowledge the team of dedicated students who worked on this issue and made it possible. Our photo includes the entire Executive team. Special thanks goes to the outgoing and incoming Design Team, featured on page 9. We hope you enjoy this issue, and we’d love to hear from you: you can email us at theimsmagazine@gmail.com and visit our website at imsmagazine.com. Happy 2020 and happy reading!
Natalie Osborne
Beatrice Ballarin
Natalie is a 4th year PhD student using neuroimaging and sensory testing to understand chronic pain under the supervision of Dr. Karen Davis. Outside the lab she loves to write about science and true crime. @NatalieRaeOz
Beatrice is an international PhD candidate in the laboratory of Dr. Michael Tymianski at the Krembil Research Institute, working on strategies to promote stroke recovery. Outside the lab she is an avid reader of non-fiction books (check them out in our Book Review section) and loves running. @BBallarina
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DIRECTOR’S MESSAGE
DIRECTOR’S
MESSAGE S
ince mid-March we have all had to face the new reality of the COVID-19 pandemic. The UofT had to quickly reorganize itself, as did the Institute of Medical Science. Our priority was to keep the student body safe, while still guaranteeing quality education standards. We quickly reorganized our classes online, and helped students meet all their academic requirements prior to graduation. Unfortunately, we had to cancel our annual in-person meeting, IMS Scientific Day. Thankfully, we were still able to connect and give our students the opportunity to present their work online. A big thank you goes to our graduate coordinators and staff for their organization efforts and tireless work to keep the IMS students informed and supported during the pandemic. This period has brought a lot of reflections regarding the new reality that we are living in. I am proud of my department for its ability to transition into digital work and accommodate all the students and their research. Moreover, in these uncertain times, many IMS labs have put together grants and reorganized themselves to contribute their knowledge towards the research for a vaccine, or to better understand the effects of covid-19. As Ontario slowly re-opens, many laboratories have resumed in-lab work with new protocols: shift hours, reduced shared space, mandatory masks, and frequent hand washing. I encourage all of you to keep up these measures to keep yourselves and your lab members safe. The theme of this issue is Bedside to Bench; it tells the stories of individuals who have been inspired by their real-world work experiences to join the IMS and conduct research to solve issues they encounter on the job. Learn how Dr. Lisa Burry’s position as a Clinical Pharmacist at Mount Sinai is guiding her research to prevent delirum and improve outcomes in ICU patients. Read how IMS MSc student Esmaeil Mansouri’s experience in mental health research is informing his work as a registered nurse specializing in cardiology. And find out how Paula Conforti is leveraging two decades of experience as a psychologist working with school boards to develop mental health interventions for youth. I also want to congratulate the new faculty members that have recently joined us in the IMS and the recent promotions. You will be able to find them at page (6). Learn more about them and their inspiring research! I am proud to welcome you to the IMS and I am looking forward to your continued excellence during your time here! As usual, I would like to thank IMS Magazine’s Editors-in-Chief, Beatrice and Natalie, all the editors, journalists, photographers, social media team, and design team for their excellent production this issue. I know the hard work that went behind each of these pages. And I hope you all find this issue as inspiring as I do! Sincerely, Dr. Mingyao Liu
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FACULTY HIGHLIGHTS
Nav Persaud is the Canada Research Chair in Health Justice and staff physician at St Michael’s Hospital. His main interest is interventions that promote health equity or fairness and he leads the CLEAN Meds trial of free essential medicine distribution.
Reto M. Baertschiger joined the Division of General and Thoracic Surgery in August 2019 with a special interest in paediatric surgical oncology and liver tumor treatment and research. Reto Baertschiger was appointed as a Scientist-Investigator in the Genetics & Genome Biology Program at the SickKids Research Institute. He started his lab under the mentorship of Dr. David Malkin, senior scientist and oncologist, and studies the micro-environment of paediatric liver tumors and the interaction of the native liver, its stroma and the tumor environment. He joined the IMS faculty as associate member in the Fall 2019. 6 |
Dr. David Gomez is an acute care and trauma surgeon at St. Michael’s Hospital and a Scientist at the Li Ka Shing Knowledge Institute. He is also an Assistant Professor at the University of Toronto in the Department of Surgery as well as an Adjunct Scientist at the Institute for Clinical Evaluative Sciences. His research interests include the evaluation of enablers and barriers of access to timely and quality emergency surgery.
Ewan Goligher MD PhD is a clinician-scientist in the Department of Medicine, University Health Network and Assistant Professor of Medicine, Interdepartmental Division of Critical Care Medicine, University Health Network. His laboratory studies mechanisms of lung and diaphragm injury from mechanical ventilation in the clinical setting and develops and tests interventions to prevent these injuries with the goal of accelerating liberation from mechanical ventilation and reducing long-term disability after critical illness.
Dr. Stephanie Lheureux is a clinician investigator focusing on how to improve the care of women
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diagnosed with gynecological cancers by developing effective treatment options that are founded upon a strong understanding of disease biology. She is the principal investigator of different clinical trials with an emphasis on translational research. Dr. Alfonso Fasano is a Professor in the Department of Medicine (Division of Neurology) at the University of Toronto. He is staff neurologist and co-director of the Surgical Program for Movement Disorders at Toronto Western Hospital in Ontario, Canada. He is also a Clinician Investigator at the Krembil Research Institute and at KITE – Toronto Rehabilitation Hospital, both in Toronto, Ontario, Canada. Dr. Fasano leads the Core E (closed-loop capabilities) of the CenteR for Advancing Neurotechnological Innovation to Application (CRANIA).
Jacob Vorstman is a child psychiatrist and works as a clinician scientist at SickKids. His ambition is to further insights into the genetic architecture underlying neurodevelopmental disorders, in particular autism, intellectual disability and schizophrenia, as well as to improve methods to measure human behavior.
Melanie Penner, MD MSc FRCP(C) is a developmental paediatrician at Holland Bloorview Kids Rehabilitation
FACULTY HIGHLIGHTS Hospital, a clinician investigator at the autism research centre in the Bloorview Research Institute, and the Bloorview Children’s Hospital Foundation Chair in Developmental Paediatrics. Her research interests are in expanding and enhancing the care provided to children with autism spectrum disorder and their families in the community.
Dan Felsky received his PhD in neuroimaging-genetics from IMS in 2016 and pursued three years of postdoctoral work in neuroimmunology and bioinformatics at Harvard Medical School and Columbia University. Dr. Felsky has recently joined the Krembil Centre of Neuroinformatics at the Centre for Addiction and Mental Health as the Head of Whole Person Modelling, studying the interactions of genomic and environmental factors in psychiatric and neurological illness.
Dr. Brige Paul Chugh is a Medical Physicist at the Odette Cancer Centre. His current clinical and research interests are in cancers of the central nervous system, stereotactic radiosurgery and MR-guided radiation therapy. He is developing novel MRbased methods for treatment planning and motion management by leading students and postdocs in this research area, as well as collaborating with industry partners.
Dr. Haykal joined the University Health Network and the Toronto General Hospital in 2018. Her clinical focus is on complex oncological reconstruction and microsurgical reconstruction of the breast, head and neck and extremity. Her research focuses on tissueengineered techniques for tracheal reconstruction and the immunology of vascularized composite allotransplantation.
and metabolic abnormalities in schizophrenia, and the effect of antipsychotics on these outcomes. To complement his research interests, he works at the Mental Health and Metabolic Clinic and the Clozapine Clinics at CAMH, which focus on applying pharmacological interventions to improve cognitive and metabolic outcomes in individuals with serious mental illness.
Dr. Colin Hawco works in the field of cognitive neuroscience, functional brain imaging, and psychiatry. His work is especially focused on the things that make us unique as individuals, and how we can explore the range of individual variability to better understand mental illnesses such as schizophrenia.
Mahavir Agarwal, MBBS, MD, PhD, is a Clinician-Scientist in the Schizophrenia division at CAMH and an Assistant Professor in the Department of Psychiatry at the University of Toronto. His research focuses on investigating the interrelationship between cognitive
Vinod Chandran MBBS MD DM PhD, is a rheumatologist and clinician-scientist based at the Krembil Research Institute, University Health Network and an associate professor at the University of Toronto. His research interests lie in the genetic and molecular epidemiology of psoriasis and psoriatic arthritis, and his translational research program is focused on developing proteomics and metabolomics-based screening and prognostic tools for psoriatic arthritis.
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CONTRIBUTORS
S u m m e r 2 0 2 0 C o n t r ib u t o r s
Mashal Ahmed is a
2nd year MSc student at IMS, studying under the supervision of Dr. Stefan Kloiber and Dr. Isabelle Boileau. Her research employs neuroimaging techniques to learn more about the neurobiological mechanisms associated with anxiety-spectrum disorders. Mashal is doublejointed and can twist her arm by 540 degrees!
Laura Best is currently a
PhD student with Dr. Isabelle Boileau at CAMH. Her work uses neuroimaging to investigate the involvement of the endogenous cannabinoid system in alcohol use disorder. Laura loves to spend time outside in the park, trail-running with her rescue dog or teaching yoga.
Sonja Elsaid is a 3rd year IMS Ph.D. student investigating brain function and cannabis use in individuals with social anxiety. Prior to going back to school, Sonja was a clinical research and medical communications professional with nearly 20 years of experience.
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Nadia Boachie is a MSc IMS student studying the effects of cannabis on the brain under the supervision of Dr. Isabelle Boileau. Her research uses neuroimaging techniques to assess changes in the brain of chronic cannabis users after approximately 1-week cessation. In her free time Nadia is passionate about cooking,
Krystal Jacques is a 3rd
year IMS PhD student using human embryonic stem cells and lineage tracing mouse models to study the origins of pancreatic stem cells under the supervision of Dr. Derek van der Kooy. Outside the lab she is passionate about fine art photography, writing fiction, painting and running. Instagram: Krystaljacques_
CONTRIBUTORS IMS Magazine is a student-led publication. IMS students are responsible for writing, editing, and photography, while BMC students create the design. Meet some of the writers for this issue below!
Jason Lo Hog Tian is a
PhD student at IMS investigating how stigma impacts the health and wellbeing of people living with HIV under the supervision of Dr. Sean Rourke. He is committed to developing his scientific communication skills and increasing science knowledge through writing for the magazine. [twitter] @JasonLoTweets
Natalie Simonian is a 1st year MSc student at IMS. She is working under the supervision of Dr. Harry Janssen investigating the pathology behind Non-Alcoholic Fatty Liver Disease (NAFLD). In her free time she likes to spend time with family and friends, write short stories, and travel. Instagram: @_nataliesim
Mikaeel Valli is currently
completing his PhD at the University of Toronto’s Institute of Medical Science with a specialization in neuroscience. He is working with Dr. Antonio Strafella and his lab using neuroimaging techniques to ultimately better understand the underlying pathophysiology of Parkinson’s disease.
T h e IM S D e s ig n T e a m 2 0 2 0 is a group of students in the MSc in Biomedical Communications (BMC) program. Turning scientific research into compelling visualizations is their shared passion, and they are thrilled to contribute to the IMS magazine.
2T0 Roxanne Ziman (Director) ig @artroxyz
Hang Yu Lin
Janell Lin
ig @hlin.visuals www.hlin-visuals.com
www.janell-lin. format.com
Ingrid Barany
Katrina Hass
Chloe Ng
Su Min Suh
ig @ chloehyng ig @su.visuals www.visualsbychloe.com www.su-visuals.com
2T1 Jennifer Barolet ig @bioscivisuals
Colleen Paris
ig @visuals.by.ingrid ig @khassvisuals ig @cparisvisuals www.ingridbarany.com www.khassvisuals.com www.colleenparis.com
Ava Schroedl
ig @schroedl_sci_vis www.avaschroedl.com
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INFOGRAPHIC
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Infographic by Hang Yu Lin
INFOGRAPHIC
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LETTER
By Dawn Tymianski
I
remember sitting in the medical library stacks at a large table, watching the dust float through the air, back dropped against the sun, with my young children skimming through surgical textbooks while I studied. I had returned to school full-time, not out of desire to learn, but out of necessity, wanting to move away from the necessary chronic night shifts required of the beside nurse. It was tough, working full-time, school full-time and with a young family. Unknowingly, I must have met an inspirational teacher, listened to an informative talk, or picked up a great article. Questions percolated. So, after a few years, and again while working full-time, I returned to school, completing a master’s degree. I landed a great job as a Nurse Practitioner in a clinical area I knew nothing about. My learning curve was steep. I reached for leadership opportunities along the way, moving into international Executive Board positions, editing a textbook, chairing international nursing guidelines, and becoming an expert in my clinical field. And of course, questions began to percolate once again and I realized I was not quite done.
from a single course wanting to shift my PhD thesis. I developed a love-hate relationship with references, wanting to read just ‘one more article’. And unfortunately I loved the feel of print, writing all over the article, keeping it to reference later, collecting mounds and mounds of paper, holding onto that favourite article that started it all. Working full time, and perhaps with a bit too much enthusiasm, I completed my PhD in Systems in less than 4 years. I was sad to see it done. What did I learn through all that? I know I would do another one, and somewhere along that journey, education innocently moved from foe to friend.
