A UNIVERSITY OF CALGARY Faculty of Medicine Publication
The Faculty of Medicine lends a hand to a devastated nation
The best laid plans
pg. Calgary’s first student-run medical clinic opens at the city’s largest homeless shelter
A Fair Trade
pg. Faculty of Medicine researchers are using an annoying illness, the flu, to fight a deadly one–cancer
The Future is Here
Medical research that’s science fact, not science fiction medicine.ucalgary.ca
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MESSAGE FROM THE DEAN
impac t is just a
matter of time With each issue of UCalgary Medicine magazine we are given the opportunity to share with you some of the successes weâ€™ve achieved at the Faculty of Medicine. Often these accomplishments have occurred in the months leading up to the magazine being published, but sometimes they are a culmination of work that has been ongoing for years. While the timeframe may differ with each achievement, the outcome remains the same; we are positively impacting and improving lives. Whether this is through our actions in the community, through educating future physicians and scientists, or through our own research, our commitment is the constant regardless of time. In this issue, time is a common theme. Medicine and medical research evolves at a furious pace, and to grow and prosper as a Faculty this is something we must be aware of. New advancements and innovations are made by forward-thinking individuals, and we are fortunate to have an abundance of these talented people in our Faculty, as you will see in our future of research article on page 12. And as we scan the health environment that exists today, there are issues and gaps in the health care system that need to be resolved. One such issue is a lack of dermatologists in Alberta, where we are well above the recommended ratio of one dermatologist per 62,000 people. To this end the Faculty of Medicine has created a new dermatology residency program, which will take
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in its first residents in July (page 5). We saw the need, and because of our commitment to social accountability, we quickly sought to ease the issue. Of course, some projects require great persistence, and perhaps the most fulfilling are those that come from seeing a task completed from beginning to end, regardless of length. 12 years ago, Dr. Patrick Lee of the Faculty of Medicine discovered that a naturally occurring virus, called the reovirus, could kill cancer cells in mice. Today, this research is being tested on humans by the Faculty of Medicineâ€™s Dr. Don Morris with very positive results (page 10). The reovirus has been shown to kill cancerous cells in the human prostate without harming the normal tissue. These are just a few of the stories youâ€™ll find in this issue. They represent the past, present and future of our Faculty, and more importantly, our efforts to make a positive impact on our community. I hope you enjoy reading them and I welcome your comments.
Tom Feasby, MD Dean, Faculty of Medicine
Volume 2 Issue 2 | Summer 2010
pg4 Triumph from tragedy | Philanthropy
For one University of Calgary philanthropist, the decision to donate came from personal tragedy. Through her generosity, Clare Westbury has single-handedly sped up melanoma research dramatically.
pg5 Diagnosis? Lack of dermatologists | Education
With dermatologist ranks shrinking across the country, the Faculty of Medicine saw a need for a new dermatology residency program, the first of its kind in Canada in over two decades.
pg6 The best laid plans | Service to Society
From conception to creation, a group of students at the Faculty of Medicine worked together to create Calgary’s first ever student-run medical clinic for the homeless.
pg8 Helping Haiti heal | Service to Society
Following the devastating earthquake in Haiti, Dr. Lane Robson (class of ’73) and first-year med student Dave Campbell represented two generations of the Faculty of Medicine as they treated pediatric patients in the wounded nation.
pg10 A fair trade | Research
Researchers at the Faculty of Medicine are using one of world’s most annoying illnesses, the flu, to help fight one of the deadliest—cancer.
pg12 The future is here | Research
Now that we’re well into a new decade, we thought it might be fun to look ahead at what the future of medical research holds. Turns out the future is already here.
ON THE COVER: A UNIVERSITY OF CALGARY FACULTY OF MEdICINE PUbLICATION
The Faculty of Medicine lends a hand to a devastated nation
ThE FUTURE iS hERE
Medical research that’s science fact, not science fiction
ThE bEST laid planS
Calgary’s first student-run medical clinic opens at the city’s largest homeless shelter
Faculty of Medicine researchers are using an annoying illness, the flu, to fight a deadly one–cancer
8 A child wanders near a road in Jacmel, Haiti.
pg14 Simulation breeds success | education
Building on an already thriving simulation program, the new undergraduate medical education simulation centre has UCalgary at the front of the class in medical education.
pg15 A bearable task | Terminus
The 2010 Vancouver Olympics have come and gone, with Canadian athletes taking home a record number of gold medals. But before all that precious metal was handed out, a few lucky Faculty of Medicine members bore the responsibility of helping deliver the Olympic torch to Vancouver.
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Triumph from Tragedy
For one University of Calgary philanthropist, the decision to donate came from personal tragedy. But with her donation already being put to use, Clare Westbury has single-handedly sped up melanoma research dramatically.
