of 2012 final.pdf · pinky gaidhu class president. md class of 1t5 boundlessimpact the historic...

fall 2012 issue | Transforming Lung TranspLanTs | Visions in pharma | sTudenT awards | BoundLess impacT

uofT meDicine

how can we intervene to help children stay on the path toward optimal health and lifelong well-being?

The firsT 2,000 days of life

“ Scholarships and bursaries from U of T allow me to focus on developing my skills and knowledge—and give me the opportunity to concentrate on becoming a really great physician.” PINKY GAIDHUClass President. MD Class of 1T5

BOUNDLESSIMPACTThe historic campaign for the University of Toronto will harness the boundless potential of students like Pinky. With your support, we can channel the immense power and talent of our community to imagine a brighter future for Canada and the world.

Please donate to the campaign today: https://donate.utoronto.ca/medicine or 416-978-0811

FIND OUT MORE AT BOUNDLESS.UTORONTO.CA/MEDICINE

Magazine-FP_medicine_Pinky.indd 1 12-08-02 2:15 PM

Faculty of medicine 3

Fall 2012 • VOlUME 7 • ISSUE 1

4 dean’s Message

5 lighTened load Bursaries and a new matching program help students shine

6 news@Medicine

8 The firsT 2,000 days of life unravelling the interplay be-tween genes and environment

13 Thinking ouTside The Body alumnus shaf Keshavjee is transforming lung transplants

14 coMplex diseases— innovaTive soluTions cancer. heart disease. diabetes. u of T researchers are connecting the dots

18 visions in pharMa donation lets students see the world

20 a huB for gloBal healTh how u of T is bringing health to the world

22 Boundless iMpacT a campaign for the future of the faculty of medicine

24 healing hearTs and Minds anne Bassett will lead clinic for patients with rare neurological condition

25 a Bridge To kenya helping to build better health care for african women

26 reModelling canada’s healTh care sysTeM Q&a with adalsteinn Brown

conTenTs

executive editor: april Kemick

senior editor: Jim Oldfield

Managing editor: Nicole Bodnar

editorial assistant: Suniya Kukaswadia

art direction & design: Fresh art & Design Inc.

Published by the University of Toronto

Faculty of Medicine, 6 Queen’s Park Crescent W.,

Suite 306, Toronto, ON M5S 3H2

phone: 416-946-8423

fax: 416-978-6999

e-mail: [email protected]

The University of Toronto respects your privacy.

We do not rent, trade or sell our mailing lists.

If you do not wish to receive U of T Medicine

magazine, please contact us.

18

4 Fall 2012

Today’s most urgent health challenges must be solved through innovation. at the university of Toronto faculty of medi-cine, we are transforming health in canada and around the

world by catalyzing collaboration across fields to address problems that simply cannot be tackled by any one discipline or institution. This is our unique strength as the only medical school in the greater Toronto area, in the most research-intensive university in canada.

Building on our track record of success, as we embark on our $500-million fundraising campaign this fall, we offer our sup-porters an unprecedented opportunity to share in harnessing the power of our partnerships. real-world innovations that enable people to live healthier, happier lives depend on an integrated approach, and we play a key role in elevating our entire net-work—including nine fully affiliated health institutions and 18 community affiliates—to a new level of impact.

with the support of our tremendously generous and visionary donors, the faculty has been able to achieve many of its core objectives in educa-tion and research. our world-leading experts are establishing new local and global networks focused on our four strategic priority areas: human development; neuroscience and brain health; global health; and complex disorders – system management.

This year, we launched a university-wide collaboration with our hospital partners—the fraser mustard institute for human development—where projects range from understanding the ef-fect of environment and toxins on genetic expression to social determinants altering health in the first 2,000 days of life. un-derstanding these mechanisms enables the emergence of more effective diagnostic and therapeutic interventions early in the life course to stem chronic illness and ensure opportunity for

individuals and populations to contribute optimally to a prosper-ous society.

our department of nutritional sciences has identified child nutrition and healthy behaviour as a key integrating focus among local collaborators in family and community medicine and global partners, including the food industry. our department of psy-chiatry recognizes the importance of adapting health professions education and care delivery to better address the needs of people suffering from both mental and physical illness. our departments of medicine and family and community medicine are working together to bridge the gap between hospital- and community-based care for individuals with complex diseases.

our defining role at the faculty of medicine is training the next generation of health leaders to solve health system challenges through interdisciplinary collaboration and innovation. The impact of this training is particularly meaning-ful for ontario, where we supply at least half of practising physician specialists and more than one-third of family physicians. we take great

pride in preparing academic leaders who populate academic health centres across canada and in an increasingly borderless world.

Leveraging the power of interdisciplinary collaboration is fundamental to our campaign promise. fluid integration—bringing the best students, researchers, national and international partners together—is critical for transforming health and health systems in canada and beyond. The faculty of medicine is com-mitted to driving strategic, interdisciplinary collaboration among our departments and centres and with our partner hospitals and research institutes. we invite you to join us as—together—we lead canada in achieving better health and better health systems for the world. ■

“Leveraging The power oF inTerDiscipLinary coLLab-oraTion is FunDamenTaL To our campaign promise”

professor catharine whiteside

Dean, Faculty of medicine

vice-provost, relations with health care institutions

FrOM THE DEaN

The power oF parTnerships


When the university of Toronto faculty of medicine offered madiha naseem a place in its undergraduate md program, she found herself in a catch-22 scenario:

thrilled at the prospect of attending one of the world’s most prestigious medical schools, but worried about the prospect of graduating with heavy debt.

“The joy of getting accepted to medical school was accompa-nied by the overwhelming fear of managing my finances—tuition alone was four times higher than my undergraduate tuition,” says naseem (B.sc. ’11), who starts her second year this fall and is con-sidering a career in internal medicine.

naseem is not alone: 70 per cent of her peers in the md program receive some type of financial aid, says professor mark hanson (md ’81, m.ed. ’98), associate dean of undergraduate admissions and student finances. This support is critical, given that average graduation debt for this group is more than $84,000.

in order to save money during her first year, naseem spent up to four hours a day commuting to Toronto from her parents’ home in Brampton while juggling her intense academic workload. The schedule was grueling, she says. Then the faculty of medicine stepped in with financial support, and it became much easier to devote full attention to her studies.

“after receiving a bursary, i was able to live closer to campus and found myself more energetic and enthusiastic while attending school. my grades and overall well-being also improved,” she says.