So where am I now? Well, I am no longer a bedside nurse. I am no longer a clinical Nurse Practitioner. I am the Chief Executive Officer of the Nurse Practitioners’ Association of Ontario, working with the government of Ontario and health care stakeholders, championing the important work for this small, but mighty, Nurse Practitioner workforce. I never really had a goal to be a CEO, for I have always looked to the horizon and never really to the stars. So what’s next? Well, it’s been a great journey. Perhaps a course or two on topics not related to healthcare. My challenge isn’t when to begin; my challenge is when to stop.
Placeholder
My second Master’s and my PhD were the most fun. Oh the challenge of trying to make my question ‘smaller’. I fell down many research rabbit holes, emerging 12 |
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Illustration by Colleen Paris
COMMENTARY
The Chinese CRISPR Babies: Lessons Learned and Paving the Way Forward By Jason Lo Hog Tian
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n November 2018, Dr. He Jiankui announced the birth of the first babies with genomes edited using CRISPR technology.1 This was met with mass controversy throughout the scientific community and sparked a debate about the ethical considerations of altering fetal genomes, all of which was covered in a viewpoint article in our Summer 2019 issue entitled The Chinese CRISPR Babies: Are We Ready for Fetal Genome Editing? Now, over a year later, this scandalous chapter draws to a close and we usher in a new era of research using the CRISPR technology.
Dr. Jiankui used CRISPR, an extremely precise gene editing mechanism, to remove the CCR5 gene from twin girls to make them resistant to HIV infection.1 The power of CRISPR to alter genes has the potential to cure genetic diseases and create new medicines, however researchers are still investigating how it works and the possible adverse effects.2 These aunknowns explain the shock within the scientific community when Dr. Jiankui announced that he had already used CRISPR to alter the fetal genome. In response to this scientific misconduct, the World Health Organization (WHO) convened an expert panel to develop oversight and governance around fetal genome editing and Dr. Jiankui was fired from his university position and underwent criminal investigation.3 In December 2019, Dr. Jiankui was sentenced to three years in prison for “illegal medical practice” and fined the equivalent of $430,000 USD.4 He has also been banned from working with human reproductive technology and applying for research funding. Two of Dr. Jiankui’s colleagues have been handed lesser prison sentences and fines.4 The swift sentencing shows China’s position on unethical Illustration by Ava Schroedl
Graphics by Ava Schroedl
research conduct and demonstrates their commitment to promoting responsible practices. The convictions also send a firm message to other researchers conducting gene editing experiments that any other missteps will not be tolerated by the greater scientific community.
to the human germline.7 While this sounds eerily similar to Dr. Jiankui’s experiments, Rebrikov has been candid with his research plans, declaring his intentions to the world and inviting each of us to consider the ramifications of editing the human genome.
The WHO expert advisory committee convened in March 2019 to address this controversy and provide regulations in anticipation of other studies that will inevitably explore similar techniques. The panel delivered an interim recommendation that “it would be irresponsible at this time for anyone to proceed with clinical applications of human germline genome editing”.5 In August 2019, the committee held a second meeting and approved a global registry to track details on clinical trials involving human genome editing.6 Clearly, the consensus is to take a conservative approach and the WHO advises that regulatory authorities refrain from approving research involving human germline genome editing until ethical and social repercussions can be evaluated.
The urgency with which global regulations regarding human genome editing must be reached cannot be understated. While understanding the social and ethical implications of gene editing seems like a daunting task, promoting a conservative approach to conducting studies and an open culture about research plans among scientists is a step in the right direction. We must all be held accountable for using CRISPR responsibly and not regard it as a callous cutting tool, for once we make changes to the human genome, there is no going back.
Despite the strong position of the WHO, researchers remain undeterred and continue to develop inventive ways to use CRISPR. Most recently, Denis Rebrikov, a Russian biologist, has started editing a gene linked to deafness in human ova, however the Russian Ministry of Health has stated that they fully support the WHO’s position against making changes
References
1. Cyranoski D, Ledford H. Genome-edited baby claim provokes international outcry. Nature. 2018;563(7733):607-8. 2. Plumer B, Barclay E, Belluz J, Irfan U. A simple guide to CRISPR, one of the biggest science stories of the decade. Vox. 2018. 3. Cyranoski D. The CRISPR-baby scandal: what’s next for human gene-editing. Nature. 2019;566(7745):440-2. 4. Cyranoski D. What CRISPR-baby prison sentences mean for research. Nature. 2020;577(7789):154. 5. World Health Organization. Statement on governance and oversight of human genome editing 2019. Available from: https://www.who. int/news-room/detail/26-07-2019-statement-on-governance-andoversight-of-human-genome-editing. 6. World Health Organization. WHO launches global registry on human genome editing 2019. Available from: https://www.who.int/ news-room/detail/29-08-2019-who-launches-global-registry-onhuman-genome-editing. 7. Kravchenko S. Future of Genetically Modieifed Babies May Lie in Putin’s Hands: Bloomberg; 2019. Available from: bloomberg.com/ news/articles/2019-09-29/future-of-genetically-modified-babiesmay-lie-in-putin-s-hands.
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FEATURE
Targeting drug safety in the ICU An interview with Clinical Pharmacist Dr. Lisa Burry
By Natalie Osborne
I
n the intensive care unit (ICU), a multidisciplinary team of health care professionals must work in tandem to treat critically ill patients. This includes prescribing high-risk medications to severely ill patients while balancing efficacy, minimizing side effects and avoiding harmful drug interactions. Enter the Clinical Pharmacist; professionals trained in pharmacology and clinical medicine who make the rounds in the ICU everyday to ensure patients are receiving safe and efficacious drugs.
It was this bedside interaction that drew Dr. Lisa Burry to the PharmD program at the University of Toronto (UofT). She had already completed a BSc in pharmacy and worked for four years as a hospital pharmacist in a small community hospital when her mentors encouraged her to pursue advanced clinical care training. She was accepted into one of just six spots in the post-doc PharmD program and hired in the Critical Care Clinical Pharmacy Specialist position at Mount Sinai Hospital even before graduation. Now, years later, Dr. Burry has decided to go back to school for yet another doctorate—this time a PhD at the Institute of Medical Science. As a Clinician-Scientist at Mount Sinai and Assistant Professor in the Leslie 14 |
Dan Faculty of Pharmacy at UofT, Dr. Burry is already an accomplished researcher. She fully credits the clinical research-centric ICU she works in for involving her in as many projects as possible from the very start of her career, and eventually encouraging her to lead her own studies. Dr. Burry is particularly interested in sedation, delirium, and pain relief in critically ill patients. Due to their serious illness as well as invasive life-saving procedures, many ICU patients experience agitation, anxiety, sleep deprivation, and pain. “My research has focussed on patient and drug safety, and symptom management. For example, if we’re giving a patient a drug to relieve their agitation, I want to determine; what’s the best option? How long do we need to give it? And how can we wean them off it once they leave the ICU?” Dr. Burry further explains, “As patients’ symptoms evolve over time, the treatment plan is also going to evolve. We need a clear plan for when some of these drugs are going to stop, because there are consequences to many of these drugs in terms of prolonged hospitalization and longterm addiction potential.” Delirium, associated with medications or severe acute infections, is a common symptom in the ICU. Dr. Burry and colleagues wanted to understand
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which common ICU drugs increased the risk of delirium, so they followed 550 ICU patients, quantifying every psychoactive drug they received and assessing them for delirium daily. Then, they ran models to assess if any of the drugs were independently associated with delirium, accounting for other potentially confounding predictors such as age and sex (e.g., older men are more likely to have delirium). They identified two classes of drugs— benzodiazepines and anti-cholinergic drugs—that were independently associated with delirium. They also determined the dose exposure of these drugs also increased delirium risk.
Lisa Burry, BSc Pharm, PharmD Clinician Scientist & Clinical Pharmacy Specialist, Dept. of Pharmacy, Mount Sinai Hospital Assistant Professor, Leslie Dan Faculty of Pharmacy, University of Toronto Graphics by Janell Lin with icons from Wanicons
FEATURE
“We know these drugs were potentially problematic, so now we need to understand what to give our patients instead,” Dr. Burry says. “Offering no treatment is not an option, because the agitation, delirium, and pain management issues are still going to be there, so we need to find better alternatives.” While Dr. Burry’s previous research has focussed on clinical practices within the ICU, she is now following patient outcomes after hospital discharge. For her thesis, Dr. Burry is focussing on geriatric patients (people over 65 years) who make up a large proportion of those admitted to Canadian ICUs. She is using the Institute for Clinical Evaluative Sciences (ICES) database to determine if patients discharged from the hospital after an episode of critical care are being sent home with benzodiazepines and antipsychotic drugs (e.g., to help with symptoms like sleep disturbances and agitation). She will identify risk factors associated with becoming an “acute user” (filling a prescription within a week of discharge) versus a “chronic user” (multiple prescription refills over six months). Dr. Burry will also track the outcomes of patients who are sent home with these drugs, such as emergency department visits, and rehospitalization.
“We know that some of these drugs are associated with falls in elderly people, but nobody has specifically looked at elderly patients who have survived an ICU stay—people we know had a major, severe illness and are more likely to be very frail,” explains Dr. Burry. “I’ll be looking at whether use of these drugs in this particular patient population is increasing the risk of falls, fractures, re-hospitalization, emergency visits and deaths.” Her planned work will also help her identify which patients should be targeted to receive alternative treatments or weaning of newly initiated drugs; this could be either a different drug, or nonpharmacological strategies that offer comfort and care. One alternative treatment for delirium could be melatonin. Outside of her thesis work, Dr. Burry has recently completed a triple-blinded randomized controlled trial to assess the feasibility of using two different doses of melatonin versus placebo to prevent delirium in ICU patients. Since three quarters of delirium patients have sleep/wake abnormalities, melatonin may reduce delirium by improving patient’s sleep quality and reducing agitation at night (as well as exposure to drugs given to relieve agitation). While returning to the classroom as a student after being out of school for a
long time was a challenge, Dr. Burry believes that being a working adult with two degrees under her belt gave her a better understanding of what she needed. It also helped her target her learning a little better than she could have coming straight from her BSc in pharmacy. She encourages other health care practitioners with an interest in research to pursue advanced research training. “I think an MSc or PhD is extremely valuable, even for someone who has as much research experience as I do. The formalized training helps solidify what you do know and identify gaps,” says Dr. Burry “This program has not only given me new knowledge, it’s also reinforced previous learnings and provided the underlying reasons for ‘why things should be done a certain way’ when it comes to certain research methodologies, and I was missing that.” “I think the fluidity and flexibility of the IMS facilitates people like me to come back and do more training, compared to other more rigidly structured graduate programs that are more of a ‘one-way’ pipeline,” says Dr. Burry. “The IMS allows people from many different disciplines to get extra training and meets the needs of adult learners.”
