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The President's Report on British Columbia's Centre of Teaching and Research in the Health Sciences 1992

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I.     PROLOGUE:   FRONTIERS   OF  HUMAN  SCIENCE     1
II.     THE  FACULTY  OF  MEDICINE    5
III.     THE  FACULTY  OF  DENTISTRY     15
IV.     THE  FACULTY  OF   PHARMACEUTICAL  SCIENCES     26
V.     THE  CARE-GIVING  PROFESSIONS     32
The School of Nursing 32
The School of Rehabilitation Medicine 36
The School of Audiology and Speech Sciences 39
VI.     THE  FACULTY  OF   GRADUATE  STUDIES     42
VII.     THE   OFFICE  OF  THE   COORDINATOR  OF  HEALTH   SCIENCES     44
VIII.     THE  HEALTH   PROMOTERS  AND   POLICY  RESEARCHERS     46
Centre for Health Services and Policy Research 47
Institute of Health Promotion Research 48
IX.  THE ETHICS OF HEALTH CARE 49
X.  UBC IN THE HOSPITALS  51
at Vancouver General Hospital 52
UBC at St. Paul's Hospital 57
UBC at the British Columbia Cancer Agency 61
UBC at British Columbia's Childrens Hospital 63
UBC at University Hospital 65
XI.     CLINICS  AND   COMMUNITY  SERVICE     73
The Allan McGavin Sports Medicine Clinic 74
The UBC Movement Disorders Clink 75
Tropical Diseases Clinic and Infectious Disease Outpatient Clinic 76
Medical Genetics Services 76 XII.     BASIC  RESEARCH  IN  THE  HEALTH  SCIENCES     77
The Biotechnology Laboratory 80
TRIUMF 81
XIII.     HEALTH  SCIENCE  RESEARCH  IN NON-MEDICAL  FACULTIES    82
The Faculty of Agricultural Science,) 83
The Faculty of Applied Science 84
The Faculty of Arts 86
The Faculty of Commerce and Business Administration 90
The Faculty of Education 91
The Faculty of Science 93
XIV.     MAJOR  NATIONAL  RESEARCH   ENDEAVORS  -  UBC  LINKS     95
National Networks of Centred of Excellence 96
The Canadian Institute for Advanced Research 101
The Canadian HIV Trials Network 103
XV.     MAJOR  MEDICAL  RESEARCH   COUNCIL  FUNDING     104
XVI.     BIOMEDICAL  SPIN-OFF  COMPANIES     107
XVII.     SUPPORT  SERVICES  ON  CAMPUS     109
Woodward Medical Library 109
Student Health Service 110
Disability Resource Centre 112
First Nations Health Care Professions Program 113
Occupational Health and Safety 114
Biomedical Communications 115
XVIII.     FUND   RAISING  IN  THE  HEALTH   SCIENCES     117
XIX.     NEW  FRONTIERS   IN  THE   '90S     122 I. c/^o^c^ue.- 3faesi#fes& cf^jr&issrtasb c^/e^ce
In the summer of 1991, leading international SCIENTISTS IN THE FIELD OF OSTEOporosis attended a symposium at the
University of British Columbia to mark
the 30th anniversary of a medical discovery MADE ON OUR CAMPUS. PROFESSOR
Emeritus Harold Copp was present to
talk about his discovery of calcitonin, a
hormone that regulates the
blood level of calcium.
in its synthetic form, calcitonin is a powerful, non-addictive pain-killer, which is used
Pharmaceutical Sciences — young in
comparison to others on this continent
and overseas — have already achieved
international reputations and are poised
TO ACHIEVE RENOWN. We ARE CONFIDENT
that ubc will become the hub of a great
health-care and health-caring centre.
Such a centre will take advantage of
the best health-care system in
the world and the trail-blazing work of our researchers
to make British Columbia a
household word in the health
THROUGHOUT EUROPE AND JAPAN     dty^ a^inavAica-     SCIENCES. THERE IS NO REASON
FOR THE TREATMENT OF OSTEOPOROSIS AND OTHER BONE DISEASES. Worldwide sales are
two-thirds that of insulin,
approaching $1 billion.
Starting from scratch in 1950
without so much as a test tube in the
store room, dr. copp launched our
Department of Physiology as one of the
original departments in the new faculty
of Medicine. He set up offices and a
research laboratory in one of the infaMOUS Second World War huts, which
served as temporary buildings. there, 10
years later, he synthesized calcitonin.
That was three decades ago. Today, our
faculties of medicine, dentistry and
WHY THIS PROVINCE CANNOT HAVE
A CENTRE THAT IS INTERNATIONAL-
LY ADMIRED.
«*£ «w»»a^ cmef    ACADEMICALLY DRIVEN AND CLINICALLY FUELLED, IT WILL BE DEEPLY
AND INEXTRICABLY LINKED WITH
THE NEEDS OF THE IMMEDIATE COMMUNITY
AND THE ENTIRE PROVINCE; IT WILL EMBRACE
THE FINEST OF GENERAL AND SPECIALIZED
MEDICAL CARE; IT WILL OFFER SUPERB EDUCATION FOR PHYSICIANS AND OTHER HEALTHCARE PRACTITIONERS. AND IT WILL FOSTER
WORLD-CALIBRE RESEARCH IN THE HEALTH
SCIENCES, LEADING TO LIFE-SAVING MEDICAL
INTERVENTIONS, TO LIFE-ENHANCING CARE
OF THE DISABLED AND, IN THE LONG RUN, TO
AN UNDERSTANDING OF THE SOCIETAL AND w
environmental factors that determine
the health of our people.
As this document reveals in rich detail,
there is world-calibre research occurring now at this university. We are well
represented in the National Centres of
Excellence, in the prestigious group
and program awards of the Medical
Research Council of Canada, and in
awards made to individuals by the MRC,
the Natural Sciences and Engineering
Research Council, the National Cancer
Institute of Canada, Health and Welfare Canada, and the B.C. Health
Care Research Foundation.
Internationally, we participate in
the Human Frontiers of Science
Program, which brings together
the best researchers in the g7
nations. Some of our investigators ARE FUNDED BY THE NATIONAL
Institutes of Health in the
United States, while others, by participating on a peer-review board, direct
the nature of dental research in that
country. No other institution in this
province does as much health-sciences
research nor does it as well.
The university is mindful of its social
contract with the people of B.C. We are
FUNDED TO TRAIN HEALTH-CARE WORKERS,
AND WE DO THAT, RECOGNIZING HOW MANY
PROFESSIONALS ARE NEEDED AND WHERE
THEY   ARE   NEEDED.   WE   ARE   ACTIVELY
Jenvece
INVOLVED IN STUDIES OF PROVINCIAL MANPOWER requirements. Even though we
produce fewer than our per-capita share
of Canadian doctors, we plan no
increase in medical enrolments. the
community-responsive family physicians
we do train have had experience in rural
or remote areas and many are choosing
to practise there.
Furthermore, we provide an irreplaceable COMMUNITY SERVICE IN THE MANY CLINICS WE CREATE AND OPERATE.  THROUGH
THESE CLINICS, LOCATED IN ALL OF OUR AFFIL
IATED TEACHING HOSPITALS, THE
PEOPLE OF THE PROVINCE WITH
SPECIALIZED HEALTH PROBLEMS
OFTEN RECEIVE CARE BASED UPON
THE MOST ADVANCED RESEARCH,
INCLUDING REVOLUTIONARY SURGI-
tv#etea&        CAL TECHNIQUES AND LIFE-SAVING
DRUGS UNAVAILABLE TO THE AVERAGE PHYSICIAN.
WE ARE COMMITTED TO FINDING WAYS TO
REDUCE HEALTH-CARE COSTS. WE TEACH
ECONOMISTS, EPIDEMIOLOGISTS, SOCIOLOGISTS AND BIOSTATISTICIANS WHOSE RESEARCH IN HEALTH POLICY AND POPULATION
HEALTH EVALUATES CURRENT SERVICES AND
PRACTICES AND EXAMINES WAYS OF ENHANCING HEALTH OUTSIDE THE HEALTH-CARE SYSTEM. AT THE SAME TIME, UBC SCHOLARS IN
VARIOUS FIELDS SEEK AN UNDERSTANDING OF
THE RELATIONSHIP OF LIFESTYLE, ENVIRONMENT AND EVEN NATIONAL CHARACTER TO erwaicem-
ILLNESS. In order to bring together the
many disciplines required to assume
these tasks, we have created an institute
of Health Promotion Research and a
Centre for Health Services and Policy
Research, which are partly funded by
the provincial government. Our leadership in this area has been recognized by
the Canadian Institute for Advanced
Research, a private, non-profit corporation, WHICH HAS CREATED FIVE WORLD-SPANning research networks. the
Institute's Program in Popula
TION HEALTH, WHICH IS SEEKING TO Jeiemed-
DEVISE A BROADER INTELLECTUAL
FRAMEWORK FOR APPROPRIATE QUESTIONS ABOUT THE DETERMINANTS OF
HEALTH, IS LED BY A UBC HEALTH
ECONOMIST AND HAS THREE OTHER
UBC SCHOLARS ON A 17-MEMBER
TEAM.
The health-sciences research
radiating from ubc is a major
industry that supports the b.c.
economy. Our faculties of Medicine,
Dentistry, Pharmaceutical Sciences and
our School of Nursing generated nearly $45 million in sponsored research
FUNDS IN 1990-91 — roughly the same
amount the university allocated to
these areas. most of this research
money originates from sources outside
the province, and most of it is spent
INSIDE THE PROVINCE. It GOES PRIMARILY TO
pay the salaries of faculty, staff and
students. it is also used to buy materials
and equipment, with roughly half the
purchases being made in the province.
What is not generally understood is
that our research has been highly successful — and will continue to be — in
generating spin-off industries and ongoing employment. in the last decade
alone, seven b.c. biomedical companies,
born out of research at ubc, have created 117 jobs and now earn
multi-million-dollar revenues.
*«* The University's policies on
patent and licence acquisitions
and on the creation of spin-off
commercial companies are not
only a model for other institu-
/    tions but also should guide
artaf
future health-sciences research
in the province. a great medi-
— **■ &     cal-school complex will make
money for british columbia out
of its research.
What will it take to achieve such greatness?
It does not demand growth for
growth's sake. We do not aspire to
growth. Instead we will continue to
improve quality utilizing our existing
resources, facilities and relationships.
The great health-sciences centre
WE envision will come about through
collaboration, cooperation and multi- 9
DISCIPLINARY ENDEAVOR IN A WORD, SYNERGY. Such interaction must be coordinated, DIRECTED BY THOSE WHO KNOW HOW
TO CONDUCT AND REVIEW RESEARCH. TO
ENSURE UNIFORMLY HIGH AND FULLY COMPETITIVE STANDARDS, ALL RESEARCH IN THE
HEALTH SCIENCES IN THIS PROVINCE? -~
WHETHER ON OUR CAMPUS OR IN AN AFFILIATED TEACHING HOSPITAL — MUST BE SUBJECT
TO TRIED AND TESTED UBC
RESEARCH POLICIES AND TO
THE HIGHEST POSSIBLE LEVEL
OF PEER REVIEW.
MEDICAL SCIENCE FACES
FRESH CHALLENGES: OVER
THE NEXT 10 TO 20 YEARS,
ITS CONCERNS WILL INCREASINGLY BECOME ENVIRONMENTAL, SOCIAL AND ECONOMIC.
OUR HEALTH-CARE SYSTEMS
WILL DEMAND THE EXPERTISE OF EPIDEMIOLOGISTS,
SOCIOLOGISTS AND ECONOMISTS TO DEAL WITH SUCH
PROBLEMS AS CHANGING
PATTERNS OF HOSPITAL UTILIZATION, ENVIRONMENTALLY CAUSED CANCERS AND THE
AGING OF THE POPULATION. IN MANY AREAS
OF SOCIAL POLICY, WE NEED TO INCREASE
THE PARTICIPATION RATE, BUT THE BASIC
OBJECTIVE OF A SUCCESSFUL HEALTH-CARE
SYSTEM IS TO REDUCE THE PARTICIPATION
RATE BY KEEPING PEOPLE OUT OF INCREASINGLY EXPENSIVE HOSPITALS.
Dr. David W. Strangway
President, The University of British Columbia
Vancouver, BC, Canada
January, 1992
^^X£U,
the range of programs, the intellectual ferment, the inter-disciplinary cooperation to meet these challenges are
resident at ubc. only the university
of British Columbia has the base necessary FOR THE LEADERSHIP THAT WILL TAKE
this province to the frontiers of
human science, place it in the forefront of health-sciences research and
keep it there.
The recent report of
the British Columbia
Royal Commission on
Health Care and Costs,
entitled 'Closer to Home'
addresses the very important issues of health-care
delivery. They focus on
effective and efficient
approaches to making the
health-care system more
responsive to the needs
of the people of british
Columbia. It does not
address the significant
topics of teaching and research in the
health-care and the health-caring disciPLINES. This current report can, therefore, BE SEEN AS A COMPLEMENT TO THE IN-
depth report of the royal commission.
This report covers those dimensions of
the health-care system that were not
covered by the commission.
**% UBC     FACULTY    OF    MEDICINE     IS    EVERYWHERE LIKE    A    THREAD    WOVEN     INTO    Tt
EALTH-CARE     FABRIC     OF    THE     PROVINCE.     IT    WOULD     BE     IMPOS5I
ILE    TO    TEASE     IT    OUT
WITHOUT    UNRAVELLING    THE    CLOTH.    AND    YET,    AT    TIMES,    IT    IS
IARD    TO    DISTINGUISI
THIS    THREAD    FROM    OTHERS.
II £we 3wz€>£i6fp e^*ytfu>e€&e£sie
Would a visitor to UBC in 19SO not have chuckled to see its fledgling
Faculty of Medicine? The dean's office, for a time, was the walled-off end of a
corridor in the Physics Building. Neurosciences had launched a brain research
centre in a three-foot-wide passageway at the back of the Chemistry Building. And
the basic science departments were housed in huts, 24-feet-wide by 60-feet-long,
liberated from demobilized army camps around the province.
The first class — 60 students selected from 270 applicants
— registered the day after Labor Day for courses barely ready to
receive them. Slides to illustrate histology lectures, made by a
technician in Oxford and sent by 'way of the Panama Canal,
arrived just in time, but lectures in Physiology had to be
postponed for six weeks, while the department head borrowed
equipment from the University of Toronto and stocked laboratory
shelves that had been empty at the beginning of September.
Those 60 students — 57 of them from B.C.; 20 of them
World War II veterans — began their study of medicine three
years before Watson and Crick would construct the double
helix model of the DNA molecule. The age of molecular biology
had already begun when Canada's twelfth Faculty of Medicine
opened the doors of its huts.
There was irony in this late and humble start. A medical
faculty had been included as one of four in the 1890 act that
established the university, and an amending act in 1908 obliged
the university to provide degree work in medicine if it had the resources to do so.
The university's first president, Franklin Fairchild Wesbrook was a medical
graduate of the University of Manitoba. He had been dean of Medicine at the
University of Minnesota, where his school got an A from Abraham Flexner, whose
1910 report led to the closing of commercial diploma mills in the United States,
and also criticized American medical schools for their failure to appreciate the
great advances in the scientific basis of the discipline. Wesbrook was respected as
a medical scientist. At UBC, he founded and became head of a Department of
Bacteriology and Preventive Medicine. He began laboratory work in 1915 in close
association with the Vancouver General Hospital. But he didn't live to see a UBC
Faculty of Medicine.
In the 20s, even with Rockefeller Foundation money available for medical
education in Canada, the province simply couldn't get together on founding a
medical school. Vancouver doctors wanted UBC to start one, but Victoria doctors
didn't. The Liberal government was opposed to the university and wouldn't provide
9
Myron Weaver UBC's first dean
of Medicine (1950 - 1956) Ml
IP
funds to develop it. And UBC was involved in moving itself from its downtown
site, near the Vancouver General Hospital, 11 kilometres west to the still-forested
lands of Point Grey. Finally, even though the Rockefeller Foundation director of
medical education declared B.C. to be the best place for a strong medical school in
Western Canada, the Foundation's money went to the University of Alberta, which
had a partial three-year medical course already in place.
In the 30s, of course, there was no money. But in 1933 a Vancouver physician,
Dr. Alexander Monro, left the university its first legacy — $80,000 for the support
of medical research. In light of this, students organized a society and informed
President Leonard Klinck that they were beginning a drive for a medical faculty
with a hospital on campus. Dr. Klinck, faced with public talk of closure and annual
cuts in budget, could only laugh.
By 1935, an important contestant in the upcoming medical school debate, Dr.
Claude Dolman, had been hired from the Connaught Laboratories in Toronto to be
head of the Department of Bacteriology and Preventive Medicine. At UBC, Dr.
Dolman investigated undulant fever, botulism and staphylococcus infection, and
made plans with provincial public health authorities for an Institute of Preventive
Medicine, plans that were interrupted by the beginning of the Second World War.
During the war, courses such as Comparative Anatomy and Histology and a
refresher course for returning medical practitioners showed the university was able
to teach pre-medical subjects.
At the end of the war, a delegation representing the B.C. Medical Association
and the university petitioned the government for a medical school to train
physicians for the province's one million residents. B.C. students had to attend
medical schools elsewhere, and it was clear that places would not always be
available for them. In 1945, the legislature included $1,500,000 in the university's
capital grant to begin a medical faculty. The plan was to provide pre-clinical
instruction at UBC and clinical work at Vancouver General Hospital.
UBC President Norman MacKenzie, newly appointed from the University of
New Brunswick, wanted to have the first class enrolled by 1946. Instead, he would
spend the next two years negotiating the university's position against that of
doctors at Vancouver General Hospital who wanted to control medical education
and entry to their profession and who were arguing for a medical school in
buildings close to the hospital.
The university's position was established in a report written in 1946 by Dr.
Dolman. He surveyed 22 American and all 11 Canadian medical schools to
produce his Report on a Survey of Medical Education, a report that became the
blueprint for medical schools outside Canada. In it, he recommended that B.C.
settle for nothing less than a first-class medical school and that this school be
wholly on the university campus, with its own hospital to provide the necessary
beds for clinical teaching.
The long and divisive debate that followed focussed on location and cost.
Opponents of the university-hospital plan argued that it was an unnecessary
expense and not useful to the city because the campus was so far from downtown.
Supporters of the university scheme pointed out that VGH was in physical
disrepair and had a weak administration.
The turning point came when the government approved funds to upgrade
VGH. The plan called for a new 700-bed acute-care unit, which would free 400
existing beds for university teaching. President MacKenzie announced that the
university had overcome its objections to a split school. The search for a dean began in 1948. It concluded the following year with the appointment of Dr. Myron
Weaver, who was Assistant Dean of the medical school at the University of
Minnesota, the same school that had supplied UBC's first president. The first class
was enrolled in September, 1950.
It's on the UBC campus, where most of the basic science departments have
their offices and laboratories, and where the office of the dean of Medicine is
located. It's 800 air kilometres north in a family doctor's office in Queen Charlotte
City. It's in Prince George where a faculty member of the Department of
Psychiatry conducts his academic activities.
It's at Vancouver General Hospital:  in the Eye  Care  Centre, the  British
Columbia Cancer Agency and the Cancer Research Centre, and
the Jack Bell Research Centre.
It's at  St.  Paul's  Hospital:  in the  Pulmonary Research rj£rVNS OF MEQ/
Laboratory,  and the  Canadian  HIV Trials  Network,  which \^ 1950-1955 £
operates in an office building on Denman Street. MYRON WEAVER
1 956-1 9S9
It's on the  Shaughnessy site at Children's Hospital,  Grace john w. Patterson
Hospital,  G. F. Strong Rehabilitation Centre and the Children's 1959-1972
... ^ ,      _ JOHN MCCREARY
Variety Research Centre.
1972-1977
It's at the University Hospital, which has three sites  —  the david v. bates
Point   Grey   campus,   Shaughnessy   and   the   George   Derby 1977-1990
^ r o ./ a ./ WILLIAM WEBBER
intermediate care centre. .„„„
1990-
It's in the offices of 1,400 clinical faculty preceptors who, martin j. hollenberg
while they practise medicine, teach undergraduates and residents.
The UBC Faculty of Medicine is everywhere — like a thread
woven into the health-care fabric of the province. It would be
impossible to tease it out without unravelling the cloth. And yet,
at times, it is hard to distinguish this thread from others.
Patients who are referred to an ophthalmologist at the Eye Care Centre at
Vancouver General Hospital may not realize that they are also encountering one
strand of the Faculty of Medicine. The centre, owned and operated by VGH,
incorporates clinical space where patients with highly specialized eye-care
problems are seen. It also contains the office of the head of UBC's Department
of Ophthalmology, offices of faculty members, and university research and
teaching facilities.
Another example of the interweaving of university and hospital is the
Children's Variety Research Centre on the Shaughnessy site. Built jointly by B.C.'s
Children's Hospital, the Variety Club and UBC in 1985, the centre is a research
facility maintained and operated by UBC. It is explicitly part of the UBC campus.
Its director — Dr. Aubrey Tingle — is a Professor in Pediatrics and Pathology at
the university and Director of Research for Children's Hospital. "All the people on
this site view themselves as having parallel reporting relationships. They view the
university as their primary relationship for the research side, and the hospital for
the clinical side.  The hospital has put money into infrastructure support. The THI    CLINICAL
university maintains and operates the centre. The hospital has put money into
supporting career scientists. The university has put money into supporting
graduate students."
To teach medicine, UBC is as dependent today on resources controlled by
hospitals as it was in 1950, But the atmosphere has changed. "We are doing
wonderful things in collaboration with the hospitals," says Dr. William Webber,
who recently stepped down as Dean of Medicine and is now an Associate Vice-
President, Academic. "I have been pleased at the hospital developments and at the
relationships between the faculty and the individual teaching hospitals. The
hospitals have developed not only clinically but have academic aspirations to want
to have heads of university departments at their institution."
The Children's Variety Research Centre was just one construction task that
occupied Dr. Webber from 1977 to 1990, the period he spent as the faculty's fifth
dean.  That was  a time  of physical and  academic growth in which the  dean
became as expert about copper pipes as about capillaries.  On the Point Grey
campus, a 240-bed acute-care unit was added to a 60-bed psychiatric unit and a
300-bed extended care unit.   (The three units are now one entity  —   University
Hospital —UBC Site.)   B.C.'s  Children's  Hospital  and  Grace  Hospital were
constructed.  The  B.C.   Cancer Agency was  rebuilt and  the  first phases  of
redevelopments at St.  Paul's and Vancouver General were completed while  Dr.
Webber was  dean.   "Teaching space was  incorporated  in these
buildings and we negotiated and collaborated with the hospitals to
do that/' says  Dr.  Webber.  "That physical growth was  needed to
DEPARTMENTS _      _ r     ^ a
allow the clinical and academic development that has gone on."
*"" LOCATEO And so, the visitor who in 4950 found the Faculty of Medicine at
wholly or the end of corridors and in a quadrangle of huts would need an
substantially airplane and many days to see what has been created in 41 years. On
campus alone, he'd tour the Health Sciences Centre where faculty
departments are located in the  Friedman,   Copp  and Wesbrook
buildings, the Instructional Resources Centre, Medical Block C, and
University Hospital. Other parts of the faculty are located in the Mather Building,
-which sits somewhat apart from the Health Sciences Centre.
In   1 950   the   Faculty   had   departments   of Anatomy,  Biochemistry,
Physiology, Medicine, Obstetrics and Gynecology, Pediatrics, Pathology, Surgery
and Pharmacology. It -was unique in having a Department of Neurological Research
— the first one in Canada and likely in North America, which in a 1980s
restructuring became a division of the Department of Psychiatry.
Today there are 17 departments. Anatomy, Biochemistry and Physiology are
the cornerstone basic-science departments. Medical Genetics, Pathology, and
Pharmacology and Therapeutics function at the interface between basic and applied
science. The other 11 — Anesthesiology, Family Practice, Health Care and
Epidemiology, Medicine, Obstetrics and Gynecology, Ophthalmology, Orthopedics,
Pediatrics, Psychiatry, Radiology and Surgery — are clinical departments.
The clinical departments are located wholly or substantially in hospitals,
where university department or division heads might also administer the
corresponding hospital department or division. For example, the largest academic
department in the faculty (and one of the largest at the university) is the
Department of Medicine, which has 78 full-time faculty,  eight part-time faculty
IN   HOSPITALS members, and 194 clinical appointees in its 13 formal specialty divisions. Only two
of its full-time faculty members are physically located on campus. The others can
be found in 17 locations. It conducts academic activities at the British Columbia
Cancer Agency, St. Paul's Hospital, Vancouver General Hospital and the three sites
of University Hospital. Faculty members in this department are also heads of the
Departments of Medicine at St. Paul's, Vancouver General and University Hospital
— Shaughnessy Site.
Faculty members are either full-time, part-time or clinical. In 1990-1991, there
-were 399 full-time faculty members and 1,500 part-time and clinical faculty.
Clinical appointees, who are private-practice physicians, undertake teaching,
research and administrative duties as well as academic-related patient care. About
20 per cent of the physicians in the province are involved in some capacity with the
faculty, which depends upon their good-will.
The faculty also has a division of Continuing Medical Education and a Division
of the History of Medicine and Science. There are two professional schools  — the
School of Audiology and Speech Sciences, -which trains audiologists and speech
therapists,  and the
School of Rehabilitation Medicine, -which
trains physiotherapists    and    occupational therapists.
The site of the original UBC campus — the huts at Fairview.
Our intrepid visitor,
having found the
Faculty of Medicine
here, there and everywhere, will seek in
vain for the school
of medicine. Dr.
Webber says, "The
layperson tends to
think of the Faculty
of Medicine as the medical school, but it's only a portion of the faculty, accounting
for about a third of the teaching. There isn't an entity called the school of
medicine, but one could think of that part of the faculty that produces doctors as
the medical school."
This non-entity is the only school of medicine in the province. It has
produced about 23 per cent of B.C.'s 6,000 physicians. Having begun -with
classes of 60 and stepped up to 80, the faculty now enrols 120 medical students
each year, a number that is under the Canadian average but allows professors to
get to know their students as individuals. There is no plan to increase
enrolment. "If we -were producing doctors at the Canadian average," says Dr.