The support has allowed naseem to consider opportunities that would otherwise be unavailable to her. in July she travelled to peru to conduct public health outreach with rural communities in the andes mountains as part of a volunteering elective with the foun-dation for international medical relief of children. “This elec-tive has been a life-changing experience. i have grown as a person, learned valuable clinical skills and developed relationships that will help me in my future career,” says naseem.

enabling students to focus on learning by minimizing debt is a continuing priority for u of T and the faculty of medi-cine, which aims to generate $100 million for student awards and programming as part of its $500-million fundraising campaign, launching this september 13.

pearl Yang (B.sc. ’01, m.sc. ’05, phd ’10), a third-year medical student with a doctorate in rehabilitation science from u of T, has

received generous donor bursaries in each year of her studies. The mother of a young son says today’s medical students must balance nu-merous competing priorities that make financial support a necessity.

“Today there are more expectations of med students. Beyond academic responsibilities, many students are involved in research and lead campus social activities. Trying to accomplish as much as pos-sible, especially with a young family, leaves me no time for part-time work. any help the university provides to lessen the debt burden after graduation is wonderful,” she says. ■

LighTeneD LoaDU of T helps students to reduce debt

By NICOlE BODNar

Needs-based awards at the University of Toronto ensure

Canada’s best young minds can fulfill their promise—

today and in the future. Through the Boundless promise

program, new this fall, U of T will match endowed

donations of $25,000 or more to provide annual

student awards of $2,000 and up. Using $25,000 as

an example, here is how the matching works:

$25,000: Donor creates endowed fund

$1,000: 4% (approx.) payout from endowed $25,000 award

$1,000: University matches payout 1:1

$2,000: Value of annual student award

bounDLess promise

STUDENT aWarDS

Pearl yang and her son lucas

6 Fall 2012

news@meDicine

FasTer cancer DiagnosisDetect diseases early in order

to save lives—that’s the

goal of a revolutionary tech-

nology developed by Profes-

sor shana kelley (Institute of

Biomaterials and Biomedical

Engineering) and the team at

her spin-off company, Xagenic

Inc. Thanks to $10 million in

investments from CTI life Sci-

ences Fund and the Ontario

Emerging Technologies Fund,

Kelley is closer to making that

goal a reality.

Xagenic has pioneered an

electronic chip that can detect

cancer disease markers at a

molecular level, enabling pa-

tients to be tested quickly and

painlessly using blood or urine

samples. The chip eliminates the

need for invasive biopsy tests

and speeds up diagnosis.

With their new funding, Kelley’s

team will develop a fully

automated, hand-held device

and disposable testing cartridge

for diagnosis outside of clinical

laboratories to improve patient

care while lowering health

care costs.Prof. Shana Kelley

worLDLy innovaTionsFaculty of Medicine researchers funded by Grand Challenges Canada are finding solutions to improve and save lives in the developing world. Here are a few

From improv-

ing cancer

diagnostics

to developing

human-powered fetal

heart monitors, grand

challenges canada

funds innovators

worldwide to address

pressing global health

challenges. Founded

by Professor of Medi-

cine peter singer

and Professor of

Surgery abdallah

daar, respectively

Grand Challenges’

Chief Executive Officer

and Chief Science and

Ethics Officer, the orga-

nization has provided

financial support to 60

innovators since 2010.

Grand Challenges plans

to announce 500 more

awards over the next

five years, backed

by the Government

of Canada.

professor Jan andrysekINSTITUTE OF BIOMaTErIalS

aND BIOMEDICal ENGINEErING

WHErE: Developing

countries, including

Chile, Myanmar and

Tanzania

INNOVaTION: a low-

cost artificial knee

joint, lC Knee, used for

lower-limb amputations.

professor diego BassaniDalla laNa SCHOOl

OF PUBlIC HEalTH

WHErE: Uganda

INNOVaTION:

a fetal heart monitor

that is rugged, reliable

and not dependent

on electricity.

professor daniel roThDEParTMENT OF

PaEDIaTrICS

WHErE: Pakistan

INNOVaTION: The use

of portable pulse oxim-

etry, which measures

oxygen levels in blood,

as a triage tool to iden-

tify sick young infants at

primary health centres.

professor ophira ginsBurg Dalla laNa SCHOOl

OF PUBlIC HEalTH

WHErE: Bangladesh

INNOVaTION:

a program that enables

health workers using

mobile phones to

refer women for breast

cancer treatment.


virTuaL yearbook are you a U of T Medicine alum

who has fond memories of

your years at school? a Faculty

member with access to historic

photos? an innovator whose

breakthrough discovery made

news headlines? If so, the inter-

active living History

website is a place to

share your story.

Inspired by a dedi-

cated group of alumni

from the Class of

1944, the new website

celebrates U of T

Medicine’s tremen-

dous legacy and

impact through memories shared

by our alumni community.

From world-famous break-

throughs to the untold stories of

U of T Medicine alumni, faculty

and staff, this virtual yearbook

preserves our history while pay-

ing tribute to our ongoing story.

Visit www.medicine.utoronto.ca/

livinghistory to share your sto-

ries, photos and memories, and

to explore our legacy.

exTraorDinary menTorshipdiana alli’s agenda is “making

this world a better place.”

From developing youth out-

reach programs to helping

students prepare medical school

applications, alli (below)

impacted countless lives over

her nearly four-decade career

with the University of Toronto

Faculty of Medicine.

Since she retired from the

Office of Health Professions

Student affairs this summer,

donations to the newly created

Diana alli Medical Student

award began pouring in.

Below is a sampling of

tributes to alli on the University

of Toronto Donor Wall

(http://give.utoronto.ca/

recognition/donor-wall/):

“Diana Alli—mother to 38 gradu-

ating U of T Medicine classes.”

SHUO (alEX) XIaNG

(student)

“She helped me and countless

other students over her career.

I will never forget her.”

PrOFESSOr COrINNE FISCHEr

(Department of Psychiatry)

an image of Dr. Wilfred Bigelow, from the living History site

By THE NUMBErS

$7Number of additional

dollars each donated

dollar yields in

further philanthropic,

granting, matching and

operating funds.

710 Number of students

enrolled in the

MD program in

2011–2012 who received

a total of $4.5 million

in student aid.

1919The year the Eaton

family funded the

first donor-endowed

chair in the British

Commonwealth.

54Number of endowed

chairs at the Faculty

of Medicine in 2012.

39How many students the

Dr. Gordon Mansfield

Memorial awards

supported in 2011.Diana alli (centre) with students

“Two worDs. one greaT LaDy. Diana aLLi.”Dr. TIMOTHy rINDlISBaCHEr (Director of the Sports Health Program for Cleveland Clinic Canada)

Visit www.

medicine.

utoronto.ca/

livinghistory

to explore the

living history

website.