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FEATURE
By Mikaeel Valli
A
n average of ten Canadians die of suicide every day.1 Across the globe in high income countries, suicide is the second leading cause of death in youths aged 15 to 24 following accidental injury.2 In most western countries, youth suicide is often linked to mental illness, especially depression. More sobering still is that an upwards of 80% of youth do not have access to treatment to address their mental health needs when and where they need it.3 School boards have been doing their best to foster a healthy and supportive learning environment for children and youth. However, the school mental health support system is overloaded with long wait lists and with fewer psychologists providing direct service in public systems. Within the context of ever-increasing needs, it is not surprising that educational facilities can become “more reactive, rather than proactive as a result” explained Paula Conforti. She has been a licensed Member of the College of Psychologists of Ontario for the past 20 years and works with school boards to help assist children and youth with mental health challenges. In an effort to address these increasing needs, Conforti additionally sought Registration with the College of Regulated Psychotherapists to supervise those in the school system who are seeking this registration path. The IMS Magazine had the pleasure of interviewing Conforti about her perspective on this pressing topic. “There is a need for more scalable and rigorous research that can prove the value of early interventions that will effectively decrease suicidal ideation and attempts among youth,” Conforti explained. Ear16 |
ly intervention is key to improving the course of various mental health disorders. Additionally, population-evidence based interventions set the stage for stakeholders within the community to better support, proactively respond to, and understand underlying mental health challenges. Conforti expressed that she’s “always been very open to helping others to not only realize their potential and build on their successes, but to assist them in understanding how their core beliefs shape their decisions and reactions.” Given her passion and the gaps she observed in the school board system, she decided to go back to school to pursue her PhD with the University of Toronto’s Institute of Medical Science (IMS) graduate program. With her intention to do translatable research that directly benefits the needs of children and youth within the school boards, she had the pleasure of joining Dr. Mark Sinyor’s lab. Dr. Sinyor is a psychiatrist and associate scientist at Sunnybrook Health Science Centre. Dr. Sinyor’s lab is focused on suicide prevention and mental health literacy in youth, which is aligned with Conforti’s goals. It is increasingly clear that youths need novel, innovative, and experiential ways to learn about mental distress and to develop a sense of resilience to overcome this distress. Together with Dr. Sinyor, Conforti and many other colleagues established a project that aims to increase mental health literacy and coping skills to grades seven and eight in schools within the GTA that elegantly fuses Cognitive Behavioural Therapy and the novel Harry Potter & the Prisoner of Azkaban. “We chose middle schoolers because this is an age group where you start to see a rise in
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depression, anxiety and youth who die by suicide,” Conforti explained. “We are anticipating that our intervention will improve student wellbeing, decrease depression and anxiety ratings, and have an overall effect on decreasing suicidal ideations and attempts. The intervention is accomplishing this rather eloquently without ever directly mentioning suicide. Hence, if results show an improvement in student wellbeing, we are interested in seeing if these gains can be maintained at the high school level, ultimately resulting in an overall significant decrease in suicidality.” Many do not know that J.K. Rowling—the author of the Harry Potter series---suffered from depression and was seeking treatment for it while writing the third novel—the Prisoner of Azkaban. Rowling channeled her experience with depression into the story by manifesting it as creatures called “Dementors” which serve as an allegory for
Paula Conforti D.C.S., C. Psych. Assoc., RP PhD Student, Institute of Medical Science Graphics by Janell Lin
FEATURE
Graphics by Janell Lin depression. “Dementors” are described as figures that suck out all the happiness from the victims, causing sadness, hopelessness and despair. The author also infused many coping strategies that she learned in her life that helped combat the Dementors in the story. “There are many comparisons used in the novel that lends itself to the mental health literacy concepts that we are trying to teach” said Conforti. This project is integrated into the English curriculum and taught by teachers who follow a protocolized manual that describes the main concepts that need to be imparted for each chapter. However, teachers are given latitude to customize and tailor the curriculum to the needs of their classroom. Through this project, “students are given tools to recognize and normalize distress in themselves and others along with tips to facilitate help seeking. They can employ some of the strategies such as stress-busters or identifying errors in thinking and basic cognitive restructuring to help them,” Conforti explained. “The lessons afford students the opportunity to self-express in very safe ways, or if they are a little more reserved, they can perhaps creatively identify and share their thoughts through discussion of the characters in the novel” Conforti added enthusiastically. To quantitively assess the effectiveness of this mental health literacy program, self-report questionnaires have been distributed to roughly 525 students whose parents have consented to date, at various time points, to assess changes in emotional functioning. On a qualitative level, the research team will communicate with the students and teachers about their experience and feedback regarding the program through semi-structured interviews and focus groups.
Viewing this literacy project from a school psychology perspective, Conforti expressed, “This is brilliant because it is teacher delivered within the classroom, lends itself to transcending language and culture, and normalizes the conversation about stressors affecting youth. I think this will have a profound effect as the kids will realize they are not alone with regards to how they are thinking and feeling.” The entire research team aspires to scale the intervention across the globe, which in turn has the potential to reduce the overall cost of mental health services, reduce suicide ideations and attempts, and improve youth resilience and positive coping. When Conforti returned to school to do this research project with the IMS, we asked her what she has learned in her research that she would like to convey to practicing mental health professionals. “There are many professions and disciplines that are aware of the rise in mental health needs. However, I think we should all be afforded time to self-reflect so we can determine how we might collectively continue to make an impactful difference in meeting the needs of the many vulnerable groups who are in our schools and universities including aboriginals, LGBTQ2, multicultural, low socioeconomic status, and youth transitioning to young adults. With the prevalence rates that we are seeing, some as high as 25%, that’s potentially 250 students in a class of 1000 with mental health needs. With 200 students not accessing outside community support because of barriers to care and/or preference to be seen within the educational system, there is a need to find better and novel frameworks to intervene.” Conforti believes that multidisciplinary professionals and funding agencies should
make it a priority to find creative ways to alleviate these barriers and encourage, support, and fund research to shed light on this. “Data speaks volumes. Research and data will prompt ministries and government agencies to realize responsible allocation of provincial mental health funds ear marked by the federal government should flow to school systems as well as health agencies,” she explained. Going forward, Conforti envisions that schools and post-secondary institutions should create a school health hub embedded in the school system and research this framework to improve access to holistic services to those students in need. Ontario health and education systems often have what can be perceived as conflicting (and complimentary) mandates. It is counterintuitive to separate mental health and education because academic success depends on accessing “the whole student” which sets the stage for flourishing. However, the complex care medical environment is starting to recognize the need for integrated service. She also would like to see the “mandate for a credited mental health and wellness course that emphasizes the importance of self-care, goal setting, self-reflection, and mental and physical awareness.”
References 1. Public Health Agency of Canada. Government of Canada [Internet]. Canada.ca. Government of Canada; 2019 [cited 2020 Mar 15]. Available from: https://www.canada.ca/en/public-health/services/ suicide-prevention/suicide-canada.html 2. Patton GC, Coffey C, Sawyer SM, et al. Global patterns of mortality in young people: a systematic analysis of population health data. The Lancet. 2009;374(9693):881–92. 3. Children and Youth [Internet]. Mental Health Commission of Canada. [cited 2020 Mar 15]. Available from: https://www.mentalhealthcommission.ca/English/what-we-do/children-and-youth
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FEATURE
MAKING WAVES IN AN AMBULANCE: Ian Drennan on becoming a Paramedic Scientist
By Laura Best Ian Drennan enjoys exploring the unknown; for him, a challenge is not a deterrent but an invitation. When he is not working to finish up his PhD at the Li Ka Shing Knowledge Institute or at the hockey rink with his kids, Ian is on the frontlines of healthcare as an advanced care paramedic. What quickly became clear in the short time we had to chat is that Ian thrives in novel environments. Being one of only a few paramedics in Canada pursuing a research-based doctoral degree, he has a unique perspective that influences the research questions he asks and the contextualization of his findings. He was eager to share his experiences and why he chose to pursue not only a professional degree, but also a graduate degree at the University of Toronto’s Institute of Medical Science (IMS) program. Ian’s career path commenced at the University of Guelph, where he completed a Bachelor of Science in Kinesiology and first realized his passion for clinical care. Soon after, he transitioned to Humber College for his Primary Care Paramedic Diploma and enjoyed the fast-paced environment. “It has up days and down days, and you’re busy – it’s always 18 |
different,” he shared. “Every scene you arrive at is different, every call leaves you learning something new.” Constantly walking into the unknown was stimulating and challenging—until it wasn’t anymore. After four years as a paramedic in Simcoe County and York Region, Ian began to feel comfortable in his role and “came to the realization that doing frontline work for the next 30 years wouldn’t be for him. [He] didn’t want to leave the profession, just wanted to do something new with it.” He felt as though “there was something more he could offer.” It was at this point that Ian began the search for a new perspective on paramedicine. After reviewing his potential options, Ian was intrigued by the way that research can inform guidelines and translate into clinical practice. He was inspired by paramedics in other provinces and countries who “forged ahead and created a better role where paramedics are really integrated in the medical system.” And, though it was uncommon for paramedics in Canada to pursue doctoral degrees at the time, Ian decided to enroll in graduate studies at U of T. Under the supervision of Dr. Laurie Morrison, Ian’s doctoral work used an existing database at St. Michael’s Hospital in Toronto to develop different risk
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stratification tools and clinical prediction rules for post-cardiac arrest patients in the ICU. When patients arrive in hospital after a cardiac arrest, it is difficult to tell if they will recover, “a sort of grey period,” Ian explained, and current trials looking at different treatments for cardiac arrest patients or any prehospital treatments have often yielded negative findings. The idea was to use these tools clinically to find the probability of a good or poor outcome, and potentially learn when to focus a treatment option on one group of patients, in which there may be better efficacy. Overall, Ian’s main focus was to develop a methodology that could be broadly applied to different areas of medicine. He expressed that he “has a whole list of things he wants to tackle after his PhD,” and hopes “to forge [his] own clinician scientist spot, as a paramedic scientist.” Having perspective from being on the frontline as a paramedic has only benefited the diverse thinking with which Ian has approached his research. It allows him to “think about what the next big research questions will be…and is helpful when putting some rational or implications behind your findings.” This unique dual experience has also allowed Ian to feel confident in bringing a valuable Illustration by Chloe Ng
FEATURE
“The paramedic role has been a unique twist to academia that most places are not as familiar with yet. The biggest challenge now is that I’m getting near the end – the now what”?”
Paramedic AMBULANCE
perspective to the panel discussions and committees he has sat on throughout his graduate degree. At the time of our interview, Ian was just finishing up his degree*. When asked about it, he replied “It’s been a bit of a journey, I’ve had some hiccups along the way… There’s been lots of good opportunities too. The paramedic role has been a unique twist to academia that most places are not Photo provided by Ian Drennan
as familiar with yet. The biggest challenge now is that I’m getting near the end – the now what?” He went on to explain that “for paramedics, only a few with PhDs… not only is there no path, but for most people it’s not even on their radar. When you say, ‘I’m a paramedic with a PhD’, the reply is often ‘oh, I’ve never thought about that before’…I’m trying to forge my own clinician scientist spot, as a paramedic scientist and it’s challenging.” Despite his uncertainty, Ian will continue to break new ground in the near future, as he has secured a unique job at Sunnybrook hospital that will allow him to meld his expertise as a paramedic and a researcher. “Part of the role will be to oversee clinical trials…and the other part will be to do my own research,” he explained. His resilience in new environments was apparent as he modestly listed some of the options afforded by his dual career path, ultimately praising the flexibility of his new role and relying on his own ability to figure it out. After twelve years of service as a paramedic and eight as a researcher, I asked Ian about any tidbits of wisdom that have impacted him along the way. After a mindful pause, he emphasized that “if you have time and energy, you can do it. Find a supervisor that can guide you through the
process.” Some of the best advice that Ian received from his own supervisor was that “collaborating is by far the best thing you can do and being able to collaborate is the best skill you can learn.” When expanding on his own takeaways from his degree experience, Ian advised to “take time during your degree to learn skills, learn how to do research and move on with your career,” as your project will inevitably grow but try your best to “keep it manageable.” Through the cumulation of knowledge gained in his unique set of experiences, Ian is well-positioned to make big waves in the paramedicine field here in Ontario. He hopes to leverage his clinical and research perspectives to improve emergency healthcare from multiple infusion points. And when asked what he does in his ample amount of time off, Ian chuckled and replied that he and his family try to stay active as much as possible. Even if that often looks like travelling between hockey arenas with the kids for their many team commitments, they always manage to find some time to for a pick-up game here and there. Since the time of the interview in March 2020, Ian has successfully defended and submitted his doctoral thesis. *
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FEATURE
Imaging Brains and Treating Hearts: An Interview with Esmaeil Mansouri By Mashal Ahmed
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part-time registered nurse (RN) at St. Michael’s Hospital and a full-time Master’s student at IMS, Esmaeil Mansouri has struck a unique balance between his dual roles as a healthcare provider and clinical researcher. However, unlike many healthcare workers, for whom problems encountered on-the-job might pique interest into research, Mansouri’s journey began at the opposite end: with clinical inquiry.
SUDs impose a significant social and economic burden on society. Alcohol use disorder, for example, accounts for an average cost of $14.6 billion in Canada every year.1 Often, patients suffering from SUDs present with multiple comorbid psychiatric disorders, including bipolar disorder, major depression, antisocial personality disorder, general anxiety disorder, and dependence on other drugs,2 which further magnify mental, physical, and socioeconomic strains. Despite the prevalence of these disorders, treatments remain sub-optimal. This 20 |
Mansouri’s research has focused on using positron emission tomography (PET) and autoradiography imaging to learn more about the interaction between the brain’s cannabinoid and dopaminergic systems; both of which have been implicated in addiction and reward-related behaviours. PET is a nuclear imaging technique that uses a radioactive tracer to measure metabolic processes within the body. Mansouri’s project employs the radiotracer [C-11]-(+)-PHNO to measure in vivo dopamine D2/3 receptor binding. “There is growing interest in the dopamine D3 receptor due to its pivotal role in addiction,” Mansouri explains. “Preclinical, post-mortem, and brain imaging studies have shown an upregulation of this receptor in stimulant users.3 Furthermore, a genetic variation (C385A) in an endocannabinoid system enzyme called “fatty acid amide hydrolase” (FAAH) has been associated with the same type of reward-related behaviours that are linked to dopamine D3 receptors.” Mansouri’s imaging results demonstrate higher [C-11]-(+)-PHNO binding and D3 receptor expression in patients with the FAAH genetic variant (C385A).4 This genetic variation (C385A) results in lower FAAH activity, which has been associated with SUDs.5,6 “It’s exciting because we replicated this finding in mice as well. These results suggest that FAAH may serve as a novel therapeutic target for SUDs, which in turn, could spark interest in the employment of FAAHtargeted treatment options”, he explains.