By Lois Epp
[Photo] Clare Westbury (centre) with Donna Senger, PhD (left), and clinical team members Dr. Greg McKinnon and Dr. Tina Cheng from the Tom Baker Cancer Centre.
first brush with melanoma came when her youngest son, then in his mid-twenties, was diagnosed and treated for early stage melanoma. He made a full recovery. Her second encounter was not so kind. In 2004 Clare’s husband, Dr. Robert Westbury, died as a result of melanoma. A family physician, Dr. Westbury was widely recognized for his interest in research and teaching. Motivated to make a difference, Clare determined the best way to honour her husband, and their shared passion for research, was to make a commitment to melanoma research. Turning off the “switch” Incidences of melanoma and incidences of death from melanoma are on the rise in Alberta. When detected early, melanoma is highly treatable. However if left undetected it can spread and relocate to other areas of the body including the brain. Patients with cancers of the brain have a very low life expectancy. Donna Senger, PhD, a basic scientist in the Southern Alberta Cancer Research Institute (SACRI) at the University of Calgary, has worked alongside Dr. Peter Forsyth for a number of years in the Clark H. Smith Brain Tumour Centre. In a recently published research paper, Dr. Forsyth, Senger and Steve Robbins, PhD, director of SACRI, discovered new evidence that revealed a specific molecular “switch” was triggered in brain cancers, causing the cancer to spread. Melanoma has a similar molecular switch. A brain cancer cell can turn on this switch using a process that has also been identified for Alzheimer’s disease. Based on this understanding, a drug currently being tested in clinical trials for Alzheimer’s disease was shown to inhibit the spread of the cancer cells. Dr. Forsyth and his colleagues in Calgary and Toronto will soon begin a clinical
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trial to investigate how brain tumours react to the Alzheimer’s drug. Senger is eager to determine if the same drug can work similarly in melanoma. Philanthropy as the accelerant Getting a research project up and running can be a lengthy process, a task Senger was in the process of undertaking when she received news that a donor wanted to make a significant gift to support melanoma research. “In one phone call, Mrs. Westbury accelerated my research program by years,” says Senger. “She provided the spark that allowed us to really take off.” With secure funding in hand, Senger has already hired her first researcher and plans to bring on two more. The philanthropic gift not only allows her to launch her program, it also leverages additional funding from external granting agencies. At the request of Westbury, a portion of the gift will be designated the Dr. Robert C. Westbury Endowment for Melanoma Research, permanently ensuring there is a sustainable funding source well into the future. Senger’s plan is to enhance the melanoma research program in Calgary to include close linkage with her clinical colleagues Dr. Greg McKinnon and Dr. Tina Cheng. The program will establish the framework for testing other experimental drug therapies for melanoma, be it those from their own research group, or from elsewhere in Canada. “From an increased knowledge base comes greater opportunity for discovery and understanding, which one day could potentially lead to a cure for melanoma,” Senger beams. Westbury extends that sentiment to include philanthropy. “I hope my gift can make a difference to Dr. Senger and the work she is doing, just as I hope my gift will inspire others to contribute. The more people who support melanoma research the greater the likelihood we will see a cure.”
Diagnosis? Lack of dermatologists With dermatologist ranks shrinking across the country and existing training programs at full capacity, the need for dermatologists is a problem that’s more than just skin deep. But thanks to the University of Calgary, help is on the way.
By Colleen Biondi [Photo] Dr. Régine Mydlarski with a patient.
it’s just the way it is. If you want to see your dermatologist, expect to wait up to three months. With a woeful ratio of approximately one dermatologist for every 78,000 people (well above the recommended ratio of 1:62,000), it’s unfortunately not a surprising fact. But starting this summer, the Faculty of Medicine’s new Dermatology Residency Program will do its part to ensure that changes. Led by Dr. Régine Mydlarski, an associate professor at the Faculty of Medicine, the program is a comprehensive hospital and community-based residency designed to train candidates to be competent and compassionate dermatological consultants. According to the Canadian Dermatology Workforce Survey update in 2006, the average age of dermatologists in Canada is 54.5, with 49.5% being over 55. It is estimated that by 2011, 50% of all Canadian dermatologists will have reduced their practices or retired. Add in the fact there are only eight Royal College of Physicians and Surgeons of Canada (RCPSC) accredited dermatology residency programs in the country and it is clear. We’ve come to a tipping point.
It is time for a new generation of dermatologists. This five-year initiative for medical residents will consist of two years of basic clinical training followed by three years of specialty training in inpatient and outpatient dermatology. Residents will rotate through several subspecialty clinics—such as pediatric dermatology, immunodermatology, phototherapy, dermatologic surgery, wound healing, solid organ transplant and skin cancer—and complete mandatory rural and research work. The program has been approved by the Specialty Committee in Dermatology at the RCPSC. Three residency positions have been selected to begin July 1; two are funded through Alberta Health and Wellness and one is an externallyfunded trainee from Saudi Arabia.