Webber, "we -would have over 200 places. I -would think that -when you get
somewhere around 160 there is probably a good argument for starting another
medical school."
9 The Faculty offers a four-year program designed to produce physicians
who will become general practitioners, specialists and, increasingly it is hoped,
clinical scientists.
Most undergraduates intend to be family physicians. In some classes, more
than two-thirds of graduates will choose general practice. Unlike their
predecessors, these doctors will have spent less time being taught in lectures and
more time learning alone or in clinical situations. The classic post-Flexnarian
model — two years of basic science and two years of clinical training — has been
replaced by a much more student-centred type of instruction. Modifications begun
at UBC in the 70s have decreased lecture hall hours by as much as half,
substituting small-group teaching and independent learning.
In order to make basic-science knowledge relevant, students are introduced to
real or simulated patients and to clinical scenarios in their first month and continue
that exposure to patients throughout their four years. They are given many
opportunities to experience the practice of medicine first hand. In the summer
between their second and third year, they may spend six weeks with a doctor who
practises in a rural area of the province. Ninety out of the class of 120 choose this
option.  A fourth-year elective gives  students the  chance to  spend six weeks  as
clinical clerks in a third-world country. As many as one quarter of
fourth-year students choose this option, and UBC medical students
have recently undertaken to raise funds so that more can do so.
Throughout their four years, UBC medical students are required
>pportunities to take courses that reflect the complexities and stresses  of modern
ro EXPER|ENCE medicine:   Biomedical  Ethics,  Medicine  and the  Law,   Drug and
Alcohol Abuse and Behavioral Sciences in Medicine. Noting that the
THE    po acticE
general practitioner of the year 2000 will need a host of skills not
m of medicine strictly medical in nature,  Dr.  Roland Lauener,  associate dean of
o first hand. Undergraduate Education,  says,  "We are looking at doctors who will
be  counsellors  and  communicators,  who will  have  the  ability to
practise independently away from an urban area,  who will be able to  critically
appraise what they are doing and what others are telling them to do, who will have
a greater understanding  of medical  economics  and who will understand that
u learning in medicine does not stop at the time of graduation."
EY   ARI
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After receiving their MlD degrees, graduates are not qualified to practise
until they have completed a one-year (soon to be two-year) internship in an
accredited hospital. This may be done as a rotating internship, as an internship
leading to specialty qualification, or as the first year of two years' training in
Family Practice.
The majority of UBC medical graduates enter Family Practice. By 1993, two
years of pre-licensure training will be the norm for family doctors across Canada.
UBC's two-year family residency program, an option that has been available for some
time, will need to double its capacity. Dr. Carol Herbert, head of the Department of
Family Practice, explains that the program seeks to train professionals who can
respond to the needs of their communities, whether that community is urban, rural or
remote. "We are publicly funded to train individuals in the health sciences to do the
job that is required in the place where they are required." The department looks with
favor upon those who come from rural communities or whose previous activities have Each year, about
120 new students
are admitted into
UBC's Faculty of
Medicine. Seventeen
departments provide
training for B. C s
future physicians —
among them,
Anatomy is one
of the cornerstone
basic-science
9
departments. demonstrated a grounding in the community. "To me," she says, "it is basic that the
school has a social contract which has to do with providing new knowledge, but also
of educating people to attend to community needs."
The faculty offers 47 medical, surgical and laboratory residency programs that
conform to the requirements of the Royal College of Physicians and Surgeons of
Canada for the training of specialists.
In Masters and PhD programs administered by faculty departments, it had 299
students registered in the 1991-92 academic year. Of note among these programs are
a newly approved MSc and PhD in Medical Genetics and the only departmental
Obstetrics and Gynecology graduate program in the country. In addition, there -were
120 post-doctoral or clinical research fellows associated -with faculty investigators.
■n
Of   the   more   than   $107   million  in grants and contracts awarded UBC
researchers in 1990-91, the Faculty of Medicine received close to 37 per cent, -with
the Department of Medicine, funded to the amount of $9.6 million, leading all other
departments in the university. Within the faculty, seven other departments received
more    than    $2    million:    Biochemistry,    Health    Care    and
Epidemiology, Medical Genetics,  Ophthalmology,  Pathology,
Psychiatry and Pediatrics. This funding is for research located on
e£^k° ^l\r campus, and in the hospitals and research centres. Of the 399 full-
1985-86 time faculty members, 253 receive research funding.
$22, 34,1  a The funding sources are: Medical Research Council, Natural
1 986-87
$24,159,868 Sciences and Engineering Research Council,  National Cancer
1987-88 Institute of Canada,  B.C.  Heart Foundation,  Health & Welfare
$26 929 301
Canada, B.C. Health Care Research Foundation, and industry.
1988-89
$29,528,588
1989-90
$34,174,595
.__-_, Experimental   Medicine   is   the   study  of the pathogenesis
1990-91 r D
$39,475,079 and treatment of disease. The emphasis of this graduate program is
training in medical research. It allows students to -work towards
an MSc or PhD with investigators in one of seven divisions -within
the Department of Medicine in the Faculty of Medicine:
Cardiology, Gastroenterology, Infectious Diseases, Molecular Medicine,
Nephrology, Neurology and Respiratory Medicine. The objectives of the program
include developing the ability to design experiments according to scientific
standards and the ability to read scientific literature critically. Dr. Gary Quamme,
Department of Medicine, is the director. In 1991-92, nine MSc and 10 PhD
candidates -were enrolled.
UBC's Faculty of Medicine began its fifth decade under a new dean.
Dr. Martin J. Hollenberg, a neuroscientist, -was Associate Dean of Research in the
Faculty of Medicine at the University of Toronto when he -was invited to lead the
faculty. Dr. Hollenberg accepted the assignment knowing of UBC's strengths in
teaching and research. "We have an exceptionally good curriculum for medical
students. It's just been revised; it's up to date and it's evolving well. As for
research — in lung disease, this is the Mecca in Canada. In hematology, -we are
close to the best. We have marvellous research in ophthalmology, in genetics, in
infectious diseases  and in  epidemiology,  and -we have  excellent molecular biological research going on here.  In fact,  I think we have a few people -who are
headed for a Nobel prize."
The faculty's strength in research stems in part from its immersion in a great
university where inter-disciplinary collaborations abound and are encouraged.
Medical research at UBC draws on and is accelerated by the basic-science
expertise in such departments as Chemistry, Microbiology, Physics and Zoology.
Its pure-science side is balanced by the many opportunities to apply and do
research in clinical settings and by the willingness of its teaching hospitals to
cooperate -with the faculty in the development of research. Commenting that
medical research need no longer be constrained by departmental, faculty or even
university boundaries, Dean Hollenberg envisages UBC-directed medical
research increasing its important contribution to the national endeavor.
Although it has the fifth-highest total enrolment in the country, it actually
offers fewer undergraduate positions on a per-capita basis than the
other 15 schools. Nearly 600 applicants compete each year for 120
first-year vacancies, and many qualified B.C. applicants are forced
to seek their medical education elsewhere in Canada or
internationally. Nevertheless, the faculty has no desire to increase
the number of undergraduate placements. Instead, in light of the
rising costs of health care and the increasing complexity of medical
services, it believes its obligation to the province is to produce
physicians versed in moral and ethical issues, concerned about cost-
efficiency and effectiveness, and -willing to practise in remote and
rural areas. In order to encourage young students to pursue a
scientific career, it has proposed a specialized stream within the
120 first-year placements for the aspiring clinician-scientist — the
doctor -who combines research with patient care.
In the past year, the faculty has outlined its plan to establish
one of the -world's leading medical research enterprises in Canada.
Already, the faculty attracts $39 million in direct research grants.
Its total Medical Research Council support is exceeded only by the
amounts awarded the much larger schools at the University of
Toronto, the University of Montreal and McGill.
"The faculty," Dean Hollenberg says,  "-will be developing a
very ambitious  plan  over the  next couple  of years which will
emphasize several key areas in research. We are looking to build on
our current strengths and develop them into internationally famous  centres  or
programs or institutes that will bring international recognition to the place as a
medical centre."
Medicine 2000, a document produced by the faculty in 1991, describes research
proposals derived from departmental programs already in place:
OF   THE    MORE    THAN
$107   MILLION
IN    GRANTS   AND
CONTRACTS   AWARDED
UBC    RESEARCHERS
IN     1990-91,   THE
FACULTY   OF    MEDICINE
RECEIVED    CLOSE    TO
37   PER   CENT,   WITH
THE    DEPARTMENT   OF
MEDICINE,    FUNDED
TO   THE    AMOUNT   OF
$9.A   MILLION,    LEADING
ALL   OTHER
DEPARTMENTS    IN
THE   UNIVERSITY.
> A   CENTRE   FOR   PREDICTIVE   AND   PREVENTIVE   MEDICINE   TO   SCREEN   FOR   GENETIC
SUSCEPTIBILITY   TO   DISEASES   AND  TO   PREVENT  OR   DELAY  THEIR   ONSET.
> A   CENTRE   FOR   TRANSPLANTATION   BIOLOGY   TO   STUDY   THE   IMMUNE   SYSTEM
AND   TO   IMPROVE   ORGAN   AND   TISSUE   TRANSPLANTS.
THE   INSTITUTE   FOR   CHILD,   MOTHER   AND   YOUTH   STUDIES   TO   STUDY
DISORDERS   THAT   AFFECT   MOTHER   AND   CHILD   IN   THE   PERINATAL   PERIOD   AND
DISORDERS   THAT   AFFECT   INFANTS   AND   YOUTHS. • The Centre of Excellence in Cancer Biology to develop diagnostic
and treatment procedures based on gene transfer and cell-
targeting procedures.
• The Brain research Centre to study, diagnose and treat
NEUROLOGICAL   DISEASES.
• The Pulmonary Research Centre to investigate common pulmonary
AND   CARDIOPULMONARY   DISEASES,   SEEKING   NEW   METHODS   FOR   THEIR
prevention and treatment.
• The Clinical Trials Facility to provide early access for British
Columbians to new drugs, to select cost-effective drugs, and to
train professionals skilled in evaluating drug information so that
they can guide rational drug therapy.
• a centre for health care evaluation to carry out scientific
research on current and new methods of health-care delivery, on
new and existing technologies, and on proposed drugs and
procedures.
• The Discipline development Program to assure that faculty
RESEARCH   GROWS   RAPIDLY   WITHIN   EXISTING   DEPARTMENTS,   DISCIPLINES
AND   SCHOOLS.
The Faculty has set a course towards the year 2000, guided by its social
contract with the people of B.C. Reacting to the realities of medical practice in a
province whose geography keeps many people distant from the major referral
centres, in a time when expensive high-tech diagnostic and treatment procedures
^^ threaten to overwhelm an already burdened medical-care system, the faculty is
111 training doctors who understand ethical and cost-management issues, who are
advocates of preventive medicine and health promotion, who are able to participate
in  clinical  research,  who  are  familiar with  community services  and who  are
UJ
E enthusiastic about practising in remote and rural areas.
Major funds in support of these objectives have already been raised through
the university's World of Opportunity campaign. There are four endowed chairs in
support of the Brain Research Centre, as well as chairs in areas such as Cardiology,
a ecLiaxrics, oursrery, xvi.eo-icine, £\nesxnesia, jtv.neuroetoiOcy, £\x\~jo ana
Ophthalmology. Details of these generous gifts from individuals and organizations
are outlined later in this report, including recognition of the key role played by the
u B.C. Government's matching program. •
U
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< WITH THE FACULTY OF MEDICINE LAUNCHED IN 19SO, THE PUSH FOR A FACULTY OF
DENTISTRY B E G A N . THE PROCESS WAS LrNGIIIY BUT NOWIEFRE ISI E A R AS
CONTBOVERSIAL.
Dentists in the province were keen to have a faculty at UBC. Since 1882
when the first Dental Act was proclaimed, British Columbians had been trained in
other provinces or in the U.S. Those who returned to practise in their native
province had been forced to organize their own form ol continuing education to
keep up to date. For years, they had held study clubs, sometimes meeting in
practitioners' offices where they might see visiting specialists
demonstrate new techniques. Increasingly, however, they hoped
for a faculty to provide continuing education.
The university wanted a faculty. Two committees on
dental education, one in 1952 and another in 1954, agreed that
one should be established, and Senate had concurred. The
provincial government gave funds so that the university could
employ a consultant in dental education. Dr. John Barloot
Macdonald, a young academic who was chair o( the Division of
Dental Research at the University of Toronto, began his
survey in 1955. His thorough Prospectus on Dental Education was
widely admired. Following Dr. Macdonald's report, the Board
ot Governors recommended the establishment of the faculty,
but the provincial government would not provide funds,
having perhaps paid heed to Dr. Macdonald's opening
sentence: "A clear distinction needs to be drawn between need
for dental services and demand for services ... the need for
dental treatment is virtually universal. That the demand for
treatment does not approach the need is natural.
In 1961, the university asked Dr. Macdonald, then in charge of a research
institute at Harvard and a candidate for the preside ncv of UBC, to revise his
report "in the light ol anv significant events bearing on problems of dental
education which might nave transpired in the past six years." He pointed out
several significant events — one being the fact that the ratio of dentists in the
rural areas of B.C. had worsened from one for every 5,500 persons to one for
every 9,500. He then summarized his conclusions in simple declarative sentences,
as if drilling home his points: "The need for a Faculty ol Dentistry at the
University of British Columbia is more urgent than it was in 1955. The ratio (of
dentists to population) in British Columbia is already as bad as predicted for ll)7().
A dean should be appointed during the 1961-62 academic year. The first class
should graduate in   1967."
Dr. Macdonald's timetable wasn't perfectly adhered to. On January 25, 1962,
in a throne speech in Victoria, it was announced that the legislature would be asked
to authorize  funds to establish  the  faculty.  A dean  was appointed  in   1962.   Fight
9
Dr. S. Wah Leung, the first dean of the Faculty
of Dentistry at UBC. He was appointed in 196 J
and remained dean for 15 years. students, who -were enrolled in  1964,  received their degrees in  1968   —  in the
presence of UBC's fourth president, John Barfoot Macdonald.
The first dean of dentistry was the first Chinese person appointed a dean at
any Canadian university. Ironically, Dr. S.Wah Leung returned to a country where
he had been unable to practise dentistry because of his race. Born in China,
educated at UBC, McGill and the University of Rochester, Dr. Leung had
established an academic career in the United States, -where he was chair of the
Department of Physiology in the School of Dentistry at the University of
Pittsburgh. He conducted research in the biochemistry of saliva and the mechanism
of dental calculus formation. When the invitation came from UBC, he had been at
the University of California at Los Angeles for a year.
Dr. Leung recruited faculty and oversaw the construction of a building, -which
began in 1965. It should surprise no one familiar with UBC history that the Faculty
of Dentistry had opened for business in a temporary hut in an orchard on the
campus. The building contained a tiny lecture room, a laboratory and offices and
research space for a few faculty. When it came time to set up a clinic for the
patients who were to be treated by the first dental class, two large commercial
trailers, bolted together, joined the hut in the orchard. These temporary facilities
were abandoned in September, 1967, when the faculty moved into its present home
— the John Barfoot Macdonald Building.
The training of dentists wasn't the only mandate of the new
faculty. In his first report, Dr. Macdonald had discussed the need for
hygienists to work -with dentists, improving their services and
lowering the cost of dental care. UBC's two-year program of dental
hygiene enrolled its first cla.ss of 20 in 1968. In 1970, the first
graduates placed in the top five per cent in American National Board
examinations, a feat that was repeated each year thereafter. In 1986,
during a period of financial restraint, this successful program was
transferred to Vancouver Vocational Institute (now Vancouver
Community College), where its high standards have been maintained.
Dental students today do a rotation at the institute learning to
integrate their -work with that of a hygienist, and senior hygienists have
contributed their services to the faculty's free summer clinic for children.
After 15 years, Dean Leung stepped down. His successor was Dr. George
Beagrie, whose ambition was to surmount the widespread focus on dental training
at universities in order to provide a profound education for dentists. In his 10 years
as dean, the faculty added several academic programs: specialty training in
periodontics, an MSc in dental sciences, a doctorate in oral biology, and a
continuing education program in local anesthesia for graduate dental hygienists. It
launched several initiatives: an oral pathology biopsy service, which today serves
the entire country; a general practice residency program, now operating in four
university-affiliated hospitals; and a dental clinic in the extended care unit of
University Hospital —UBC site. It restructured itself from the original six
departments to the current three: Clinical Dental Sciences, Oral Biology, and Oral
Medical and Surgical Sciences.
Dean Emeritus Beagrie has recently been made an honorary member of the
American Dental Association, an honor conferred on those who have made
outstanding contributions to the advancement of the art and science of dentistry.
Deeply involved in international dental health, Dr. Beagrie chaired the Federation
Dentaire Internationale Commission on Dental Education and Practice and was a
THE   FIRST   DEAN
OF   DENTISTRY
WAS   THE   FIRST
CHINESE   PERSON
APPOINTED
A   DEAN   AT
ANY   CANADIAN
UNIVERSITY member of a World Health Organization Expert Advisory Panel on Oral Health.
The faculty's current dean, Dr. Paul Robertson was appointed in 1988. He
came to UBC from the University of California, San Francisco, where he was a
professor of Stomatology (the study of the shape, structure, function and diseases
of the oral cavity). He completed graduate training in experimental pathology and
certification in periodontology at the University of Alabama. Six months after
Dean Robertson assumed office, the faculty's teaching, research and patient-care
programs were reviewed by the Council on Education and Accreditation of the
Canadian Dental Association. It reported, "The program in dentistry at the
University of British Columbia is a mature educational program with many
strengths." The council recommended full approval of both the undergraduate and
periodontal postgraduate programs for a period of seven years.
Today, the faculty has 36 full-time faculty members and 112 clinical faculty.
For the degree Doctor of Dental Medicine, it admits a class of 40 and graduates a
number equal to about half the dentists who retire in the province every year.
Although the province could accommodate more made-in-B.C. dentists, the faculty,
taking into account the size of its physical plant, does not plan to
increase its undergraduate class.
In the PhD program in Oral Biology, begun in 1986, faculty now
supervise 12 or 13 candidates, while there are seven places in the MSc
(Dental Sciences) program. Post-graduate specialty training is offered
in periodontics, oral medicine, oral pathology and oral radiology, and
seven hospital residency positions are available in a one-year program.
PERFORMANCE
TRAINING
BEOINS    IN    Tl
ST   YEAI
IN   THE   SIMLAB,
tr^Uf^e^
A   TEACHING.
INIT,   WHICI
ONE    OF    ONLY
TWO    INSTALLED
9
IN   NORTE
Because   no   internship  or   residency  experience is required to
enter  general practice  in the  province,  the  faculty must prepare
graduates who have a high degree of technical skill as well as a sound
background in the biological sciences.  The four-year DMD program
comprises 4,100 hours of didactic and clinical instruction. About 80 per
cent of the program is taught by Dentistry faculty and a substantial proportion of
the clinical instruction depends upon part-time faculty members.
Dental students study the same basic sciences as medical students and take
many of those courses with them for the first two years. But in the final two
years, dental students concentrate on acquiring the unique clinical skills
necessary in the profession.
Performance training begins in the first year in the SIMLAB, a teaching unit,
which is one of only two installed in North American dentistry schools. The
SIMLAB setup provides each student with an adjustable stool, instrument tray, air
suction, drill, overhead light and a permanently gape-mouthed mannequin on
which to practise.
For the past two years, Dr. Lance Rucker, chair of the Operative Dentistry
Division, has used peak performance training to enhance the efficiency of his
students in achieving the levels of precision necessary to work in the mouth. "We
are talking about the use of dental drills and hand instruments inside the mouth
with better than one-millimetre accuracy, using mirrors no less," he says. "Peak
AMERICAN
DENTISTRY
SCHOOLS. ^■J
Q
u.
O
performance training teaches people how to apply visualization and imagery to
achieve their highest levels of physical, emotional and mental performance."
Studies of students using the technique have shown a five-per-cent improvement in
measurable performance.
In their third and fourth years, students transfer the techniques practised on
mannequins to real patients, -whom they treat in the faculty's clinic in the
Macdonald Building — the largest outpatient clinic in the province. With 80 chairs,
filled five days a week, nine and a half months a year, the clinic is a formidable
operation. It has x-ray facilities; units for developing radiographic film;
laboratories -where bridge-work and dentures are designed and fabricated; and a
dispensary -where one endless chore is the sterilizing of instrument kits.
Necessary in the training of students, the large clinic is also a community
service, providing dental care at about one-third the fee recommended by the
College of Dental Surgeons. During the university term, students treat adults,
selected because their requirements will provide experience in the various dental
specialties. They also treat children, selected -within the school system on the basis
of treatment and financial needs, and others whose
parents have applied for service. Twice a -week in
first term and once a -week in second term,
40 children under 15 come by bus from localities in
the Greater Vancouver region. Dr. Penelope
Leggott, who has organized the pediatric dentistry
teaching program, explains that while the children's
needs come first, a goal is to make sure that
undergraduates get experience with various dental
problems. "Students here get the best clinical
pediatric dental education in North America."
An ambitious extension of the academic
program is a Summer Dental Clinic, begun in 1974,
and operating now for six weeks in May and June.
Funded by the provincial government, the clinic
provides free treatment for about 700 school-age
children in Vancouver, Richmond and Burnaby and
from Health Units in Surrey, New Westminster/
Coquitlam and Maple Ridge. Twenty-four students,
who have just finished the third-year program and -will be promoted to fourth year,
take part in the clinic, supervised by faculty members in the Division of Pediatric
Dentistry. Most children whose treatment cannot be completed in the summer return
in the fall and spring clinic sessions — a service for -which they are not charged.
This university-based community service is organized and directed by faculty
from the Division of Preventive and Community Dentistry. In six -weeks, it
provides services estimated at more than $200,000, and chairside education of
inestimable value.
The temporary huts (1964) which first housed the Faculty of
Dentistry's teaching clinical facilities
<^fecuz&M- <~JeteJVC&fok dne Z^ewv/ruewJfa,
British Columbia Oral Pathology Biopsy service
An initiative of the Faculty of Dentistry, the Oral Pathology Biopsy Service is funded through and operated from University Hospital-Shaughnessy Site. Dr.
Robert Priddy, Assistant Professor in the Department of Oral Medical and Surgical
Sciences, started this mail-order diagnostic service in 1980. It is available to
health-care professionals in the province, and is used primarily by dentists or
maxillofacial surgeons, and sometimes by dermatologists and ear, nose and throat
specialists. Its purpose is to microscopically review abnormal tissues from mouths
and jaws. Dr. Priddy points out that the service is enhanced by the availability of
both hospital diagnostic tests and university sophistication. Recently, he turned to
colleagues in the Physics Department at UBC to determine whether metal used in a
jaw surgery had been defective. Dr. Priddy says, "It's a unique service. We have
material coming to us from all over B.C. A dentist in an isolated community can
remove something from a patient's mouth, send it to us in the mail, and a week or
so later have a report. That is quite a sophisticated tertiary diagnostic service."
Approximately 2,800 biopsies are performed in a year.
National sterilizer monitoring service
The Department of Oral Biology's sterilizer monitoring service, which for
some time was limited to dentists' offices in B.C., has just gone national, having
been chosen by the Canadian Dental Association as a member service. Its purpose
is to test the efficiency of office autoclaves — pressurized-steam
devices used to sterilize instruments. The department sends
subscribers a strip of paper bearing spores of a hardy organism. If it
is killed by the office's sterilizing process, disease-causing microorganisms would also be killed. Approximately one-third of the
dentists in the province use this-service.
LEUNG,   A
DECISION   WAS
MADE   TO   FOCUS
ON    CRANIOFACIAL
BIOLOGY   AND
PERIODONTAL
MICROBIOLOGY.
Hospital dental Clinics
The Department of Oral Medical and Surgical Sciences is
responsible for the development of hospital dentistry and the related
disciplines of oral medicine, oral pathology, oral radiology and oral
maxillofacial (or upper jaw) surgery. It has developed departments in
five locations in university-affiliated hospitals. As well as teaching at the
undergraduate and graduate levels, these departments provide specialized dental
care for accident victims, children, cancer patients, and people v/ith facial pain,
Hepatitis B and disorders of the temporomandibular joint, which connects the
lower jaw bone to the skull. Their facilities include an operating suite fully
equipped for major oral and maxillofacial surgery and operatories for inpatient and
outpatient services.
RESEARCH
Having begun dental research when it was young and small, the faculty
made a commitment to being great in a few areas and good in the rest. Under Dean
Leung, a decision -was made to focus on craniofacial biology and periodontal
microbiology. The present dean supports that early choice. "I think we've
continued to make major contributions to science and to health in the areas we
deem the most important," says Dr. Robertson. "At the moment, -we consider
infectious diseases — infections that affect the mouth and other parts of the body
— to be a major problem in society and -we have chosen to concentrate there. And
we've decided that the development of the head, face, eyes and ears and the things
in the environment that cause them to develop abnormally are a critical problem." w
By the time of its 25th anniversary in 1987, the faculty had a strong
international reputation in research and its grant-funding relative to size was
among the highest in Canadian dental faculties. It had hosted two international
research symposia and had organized the North-west section of the International
Association for Dental Research, holding periodic meetings of the group. Dean
Beagrie was the past president of the International Association for Dental
Research, and other faculty members had served as its officers. In that
association's programs, the faculty was cited as having one of the highest
participation rates.
In Canada, faculty members have served on the Medical Research Council of
Canada, the Medical Research Council Fellowship Committee and the research
committees of the Canadian Association for Dental Research and the Association of
Canadian Faculties of Dentistry.
Today, the dean chairs the Special Grants Review Committee of the National
Institute for Dental Research in the  United States, while Dr. Alan Hannam,
Professor of Oral Biology, chairs the Dental Sciences Peer-Review Committee of
the Medical Research Council. With the participation of other UBC professors on
these  committees,  the faculty has a major influence  on the
direction of dental research in North America.