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“Modulation of FAAH activity within the endocannabinoid system could have beneficial effects on the dopaminergic system, aiding in the treatment of SUDs.” As the interview continues, we walk through the bright halls of the Research Imaging Centre at CAMH. Mansouri leads us into one of the patient prep rooms. “While preparing patients for imaging procedures I came to really enjoy the element of patient interaction; building rapport, learning uniquely different life stories, and providing emotional support when needed.” Mansouri explains. “Out of curiosity, I began talking to CAMH nurses to get a sense of their job experiences. It was these direct patient interactions and discussions that piqued my interest in clinical care and nursing. I loved my role in research, but I also wanted to make a difference on an individual basis.” Photo provided by Esmaeil Mansouri
After graduating from the University of Toronto in 2014 with a Bachelor of Science in Neuroscience and Chemistry, Mansouri began working at the Centre for Addiction and Mental Health (CAMH) as a research assistant. This position eventually led him into his current Master’s program, which he began in 2018. For the past six years Mansouri has worked with the Human Brain Imaging Lab under the supervision of Dr. Isabelle Boileau to better understand the biological mechanisms underlying mental illness and substance use disorders (SUDs).
highlights the need to better understand the neurobiological under-pinning’s of such disorders.
ESMAEIL MANSOURI, BSc, RN MSc Student, Institute of Medical Science, University of Toronto Illustration by Chloe Ng
FEATURE
“ I learn about the brain...
A common misconception in research as well as the medical field in general, is that one’s area of expertise should be very specific and niche. While it is true that researchers and clinicians should be knowledgeable in their field, this notion should not hinder exploration of other areas, medical or otherwise. Branching into new endeavours promotes personal growth and provides broader perspective into one’s original field of work. That was the case for Mansouri. Mansouri completed nursing school in 2017 and began working as an RN in the Cardiovascular Intensive Care Unit (CVICU) at Toronto General Hospital in January 2018. “It was a big leap to go from working in a mental health hospital to the CVICU. A number of people questioned the seemingly great difference between my research and clinical work.” Yet for Mansouri, this was an exciting transition. “From my perspective I was bringing the patient interaction skills I had developed from working with mentally vulnerable populations and applying them to a different set of patients”, he explained. Patients admitted to the CVICU are either suffering from acute coronary syndromes, recovering from a major cardiothoracic-related surgery, or receiving critical treatment for a chronic cardiothoracic illness. Due to the severity of their ailments, these individuals often experience a roller-coaster of emotions, ranging from depression to extreme anxiety to delirium. “Having a background in mental health helps me better connect and understand these additional challenges. In turn, this allows patients to more easily build trust and have a more comfortable hospital experience. I like to
tell people ‘I learn about the brain and help treat the heart’”. Mansouri’s experience in research also helped him understand the importance of transitioning towards evidence-based clinical practice. A few decades ago, many medical procedures were anecdotal; if they worked for a handful of patients, surely they would work for others presenting with similar symptoms, right? Today, hospitals are moving away from this form of thinking and implementing practices that are based on reliable medical research and peer-reviewed literature. “My exposure to the scientific method taught me about the importance of evidence-based medicine early in my career, and I carry this knowledge forward through my job.” “What about vice versa? What has your role as an RN taught you about research?” I ask. “The bigger picture”, he answers almost immediately. “As graduate students, we can easily be consumed with the nitty, gritty details of our work; striving to find statistical significance in our hard-earned data. But does statistical significance equate to clinical relevance? Not always.” Mansouri continued, “Working in healthcare has taught me to step back from my research and question how this will translate to bedside. This form of thinking has also helped me keep my manuscripts and thesis focused on the main purpose: How will these findings contribute to the medical community?” As one might expect, the workload from navigating a Master’s project and concurrently working as an RN can be overwhelming. Initially Mansouri was working fulltime, but it became very stressful to balance with the academic
“
... and help treat the heart.
expectations of his program. To maintain a healthy balance with his dual roles and responsibilities, Mansouri has started working part-time as an RN. “I try to work night shifts and weekends at St. Micheal’s and come into the lab to work on my thesis project. I also make time for taking power naps, working out, and hanging out with friends. I think these breaks between school and work are essential to maintaining this busy lifestyle. There is no way to survive without it”, he laughs. As his Master’s comes to an end this summer, Mansouri contemplates the next steps in his career. “My options are wide open. I definitely want to remain in the healthcare field. I might pursue my PhD or further my studies to becoming a nurse practitioner. But as always, I am keeping my options open!” For anyone considering a similar, unconventional route in medical research and healthcare: stay open-minded about your opportunities; you might just end up imaging brains and treating hearts. References 1. 1Rehm J, Baliunas D, Brochu S, et al. The costs of substance abuse in Canada 2002 (Highlights). Canadian Centre on Substance Use and Addiction. 2006. 2. Grant BF, Stinson FS, Dawson DA, et al. Prevalence and cooccurrence of substance use disorders and independent mood and anxiety disorders: results from the national epidemiologic survey on alcohol and related conditions. Archives of general psychiatry. 2004 Aug 1;61(8):807-16. 3. Payer D, Balasubramaniam G, Boileau I. What is the role of the D3 receptor in addiction? A mini review of PET studies with [11C](+)-PHNO. Progress in neuro-psychopharmacology and biological psychiatry. 2014 Jul 3;52:4-8. 4. Mansouri E, Nobrega JN, Hill MN, et al. D3 dopamine receptors and a missense mutation of fatty acid amide hydrolase linked in mouse and men: implication for addiction. Neuropsychopharmacology. 2019 Nov 27:1-8. 5. Boileau I, Tyndale RF, Williams B, et al. The fatty acid amide hydrolase C385A variant affects brain binding of the positron emission tomography tracer [11C] CURB. Journal of cerebral blood flow & metabolism. 2015 Aug;35(8):1237-40. 6. Tyndale RF, Payne JI, Gerber AL, et al. The fatty acid amide hydrolase C385A (P129T) missense variant in cannabis users: studies of drug use and dependence in Caucasians. American journal of medical genetics part b: Neuropsychiatric genetics. 2007 Jul 5;144(5):660-6.
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BMC FEATURE
MASTER OF SCIENCE IN
BIOMEDICAL COMMUNICATIONS YEAR 2T0
Caitlin Chang My interest in illustration started at an early age. However, an interest in biological and social sciences led me to study and receive my undergraduate degree in Health and Disease and Women and Gender Studies at the University of Toronto. Communication through illustration can be a powerful tool to create awareness and compassion for the more vulnerable in our communities. Being at the BMC program has empowered me to explore this route of activism and I am looking forward to advance my skillset.
YEAR 2T0
Miranda MacAskill Miranda MacAskill is a biomedical communicator specializing in interactive media and illustration. She has a B.Sc. in Biomedical Science from the University of Guelph and is currently completing her M.Sc. in Biomedical Communications at the University of Toronto. In addition to her biomedical work, Miranda has almost a decade of experience working in marketing and corporate communications as a graphic designer and communications specialist. View her portfolio at:
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BMC FEATURE
Featuring: Caitlin Chang, Miranda MacAskill, Chloe Ma, Deniz Kaya
YEAR 2T1
Chloe Ma Visualization is a powerful language that is accessible to people across the world. I aim to translate science into visual art, revealing the beauty of this hidden world, to facilitate education and professional communication. In my Master’s Research Project, I will create a visual language framework for visualizing the unique molecular properties of intrinsically disordered proteins, and develop software tools that facilitate the creation of these visuals. For my future career, I will keep sharpening my visualization skills to communicate each educational subject in its own elegant and proper presentation.
YEAR 2T0
Deniz Kaya Deniz Kaya is graduating this year from the Master of Science in Biomedical Communications program at the University of Toronto. She was in the biomedical visualization design stream and created an original animation about the role of torpor-use in energy management for hummingbirds. Deniz specializes in image segmentation, character animation, storyboarding, and human anatomy. She also has a BSc with Distinction in Psychology from the University of Calgary and has completed fine-art training with the Academy of Realist Art. More of her work can be viewed on her website: www.denizkaya.ca IMS MAGAZINE SPRING/SUMMER 2020 BEDSIDE TO BENCH
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VIEWPOINT
The Nobel Prize: An ignoble history of gender bias By Krystal Jacques
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ost of us have heard of the prestigious Nobel Prize, awarded annually in five categories: Physics, Chemistry, Physiology or Medicine, Literature, and Peace. There is also an additional Memorial Prize in Economics. Not a single woman was awarded last year.1 This may or may not be coincidental. Where does this award come from in the first place? And how are awardees selected from hundreds of candidates? How does one decide on whom to choose? The process behind the Nobel Prize is elusive to most of the public, but the controversial ways in which people are selected for the award warrants public attention. The Royal Swedish Academy, which was founded in 1739, initiated the existence of the five categories of the Nobel Prize in 1835 after the death of Alfred Nobel, a Swedish chemist and engineer.2 Alfred Nobel amassed a fortune during his lifetime due to his impressive 355 inventions. His will specified that his fortune be used to create a series of prizes for individuals who create the “greatest benefit on mankind in physics, chemistry, physiology or medicine, literature, and peace.”2 I imagine the process of deciding whose work fulfills this criteria is not entirely unbiased. Each award recipient, known as a Nobel Laureate, receives a diploma, a gold medal, and a sum of money. As of 2020, each award in each category is worth about $935, 366 U.S. The recipient of the award must be alive, and the award cannot be granted to more than three individuals in any one category. The Royal Swedish Academy’s core committee of 18 Swedish members confidentially invites people to nominate 24 |
potential winners. Those who are invited to nominate generally include its own members, past Nobel Laureates in the field, tenured professors from Sweden, Denmark, Finland, Iceland, and Norway, department chairs from elsewhere, and other scientists or presidents of author societies. Membership lasts three years. Today the committee who nominates and selects awardees consist of 440 Swedish and 175 international members.1 In the last few years, more women were elected to the Royal Swedish Academy of Sciences, which awards the Nobel Prizes in physics, chemistry and economics. By involving more women in the selection and nomination process, the organizations that award the Nobel Prizes hoped bias towards males being selected would be reduced.3 However, this is most likely unhelpful as it has been well documented that women do not select women any more than men during the process of evaluation for recruiting in the academic and nonacademic workforce, and when reviewing publications for journal acceptance.4,5,6 The proportion of women who have won the Nobel prize in Physics, Chemistry, Physiology or Medicine has remained consistent in the past century despite the growing number of women significantly contributing to the scientific research field.7 As of today there are only 46 female laureates. Out of these 46 women, only 16 were awarded the Nobel Prize for their contribution in research while the remaining 30 women obtained the prize in economics, literature and peace.7 Marie Curie was the first woman Nobel Laureate in physics — which was awarded in 1903. For the next six decades, no other women physicists were found eligible to receive this honor. In 1911,
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Marie Curie won the Nobel Prize again in Chemistry. Her daughter, Irene-Joliet Curie, was awarded a Nobel Prize, along with her husband, in Chemistry 24 years later for her work in the synthesis of new radioactive elements. Maria GoeppertMayer is the second female physicist to have won the Nobel Prize in Physics along with Wigner and Jensen in 1963. Gerty Cori was the third woman ever to have won the Nobel Prize for her work on identifying some of the intermediates formed during glucose metabolism. In retrospect, there are many other notable women who should have won the Nobel Prize to fill in the long gaps seen here, such as Nattic Maria Stevens whose work concluded that a combination of X and Y chromosomes could determine an individual’s sex. Rosalind Franklin’s story is an excellent example of how a woman researcher got pushed aside during the recognition process. Franklin was an expert on X-crystallography, and was one of the few scientists at the time trying to determine the structure of DNA.1 Based on her X-ray diffraction images Franklin had determined the precise distances between repetitive elements and angles formed by chemical bonds.8 She had written all her observations and measurements as an informal report which was sent to Max Perutz (who also won the Nobel Prize for his work on hemoglobin) at Cambridge University soon before she decided to abandon her work on DNA.8 Max Perutz shared her private work to his protégés Watson and Crick who realized that Franklin’s images immediately suggested a double helical structure of DNA. Watson and Crick interpreted Franklin’s data in new insightful ways to create a detailed model of double helical structure of DNA in 1953.8 At that time of proposal, Franklin Graphics by Chloe Ng