A huge amount of planning and administrative work was involved to get this program off the ground, says Mydlarski. Both practicing dermatologists and academic specialists—based out of the Foothills Medical Centre—participated in the design. “For me, the best parts will be teaching and collaborating with the residents in order to fine-tune the program and ensure it provides a first class experience for all.” Once the program begins, anonymous teaching evaluations and collective feedback drawn from residents will inform changes to the program and preserve its integrity. Critical responses could result in removing teachers or adjusting the nature of their involvement. Every fall, members of the Residency Training Committee and participating residents will go on retreat. They’ll examine all aspects of the program— from the selection process and the program’s objectives and goals, to the evaluation process and the structure of rotations and electives. Improvements will be recommended and voted upon. Like any other democracy, the majority will rule. “I will be responsible for the overall conduct of the residency program,” says Mydlarski. As chair of committee meetings, she will conduct the review process related to the selection, promotion and evaluation of residents. Her key duty will be providing an education program which continues to meet the robust standards of the RCPSC. “I am most excited to have the Division of Dermatology move forward in our education mandate,” she adds. The Dermatology Residency Program is certain to tackle that challenge head-on as it offers up Canada’s latest (and Calgary’s first) detailed and multi-faceted framework to learn about the largest organ of the body—the human skin.
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Service to Society
best laid plans
By Kyle Glennie
From conception to creation, a group of students at the Faculty of Medicine worked together to create Calgary’s first ever student-run medical clinic for the homeless.
It’s just after
6:00pm when I arrive at the Calgary Drop-In and Rehab Centre. A group of close to 15 people are gathered around the front door of the building as I wait for my photographer. Tonight’s goal is relatively simple: photograph a group of UCalgary medical students as they do something that is anything but simple; create a student-run clinic to help Calgary’s homeless population. After a short wait, I’m greeted at the front door by Richelle Walsh. A member of the student executive committee, she’s one of a large group of UCalgary medical students behind this pilot project. The clinic itself has been operating at the Drop-In Centre for some time, with Dr. Janette Hurley, a member of the Faculty of Medicine, and a licensed nurse on the front lines treating patients. The students got involved through their desire to help those without proper access to health care. “Dr. Hurley was teaching an ethics course I was taking and she mentioned there were no medical students volunteering at the clinic she ran that served Calgary’s homeless population. I thought ‘what a great opportunity to help these individuals in need,” recalls Jori Hardin, a second year medical student and the inaugural president of the Student Run Clinic Organization (SRCO). After months of planning the students’ dream of creating their own clinic is underway. I’m visiting the clinic during a six-week pilot project in which the students will see patients under the guidance of Dr. Hurley, and experience what it means to operate a clinic for the homeless.
“You mean the four patients that you dream of seeing?” laughs Dr. Janette Hurley. “Remember you’re at the Drop-In, the best laid plans of mice and men…”. In her jovial, Caribbean-tinged voice, Hurley’s sums up the Drop-In Centre clinic perfectly. It’s not that the clinic has a lack of patients—on the contrary; the clinic would be open 24 hours a day, seven days a week if funding permitted. But as Hurley opined, the best laid plans of mice and men often go awry. Especially at Calgary’s largest homeless shelter.
How can we help? With patients lining up outside the door, the shelter opens for the evening. Candace Rypien, the chair of the SRCO, and Dave Campbell, sit down in a small room with *Steve, their first patient. Hunched over and breathing heavily, Steve thinks he may have pneumonia. After the first year medical students take a detailed history and probe him about his current health problems, we find out that Steve has only been smoking for about a year, and that he’s had some problems with his girlfriend recently. As the students continue to speak with Steve, it becomes clear the visit is part medical check-up, part therapy session. “I think for a lot of these people we’re someone to talk to, and that’s part of what we do, we listen,” Candace acknowledges. Regardless of the motive, Candace and Dave listen to Steve’s breathing and run some simple tests. After conferring with the students, Dr. Hurley takes a look at Steve herself, as she does with all patients. The diagnosis?
Four patients. That’s the number the medical students hope to meet with. It’s also what they’re hoping to discuss as they gather for a briefing before the clinic opens for the night.
“It looks like he has a cold and a fever, so we’ll give him some Advil for that,” says Dr. Hurley.
“So can you brief us on the four patients that we will be seeing?” asks Walsh.
The therapy session was an added bonus.
