12 Doubling down 11 Residencies 14 Looking for a on a proven spread beyond rare liver disease treatment Vancouver … in diapers UBC MEDICINE VOL 9 | NO 2 FALL 2013 THE MAGAZINE OF THE UBC FACULTY OF MEDICINE How our physical and social CORPUS POROUS environment gets under our skin 04 12 07 FACULTY OF MEDICINE 16 UBC MEDICINE VOL. 9 | NO. 2 FALL 2013 A publication of the University of British Columbia’s Faculty of Medicine, providing news and information for and about MESSAGE FROM THE VICE ProvosT HEALTH AND DEAN 03 faculty members, students, staff, alumni and friends. FOCUS ON: ENVIRONMENTAL HEALTH Letters and suggestions are Building an airtight case 04 welcome. Contact Brian Kladko at [email protected] The graveyard shift 07 Address corrections: At the nexus of nature and nurture 08 [email protected] A recipe for understanding cancer 10 Residencies proliferate beyond Vancouver 11 Communications Director Brian Geary Doubling down on a proven treatment 12 Editor/Writer Blanket? Check. Car seat? Check. Poop colour chart? Huh? 14 Brian Kladko Contributing writers Investigations and breakthroughs 16 Anne McCulloch Daniel Presnell Thousands of shades of grey 18 Design UBC hosts a centre for compassionate care 20 Signals Design Group Inc. www.signals.ca An instructional video breaks out of the classroom 21 Online at http://med.ubc.ca/news/ Enhancing excellence: New arrivals to the Faculty of Medicine 22 ubc-medicine-magazine An unrestricted gift, from an unexpected source 24 An anesthesiology pioneer helps others pursue the research she could not 24 Young scholars take UBC to the world 25 From the executive suite, focusing on street-level challenges 25 A $35 million boost rewards long-term thinking in heart and stroke research 26 MEDICAL ALUMNI NEWs 27 DEAN’S GREETING UBC MEDICINE 3 MESSAGE FROM THE VICE PROVOST HEALTH AND DEAN It may seem unexpected, but as an academic oncologist who cares The challenge is finding the operative factors amid hundreds of for women with gynaecological cancer, I’ve become an expert in different environmental variables. denial – not of the reality of disease, with which I’m all too familiar, Overcoming that challenge is essential if we are to become a but of its origins. healthier society. It’s a task ideally suited to academic health Perhaps I’m so focused on the present reality of therapeutic scientists, like the brilliant ones described in this issue of options that the fundamental “why” gets lost. Or, perhaps, I would UBC Medicine, because they have the training, the acumen, the rather not go there. Although there are no “sure outcomes” in caring discipline and hopefully the resources to discern the signals from for those persons affected by cancer, the causes of the disease are the noise. far murkier. It’s easier to attribute the clinical state of the woman It is slow, with some projects, like the BC Generations Project, sitting in front of me to the roulette wheel of misfortune – some unlikely to yield meaningful insights for decades. But knowing that arbitrary genetic mutations – than to ponder what they might have these efforts are underway, and the skills and dedication of those done or what they might have been exposed to that ultimately behind such efforts, I have no excuse to be in denial. Answers are brought them to seek care from the BC Cancer Agency. There must on the way. be a reason that these cells followed an aberrant pathway. We all suspect that actual environmental factors – whether it’s Gavin C.E. Stuart, MD, FRCSC lifestyle, pollutants, or our domestic and social circumstances Vice Provost Health, UBC – likely overwhelm sheer randomness as a cause of disease. Dean, Faculty of Medicine L ETTER to the editoR: As a general surgeon involved in teaching surgical and family is providing the best patient care of which we are capable? practice residents, I read the sentence “patient safety requires Ironically, far from evolving from the “sink or swim” approach of limited work hours” with disbelief. There is no doubt that this Dr. Stuart’s grandfather, we are in danger of completing the circle message has been driven home to the residents. As an example, our and returning to these very days. current family practice residents spend a grand total of six weeks The conversion of medical training from a patient-centred doing the surgical part of their rotation but are severely restricted in approach to an almost unionised shift system where the lifestyle of the number of hours they can work. Working past midnight is a thing the practitioner takes centre stage has been depressing to observe. of the past, and when “academic” and “clinic” days are subtracted, The day will come when we have to rely on these graduates for our their exposure to clinical medicine is clearly woefully inadequate. own health care – not an encouraging prospect. On this basis, it is impossible that the three “pre-eminent principles” quoted in the article could ever be met. Clinical skills Gordon McLauchlan are