VIEWPOINT
“The process behind the Nobel Prize is elusive to most
of the public, but the controversial ways in which people are selected for the award warrants public attention.” was invited to see the model.8 Immediately after watching their proposal, she believed that the model must be right. The model was published as the sole work of Watson and Crick, while the supporting data was published by Franklin and her supervisor Wilkins.8 Eight years later the Nobel Prize was awarded to Watson and Crick.1 By this time Franklin had already died from ovarian cancer, and the Nobel Prize cannot be awarded posthumously. There are other similar, unfortunate cases such as these. Canadian Maud Menten discovered the constant Km in 1912 and along with Michaelis developed the Michaelis-Menten equation.9 There were many opportunities in which Menten’s work could have been considered for the Nobel Prize between 1912 and her death in 1960. Ida Noddack (1896–1978), who discovered the element rhenium and was the first to mention the idea of nuclear fission, published a paper in 1934 criticizing Enrico Fermi’s apparent discovery of element 93 being a product of nuclear fusion by the bombardment of uranium with neutrons.10 She suggested that his experimental results lead to nuclear fission, not fusion, as the process creating element 93. Her hypothesis was actively refused for nine years,10 and instead Enrico Fermi was awarded the Nobel Prize for his supposed work on fusion in 1938.1 However, it turned out Noddack was right -it was fission. She was nominated for the Nobel Prize in Chemistry three times however was never successful in obtaining it.10 For both Menten and Noddack these instances suggest that it was not because of a short lifespan and delayed recognition of their work that lead to them not receiving the Nobel Prize, but rather their work was overlooked or under biased review. Despite Franklin, Leonara, and Noddack, as well as other women making outstanding contribution to innovative scientific research, the Nobel nomination eluded them. Besides the lack of female
nominations in research, there are other instances in which the Nobel awards were controversial, such as Barack Obama being awarded with the Nobel Peace Prize in 2009 (one year after being elected as President) for his promise in the future to prevent nuclear war.1,11 However, Obama has been criticized for merely replacing one type of war with another, by means of employing new technology, including armed drones and cyber weapons. During all eight years of Obama’s presidential tenure, U.S. military forces have been at war with several countries including Afghanistan, Iraq, Syria, Libya, Yemen, Somalia and Pakistan.11 The award couldn’t have come at a more awkward time: when Obama finalized plans to send 30,000 more U.S. troops to airstrike Afghanistan in an attempt to stabilize the country.11 Many Obama supporters did not understand this decision and agreed that Obama was not a worthy recipient of that award-“12 Obama’s acceptance speech at the award ceremony in Norway reflects his own hesitancy to pick up the award: “To say that force may sometimes be necessary is not a call to cynicism. It is a recognition of history, the imperfections of man and the limits of reason.”11 In addition, when deciding the 2010 Nobel Peace Prize recipient, Norway’s foreign minister at the time attempted to dissuade the committee from awarding Liu Xiobo, an activist in China, fearing it would strain Norway’s relationship with Beijing.13 Not only is the Nobel Prize nomination committee lacking in diversity and intentionally or unintentionally biased to not select women for science Nobel Prizes, but the selection process is also highly political. The awards committee acknowledges their gender bias existed up until the 90’s and have made efforts to have better women representation on the nomination committee. However, women are also more likely to nominate men over women just like their male peers. Despite the possibility that this may not lead to women being recognized in research, the Nobel committee believes that the
fraction of women Nobel Laureates will increase as time moves forward without any other changes. Perhaps the committee will consider blinding a part of the reviewing process, such that one group of nominators would receive the work of potential individuals, and evaluate their work without being aware of the names of the individuals. Until then, it is our social responsibility to have an interest in the political nature of the Nobel Prize, and in all the ways that sex, and privilege shapes the reality we live in.
References 1. Nobel Media AB [homepage on the internet]. Updated 2020. Available from: https://www.nobelprize.org/all-2019-nobel-prizes/. 2. Locke, S. How the Nobel Prize became the most controv ersial award on Earth. [Internet]. Vox; 2016 Oct 5 [cited 2020 Mar 9]. https://www.vox.com/2014/10/6/6895363/nobel-prizes-winners-controversies-explained. 3. Frazee G. Why the 2019 Nobel Prizes in STEM struggled with diversity. [Internet]. Making Sense; 2019 Oct 14 [cited 2020 Mar 9]. https://www.pbs.org/newshour/economy/making-sense/why-thenobel-prizes-in-science-are-struggling-with-diversity. 4. Moss-Racusin CA, Dovidio JF, Brescoll VL, Graham MJ, Handelsman J. Science faculty’s subtle gender biases favor male students. Proc Nat Acad Sci. [Internet]. 2012 Oct 9 [cited 2020 Mar 9];109(41):16474-9. Available from: https://www.pnas.org/ content/109/41/16474. 5. Helmer M, Schottdorf M, Neef A, Battaglia D. Gender bias in scholarly peer review. Elife. [Internet]. 2017 Mar 21 [cited 2020 Mar 9];6:e21718. Available from: https://elifesciences.org/articles/21718. 6. Knobloch-Westerwick S, Glynn CJ, Huge M. The Matilda effect in science communication: an experiment on gender bias in publication quality perceptions and collaboration interest. Sci Commun. [Internet]. 2013 Oct [cited 2020 Mar 9];35(5):60325. Available from: https://journals.sagepub.com/doi/ full/10.1177/1075547012472684. 7. Modgil S, Gill R, Sharma VL, Velassery S, Anand A. Nobel nominations in science: constraints of the fairer sex. Ann Neurosci. [Internet]. 2018 [cited 2020 Mar 9];25(2):63-79. Available from: https://www.karger.com/Article/Fulltext/481906. 8. Cobb, M. Sexism in Science: did Watson and Crick really steal Rosalind Franklin’s data. [Internet]. The Gaurdian; 2015 Jun 23 [cited 2020 March 18]. 9. Bergeron, J. A Canadian science heroine’s role in this year’s Nobel. [Internet] McGill Publications; 2018 Nov [cited 2020 July 13]. Available from: https://publications.mcgill.ca/medenews/2018/11/07/acanadian-science-heroines-role-in-this-years-nobel-chemistryprize/ 10. Santos GM. A tale of oblivion: Ida Noddack and the ‘universal abundance’of matter. Notes and Records: the Royal Society Journal of the History of Science. 2014 Dec 20;68(4):373-89. 11. Parsons, C and Hennigan, W.J. President Obama, who hoped to sow peace, instead led the nation in war. [Internet]. The Los Angeles Times; 2017 Jan 13 [cited 2020 July 13. Available from: https://www. latimes.com/projects/la-na-pol-obama-at-war/ 12. Nobel secretary regrets Obama peace prize [Internet]. BBC news; 2015 Sept 17 [cited 2020 Mar 9]. Available from: https://www.bbc. com/news/world-europe-34277960. 13. Nobel Peace Prize faces boycotts over Liu Xiaobo. [Internet]. BBC News; 2010 Sept 7 [cited 2020 Mar 9]. Available from: https://www. bbc.com/news/world-europe-11935230.
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FACULTY SPOTLIGHT
Mental Health at U of T: the new horizon of My SSP app By Rehnuma Islam While your Fitbit counts the number of steps to reach a goal, the University of Toronto is taking steps towards improving students’ mental health. The question is how many steps will it take to get there? In the past year, the university has been under scrutiny after a series of students died by suicide, sparking an outcry for improved mental health services. In an interview with Global News, U of T’s President Meric Gertler explained that more students are seeking support from mental health services.1 But importantly, the rate of suicide remains stagnant despite a three-million-dollar investment into mental health resources over the past two years. These frustrations were echoed by student groups demanding sweeping changes to curb suicide rates. In response, the university has since met with students to generate a mental health report to outline the needs of students and where improvements can be made.
“... the anonymity of the individual seeking service and their 24/7 support makes this program an essential mental health service to students.” 26 |
There are 5 ways U of T is addressing the needs of its students: 1. Easier tri-campus wide mental health service integration with support from CAMH 2. Drop-in counselling at Robarts Library during final exam session 3. A healthy lab initiative led by Dr. Reinhart Reithmeier to improve laboratory atmosphere and identify best practices for managing labs 4. Raising the need for support from government funding 5. My Student Support Program (My SSP) As part of the mental health initiatives, the My SSP program was introduced to international students in March 2019 and domestic students later in 2019. The program is an external thirdparty app managed by the company Morneau Shepell, giving students access to professional counsellors around the clock. The program has been adopted across many universities within Canada and the US, prior to its adoption at U of T. The idea is to increase the number and ways in which mental health services reach students. The program is touted to be private, anonymous, available in 146 languages, accessible 24/7, and at no additional cost to students.2
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In an interview with U of T News, ViceProvost Sandy Welsh said students deemed the program a great success at other institutions. However, when we asked the UofT media relations about the app’s performance at U of T, the response was, “we do not have data available on the My SSP app”. Perhaps it is too early to assess the benefits of the program at U of T, but one student’s response suggests that the anonymity of the individual seeking service and their 24/7 support makes this program an essential mental health service to students. The stigma around mental health is slowly lifting. However, until conversations surrounding mental health become the norm, the apps’ ability to allow users to stay anonymous gives it an edge. The app’s benefits can extend even further by integrating an everyday wellness assessment so that individuals can assess their own progression of mental wellness. There are already mental wellness tips within the app which can help to curb negative thought cycles. Perhaps expanding their service to include behaviour therapy can allow individuals to modify negative thoughts by introducing positive ones. As a society we need to look at the underlying causes of mental health issues. The UK has appointed a loneliness minister as a result of pressing concerns over a report that nine million of its inhabitants felt lonely.3 Canada should consider this as one in five Canadians identify as feeling lonely.4 Many international students leave their family Illustration by Chloe Ng
VIEWPOINT
“Even music artist, Lauv,
wrote in his song ‘modern loneliness, we’re never alone but always depressed’.”
and friends to face a new environment alone. Domestic students, regardless of their social setting, can also experience loneliness. Even music artist, Lauv, wrote in his song “modern loneliness, we’re never alone but always depressed”. Loneliness is felt by everyone at some point in time, however chronic feelings of loneliness can be a comorbidity for other psychological and physical health risks, such as depression5. According to one paper, loneliness serves to remind us to re-establish meaningful social connections because evolutionarily humans survived better in groups6. What can contribute to this increasing feeling of loneliness? No one knows exactly, but research suggests it could be from multiple contributors, such as being in a new social environment which can lead to low quality of social relationships
or sleep deprivation.7,8 Many studies have also linked mental health with increased risk for detriment to physical health and increased mortality.9,10 Therefore, the responsibility lies with both the university and government to optimally understand and implement effective mental health policies and services. What remains to be seen is whether the current mental health initiatives lead to real results in student’s lives. The university should seek to continually assess that students’ needs are being meet and bring mental health to the attention of the government. The mental health initiatives set after 2019 seems to be a start in the right direction, because good mental health is important not only at the individual level, but for the community as a whole.
References 1. Friesen, Joe. “University of Toronto Installs Safety Barriers after Third Student Suicide in 18 Months.” The Globe and Mail, 2 Oct. 2019, www.theglobeandmail.com/canada/article-university-of-toronto-installs-safety-barriers-after-third-student/. 2. Kalvapalle, Rahul. “U Of T Rolls out on-Demand My SSP Counselling Service to All Students.” University of Toronto News, 2020, www.utoronto.ca/news/u-t-rolls-out-demand-my-ssp-counsellingservice-all-students. 3. John, Tara. “Meet Tracey Crouch, Britain’s Minister for Loneliness.” Time, Time, 25 Apr. 2018, time.com/5248016/tracey-crouch-uk-loneliness-minister/. 4. Stroh , Perlita. “Feeling Lonely? It Could Be Doing You Physical Harm | CBC News.” CBCnews, CBC/Radio Canada, 19 Jan. 2019, www.cbc.ca/news/health/national-dealing-with-loneliness-1.4828017. 5. Erzen E, Çikrikci Ö. The effect of loneliness on depression: A meta-analysis. Int J Soc Psychiatry. 2018 Aug;64(5):427-435. 6. Masi, M. et al. A Meta-Analysis of Interventions to Reduce Loneliness. Pers Soc Psychol Rev. 2011 Aug; 15(3) 7. Walker, M.P. and Simon B. Sleep loss causes social withdrawal and loneliness. Nat Commun. 2018 Aug 14;9(1):3146. 8. Khaja, Mariyam. “Students Are Lonelier than Ever.” Macleans.ca, 30 Oct. 2019, www.macleans.ca/education/students-are-lonelier-than-ever/. 9. Xia, N. and Li H. Loneliness, Social Isolation, and Cardiovascular Health. Antioxid Redox Signal. 2018 Mar 20; 28(9): 837–851. 10. Malcolm, Martin et al. Loneliness and social isolation causal association with health-related lifestyle risk in older adults: a systematic review and meta-analysis protocol. Systematic reviews vol. 8,1 48. 2019.