. \Bf H   F U M n Craniofacial morphology  —  abnormal development in the
l*-" 'IfQ face,  mouth and teeth   —  is still the strongest research area of
the faculty.  It includes  neuromuscular control of the tongue
lass.ii and  airways,   as  well  as  dental  occlusion  and  related jaw
1337as biomechanics. Sleep apnea — cessation of breathing — and cleft
-'-:-----= palate are two clinical manifestations of abnormal development
studied at UBC.  "In both those  subjects, -we are leading the
3-*o research in  Canada and we  are  one  of several large  North
American centres," says Dr. Robertson.
:•:•:■ Other research in oral biology stresses the biochemical,
microbial,  immunologic,  and developmental aspects  of oral
tissues.  It has been facilitated by the presence in the faculty of
the current Dean of Science.  Dr.  Barry McBride, who was head
of   Oral   Biology   for   seven   years,    is   a   -world-renowned
microbiologist,  specializing in oral organisms.  He has a joint appointment in
Dentistry.
Clinical research encompasses such diverse topics as pediatric AIDS, the
effects of smokeless tobacco, the performance of restorative dental materials, the
diagnosis of temporomandibular joint disorders, methods for improving oral
radiological diagnosis, and the ergometrics of practice — those performance-
enhancing principles taught to students.
Basic dental science research is not isolated from biological research. Many
Dentistry Faculty members have a doctorate in a basic science and apply their
knowledge of neurophysiology, forensics, biochemistry and molecular biology to
dental research. They also collaborate with colleagues in disciplines, such as
medical genetics, and in areas of expertise, such as the biomaterials program in
the Faculty of Applied Science. "The faculty is looking to expand its
collaborative efforts with pther faculties," says Dean Robertson. "Our intent
has been not to have any dividing lines between this faculty and others, and we
have tried over the years to collaborate and cooperate -with other strengths on
the campus."
1 9SS-S9 «^aa^t
'edeezdea
Donald Brunette and Biomaterials
To UNDERSTAND THE PROBLEM that Dr. Donald Brunette is trying to solve, one
has only to think of the body's response to a sliver. Epithelial tissue grows down
and under anything foreign, attempting to push it up and out. Because of this,
implants — such as catheters for kidney dialysis — tend to be gradually expelled.
Dr. Brunette, -who is head of the Department of Oral Biology, is particularly
interested in improving the retention of dental implants that penetrate the gingiva
— gum tissue. His research has focussed on how the surface topography of an
implant affects the behavior of epithelial cells. Adapting techniques developed in
the Department of Electrical Engineering to make solar cells, Dr. Brunette has
put patterns on biomaterial surfaces — parallel grooves -with a specific
orientation. These impede downward growth by affecting the path of cell
migration — a phenomenon that Dr. Brunette has been able to observe -with his
department's newly acquired confocal laser scan microscope and to record
through time-lapse photography.
Virginia diewert and Clefting
Dr. VIRGINIA DlEWERT, chair of the Division of Orthodontics in the Department of
Clinical Dental Sciences, is one of only a handful of people in the world studying
the early development of the face and the relationship to birth defects, such as cleft
palate. Using different strains of mice, some of which get spontaneous cleft lip, she
is analyzing the development of the face and what interferes -with it at the critical
time. "It looks like the gene or genes that cause cleft lip. have some of their
expression in the morphology of the face. They make it more difficult for the facial
prominences — the little bulges that form the lips — to grow properly." Since not
all mice with the gene develop a cleft, Dr. Diewert suggests that an environmental
insult may be the key. In humans, that insult might be cigarette smoking, hypoxia
or drug use. In order to understand normal development, she studies early human
embryo collections in Washington, D.C, and Kyoto, Japan, -where there are
embryo collections made early in the century. "When -we have a better
understanding of normal development, -we can then go to experimental work to test
the effect of environmental insults, hoping one day to find out if there are ways of
over-riding the gene effect."
Alan hannam and Jaw Muscle Function
It IS DIFFICULT to electrically measure forces three-dimensionally in the small,
damp space of the human mouth, but Dr. Alan Hannam, professor of Oral Biology,
and his team have pioneered a technique for doing so. The team is also able to do
something else that not many labs in the -world can do: using Magnetic Resonance
Imaging it has pioneered the recording of jaw reflexes at the level of the basic
functional units in muscle. Computer reconstructions from the MRI scans
contribute to this fundamental research on how the complex, multi-layered jaw
muscles are organized. In another area of research, Dr. Hannam has borrowed a
well-known engineering technique — finite element modelling — to look at the
deformation and bending of the jaw -when muscles contract. Dr. Hannam's -work has
practical applications in the surgical reconstruction of the face and in the planning
of therapeutic procedures on the teeth. BS
Q
u.
O
The Faculty of
Dentistry offers
dental services to
residents
throughout the
Lower Mainland
at its dental
clinics at UBC.
Senior students
gain confidence
through clinical
practice under the
supervision of
faculty instructors. PENELOPE   LEGGOTT   AND   PEDIATRIC   AIDS
Dr. Penelope Leggott, who came to UBC in 1989, started working on pediatric
AIDS in 1984 with well-known American AIDS researchers, John and Debra
Greenspan. As an associate professor in the Department of Clinical Dental
Sciences, she continues her association with the Oral AIDS Center at the
University of California, San Francisco, working on projects with American
colleagues. One, which involved psychologists, neurologists and pediatricians, is a
long-term prospective study of children born to HIV-infected mothers in the Bay
area. Another study -with the University of Miami involves 100 children. Dr.
Leggott is examining correlations bet-ween their immune status and any oral
lesions. She explains that the oral manifestations of AIDS are quite different in
children. "The most striking lesion -we see is swelling of the saliva-producing gland
in children. A third of the children get parotid swelling, but very few adults do."
A second focus of Dr. Leggott's research involves the effect of radiation on
craniofacial development. She explains that children -who receive bone marrow
transplants used to be given a single dose of radiation to the whole body. They are
now given fractionated radiation — more limited, twice daily doses over three days.
While research has shown that single-dose radiation affects both long-bone and
endocrine growth in children, it is not known if craniofacial
development is also affected. Dr. Leggott has demonstrated that in
rats, craniofacial development proceeds more slowly after single-dose
radiation and normally after fractionated radiation.
APNEA
CESSATION    OF
AFFECTING   TWO
PER   CENT   OF   MEN
BREATHING   	
DURING   SLEEP
Alan A. Lowe and Obstructive Sleep Apnea
ONLY IN THE LAST DECADE have scientists begun to study sleep apnea,        ~»ay »>"ot be well
-which  is  a progressive  and  potentially  fatal  condition.   UBC's known, but it
contribution to that research is unique and has received a great deal
1 ° IS   WIDESPREAD,
of international attention.
Apnea —  cessation of breathing  —  during sleep may not be well
known,  but it is widespread,  affecting two per cent of men over 50.
People -with moderate to severe conditions may stop breathing for so over so.
long that low oxygen levels cause heart arrhythmia. "A large number
of people who died in their sleep in years gone by were diagnosed as having had a
heart attack or stroke, -which -were actually secondary events after apnea," says Dr.
Alan Lowe, head of the Department of Clinical Dental Sciences.
There are two schools of thought concerning the cause of sleep apnea. One
holds that it occurs because the tongue is too large or the airways are too small; the
other suggests that brain function interferes with the respiratory muscles.
Dr. Lowe has focused on the size of the tongue and airways. Having done his
PhD on neural control of tongue posture, he began to work with UBC's Dr. John
Fleetham, an associate professor in the Department of Medicine and director of the
Respiratory Sleep Disorders Clinic at University Hospital-UBC Site. Beginning in
1984 with CAT-scan measurements, they developed a computer program to quantify
tongue and airway size and to pinpoint where breathing is obstructed. The program is
recognized internationally as the most advanced diagnostic tool in the field. It is being
used extensively at UBC to screen patients being considered for surgery. It is also
being used to evaluate CAT-scan images sent by physicians in other provinces and the
United States. "At the moment, the Faculty of Dentistry is the only place equipped to
do three-dimensional reconstruction for patients with obstructive sleep apnea," says
Dr. Lowe. "No one else has the software and no one else is providing the service." The service identifies patients suitable for surgery because they have
enlarged soft palates, and those with large tongues who can benefit by using a
dental appliance. Concomitantly, Drs. Lowe and Fleetham are now testing all
known appliances that reposition the jaw and tongue, to see which are effective in
sleep apnea. They have recently acquired a home monitoring device, which may
circumvent the need for hospital admission, and will facilitate the testing
of appliances.
'SEVENTY   PER
CENT   OF   60-YEAR-
OLD   CANADIANS
HAVE   RETAINED
Paul Robertson and Smokeless Tobacco
WITH Dr. TIMOTHY GOULD, associate professor in the Department of Clinical
Dental Sciences, Dean Paul Robertson is taking part in an American study of
smokeless tobacco, a product used by 20 per cent of young males in the U.S.
and Canada, and 55 per cent of baseball players. The research team,
coordinated out of the University of California, includes cardiologists,
epidemiologists and sports medicine experts. As the team dentist, Dean
Robertson has attended baseball spring training camps in Phoenix for the past
three years, examining major and minor league players. "About half those -who
use smokeless tobacco have obvious lesions in the mouth," says
Dean Robertson. "We don't know if the lesions will result in
cancer. A much higher proportion have gum disease at the site
where the tobacco is used. The gum has been destroyed and the
recession is permanent. Depending on the cancer results, that may
be the saddest thing because gum disease predisposes one to a lot
of other problems."
9
■ R   TEETH.    THAT
REQUIRES    CARE
TO   BE   PREPARED
FOR    1 S   OR   20
YEARS   AGO.
JOSEPH   TONZETICH   AND   PERIODONTAL   DISEASE
In 1970, Dr. JOSEPH TONZETICH adapted a technique called "gas
chromatography" in order to determine the components of bad breath.
He was able to demonstrate that the culprits are sulphur compounds,
which occur in small quantities in the mouth and are hard to separate
from other compounds.
There have been three outcomes of that discovery: Companies
from all over the -world have asked him to test the efficacy of their mouth -washes.
He and two American scientists developed a breath test that pinpoints the precise
time of ovulation by tracking the sulphur compounds in a -woman's breath — a test
that -was patented -with the idea that it,might be used as a birth-control measure or
as an aid to conception. And, today, Dr. Tonzetich is examining the role sulphur
compounds — hydrogen sulfide and methylmercaptan — play in periodontitis, a
disease that causes more loss of teeth in adults over 30 than do cavities.
Noting that levels of hydrogen sulfide and methylmercaptan were elevated in
periodontitis, he has demonstrated that they fuel a chain reaction that results in the
destruction of collagen in gum tissue. Methylmercaptan is the more destructive
compound. He explains: "It augments the effect of endotoxin — a bacterial product
— on macrophages [scavenger cells], causing them to produce more interleukin-1,
which affects the metabolism of cells, such as fibroblasts, causing them to produce
enzymes that destroy collagen in the tissues that support the teeth."
Early diagnosis of periodontitis is difficult because the disease has high-active
and low-active periods. Dr. Tonzetich hopes that his gas chromatograph test -will
assist diagnosis of the active state of the disease, allowing early application of
remedies and helping people to keep their teeth longer. While  the  Faculty of  Dentistry does not plan to enlarge its undergraduate
class, change will occur in other areas.
A post-diploma degree program in dental hygiene, approved in 1991, -will
prepare future academic and clinical leaders in the field. It builds on the Vancouver
Community College diploma course for dental hygienists, which was originally
developed and conducted by the faculty. The new degree course work will allow
students to focus on community dental health care, advanced clinical practice or
allied dental education and research. The program -will be the first at a western
Canadian university.
Graduate programs will be developed in oral radiology, oral medicine, oral
pathology, and oral and maxillofacial surgery.
On the teaching side, oral biomaterials used in esthetic dentistry and in teeth
implants will assume greater importance in the curriculum. The faculty -will forge
links -with the faculties of Science and Engineering to enhance a developing
expertise in materials science and bioengineering.
The curriculum -will respond to the changing Canadian demography. Dean
Robertson explains that with a longer-lived population, dentists have to be trained to
meet different needs. "Seventy per cent of 60-year-old Canadians have retained their
teeth. That requires care we didn't have to be prepared for 15 or 20 years ago.
Because people are living longer, their teeth and surrounding tissues are at greater
risk. Our curriculum is shifting towards the care of the older and medically
compromised patient and the institutionalized person. Dentists must be trained to
manage patients who have systemic diseases -which require the use of medications that
may affect the saliva and the -way the teeth -work."
To understand and meet the dental needs of the rising number of elderly
Canadians living in institutions, the faculty is seeking funds to establish a chair for
Geriatric Dentistry in partnership with University Hospital—Shaughnessy Site, and
the Department of Veteran's Affairs. An endowed Chair in Geriatric Dentistry is
the faculty's primary development campaign goal.
Having doubled its research funding in the past five years, the faculty is o
committed to increasing this rate of growth.*
w
2 WHEN THIS UNIVERSITY WAS BEING PLANNED IN THE EARLY YEARS OF THE CENTURY,
THE PHARMACEUTICAL ASSOCIATION OF BRITISH COLUMBIA APPROACHED THE
MINISTER OF EDUCATION RECOMMENDING THAT A COURSE IN PHARMACY BE INCLUDED
TO KEEP THE PROVINCE IN LINE WITH DEVELOPMENTS IN PHARMACEUTICAL EDUCATION
ELSEWHERE IN THE COUNTRY. THAT PRUDENT PRESCRIPTION WOULD REMAIN UNFILLED
THROUGHOUT,   AND   LARGELY   BECAUSE   OF,   TWO   WARS   AND   A   DEPRESSION.
IV. ^we ^yfccti/i^ 0fc/s^synset>c&€tJ/eee^*y%wsice&
deans of
pharmaceutical
sciences
1946-1951
ESLI L. WOODS
1952-1967
A. WHITNEY MATTHEWS
1967-1984
BERNARD RIEDEL
1985-
JOHN MCNEILL
At the end of the Second World War, the association renewed its efforts,
presenting a brief that emphasized that the province was losing stature nationally
because a university degree was not required to enter the
profession. The association offered $5,000 to equip a Department
of Pharmacy, and the owner of a large chain of B.C. pharmacies,
George T. Cunningham, said he would give $25,000 for a building.
In August, 1945, the Board of Governors and Senate approved the
establishment of a degree course, which -was to be offered by a
Department of Pharmacy in the Faculty of Arts and Science. Esli
L. Woods, who was on the faculty of the College of Pharmacy of
the University of Saskatchewan, -was hired to organize the course.
He was assigned four of the ubiquitous army cast-off huts, which
were outfitted as offices, laboratories and a lecture hall.
Qualifying examinations were held in the summer of 1946 and 68
students were approved for admission. Eight of them -were women
and 54 -were -war veterans.
When Dean Woods died in 1951, he was succeeded by Dr. A.
Whitney Matthews, the first Canadian pharmaceutical sciences
teacher to have a doctor of philosophy degree. By the end of its first decade, the
faculty -was confidently meeting its responsibility to the professional community by
providing the basic scientific and practical training for the practice of retail pharmacy.
The growing need for pharmacists in hospitals was adding new responsibilities
for the faculty. At the undergraduate level an option in Hospital Pharmacy
Administration -was provided, and internships -were established in UBC's teaching
hospitals. Faculty members, collaborating -with hospital pharmacists, directed an
instructional program that included study of hospital administrative policies,
accounting procedures, inventory control and budget.
With the appointment in 1967 of its third dean, the faculty began to develop
graduate training and research efforts. Having earned a doctorate in biochemistry
at the University of Western Ontario, Dr. Bernard Riedel joined the Faculty of
Pharmaceutical Sciences at the University of Alberta and helped to begin a
research program there. Before coming to UBC, he had surveyed pharmaceutical
sciences research in the country on behalf of the Medical Research Council.
Because of his recommendations, grant funding in this area was moved from the
National Research Council to the MRC. At UBC, Dean Riedel prepared to build a strong research faculty. An
appropriate step was a new name: the Faculty of Pharmaceutical Sciences. In 1970,
a research -wing -was added to the George T. Cunningham Building and, -with
$100,000 given by the Cunningham family, a mass spectrometer was purchased. A
PhD program was approved and research-strong teachers -were hired. "We had
three areas of strength," says Dean Emeritus Riedel. "Pharmaceutical chemistry —
the mass spectrometer added to the strength of that group — pharmacology and
pharmaceutics." By the time Dean Riedel retired in 1985, the faculty -was bringing
in research funding equal to its portion of the university budget.
Maintaining its social contract in this period, the faculty began producing
more pharmacists for the province, increasing its graduating class from 25 in 1967
to around 125. Under Dean Riedel, a program of clinical teaching in hospitals and
pharmacies and a residency program in the hospitals -were also developed.
Confusing to the outsider is the presence
on campus of two seemingly similar instructional
and research programs. As well as the Faculty of
Pharmaceutical Sciences, there is -within the
Faculty of Medicine a Department of Pharmacology and Therapeutics. At the undergraduate
level, the department offers a four-year BSc in
Pharmacology -while the faculty offers a five-year
professional degree in Pharmacy. Both offer MSc
and PhD degrees.
Dr. John McNeill, dean of the Faculty of
Pharmaceutical Sciences since 1985, says that he
is often referred to as the Dean of Pharmacology,
which is understandable because he is a pharmacologist. But Pharmacology is only one of the
pharmaceutical sciences. "The pharmaceutical
sciences include pharmacology, -which is the study
of the effects of drugs; medicinal chemistry, the
study of the chemistry of drugs; and pharmaceutics, which has two branches involving
the formulation of drugs, and the -way drugs get into the body, where they go and how
they get out." These sub-specialties are reflected in the organization of the faculty
-which has divisions of Pharmacology and Toxicology; Pharmaceutical Chemistry;
Pharmaceutics and BioPharmaceutics; Pharmacy Administration; and Clinical
Pharmacy. Medical, dental and science students study pharmacology but not to the
same extent as the pharmacy student.
Today, with 35 full-time faculty and 292 clinical assistant professors and
clinical instructors, the faculty has approximately 425 undergraduate students. It
can take in a maximum of 132 new students. Recent classes have had high incoming
averages. While the University Calendar gives a 60 per cent average in the first-
year science program as a requirement, the mean for the 1990-91 class was 7A per
cent. Dean McNeill points out that there used to be a significant attrition rate in
UBC benefactor, George T. Cunningham, after whom the building that
houses Pharmaceutical Sciences is named, is flanked on the left by former
President Norman A. MacKenzie (1944-62) and on the right by former
Chancellor Albert E. Grauer (1957-1961) with Dr. A Whitney Matthews,
UBC's second dean of the Faculty of Pharmaceutical Sciences. 9
pharmacy classes because students -would fail or switch to other disciplines. That
no longer happens, says the dean, because students are academically superior and
because they are committed to pharmacy.
The faculty has recently revised its curriculum, increasing the pharmacy
practice content in the entire program and introducing it into the first- and second-
year curriculum. These changes respond to a need to equip a pharmacist quite
differently today. "The cliche is that we have gone from a product-oriented
profession to a people-oriented profession," says Dean McNeill. He explains that
there -was a time -when pharmacists compounded the remedies they sold. As the
complexity and number of pharmaceutical preparations increased, pharmacists
began to dispense products they obtained from industry in a finished form. "We
-went through a bad time, not so long ago, -when we counted, poured, licked and
sticked," he says. But today the profession is in a new phase. Pharmacists act as
supervisors and controllers of drug therapy — making sure that people get the
right drug -with the right directions and with some assurance that there -will be no
adverse reaction. In hospitals, they are involved in deciding what drug should be
used and how it should be given — decisions that used to be totally in the realm of
medicine. "A capsule comment," Dean McNeill quips, "-would be
that pharmacists are now drug-information specialists."
RESEARCH   FUNDS „.,   ., , , -11      1 1 1
received by the While   pharmacy   students    still   learn   chemistry   and
faculty compounding, the required courses in their final year, taught by
1985-86 the Division of Clinical Pharmacy, are devoted to learning the
practical aspects of the profession. Approximately 110 community
1986-87 , ... . , ....
$2,u2,587 pharmacies in the province are used as training sites -where
1987-88 students spend  160 hours in a four- to five-week period in the
summer before their final year and four -weeks in their final year.
1988-89 J J
$1,852,337 In addition, students spend two weeks in one of 18 hospitals in the
i989-9o Lower Mainland.  Graduates must also -work for  160 hours in
$1,972,079
1990-91 community pharmacy before they take their licensing examination.
$3,o92,556 This puts a heavy burden on the pharmacist who is trying to run a
business.  "Our profession is very good to us,"  says  Senior
Instructor  Marguerite  Yee,   -who   assigns   students  to   their
community clerkships.  "Without their help we -would be hard-
pressed to give practical experience to our students."
In graduate studies, there are 16 MSc candidates and 22 PhD candidates. The
faculty initiated the first professional PharmD program in Canada in September,
1991. It is intended to provide a more highly trained pharmacy practitioner. The
faculty has also gained a Chair in Pharmacy Administration and two Professorships
in Clinical Pharmacy.
UBC's faculty is one of the most active in pharmaceutical research in
Canada. Currently, the faculty receives substantial awards from the Medical
Research Council, B.C. Heart Foundation, the B.C. Health Care Research Fund, the
Cystic Fibrosis Foundation and the National Centres for Excellence. Researchers in
the faculty continue to achieve national and international recognition for their expertise in the areas of diabetes, cardiovascular disease, cystic fibrosis,
pharmaceutics and drug metabolism, and drug analysis and kinetics. A team of three
faculty researchers — Dr. James Axelson, Dr. Frank Abbott and Dr. Wayne Riggs
— has one of the few program grants ever awarded to a pharmacy faculty. As well,
Dr. Peter Soja, assistant professor of Pharmacology and Toxicology, has a major
MRC development grant — also a rarity in pharmacy schools.
Prank Abbott and Drug Metabolism
Dr. FRANK ABBOTT, chair of the Division of Pharmaceutical Chemistry, is also an
associate member of the Department of Pediatrics. The emphasis of his research is
drug metabolism. He is developing methods of identifying and quantifying drugs
and metabolites in biological tissues. Among the drugs Dr. Abbott is investigating
is the anticonvulsant, valproic acid, which is used in the treatment of seizures. Its
metabolites are thought to cause a rare but fatal liver toxicity. Dr. Abbott works in
close collaboration with Dr. James Orr, whose specialty is pharmacokinetics, and
with Dr. Kevin Farrell, a neurologist and head of the epilepsy clinic at B.C.'s
Children's Hospital.
James Axelson and Drug Effects
in Pregnancy and the Neonate
Dr. JAMES AXELSON, a professor in the Division of Pharmaceutics
and BioPharmaceutics, is coordinator of a multi-disciplinary group of
investigators funded by the Medical Research Council. The group
includes Dr. Frank Abbott and Dr. K. Wayne Riggs of the Faculty of
Pharmaceutical Sciences, as -well as others in the Faculty of Medicine.
It has $2.7 million over five years to study drug effects and
toxicology in pregnancy, the newborn child and the young child. In
announcing the grant, Dr. Lewis Slotin, MRC program director, said,
"The team ... has been identified by the MRC to be unique in Canada
for their collective expertise and ability to focus on drug toxicology
in early life." Currently, Dr. Axelson is studying the effects on the
fetus and in the mother of antihistamines, antiemetics, tocolytic
agents used to suppress premature labor, and drugs used to treat
pregnancy-induced hypertension.
TODAY,   WITH
35   FULL-TIME
FACULTY   AND
292   CLINICAL
ASSISTANT
PROFESSORS   AND
CLINICAL
INSTRUCTORS,
THE   FACULTY   HAS
APPROXIMATELY
UNDERGRADUATE
STUDENTS.
Gail Bellward and Cytochrome P4SOs
Dr. GAIL BELLWARD, professor of Pharmacology and Toxicology, studies a family
of enzymes known as cytochrome P450s, which break down foreign chemicals so
that the body can dispose of them. From a medical standpoint, Dr. Bellward is
interested in the activity of P450s when people are taking several prescription
drugs, with the ultimate goal of suggesting more rational drug therapies. She
explains that when the synthesis of one P450 has been activated by exposure to a
chemical in a prescription drug, there is commonly a decrease in the synthesis of
other P450s. If these latter enzymes are unavailable to deal with chemicals in a
second prescription drug, toxic levels can build up rapidly. Her recent research
has shown that the drug Cymetadine inhibits only one form of cytochrome P450,
indicating that it is a safe drug except in extremely specific situations when it
could be dangerous. In another area of research, Dr. Bellward studies imprinting,
which is a term for the action of a sort of gender-related DNA alarm clock that is
set ticking at about six months  of age and activates an event,  such as puberty, u
years later. Dr. Bell-ward has been able to show that imprinting can occur after the
neonate period — that a female rat treated with testosterone for a few days during
puberty will begin to express a cytochrome P450 that is found only in males. The
findings have relevance for female athletes -who are taking high amounts of
corticosteroids which have androgenic side-effects similar to testosterone and
might permanently affect their metabolism. Dr. Bell-ward's imprinting research has
implications for the babies of opiate addicts -who were maintained on narcotic
substitutes during pregnancy.
JACK   DIAMOND   AND   CYCLIC   NUCLEOTIDES
Dr. Jack DIAMOND is chair of the Division of Pharmacology and Toxicology. In
the past few years, his research has been concerned -with the roles of two cyclic
nucleotides in the control of cardiovascular function. Cyclic AMP and cyclic GMP
are believed to mediate the effects of various drugs and hormones on a number of
tissues. Evidence from Dr. Diamond's laboratory suggests that the major role of
cyclic GMP in the cardiovascular system is as a mediator of the vascular relaxation
caused by relaxants such as acetylcholine and by vasodilators such as nitroglycerin.
David Fielding and Continuing professional competence
Dr. David FIELDING, chair of the Division of Pharmacy Administration, has been
-working on a three-year joint venture -with the College of Pharmacists of British
Columbia, investigating -ways of ensuring the continuing competence of licensed
pharmacists. More than 500 pharmacists in the province have participated in the
study, helping the UBC team from Medicine, Statistics, Education and
Pharmaceutical Sciences to define and validate areas of competence and to check
possible test instruments. Dr. Fielding explains that there are different
philosophical approaches to the issue of continuing competence. Many jurisdictions
make continuing education mandatory but do not test practitioners. Feeling that
competence is the ultimate goal, the B.C. college has chosen to make continuing
education voluntary but testing mandatory. The UBC team's task has been to
develop a test that is reliable, valid, acceptable to the membership and able to be
administered all over the province and to members -who have left B.C. but -want to
maintain their status.