By SUNIya KUKaSWaDIa

8 Fall 2012

COVEr STOry


The FirsT2,000 DaysoF LiFebreastfeeding may neutralize a baby’s genetic predisposition to obesity. what else can research on early human development tell us?

by marcia kaye


10 Fall 2012

Two babies are born in the same neighbourhood, both with genetic predispositions to develop depression in their 20s, obesity in their 30s and diabetes in their 50s. one child will grow up to have all these conditions, while the other will develop none of them. it’s the same story with other non-communicable conditions,

including learning disabilities, anxiety disorders, high blood pressure and cardiovascular disease. why does this happen, what environmen-tal influences may be interacting with those genes, and how can we intervene to help more children—in fact, all children—stay on the path toward optimal health and lifelong well-being?

as researchers around the world pursue these questions, the university of Toronto is creating a unique new research and out-reach institute that could revolutionize our understanding of these issues. The fraser mustard institute for human development is an academic umbrella that links researchers across multiple disci-plines. a virtual construct whose scope is not restricted by the size of a building, the fraser mustard institute immediately attracted interest from 75 researchers and expects to keep growing. “it’s bigger, wider and more comprehensive than anything we’ve ever done,” says executive director stephen Lye, a u of T professor in the departments of obstetrics and gynaecology and physiology, and the associate director of the samuel Lunenfeld research in-stitute (sLri) at mount sinai hospital.

while many conditions don’t manifest themselves until adulthood, researchers at the fraser mustard institute will be

examining what occurs years or even decades earlier. “rather than trying to treat the symptoms, we’re better off trying to pre-vent them in the first place, and we have a very real prospect of doing that in the first 2,000 days of life,” says Lye. he emphasizes that what happens during that crucial time—from conception to around age five—can set a child on trajectories that will impact his or her entire life.

Those far-reaching effects encompass not only physical and mental health but also the ability to learn and the capacity for posi-tive social interactions. Traditionally, research has been divided into discrete “silos” of health, education and social sciences. But the fra-ser mustard institute removes those barriers. “our belief is that a developing individual doesn’t separate his or her health, learning part or social functions,” says Lye, who holds the canada research chair in improvement in health and function. “studying these aspects together will allow innovations to emerge rapidly.”

“raTher Than Trying ToTreaT The sympToms,we’re beTTer oFF TryingTo prevenT Them in The FirsT pLace”

Mats Sundin, who established fellowships between U of T and Sweden’s Karolinska Institutet, talks with Profs. Stephen Matthews, left, and Stephen lye

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While attracting researchers from various areas of human development, the initiative has also recently attracted the attention of an international superstar whose field

isn’t science at all, but professional sport. national hockey League legend mats sundin, former captain of the Toronto maple Leafs, feels so passionately about the issues that he has established fel-lowships for an elite exchange program for two scientists in de-velopmental biology between u of T and Karolinska institutet in his home country of sweden. Beginning this september, one candidate from each university will be chosen to do a year of postdoctoral research at the other’s institution. “i’m really excited about being able to get involved and give back to two of the best research centres in the world,” says sundin.

The early years have long been an area of interest for sundin, son of a pediatric nurse. “over my years in Toronto i had a big involvement in different charities, but what kept me coming back was children,” he says. he often visited young patients in hospital, and he started captain’s corner, where kids dealing with life chal-lenges had special box seats to watch hockey games in Toronto’s air canada centre. sundin, who now lives in sweden, says, “when i was part of a seminar on sports and health at Karolinska, i started thinking about ways i could support research that could help chil-dren in the early stages of life. it was important for me to give back in sweden, but maybe even more important in Toronto, where i spent most of my career. Toronto really feels like my home.” he was encouraged to learn that u of T and Karolinska already had academic partnerships, so his involvement was an easy fit.

There are surprising parallels between elite scientists and elite athletes, says sundin, who will be inducted into the hockey hall of fame in november, and had his number 13 jersey honoured in a Toronto ceremony in february. he says, “when you’re a professional athlete you’re always trying to be on the edge, at the forefront, col-laborating with your teammates but having that competitive drive to be the best.” sundin now has a new reason for his interest in the well-being of children: his wife Josephine gave birth to their first child, a baby girl, in august.

sundin has personally donated more than $300,000 for the fel-lowships, matched by u of T and Karolinska, with another $50,000 from maple Leaf sports and entertainment. But sundin’s involve-ment goes far beyond money, says Lye, who will oversee the fel-lowships from the u of T side. sundin has made several personal appearances (when he announced the fellowships earlier this year he proudly brought his entire family to u of T, including his par-ents and siblings), he is helping to fundraise, and he inspires young people to think about careers in science and research. Lye adds, “professional hockey is all about excellence and attracting the best talent from around the world, and so is our institute. having mats sundin involved offers us a great opportunity to get our message out.” indeed, sundin’s announcement generated widespread media

attention, which is shining a spotlight on various research initiatives in u of T medicine that are having an international impact.

much of the research focuses on the interplay between genes and the environment. whereas the genes that we inherit were once thought to be our destiny, it’s now believed that they interact with the environment in ways that can alter their expression. Those en-vironmental influences, both positive and negative, may include nu-trients, contaminants, medicines, stress, stimulation and potentially thousands of other factors. Lye’s own research, in an international collaboration with colleagues in perth, australia, involves a huge dataset of 3,000 children who have been genotyped and followed from age 18 weeks to age 21 years. The researchers, led by dr. craig pennell, found that those children born with a specific genetic vari-ant that predisposes them to obesity had a higher than normal body mass index (Bmi) as early as age seven.

“But the really interesting bit,” Lye says, “is that if the mother exclusively breast-fed for the first three to six months, the children with the adverse variant had a normal Bmi by age seven.” That finding, by mount sinai hospital investigator and u of T dalla Lana school of public health professor Laurent Briollais, shows that in the right environment, adverse effects can be mitigated, says Lye. a large part of the research is determining exactly what the “right” environment is in every instance to produce optimal outcomes. To that end, the fraser mustard institute is spearhead-ing another initiative called the ontario Birth study. it is re-cruiting women to take part in an observational study that will follow them through their pregnancies, then follow their children

through early childhood and beyond. “it will be a living labora-tory, and i think it’s going to be a remarkable resource,” Lye says.

Obesity, which carries higher risks for diabetes, heart dis-ease, stroke and some cancers, is a major cause of dis-ability around the world. But another leading cause of

disability is depression. physician-researcher Valerie Taylor is in-vestigating how these two disorders—obesity and depression—are connected. “i’m interested in what comes first,” says Taylor, head of u of T’s division of women’s mental health and psychi-atrist-in-chief at women’s college hospital. “and i keep going back further and further, to early fetal programming and what’s happening in utero.”

Taylor emphasizes that not everyone with depression has a weight problem, and not everyone who is overweight has a mental illness. But she says several links have been found. for example, fat

“i keep going backFurTher anD FurTher,To earLy FeTaL pro-gramming anD whaT’shappening in uTero”

Prof. Valerie Taylor

12 Fall 2012

tissue, which is biologically active, contains the stress hormone cortisol. elevated cortisol levels are common in people with depres-sion. and, in what may be a vicious circle, excess cortisol leads to an accumulation of abdominal fat. Likewise, many antidepres-sants and antipsychotics lead to weight gain, and yet people with depression may lack the energy or motivation to plan healthy meals or pursue physical activity.