acquired by exposure to patients, but when residents are not Clinical Instructor, Department of Surgery “allowed” (their words, not mine) to work outside their allotted General Surgeon hours, how can this be compatible with our primary aim, which Nanaimo FUBCOCUS MEDICINE ON: 4 ENVIRONMENTAL HEALTH UBC MEDICINE 5 Denise Daley and Andrew Sandford are investigating whether exposure to smoking leaves marks on children’s genes. PHoto CREDIT: MARTIN DEE BUILDING AN AIRTIGHT CASE DO ENVIRONMENTAL FACTORS CAUSE OR EXACERBATE ASTHMA? UBC sCientists searCh for evidenCe Chris Carlsten’s lab is relegated to the basement of a research “To get regulations passed and tighten standards, we need annex at Vancouver General Hospital, and that’s probably just multiple layers of scientific evidence,” says Dr. Carlsten, as well. an Associate Professor of Medicine and the Astra-Zeneca Chair of Occupational and Environmental Lung Disease in the Division First of all, there is the dull rumble of a diesel generator that of Respiratory Medicine. “While epidemiological patterns and reverberates throughout the room whenever an experiment is correlations can be very convincing, opponents can dismiss them, running. Then there is the smell – unnoticed by some, but distinctly claiming there is ‘unmeasured confounding.’ But if you can show detectable by others – of exhaust. it experimentally, and it matches the epidemiology, you’re creating But most of all, there is the polycarbonate-enclosed chamber, a stronger case that is harder to deny.” about the size of a standard bathroom. In Dr. Carlsten’s Building a stronger case for environmental modifications – experiments, research subjects sit and exercise in the chamber for that is the ultimate goal of researchers exploring the molecular two hours, inhaling the diluted and aged exhaust that simulates and physiological forces underpinning asthma, which affects the air quality along highways in such places as Beijing or at busy eight per cent of Canada’s population, including 486,000 children. ports of British Columbia. Some, like Dr. Carlsten, aspire to influence public policy. This somewhat unnerving set-up, one of only five such Denise Daley, on the other hand, envisions changes in pollution labs in the world, is key to Dr. Carlsten’s mission: individual behaviour. to establish a definitive link between diesel exhaust and asthma, the intermittent constriction of the lungs that causes chest An Assistant Professor in the Department of Medicine, Dr. Daley tightness, shortness of breath, and coughing. is leading a five-year study exploring whether early life exposure to cigarette smoke alters the expression of certain genes, and Although there is ample epidemiological evidence that diesel whether that increases susceptibility to asthma. And her research exhaust exacerbates the disease among people who already have tools, like Dr. Carlsten’s, are relegated to the basement. it, Dr. Carlsten is using his lab to understand exactly how that happens. One theory he is testing is that diesel exhaust triggers Stored in industrial-sized freezers at St. Paul’s Hospital are oxidative stress – a chain reaction of harmful chemical reactions thousands of frost-covered vials, containing blood and blood that disrupt the normal functioning of cells, particularly their components donated by parents and children in British Columbia membranes and DNA. and Manitoba over a 15-year period. The donors also provided information about their health, and in the case of the parents, their Demonstrating such a physiological proof of damage, he believes, smoking habits. is the only way to get tougher policies enacted. He refers to it as “biological plausibility.” Dr. Daley and her collaborators will use those samples to look for a type of genetic alteration known as methylation, in which a compound of carbon and hydrogen latches onto a part of the DNA. That bonding can dampen the expression of individual Chris Carlsten in the chamber that simulates levels of diesel exhaust in places like Beijing. PHoto CREDIT: DON ERHARdt Continued on next page FUBCOCUS MEDICINE ON: 6 ENVIRONMENTAL HEALTH Ryon Anas participates in an experiment in Chris Carlsten’s Air Pollution Exposure Laboratory. PHoto CREDIT: DON ERHARdt Continued from p. 5 genes, leading to significant changes in how cells develop “We’re not far from determining a child’s susceptibility,” she says. and function. “If we can identify what types of gene-environment interactions The connection between parents’ smoking and children’s asthma they are susceptible to, then, working with the parents, we might is already well established, but much like diesel exhaust, it’s be able to modify their environment.” a circumstantial case, based on statistics about patterns of Dr. Carlsten, while believing tobacco use has “no redeeming behaviour and illness. So even though smoking is a “risk factor” value” and therefore should be choked off as quickly as possible for asthma, it hasn’t proven to be a cause.