Continuing education in Pharmaceutical Sciences is a cooperative venture of
the college and the faculty. In 1976, a coordinated system of continuing education
courses was begun. It now involves 30 communities around the province. "We have
a program that would rival any other in the country in terms of the number of
diversity of courses," says Dr. Fielding. Some pharmacists in the province
participate in correspondence programs; others do a lot of self-directed learning.
"One of the things that the college competency assessment program is saying is we
don't care how you do it," says Dr. Fielding. "All we say is -we will define -what we
consider the minimum level and you must meet it or do something about it."
Sidney katz and basic ion-transport Defects
Dr. Sidney Katz, a professor in the Division of Pharmacology and Toxicology, is
investigating basic ion-transport defects in cystic fibrosis. In the area of heart
research, he is looking at the role of calcium and protein kinases (regulatory
enzymes) in heart contraction. "We are well on the way to understanding how the
cystic fibrosis gene causes problems," says Dr. Katz. "We hope to play a role in
understanding the defect and finding a treatment." Dr. Katz is known nationally as a public speaker and broadcaster on science. The Canadian Federation of
Biological Societies has given him the first Gordin Kaplan Award for his
exceptional contribution to raising public awareness of science. Dr. Katz is a
member of the Respiratory Health Network of Centres of Excellence and has
recently been appointed executive director of Science World British Columbia.
John  McNeill and Vanadium  Use in Diabetes
Dean McNeill's RESEARCH involves vanadium, a simple inorganic trace element.
He has created vanadium compounds that can mimic the effects of insulin or
enhance the effect of small amounts of insulin produced by diabetic animals.
Recently, with Dr. Chris Orvig in the Department of Chemistry, he has applied for
a patent on an organic vanadium compound that -works better than previous
compounds he has tested. Dean McNeill has been appointed to the board of
directors of the Pharmaceutical Manufacturers' Association of Canada Health
Research Foundation. The foundation provides funds for research and personnel
support in Canada in the fields of pharmacology, clinical pharmacology and
therapeutics. Dean McNeill -will review funding applications and participate in
setting the policy of the board.
B.C. Drug and Poison Information centre
The B.C. Drug and Poison Information Centre, located at St. Paul's Hospital,
-was established in 1975 by the Hospital Programs Branch of the B.C. Ministry of
Health and the Faculty of Pharmaceutical Sciences. It is staffed -with pharmacists,
nurses and physicians who have expertise in the provision of drug and poison
information services. Expanding on its original mandate to create services to help
health professionals in the province provide the best possible drug therapy and
poison management, the centre has added publications and telephone request
services. It produces several publications:
• The  Drug  Information  Reference with 325  monographs on  frequently
used drugs.  Available in textbook and  electronic versions, the  DIR  is
widely  used  in acute-care and long-term  facilities in  b.c. and across
Canada. The electronic versions are  installed in  hospital
information and pharmacy  departments in 27 canadian  hospitals and
four australian  health-care  facilities.
• Drug  Information  Perspectives  is a quarterly  newsletter sent to
subscribers of the  dir.  it is  used to update  information,  mentioning
new drug  interactions and adverse effects.
• The  Master  Drug  List lists all drug  products approved for sale  in
Canada.  Its  unique classification system  provides automatic alerts on
drug allergies and interactions.  in  hospitals, the  mdl can serve as a
baseline  for  developing formularies,  drug  inventory control and
drug-use  review programs.
• The  Poison  Management Manual for  managing poisoned patients  is
made available to all emergency departments  in the province  and is
used extensively across canada.
• Poison  Perspectives  Newsletter  is a quarterly distributed to healthcare   PROFESSIONALS   IN   ACUTE-CARE   HOSPITALS   AND   PUBLIC   HEALTH    UNITS.
The centre provides drug and poison telephone consultations for professionals
throughout B.C. and poison information for the public in Greater Vancouver and
the Lower Mainland, and in the Capital Regional District. The centre operates a Drug Use Review program to assist physicians and
pharmacists in improving the quality of prescription drug usage in the province.
Patterns of exceptional prescribing and use of drugs are identified through
patient prescription records. These exceptional cases serve as the basis of
educational programs. Physician and patient confidentiality is maintained through
a coding system.*
IN 1922, WHEN UBC STUDENTS MARCHED EN MASSE FROM THE UNIVERSITY'S
DOWNTOWN LOCATION TO ITS PROMISED BUT MUCH-DELAYED NEW SITE AT POINT
OREY, THREE STUDENTS PROUDLY CARRIED A BANNER, PROCLAIMING, "WE'RE THE
FIRST   THREE   WOMEN   IN   THE   BRITISH   EMPIRE   TO   OET   DEGREES   IN   NURSINO."
V. 2m&   &<%<*«& - &r/&thp Ky?*C^M40fl&>
&72
Beatrice Johnson, Marion Fisher, and Margaret healy were graduated
from the UBC Department of Nursing in May, 1923. Beatrice Johnson, who later
married Professor Frederic Wood, founder of UBC's Players' Club, recalls the
challenge and excitement surrounding the early days of the nursing school: "Like
all pioneers, we found a tremendous satisfaction in accomplishing our purpose. It
was exciting to be first in the new field."
Ever since its inception as a department in the Faculty of Applied Science in
1919, the UBC School of Nursing has been committed to pioneering new directions
in the profession. Established very much in the spirit of ground-breaking, the
school has throughout its long history resolved to develop the role of the nurse in
the medical team by constantly re-evaluating and revising its teaching in nursing
practice, research and instruction.
Change often meets with resistance, and the Department of Nursing certainly
faced its share of opposition, especially in its fledgling years. When presented with
the suggestion of a university degree program for nurses, the College of
Physicians and Surgeons responded in 1919 that "the overtraining of nurses is not
desirable and results largely in the losing of their usefulness." The antipathy of
medical men towards advanced training for nurses was fortunately not shared by
all doctors, however. In fact, it was Dr. Malcolm MacEachern, Medical
Superintendent of Vancouver General Hospital, -who first broached the notion of a
UBC nursing program.
Dr. MacEachern, a well-known proponent of the Hospital Standardization
movement then gaining popularity throughout North America, saw the
establishment of a uniform, standardized university nursing course as part of a plan
to improve hospital services as a whole. In 1918, at the first meeting of the British
Columbia Hospitals Association, he proposed that a nursing chair or department be set up at the University of British Columbia — at that time located right next door
to the hospital on the Fairview site. He also suggested that the university take over
instruction at the Vancouver General Hospital Training School for Nurses.
UBC President Franklin Fairchild Wesbrook was not enthusiastic about the
idea. Although himself a medical doctor -who had previously been involved in the
inauguration of the Department of Nursing at the University of Minnesota, Dr.
Wesbrook held that the poor financial situation of UBC precluded the
establishment of a nursing school at that time. The lack of funding from the newly
elected Liberal government, combined with wartime cutbacks, had left the
university in no position to branch out in a new, untested direction.
Dr. MacEachern responded, in a February, 1919, letter to the UBC Senate,
that the hospital -would be responsible for all expenses associated with the nursing
program. This included the salary of the hospital's director of nursing, -who -would
also serve as the director of the university's department. The UBC Senate
subsequently recommended to the Board of Governors that the scheme be adopted.
At that time, spurred by the aftermath of the First World War
and the devastation of the Spanish Flu epidemic that had
swept the -world, the university had been concerned about
providing useful vocational skills to its students as well as
purely academic preparation. The establishment of a practical
training program, such as the nursing school, thus fit well
with the university's needs at that time, especially since
nurses were in short supply throughout the province. In
October of 1919, the UBC Board of Governors approved the
Senate recommendation, and the first university school of-
nursing in Canada -was born.
The department was fortunate to acquire as its first
director, Ethel Johns, -who was principal of the training
school at Winnipeg Children's Hospital and an executive
member of the Canadian Association of Nursing Education.
Miss Johns was initially a concern because she did not have a
university degree, but she quickly proved herself to be highly
competent. Her exceptional insights into nursing education
formed the backbone of the instructional program, -while her
rousing speeches and eloquent writings on the subject of
broader and more advanced training for nurses no doubt
converted many a skeptic.
The five-year baccalaureate degree developed by Miss Johns and her
colleagues, comprising three years of university study and two years of hospital
training at VGH, -was known as the "combined course." In addition to practical
clinical training, students attended university classes in nutrition, sanitation and
hygiene, the history of nursing, and motor mechanics. The latter was designed for
public health students -whose careers -would entail a good deal of travelling by car
in rural and remote areas.
The emphasis on advanced education for nurses was to prepare them to fill
expanded roles as administrators and educators and, especially, to provide public
health nursing. These goals were closely linked to the health concerns of the time,
which included spread of communicable diseases and high infant mortality.
The affiliation between UBC and VGH was never intended to be exclusive, but
the successful joint program continued in this way for more than 40 years, with the
Ethel Johns, the first director (1919- 1925)
of UBC's School of Nursing.
O last class to complete the combined course graduating from the hospital in  1960
and the university a year later.
In 1951 the department had become a school. Its director at the time was
Evelyn Mallory. Never happy about an arrangement that had nursing students at
the university for two years, at the hospital for two years and then back at the
university for a final year, Mallory revised the degree program to entail extensive
clinical -work at various hospitals — in the Lower Mainland and throughout the
province. A new uniform, cap and pin -were introduced, and the curriculum -was
changed to reflect emphases on technical requirements for nurses in hospitals.
Plans for a graduate program were made at this time, although it was not until 1968
that the two-year masters actually came into being. In 1973, the baccalaureate
degree program -was reduced to four years — a format that continues to this day.
The   school,   still   a   separate   entity   within the  Faculty of Applied
Sciences, now offers a four-year baccalaureate program for initiate nurses and a
two-year baccalaureate program for registered nurses   —  both
leading to the degree of Bachelor of Science in Nursing.  Also
offered is a two-year Master of Science in Nursing.  The school
-t^kRCrl  fUND/A. has    earned   a   national   reputation   for   excellence    in    its
undergraduate and masters programs, and -will be among the first
to offer a doctorate in nursing beginning in September,   1991.
$70o,6 According to  Director Marilyn  D.  Willman,  the  doctorate
1987-88 program -will provide  a major avenue for advancing nursing
science and care as laid out. in the UBC Model of Nursing, which
$176,874 is a sort or mission statement tor the university s student nurses.
1989-90 The UBC model was introduced into the program in the early
$225,909 ... .
<n 1970s to provide direction for nursing research,  teaching and
2 1990-91 r ° °
o $34 1,486 practice, and it continues to provide a frame-work for instruction
2 and learning today. The model stresses the role of the nurse as a
o nurturer of health rather than a curer of diseases. The nurse makes
°- this unique contribution of care, as opposed to cure, as an integral
h member of the team of health professionals whose ultimate goal is
the optimal health of the population. The model has been adopted by a number of
hospitals in British Columbia as a framework for providing care.
The school continues to develop -within the framework of the model. In
particular, there has been a substantial increase in research activity in recent years,
including the establishment of a Nursing Research Unit in 1988. The unit -was
established to support the development of nursing research -within the school and is
designed to improve the quality of health care in the province by generating
knowledge through nursing research. In 1989-90, research funding in the school
rose from $225,909 to $341,486. An Endowed Chair in Nursing and development of
the PhD program in nursing will also contribute to the application of research
findings in the improvement of health and nursing care.
Four major areas of research activity are being actively pursued by faculty and
students: family health care; the management of chronic illness; cross-cultural
health care; and aging. The school is committed to addressing these dominant
health problems through its research projects.
o Sibling Death Trauma:
Dr. Elizabeth Davies is exploring the effects of death and disease on the patient's
family, particularly siblings, to discover the ways in -which nurses and other healthcare professionals can help during the terminal phase so that long-term
bereavement is less traumatic. Professor Davies is the first nurse recipient of an
investigatorship funded by the B.C. Children's Hospital Research Division.
Breastfeeding Studies:
In various studies conducted by Donelda Ellis, associate professor, and Roberta
Hewat, assistant professor, problems experienced by nursing mothers are being
examined. The two researchers have also established a free breastfeeding clinic at
UBC to instruct and inform mothers about proper breastfeeding techniques. The
clinic is one of only two in Canada.
Caring for MS Patients:
Helen Niskala, associate professor, and Marilyn Dewis, assistant professor, are
studying the -well-being of the family members caring for an MS
patient   to   understand   the   ways   these   caregivers   can   be
emotionally supported by nurses and other medical professionals.
THE   DIR ECTORS
OF   TH E   SCHOOL
OF   N U RSI NG
Midwifery studies: 1919-1925
T71     • /-1 • r 1      Al- r> • • ETHELJOHNS
rJ/laine L-arty, associate proressor,  and Alison Rice, assistant
1925 -   1941
professor, are qualified midwives, working to establish midwifery mabel f. gray
9
as a recognized profession in order to complement existing 1941-1967
° r r ° EVELYN MALLORY
provincial health-care services and help cut maternity-care costs.
1967 -  1971
ELIZABETH KENNY MCCANN
197!   ■  1977
MURIEL UPRICHARD
MARILYN WILLMAN
In   addition   to  the   researchers   discussed  above,   Dr.
Joan   Anderson   has   brought   a   particularly   high   level   of 1977
recognition to UBC's nursing program through her activities as
National Health Research Scholar (1988-1993).  Dr. Anderson's
work has centered on caregiving in a multicultural context.
Nurses in British Columbia are increasingly coming into contact
■with people from a variety of different ethno-cultural groups, and according to Dr.
Anderson, it is important that they understand the impact of cultural and social
factors on how people manage their health.
Dr. Anderson's research includes comparative studies of Chinese and White
families caring for a chronically ill child at home; an examination of the health
status of immigrant women; and research into the cultural context of caregiving.
Along -with Dr. Nancy Waxier-Morrison, in the Department of Anthropology and
Sociology, she has recently published a unique handbook for health professionals in
Western Canada. It deals -with cross-cultural caregiving, and gives specific
guidelines for providing care to recent immigrant groups from Vietnam, South and
Southeast Asia, China, Japan, Central America, the West Indies and Iran.
While continuing to develop its research and scholarly programs, the
School of Nursing is also committed to remaining loyal to its founding principle —
training students to provide high-quality nursing care to the public. With its
collaborative approach to the health sciences, the UBC School of Nursing is
■working to reduce health-care  costs through more effective care-giving in
e> conjunction with physicians,  therapists,  social workers,  and other medical
professionals for the betterment of the B.C. and Canadian health-care systems.
*-Stte eJ^&CW1«/^^ %yWecuc€me
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In some ways, the School of Rehabilitation Medicine is a square peg in
a round hole. Administratively placed in the Faculty of Medicine, it approaches
health problems in a way that is more closely allied with social sciences. "We don't
view things within a medical frame of reference," says its current director, Dr.
Charles H. Christiansen. "We aren't oriented by the idea that a diagnosis has to be
made in order to determine what has to be done. In rehabilitation, the first thing
that must be asked is how does the deficit affect the person's lifestyle?"
Not to be  confused with the  Division of Rehabilitation Medicine in the
Department   of  Medicine,   the   school   offers   a   professional   program   for
physiotherapists and occupational therapists, whose role is caring for chronically
disabled  patients  at  the  point where  medical  or  surgical   care  stops.   Dr.
Christiansen explains: "Our view in this school is that people
who have conditions that are not amenable to surgical or medical
cure should not be tucked away and forgotten."
The school's first director, Dr. Brock Fahrni, had come to the
university in  1952 as a clinical instructor in the Department of
Medicine. Renowned for his radical approach to geriatrics,  Dr.
Fahrni challenged traditional ideas about aging and worked to
provide programs of assistance to keep elderly people in the
community. Thus founded on the basis of opposing traditional
stereotypes of aging, the school has had a long history of helping
the elderly and the chronically disabled overcome both the
physical and emotional deficits brought about by their conditions.
In  1961,  the school launched its  Certificate  Course in Physical Medicine
Therapy.  It was a combined course in physiotherapy and occupational therapy. A
year later a degree program -was offered. In 1983, the combined program divided,
offering separate BSc degrees in Occupational Therapy and Physical Therapy.
Today, the school occupies a portion of the third floor of the University
Hospital-UBC site, where 19 full-time faculty members prepare more than 200
students in three-year programs following first-year Arts or Science. Thirty-five
students are admitted into each stream. A new program in Vocational
Rehabilitation has also recently been added to the curriculum. This degree will
prepare students to assist chronically disabled persons perform specifically work-
related roles. It -will include the design of training programs and working with
employers to place people in satisfying jobs. A masters degree program in
Rehabilitation Medicine is planned to begin in 1992.
While the term "occupational therapist" tends to be associated with vocation,
these professionals address any goal-directed daily activity. Occupational
therapists look at the effects of deficits on the requirements of living — from
brushing teeth and fixing meals, to finding satisfaction through work and play.
Physical Therapy degree students, mean-while, specialize in problems related
to movement. Through various treatments and with the aid of mobility devices
THE   SCHOOL  OFFERS   A
PROFESSIONAL   PROGRAM
FOR   PHYSIOTHERAPISTS
AND   OCCUPATIONAL
THERAPISTS.   WHOSE    ROLE
IS   CARINO   FOR
CHRONICALLY   DISABLED
PATIENTS. Physical Therapy
students in
UBC's School of
Rehabilitation
Medicine have the
benefit of learning
with the aid of
sophisticated
equipment.
9
o
at
O.
is
z
>
ID
u
«
< (such as braces, crutches and wheelchairs), physiotherapists enable their patients
to move as independently as possible in spite of muscular, respiratory or
cardiovascular impairment. The development of these biotechnology tools is central
to rehabilitation therapy.
Graduates of the school work in community-oriented rehabilitation centres,
special facilities for people with chronic conditions, and in hospitals. They are in
great demand in the province and routinely have job offers in hand -when they
finish their training. Because of B.C.'s growing population of older individuals, for
example, there has been a progressively greater need for chronic-care services
provided in homes and community facilities, in addition to hospital-based acute-
care services. "In short," Dr. Christiansen says, "greater emphasis will need to be
placed on maintaining performance capabilities so that persons can remain active in
their older years and lead satisfying lives -while continuing to reside in their own
homes. Improved understanding of the ways in -which technology can be used to
extend independence in persons -with chronic or debilitating diseases -will be
essential to this effort."
For a long time the theory of rehabilitation sciences was borrowed from other
disciplines. Only within the past 10 or 15 years have enough practitioners earned
doctoral degrees and become scientists in their own right. Now, a body of
knowledge unique to the rehabilitation sciences is emerging.
Our school has reached the point in its evolution -where its faculty members
have the credentials to receive grant funding, -which comes largely from the
provincial government. In physiotherapy, it is assembling people -with an interest in
muscle fatigue and how that results in injury. In occupational therapy, a developing
area of interest is the objective assessment of function.
Other areas of inquiry include:
THE PATHOPHYSIOLOGY OF PULMONARY FATIGUE  •  FACTORS AFFECTING
CARDIOPULMONARY EFFICIENCY  •  MANAGING THE FUNCTIONAL EFFECTS OF
MULTIPLE SCLEROSIS  •  FUNCTIONAL SPLINTING IN ARTHRITIS  •  CULTURAL
FACTORS AFFECTING TREATMENT COMPLIANCE  •  FACTORS AFFECTING
RECOVERY FOLLOWING STROKE
Through its research activities, the school has developed important links -with
various medical facilities throughout the province, including Vancouver General
Hospital, University Hospital—UBC Site, Queen's Park Hospital, the G. F. Strong
Rehabilitation Centre, the Sports Medicine Clinic of the Department of Family
Practice, and the Arthritis Centre of Vancouver.
CEREBRAL   PALSY   IN   HIGH-RISK   INFANTS:
Dr. Susan Harris, associate professor, is one of the top five researchers in physical
therapy in the -world. Concerned primarily -with motor development in infants and
the early diagnosis of cerebral palsy in high-risk children, she is currently funded
by a research fellowship from the National Institute of Disability and
Rehabilitation Research of the U.S. Department of Education. Dr. Harris is
-working to develop an assessment tool for early diagnosis of cerebral palsy so that
these young patients can be referred to appropriate intervention therapy. It has
recently been confirmed that early treatments, such as correct positioning through the use of cushions, bolsters and mobility devices, can reduce the negative
influences of the patients' conditions. Her work has brought international attention
to the UBC school.
Prevention of decubitus Ulcers:
A former director of the school, Dr. Tali Conine is studying the effectiveness of
cushions in the prevention of decubitus ulcers, or pressure sores, caused when
disabled patients sit in one position for a long time. She is working -with elderly
persons in B.C. extended-care facilities to test the efficacy of various biotechnology
devices and cushions in the prevention of pressure sores. Dr. Conine is currently
funded by Health and Welfare Canada to explore how these various devices can be
used to help improve the lives of elderly and disabled patients.
Post-Polio Syndrome Treatment:
Funded by the B.C. Medical Services Foundation, Dr. Elizabeth Dean is comparing
two treatment approaches to the management of patients -with post-polio syndrome.
Hundreds of British Columbians between the ages of 30 and 70, all with histories
of polio, have come forward with symptoms that appear to be a progression of the
disability that incapacitated them years ago. Dr. Dean is hoping to find out
whether a general conditioning program will improve the strength patients need to
overcome the limitations brought on by this syndrome.
The   research   conducted  within the School of Rehabilitation Medicine at
UBC is contributing to a new body of knowledge unique to the rehabilitation
sciences. The disciplines of Physical Therapy and Occupational Therapy are just ■!
now "coming of age" as academically based areas of study, and it is a very exciting ™
time for scholars in these fields. Practices that prevailed in the clinic for decades
are currently being questioned and investigated by researchers in rehabilitation w
science.  The development of biotechnology devices,  many of them having 2
microprocessors, is now showing that the negative influences of chronic conditions ">
can indeed be reduced. In the spirit of the original founder of the school, Dr. Brock o
Fahrni, traditional ideas about the elderly and the chronically disabled are being °-
ignored at UBC, and new -ways of helping these patients deal with their everyday
life activities are triumphantly being developed. A new Endowed Chair in Arthritic
Diseases -will help in this quest to find more effective medical solutions.
<_>>%? ^yo^c^cy^XJKi^c^ca^U' awtv^/faecn Cyccewced
The newest member of the care-giving team at UBC trains audiologists
and speech-language pathologists among whose clients -will be children -with
language-learning problems, adults -who have had cancer of the larynx, post-stroke
patients, and people -who stutter or have hearing losses. The range of services
required is broad, and the demand for their expertise is high.
Since its establishment in 1969, the School of Audiology and Speech Sciences
has developed high standards of excellence in teaching and research.
A program in speech sciences -was first proposed in 1961 in the Hall
Commission Report on Health Services. The B.C. Speech and Hearing Association
o
O (now the B.C. Association of Speech-Language Pathologists and Audiologists)
worked with a UBC committee to convince the university's Faculty of Graduate
Studies to develop a Master of Science degree program in speech sciences. The
program as laid out by Dr. John Gilbert was approved in 1968, and the first six
students -were enrolled in 1969. Dr. Gilbert became the school's first director.
Today, the school is housed in the James Mather Building on campus. It has a
faculty of 10, seven of-whom are PhD holders. A large proportion of the faculty was
added after the school received a Provincial Funds for Excellence Award in 1987.
Twenty-three students are accepted in each year. They enter the school having
already completed a four-year undergraduate degree -with specialization in
linguistics or psychology, and they spend a further two years in the school to
obtain their Master of Science degree.
The school requires that its graduates be familiar -with current research in
speech, language and hearing, and that they clearly demonstrate clinical
competence in a wide variety of settings. To this end, students complete 300 hours
of clinical experience in hospitals, clinics and extended-care facilities throughout
the Lower Mainland. While students are in these community settings, they are
trained by the school's 130 clinical faculty members.
Graduates  become  audiologists  or  speech  pathologists  in
hospitals,  private agencies,  schools,  clinics and health units.  They
purpose of the provide professional services to help the communicatively impaired —
ubc school those -with speech, language or hearing disabilities. This may include
detecting hearing loss in small children so that they can receive the
appropriate treatment as soon as possible; helping stroke patients
and speech maximize their language recovery at rehabilitation  centres;  or
sciences is to selecting appropriate hearing aids and other special devices for
elderly people who suffer from hearing loss. In all of these settings,
UBC graduate audiologists and speech pathologists work to help
people with communication impairments cope -with their conditions
™ teaching and and, where possible, regain their lost hearing or speech abilities.
o research. The school's  second director,  who took over in  1988,  is  Dr.
Q- Judith Johnston.  Guided by a desire to create opportunities for a
greater level of specialization for professionals and to develop more flexibility in
the curriculum, the school has devised and will soon put in place a three-year
curriculum, the first year of which may or may not be taken at the undergraduate
level. "What we've done," says Dr. Johnston, "is to recognize the need for
increased professional training against the background of a knowledge explosion in
our field." Having for a long time received its students from a feeder program in
the Department of Linguistics, the school has now created an alternative track
through Psychology. "We're trying to recognize that the field is interdisciplinary
and that people -with different disciplinary commitments might be interested in this
as a profession."
A second purpose of the UBC School of Audiology and Speech Sciences is to
prepare future academics for teaching and research. A PhD degree program was
approved in 1983, and is now one of only two doctoral programs in speech and
hearing sciences in Canada. Candidates specialize in experimental phonetics,
speech production, speech perception, neurolinguistics, language acquisition,
psychoacoustics and physiological acoustics.
First-rate students from across Canada and from other countries are attracted
to the UBC school, not only because of its excellent reputation as an educational
PREPARE    FUTURE
■ CS   FOR
O
O facility, but also because of its faculty research programs, many of -which have
gained international attention. Research funding, -which jumped by 85 per cent
between 1989 and 1990, comes primarily from the B.C. Medical Science
Foundation. A Chair in Audiology and Speech Science has also been added to the
school. "In our own -way," says Dr. Johnston, "-we have started to develop areas of
expertise. We have recognized expertise in matters concerning language learning
and speech development."