To complicate the issue further, these drugs cross the placenta to the fetus, and the effects aren’t fully understood. what is known is that significantly overweight chil-dren are at much higher risk of developing a mental illness as they get older, and children with a mental illness are at much higher risk of becoming obese. This connection has ma-jor implications not only in canada, where almost two-thirds of canadian adults are overweight and one in four will experience depression, but also worldwide, where these two conditions are increasingly spoken of as a “double epidemic.” early interventions may potentially include specific antioxidants or behaviour modifications for the pregnant woman that could have protective effects for the fetus, says Taylor. more research is needed, but Taylor, a member of the fraser mustard institute, believes the answers lie in studying the early years. “for me, looking at the first 2,000 days is essential for understanding the next 90 years.”

One of the driving forces in genetics research is better, cheaper technology. stephen scherer (m.sc. ’91, phd ’95), professor of molecular genetics, director of u of T’s mcLaughlin

centre and one of the world’s top autism researchers, says, “Technol-ogy is moving at a breakneck pace.” eighteen months ago, as part of the international autism genome project to analyze the genes of 10,000 families with autism diagnoses, scherer’s lab was able to sequence only 1.5 per cent of all dna in a genome. This past sum-mer, they could sequence the entire human genome within a couple of weeks at a cost of $5,000. This fall, with new technology they will complete the same process within a couple of hours for $1,000.

some of the results have been stunning. “The new story is that genes we’re finding in our autism studies are also being found in schizophrenia, attention deficit hy-peractivity disorder and bipolar disorder,” says scherer, who holds the glaxosmithKline chair in genetics and genomics and is also the director of the centre for applied genomics at The hospital for sick children. several studies are looking at why the same genes lead to one condition over another. since many of the genes are involved in the same genetic pathways, there’s a very real possibility that drugs that work for one condition

may be useful in another. But since scherer’s work suggests that people with autism—and perhaps schizophrenia too—each have their own individual genetic form of the condi-tion, it’s important to translate the data for families in order to personalize treatment.

while studying common conditions of childhood can yield significant data, conversely so can studying rare disorders. department of paediatrics professor Berge minassian, who holds the michael Bahen chair in epilepsy research and is also a scientist at sickKids, studies a rare, neuro-degenerative form of epilepsy called Lafora disease. affecting one in 200,000 people, it’s a fatal seizure disorder that progresses rapidly to constant seizuring and dementia, and leads to death about 10 years after on-set. although symptoms don’t show until age 13 or 14, the roots of the disease begin much earlier. minassian’s lab discovered the two gene defects that cause the disease by producing an accumulation of glycogen in the brain.

“we’re actually very close now to hav-ing an almost complete understanding of all the steps of the disease,” minassian says. But one of the barriers to progress is the difficulty of getting funding to research a disease like Lafora. he says, “people think

these diseases are too rare to fund. But these rare diseases are gems for research. They give us precise views of what happens when one specific piece is affected.” minassian says the study of Lafora will increase the understanding of other, more common forms of epilepsy. moreover, since the brain is continually chang-ing and developing in the early years, animal studies are helping to determine the optimal time for drug intervention to prevent or mitigate the disease. minassian’s lab is also studying a rare form of infant-onset parkinson’s disease, which may have implications for the much more common adult-onset form.

at u of T medicine, it’s not just about research; it’s about out-comes, says the fraser mustard institute’s Lye. “we don’t just want to do research,” he stresses. “we want to take our research and the information that’s already out there and apply it to improve the

health, learning and social function of children.” with its interdisciplinary approach and global reach, Lye says u of T has the potential to be the world leader in look-ing for best practices around the globe and applying them to significantly improve the lives of children, and the adults they will become. “The biology that takes a single fertilized egg to a child who can learn in school in a few short years is nothing short of a miracle,” Lye says. “we’re committed to finding how to make that development optimal so that children will be set on tra-jectories that are optimal for life.” ■

The Fraser musTarD insTiTuTeTo mark its official opening, the

Fraser Mustard Institute is hosting

the Connaught Global Challenge

International Symposium from Sep-

tember 27 to 29, where national and

international scientists will speak on

“Investing in Mothers and Children:

Developmental Trajectories, Health,

learning and Society.”

The Fraser Mustard Institute

involves U of T’s Faculty of Medicine,

U of T Mississauga and Scarborough,

the Faculty of arts & Science and

the Ontario Institute for Studies in

Education, and links into several

of U of T’s affiliated hospitals. It is

named for Dr. Fraser Mustard, the

internationally renowned physi-

cian and scientist who passionately

campaigned to bring the world’s

attention to the importance of the

earliest years of life.

Prof. Stephen Scherer

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Thinking ouTsiDe The boDy

Professor shaf Keshavjee (md ’85, m.sc. ’90) still remembers the day in 1983 when he heard exciting news

on his car radio: university of Toronto sur-geons had performed the world’s first suc-cessful lung transplant at Toronto general hospital. “i thought, that’s cool—i would never have thought you could transplant lungs,” recalls Keshavjee, a u of T medical student at the time.

Three years later, another world first occurred—a double-lung transplant—and Keshavjee was there, as a junior u of T md resident assigned to thoracic surgery at Toronto general hospital. “history was being made and i was a part of it,” he says.

Keshavjee has been part of many other firsts since then.

now a professor in u of T’s depart-ment of surgery, director of the Toronto Lung Transplant program and surgeon-in-chief at university health network (uhn), Keshavjee has performed more than 300 transplants, most of them double-lung. he is a driving force behind inno-vations that have transformed lung transplantation globally. his development of a lung preservation solution—which boosted the patient survival rate for single-lung transplants from 50 per cent to over 90 per cent—is now a world standard.

Keshavjee says u of T’s surgical scientist program facilitates such innovation. “one of the great things about the university is that surgeons can take time out of their clinical work for sci-ence. after spending two years conducting research from 1987 to 1989, i was able to develop the preservation solution in the lab and translate it into clinical practice,” he says.

Keshavjee is glad he chose u of T, despite receiving two open scholarships from elsewhere. “u of T gives one the confidence and ability to play on the international stage, to do things that are truly shoulder to shoulder with the world’s best institutions.”

since his time as a trainee at u of T, Keshavjee has also devel-oped a type of gene therapy to make donor lungs less prone to

rejection by the immune system, and figured out a way to im-prove gene therapy too. The result is an ex-vivo technique—basi-cally a breathing lung in a box—that allows an organ to remain outside the body and recover at normal body temperature.

currently, 85 per cent of donor lungs are not used because it’s uncertain whether the human lung will work, says Keshavjee, who is also the director of Latner Thoracic research Laborato-ries and holds the James wallace mccutcheon chair in surgery at uhn. But with the ex-vivo technique, clinicians can confirm that a lung will work and, if there’s a problem, use targeted gene and cell therapies to repair it, he says.