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[Photos] Clockwise from top left: Two students prepare before the clinic opens; med students Roisin Byrne, Erin Carter, and Dr. Tom Feasby speak to a patient; Erin Carter examines a patient; the Calgary Drop-In Centre; Dr. Janette Hurley meets with a patient; Dave Campbell treats a patient’s wounded foot.
Not all patients are there to talk though. After examining Steve, Dave and Sandy, the clinic’s nurse, meet with a patient suffering from frost bite on his big toe. The patient was first treated for it over Christmas, and now his bandages are changed at the clinic twice a week. “It’s great to get some exposure to wound care and Sandy is a great teacher,” Dave gushes. He’s not the only student to benefit from Sandy’s expertise; she’s taught wound care to several of the students. After re-bandaging, Dave and Sandy send their patient off with some anti-inflammatory medication. “We also have an advanced wound care nurse that comes to the clinic, which really is an incredible resource,” explains Sandy. “Without advanced care, some of the frostbite or severe infections we see could result in amputation.”
Daniel and the Dean During this pilot project, the student-run clinic operates every Tuesday from 6:00pm to 9:00pm. And on this night I’m not the only observer—Dr. Tom Feasby, dean of the Faculty of Medicine, is also here. Dr. Feasby has given his full support to the students from the beginning, but tonight he seems to be taking on another role—mentor. The last patient of the night is *Daniel. The 58 year-old lives at the Drop-In Centre on the fifth floor where he has his own bed and locker. Daniel came to the clinic not on his volition though; the students noticed he had an abnormal gait and asked if he would be interested in an examination. “Some people at the Drop-In Centre don’t realize the clinic exists yet, so we walk around the floors and introduce ourselves to see if there is anyone who perhaps needs some medical attention,” explains Candace.
and second-year student Erin Carter begin their examination by asking Daniel about his medical history and his injury. After a round of questions, the students have him change into a gown so they can examine him further. As the second-year student, Erin takes the lead and checks Daniel’s eyes and reflexes before completing some simple neurological tests. She’s confident and professional, the same traits each student has shown all evening. With Dr. Feasby in agreement, the students confer Daniel’s issue is neurological and not a leg injury. “Having Dr. Feasby there was a great experience, especially with a neuro case and he being a neurologist,” says Erin. I doubt Daniel thought he’d be getting this kind of treatment when he walked into the clinic. Following the exam he is referred for an MRI, and the students will even arrange transportation so he can have the treatment. As the night winds down and the clinic shuts its doors, the students tackle the paperwork that inevitably accompanies patient care. Three short hours have passed yet lives have been altered in a positive way—those of the patients, that much is obvious. But equally has the lives of the students been altered. Their goal of creating this clinic so they can learn and serve has been realized. “This definitely isn’t for everyone, but these students want to be here and they are passionate and extremely enthusiastic,” Hurley beams. “As Gandhi says, ‘you must be the change you want to see in the world’, and they’re doing it.” Now what was that saying about best laid plans?
That’s how the students found Daniel, and how he found his way into the clinic tonight. With Dr. Feasby looking on, first-year med student Roisin Byrne
* The names of the patients have been changed to protect their privacy.
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Service to Society
For 14 days in March, Dr. Lane Robson (class of ’73) and first-year med student Dave Campbell represented two generations of the Faculty of Medicine as they treated pediatric patients in Haiti. The experience was full of mixed emotions for both men, and one that will last a lifetime. By Kyle Glennie
there were hundreds of people lined up each day, about a third of them children. One day a young girl was brought in, she was being carried on the shoulders of a relative and was critically ill. After examining her and conferring with an experienced Médicins Sans Frontières (MSF) doctor, we concluded she likely had HIV and tuberculosis. She was 12 years old.” With good reason, Dr. Lane Robson gets emotional when telling me stories like this. And there are many more that he shares while we talk about his trip to Haiti to support local pediatric services. The University of Calgary alumnus, who started the Division of Pediatric Nephrology at the Faculty of Medicine, volunteered to travel to the earthquake ravaged country as part of the Team Canada Healing Hands for Haiti effort. During his two weeks in Haiti—10 days of which were spent looking after pediatric outpatient care in a United Nations tent in Jacmel, a city that was also devastated by the earthquake—Robson worked in unimaginable conditions and encountered patients he would never forget.
“However bad you can imagine it, I promise you it was a lot worse”
[Photo] Med student Dave Campbell speaks to a mother with her child.
Want to volunteer in Haiti? We can help! The Faculty of Medicine is proud to offer financial support to medical professionals within the Faculty who wish to volunteer in Haiti. Email Valerie Matwick at firstname.lastname@example.org for more information.