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VIEWPOINT
THE HIDDEN PANDEMIC:
COVID-19 Misinformation in the Media By: Jason Lo Hog Tian
A
fter welcoming the turn of a new decade, the world woke up to news of an emerging infectious disease that would grow to become the largest outbreak in recent memory. COVID-19 exploded onto the world stage as it spread internationally and prompted worldwide collaboration between doctors, researchers, and health officials to understand this new disease. On March 11th 2020, as the number of cases approached 4 million, the World Health Organization (WHO) declared COVID-19 a pandemic.1 Millions more have been infected since then and with unprecedented lockdown measures being implemented in many countries, the world will surely continue to feel the impact of the pandemic long after COVID-19 is behind us. While only a percentage of the world have experienced having COVID-19, almost everyone has been touched by the fear and anxiety that comes with the emergence of a new infectious disease. Rapid spread and lack of information about the novel coronavirus created the ideal environment for another “pandemic” that may be as widespread and long lasting as the disease itself – one of misinformation in the media. In December 2019, a patient with a mysterious respiratory
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disease was reported in Wuhan, a city in the Hubei province in China.2 The WHO later named the disease “coronavirus disease (COVID-19)” and the virus that causes it “severe acute respiratory syndrome coronavirus 2 (SARSCoV-2)”.3 The virus is named after the projections on their surfaces that form a “corona” which in Latin means “halo” (see Figure 1 for illustration). These projections bind the virus to human cells, allowing the viral DNA to enter. While there are hundreds of coronaviruses, only seven cause human diseases, most notably the SARS outbreak in 2002 in China and the MERS outbreak in 2012 in the Middle East.2 People infected with COVID-19, like with other coronaviruses, commonly have flu-like symptoms including fever, cough, and shortness of breath.2 Most people experience mild symptoms, however COVID-19 has caused many deaths, mostly in those with compromised immune systems.4 While all initial cases had contact with the food market in Wuhan, cases that had no contact quickly appeared, providing evidence for human-to-human transmission of COVID-19. The virus is thought to be transmitted via respiratory droplets from infected persons, although there is still debate on whether airborne transmission
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is possible.5 Health authorities recommend “social distancing” to combat this method of transmission and many nations have implemented stay-at-home measures to reduce the spread of COVID-19. There is currently no treatment available for COVID-19 and the focus is on managing symptoms, however there are numerous clinical trials underway. Vaccines are being developed using knowledge from previous coronavirus outbreaks. Researchers are currently focused on using the coronal projections to safely activate an immune response that will protect an individual should they become infected later on.6 However, the development process is lengthy with experts predicting that a vaccine will not be ready before 2021.7 Despite the virus spreading rapidly, 80% of cases are mild and recover completely. Around 5% of cases are critical and experience symptoms such as respiratory failure, septic shock, and multiple organ failure. These critical cases are responsible for most of the deaths with a total mortality rate for COVID-19 around 2-3%.8 It is no surprise that media sources are providing around the clock coverage of such a major world event as it develops, however when an issue is covered as much
Figure 1: Illustration of the SARS-CoV-2 virus particle
VIEWPOINT
Nick Woolridge / Biomedical Communications
as COVID-19, it’s hard not to be fearful and anxious of a disease that seems to envelop our collective consciousness. Social media allows anybody to voice their opinion to an audience of thousands or millions which makes it easy for misinformation to spread. Social media sites are littered with crackpot cures, ineffective preventative measures, and conspiracy theories speculating the origin of the virus, some of which can have dangerous implications. One notable example occurred in March 2020 when a document claiming that chloroquine, a malaria drug, was an effective treatment for COVID-19. Major news outlets quickly picked up the story and shortly after, U.S. President Donald Trump as well as Brazilian President Jair Bolsonaro endorsed a related drug called hydroxychloroquine as an effective treatment despite a lack of evidence.9 Google then saw a surge of searches for the compound and hospitals reported patients with toxic side effects from pills containing chloroquine.9 This example illustrates how a piece of misinformation can escalate quickly from a single source to widespread global coverage and the potentially dangerous implications this can have. In the wake of COVID-19, social media platforms such as Twitter, Facebook, and YouTube are battling the spread of misinformation on their sites and funneling users towards reputable sources.10 All three platforms even deleted posts from the Brazilian President after his promotion of hydroxychloroquine as a potential treatment on the grounds that
it could cause harm.9 However, misinformation is difficult to contain with the sheer volume of online content making it hard to piece together the truth. This is especially worrying when people do not realize or believe that they could be misinformed. One Canadian study showed that over half of the participants surveyed were confident they could “easily distinguish conspiracy theories and misinformation from factual information about COVID-19”.11 The same study showed that approximately half of those who believed that COVID-19 was engineered as a bioweapon in a Chinese lab or that COVID-19 is being spread to cover up harmful effects of exposure to 5G wireless technology said they could easily distinguish between COVID-19 facts and misinformation.11 Like COVID-19 itself, misinformation about COVID-19 is difficult to fight when people do not know they are infected in the first place. With “fake news” being so prevalent today, it’s easy to forget that media has had a positive effect on the collective knowledge of the world by increasing access to information. Mass media coverage plays a large role in slowing disease spread by informing the public about disease transmission and preventative measures they should take. Media not only keeps the public knowledgeable, but research has shown that it changes behavior, with more news reports being linked with fewer hospital visits and a lower number of new cases.12 While even the most reputable sources can be subject to misinformation and sometimes contradict themselves, this is often
a reflection of the scientific process where knowledge is constantly developing and being updated. During the outbreak of a new infectious disease, making informed and responsible decisions becomes even more important and an effective media strategy can educate the public on a scale never seen before. The COVID-19 pandemic is still evolving and the scope of its impact on society remains unclear. Misinformation in the media will also remain a problem and it’s up to us to navigate the media wisely by remaining skeptical, rational, and unwavering in the pursuit of the truth. Relying on reputable sources is key in preventing you from falling victim to conspiracy theories and accurately measuring the threat to your health. While many of us may feel powerless to help in the fight against COVID-19, we can all do our part in battling the pandemic of COVID-19 misinformation. References 1. Organization WH. WHO Director-General’s opening remarks at the media briefing on COVID-19-11 March 2020. Geneva, Switzerland. 2020. 2. Wu F, Zhao S, Yu B, Chen Y-M, Wang W, Song Z-G, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020:1-5. 3. World Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it 2020. Available from: https:// www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-andthe-virus-that-causes-it. 4. Public Health Agency of Canada. Epidemiological summary of COVID-19 cases in Canada 2020. Available from: https://health-infobase. canada.ca/covid-19/epidemiological-summary-covid-19-cases.html. 5. World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/who-chinajoint-mission-on-covid-19-final-report.pdf. 6. Callaway E. The race for coronavirus vaccines: a graphical guide. Nature. 2020;580(7805):576. 7. Wetsman N. It’s going to take a lot longer to make a COVID-19 vaccine than a treatment: The Verge; 2020. Available from: https://www. theverge.com/2020/2/28/21156385/covid-coronavirus-vaccine-treatment-moderna-remdesivir-research. 8. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020. 9. Ball P, Maxmen A. The epic battle against coronavirus misinformation and conspiracy theories. Nature. 2020;581(7809):371-4. 10. De Vynck G, Griffin R, Sebenius A. Coronavirus Misinformation Is Spreading All Over Social Media: Bloomberg; 2020. Available from: https://www.bloomberg.com/news/articles/2020-01-29/coronavirus-misinformation-is-incubating-all-over-social-media. 11. Everts S, Greenberg J. New Carleton Study Finds COVID—19 Conspiracies and Misinformation Spreading Online: Carleton Newsroom; 2020. Available from: https://newsroom.carleton. ca/2020/new-carleton-study-finds-covid-19-conspiracies-and-misinformation-spreading-online/. 12. Yan Q, Tang S, Gabriele S, Wu J. Media coverage and hospital notifications: Correlation analysis and optimal media impact duration to manage a pandemic. Journal of Theoretical Biology. 2016;390:1-13.
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FACULTY SPOTLIGHT
By Nadia Boachie
C
ritical care is not for the light-hearted. If you have been to an Intensive Care Unit (ICU), you have seen several patients on the brink of life and death. They are being kept alive by machines and cared for by hardworking healthcare professionals that devote their lives to people in dire health states. Dr. Ewan Goligher is one such individual working at the Toronto General Hospital as a Clinician Scientist. His mission is to minimize the adverse long-term effects of certain life-saving medical interventions used in the ICU, and to ensure critical and end of life care is delivered in a patient-centered and ethical way. After completing medical school, Dr. Goligher came to Toronto for his internal medicine residency. He worked with Dr. Niall Ferguson, who sparked his interest in mechanical ventilation. Dr. Ferguson later became his supervisor when he pursued a PhD in the Department of Physiology at UofT. The main goal of Dr. Goligher’s research is to determine how mechanical ventilation can cause damage to patients’ lungs. He wants to prevent the complications associated with prolonged ventilation, so patients can recover and live healthier lives in the long
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term. Through these goals, he aims to have a global impact on patients who suffer from acute respiratory failure. Ventilators are designed to replace breathing muscles. However, Dr. Goligher indicates that they can also damage the lungs and principally, the diaphragm. He hypothesized that perhaps ventilators injured breathing muscles and led to their acute atrophy. As a result, muscles that facilitate breathing become too weak and patients fail to breathe on their own. Dr. Goligher’s research asks the questions, “How do we characterize what happens to the breathing muscles when you are on a ventilator?” and “How do we predict those changes?” Currently, he is designing clinical trials to evaluate how to protect patients’ diaphragms when using ventilators. As a clinician scientist, Dr. Goligher’s responsibilities extend beyond research. Because he often treats patients in their final stages of life, Dr. Goligher constantly deals with challenges pertaining to the ethics of end of life care. Patients are of varied cultural and religious backgrounds, and this may mean that agreeing on the appropriate medical interventions during this unstable period can be a source of contention. He
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explains that one of the joys of living in Canada is that it is a pluralistic society. Canadians have the opportunity to live and work with people of different cultures, backgrounds and belief systems. Dr. Goligher describes how pluralism can introduce challenges when looking after patients, “it sometimes creates dramatic ethical conflicts about what patients might want and what we as physicians think is good for the patient”. Cases in which to perform or withhold cardiopulmonary resuscitation (CPR) is an example of a medical intervention where sometimes doctors and patients do not align. Doctors try and avoid prolonged death. However, in cases where the probability of successful resuscitation approaches zero, doctors may deem it medically inappropriate to intervene with CPR. “Anytime you initiate CPR, you end up on life support, so it is a big package of very heroic interventions”, explains Dr. Goligher. When doctors intervene, they often see journeys of prolonged dying rather than recovery. Given the poor outcomes after CPR intervention, performing CPR can trigger tremendous amount of moral stress for doctors, nurses and respiratory therapists. Despite their best intent, it is Illustration by Ingrid Barany
FACULTY SPOTLIGHT human, including the consequences of weakness and vulnerability.