Computer Analysis of visual Elements in the speech Signal:
Dr. Andre-Pierre Benguerel is designing and building a computer-controlled system
for the automatic acquisition, organization and display of speechreading data.
Video images of a speaker's face provide information about the movements of the
lips, tongue tip, teeth and jaw. Automation allows the painless processing of large
amounts of data, -with the long-term outcome of creating training programs for
speech-reading.
Early vocal Behavior:
As -well as performing an acoustical analysis of the vowel system of one
phonologically disturbed child and developing a soft-ware program to analyze a
number of different biological signals, Dr. John Gilbert is attempting to
demonstrate that in all infants (regardless of their language community) speech
sounds emerge -with relatively similar properties because the vocal tract and ear
have inherent limiting characteristics.
Inner Ear Response to Sound:
Dr. Don Greenwood is studying the way the inner ear processes sounds of different
pitches. His research has implications for the design of hearing aids and the
understanding of the effects of some drugs, such as aspirin and chemotherapeutic
agents, on the inner ear.
o
e>
Language Development in Twins, One of whom is Blind: °-
Dr. Carolyn Johnson is analyzing various aspects of language acquisition in a set z
of twins whose biological endowment and home environment are identical except
for the fact that one of them is blind. She has demonstrated that blind children use
auditory signals to make intellectual generalizations   —  putting objects into
categories by sound in the same -way that seeing children do using visual clues.
Findings from this study -will provide better information about the role of vision in
language learning and -will thus help educators to improve the preschool curriculum
for blind children.
Predicate Acquisition in language-Impaired Preschoolers:
Young children usually learn cognitive-state predicates such as know and think
only after they have learned the verbs that express actions. The purpose of Dr.
Judith Johnston's -work, -which involves collaborations -with researchers at the
University of Wisconsin, Rutgers and UCLA, is to understand -why this is so. There
are two explanations: one is that a more advanced level of intellect is required to
talk about mental activities; the other is that cognitive-state predicates lack
perceptual correlates. Dr. Johnston is using a clinical population of children -with
language-learning problems to see if their more advanced physical age at the time they are learning language affects their use of cognitive-state predicates. If it is
found that perceptual correlates are important in language learning, Dr. Johnston
suggests that therapists might -want to provide a visual accompaniment -when they
are teaching language-impaired children.
Age-Related hearing Loss:
Dr.  Kathleen Fuller is researching how everyday communication in the elderly is
affected by specific age-related changes in audition and cognition.  Auditory
performance in real-life situations depends not only on the nature of hearing loss
but also on the listener's ability to cope with distraction and to supplement the
acoustic signal with information drawn from other sources.  Dr.  Fuller's research
z will provide  a basis  for the development of new clinical tools   —   such as
o
^ rehabilitation techniques that emphasize compensatory strategies  —  to help the
u elderly communicate better in the noisy situations typical in daily life.
o
ce
0.
The   research   conducted   by the students and faculty of the  School of
Audiology and Speech Sciences is carried out according to the same exacting
o standards to -which its clinical community -work conforms. Graduates have earned a
£ strong reputation for outstanding clinical service in the B.C. medical system and
o are in extremely high demand throughout the province. This demand -will see the
i school continue to expand its teaching and research programs in the coming
decades, and develop its -widening reputation -within the field of audiology and
speech-language pathology.!
(/>
o
VI *^t& ^ezeetci^ of&/e€ze£i€i<fe ^/feet/je^
ubc   has   declared   its   graduate   programs   to   be   a   major   priority
recent   years   has   encouraged   new   initiatives.   among   those   in   the   healti
sciences  have  been the   following:
western canada's first msc program  in occupational hygiene.    •
Canada's second PhD program  in  nursing.    •    Canada's  first clinical
professional doctorate  in  pharmaceutical sciences.    •    canada's
first meng program  in clinical engineering.    •    canada's only
graduate  program  in obstetrics and gynecology.
UBC's clinical engineering program trains graduates to -work in hospitals
and other health-care institutions -where they apply engineering principles to the
use and development of technology in patient care. A 12-month internship in one
of several B.C., Quebec and Ontario hospitals gives students experience in the
design,  development and management of technological devices,  such as imaging and monitoring systems, life-support systems, transportation devices,
communication aids and artificial limbs. Dr. Charles Laszlo, Department of
Electrical Engineering, is the director of this masters level program, which had six
students enrolled in 1991-92. While the clinical engineering program is primarily
aimed at engineering support in the clinical environment, a newly approved
Biomedical Engineering masters degree will educate engineers primarily in the
design functions in industry and biomedical research centres. It is intended to
increase engineering expertise and apply it to biomedical devices, and to create
high technology jobs in British Columbia.
Although there is no Department of Genetics at UBC, studies leading
to MSc and PhD degrees in genetics are available with faculty members in Animal
Science, Anthropology, Botany, Biochemistry, Forest Sciences, Medical Genetics,
Microbiology, Pathology, Plant Science and Zoology. The program is flexible to
accommodate the diverse backgrounds of students wishing to enter it and to take
account of the broad nature of genetic research. In 1991-92, 15 MSc and 33 PhD
students -were registered. Dr. Diana Juriloff, Department of Medical Genetics, is
the program chair. An MSc/PhD program in Medical Genetics approved in 1991 is
run by the Department of Medical Genetics in the Faculty of Medicine.
iSne i^/n<)&&6& c^<?7cecz6^ iLStevn&fori t-SledeezteM
This broadly based Institute, established in 1990, is coordinating research
relating to such topics as smoking cessation, lifestyle, diet and exercise from a
social science viewpoint, as -well as from a health sciences vantage point. Under its
new director, Dr. Lawrence Green, the institute is cooperating with groups at
Simon Fraser University, the University of Victoria and the B.C. Ministry of
Health to form a British Columbia Consortium for Health Promotion Research.
t^VeeeWtiez&ttce
This is a multi-disciplinary program involving 60 faculty members in 13
departments from the faculties of Medicine, Science and Arts. The objective of the
program is to educate neuroscientists with a broadly based knowledge and -with
intensive experience in at least one area of research. Core courses cover all aspects
of the discipline, from molecules to behavior, and students are expected to engage
in research from the start of their studies. Candidates can work towards MSc and
PhD degrees and are accepted from a variety of disciplines — Biology,
Biochemistry, Computer Sciences, Engineering, Mathematics, Neurosciences,
Pharmacology, Physics, Physiology, Psychology and Zoology. In the 1991-92 year,
13 MSc and 20 PhD candidates were listed. Dr. Christian Fibiger, Division of
Neurological Sciences, Department of Psychiatry, is the director.
In 1992, we will offer western Canada's first graduate program in
occupational hygiene. An endowment of $3 million from the Workers'
Compensation Board of B.C., matched by the provincial government, has allowed
us to create three new faculty positions, which -will complement existing expertise
in the area in the faculties of Applied Science, Medicine and Science. The
objective of the program is to train professional and academic occupational
hygienists able to identify and evaluate the risks of exposure to physical, chemical
cs and biological hazards in the workplace, and able to effect changes that will
eliminate or control these hazards. Dr. Susan Kennedy, Department of Medicine,
is the acting coordinator.!
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WE    AT    UBC    REMEMBER    HIM    AS    THE    VISIONARY    CREATOR    of  Concepts   that
aimed to revolutionize the way we teach health-care professionals.
Dr. McCreary joined our Faculty of Medicine in 1951 as head of the
Department of Pediatrics. From 1959 to 1972, he was dean of the faculty. From
1972 until his retirement in 1975, he was the Coordinator of Health Sciences, a
position created largely through his efforts and because of his beliefs.
As Dean of Medicine, Dr. McCreary recognized that increasing pressures on
physicians were demanding a change in the way medical students were taught. If
primary-care physicians were to continue to be effective, they would need to know
how to utilize the expertise of other health-care workers. It v/as Dr. McCreary's belief
that all health-care professionals had the same basic motivation but their separate
training programs did nothing to help them learn to work together in the real world.
In this regard, Dr. McCreary's goal was the creation of a Health Sciences
Centre, where students of various disciplines might learn together and perhaps
collaborate more effectively when they were qualified professionals. The process of
coordination was initiated by a committee in 1961. At that time, our students in the
health professions were separate — as if they were on different campuses. The first
effort to bring them together occurred in the planning of the Woodward Biomedical
Library, which provided space for students in all the health sciences. When the
Faculty of Dentistry was started in 1964, the first two years of its program were
made almost identical with Medicine's program, so that dental and medical students
were virtually inseparable. The Psychiatric Unit, a 60-bed hospital opened in 1968,
was jointly planned by all those who used it. And the 1972 Instructional Resources
Centre provided shared audio-visual facilities, lecture halls, and seminar rooms, as
well as offices for Health Sciences deans and directors.
The   Office  of  the   Coordinator  of   Health   Sciences,   created in  1970,
was the formal embodiment of Dr. McCreary's coordination efforts.  Its divisions set to work promoting interprofessional education on campus, health services
research and development, and continuing education for professionals. Today,
several of its original divisions have been amalgamated or discontinued. The
Division of Health Services Research and Development is now the Centre for
Health Services and Policy Research. It is physically located in the Coordinator's
Office and reports to a decanal committee chaired by the coordinator.
o^fc^s-fcfc^ cy&aMca&>M- t^/c^M&bef ant/.^//eve&femerzJ
In 1974, when this Division was established, its mandate was to provide
guidance and services to improve the quality of education in the health sciences.
Its personnel are trained in the process of planning, implementing and evaluating
instructional programs, and they work -with health professionals in developing
teaching materials, evaluating students, defining objectives and preparing research
proposals. Since 1986, it has added a funded-research focus to its service
component, and it has been highly successful in acquiring significant funding to
support this emphasis.
In the recent past, the division has introduced microcomputers into the
biomedical libraries at the university and the university teaching
hospitals for literature database searches and computer-assisted
instruction.  It has taken part in the review and revision of the health sciences
medical school curriculum. It offered two-day workshops in
effective teaching techniques. It processed students' evaluations of 1972-75
P1 ,. ti 11111- -1 IIP JOHN  F. MCCREARY
taculty teaching, lt has helped develop instructional modules lor
several   Faculty  of Medicine  departments.   For  off-campus harold copp
professional organizations,  Dr.  Gordon  Page,  director,  has 1977-84
. .        '. BERNARD RIEDEL
contributed to the development of tools to assess continuing 1984-85
competence. He has offered a -workshop to nursing instructors at peter larkin (acting)
the  British  Columbia Institute of Technology,  conducted an morton low
external review at Sherbrooke University's Faculty of Medicine, 1989.
J J J TJ j.' l-< •*.*. f    ,L r< J- PAUL ROBERTSON
and served on the executive Committee ol the Lanadian
Association of Medical Education, an organization set up to help
medical faculty become more effective in teaching.
A major project in the division has been the revision of the
fourth booklet of the Medical Council of Canada Qualifying Examination. Dr. Page
has been a co-principal investigator on this five-year funded project with Dr.
Georges Bordage of Laval University. The project began in 1987.
Begun   in   1968,   the  division provides  continuing  education  for  health u
professionals in or near the communities where they live as well as on campus. ^
Continuing education has been organized in Audiology and Speech Sciences,
Dentistry, Medicine, Nursing, Nutrition and Dietetics,  Pharmaceutical Sciences,
and Rehabilitation Medicine. More than 5,000 physicians, 7,000 dentists and 3,000 -
pharmacists as well as other health professionals participate annually in a variety q
of types of learning activities. They may attend lectures on campus or seminars in ■"
Hawaii. They may borrow videotapes to studyiindependently or sit in on audio-
teleconferencing lecture-demonstrations. As well, the division helps health
professionals in the community initiate their own continuing education activities.
One of the division's objectives is to stimulate learning among members of two or
more health professions. To that end, it held a four-day interprofessional conference
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on AIDS and Related Issues in the Native Community, the first conference of its kind
in Canada. Other similar events, held either on campus or in downtown Vancouver,
have had such topics as Demystifying the Burn Injury and Controversies in Diabetes.
Research grants have been obtained by division members to study an alternative
way of providing continuing medical education for geographically isolated physicians
and to develop a -way of assessing the continuing competence of pharmacists.
<Sceence& Ween:
The highlight of our efforts to stimulate interprofessional learning among
undergraduates is the Health Care Team Clinical Competition, which takes place
annually as part of Health Sciences Week in October. The idea of the competition
is to enhance students' knowledge about other health professionals and their
clinical roles. The two-hour public event involves three teams of nine students from
° the senior year of each UBC health science faculty,  school and department.  The
teams are organized by the Health Sciences Students Association. Presented v/ith a
hypothetical, complex case study, the teams answer questions that test critical
judgment in handling acute and and long-term care. "The Health Care Team
Clinical Competition is absolutely unique in Canada," says Dr. Ravindra Shah, who
chaired the 1990 competition committee. "We have received inquiries from other
post-secondary institutions across North America that would like to organize one
for their health sciences students."•
A NUMBER OF ACTIVITIES AT UBC ARE EXAMPLES OF A GROWING INTEREST IN
STUDYING THE LIMITS OF TECHNOLOGICALLY BASED MEDICAL CARE A IM D THE
SIGNIFICANCE OF THE BROAD DETERMINANTS OF HEALTH. DR. ROBERT EVANS'
PARTICIPATION IN THE POPULATION HEALTH PROGRAM OF THE CANADIAN INSTITUTE
OF    HEALTH    IS   ONE    EXAMPLE.
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Another is the multidisciplinary task force created on our campus to
look at ways of making communities healthier and better equipped to sustain
themselves in the future. In the first phase of this research program, eight faculty
members — from the Family Practice Unit, the schools of Rehabilitation Medicine,
Social Work, and Community and Regional Planning, the Centre for Human
Settlements and the Department of Health Care and Epidemiology — will spend
18 months looking at indicators of health in one rural and one urban community.
Recognizing that our society has long judged its progress in economic terms, this
task force will consider other indicators, such as infant mortality rates, longevity figures and the incidence of disease. To further test the communities'
sustainability, members -will gather data on commute times and the average
consumption of fossil fuels.
Yet another example is the 1991 conference sponsored by the university and the
local section of the American Industrial Hygiene Association, which focused on
health risks in the construction industry in an effort to better equip industrial
hygiene and safety professionals to recognize disease-causing materials and to
control exposure to them. Among the topics addressed were the potential dangers of
asbestos substitutes such as glass and ceramic fibres; excessive dust exposures from
concrete grinding; and asthma among painters and machinists. In this area, the
departments of Health Care and Epidemiology and Medicine have been funded by
the Workers' Compensation Board to study the effects of cobalt and other metals on
sawmill saw filers. Recently, UBC epidemiologists have conducted a $500,000 Health
and Welfare Canada study of B.C. sawmill workers exposed to chlorophenols.
Much of the activity in health promotion, health policy and health services
research springs from or is associated with our Department of Health Care and
Epidemiology in the Faculty of Medicine. The department has over the past 10
years increased the visibility of clinical epidemiology by providing in-depth
training to residents and by collaborating -with the teaching hospitals to enhance
the presence of clinical epidemiology in the hospital context. One example is the
Clinical Epidemiology Unit at Children's Hospital. The department's graduate
program in Health Administration is designed to provide the educational and
professional foundations necessary for those aspiring to management and
leadership positions in the health-care field. In addition, the department has an
MHSc program for physicians in the areas of clinical epidemiology, occupational
health and community health. Its MSc and PhD programs are designed to provide
needed research expertise for B.C.
Because -we feel that solutions to today's health-care problems will be found by
bringing together many disciplines, -we have recently created two new entities on
campus. Described below, the Centre for Health Services and Policy Research and
the Institute of Health Promotion Research strengthen our studies of the dynamic
bet-ween health and health care and our efforts to enhance the health of
communities and to use increasingly scarce health-care resources efficiently.
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Problems   in   the   delivery  of  health   services,  in the understanding of <
health and health-care system dynamics, and in the formulation and evaluation of ™
health policy transcend the traditional boundaries of academic disciplines. To examine i-
and solve these problems we must draw upon a broad range of disciplines and provide *
environments conducive to collaboration among them. The Centre for Health Services a.
and Policy Research provides a -way to facilitate team research in these areas. I
Launched in 1990, the centre grew out of a division that had been part of the ■*
Health Sciences Coordinator's Office since  1971.  It continues to be based -within T
tij
the office and reports to a decanal committee chaired by the Coordinator of Health =
Sciences. _
The division became home to several endeavors which are now part of the jj
centre:
The  Health  Human  Resources  Research  Unit:  Located in the  Health
Services  Research  Division since  1973,  it has eight full-time staff
members funded by the  ministry of health.  its activities include an g
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ANNUAL   STATUS   REPORT   ON   THE   PRODUCTION   OF   HEALTH   AND   HUMAN
SERVICES   PERSONNEL   IN   B.C.    IN   ADDITION,   IT   EXAMINES   SUCH   TOPICS   AS   THE
USE   IN   THE   PROVINCE   OF   O P H T H A L M O LOG I C A L   AND   OPTOMETRIC   SERVICES.
AN   EDITORIAL   OFFICE   OF   THE   INTERNATIONAL   JOURNAL   SOCIAL   SCIENCE
AND   Medicine:   IT   HAS   EDITORIAL   RESPONSIBILITY   for   SUBMISSIONS   in   t
area of health-care  economics.
health  policy  research  unit: with support from the vancouver
Foundation, the Woodward  Foundation  and the  Ministry of Health,
this  unit was  established in   1988.  its  members   ubc  faculty  from
the  departments of  health care and epidemiology,  pediatrics and
economics, the  faculty of commerce and the school of nursing 	
sponsor seminars and workshops, and produce discussion  papers
dealing with subjects such  as recent trends  in  caesarean  section
rates or the sources of increased hospital services  utilization
among elderly people in b.c.
the office of the  director of the  population  health  program of the
canadian  institute  for advanced  research:  dr.  robert  evans,
Professor of  Economics,  is the director of this program  which
focuses on large populations and on the factors that affect the
distribution of health within them.  research  in this  field aims to
increase  knowledge  about the  determinants of health and of the
measures that can  be taken to improve the  health of populations  in
Canada and other countries.
Office of Health Technology assessment: With  $250,000 in start-up
funds provided by the  Ministry of  Health, the centre  has
established this office to assess and  evaluate  new AND  EXISTING
HEALTH-CARE   TECHNOLOGIES.   A   QUARTERLY   NEWSLETTER   REPORTS   ON
SPECIFIC   TECHNOLOGIES.
With inter-disciplinary research as its major activity, the centre continues to
investigate in such areas as the socioeconomic determinants of health; the impact of
the health-care system on the health of populations; options for financing and
organizing the delivery of health care; and international comparisons of health-care
systems. It continues to develop its databases which have information on more than
30 health human-resource groups, on medical and hospital utilization, and on
hospital services and facilities for all Canadian hospitals for the past 30 years. The
databases are seen as a provincial and national research resource, among the
richest anywhere.
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In 1 990, through an endowment, UBC established the Institute of Health
Promotion Research as an entity in the Faculty of Graduate Studies. It provides a
focus for research, education, collaboration and service in the field of health
promotion. Linked to faculty members in the behavioral, biomedical, educational,
environmental and social disciplines, it aims to meet the challenge of improving
health and quality of life.
Its goals include developing, evaluating and diffusing effective methods of
promoting health; integrating health promotion into the clinical education of
health professionals; and extending research and teaching at UBC into health
promotion and into the evaluation of health promotion programs and policies. It
-will develop an MSc/PhD graduate program and expects to take in students by
September, 1992.
The institute had its genesis in the Division of Health Systems, established by
Dr. John Milsum. Now retired, Dr. Milsum -was the institute's acting director and worked -with  Dr.  Morton  Low,  then  Coordinator of Health  Sciences,  to get
Ministry of Health funding for the institute's first five years.
The institute's first director is Dr. Lawrence W. Green, -who was appointed in
July, 1991. Dr. Green recently completed three years as the Kaiser Family
Foundation's vice-president and director of the Health Promotion Program. Prior
to coming to UBC, he -was a Visiting Research Social Scientist with the Institute
for Health Policy Studies at the University of California, San Francisco. He has
served on the public health faculties at Berkeley, Johns Hopkins, Harvard and the
University of Texas and on the medical faculties at Johns Hopkins, Harvard and
the University of Texas. From 1979 to 1981, Dr. Green served in the Carter
administration as the first director of the Office of Health Information, Health
Promotion, Physical Fitness and Sports Medicine. At the University of Texas
Health Sciences Center at Houston from 1981 to 1988, he was the founding
director of the Center for Health Promotion Research and Development.!
DO YOU OIVE A KIDNEY TRANSPLANT TO AIM U N REGE N E RATE ALCOHOLIC? WHICI
CASES OF GENETIC ABNORMALITY JUSTIFY TERMINATING A PREGNANCY? IF A CHILI
HAS HAD TWO LIVER GRAFTS AND THE SECOND FAILS, DO YOU SEND THE PATIEN
FOR   A   THIRD       AT   A   COST   OF    $300,000?
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These are the kinds of crucial ethical questions that health-care
practitioners are increasingly being asked to weigh and decide. Recognizing the
profound need to provide a forum for students and graduates to consider these
issues in a structured and informed context, the university has been offering
courses in biomedical ethics both to those within and those outside the health
sciences. We are in the process of launching the centre for Applied Ethics, one of
the few such centres in Canada, as a formal entity -within the Faculty of Graduate
Studies. Designed to offer inter-faculty, campus-wide intellectual leadership in the
field, including business and professional ethics, the centre has mounted a
campaign to actively seek funding for a Chair in Biomedical Ethics.
Dr. Vincent Sweeney, Professor of Neurology in the Department of Medicine,
was a member of the centre's organizing committee. "This is a field whose time has
come," he says. "It's an ever-increasing problem with medical technological
advances and our ability to keep people alive -with a high degree of secondary
misery. There is tremendous interest in the subject on the part of the public and the
professions." Most major hospitals in the U.S. and a few in Canada have clinical
ethicists on staff.
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ma Dr. Sweeney, -who formalized his own training -with studies of moral philosophy
at Oxford and the Kennedy Centre of Ethics in Washington, D.C, has helped to
create' compulsory courses for first- and fourth-year medical students, -which -will
eventually be offered to those in the intervening years as well. For the past decade,
an introductory course for interns has included two days of medical ethics. More
recently, a 12-hour course has been given to first-year students, -who learn by case
example in small groups led by a team of two facilitators, one a physician, the other
from various caring professions. The non-medical facilitators come from the areas of
philosophy, theology, nursing, law, medical administration and hospital pastoral
services. The current cadre of about 50 facilitators attend their own unique course
of instruction, an annual evening of presentations on the teaching of applied ethics.
The issues raised range from non-initiation of treatment to withdrawal of life-
support systems, from new reproductive technology to living wills.
The Royal College of Physicians and Surgeons of Canada recently announced
that medical schools must soon provide a post-graduate program in
medical ethics for its specialist members — a challenge that Dr.
Sweeney says UBC will meet. Meanwhile, the university is seeking
funds to expand the undergraduate courses into other health-
science disciplines, such as nursing, dentistry, pharmacy and
rehabilitation medicine.
IE    PROBLEMS
ARE   ABORTION,    DEATH
AND    EUTHANASIA
GENETIC    ENGINEERING,
BEHAVIOR
MODIFICATION,
COMPULSORY
TREATMENT
EXPERIMENTATION
IN    BEINGS
AND   ANIMALS,   AND
THE    RELATIONSHIP
BETWEEN
PROFESSIONALS    AND
SIR    PATIENTS,
SUBJECTS    OR    CLIENTS
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Nursing and pre-med students constitute the largest groups
among the 500 who each year take a similar course offered by the
Philosophy Department. About the same time Dr. Sweeney was
helping to launch the co.urse for interns in the Faculty of
Medicine, Dr. Earl Winkler, Professor of Philosophy, created a
Bio-Medical Ethics course within his department. "At the time,
public debates were raging and there was more and more in the
media about such issues as abortion and euthanasia," he recalls. In
its first year, the course attracted about 35 students; demand has
since far exceeded supply for a course that is taught in several
sections, days and evenings, throughout the year.
Its content covers moral problems arising in the health sciences,
especially in medicine but also in biology, psychology,  social -work
and other professions, which are considered both concretely and in
relation to general ethical theory. Among the problems are abortion,
death and euthanasia, genetic engineering, behavior modification,  compulsory
treatment,  experimentation -with human beings and animals,  and the relationship
between professionals and their patients, subjects or clients.
Dr. Winkler -was a pioneer planner of the new UBC Centre for Applied
Ethics. Today, he is a Senior Research Fellow in the centre, which he says not
only provides inter-faculty synergy in research, teaching and consulting to the
community, but also serves to coordinate national efforts in the area of applied
ethics. Its founding director, the first occupant of the Maurice Young Chair in
Applied Ethics, is Dr. Michael McDonald. As an associate professor of Philosophy
at the University of Waterloo, he -was the principal author of a report by the
Canadian Federation for the Humanities to the national Social Sciences and
Humanities Research Council. The report motivated the council to establish a
strategic research theme in applied ethics. Dr. McDonald, president of the
Canadian Philosophical Association, came to UBC in 1990. His mandate has been to create a centre that will develop a serious research
capacity -while serving various disciplines in the applied-ethics field, including the
health-oriented faculties in both their health-science and health-caring aspects.
"We intend to create a credible research base that will form the intellectual
foundation for teaching and consulting and help us attract good students and
researchers." Dr. McDonald stresses the importance of building and maintaining
strong links -with the university's teaching hospitals and health professionals'
organizations. As -well as offering workshops and organizing a graduate-level
seminar course in applied ethics that began in the fall of 1991, the centre's staff is
consulting to medical students, nurses, rehabilitation therapists and various public-
interest groups. •
UBC    HAS    SEVEN    AFFILIATED    TEACHING    HOSPITALS WHERE    FACULTY    MEMBERS    TRAIN
DOCTORS, DENTISTS, PHARMACISTS, IM U R S E S , NUTRITIONISTS AND D I E T I T I A IM S ,
SPEECH! PATH O L O CS I STS AND A U D I O L O G I S T S , O C C U P A T I O IM A L AND PHYSICAL
THERAPISTS,    SOCIAL   WORKERS    AND    PSYCHOLOGISTS.