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“I wasn’t sure where I was going to be working in Haiti, whether it was Port-au-Prince or somewhere else,” says Robson. One thing he did know was that he wanted to help the people of Haiti who were devastated by an earthquake that killed well over 200,000 and left the country in ruins. Robson is a graduate of the first medical class of the University of Calgary, has served as a physician for over 40 years, and is currently the medical director of The Children’s Clinic in Calgary. After contacting Dr. Jamie Yu, a resident in the Physical Medicine and Rehabilitation program at the Faculty of Medicine and a member of Team Canada Healing Hands for Haiti, he was told he would be leaving for Haiti at the end of March. “After landing in Port-au-Prince we quickly drove to Jacmel where the St. Michelle Hospital was located. It was partly destroyed in the earthquake, but the United Nations and MSF had tents set up to see patients,” recalls Robson. And see patients they did. All of the health care providers worked nine hour shifts beginning at 8:00am, and even after treating patients all day they still had to turn people away. Adding to the difficulties was a severe lack of pediatric medicine, particularly oral rehydration fluids, that made practicing medicine in the tents especially difficult. “However bad you can imagine it, I promise you it was a lot worse,” says Robson. “Sterile in Haiti is a relative term.” What may come as surprise, however, is that most of the patients Robson examined, all of whom were under the age of 14 as he was working in pediatric outpatient care, were not classified
as “earthquake cases”. “Most of the cases were illness or infectionrelated stuff that you would normally see in developing countries. In addition to the acute problems patients would come in with, which were mostly diarrhea or fever, they often suffered from tinea, impetigo, scabies and abdominal parasites.” He also saw what looked to be cases of malaria, dengue fever and bacterial gastroenteritis. The emotional toll this took on Robson is obvious. He pauses several times while recalling his experience with me, and seems anxious to change the subject before offering one last thought. “What’s happening there shouldn’t be happening anywhere in the world. I saw these children every day, I saw poverty and misery and helplessness. To think those people had to go through an earthquake of that magnitude is awful.”
“Thank God we had Dave” For all the challenges Robson and the other medical professionals had to face, perhaps the most frustrating was communicating with their patients. The vast majority of the Haitian population speaks Creole, and locals were hired to act as translators. While some of the translators took their job very seriously, it was clear to Robson that wasn’t the case with all. “Thank god we had Dave.” ‘Dave’ is Dave Campbell, a first-year University of Calgary medical student who is also a part of Team Canada Healing Hands for Haiti. Fluent in Creole from serving a two-year Mormon mission in small Haitian communities in Florida, Campbell’s role as translator quickly morphed into one utilizing his medical skills. “Dr. Robson would be seeing 35 to 40 patients a day and we still hand to turn many away, so I jumped at the chance when he suggested I see patients under his supervision,” says Campbell. “Dave is a special fellow and he’s very passionate. With his translating he made a huge difference because he knew how to get through to these mothers who were trying to care for their sick children. And I never had any qualms about having him see patients because he’s so bright and confident. He was a tremendous asset.” For Campbell, the opportunity to practice medicine and help the Haitian people he had come to know so well was doubly satisfying. “It was extremely rewarding for me from an educational standpoint, where I got some hands-on experience and one-on-one training with Dr. Robson. And it was rewarding to help a country that I have such an attachment to.” After dealing with brutal conditions, lack of medicine, disease and poverty, Robson and Campbell spent two days lending a hand in the Project Medishare pediatric tent in Port-au-Prince before boarding a flight home. Reflecting on their time spent in Haiti, the two men offer different perspectives. “The attitude of the Haitian people even in the face of such destruction, living in tents and losing so many loved ones, was still so positive,” marvels Campbell. “How everyone was trying to return their lives back to normal was really uplifting.” For the ever-humble Robson, whose selflessness even goes as far as not wanting a photo of himself in this magazine, the inability to provide the care these people deserve was difficult to deal with. “I left Haiti with very mixed emotions. My mind is filled with many images of misery, helplessness, and poverty. Two weeks in Haiti is a long time.”
[Photos] From top: Fresh water, an absolute necessity; a banner hangs over tents set up in Jacmel; bathing and collecting water from the river; inside the United Nations tent where Dr. Robson and Campbell treated patients; the sign says it all.
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Having the flu is awful. You’re tired, your nose is runny, your muscles ache, and you generally feel like staying in bed for days. But would you be willing to take on the flu if it meant the death of harmful cancer cells in your body? Researchers at the Faculty of Medicine are betting you will, and they’re already achieving incredible results. By Marta Cyperling
The flu or cancer.
If ever there was a no-brainer decision to be made this is likely it. While it may not be entirely that simple, researchers at the University of Calgary are looking at a new way to treat cancer using a naturally occurring virus, and have tested this viral approach in a small number of men with prostate cancer. The research, published in the March issue of Cancer Research, a journal of the American Association for Cancer Research, could result in more effective cancer therapies.