Keshavjee has performed 53 lung transplants using the meth-od, which surgeons around the world are now adopting. The hope is that this approach will triple or quadruple the number of viable transplants. “There are many people living full, produc-tive lives because of what we do,” says Keshavjee. “But what’s also gratifying is taking transplant surgery to the next level and asking, ‘how can we do this better?’” ■

alumnus Shaf Keshavjee is transforming lung transplantation

By aNGEla PIrISI

Prof. Shaf Keshavjee

alUMNI PrOFIlE

14 Fall 2012

Unlocking the secrets of the human genome flooded our understanding of complex diseases such as al-zheimer’s, heart disease, osteoporosis, stroke, cancer and diabetes. medical science has responded to this change by moving beyond efforts to pinpoint spe-cific holy grail genes and mutations, toward con-

necting the dots between various complex diseases. as with blind men trying to define an elephant by each exam-

ining a different part, the approach most likely to yield answers is a merging of perspectives. That means combining the strengths of many disciplines, including genetics, epidemiology, physiology and immunology, to name a few. it also involves casting a net wider for clues by examining the possible overlap and interplay of risk factors and biologic pathways involved in different diseases.

university of Toronto researchers are taking precisely this multi-faceted approach when it comes to decoding complex diseases—and with promising results. Their insights into the mechanisms of disease

have changed the way we approach everything from deciphering risk factors and finding novel therapeutic targets to improving health care delivery models.

diabetes offers a good working example of complex diseases because it’s inextricably linked to many other diseases. “diabetes doesn’t usually occur in isolation; people with diabetes also may have heart disease, high blood pressure, high cholesterol and many other complex diseases,” says gary Lewis, a professor of medicine and the director of u of T’s Banting and Best diabetes centre (BBdc), who holds the drucker family chair in diabetes research.

high blood sugar wages multiple assaults on the body, damag-ing eyes, kidneys, nerves and limbs. “But if you lower glucose, by any means, you dramatically reduce these microvascular compli-cations,” says Lewis. diabetes is also complicit in cardiovascular disease (cVd). “approximately 70 per cent of people with dia-betes will die of heart disease, not from high blood sugar. and the major costs of diabetes are incurred by in-patient management

compLex Diseases— innovaTive soLuTionshow u of T researchers and clinicians arejoining forces to develop novel strategies forthe most challenging medical conditions

by angeLa pirisi

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16 Fall 2012

of cVd—it’s overwhelmingly the biggest cost associated with diabetes,” says Lewis.

Because diabetes is linked to many chronic diseases, researchers and care providers have broadened their perspective to consider aspects of the disease that accompany insulin resistance (a pre-di-abetic state in which the action of insulin in the body is blunted). Lewis’s lab is focused on teasing out the relationship between dia-betes and heart disease by examining how insulin resistance relates to abnormal lipid changes.

Vital to examining links among complex diseases is exchange of knowledge among experts in various disciplines. an example of this cross-pollination at BBdc is the creation of insulin-pro-ducing cells from stem cells. “we have very close collaboration between cell biologists who understand pancreatic cells and de-velopmental biologists who understand stem cells,” says Lewis, who is also a scientist at university health network (uhn). “even if you can make insulin-producing cells, it’s still a big step to see if they mimic normal pancreatic, insulin-producing cells.

The next step is to test them in animals (we have physiologists working on that), then in humans. so you can see the need for a totally multidisciplinary team that takes this kind of massive project from the lab bench to humans.”

Department of medicine professor mansoor husain agrees. “diabetes takes a whole team of scientists and health care workers, not just doctors, to impact the disease,” says husain,

a cardiologist who has studied the overlap between diabetes and heart disease. in collaboration with researchers at mount sinai hos-pital, he tested the cardiovascular effects of a glucose-lowering drug, called a gLp-1 receptor agonist, which improves glucose control and various heart health measures as well, such as blood pressure and weight. “it took someone with interest in cVd and someone with interest in diabetes, working together on chronic disease,” says husain, who is also the director of the Toronto general research institute at uhn.

husain also recently developed and patented a peptide that can inhibit smooth muscle cell proliferation, which is at the root of ar-tery narrowing and blockage. But there is interest from a canadian biotech company, soricimed Biopharma inc., to explore its poten-tial use in cancer. husain explains, “Both cancer and atherosclero-sis are proliferative diseases, so the peptide i clearly developed for smooth muscle cell proliferation is being eyed for cancer.”

immunology is also increasingly important in deciphering the pathways shared by complex diseases. The body’s immune system plays a role in most if not all complex diseases, points out depart-ment of immunology professor Tania watts, who holds the sanofi

The BrIDGES program: Stephanie Sanders (right) and Dr. Thuy-Nga Pham visit Daniel Donison and his wife Margaret in their home

“DiabeTes Takes a whoLeTeam oF scienTisTs anDheaLTh care workers,noT jusT DocTors, To impacT The Disease”

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pasteur chair in human immunology and is the director of the Toronto human immunology network. The network is attempt-ing to break the silos between researchers studying organ-specific diseases with a view to finding common ground for studying im-mune aspects of many diseases. “we’re seeing an emerging theme that inflammation (an immune-mediated response) underlies many chronic diseases,” says watts.

in fact, recent research has helped redefine Type 2 diabetes as an autoimmune disease, which has widened the lens on therapeutic targets in diabetes and other conditions. Nature Medicine published two key discoveries from the department of Laboratory medicine and pathobiology by professor and uhn scientist daniel winer (B.sc. ’98) and colleagues, in 2009 and 2011. The first paper proved that immune T cells jumpstart insulin resistance; the latter demon-strated that B cells and their antibodies may impair cells’ ability to respond to insulin.

Meanwhile, myron cybulsky (md ’82), also a professor in u of T’s department of Laboratory medicine and patho-biology and a scientist at uhn, published findings in

2010 that implicated other immune cells, called dendritic cells, in forming the plaque that block arteries in atherosclerosis. while dendritic cells can be very helpful in fighting infection, cybulsky’s lab showed that they are important initiators of arterial inflamma-tion and blockage.

unraveling the complicit role of immune-mediated inflamma-tion in many diseases should lead to better treatments for many diseases. “we are working toward a better understanding of what constitutes a normal immune re-sponse, and seeking to identify biomarkers of disease that tell us how the immune system is behav-ing,” says watts. “i think we’re go-ing to see that there’s a broad range of responses in every disease and in every person. we’re starting to learn about the diversity of individuals, genetically and at physi-ological and immunological levels.” studying small genetic varia-tions may ultimately provide insights about how an individual will respond to a certain drug or disease.

on the clinical care side, linking people and technologies to download research innovations to patients is a key priority for u of T researchers. sharon straus (md ’90, m.sc. ’03), a professor of medicine and director of the division of geriatric medicine at u of T works to improve patient care by ensuring that new discoveries are implemented and that “research findings don’t just languish in a journal.”