Dr. Ewan Goligher, MD, PhD, FRCPC Scientist, Toronto General Hospital Research Institute (TGHRI) Assistant Professor, Interdepartmental Division of Critical Care Medicine, University of Toronto Photo Credits: Dorsa Derakhshan
distressing to see that intervention only leads to prolonged suffering. Dr. Goligher believes medicine is a very human endeavor. Over the years, he has learned that taking the time to listen and understand where people are coming from and how they see the world is half the battle when dealing with conflict. When people feel heard and understood, it can be a trust building experience for more effective decision making. However, he adds, “it does not mean that all the differences of opinion go away”. Understanding the humanness of medicine is how Dr. Goligher copes with the trauma of his work environment. Dr. Goligher explains that physicians put up a metaphorical wall. Doctors cope with the pain and suffering by working on the assumption that such events do not happen to them. When suffering does break into the lives of doctors, they are humbled and forced to recognize that like the person on the other side of the gurney, they are human too. “I feel the brokenness of the world”, shares Dr. Goligher. Doctors get the experience of what it is like to be
Patient-centered care has always been Dr. Goligher’s focus. He strives to increase knowledge about ways to improve outcomes of patients that need mechanical ventilation. Currently, Dr. Goligher is at a pivotal point in his career. With the help of collaborators, based on trials they are planning, the results may change the way that ventilation is applied worldwide. “This is a junction where there are so many opportunities, there are so many really interesting questions to answer and time is really the only limiting factor”, claims Dr. Goligher. Motivated by the belief that his research is very rewarding, as he understands more, Dr. Goligher will be more compelled to look for answers. IMS magazine spoke with Dr. Goligher sometime after his initial interview and asked him how COVID-19 has impacted his ICU unit and his current research on ventilation. Dr. Goligher explained that “COVID-19 proved to be a huge challenge for the whole health system”. Specifically, “in the ICU we completely redeployed to focusing on caring for patients with severe COVID-19. They were often challenging to manage with severe derangements in gas exchange and a very prolonged recovery process.” COVID-19 has delayed but not cancelled the research Goligher and his team had planned. Goligher explained how the research studies they would normally conduct were shut down so that staff could stay at home. He explained how the “opportunities to continue mechanical ventilation research on
the diaphragm were limited.” “We were able to collect some data on lung function in these patients and we are working on describing our findings. Even as the pandemic settles in Canada, we’re continuing to work on developing a pandemic ventilator that can ventilate many patients at once in case of future need” Dr. Goligher added. Despite research stopping, doctors and hospitals were able to gather crucial information about how bets to care for patients. “Treating these patients raised important questions about how we decide when to put patients on a ventilator and how best to maintain their oxygen levels once they are on the ventilator. These will be important areas of future research in the ICU.” Dr. Goligher concludes. It will be interesting to see the amount of information that has been generated out of the global pandemic. The world continues to look to doctors and researchers like Dr. Goligher to help in recovery from the pandemic and to prevent or better handle any future outbreaks. Recently, the Toronto General Hospital was ranked the 4th best hospital in the world for excellent standard of care. According to Newsweek’s top 100 list, Toronto General was ranked behind Mayo Clinic, Cleveland Clinic, and Massachusetts General1. The hard work done by doctors and other medical staff, like Dr. Goligher, is recognized on a global scale. Doctors and researchers are working together to provide the References 1. Cooper, Nancy. “World’s Best Hospitals 2020 - Top 100 Global.” Newsweek, Newsweek, 24 Feb. 2020, www.newsweek.com/ best-hospitals-2020.
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FACULTY SPOTLIGHT
McGill UM NUSC UiO UofT
LookingBehindtheMirrorwithDr. MarianneKortizinsky
By: Sonya Elsaid
T
he journey is as equally important as the destination, echoed Dr. Marianne Koritzinsky, a Scientist at the Princess Margaret Cancer Center, and an Associate Professor at the Department of Radiation Oncology at the University of Toronto (U of T). Dr. Koritzinsky is also recently appointed Director of MSC 1010Y/1011Y Seminar Series in Translational Research course and the Member of the Institute of Medical Science (IMS). IMS Magazine interviewed Dr. Koritzinsky to learn more about her journey to becoming a successful scientist, community leader, and a mentor to many graduate students at the IMS. Even before enrolling in her undergraduate program at the Norwegian University of Science and Technology in her native country - Norway, Dr. Koritzinsky has always known that she wanted to do research in radiation biophysics. Although at that time she was very fascinated by the laws of physics, the biological revolution that was happening in the 1990s— especially our growing ability to elucidate the relationship between genes involved in metabolic and signaling pathways in disease states, such as cancer—swayed her decision to refocus her research on molecular biology. Wanting to explore this field in greater depth and work with some of the best experts in the field, Dr. Koritzinsky traveled to Canada during her graduate training to spend six months under the tutelage of Dr. Nahum Sonenberg (Department of Biochemistry, McGill University). Dr. Sonenberg was one of the first scientists to study mRNA translation—a topic that very much intrigued Dr. Koritzinsky, and regulation of mRNA translation under hypoxia in tumor cells eventually became the theme of her research. After completing her
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doctoral training at the University of Oslo, Dr. Koritzinsky obtained a post-doctoral position at the University of Maastricht in the Netherlands, where she also received her first job working as a scientist. However, living in a small town in the south of the Netherlands did not feel quite at home. Although Maastricht was a beautiful European town and the Dutch culture was very similar to the Norwegian, Dr. Koritzinsky found it difficult to integrate into this very much ethnically homogeneous, Dutch society. This was one of the reasons that led Dr. Koritzinsky to immigrate to Canada in 2008. Knowing that the University Health Network’s (UHN) Cancer Centre was internationally recognized for its cutting edge research in tumor hypoxia and radiation oncology, the move to Toronto was a natural choice. For her, Toronto represented a place where people from different parts of the world came ‘to work in harmony and thrive together.’ It was in Toronto that Dr. Koritzinsky found her home, making it easier to become fully integrated into Canadian society. At first, Dr. Koritzinsky worked as a Scientific Associate at the Princess Margaret Cancer Centre at the UHN. She also took on an Assistant Professor role at the Department of Radiation Oncology at the U of T. However, given that the Department of Radiation Oncology did not have a graduate department, and Dr. Koritzinsky wanted to supervise graduate students, in 2011 she pursued and obtained membership at the IMS, and later became an independent Scientist at the Princess Margaret Cancer Centre. However, her successful career path did not come without having to
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overcome adversity, seek advice from her senior peer scientists, and network with her colleagues. Besides having to communicate in English, which was not her first language, one of the main challenges for Dr. Koritzinsky was having to adjust to the Canadian culture of self-promotion. Unlike in Norway, where modesty and humility were very much valued, Dr. Koritzinsky had to get used to promoting her research and nominating herself for leadership positions. She credits her collaborators and mentors for helping her overcome this cultural difference. Some mentors and colleagues from Dr. Koritzinsky’s network included Dr. Richard Hill (Professor Emeritus at the Medical Biophysics Department at the U of T), Dr. Michael Milosevic (Vice Chair of Research at the Department of Radiation Oncology) and Dr. Mary Gospodarowitz (Medical Director at Princess Margaret Cancer Centre). These researchers supported for instance, Dr. Koritzinsky’s application for the Terry Fox New Investigator award, of which she was a recipient in 2011. This award is usually presented to a young scientist who works in a supportive environment and who is surrounded by an extensive network of senior peers that can provide mentorship. Similarly, Dr. Koritzinsky credits her mentors for winning the Michael Fry Research Award from the Radiation Research Society in 2016. Again, her mentors and collaborators nominated her and provided letters of support. They generously dedicated their time to promote her career. In fact, it is from her mentors that Dr. Koritzinsky learned to become a mentor herself to many students at the IMS. Graphics by Jennifer Barolet
FACULTY SPOTLIGHT
Dr. MarianneKortizinsky, PhD
Scientist at the Princess Margaret Cancer Center, Assistant Professor at the Department of Radiation Oncology Director of MSC1010Y/1011Y Seminar Series in Translational Research course and the Professor at the Institute of Medical Sciences (IMS), University of Toronto
Photo Credits: Krystal Jacques
“The Journey is as equally important as the destination.” Believing that all scientists in training could benefit from learning the general fundamentals of research, Dr. Koritzinsky decided to pursue the position of the Director of the MSC 1010Y/1011Y Seminar Series in Translational Research course. As the Director of this course, a graduate student supervisor, and an advisor, she became a mentor for many. According to Dr. Koritzinsky, the recipe for contributing to student success is being able to provide a balance between challenge and support to her students. She readily challenges her students to pursue learning opportunities by presenting their research at national and international conferences, applying for awards and continuously building a network of collaborators and peers. Equivalently, Dr. Koritzinsky supports her students by providing the necessary financial aid for traveling to conferences. Moreover, she tries to help her students build on their strengths and work on their weaknesses. She also champions her mentees by
encouraging them to seek various leadership roles either in her lab or in their communities. Dr. Koritzinsky leads by example by being a prominent figure in her Norwegian community. In addition to working as a Scientist at the UHN and a Professor at U of T, she serves as Honorary Norwegian Consul General in Toronto by providing consular services to the Norwegian nationals. Some of her other tasks in this role include promoting the exchange of arts and culture between Norway and Canada and hosting visits to Canada for Norwegian diplomats and politicians. As someone who has traveled a long journey to becoming an outstanding community leader and a scientist, Dr. Koritzinsky has advice to give to the IMS students. According to Dr. Koritzinsky, the journey through graduate school is as important as receiving the degree itself. Graduate training is not only about
learning how to be a good scientist, but also recognizing that in research, our progress may sometimes stall and our methods may not work. We—as graduate students—may experience momentary ‘failures’ with our experiments, or receive criticism from advisors that our work needs improvement. However, the whole point of being a graduate student is acknowledging that growth is a part of the academic exercise. By trying something new, failing, and trying something different, is the process rewarding in itself. This is what it means to be a scientist. Developing the resilience to move forward, even when our grants don’t get funded, or when our papers get rejected, is essential to growth. Accepting the uncertainty of scientific discovery is, therefore, an unavoidable journey that every scientist must learn to embrace and enjoy.
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STUDENT SPOTLIGHT
InMemoriam:
Dr. MohammadAminJebelli By: Parisa Dastoori
“He wanted to be remembered as a friend and as a brother, and someone who cared about the people around him and made the world a better place. His profession was a means of him doing that.”
Those who embodied the ideals of knowledge and grace, In the gathering of peers were candles that lit the place, Did not find their way from this dark night till the day: They told their mortal tales and vanished without a trace. Omar Khayyam (Translated by Sahand Rabbani)
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Graphics by Jennifer Barolet
STUDENT SPOTLIGHT
F
ifty seven Canadians died on a plane crash in Iran at the beginning of 2020.1 Similar to how a candle illuminates the darkness with the light that it emits, many of the deceased were scientists who enlightened their communities with knowledge. Mohammad Amin Jebelli, a Masters of Health Sciences student in the Translational Research Program at the University of Toronto, was one such bright candle.
We remember Amin as a 29-year old medical doctor who graduated in 2007 from Tehran University of Medical Sciences. From completing a topranking medical program in Iran, he was well prepared to serve as a family physician1. In addition, he participated in various community volunteering initiatives. For example, he was a volunteer at the Primary School Health Program, which is an annual medical check-up program that screens children for undiagnosed health issues, such as developmental disabilities, medical diseases, and mental health concerns.2 During his practice, Amin became interested in advanced cardiac imaging techniques, such as cardiac magnetic resonance imaging and cardiac computed tomography.3 He was curious to learn how these techniques can be used to diagnose cardiovascular diseases; particularly coronary artery disease, which is a prominent cardiovascular morbidity in Iran. Motivated from seeing his patients, Amin wanted to find out ways to help people in his home country of Iran. Thus, he contemplated pursuing a PhD.1, 3 Following his academic passions, in 2018, Amin joined the Translational Research Program (TRP) in the UofT’s Faculty of Medicine. Quoting Dr. Richard Foty (Assistant Professor, TRP) and Dr. Joseph Ferenbok (Director of TRP), “Jebelli attended UofT because of an intense love of learning. He wanted to have (an) impact on patients, so he was looking at a biomaterial that he learned about in Canada (and how) it could potentially be used to treat people in Iran with a specific type of medical condition”.1 Amin was known among his peers at university and the community as a gentle, bright, and caring individual. “He wanted to be remembered as a friend and as a brother, and someone who cared about the people around him and made the world a better place. His profession was a means of him doing that,” recalled Dr. Foty.1 So, let us remember Amin’s character, passions and accomplishments.
References 1. Giroday G. ‘He did everything for everybody’: Remembering U of T student Mohammad Amin Jebelli. U of T News, Jan 10, 2020. [cited 2020 Apr 1]. Available from: https://www.utoronto.ca/news/remembering-u-t-student-mohammad-amin-jebelli 2. Subramaniam V. Mohammad Amin Jebelli. The province, Jan 12, 2020. [cited 2020 Apr 1]. Available from: https://www. pressreader.com/canada/the-province/20200112/284099208407513 3. Aguilar B. U of T students killed in Iran plane crash remembered at vigil. Jan 10, 2020. [cited 2020 Apr 1]. Available from: https://trp.utoronto.ca/student/mohammad-amin-jebelli/ Photo: Dr. Mohammad Amin Jebelli’s Facbook Page
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DIVERSITY IN SCIENCE
By Nadia Boachie and Laura Best
W
hat do you want to be when you grow up? It’s a common question; one that, you too, were likely asked. Perhaps you dreamt of becoming a physician or architect, an astronaut or an accountant - one day obtaining an education based in science, technology, engineering or mathematics (STEM). Or, perhaps, because of factors unrelated to your intelligence, abilities or work ethic, these career options seemed impossible. Despite increasing eff orts among STEM fields to increase accessibility for Black, Indigenous and People of Colour (BIPOC), systemic barriers exist that prevent BIPOC from entering and succeeding in STEM careers. However, 2020 has illuminated some of the issues that prevent minority groups from entering STEM fields, as well as the detrimental impact that excluding certain groups of people can have on the overall success of these fields. “Diversity in science refers to cultivating talent and promoting the
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full inclusion of excellence across the social spectrum.” - Dr. Kenneth Gibbs, Jr. (Scientific American, 2014). Consider the journey for a student through the Ontario education system. As early as elementary school there are signs that children from minority groups are not treated equally. Not only does this affect their wellbeing, but also their future. Though institutions try to tackle the lack of diversity in STEM fields at the post-secondary level, deeply rooted biases and systemic barriers exist in early education systems that prevent BIPOC from pursuing STEM fields. Combatting these barriers is Dr. Chika Oriuwa, a recent graduate and valedictorian of the University of Toronto (U of T) Medical Class of 2020. Recently, IMS Magazine had the pleasure of sitting down with her to discuss her experiences. Dr. Oriuwa is black, a child of immigrant Nigerian parents, and a prominent advocate for diversity and inclusion in medical education and beyond. She feels that “when you have a more culturally and ethnically diverse class, you’re really providing better health care to the community that you’re servicing.”