Dr. Don Morris and his team injected the tumours of six prostate cancer patients with a reovirus three weeks before they were to have their prostate glands removed as part of a standard cancer treatment. This allowed researchers to take a closer look at the entire prostate gland which showed the reovirus killed the cancerous cells but did not affect the normal tissue. Researchers say the virus is able to get into cancer cells, divide and grow, then trigger the cancer cells to explode, while the virus does not seem to affect healthy cells. It’s an important discovery because radiation and chemotherapy kills both cancerous and healthy tissues. “It’s one thing to see research results in a test tube. It’s another to see your idea work in humans,” says Morris, a medical oncologist, translational researcher and member of the Southern Alberta Cancer Research Institute (SACRI) at the Faculty of Medicine. “We were ecstatic to see these results.” Researchers say the next step is to confirm their results in a larger clinical trial. The new discovery may work well with current cancer therapies such as chemotherapy, because there likely has to be some suppression of the immune system for the virus to work optimally.
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“Using a virus to infect and kill cancer cells is a very interesting idea that needs to be further studied in the lab and in clinical trials,” says Dr. Peter Forsyth, a University of Calgary oncologist who is not involved with this study. “There is no way to tell if this would be useful in people without doing the clinical studies to show it is both safe ,which it likely will be, and effective in actual patients.” Morris says the pre-clinical and animal data do not show many side effects, and the side effects that are experienced by patients are similar to a mild flu like illness. While researchers admit the number of subjects in the study is small, it confirms an idea that their lab has been working on for more than 10 years. It was back in 1998 that Dr. Patrick Lee at the University of Calgary discovered that the reovirus, a naturally occurring virus, could kill cancer cells in mice. His discovery was published in the journal Science and prompted much international media attention. With other members of his lab he created Oncolytics Biotech Inc., and that company holds a patent of the reovirus trademarked as REOLYSIN®. The company was created to further develop research regarding the use of reovirus in treating different types of cancer. Oncolytics is currently the holder of 13 Canadian patents, all of which deal with the treatment of cancer through viruses and has been involved in over 20 phase I and II clinical trials. “Reovirus (REOLYSIN®) has now been tested in hundreds of patients either via an intralesional or intravenous route of administration, and to date there has not been any significant toxicities even at the highest dose levels tested. This lack of side effects supports the results in animal models that reovirus does not affect normal tissues in healthy animals and is tumour specific,” says Morris. Researchers decided to initially test the reovirus on early stage prostate cancer because they could easily examine the infected tissue when it was being removed. Another remarkable aspect to the research is that scientists believe the reovirus is not only effective in prostate cancer but could target brain tumours, lung cancer, blood and head and neck cancers. Both Morris and Forsyth say that if clinical trials are positive it could be two to three years for the reovirus (REOLYSIN®) to be approved for clinical use.
[Photo] Dr. Don Morris in his lab at the Tom Baker Cancer Centre in Calgary.
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Future is Here
We’ve turned a corner and are now into our second decade of the third millennium—2010. A lot has changed in medicine since the days of the humour theory and using leeches for bloodletting. So what’s on tap for the next 10 years? We pooled a wide range of top researchers at the Faculty of Medicine to find out what the next ‘big thing’ is in medicine. It turns out the future is already here. Page 12 | ucalgary medicine
[Photo] Ross Mitchell, PhD, shows off the Resolution MD Mobile software available for use with the iPhone.
[Photo] Dr. Greg Cairncross
Remote viewing of high resolution medical images Think the iPhone is just a cool toy that keeps you connected to your friends and colleagues? Think again. Now it’s also a medical tool that allows doctors to look at brain scans and other diagnostic images, thanks to the work of Ross Mitchell, PhD, of the Faculty of Medicine. Mitchell and his students, working with his spinoff firm Calgary Scientific, have received Health Canada approval for their Resolution MD Mobile Software, which lets physicians view and manipulate remote medical images in high-resolution 3D on the iPhone 3G, allowing a quick diagnosis for the treatment of stroke, cardiac arrest or other emergencies. For now the technology is best suited for diagnosing brain diseases like cancer and stroke, according to Mitchell. But he hopes it will also be useful for illnesses such as breast and prostate cancer. The software is currently being tested on the new iPad.