X. ^tMWsm 4& ^Sik^MtS-
Several faculties have a major presence in these teaching hospitals.
Twelve of the 17 departments in the Faculty of Medicine are located wholly or
substantially in hospitals affiliated with us, and several of these departments have a
presence in more than one hospital.
The UBC Department of Medicine, the largest department in the faculty,
conducts academic activities in space provided by the B.C. Cancer Agency, St.
Paul's, the two sites of University Hospital, and Vancouver General Hospital.
Organized into 13 specialty divisions, this complex department provides state-of-
the-art patient care for B.C. residents.
The Faculty of Dentistry trains general practice residents at four hospitals,
-where it provides in-patient and out-patient services, maintaining operating rooms
designed and equipped for oral surgery and dental laboratories. In these hospitals,
it gives specialized treatment for cancer patients, children and the elderly. At
University Hospital, it maintains clinics for oral mucosal disease, facial pain and
jawbone-joint disorders.
The Faculty of Pharmaceutical Sciences has clinical faculty members in every
hospital in the Lower Mainland. They work closely -with physicians, suggesting
drug therapy and monitoring it. The faculty's Drug and Poison Information Centre
operates at St. Paul's Hospital.
Beyond these patient-care activities, UBC faculty do research in the hospitals.
Some of it is basic-science research  —  as fundamental as that undertaken in our
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campus laboratories. Some of it is clinical in nature, depending upon an interaction
between investigator and patient. Much of it brings the latest medical advances
directly to patients who are ill today.
The investigators profiled on the folio-wing pages either head large UBC
research endeavors in the hospitals or lead large groups of colleagues involved in
national research net-works.
Vancouver General Hospital is a 1,100-bed facility on a 35-acre site in
central Vancouver, a tertiary-care referral hospital for all of British Columbia and
one of the most modern referral and trauma health-care centres in Canada. UBC
has been associated with VGH since 1919, -when the first university nursing school
in the British Empire was created. In 1950, the university used clinical facilities on
the hospital site and a team of medical specialists -with dual appointments -was
named to head the various departments at the new medical school and the hospital.
Today, UBC/VGH departments of Medicine, Surgery, Anesthesia, Pathology
and Psychiatry are housed in academic and office space in the hospital's Emergency
Centre; some UBC medical departments have their offices entirely on site. The
university conducts research in the hospital, much of it advanced in nature, as
recorded throughout this report.
The -work of the folio-wing UBC profesjsors — in areas as disparate as organ
transplants, ophthalmology and toxic shock — merely suggests the variety and
quality of the groundbreaking research being done at Vancouver General.
Paul  Keown  and the  University Centre
for Transplantation Immunology
In THE PAST THREE YEARS, B.C.'s organ transplant program has become one of the
biggest in Canada. The success of renal transplants -within the province equals or
exceeds that of major units throughout the world. Heart, lung, liver and heart-lung
transplants, previously done exclusively outside the province, are performed now
in units at Vancouver General Hospital, British Columbia's Children's Hospital and
St. Paul's Hospital, with regional transplantation units being developed in Victoria,
Prince George, Kamloops, Kelowna, Penticton and Trail. UBC participates in every
facet of this program.
Dr. Paul Keown, professor of Medicine in our Division of Nephrology, is
director of the B.C. Transplant Society, a comprehensive health organization that
brings together the activities of the Ministry of Health, the British Columbia
Health Association, the health-care professions and UBC in the provision of
organ transplants and care of patients -with vital organ failure.
The society administers the University Centre for Transplantation
Immunobiology. Located at Vancouver General Hospital, the UBC centre
encompasses research, teaching and clinical care. Within the clinical sphere, it
draws on five Faculty of Medicine departments: Surgery, Medicine, Pediatrics,
Pathology and Anethesiology. Research projects involve these departments as -well
as people in Chemistry, Physiology, Nursing, Economics, Philosophy and the
Faculty of Pharmaceutical Sciences. University Hospital -
Shaughnessy site is
home to one of
Canada's leading
spinal cord injury
treatment centres,
with over 220
patients a year.
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IERE    ARE    SEVERAL
MAJOR   PROJECTS   UNDER
WAY   AND   PROPOSED
THEY   INVOLVE
DEVELOPING   DIFFERENT
KINDS   OF   TRANSPLANTS
IMPROVING   THE
STORAGE    OF    ORGANS,
It -was this rich pool of expertise at UBC that attracted Dr. Keown away from
the University of Western Ontario, which for many years had had the largest
transplant program in the country. "When I came here," he says, "I think perhaps
the single determining factor was the depth of academic ability at UBC. There's no
comparison; the opportunities here far exceed anything -we ever had in London."
Having spent three years getting B.C.'s clinical program going and having seen
it equal in size the top five or 10 per cent in the world, Dr. Keown anticipates an
equally rapid growth in research. There are several major projects under -way and
proposed. They involve developing different kinds of transplants, improving the
storage of organs, and overcoming the problem of rejection by altering immunosuppressant drugs or by manipulating the immune system.
Dr. Keown foresees a revolution in the treatment of vital organ failure. With
the 90-per-cent success of kidney transplants, he predicts the demise of expensive
chronic dialysis. Pointing out that the number of needed hearts -will always exceed
those available, he predicts the reinvention of totally implanted cardiac devices and
the cloning and growth of whole organ structures in vitro. "That
relies upon the discovery of the differentiation factors in tissue
development," he admits. "But just as surely as the understanding
of the communication between lymphoctes and the immune
response has come, so an understanding of tissue differentiation
will come. We -will then have replaceable parts — banks of organs.
We will be able to match them or adjust the immune response of
the recipient. So everything we do now -with crude immunosuppression will be a horror story of the past."
Dr. Paul Keown id professor of Medicine in the Division of Nephrology
and director of the British Columbia Transplant Society.
AND   OVERCOMING
IE   PROBLEM   OF
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REJECTION    BY   ALTERING
IMMU NO-SUPPRESSANT
tUGS   OR   BY
IMMUNE    SYSTEM.
Max Cynader and the VGH/UBC Eye Care centre
Sick neurons in THE VISUAL CORTEX are the focus of Dr. Max
Cynader's -work, and basic science research is what he does. But
he and his research team wanted the chance to work in a hospital
with specialists -who are treating interesting clinical problems.
"Basic sciences have tremendous technology but -we often lack the
detailed knowledge of clinical problems," he says. "The physicians
out there in the trenches know what the problems really are."
And so, offered the opportunity to direct research in our
Department of Ophthalmology, which functions in the VGH/UBC Eye Care Centre
in the general hospital, Dr. Cynader made the move from Dalhousie University to
UBC in 1988. He brought with him four colleagues — Dr. Christopher Shaw, Dr.
Nicholas Swindale, Dr. Robert Douglas and Dr. Joanne Matsubara — all now on
our faculty.
Not an ophthalmologist but a neuroscientist, Dr. Cynader finds himself leading
a group that includes medical doctors -working on PhDs or doing research at the
interface between basic and clinical science, as well as graduate students in several
different departments — Electrical Engineering, Computer Sciences, Pathology,
Psychology and Neuroscience. Approximately 40 people are in the group.
On the medical side, their research has relevance to conditions such as
strabismus (crossed eyes) or amblyopia, -which is reduced vision in an eye that
appears to be structurally normal. (There are five million amblyopics in North
America.)  On the computational side,  it is of interest to those -who are trying to build visual processing machines. And, if a way can be found to regenerate activity
in neurons, it may have relevance to diseases such as Alzheimer's and Parkinson's.
Basically, Dr. Cynader's team is trying to find -ways of seeing neural activity in
real time and regenerating neurons that aren't working. He explains that if for
some reason an eye doesn't -work, it loses access to the cortex. "It's like survival of
the fittest," he says. "This eye is not giving useful information and so the brain
-won't devote a lot of space to it." Dr. Cynader's two-pronged approach to his
research involves using fluorescence imaging to see neural activity and using
viruses to transfer genes into populations of non-functioning neurons with the idea
of causing them to regenerate.
"Other people are trying to transplant neurons, which I think is not really the
answer," he says. "What we'd like to do is get the neurons that are in there to make
new products." Although there are four other groups in the world -working in the
same area, Dr. Cynader feels that the UBC group has the combination of talents
necessary to succeed.
Dr. Cynader explains that there is a critical period in youth when the eye can
still regrow connections to the brain. "What I hope to do in the next 10 years is to
extend the critical period into adulthood. We will insert genes
into specific populations of neurons and get them to express
genes they may once have expressed but don't express anymore.
So -what -we're doing is positioning ourselves to be able to go in
there and manipulate the brain."
Dr. Cynader's lab has eight major grants. Two from drug
companies allow the lab to follow a bit of a tangent. Both
companies are supporting research looking at important
molecules -within the human eye. Diseases like glaucoma, diabetic
retinopathy and retinitis pigmentosa are the eventual targets of
this research. With a new confocal microscope, UBC researchers
are able to examine a cross-section of the eye and see -where
treatment drugs are actually processed — where the receptors
are. "People have been getting beta-blocking drugs for glaucoma
for 50 years," says Dr. Cynader. "But this has never been done.
It's amazing."
Dr. Cynader participates in two Canadian Net-works of Centres of Excellence,
in the Canadian Institute for Advanced Research's Artificial Intelligence and
Robotics program and in The Human Frontiers of Science program, -which melds
international research teams. In the latter, his lab and four others in Japan,
England, France and the United States are examining mechanisms of plasticity and
principles of neuronal computation in the cerebral cortex. An outcome,
advantageous to his research, is the sharing of frozen brain tissue from Japan. The
Japanese, he explains, are leaders in being able to culture pieces of brain so that
they grow together, allowing investigators to -watch as connections are made.
Understanding the principles of computation in the cortex contributes to yet
another research theme: building a vision system — a computer that can see. The
Cynader team has already improved present image-processing systems by
suggesting that designers should mimic the human eye's ability to compute how
curved something is. Dr. Cynader predicts that the development of seeing-eye
machines capable of such tasks as reading x-rays will have profound implications
for health-care delivery. "Ten years from now, I would hope that we -would have
seeing machines that would resemble  nothing so much as the  structure  of the
CYNADER'S   LAB
EIGHT   MAJOR   ORAI
TWO    FROM    DRUG
COMPANIES   ALLOW   THE
LAB   TO   FOLLOW   A   BIT   OI
A   TANGENT.
COMPANIES   ARE
PPORTING   RESEARCH
LOOKING   AT    IMPORTAI
MOLECULES   WITHIN    THE
HUMAN    EYE.
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CLINICIANS    SO   THAT   WE
CAN   VERY   RAPIDLY   BRING
human cortex, and that this will emerge from an understanding of how the cortex
— the biological system — processes information, and from synergistic interaction
between biologists, engineers and computer scientists."
Dr. Cynader is British Columbia Fellow, Canadian Institute for Advanced Research,
Professor and director of Research in the Department of Ophthalmology, and professor of
Psychology and Physiology.
Anthony Chow and the G.P. strong
INFECTIOUS   DISEASE   RESEARCH   LABORATORIES
Dr. ANTHONY CHOW IS AN EXAMPLE OF A RARE BREED in Canadian medical research
— the clinician scientist. He might very well, as he says, hide away in a basic
science laboratory doing his research -without interruption, but he functions in a
hospital where patients give a life-and-death urgency to theoretical pursuits. "We
woulddike to bridge the gap between the scientists and the clinicians so that we can
very rapidly bring new discoveries in the laboratory to the bedside, and at the same
time be able to take the problems from the bedside into the research laboratory."
The problems encountered at the bedside by Dr. Chow and
"we would like to his colleagues in the Division of Infectious Diseases can be very
urgent indeed. Dr. Chow's expertise is in gram-positive bacteria,
BRIDGE   THE   GAP   BETWEEN loll 1     c
such as Staphylococcus and Streptococcus, micro-organisms
responsible for a host of problems but most dramatically for
toxic shock, which can kill so rapidly. Working on three levels —
at the molecular level, in animal models, and in patients — Dr.
Chow and his colleagues seek to understand the pathogenesis of
NEW   DISCOVERIES   IN   THE .-11 1    ,
toxic shock and to test new treatments.
laboratory to the Based on new understanding of the interaction  of gram-
bedside, and at the positive bacteria and the immune system,  Dr.  Chow and clinical
m professors  Dr. Martin Tweeddale and Dr.  James  Russell are
-J SAME   TIME    BE   ABLE   TO . , ... r. .        ,
J conducting a trial or an exciting therapy never  before tried on
a. take the problems from        patients in Canada. The current thinking about shock syndrome
x the bedside iNTo the is  that g r am - p o s i t i v e  bacteria produce  proteins  that  over-
stimulate the immune system's monocytes and lymphocytes,
causing them to make substances that are harmful to the patient
rather than beneficial. The UBC researchers will treat patients
with a monoclonal antibody which is directed at one of the substances produced by
the monocytes. "For the first time we may have a substance that can act on both
gram-positive and gram-negative bacteria," says Dr. Chow. "Here is an example
where you start by understanding the pathogenesis, go through the animal model
system, and then to the patient population, within a period of 10 years."
Another area of Dr. Chow's investigative activities, -which is more clinical in
nature, involves controlling infections that develop in hospitals. Because hospital
patients -who are weakened by surgery or potent immuno-suppressant drugs are
very susceptible to infection, improving precautionary procedures is critical. Dr.
Chow chaired a -working group set up by Health and Welfare Canada to devise
infection-control guidelines for Canadian health-care facilities. He has, as well,
participated with UBC colleagues in the Department of Health Care and
Epidemiology, the Department of Statistics and the Division of Medical
Microbiology in a survey of the impact on Canadian acute-care hospitals of
recommended universal infection-control precautions. "In the age of AIDS," he
says, "we find that Canadian hospitals are not coping very well." In a second phase
RESEARCH    LABORATORY.' of that study, intensive care units in several hospitals -will be studied. A third phase
■will focus on the unit's own intensive care unit, examining the incidence of and
trying to prevent infections from intravenous catheters.
In yet another area of research interest, Dr. Chow is involved in new-drug
development. "We are in a unique position to determine what diseases require
newer treatments, to evaluate new drugs, and to encourage the development of
drugs for diseases for -which there is no treatment available." Recently, Dr. Chow
-was the only Canadian appointed to an American committee set up by the Food and
Drug Administration along with the Infectious Disease Society of America to
recommend standards for the development of new drugs. In this instance, he
chaired a subcommittee on respiratory remedies, making recommendations that
have been incorporated into FDA regulations.
Dr. Chow conducts his studies of the pathogenesis of toxic shock with two
major grants. Within the Canadian Bacterial Diseases Network, his research
involves the genital tract as a target for toxic shock. His MRC grant work looks at
the blood stream as the target.
Clinician-scientists like himself are finally being accepted, says Dr. Chow.
Physicians see that there are practical applications of scientific research, and patients
prefer to go to a place -where research is going on because they will be examined much
more critically. "In 10 years -we have made tremendous strides in being understood for
-what -we are trying to do," he says. "It's an exciting time to be a researcher."
Dr. Anthony Chow is professor of Medicine, head of the Division of Infectious Diseases in
the Department of Medicine, director of the G.F. Strong Infectious Disease Research
Laboratories at the Vancouver General Hospital, and UBC coordinator of the Canadian
Bacterial Diseases Network.
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Located near the very heart of downtown Vancouver, St. Paul's suffers and
surmounts the classic stresses of the inner-city hospital. But its central site, and the
array of patients it attracts, offer advantages to the UBC care-givers, teachers and
researchers -who serve its 22,000-plus patients each year.
In its recently adopted strategic plan, the hospital reaffirmed its commitment to
increased involvement as a teaching hospital for UBC. Most of the medical staff
members are active in teaching undergraduates and postgraduates and providing
continuing medical education to doctors and other health professionals throughout
B.C. St. Paul's strategic plan also emphasized its strengths as a comprehensive
community health centre and its leadership in cardio-vascular, thoracic and critical
care; digestive and nutritional disorders; geriatrics; endocrine, kidney disorders and
transplantation; and HIV and related viral diseases.
UBC medical researchers have long had a profound relationship with the
hospital. Currently, St. Paul's takes particular pride in Dr. Jim Hogg's Pulmonary
Research group, which plays a vital role in the National Centres of Excellence
Respiratory Diseases Network; and in the HIV Disease team, led by Drs. Julio
Montaner, John Ruedy and Martin Schechter, which has been selected by Health
and Welfare Canada as the National Coordinating Centre for clinical trials in HIV
disease. These UBC faculty members are profiled below.
mm
O
m Julio Montaner, John Ruedy and martin schecter and
the Canadian HIV Trials Network
AIDS RESEARCH AT UBC is one of the strongest programs of its kind in the
country. It is fostered by collaborations among members of the departments of
Medicine, Pathology, Health Care and Epidemiology, and Botany. UBC faculty
members participate on provincial, national and international advisory committees.
At St. Paul's Hospital, three UBC investigators lead a clinically based national
attack on AIDS. Dr. Martin Schechter is an epidemiologist who is on the World
Health Organization's Steering Committee on AIDS Epidemiological Research. Dr.
John Ruedy is head of the Department of Medicine at St. Paul's Hospital and
specializes in clinical pharmacology. Dr. Julio Montaner, whose expertise is in
respiratory medicine, conducts trials for the national net-work these three
investigators have developed with federal funding.
By 1982, Dr. Schechter was directing the Vancouver Lymphadenopathy-AIDS
Study, now one of the oldest and largest studies in Canada. He explains that the
name of the study is a throwback to the days -when patients appeared with
lymphadenopathy, or swollen glands, but were not yet developing AIDS. "We have
assembled a cohort of 700 gay men who are seen by family doctors at St. Paul's,"
says Dr. Schechter. "Half of them are infected and -we are monitoring their clinical
condition. The others are HIV-negative and we are rating new infections, risk
factors and behavioral changes."
at st. paul's The general objectives of the study, which is supported by $2.4
million from National  Health and Welfare,  are to investigate the
REE °
natural history,  epidemiology and modes  of transmission  of HIV
HOSPITAL,
IBC    INVESTIGATORS
■■■ ~ '    " infection and to develop mo.dels  of the likely progression  of the
LEAD   A   CLINICALLY
ATTACK   ON    AIDS.
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disease. The study has demonstrated a fact of relevance to the study
„_,._~ „„,..,^„«. of the role of the immune system: among those infected for the same
BASED    NATI^>NAL J o
amount of time,  some have been able to  contain the virus while
others  have  not.   It  suggests,   says  Dr.  Montaner,  that there  is
something right about the former group.
Like most physicians, the Vancouver researchers were slow to recognize the
implications  of HIV infection.  "We didn't know in the beginning that we were
involved with a serious epidemic," says Dr. Montaner. "We were dragged into HIV
care by the fact that we were in the West End hospital, which serves the population
at risk." Becoming more interested and supportive as they dealt with patients, Drs.
Montaner,   Schechter and  Ruedy sought a way to treat Pneumocystis carinii
pneumonia — or PCP  — which is the disease that brought most HIV patients into
hospital. They began using anti-inflammatory medication to mitigate the symptoms
of PCP.  This form of treatment,  questioned for several years by some American
researchers, has been proven effective in other centres and has now been adopted
by the National Institutes of Health in the United States.
At the same time, they found that aerosolized pentamidine provided an 80 per
cent protection against PCP relapse. This has become a standard mode of
preventing PCP. "When we started fighting against PCP, it had a very dismal
prognosis," says Dr. Montaner. "We have modified the mortality rate and we have
modified the recurrence rate very dramatically."
By 1983, the cause of AIDS was thought to be the HIV virus, and the drug
zidovudine (previously known as azidothymidine or AZT) -was being tested in the
U.S. and used on patients in an advanced state of disease. Drs. Ruedy and
Montaner decided to investigate the use of the drug in people in earlier stages. They set up a multicentred Canadian trial with 72 subjects, which is now the
longest-running therapeutic study of AZT, boasting a group of patients who have
lived the longest on the drug.
As a result, Dr. Montaner says, they have been able to monitor its long-term
effectiveness and have demonstrated that the virus learns biological tricks to deal
-with the drug. Now, warned that early administration of AZT may not be the
answer, the UBC team is looking at another compound — dideoxyinosine or ddl —
-which they are giving on a compassionate basis to 700 Canadians -who cannot
tolerate AZT or who are failing on it. They are considering two approaches to get
around the body's ability to develop resistance to AZT — early intervention with
ddl or alternating use of both drugs.
Because AIDS patients develop many different types of problems, the UBC
group is promoting trials of therapies for sarcoma, gastro-intestinal complications
and bone-marrow malfunctions.
Dr. Schechter is also an investigator in the B.C. Prenatal Survey, -which is
anonymously screening blood specimens obtained from all pregnant women in the
province in order to establish an estimate of the extent of HIV infection in this
group. Bet-ween April and September, 1989, more than 22,000 specimens tested
revealed that in Vancouver and Victoria, roughly one in 1,200 -women aged 15 to 29
-was infected. "Pregnant -women are a biased subset in that they usually don't have
multiple sexual partners," says Dr. Schechter. "That figure is quite a surprise. It is
higher than -we suspected."
Internationally, Drs. Schechter and Montaner have collaborated with the Pan
American Health Organization in the development of a case definition that is being
used for surveillance purposes in South and Central America. For the World
Health Organization, they developed a procedure for staging treatment based on
clinical features rather than on laboratory blood tests which may not be available
in some parts of the -world.
UBC researchers have made some progress in treating AIDS and in slowing
its progress. As a result, says Dr. Montaner, AIDS patients are surviving longer,
living better and being hospitalized less often. But he -warns, "AIDS remains a
lethal, fatal disease."
Dr. Martin Schechter is an associate professor of Health Care and Epidemiology. Dr.
John Ruedy is professor of Medicine and head of the Department of Medicine at St. Paul's
Hospital. Dr. Julio Montaner is an assistant professor of Medicine.
James  Hogg and the Canadian
respiratory diseases network
Dr. James HOGG is a pathologist — a basic scientist whose research is
conducted in a hospital where he has access to human tissue and to patients -with
obstructive-air-ways disease -which is the focus of his work. Obstructive-airways
disease is the medical term for conditions that create an obstruction of the
respiratory tract — diseases such as cancer, emphysema and asthma.
Although he doesn't study lung cancer per se, the effects of cigarette smoking on
the lung are part of his research, and his presence in St. Paul's Hospital, where there
are 500 admissions for lung cancer every year, has given him a unique opportunity to
correlate lung structure and function. Since only 10 per cent of lung cancer cases are
operable, approximately 50 lung resections are done in a year at St. Paul's. Most of
those cases involve only small peripheral tumors, but because an entire lobe must be
removed, a great deal of normal tissue is made available for study.  Before the
o
CQ IOGG   AND
GROUP    HAVE    SET    UP
A   MOLECULAR
BIOLOGY
operation, most patients are willing to participate in studies of their function. Having
done this now for 10 years, Dr. Hogg and his team have 450 cases in their study. "I
think -we have the biggest study in the world by far in terms of the structural-
function relationships in obstructive lung disease," he says.
Over the years, Dr. Hogg has been able to look at a number of aspects of the
pathogenesis of chronic obstructive lung disease. The most interesting thing about this
disease, he says, is that not all heavy smokers get it. About 30 per cent do. His current
hypothesis is that those -who get air-ways obstruction have latent viruses living in their
lungs. Most of his studies have been done on the adenovirus — which is a family of
viruses that cause upper respiratory infections — and on respiratory syncytial virus,
which is a common cause of epidemics of acute bronchiolitis, bronchopneumonia and
the common cold in young children and sporadic acute bronchitis in adults.
Having shown that patients -with airways obstruction have more adenovirus
infection,  Dr.  Hogg and his group have set up a molecular biology laboratory,
funded through the National Centres of Excellence, to study how the virus acts on
lung tissue. "We all get viral infections and -we throw them off," he explains.  "But
sometimes some viruses hang around, and they may interact -with the
smoking to produce the inflammatory reaction in the peripheral areas
that we think causes air-ways obstruction.  The virus can sit in your
airways and produce the proteins it needs for reproduction without
reproducing. Some of these proteins have very interesting properties
that  can  sensitize your  cells.   So  that means when you  smoke
cigarettes and get a little inflammatory reaction, the virus might make
LABORATORY, O O J O
the tissue much more sensitive by producing this protein."
FUNDED   THROUGH tt    • 1   ■ , J j 1      ,      j ,1 j.    1 A
Using his computerized records accumulated over the past  10
the national years,   Dr.  Hogg can  easily match and compare  smokers -with  or
-without airways obstruction and then analyze their filed tissues. "I
believe that -we are the only people in the world -who have this
opportunity at this moment," he says. In recognition of their
international excellence, Dr. Hogg's group has been asked to
x virus acts on function as the pathology core for a University of Iowa study funded
by the National Institutes of Health in the United States.
Dr. Hogg's laboratory has ongoing projects on asthma, including
building a computer model of the condition. Some patients whose
lungs are in the tissue bank also had asthma, which has provided an opportunity to
study asthmatic air-ways and measure their characteristics. "We think," says Dr.
Hogg, "that our lab has pointed out more than any other lab that asthma is not
necessarily a smooth muscle disease. Most people think you get bronchial
constriction because the muscle function is abnormal. Our data have shown that
the major problem is the airway becomes thickened by an inflammatory reaction.
Then normal smooth muscle contraction can narrow the air-way." Dr. Hogg says
that information suggests that therapy should also involve anti-inflammatory
agents. In this research, Dr. Hogg has been a consultant on an asthma study in
New Zealand, where two hospitals have been collecting tissue and sending it to him
for examination.
Dr. Hogg's other area — the kinetics of neutrophils — is important in
emphysema. Neutrophils are protective -white bloods cells -which, -when needed,
migrate from vascular spaces into tissue, pick up microorganisms and eat them. To
do this they produce very powerful enzymes. Neutrophils are concentrated in the
lungs, and it is Dr. Hogg's hypothesis that cigarette smoking delays the movement
CENTRES   OF
EXCELLENCE,
O
LUNG   TISSl of the neutrophil, allowing it to be activated within the vascular space where it
releases its enzymes, -which cause tissue damage. "I think this hypothesis is unique
-with us," he says.
