28 minute read
Viewpoints
The Nobel Prize:
An ignoble history of gender bias
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By Krystal Jacques
Most 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 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, 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
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.
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.
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 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
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.
THE HIDDEN PANDEMIC:
COVID-19 Misinformation in the Media
By: Jason Lo Hog Tian
After 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. 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 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
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.
By Nadia Boachie
Critical 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 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 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
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 human, including the consequences of weakness and vulnerability. 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