Identifying cancer biomarkers The search for biomarkers—or genetic hints that help doctors predict if a patient will respond to therapy—has become the focus of cancer researchers all over the world. By identifying these biomarkers, scientists hope to move from a one-drug-fits-all approach to individualized treatment for patients with cancer. At the Faculty of Medicine, researchers are already finding positive results. Dr. Greg Cairncross, head of the Department of Clinical Neurosciences, has identified a specific genetic lesion that predicted good clinical response to chemotherapeutics in patients with oligodendrogliomas, a form of brain tumour, drastically increasing their chances for recovery. Indentifying more of these biomarkers is a key priority of the Southern Alberta Cancer Research Institute (SACRI) at the Faculty of Medicine, of which Cairncross is a member. “Our goal is to get to a point where we can say ‘this patient’s tumour has characteristic X, therefore we treat them with drug A’,” says Steve Robbins, director of SACRI. “That’s the whole philosophy.” Spinal cord and brain axon regeneration Through the creation of the Hotchkiss Brain Institute’s Regeneration Unit in Neurobiology (RUN), researchers are making headway into something once thought impossible: reconnecting or regenerating injured peripheral and central (spinal cord, brain) nerve fibres, or axons as they are known. With specialized laser microscopy suites and other novel facilities, RUN will allow investigators at the Faculty of Medicine to develop new therapies and biomedical engineering
[Photo] Dr. Meiqing Shi and Dr. Christopher Mody
solutions for reconnecting broken and damaged nerve fibres, or axons. When axons are broken, they quickly degenerate and must be re-grown or regenerated to establish the connection again. RUN will allow more research to be completed on axon regeneration, but with a particular focus on treatments for people with neurological injury and disease.
Fighting the emergence of foreign diseases Thanks to higher temperatures around the world, diseases once thought to be contained in foreign areas are showing up in unusual locations. Cryptococcus, for example, first appeared on Vancouver Island in 1999, and has spread into the B.C. lower mainland as well as down the Pacific coast into Washington and Oregon. Cryptococcus disease is a rare but serious infection resulting from inhaling a toxic fungus often found in fir trees. Approximately 250 people have been infected with the disease in British Columbia since its emergence in 1999. The disease can cause meningitis, pneumonia and in 10% of cases it can lead to death. Researchers at the Faculty of Medicine, however have made a key observation. Using a mouse model, Dr. Meiqing Shi and Dr. Christopher Mody and their team noticed that a class of therapeutic drugs already approved for other medical uses could stop the fungus from crossing the brain-blood barrier and therefore reduce brain infection. The finding was published in the May edition of the Journal of Clinical Investigation.
Nanoparticle vaccine therapy Dr. Pere Santamaria, a professor in the Department of Microbiology and Infectious Diseases at the Faculty of Medicine, used a sophisticated nanotechnology-based “vaccine” to successfully cure (Continued on page 14)
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Education [Photo] Dr. Pere Santamaria
mice with type 1 diabetes, and slow the onset of diabetes in mice at risk for the disease. Santamaria and his team developed a unique vaccine comprised of nanoparticles, which are thousands of times smaller than the size of a cell. These nanoparticles are coated with protein fragments, called peptides, specific to type 1 diabetes that are bound to MHC molecules that play a critical role in presenting peptides to T cells. The nanoparticle vaccine worked by expanding the number of peptide-specific regulatory T cells that suppressed the aggressive immune attack that destroys beta cells, shutting down the autoimmune attack.
Generating engineered tissue Over 50,000 Canadians suffer from disc-related back pain, an affliction that costs the Canadian economy an estimated $5-10 billion every year in healthcare costs and lost work time. Tissue engineering is a process in which transplantable human tissue is grown artificially in the laboratory. “In order to build a new tissue in the lab for therapeutic implantation, we need ‘scaffold’ materials which the cells can reside in. These scaffolds can be chemically and mechanically manipulated to guide cell behavior and tissue growth,” explains Christopher Hunter, PhD, a member of the McCaig Institute for Bone and Joint Health. Hunter develops biomaterials for the growth of engineered tissues that would be used to replace tissues which have degenerated so badly that conservative treatments are of no help.
Predicting cardiovascular disease before it happens Up to half of all deaths of individuals with cardiovascular disease occur suddenly. This presents a challenge for diagnosis and obtaining prognostic information for patients with and without established cardiovascular disease. The probability of a patient developing cardiovascular disease is usually determined based on traditional cardiovascular risk factors including blood pressure, cholesterol, diabetes, and smoking status. Identifying biochemical and genetic indicators, however, would help predict individuals at risk of developing cardiovascular disease more effectively, and represents a key focus of researchers at the Libin Cardiovascular Institute at the Faculty of Medicine. Dr. Todd Anderson, interim director of the Libin Institute, has for the last decade followed almost 1600 Canadian firefighters with no pre-existing cardiovascular disease. Results were recently reported, and Anderson and his colleagues found markers of small vessel function in the forearm were predictive of cardiovascular events in these individuals. This suggests that abnormalities of how blood vessels work could predict individuals who go on to develop heart attacks and strokes.