In collaborative -work with the hospital's intensive care unit, Dr. Hogg is also
looking at the role neutrophils play in adult respiratory distress syndrome, which
can occur as a result of trauma or sepsis elsewhere in the body. Dr. Hogg suggests
that activated neutrophils delayed in their passage through the lungs release their
enzymes, destroying the lung's surface and producing a hemorrhagic pulmonary
edema that causes respiratory failure and death (in half those stricken). As a
method of predicting -who will get ARDS, UBC professors at St. Paul's are
labelling neutrophils with isotopes and following their movements through the
lungs. They are part of a National Institutes of Health clinical trial of therapies.
As part of the pathology department's outreach, pathologists anywhere in the
province can consult Dr. Hogg if they have problem cases. Over the years, he has
accumulated files on 1,500 such cases. "We have seen almost every kind of lung
disease you could possibly imagine," he says.
Dr. James Hogg is a professor of Pathology and Vancouver coordinator of the Canadian
Respiratory Diseases Network.
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The goal was straightforward: to establish a Cancer Research Centre of
international renown. UBC was one of the partners in 1979 -when the B.C. Cancer
Foundation opened the centre on a former Vancouver bakery site, in collaboration
-with the Canadian Cancer Society and an organization that has since been renamed
the B.C. Cancer Agency. The provincial government agency, which is responsible
for the diagnosis, treatment and prevention of cancer in the province, operates a
teaching hospital in which UBC carries out teaching and research.
While UBC faculty members undertake cancer research in other locations,
such as Children's and Vancouver General hospitals, they do the majority of such
■work at the Cancer Research Centre and the adjacent A. Max-well Evans Clinic.
There, scientists and physicians investigate new cancer drugs and treatment
protocols; study the incidence of cancer in society and the workplace; and work to
solve the puzzle of how and -why the disease originates.
Their research protocols have won global acclaim. Among the trailblazers is Dr.
Hans Stitch, who founded the centre's Environmental Carcinogenesis Unit in 1968
-when he joined UBC's cancer research group, headed by the eminent researcher Dr.
Robert Noble. Working -with tobacco-chewing populations in such developing
countries as the Philippines and India, Dr. Stitch and his ECU team proved
conclusively that pre-cancerous lesions — indicating tissue damage that -would
eventually become cancerous —would respond well to Vitamin A and Beta-
Carotene, found naturally in such tropical plants as red palm oil and sweet potatoes.
With Dr. Stitch's planned retirement, the ECU has dissolved. Advanced
research continues in the centre's remaining six divisions: a medical biophysics
unit; epidemiology, biometry and occupational oncology; advanced therapeutics;
cancer endocrinology; and the Terry Fox Laboratory.
Dr. Allen Eaves and the Terry Fox Laboratory
UBC's Division of Clinical Hematology, which incorporates staff at the Terry
Fox Laboratory and the Leukemia/Bone Marrow Transplant Program of B.C., has
created the largest bench-to-bedside leukemia treatment and research program in
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=> RESEARCHERS
DISCOVERED   A
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Canada. Researchers here have discovered a new approach to treating patients with
advanced chronic and acute myeloid leukemia. At the beginning of 1991, 12
patients with chronic myeloid leukemia had undergone the procedure and most
-were doing well. The first patient treated is now three years post-transplant with
no evidence of leukemia.
Dr. Allen Eaves, professor of Medicine, Pathology and Microbiology and head
of our Division of Hematology, is director of the Terry Fox Laboratory. Core
support is provided by the British Columbia Cancer Agency and the British
Columbia Cancer Foundation. Research is funded by grants totaling over $3
million, held by the 10 university senior scientists. The laboratory occupies 15,000
square feet in the Cancer Research Centre and has a staff of 100, -with more than
40 students and postdoctoral fellows.
Leukemia — cancer of the blood — is the disease focus of the Terry Fox
Laboratory. While chemotherapy is usually effective in curing or controlling the
acute and chronic forms of lymphocytic leukemia, bone-marrow transplants are
needed to cure myeloid leukemia, which primarily affects middle-aged people.
However, only a third of patients -will have a donor, and graft-versus-host disease is
a major complication of transplants, increasing with age and generally disqualifying
people over 50 from having transplants.
The Vancouver team's approach has been to get patients to be
their own donors, where everyone has a donor and there is no graft-
versus-host disease. It is based on an observation made by Dr. Eaves
and his -wife, Dr. Connie Eaves: cultured outside the body, leukemic
cells die off more rapidly than normal cells. An autologous transplant
begins with the removal of as much of the patient's own bone marrow
as is possible. While the patient receives chemotherapy and radiation
to kill all his remaining marrow cells, the removed marrow is purged
in culture for 10 days. The leukemic cells die and surviving normal
cells are then returned intravenously to the patient. Usually after one
to two months, enough normal blood cells are being produced that the
patient can be sent home.
The Vancouver results are considered to be extraordinary in
the treatment of a disease that is usually lethal. The development of this
treatment shows the importance of laboratory research in finding better -ways of
treating cancer. It also shows how the process of bringing research to the
bedside is facilitated by having basic scientists working in close collaboration
■with physicians.
The lab's molecular geneticist, Dr. Keith Humphries, is an associate professor
of Medicine at UBC. With his skills in growing marrow stem cells, Dr. Humphries
■worked with American genetic engineer Dr. French Anderson, famous now for
conducting the first approved use of gene therapy in a patient. Recruited back to
the Terry Fox Lab as a Medical Research Council of Canada Scholar, Dr.
Humphries is leading the molecular biology component of the leukemia and bone
marrow transplant research program. "We now have a hematology research group
in the front rank, internationally," he says. "In fact, we in British Columbia have an
excellent chance of making significant further contributions to improved treatments
for leukemia — if not the cure."
Dr. Allen Eaves is professor of Medicine, Pathology and Microbiology, head of UBC's
Division of Hematology, and director of The Terry Fox Laboratory.
TO   TREATING
PATIENTS   WIT
ADVANCED
CHRONIC   AND
ACUTE    MYELOID
LEUKEMIA. British Columbia's Children's Hospital is not only the province's preeminent child health-care centre, -with 242 inpatient beds and nearly 50
outpatient clinics serving acutely ill and injured children from more than 200
communities. It is also the locus for UBC's pediatric research and education,
training physicians, nurses and other health-care professionals and is actively
involved in world-calibre research to discover better -ways to treat and prevent
childhood diseases.
Children's has evolved into a Western Canadian resource that concentrates on
tertiary, specialized pediatric care -while fostering the development of quality
pediatric services elsewhere in the province. This is the only hospital in B.C.
equipped for such specialized procedures as pediatric organ transplants and heart
and brain surgery and is the major referral centre for newborn babies who require
extensive medical attention. Among its facilities is a five-room bone-marrow
treatment and isolation complex.
Many of the university investigators who -work at the hospital
and at the UBC laboratories at the nearby Children's Variety
Research Centre are also clinical specialists directly involved in
treating children admitted to the hospital. Researchers are creating
new comprehension of normal growth and development and healthcare delivery as well as expanding the knowledge of childhood
disease in such areas as understanding genetic predisposition to
inherited disorders and clarifying the role of infection in childhood
arthritis. Two of them, profiled here — Dr. Aubrey Tingle and Dr.
David Scheifele — helped create the first formal centre for
independent vaccine evaluation research in Canada.
DR.    TINGLE'S   VIRAL
RESEARCH   LED
ESTABLISHMENT   IN
1 985   Ol
CHILDREN'S   -VARIETY
RESEARCH   CENTRE,
WHERE   WORLD-
CALIBRE    RESEARCI
AS   ATTRACTED
SCIENTISTS   WORKING
Aubrey j. Tingle, David Scheifele and
the children's variety research centre
AUBREY TINGLE HAD A RASH. He was an intern at the time and soon
after he had the rash from rubella, an acute infectious viral disease,
he developed arthritis  in his hands  for a -week.  This  sequence  of
events prompted him to begin investigating the possibility that arthritis was caused
by a virus.  At the time,  -with neither the  resources  nor the  sophistication to
consider all possible viruses, he decided to choose a particular one  —  rubella  —■
and follow its effects on a chronic disease like arthritis.
That was nearly two decades ago. Dr. Tingle's viral research led to the
establishment in 1985 of the Children's Variety Research Centre, where world-
calibre research has attracted scientists -working at the forefront of medical
knowledge. Joining UBC's Faculty of Medicine in 1974 as a professor of
Pediatrics, Dr. Tingle later helped raise funds to begin UBC's research program at
B.C. Children's Hospital, to buy the equipment and even the trailers to house it. He
is now chair of the Research Advisory Committee of the hospital's research
division. The research centre, on the Shaughnessy site, was funded by Children's,
the Variety Club and UBC. It has become the laboratory base for much of the
research activities within the hospital, generating interaction bet-ween clinicians
and scientists, increased collaborative studies, and a rapid growth in publications
and research funding.
AT   THE    FOREFRONT
OF    MEDICAL
KNOWLEDGE.
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One focus has been the rubella virus that inspired Dr. Tingle. A biochemist,
Dr. Shirley Gillam, an associate professor of Pathology, has done the molecular
biology of the virus, sequencing both it and the rubella vaccine and cloning each of
the proteins in the virus. A virologist, Dr. Janet Chantler, an assistant professor of
Pathology, has studied the persistence of the rubella virus, demonstrating that it is
present in patients who develop arthritis after rubella. Meanwhile, Dr. Tingle, Dr.
Chantler and Dr. Ross Petty, head of the Rheumatology Division in the Pediatrics
Department, have learned in their research of juvenile rheumatoid arthritis that 35
per cent of children with the condition are carrying the rubella virus in their joints
or bloodstream, suggesting that rubella is causing about one-third of the cases.
A major spin-off of the research program has been the Vaccine Evaluation
Centre, the first formal facility in Canada for independently evaluating vaccines
and helping health authorities select the best vaccines and strategies for use in
immunization programs. "The vaccine centre arose from a conversation where
David Scheifele and I jointly came up with the idea," Dr. Tingle recalls. He is now
co-director with Dr. Scheifele, a fellow professor of Pediatrics.
Funded jointly by UBC and Children's Hospital, the centre opened in 1988
and quickly altered the relationship with vaccine manufacturers to one in which its
researchers play the major role in planning and conducting clinical trials. It now
conducts about 60 per cent of the evaluation research of children's vaccines in
Canada. The director of the federal government's Bureau of Biologies describes the
centre as "the right idea at the right time."
The centre's first and largest study was a surveillance of adverse reactions to a
Haemophilus b conjugate vaccine. Haemophilus is characterized as the single worst
germ in children, one that causes roughly three-quarters of the cases of childhood
meningitis, the leading cause of acquired deafness and retardation. Collaborating
with three local health units, the centre monitored more than 5,000 children for
adverse events in the 30 days following immunization — the first major postmarketing study of a vaccine to be done in Canada. With such studies expected to
be required for the future licensing of vaccines, the centre is well positioned to
provide leadership in this area.
Collectively, the 15 researchers on the centre's advisory committee have skills
unequalled by any other Canadian university group or manufacturer in this field of
preventive medicine. Its team includes specialists in immunology, adult and
pediatric infectious diseases, epidemiology, public-health policy and practice,
clinical-trials methodology and statistics, bacteriology, virology and serology (the
study of serums and their effects).
They are responding to advances in molecular biology that have stimulated
vaccine development and basic vaccine research by universities, biotechnology
firms and large corporations. Old vaccines are being improved; many new
vaccines are being developed for infections that cannot yet be controlled. The
number of infections preventable by vaccines promises to nearly double during
the next decade. And a few dollars per dose can prevent suffering associated with
major infections and avoid mounting costs of caring for the ill. As Dr. Tingle
says, no other procedure in modern medicine is as cost-effective as a good
vaccine. "We felt there was a need to have an organization that was independent
of government and industry, one that can ask the question: 'What's in the best
interests of child health?'"
About half of the evaluation centre's work has been on grant-funded,
investigator-initiated questions related mainly to licensed vaccines; the other half are evaluations of new vaccines for manufacturers. As Dr. Scheifele points out, the
pace of new vaccines coming on the market is accelerating. "And the same
technology that has allowed greater ease of invention has invited more inventors
into the process. So we don't just get four or five new vaccines; for each of them,
we get several competing variations. This means that the process of sorting out
which of the competing viruses is superior becomes more complex. You need an
independent group able to do studies on a scale -where you can begin to compare,
and do it with enough credibility that the manufacturer will buy into the process.
"This is -why the centre is attracting such attention. We told the
manufacturers that -we would take the initiative, provide the quality assurance,
analyze the data in a way that would stand up to peer review. That was the big
gamble -we took in 1988. We didn't know how long it would take for us to move
into this new mode of being independent investigators. To our surprise, it
happened within the first year."
Dr. Tingle is a professor of Pediatrics and of Pathology and Dr. Scheifele a professor of
Pediatrics in the Faculty of Medicine. They are co-directors of the Vaccine Evaluation Centre.
THE    HOSPITAL    IS
KNOWN
INTERNATIONALLY    FOR
ITS   WORK   IN   MULTIPLE
University     Hospital    is    a    recent    union    of   two
SCLEROSIS,    MEDICAL
independently run operations, the 568-bed UBC Health Sciences
Centre Hospital on the UBC campus and the 643-bed Shaughnessy
Hospital on the residential west side of Vancouver.  The hospital's        Alzheimer's disease,
900 practising physicians treat more than  10,000 patients a year,        srinal cord injury,
providing a full range of multidisciplinary treatment and diagnostic co
. . , . 7 . BACK    RAIN    IN -•
services   covering   the   entire   range   of   acute,   psychiatric, jf
intermediate  and extended care.  Medical students and residents astronauts,                           q.
train on both sites in most medical specialties; students in nursing, surgical robotics                    x
diagnostic,   professional,   social  science  and  support-service x
O '     C ff AND    SCHIZOPHRENIA. ^
programs gain educational and clinical experience here. z
UBC schools of Nursing and Rehabilitation Medicine and
some Faculty of Medicine offices are located on the university site.
The hospital is known internationally for its work in multiple sclerosis, medical
genetics, Alzheimer's disease, spinal cord injury, back pain in astronauts, surgical
robotics and schizophrenia. UBC researchers — including -what is considered by
some to be one of the strongest research teams on neurological diseases in the world
— do significant work in the hospital's clinics and laboratories, typified below by
four investigators pursuing the riddles of Huntington's disease, movement disorders,
multiple sclerosis, and spinal cord injuries.
Dr. Michael Hayden and Huntington's disease
UNLIKE OTHER GENETIC DISORDERS which become apparent soon after birth,
Huntington's disease does not strike until middle age. Then it produces progressive
deterioration of the brain, leading slowly and irrevocably to death within 10 to 15
years. There is no effective treatment or cure.
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The disease is caused by a dominant gene. If a parent has Huntington's, each
child has a 50 per cent chance of inheriting the gene and of developing the disease.
Because the illness appears late in life, victims have had children, -who may
themselves have had children, before the family knows what seeds have been sown.
Until recently there was no way to tell if the children of Huntington's patients
had inherited the defective gene. These people at risk lived in uncertainty — not
knowing whether to marry or to have children, not knowing whether to plan for
retirement or an extended illness and early death. Now, however, researchers have
discovered that the Huntington's gene is on chromosome number four, close to an
identifiable marker, -which has two forms. By examining blood samples from
affected and unaffected family members, researchers can tell which form of the
marker is inherited along with the Huntington gene. They can then tell -whether
persons at risk have inherited the marker, and, with 95-per-cent accuracy, say what
percentage of chance they have of getting the disease.
A first Huntington's marker was discovered in Boston in  1983;  since then
closer markers have been found  —  some of them by geneticists at UBC led by Dr.
Michael Hayden, an associate professor of Medical Genetics.
Trained as an internist,  Dr.  Hayden was drawn to Huntington's
from   the   humanistic   perspective   of  a   caring   physician.   "My
is work   dr involvement in  Huntington's disease  really started at the level of
seeing the pain and suffering of families -with this disorder and
recognizing that nobody knew anything about it." In 1975 he began
to see patients in South Africa and to study patterns of presentation,
which led to the first published monograph about the genetics of this
disorder. After doing a doctorate in population genetics and
epidemiology and post-doctorate research in molecular genetics in
Boston, Dr. Hayden came to UBC where he has been able to
integrate basic and clinical research.
"I always believed and continue to believe that on the road to a
cure there's lots of room for caring. As a primary researcher my goal is
to clone the gene for Huntington's disease, but there's an equal need to
provide something else for families right now and not to -wait for some
cure that may or may not come at some time in the future," he says.
In 1986, Dr. Hayden started a predictive testing project at UBC.
In 1988, it became the only national program for Huntington's disease in the world,
and UBC remains one of only four centres offering predictive testing. Because Dr.
Hayden believes the service must be universal, the UBC group coordinates
counsellors in 14 cities in Canada and has made testing available to people in other
countries. So far, 350 people have been tested nationally and 25 internationally.
People who enter the program meet with counsellors three times before hearing
their results. Some decide that they don't -want to know. For them, living with a 50-
per-cent chance is preferable to knowing a virtual certainty.
The object of the predictive testing service is improved quality of life. It is not
to decrease the frequency of occurrence of the gene in the population by
counselling people not to have children. "It's not for me as a physician to judge
that," says Dr. Hayden. "There are many people -who developed Huntington's
disease who led wonderful lives. Woodie Guthrie, for example. We would not have
had This Land is Your Land if Woodie hadn't been born."
Dr. Hayden believes that the Huntington testing program at UBC is a model
for dealing with the ethical, legal and social issues that will arise when predictive
■ IM   THE    BASIC-
SCIENCE   ASPECT   OF
IAY-DEN    IS    ONE    OF
SEVERAL   UBC
INVESTIGATORS
FUNDED    IN    Tl
RESEARCH    GRANT
EVER   AWARDED
■ BC   BY   THE
MEDICAL   RESEARCI
COUNCIL. tests for Alzheimer's, cancer and heart disease are available. "We see people being
discriminated against because they have a family history. We need more
appropriate legislation to protect individuals from the impact of such information
because the truth is we are all affected. We're going to find a test for some disease
that your grandparents had."
In the basic-science aspect of his -work, Dr. Hayden is one of several UBC
investigators funded in the largest medical research grant ever awarded UBC by
the Medical Research Council. The MRC Group in Degenerative Disorders of the
Motor Path-ways is directed by UBC neuroscientist Dr. Donald Calne. Dr. Hayden
is collaborating with neuroscientists and others on a unique two-pronged approach
to studying Huntington's disease. Searching for markers that predate clinical
symptoms, the group is correlating changes in DNA -with changes in positron
emission tomography (PET) brain scans. "We've already shown that changes occur
metabolically before there is cell death in the brain. We're correlating the changes
in DNA -with the changes seen on PET scans. We've been able to show that certain
regions of the brain have less uptake of glucose, even before the cells die or before
a lot of cells have died. We're interested to see what drugs can be used to reverse
that process — so -we're looking at drugs even before we understand the
pathogenesis of the disease."
For Michael Hayden, the challenge is the disease. As a medical geneticist, his
goal is to clone the gene. As a basic scientist, he uses state-of-the-art technology to
understand the disease. As a physician, his goal is to improve the quality of life for
patients who have or may have this devastating disease.
Dr. Hayden is chair of the Scientific Advisory Board of the Huntington's Disease Society
of Canada, national scientific director of the Canadian Genetic Diseases Network and director
of the Adult Genetics Clinic at University Hospital—UBC Site.
Donald Calne and Parkinson's,
Amyotrophic Lateral Sclerosis and dystonia
UBC's DONALD CALNE has never been afraid of asking questions. In his 25 years as a
research neurologist, Dr. Calne was the first to introduce bromocriptine as a treatment
for Parkinson's disease (for which it is now routine therapy) and with a colleague from
the United States, -was the first to recognize the existence of two categories of
receptors for dopamine, a vital chemical agent that transmits information bet-ween
nerve cells in the brain. When Oliver Sacks, of 'Awakenings' fame, -was giving 1-dopa
to Parkinsonian patients in New York, Dr. Calne -was giving it to similar patients in
London, England. Hearing of patients in Guam with a disease that resembled
Parkinson's, Dr. Calne arranged with the U.S. Navy to fly them to UBC. Knowing of a
group of people in southern California -who had taken a drug that caused some of them
to develop parkinsonism, he solicited the cooperation of Immigration Canada in
bringing unaffected members of the group to UBC for brain scans.
The Donald Calne story would show a man concerned for his patients, an
innovative researcher and a superb organizer — a man able to assemble a first-
rate research team and to create one of the strongest movement-disorder groups
in the world.
Dr. Calne's UBC team comprises 11 full-time and eight part-time researchers,
funded by a $6.1 million MRC group grant and an additional $2 million from public
and private sources. They are focusing on four diseases — Parkinson's,
Huntington's, dystonia, and Lou Gehrig's disease, which doctors call Amyotrophic
Lateral Sclerosis, or ALS.
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Dr. Calne's research involves Parkinson's, ALS and dystonia. These movement
disorders are becoming more frequent as life expectation increases, and are being
seen more often in elderly people.
Approximately 70,000 Canadians have Parkinson's — a progressive
degenerative disorder -with symptoms that may include tremor and muscular
stiffness and rigidity.
Twenty-five thousand have ALS. The number is lower, Dr. Calne says, partly
because ALS is an aggressive disease that usually kills -within five years. It is
characterized by muscular -weakness and atrophy, often accompanied by spasticity.
"There are certain common features in the mechanism of ALS and PD," says
Dr. Calne. "There are similar changes in the nerve cells — nerve cells concerned
■with controlling strength in the case of ALS, and nerve cells concerned -with
planning or organizing movement in the case of PD."
Current medical research indicates that an environmental factor — perhaps a
toxin or an infection — may be the cause for both diseases. In contrast,
Huntington's, which affects about 40,000 Canadians, has a clearly defined
genetic origin.
Dystonia, which affects approximately 8,500-9,000 Canadians, is a syndrome
of sustained muscle contractions, frequently causing twisting, repetitive
movements or abnormal postures. It may be confined to one body part — the eye,
the neck or the jaw — or it may be more generalized. In 1984, UBC researchers
pioneered the use of botulinum-A toxin, injected into neck muscles to reduce the
force of contractions.
"We're interested in detecting these diseases even before people have
symptoms," says Dr. Calne. "If we can identify them, -we can begin to treat them
early." The area of the brain involved in Parkinson's is the substantia nigra, -which
contains cells that produce dopamine. With the death of these cells and a
consequent deficiency in dopamine, the transmission of messages bet-ween nerve
cells is interrupted. Positron emission tomography scans can show changes in the
brain before a person exhibits symptoms.
The traditional treatment of PD has been to replenish the deficient dopamine
by giving drugs that are converted to dopamine or that mimic its action. Based on a
theory that excessive drive of the nerve cells may contribute to their early death,
the Calne team is testing a new drug — lamotrigine — -which reduces the release of
excitatory agents. Dr. Calne says lamotrigine might be useful in ALS, for -which
there has been no treatment so far.
In 1985, in the journal Nature, the Calne team reported its findings of PET
scans in four Californians who had taken MPTP — a synthetic heroin, -which had
induced parkinsonism in others. Although these four -were symptom-free, they had
abnormal scans. This -was the first direct evidence that dopaminergic impairment
can exist without clinical deficits. As a result, the team hypothesized that
Parkinson's disease may result from an environmental event -which precedes the
onset of symptoms by many years, and that normal aging erodes the compromised
cells, resulting in the emergence of the disease.
Further evidence of an environmental link in Parkinson's comes from Dr.
Calne's study of natives of Guam, -where there is a very high incidence of a disease
like PD. In 1986, the U.S. Navy began flying patients to UBC for PET scans. The
disease is occurring less frequently now, -which, says Dr. Calne, is a clue to its
cause. "Something happened during the war — some major change in diet or a
change in minerals in the water supply," he suggests. Dr. Calne's association -with Huntington's disease.
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Guam has produced both Guamanian government funding for the research at UBC
and a personal award of gratitude.
With the rising incidence of all the movement-disorder diseases, the outcome
of Dr. Calne's research -will affect many Canadians. "I would hope," he says, "that a
substantial advance in our understanding of mechanism, cause or treatment -will
occur -within the next 10 years."
Dr. Donald Calne is the Belzberg Family Professor of Medicine and head of the Division
of Neurology at the University Hospital's UBC Site. He is director of the Medical Research
Council Program in Degenerative Disorders of the Motor Pathways.
Donald Paty and Multiple sclerosis
You COULD SAY that Donald Paty is a one-disease neurologist. "MS is my thing,"
he says. "When I started looking at it, it -was obvious to me that it -was one of the
most fascinating diseases because it involved viruses, immunology, the nervous
system, genetics and a whole lot of other things."
Not all physicians are willing to spend their lives caring for people who have a
disease that cannot be cured. But some are. "In neurology, particularly," says Dr.
Paty, "you have made peace -with the inability to be a compulsive therapist."
Multiple sclerosis is a progressive, autoimmune disease in which the body
attacks the myelin sheath around nerve fibres in spots scattered throughout the
brain and spinal cord. As a result, messages transmitted to many different muscles
become imprecise. The disease can take a chronic form, but most patients have
spontaneous remissions and relapses. It is a young adults' disease, the mean age of
onset being 31. No one knows -why but MS is more common in northern latitudes.
The rate of prevalence in the U.S. is 60/100,0.00; in Vancouver it is 130/100,000.
Dr. Paty attacks the disease both as a clinician and as a scientist. His
approach has been to understand -what is going on -with the patient in order to
formulate questions for his basic research. Determined to -work with and learn
from patients, he -went in 1970 to Newcastle-on-Tyne -where there -was probably
more MS than in any other place in the -world. The British Medical Research
Council had a research centre there, but, says Dr. Paty, they had no organized
system to see patients and collect data from them. "I had to beg on the wards to be
able to see patients."
At the University of Western Ontario in the 70s, he started an MS clinic. The
concept of a prospective follow-up of patients caught on, and with the sponsorship
of the Canadian MS Society, clinics were set up across the country. Those clinics
now use a standardized approach to collecting data, designed by Dr. Paty and Dr.