“consistent evidence shows that health systems globally fail to optimally use evidence, resulting in inefficiencies, reduced quantity and quality of life for citizens and lost productivity,” says straus, who is also the director of the Knowledge Translation program at the Li Ka shing Knowledge institute of st. michael’s hospital.

“we are working to provide a better quality of care for people

with chronic, complex diseases and to ensure a better return on investment in research,” says straus. The task does not belong to one individual or discipline: her team includes physicians, nurses, reha-bilitation therapists, pharmacists, epidemiologists, health services re-searchers, statisticians, computer scientists, human-factors engineers and cognitive psychologists.

primary care is another area of medicine where the need for interdisciplinary teams has not been lost. Lynn wilson (md ’83), professor and chair of u of T’s department of family and com-munity medicine, says that physician training is now more in-terdisciplinary to address the boom in complex disease patients. “all our 14 core academic teaching units have transformed into academic family health teams,” she says. “By having inter-profes-sional teams that include, for example, nurse practitioners, social workers and clinical pharmacists, we are developing evidence-based care pathways to deal with chronic diseases that are very common in family medicine.”

meanwhile, the Building Bridges to integrate care (Bridges) project is promoting the creation of integrated care delivery mod-els—developed, tested and implemented by the u of T departments of medicine, and family and community medicine. The program is funded by the ontario ministry of health and Long-Term care and links hospitals, primary care clinics and community services to improve patient care and reduce health care costs.

No scientist or clinician is an island. one of the main chal-lenges of health care research, says husain, is what he calls “clinical-research integration,” which is “bringing together in

an organized way the people who are working on innovation and people who are actually delivering the care.” he sees one of his main tasks as getting people talking, and making certain that “researchers aren’t under the illusion that they can do basic science research or epidemiology research in isolation from clinicians. we have to ask: what are the gaps, and do the innovations fill those gaps?”

working in specialized silos isn’t a viable solution for meeting evolving health care needs and the increasing burden of chronic disease that define them. educators, researchers and clinicians in u of T’s vast faculty of medicine network are working together, without the presumption that one perspective will yield all ger-mane answers, and this bodes well for the future of medicine. But, says straus, “we need to optimize the skills and expertise that various team members bring—and remember that the team includes patients and their families.” ■

“we are working To proviDe a beTTer quaLiTy oF care For peopLe wiTh chronic, compLex Diseases”

Prof. Sharon Straus

18 Fall 2012

Prague. orlando. austin. ottawa. montreal. These are a few of the cities where nael al Koudsi met ex-perts in addiction and mental health while studying at u of T medicine.

so formative were those encounters for al Koudsi (B.sc. ’04, phd ’10) that upon completion

of his doctorate in the department of pharmacology and Toxi-cology, he felt compelled to make a $10,000 gift to enable other students to attend global research gatherings.

“academic conferences provide significant career-develop-ment opportunities for students,” says al Koudsi. “They’re a won-derful platform to share ideas and meet new people in a different cultural setting, while honing listening and presentation skills.”

al Koudsi’s generous gift helped the university establish the Visions in pharmacology Travel award. for the next five years, it will support one graduate student in al Koudsi’s home depart-ment with $2,000 for travel to international research meetings.

This July, al Koudsi returned to Toronto for the first time since his graduation. now based in dubai, he travels the world in a business development role with new country healthcare, a dis-tributor of international nutritional and pharmaceutical products

in the united arab emirates. here to visit his family, the trip also offered al Koudsi a chance to catch up with former colleagues and friends at u of T.

“it was so great to see everyone,” says al Koudsi. “The depart-ment of pharmacology and Toxicology holds a very special place in my heart.”

for his doctorate, al Koudsi studied mental illness and addictions in the lab of professor rachel Tyndale (m.sc. ’88, phd ’92), canada research chair in pharmacogenetics at u of T and head of pharmacogenetics at the centre for addiction and mental health.

“in rachel’s lab, i learned so much and valued her fabulous mentorship. i always wanted to study pharmacology, and i chose a field of research—addiction and mental health—for both its re-markable scientific complexity and great socioeconomic impact,” says al Koudsi, who hopes to further support other students in their educational pursuits.

“The future of the department of pharmacology and Toxicol-ogy is bright, with fantastic education and research opportuni-ties,” he says. “we need to ensure those opportunities are there in the future.” ■

Donation establishes international travel award for students

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Nael al Koudsi

20 Fall 2012

a hub ForgLobaLheaLThnew institute will extend u of T’s international reach

The facts read like errors: in ethiopia—a country of 84 million people—there are fewer than 2,000 practising physicians. That means one doctor for every 42,000 people. a staggering 80 per cent of ethiopian-born medical specialists who train abroad do not return to their home country.

But change is coming, thanks to ambitious plans by the ethio-pian government to stop the brain drain and drasti-cally improve health care for its booming population. in just six years, ethiopia will graduate 15,000 doc-toral and master’s students—an extraordinary chance for transformation.

“what’s happening in ethiopia is part of a global shift in medicine that is addressing inequity,” says clare pain (BspT ’80), a professor in the depart-ment of psychiatry, director of the psychological Trauma program at mount sinai hospital and coor-dinator of the Toronto addis ababa academic col-laboration (Taaac). The collaboration’s purpose is to help ethiopia’s addis ababa university build and strengthen capacity and sustainability in medical and some non-medical specialities.

“investing in postgraduate medical education means training clinical specialists, who can also work with the government to encourage and sup-port change through the development of policies

and legislation, ongoing training and community programs,” says pain. “Thanks to the university of Toronto faculty of medicine’s strong ties to addis ababa university, our students and faculty have the unique opportunity—and responsibility—to be part of this transformative moment in medicine.”

Throughout the year, volunteer Toronto specialists and medi-cal students travel to addis ababa for one month to train residents

and graduate students, who subsequently expand the ethiopian health care structure and form a crucial health pyramid for the country, says pain. in total, Taaac involves six u of T faculties and oversees 16 collaborative programs.

research on precisely this type of collaborative initiative is what u of T’s new institute for global health equity and innovation will support, says in-terim director donald cole (md ’78), a professor at the dalla Lana school of public health.

“we are part of a world that has huge challenges. it is our social responsibility to tackle issues of ineq-uity in global health, both as individual researchers and as part of a faculty of medicine that has pri-oritized global health as part of its mandate,” he says. The faculty recently launched a global health road-map as part of a larger five-year strategic plan.

as inaugural interim director of the new institute, cole is striving to draw together experts at u of T

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and from around the world to engage in complex, global-health-equity problem-solving. The institute will link researchers and educators from diverse university divisions to create u of T’s first integrated and coordinated structure for research and graduate education in global health.

faculty of medicine researchers are already breaking down silos when it comes to tackling global health problems, says pro-fessor Kue Young (m.sc. ’79) of the dalla Lana school of public health, but the institute will provide leaders with new opportu-nities to address the issues faced by vulnerable populations.