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Dr. Oriuwa identified issues that likely prevented many of her peers from following the same career path as she. “It was long before medical school [when] I realized that there was racial inequity in regard to who was even pursuing science and who wasn’t,” Dr. Oriuwa explains. “As far back as elementary school, you start to pick up on the fact that black students are often placed into academic streams below their capability” she further explains. Despite her secondary school being one of the more culturally and racially diverse institutions that she attended, Dr. Oriuwa recalls the impacts of academic streams were still evident. “There were definitely less black students in my sciences, mathematics, my calculus, chemistry, biology courses - things that would prepare you for an undergraduate degree in some kind of science field,” she explained. It was announced this July that Ontario plans to end streaming. This practice, where high-school students were required to choose the pursuit of an “academic” or “applied” track, has been criticized for pigeonholing a disproportionate number of black and disadvantaged students. Education Minister, Stephen Lecce,
DIVERSITY IN SCIENCE
says the province’s math curriculum will be the first to be de-streamed as of September 2021. Research has shown that racialized groups or people of low-income households are often forced into non-academic streams which, in turn, affects graduation rates and future employment prospects1. Implicit biases cause educators to discourage students from pursuing STEMbased paths, which are often based on wrongly perceived capabilities of these students. By eliminating stream-based learning, Ontario’s education may finally align with the rest of the country and remove one facet of inequity that was built into the education system.
“As far back as elementary school, you start to pick up on the fact that black students are often placed into academic streams below their capability.”
Illustrations by Janell Lin
Upon attending the Health Sciences Program at McMaster University, Dr. Oriuwa once again noticed the lack of diversity: “I was the only black student in my year of program and that was quite jarring... what I found was that so many students that were in the Health Science Program actually came from private schools or they came from extremely affluent backgrounds.” Too often, university classes, including those in medical schools, are not reflective of the socioeconomic and racial diversity present in society. The number of black and Indigenous medical students and doctors has been historically much lower than what is representative of the general population. The black population is about 4.7 percent of Ontario’s population2, but the Black Physicians’ Association of Ontario estimates that black physicians make up about 1 to 1.3 per cent of the physician population3. In 2016, Dr. Oriuwa was the only black medical student in a class of approximately 2604. “It is profound - there are so many factors that go into why we don’t see a lot of black individuals in these higher academic, ivory tower-type situations,” says Dr. Oriuwa. Socioeconomic status and destabilization of families
due to higher rates of caregiver incarceration for example, are disproportionately higher in minority groups, and are known to impact child wellbein5. Universities are trying to address this gap at the post-secondary level. U of T has introduced an application stream and support systems for BIPOC students. The Black Student Application Program (BSAP), a program that Dr. Oriuwa is “exceptionally passionate about”, aims to “break down some of the barriers that might impede black students from applying, and nurture an inclusive environment that is welcoming to all,”6. This year, twentyfour black students, the largest group in Canadian history, were admitted to the University of Toronto’s faculty of medicine. This represents the potential for change, despite a myriad of early-life barriers remaining to be addressed. Dr. Oriuwa also highlights mentorship as an important resource to support BIPOC and economically disadvantaged students. The Community of Support is one such initiative offered by the U of T Faculty of Medicine. It longitudinally supports BIPOC and economically disadvantaged students through preparation and applying for medical
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DIVERSITY IN SCIENCE
school7. Overall, however, when asked about inequities in both education and health outcomes, Dr. Oriuwa feels that “we need to take a proactive approach [about] how we’re going to deal with anti-blackness and anti-indigeneity. Everything else will kind of just be a band-aid solution.” The insufficient solutions to academic barriers earlier in life, results in a lack diversity among medical professionals downstream. This lack of diversity amongst doctors and researchers can lead to poorer health outcomes among minority groups. Black people’s health and access to care is affected because of the racist environment in which they live and, similar to the experiences of Indigenous peoples, racism during interactions with medical professional8. One suggestion to improve health outcomes in racialized patients is race-matching. This is the idea that patients treated by doctors of the same race have better outcomes. While race matching may help improve patient outcomes, and some studies have found this to be true10, it still does not address the underlying socio-economic reasons that racialized groups tend to have
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disproportionately worse health outcomes. Similarly, there is strong evidence of a gap in medical research pertaining to minority groups. The omission of health data about racialized groups like black Canadians can be life threatening. One study showed that although black Canadians are the third largest minority group in the country, researchers could find only 23 studies pertaining to breast cancer, cervical cancer and black Canadian women within the last 15 years. In addition, black women could be predisposed to worse outcomes from these diseases9. Collecting racialized data in healthcare and acknowledging inequities forces investigation of the underlying cause. In the last few months, the world has witnessed thousands of people marching in streets across North American in solidarity with the Black Lives Matter movement. There has been a dramatic increase in civil protests of unjust treatment of BIPOC. Though inequities and barriers have existed for centuries, discussion around this topic has most definitely increased. As such,
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it is our duty, as academics from all walks of life, to come together to try and unlearn centuries of systemic racism that has inhibited the success of racialized groups in STEM. This is the first article in the new IMS Magazine Diversity in Science Feature. Check out future issues for more discussion on diversity in science. References 1. https://youthrex.com/wp-content/uploads/2019/05/Towards-Race-Equity-in-Education-April-20172.pdf 2. Stats Canada (2016) 3. https://www.ctvnews.ca/health/ontario-med-school-sees-increase-in-black-students-after-launch-of-special-application-process-1.4305273 4. https://www.cbc.ca/news/canada/toronto/black-medical-school-students-community-of-support-1.4234227 5. http://www.ohrc.on.ca/en/interrupted-childhoods#4.2.Black%20 children 6. https://applymd.utoronto.ca/black-student-application-program 7. https://www.ctvnews.ca/health/ontario-med-school-sees-increase-in-black-students-after-launch-of-special-application-process-1.4305273 8. https://www.wellesleyinstitute.com/wp-content/uploads/2012/02/ Colour-Coded-Health-Care.pdf 9. 9https://muse.jhu.edu/article/737220
BOOK REVIEW
Beatrice’s Pick “When the present falls apart, so does the future we had associated with it.” By Beatrice Bellarin
T
“didn’t want to live with a 10-year-old after all”. And so, this is where this book starts at. If things would have been different, Gottlieb may have ended up writing “the happiness book”, but everything happens for a reason- or so I believe.
This is not your typical non-fiction book. It’s more of a memoir by author and psychotherapist Lori Gottlieb about psychotherapy from the perspective of both the therapist and patients. It’s the true story of a single mother with a young son, who is madly in love with the man that was supposed to marry her. Except that one day, without any warnings, this man just decided to break up with her because he
Unable to cope with the pain of this unexpected break-up, Gottlieb decided to seek therapy herself. In a funny way she describes all her main disappointments from her lost love story, to then realize that the “break-up” was only the tip of the iceberg, with many deep unsolved issues hiding underneath. Gottlieb’s own patients are passengers carried along with her on her inner voyage to happiness. These patients are all very diverse and with incredible life stories, There’s the young professor diagnosed with terminal cancer (famous for her t-shirt “namaste in bed”, which I relate). The older lady who is searching for a meaning to her life; and intending to commit suicide in one year if nothing changes. The adventures of a young twenty-something stuck between a bad relationship and alcohol abuse. And an egocentric Hollywood producer - my personal favourite sub-story in the memoir. While Gottlieb analyzes these stories and helps her patients with their own lives, it’s Wendell, her own psychotherapist (with nice paired socks), helping her put herself back together.
his book was part of a very long Christmas wish list which, as you can imagine, mainly consisted of the latest hot releases of book titles. I can’t exactly remember why I wanted to read this one so badly. I didn’t know the author beforehand, nor the publishing house. To tell you the truth, I could not find it in Canada at the time, and had to order it through the American amazon- just to give an idea of how badly I wanted this book. Maybe I had been influenced by one of the book-lovers Instagram accounts that I follow. Or perhaps it was the title: Maybe you should talk to someone. That phrase sounded familiar in my ears. It remined me of a suggestion given to me by a friend in a moment of struggle. Indeed, I think I can rely and best describe the year 2019 as my own annus horribilis—and when I saw that title, it felt like perfect timing.
Often therapy focuses a lot on the past and its regrets. And some therapists emphasize the power of the past and how it informs of the present. But what about the future? What does the past have to say for that lost future? This story starts “when the present falls apart, so does the future we had associated with it. And having the future taken away is the mother of all plot twists.” Gottlieb is very authentic and human, even confessing to stalking her ex-boyfriend on social media. She confides that she gets bored at times with her patients, especially when they don’t take the next step and go on and on for sessions about the same issue. And then she ends up doing the same to her own therapist, Wendell. The spontaneity of these events made it feel more real. It made is okay to be human and have defects. In a way it made me accept my own behaviors more and be more forgiving with myself. I think “Maybe you should talk to someone” is a perfect read for living in this pandemic. Getting a different perspective on one-self, even if indirectly through the characters in Gottleib’s story, could help you turn the page on your own issues. And instead of focusing on how to re-do the past, maybe this time we should focus on how to improve the future that we have left.
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Bonjour! Bienvenue a le Congres TRAVEL TRAVEL BITES BITES
Canadien D’Hepatologie!
By: Natalie Simonian
P
revious travel bites in the IMS Magazine have reported leaving frigid Toronto behind for warmer cities. To d eviate from this common theme, I left late Thursday afternoon to head to Montreal, Toronto’s (colder) cousin! The road to Montreal was paved with good intentions and a long six-hour drive. Luckily, I had the company of my family, as my mother is a gastroenterologist attending the gastro version (CAG) of my liver conference. The morning after my arrival, I spent the day exploring Montreal. Overall, the city is very historic, as demonstrated by the cobblestone walkways down Rue St. Antoinne. Saturday began bright and early at the liver conference. Since this was my first conference, I’ll admit I was intimidated more than once during that weekend. I was a first-year master’s student among all the PhDs and physicians who had been in the hepatology field for years. I made my way to registration, donned my badge and looked at the program.
Many of the talks were centered around Non-Alcoholic Fatty Liver Disease which is my research focus. While all talks were interesting, a couple of speakers stood out, because they brought a human element to their presentation. At the pediatric liver disease talk, the presenter mentioned that many adolescent liver 40 40 |
transplant recipients die because of lack of adherence to medication in this transitionary adolescence period of their life. With a heavy heart, he explained the need to adequately bridge pediatric care to the transitionary period to an internal medicine doctor, in a way that I’m sure impacted everyone in the room (master’s students and physicians alike).
Photos by Natalie Simonian
Other interesting snippets I picked up were the occurrence of sexual dysfunction in cirrhotic patients (patients with advanced liver fibrosis due to hepatitis B/C/fatty liver). The presenter (a hepatologist) explained how out of his depth he felt when patients expressed they were experiencing sexual performance problems, because after all, hepatology is a sub-specialty of internal medicine and not focused on reproductive issues! The hepatologist explained the need to expand their knowledge base to include potential reproductive issues in order to holistically treat the patient, instead of focusing on a single organ. To be able to see the whole picture, as well as the component parts, is how I would like to practice medicine in the future! After spending Saturday learning about the consequences of liver dysfunction, I spent Saturday evening at a reception drinking white wine with my co-workers, the irony!
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Illustrations by Katrina Hass
I awoke the next Sunday and attended more talks until about 12 pm. As the conference hit closing ceremonies, I left and hit the streets of Montreal one last time to try some of the spectacular bagels at St. Viateur Bagel Shop, and if you are going to Montreal, I definitely recommend trying their “all-dressed” bagels as well as trying some lamb poutine from Modaive. Overall, the trip was filled with warm welcomes from presenters and cold hands courtesy of the Montreal frigid air!
IMSSA
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