Page 14 | ucalgary medicine
imulation breeds uccess
Building on an already thriving medical simulation program, the new undergraduate medical education simulation centre has UCalgary at the front of the By Jordanna Heller class in medical education. The Faculty of Medicine’s undergraduate simulation program—already one of the foremost simulation programs used worldwide—just got a little bit bigger. Expanding on their existing space, the new SimSchemes Centre is a modern facility with four multi-purpose rooms that can teach skills such as responding to emergency room scenarios, listening for specific lung and heart sounds, performing procedures and suturing limbs. “This new space is essential to providing our students a safe place to practice clinical skills,” explains Dr. Bruce Wright, associate dean of Undergraduate Medicine Education (UME) at the Faculty of Medicine. “Students can make mistakes and learn from those mistakes while they are early in their training.” The centre includes three Harvey simulators that allow students to deal with a mock clinical setting, complete with patient monitors showing blood pressure, chest x-rays and laboratory results. There are also two SimMan3G simulators that, with assistance of a technician, can talk and respond to injury or treatment like a real human might. These manikins allow students to practice everything from chronic disease management to complicated emergency situations, such as heart attack or stroke. The UME simulation program at the Faculty of Medicine is unique because medical students train on simulators right from the beginning of their schooling, before they start working in hospitals. “We have shown that simulation has a positive impact on learning essential clinical skills in pre-clinical years and that those skills are retained,” says Dr. Kristin Fraser, director of simulation for UME and a clinical associate professor in the Department of Medicine. “We’ve also shown that the acquired skills are transferable to real patients with similar conditions to the manikin. We’re giving students sessions early in their training to target key skills for the future.” The new centre is an expansion of the anatomy simulations laboratory which allows the students to learn basic science in one room and then potentially walk next door to a manikin simulator and apply that knowledge to clinical practice. “I’ve found that simulation training is terrific for experiencing scenarios that we only read about as medical students,” says second year medical student Miles Smith. “And discussing the situation afterwards with our supervisor means that we learn from both our successes and oversights.”
45,000 kilometres, 12,000 people and 106 days. Carrying the Olympic flame from coast to coast is no small feat. But for a few lucky Faculty of Medicine members, it was a task they’d gladly accept again. By Marta Cyperling
[Photo] Dr. Chip Doig carries the Olympic torch in Banff, Alberta.
[Photos] The Olympic torchbearers gather for a photo; Dr. Chip Doig brightens a fans’ day; Dr. Wendy Tink.
A bearable task We all remember where we were when Sidney Crosby scored the winning goal in overtime that gave Canada Olympic gold in a 3-2 win over the U.S. Our country’s ‘Own the Podium’ campaign resulted in 26 medals—14 of which were gold, more than any other country at the 2010 Vancouver games and an Olympic record.
But before Crosby scored, before Joannie Rochette won the heart of the nation and before Alex Bilodeau struck gold at home, there was the relay. Even before the games began, the Olympics were bringing Canadians together in another way. For 106 days, Canadians lined their neighbourhood streets to watch as the Olympic torch travelled 45,000 kilometres across their country. 12,000 torchbearers carried the flame in the largest-ever Olympic torch relay in one country. A group of physicians from the Faculty of Medicine were selected to join the Alberta Medical Association’s (AMA) torch relay team. The group of 19 runners sported the official white track suits and the now famous redmittens and ran with the Olympic torch through a one kilometre stretch of highway near Banff, Alberta on January 21, 2010. For family physician Dr. Wendy Tink it was an emotional moment. “Never in my wildest dreams could I have imagined that my husband and two
young children, who braved the cold early one morning in 1988 to watch the Olympic flame enter Calgary, would be cheering me on as an Olympic torchbearer 22 years later.” Close to 20 of her family and friends from the University of Calgary North Hill Medical Clinic were there to cheer her on. “The run was truly an amazing moment. The best part was the power and passion of people coming together to share the excitement of the run.” Dr. Chip Doig, president of the AMA and head of the Department of Community Health Sciences at the Faculty of Medicine, was also cheered on by his family. Doig was amazed at how many people in the Banff community filled the streets. A loud crowd, some dressed in their 1988 Olympic outfits, ran the route alongside the AMA runners; others held up banners.
“During part of my run there was an older gentleman at the side of the road. He was clearly chronically ill; he was in a wheelchair, and was wearing oxygen. I asked the run organizer if I could stop for him and I let him hold the torch with me,” recalls Doig. “That’s when this gentleman started to cry, and as a physician, reaching out to an ill individual and making a difference to him is a symbol of the role of our profession. It will be the most endearing memory for me. Before and after the run, I was amazed how many people wanted to touch the torch. The Olympic flame is a very powerful symbol.”
ucalgary medicine | Page 15
Medicine Vol 2 Issue 2 | Summer 2010
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Published on Jul 1, 2010
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