Young, the Transcanada chair in aboriginal health, is working to uncover new approaches to preventing and controlling the dev-astating health problems of indigenous people. using information gleaned from thousands of interviews and exams with adults living across the canadian arctic, Young’s inuit health survey looked at 2,500 adults in 36 communities to get a clear picture of health and disease in the canadian arctic. now, Young is joining forces with researchers who have conducted similar surveys to create a circumpolar inuit cohort that can measure and track the health of indigenous people in a comprehensive way.

“we have a segment of the population that is suffering im-mensely compared to the general population, and that inequity is something we should all be concerned about,” he says. “gathering and sharing information—across disciplines and geographic bound-aries—is a crucial first step towards preventing and managing some of the distinct health risks faced by our indigenous people.”

addressing these health inequities is a core part of the new institute’s mission, says cole, and a growing number of u of T medicine researchers are already attracting international atten-tion for their work in that direction.

for professor izzeldin abuelaish, a crucial factor in tipping the global health equity balance will be achieving peace and stability for war-torn nations. “peace is a critical factor in improving the overall health of populations around the world who are suffering disproportionately,” says abuelaish, the michael and amira dan professor in global health at u of T’s dalla Lana school of public health. “it’s about creating a stable climate where people can live healthier lives, physically and emotionally.”

after losing three daughters in a 2009 bombing on the gaza strip, the palestinian doctor has very personal reasons for striving toward peace, which he has documented in a best- selling book, i shall not hate: a gaza doctor’s Journey on the road to peace and human dignity. now, abuelaish is examining the links between peace and health on a global scale. his aca-demic research contributes to a growing international body of literature that connects peace and societal cohesion to health indicators, the development of health systems and the overall well-being of populations.

“across the board, our faculty members are already making extraordinary strides to impact global health,” says cole. “This institute will ratchet up our contributions to improve the lives of people around the world.” ■

U of T faculty are improving health care in Ethiopia, the Middle East, the Canadian arctic and many other places around the globe

22 Fall 2012

bounDLess impacT

When one of dr. gary mooney’s two sons was diagnosed with attention deficit disorder, the father struggled to understand how to help. in his search for answers,

mooney (ma ’69, mdiv ’73) learned about the world-leading neuroscience research conducted at the university of Toronto’s faculty of medicine.

“The faculty of medicine has several of the world’s best research-ers in neuroscience who are working to understand and manage learning challenges like add,” says mooney, a leading Toronto-based lending industry consultant and lawyer. “i’m very interested in helping to marshal the faculty’s incredible research talent to do something for a segment of the population that needs solutions.”

This september 13, u of T medicine will take a historic step toward its goal of transforming health in canada and worldwide by launching its $500-million campaign, and mooney will be a key player in achieving that vision. as a member of the campaign cabinet, the chief executive officer of canadian Lender solu-tions and managing partner of anderson sinclair LLp is bringing aboard individuals from his professional network who care about health care and have experience making large-scale changes.

“i want to support what i feel is the best institution in the country,” says mooney, pointing to the faculty’s stellar track re-cord of research and clinical accomplishments, large and inte-grated health sciences networking and the broad thinking and determination of its leaders. “The thrust of u of T medicine al-lows us to attract people who are open to investing and giving, and to bring them immediate global engagement in a very basic and effective way, so i’m very optimistic that this campaign will find tremendous success.”

The campaign—which accounts for one-quarter of the uni-versity’s overall $2-billion Boundless campaign—hinges on u of T

medicine’s role as an integrator and catalyst for collaboration, both among its own departments and centres, and its partner hospitals and health institutes. That unique integrative role, coupled with its man-date to train transformative leaders and put discovery into action, is what sets the u of T medicine campaign apart, says mooney.

passionate donors are also committing their time and talent to enable the greater Toronto area’s only medical school to further its role as an engine for prosperity at home and abroad.

one of those supporters is susan murray, a seasoned government relations professional who has volunteered extensively on boards for universities, health charities and cultural institutions. This past spring, she co-hosted an event with professor catharine whiteside, dean of the faculty of medicine, to share the faculty’s vision with academic, business and government leaders—and to strategize on how to bolster u of T medicine’s reputation as a global magnet for researchers, educators, donors and volunteers.

“The faculty wants to make medicine better by fostering break-throughs that will change how long people live and their quality of life. it’s own-the-podium, results-oriented thinking, and it resonates with my own philosophy of achievement,” says murray, who runs samci, a national, non-partisan government relations firm.

murray first became involved with the faculty of medicine by facilitating a donation from a canadian mining company. since then, she has shared with the faculty the relationship-building skills she has gained during decades of interactions with elected officials and public servants.

“i enjoy bringing my connections and experiences to bear,” she says. “The funds from this campaign will help the university attract and keep top researchers, fund more student research, en-hance infrastructure and programs and promote its world-class reputation.” ■

On September 13, the Faculty of Medicine will launch the largest fundraising campaign in its storied history—$500 million. Key to success will be the unsung dedication of volunteers. Meet Susan Murray and Gary Mooney

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Susan Murray and Dr. Gary Mooney

24 Fall 2012

Patients with 22q11.2 deletion syn-drome face complex health chal-lenges. symptoms range from mild

to severe, and can include heart defects, speech and language problems, learn-ing difficulties, physical abnormalities and schizophrenia. moreover, these symptoms can appear at different times and over many years, requiring coordinated treat-ment by multiple specialists. often, the comprehensive patient care required be-yond childhood is not met adequately.

That is about to change, however, with the establishment this fall of a multidisci-plinary clinic devoted to adults with the condition, known as 22q11.2ds.

The new dalglish hearts & minds clinic will be located at university health network’s Toronto general hospital, and led by anne Bassett, professor of psychiatry and canada research chair in schizo-phrenia genetics and genomic disorders. “The coordination of care for patients with 22q11.2ds is critical and there’s no better place to centralize this than in Toronto, where we have a concentration of world- renowned specialists and researchers,” says Bassett, who is also a senior researcher at the centre for addiction and mental health.

professor alan fung, also of u of T’s department of psychiatry, will co-direct the clinic, which will provide care by endocrinolo-gists, neurologists, psychiatrists and cardiologists, among other specialists and health professionals. clinic staff will work together to ensure patients get the care they need. Key to this care is the timely and accurate diagnosis of 22q11.2ds symptoms—so pa-tients receive treatment by the right specialist.

Bassett’s research on the chromosomal deletion that causes 22q11.2ds has provided the first evidence for a molecular ge-netic risk factor for schizophrenia. now it is finally possible to identify individuals with this particular subtype of schizophrenia and to adjust their management accordingly.

“dr. Bassett’s discovery of novel genetic alterations causing schizophrenia is changing the way this disorder, and related neu-ropsychiatric conditions, are diagnosed and treated,” says profes-sor stephen scherer, Bassett’s main collaborator for genomics research who is the director of the u of T mcLaughlin centre and a scientist at The hospital for sick children.

in addition to improved patient care, genetic advances in the understanding of 22q11.2ds have lessened the stigma attached to schizophrenia and related conditions. says Bassett, “few moments have been as gratifying in my career as telling the elderly parents of my middle-aged patients—who have wondered and worried about what they did decades ago to contribute to their child’s ill-ness—that, in many cases, schizophrenia is not inherited but the result of a spontaneous genetic change.” ■

heaLing hearTs anD minDsWorld’s first clinic for patients with rare genetic deletion syndrome to open in Toronto

Prof. anne Bassett

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a briDge To kenya

From delivering conjoined twins in Zimbabwe to training reproductive health physicians in Kenya, profes-

sor rachel spitzer has witnessed the vast differences in maternal health care be-tween africa and canada.

But one sharp contrast stands out in her mind.

“in north america, we live in an envi-ronment where labour and delivery have traditionally been so safe that many women are now opting to deliver at home,” says spitzer, from the university of Toronto faculty of medicine’s department of obstetrics and gynaecology. “The irony is that in other parts of the world—like africa—health care professionals are strug-gling to give women access to facilities to deliver their babies.”

This fall, spitzer will travel to Kenya as part of the academic model providing ac-cess to healthcare (ampaTh) program, to help eldoret’s moi university enhance md resident training programs. spitzer’s hope is that the training will enable select Kenyan md residents to later take elective courses at u of T’s affiliated hospitals in obstetrics and gynaeco-logy sub-specialty rotations not typically available in Kenya. in Toronto, trainees would also experience an inter-professional ap-proach to health care that has yet to take hold in africa.

“Teams of doctors, residents and nurses working together may be the norm at u of T, but Kenyan medicine tends to fol-low the traditional British model and is more hierarchical,” says spitzer, who is also the academic coordinator of the department of obstetrics and gynaecology’s global health initiatives. “intro-ducing the interdisciplinary model breaks down barriers and refocuses management on the system rather than on individuals—a crucial change to transform health care in Kenya.”

The department of obstetrics and gynaecology became the first canadian partner in ampaTh in 2007, 18 years after

indiana university established the program. The reproductive health component of ampaTh aims to improve the quality of health care by enhancing clinical maternal and gynaecological services, providing continuing medical education and enabling health system research.

spitzer’s Kenyan colleagues say the program—driven by in-volvement by dedicated professionals like spitzer—has had a transformative impact on maternal health care.

“Thanks to ampaTh collaborative outreach programs, wom-en of western Kenya have better access to health care,” says dr. elkanah orango, an obstetrician, gynecologist and lecturer at moi university school of medicine, department of reproduc-tive health. “rachel’s upcoming visit will go a long way in sup-porting teaching of our medical students and residents.” ■

Improving women’s health through academic medicine partnership

By NICOlE BODNar

Prof. rachel Spitzer (right)

FrOM THE FIElD

26 Fall 2012

Canadians are willing to spend money for better health: to-tal health care expenditures in the last decade have almost doubled, to roughly $200 billion. But in many comparative

studies of health care in industrialized countries, including a recent commonwealth fund report, canada places near the bottom—ahead of only the united states. professor adalsteinn Brown is the newly appointed chair of the institute of health policy, man-agement and evaluation at the university of Toronto, and a scientist in the Keenan research centre of the Li Ka shing Knowledge institute of st. michael’s hospital. here he shares his views on can-ada’s health care system performance with suniya Kukaswadia.

how can we improve health care in canada? we need to con-nect improvement with higher-quality care. Let’s take manag-ing people with chronic diseases, such as diabetes, as an example. some of these patients need better management of their condi-tions day-to-day to lessen their need for costly in-hospital care. This could include more frequent monitoring by family physi-cians, home visits from other health care professionals or better support for self-management. a growing body of evidence shows that providing higher-quality care is often cheaper.are we moving toward prevention and better management of

disease? canada’s leading health care institutions are doing it more and more. The key lies in focusing on the quality of care

we provide and the fidelity of that care to the evidence avail-able. That means ensuring the right evidence gets to the point of care. our institute has a crucial role in generating that evidence through research, and in supporting policies that encourage the uptake of knowledge—bridging the “know/do gap.” our faculty members have a long history of working with government, in advisory roles and on committees, and have helped shape some of the positive reforms of the last two decades.what are we doing well in health care in ontario? we’ve become better at patient safety. we’ve seen a remarkable sea change result-ing not from one study or one school of thought but rather from a general demand by people across the health care system for bet-ter accountability around safety. we also do a great job of training health care leaders, and here again u of T has played a strong role. as a result ontario has capable people doing practical, relevant research, and many points of excellence across clinical disciplines.is more privatized care a means to improving our health care

system? i haven’t seen much evidence that shows privatization pro-duces better health care system performance. systems that do well frequently have three things in common: commitment to a set of goals that are measurable; effective evaluation of performance rela-tive to those goals; and a genuine engagement in quality improve-ment by clinician-leaders. if those three elements are in place, then the distinction between private and public doesn’t matter. ■

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remoDeLLingcanaDa’s heaLTh care sysTemare we getting the health care we deserve for the money we spend?

Q&a: aDalSTEINN BrOWN

28 Fall 2012

CALLING ALLALUMNI:GET INVOLVED! university of Toronto faculty of medicine alumni make up a net-work of almost 50,000 professionals who impact health in canada and around the world. alumni also play vital roles in the faculty of medicine community as mentors, volunteers and donors.

As AN ALUMNUs Or ALUMNA, yOU CAN: • network with other professionals by volunteering with your

specialty alumni association. • Be part of our Living history by telling your story online at

www.medicine.utoronto.ca/livinghistory • access the university of Toronto’s vast library resources.• attend university, faculty and department events.• impact student life by becoming a mentor.• Join our recreation and athletics facilities.

If you would like to learn more about your alumni association or any programs offered by the Alumni Relations Office, please contact [email protected] or call 4169460542.

UPCOMING EVENTsseptember 30medical imaging alumni reception, Toronto

October 11institute of health policy, management and evaluation alumni dinner, Toronto

October 29radiation oncology alumni reception, Boston

November 7oB/gYn 125th anniversary dinner, Toronto

November 15nutritional sciences edna park Lecture and reception, Toronto

November 15family and community medicine alumni reception, Toronto

To register or for more information, contact [email protected]

PM40786012

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