Donald Studney of the Department of Medicine. MS-COSTAR, a modified version
of the public domain system, COSTAR, is used by six Canadian clinics and was
selected by MS researchers in the U.S. after six years of exhaustive evaluation. Dr.
Paty says that European countries are interested in COSTAR as -well, because it
-will make them compatible with what is going on in Canada. UBC has made the
software available to participating clinics for $1.
At UBC since 1980, as head of the Division of Neurology in the Department of
Medicine, Dr. Paty has directed MS research programs, basing them on a mutually
beneficial relationship -with patients. "Patients understand that we have a dual
purpose in meeting. They can benefit from the expertise of someone interested in
their disease, and we get data and material from them for our research programs."
He sees patients at the Multiple Sclerosis Clinic at University Hospital—UBC Site.
"One of our missions is to be available to the patients -with MS in the province -who want to see us. Patients with chronic, incurable, unpredictable, neurological
diseases know that there is no magic available to them, but they always respond
very well to people taking an interest in their problem."
In 1988 in the journal Neurology, Dr. Paty and his team reported the results
of Magnetic Resonance Imaging of 200 suspected MS patients, comparing the
scans with other diagnostic tests. Their conclusion was that MRI was the most
sensitive tool for diagnosing MS and that it would be useful in determining the
efficacy of treatments.
Dr. Paty explains that typically in MS there are lesions — multiple areas of
abnormality in the white matter of the nervous system. MRI gave researchers a
way of seeing the extent of these lesions and following them over time. They were
not surprised to find that symptoms did not correlate with lesions — that there
could be 10 times more activity in the nervous system than was expressed in
symptoms. But they were surprised by one observation: the abnormal areas went
away and returned, and it could take years for a lesion to become permanent.
"That is just a revolution in thinking about the disease," says Dr. Paty. "The good
news about MS is that built into the nervous system is a control
mechanism that can reverse the process."
17 AT   UBC    SINCE    1980,
With this in mind, Dr. Paty looked again to his patients to try
to understand the relationship of the immune system to activity in
the disease. It was obvious that the immune systems of MS people division of
operated differently, but it was difficult to correlate immune system neurology in the
abnormalities -with symptomatic attacks. However, with MRI scans
DEPARTMENT   OF
in hand, one could relate abnormalities in the nervous system with
I.    PATY
RESEARCH    PROGRAMS,
MUTUALLY    BENEFICIAL
RELATIONSHIP   WITI
PATIENTS.
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synchronous changes in the immune system.
Using MS-COSTAR, UBC researchers have logged in 2,500 has directed ms
patients in the past nine years, which is the largest computerized
MS database known. This collection of well-studied patients
folio-wed over a long period of time is a tool that can be used to
predict prognoses for new patients. That is important in deciding
whether to administer the powerful, toxic immuno-suppressant or
anti-viral agents that are typically used in MS.
In the next decade, genetic studies in MS -will become more
important, and UBC is -well positioned to participate.  Dr.  Paty's
colleague,  Dr. Adessa Sadovnick, professor of Genetics, has diligently collected m
family-related information on MS. As a result she has the best MS genetics
database in the world. The next task is to do the molecular studies on those
patients to try to understand -why inherited factors are important.
Dr. Paty says research will show the genetic basis of MS to be unlike
Huntington's where one gene is probably the culprit. In MS, he suggests, a
combination of genes will prove to be a necessary but not sufficient prerequisite.
The trigger may be a virus that comes at a time of susceptibility, probably around
puberty, and causes the immune system to malfunction, producing symptoms
anywhere from five to 20 years later.
"I think we will have ways of controlling the disease long before we have the
answers to what is causing it," says Dr. Paty. "In another 10 or 15 years, we will be
in a position to be much more specific about modulating the immune function when
it is abnormal as in MS."
Posing the questions that research must answer will be clinician-scientists,
like Dr. Paty, who have studied the disease in all its etiological complexities. "I'm proud to  say that  Canadian  research  has  contributed  enormously towards
understanding what is going on with the patient."
Dr. Paty is head of the Division of Neurology in the Department of Medicine.
Peter Wing and Spinal Cord research
SINCE 1985, A TEAM OF UBC RESEARCHERS has been designing experiments with
some rather strange criteria. The equipment needed must fit into a shoebox. It
must be light, require no power, gives off no gases and if it is blowtorched, it must
not burn.
Getting an experiment ready to go into space is no easy matter, as researchers
in the Orthopedics Department at University Hospital—Shaughnessy Site, have
been learning. NASA's standards are exacting, but more difficult to bear has been
-waiting for the launch. Dr. Peter Wing and his two crews have experiments
prepared for two International Microgravity Laboratory missions.
Dr. Wing and his cohorts have waited this long time to try to determine -why
astronauts get taller in space.  Height increases of up to seven centimetres have
been documented on previous flights,  and it is well known that two-thirds  of
astronauts suffer back pain. What Dr. Wing -wants to do with his experiments is
confirm the  amount of height change  and try to  establish  how it
'one of our happens.  Does the spine change length or shape or both?  Then he'd
like to see if he can ascertain how that change produces pain.
Dr. Wing's involvement -with the American space program grew out
MISSIONS   IS   TO
9
BE   AVAILABLE   TO
of his work in the Back Pain Clinic, -which he started in  1979 -with
IE patients Woodward Foundation funding. The Back Pain Clinic continues to offer
WITH    MS    IN    T
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its assessment of individuals with chronic and intractable back pain. It is
one component of a focus at the hospital on spinal cord problems.
University Hospital—Shaughnessy Site, is the provincial referral
centre for all spinal cord injuries in B.C. In a province that has the
highest number of such injuries in North America, the Spinal Cord Injury Unit is
proud of the fact that it can have a person, injured anywhere in the province, on an
operating table within four hours. The 22-bed unit treats 220 patients a year. Its
multidisciplinary team of physicians, nurses, physiotherapists, occupational
therapists and counsellors helps patients deal -with their severe injuries. Since a
large proportion of spinal cord injuries occur in young men, the unit draws on the
expertise of Dr. George Szasz, a professor of Psychiatry, in the area of sexual
function and fertility in the spinal-cord injured person.
The unit also engages in research on fracture patterns (Dr. J. F. Schweigel,
associate professor of Orthopedics, and Dr. William Yu, clinical associate professor
of Orthopedics); and on urinary infections in the spinal-cord-injured population
(Dr. Marie Gribble, assistant professor of Medicine).
Dr. Wing isn't quite yet sure -what outcome the IML-1 experiments might
have for back-painx sufferers on earth. But he says the study is important to our
understanding of how the spine responds to stress here on earth. UBC's
involvement in the space program has produced spin-off benefits for patients. In
zero-gravity training flights, the UBC investigators have performed experiments
with the Transcranial Doppler, as a -way of measuring blood flow using
ultrasound. That technique is being tested here to monitor infants who are being
flown on air ambulances. As well, the unit's doctors are testing one space-inspired treatment measure.
When astronauts return to earth, they suffer orthostatic hypertension — they faint
when they stand up. Since spinal cord patients are often dizzy when they first get
up, the unit has been testing the astronauts' solution to the problem, which has
been to drink a lot of water. With Dr. John Ledsome, head of our Department of
Physiology, the unit has been giving spinal cord patients a short, quick intravenous
to balance their fluid load.
Reflecting on the lessons that space research can teach us about spinal cord
injuries, Dr. Wing comments that the caution NASA practises is worth emulating:
"If people approached driving a car with as much care as NASA does flying the
shuttle, -we'd have a much lower injury rate."
Dr. Wing is head of the Department of Orthopedics at University Hospital-Shaughnessy
site, and associate clinical professor in UBC's Department of Orthopedics. ■
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MANY FORMAL CLINICS AND UNITS HAVE B E E IM CREATED BY UBC FACULTY. ON THE
ONE HAND. THESE CLINICS ENHANCE TEACHING AND RESEARCH; ON THE OTHER, THEY
PROVIDE    AN    IMPORTANT    SERVICE    TO   THE    COMMUNITY.
A  few   examples  indicate the range of clinical services provided by the Faculty >■
of Medicine: z
Z
• The Division of Dermatology operates a Psoriasis unit and, among ^
others, offers clinics specializing in pigmented lesions, human <->
papilloma virus, ichthyosis (a condition characterized by dry, scaly °
skin), and epidermolysis bullosa (a rare, hereditary skin disease). <
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• The Division of Cardiology operates a heart arrhythmia management ~
program that handles  1.000 patients a year. the division is the most ii
(J
advanced in the country in the treatment of abnormal heart rhythms
with ablation. (electrical catheters are used to cause a localized —
area of injury that cures the arrhythmia.) the division started and is
the centre of a cardiac drug trials network involving 13 b.c.
hospitals.
• The  Division of Geriatric Medicine operates an Alzheimer
assessment and follow-up clinic at university hospital, an
incontinence clinic at vgh, and geriatric medicine consultation
services in various hospitals.
• the  division of nephrology operates a  renal stone clinic at vgh
and the cooperative osteoporosis clinic which  is i n t e r - h os p i t a l in
SCOPE. NAMED    FOR   A
FORMER   UBC
CHANCELLOR   WHO
CONTRIBUTED
ENORMOUSLY   TO
SPORT   DURING   HIS
CAREER,
IE   CLINIC   IS
9
OPERATED   BY   THE
SPORTS   MEDICINE
DIVISION   OF   THE
FACULTY   OF
MEDICINE'S
DEPARTMENT   OF
FAMILY   PRACTICE   AND
THE    SCHOOL   OF
PHYSICAL   EDUCATION
AND   RECREATION.
The Allan McGavin sports medicine Clinic,
South Campus, UBC
IT'S THE FOREMOST CENTRE OF ITS KIND IN CANADA: the Allan McGavin Sports
Medicine Clinic is unparalleled in this country in its blend of academic and service
functions for both elite performance athletes and people in the community -who lead
active recreational lives. Its staff of specialists treats an average of 1,000 a -week
from all the -western provinces as -well as Yukon and the Northwest Territories.
The outreach clinic ministers to everyone from teenagers to the elderly, from
Olympic athletes to lawn-bowlers. Named for a former UBC chancellor -who
contributed enormously to sport during his career, the clinic is operated by the
Sports Medicine Division of the Faculty of Medicine's Department of Family
Practice and the School of Physical Education and Recreation. Its co-directors,
Drs. Doug Clement and Jack Taunton, are among four full-time and four part-time
physicians providing primary care; three full-time and one part-time
orthopedic surgeons; four full-time physiotherapists; and a
rehabilitation consultant and an arthritis consultant.
The co-directors are prominent in the world of Canadian sport.
Recently made a member of the Order of Canada, Dr. Clement has
for 10 years been the national coach of Athletics Canada (formerly
the Canadian Track and Field Association). He sits on the
accreditation committee of the Canadian Academy of Sports
Medicine (CASM). Dr. Taunton was chief medical officer for the
1991 Pan American Games in Cuba and held the same position for
an earlier Pan Am Games and two World Student Games as well as
being a medical officer in the 1984 and '88 Olympic Games,
primarily for the Canadian national men's and -women's field hockey
teams, of which he is team doctor. A marathon runner himself, he
coaches two leading Canadian runners and an international runner.
He is past president of B.C.'s Sports Medicine Council and now is
working to develop a Sports Research Foundation for the council.
Among the part-time physicians in primary care is Dr. Gordon
Matheson, team doctor for the Vancouver Canucks of the National
Hockey League. He is also the founding editor of The Clinical
Journal of Sport Medicine, published by the CASM, -whose editorial
board includes the clinic's co-directors. Dr. Ralph Davidson is the
Canucks' team surgeon. Others affiliated with the clinic are doctors
for several of Canada's national teams: Pat McConkey (downhill ski and men's
basketball); Jim Macintyre (downhill ski); Rob Lloyd Smith (cross-country ski);
Don McKenzie (canoe/kayaking); and Sue Hopkins (cycling). Physiotherapists
involved -with national teams include Ron Mattison (men's field hockey) and Clyde
Smith (-wrestling).
The focus of research undertaken by clinic physicians ranges from the very
young to the very old. Dr. Don McKenzie is studying attitudes towards exercise
and how they affect oncology and juvenile rheumatoid arthritis patients at
Children's Hospital. Dr. Jack Taunton, working -with the Department of Family
Practice, the School of Physical Education and VGH, is coordinating an
investigation into the effects of exercise on early elderly women. Dr. Taunton is
also coordinator of a research project to determine the best management of stress
fractures using an air-cast; and, collaborating -with the School of Family and
Nutritional Sciences,  he is looking at the effects on metabolism and fat-store redistribution of cyclic -weight loss by such athletes as wrestlers, and at the effects
of different frequencies of running exercise on adults newly diagnosed with
diabetes. As well, he is conducting on-going research on the causes, effects,
treatment and rehabilitation of specific sports-related medical problems, such as
hamstring injuries. Dr. Clement studies the incidence, clinical presentation and
course of treatment of femoral stress fractures in athletes. With a former graduate
student now on the faculty of Lakehead University, he is also researching iron
metabolism in athletes.
The Sports Medicine Division presents two symposiums on its specialty each
year, and the staff teach several courses throughout the province as -well as making
presentations to hospitals and medical associations.
The clinic remains best known for what its administrator has described as its
"one-stop-shopping" style of public service, its treatment of a spectrum of athletic
and recreational injuries that range from those resulting from over-use to acute
sports injuries that demand immediate attention.
The ubc Movement disorders Clinic, University Hospital-UBC site
People from as far away as Australia and India have attended the UBC
Movement Disorders Clinic. A child with generalized dystonia flies in from the east
coast once every three or four months to receive injections of botulinum toxin.
Patients who are taking part in a Swedish brain-cell transplant program have come
for pre- and post-operative PET scans.
UBC has the strongest movement-disorder PET scanning group in the world,
and the results of research conducted by that group have already benefited patients
-who have Parkinson's and dystonia. Ml
The clinic was established in  1981  to conduct research and to provide ™
treatment and counselling for people -with dystonia and other neurological
disorders of movement. It is one of several clinics funded by the Dystonia Medical
Research Foundation.
Coordinator Susan Calne explains that everybody who comes to the clinic
understands that it has a research program. Everyone becomes a passive subject in
that charts are maintained on their progress, but no one is obliged to take part in z
projects and fewer than a fifth do so. "We provide a superb service in this clinic," |
she says.  Patients are seen by Dr.  Donald Calne,  or one of five post-doctorate 0
fellows. They also see a nurse, -who explains and monitors their drug regimen. For Q
those -who need them, an occupational therapist, speech language pathologist,
physical therapist and social worker are available. Dystonia patients, -who are
usually younger than those who have Parkinson's and have to hold down jobs,
receive help coping with the related physical and emotional impact of their disease.
It is Mrs.  Calne's job to recruit patients for research projects, such as the *
phase-one and comparative drug studies that the clinic regularly conducts. She finds
that there are patients who like to take part in studies, partly because they know
they will receive good care (a nurse is available to them 24 hours a day) and partly
because they want to make a contribution to knowledge. "We live in a society where
intelligent patients are their own advocates in their own disease. They are well read
and well informed. They are genuinely interested in increasing knowledge."
Normal subjects who have volunteered for PET scans are often patients'
relatives, who want to aid scientific research. Even clinic Director Donald Calne
has had one. "It's a risk I was prepared to take to provide information."
In a year, the clinic sees 400 patients with Parkinson's and dystonia. Tropical diseases Clinic and infectious diseases Outpatient
Clinic, VGH, University Hospital and UBC Sites
Malaria, leishmaniasis, giardiasis and echinococcosis may not be that
common in the average general practitioner's waiting room in B.C., but they are
frequent souvenirs of foreign travel. Western Canadians who have acquired these
parasitic diseases can take them to the Tropical Diseases Clinic, which is an
initiative of UBC's Division of Infectious Diseases, operated at Vancouver General
Hospital. It is the only clinic of its type west of Toronto, serving all of B.C. and
accepting referrals from CUSO and other government agencies. It maintains an
exotic anti-parasitic drug depot, with medications not available by prescription and
probably not known to general practitioners. Doctors here are on the forefront,
knowing what drugs are under investigation and having access to them before they
have been released by regulatory agencies. They see a lot of malaria, and types of
life-threatening malarias that are resistant to drugs. They have the expertise to
treat malaria in a pregnant woman when the drug therapy might harm the fetus.
The division's Infectious Diseases clinics see approximately 1,200 new
outpatients in a year and consult to physicians in remote cities in B.C. and in
Alberta and Washington State. People with serious infections — in the heart valve
and prostate gland, in bone and bone marrow and in the central nervous system —
may be treated -with thrice-daily intravenous injections, given in collaboration -with
VGH's Medical Day Care Unit.
Medical Genetics services, University hospital-Shaughnessy Site
The clinical program in Medical Genetics begun in 1978 at Grace Hospital
now serves approximately 6,000 B.C. families a year from a central office at
University Hospital-Shaughnessy Site. Dr. Barbara McGillivray of our
Department of Medical Genetics is clinical director of the service, -while Dr.
Judith Hall, now head of our Department of Pediatrics, was the director for
several years.
The clinical services offered by UBC genetic physicians include assessment,
diagnosis and counselling. In Vancouver and on frequent outreach visits in Victoria
and the Thompson/Okanagan region, the medical staff advise people who are
considered to be at very high risk — people with family histories of Huntington's
disease, muscular dystrophy, congenital structural abnormalities (such as Noonan's
syndrome and neural tube defects) and chromosomal abnormalities (such as Turner's
syndrome). Women who have had a previous child -with a condition such as Down's
syndrome or pregnant women -who have been exposed to occupational chemicals,
medicines or drugs are also counselled.
Counselling may point people in the direction of support groups; it may help
them to explore the ramifications of having an abnormal child; but it does not
question a couple's right to conceive. "Most people," says Dr. Hall, "think a
geneticist's job is to say you shouldn't have children because you are at risk. None
of us feels that -way."
Through the UBC service, discoveries in gene-mapping can help people. Dr.
Hall points out that a new disease is mapped every week. "I think what's dramatic
about medical genetics is the rapidity with which things are discovered on a basic-
science level and become immediately something you can use to take care of
families," says Dr. Hall.
Geneticists at UBC are contributing to the explosion of information about
genetic disease.  Dr. McGillivray's research with investigators at the Whitehead Institute for Biomedical Research at the Massachusetts Institute of Technology
has demonstrated that a single gene may determine whether a human embryo will
grow into a male or female. The discovery has allowed Dr. McGillivray to
reassure patients: "I can tell a man that although he has two X chromosomes, he
still has the crucial gene that makes him a male," she says.
Dr. Jan Friedman, acting head of the University Hospital Department and our
Department of Medical Genetics, has developed a database that provides doctors
-with information about the effects of drugs on unborn babies. The Teratogen
Information System (TERIS) is available on-line or on disc and is subscribed to by
15 centres in Europe and 25 in North America. Information is usually sought on
behalf of -women who drank alcohol or used medications before they knew they
were pregnant.
UBC medical geneticists are envied for their ability to access the B.C. Health
Surveillance Registry, which was set up 40 years ago by farsighted officials in the
Division of Vital Statistics. One of the best population-based registries in the
world, the registry lists the genetic disorders and handicapping disabilities of over
170,000 British Columbians.  Using data from the registry,  Dr.  Patricia Baird has °
refuted suggestions that environmental factors may be causing an increase in the
incidence of Down's syndrome. She has demonstrated that genetic inheritance is a
very important determinant of health or illness. And she and UBC industrial
hygienist Kay Teschke have shown that certain birth defects, in particular heart
defects, may be more common among children whose fathers are firefighters and
were exposed to inhaled toxins. Dr. Baird, who was head of our Department of
Medical Genetics and remains a faculty member, has chaired the Royal Commission
on New Reproductive Technologies and is a vice-president of the Canadian
Institute of Advanced Research. •
SIR FRANCIS CRICK ONCE WROTE THAT THE LEADING EDGE OF RESEARCH IS ALWAYS
IN A FOG. BUT THE TRICK ABOUT BEING I IM A SCIENTIFIC FOG, HE EXPLAINED, IS TC
BE    IN   THE    RIGHT    FOG   WITH    THE    RIGHT   COMPANIONS.
Crick says that he and Dr. James Watson did a number of things right in
constructing their double helix model of the DNA molecule. One was that they
picked the right problem and stuck to it. The other was that they worked together.
"In solving scientific problems of this type it is almost impossible to avoid falling into
error," he writes. "Intellectual collaboration helps jolt one out of false assumptions."
More and more such collaborative association characterizes basic science
research in the biomedical field at UBC. We at UBC are doing everything we can
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to foster campus and campus-hospital collaborations, to bring together individuals
whose research interests coincide, and to provide common facilities that can be
used by investigators in many disciplines.
Collaborations in biomedical research cross departments and faculties. A
neuroscientist in Psychiatry in the Faculty of Medicine works with a
biopsychologist in the Faculty of Arts studying the relationship of the brain and
behavior. An oral biologist in the Faculty of Dentistry interested in dental implants
uses the materials expertise of electrical engineers in the Faculty of Science. An
animal scientist in the Faculty of Agricultural Sciences meets with an
endocrinologist in the Faculty of Medicine to study osteoporosis. A Faculty of
Science botanist whose expertise is in medicinal chemicals in plants publishes
papers with a medical microbiologist in the Faculty of Medicine. A professor of
Pharmaceutics in the Faculty of Pharmaceutical Sciences leads a national research
program that includes an obstetrician/gynecologist and a pediatrician in the
Faculty of Medicine.
This is not to say that there have not been outstanding achievements by
individuals on our faculty.
Dr. Harold Copp, the first head of Physiology, has been honored nationally and
internationally as the discoverer of the hormone calcitonin, which regulates the blood
level of calcium and suppresses bone loss. Dr. Copp is one of 28 Canadians who have
received the Gairdner Award for outstanding achievement in Canadian medical
science. He was also the first gold medal winner in the Science and Engineering
Awards established by the Science Council of British Columbia in 1980.
Dr. Copp's fellow physiologist, Dr. John Brown, received the B.C. gold medal
in 1983, and many other awards, recognizing his two important discoveries — GIP,
or gastric inhibitory polypeptide, and motilin, which is a polypeptide that
stimulates gastric motor activity.
Other UBC scientists working in the biomedical field have been given the
Science and Engineering gold medal:
•  1982: Dr. Julia Levy, Department of Microbiology, for the
x development of a sensitive, rapid and inexpensive test for the
j early detection of lung cancer.
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^ • 1985: Dr. Robert Noble, the first director of UBC's Cancer
Research centre, who in the  1950s discovered that extracts of the
leaves of the jamaican periwinkle contained vlnca alkaloids, which
could be used in the treatment of cancers.
• 1988: Dr. Donald Calne, department of medicine, for his research
and treatment relating to dystonia.
• 1990: Dr. David Dolphin, Department of Chemistry, for his research
into innovative, cancer-combatting drugs.
There has as yet been no Nobel Prize given a UBC scientist, but our
association with one Nobel Prize winner serves to make a point about the
ramifications of scientific interactions. From 1952 to 1960, Dr. H. Gobind Khorana
worked on our campus. Here he discovered a method for synthesizing small
fragments of DNA called oligonucleotides. He also laid the foundation for work he
would complete at the University of Wisconsin — the deciphering of the genetic
code, for which he shared a Nobel Prize in 1968.
While Dr. Khorana was at UBC, a young chemist came to work in his lab.
There he became interested in biology and began to do DNA research, which would ALTHOUGH   THERE
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eventually take him to the Medical Research Council in Cambridge, England. In
1977 he and others helped Dr. Frederick Sanger work out the complete sequence of
the 5,386 nucleotides in the DNA of one small virus. Dr. Michael Smith, professor
of Biochemistry, brought the methodology he learned in Sanger's lab back to UBC
and is applying it now in the research he directs through our Biotechnology
Laboratory, a joint venture of five UBC faculties that is supported by provincial
Excellence in Education funding.
The possibility of establishing interdisciplinary and clinical connections
brought five scientists en masse from Dalhousie University to UBC in 1988. The
five, who are engaged in fundamental studies of the visual cortex, are now members
of our Department of Ophthalmology. "Why did we come?" says Dr. Max Cynader.
"The answers would be the opportunity for clinical interactions, the opportunity
for computational interactions, and the opportunity for basic-science interactions.
UBC is a tremendous store of talent and academic expertise." The Cynader team's
eight research projects draw on UBC experts in molecular biology, electrical
engineering, neuroscience, computer science and psychology.
For instance, Dr. Frank Tufaro, assistant professor of
Microbiology, has shown the team how to use viruses to transfer
genes into neurocells. To help them visualize particular populations of
neurons, they have linked with Honorary Assistant Professor Branko
Palcic, who has developed high-tech imaging systems at the B.C.
Cancer Agency. In order to understand the principles of computation
in the visual cortex, the group shares ideas with computer scientists
who are trying to build a vision system. Ideas are the fare at their
regular computer-vision lunch meetings. "We see something.in the
brain that turns out to be incredibly necessary to get a vision system
to work and we tell them they really ought to try engineering this
thing," says Dr. Cynader. "Then they say they want to build
something — say, a variable depth-of-focus controller — and is there
such a thing in the brain? And when I think about it I realize it is in
the brain but nobody has ever named it that. There's a terrific and
very exciting interplay between us — the biological scientists — and
the people who are building things."
Although there are no hard-and-fast distinctions,  biomedical
researchers seem to fall into two categories   —  those 'who set out to
cure a disease and those who want to solve a biological puzzle.  Basic science
researchers tend to be of the latter type even though they can foresee eventual
health-care outcomes for the research that goes on in their laboratories.
Direct delivery of drugs to specific sites in the body is the outcome of research
conducted by Dr. Pieter Cullis, professor of Biochemistry. He studies the physical
properties of phospholipids, the major components of cell membranes, which can be
formed into sealed closed sacks — liposomes. Dr. Cullis has found that drugs loaded
into liposomes survive longer in the body and are less toxic. His current challenge is
to target liposomes to specific tissues in the body.
Dr. Christian Fibiger's puzzle is measuring the release of neurochemicals in
very small, discrete regions of the brain. As a researcher, Dr. Fibiger has Medical
Research Council funding -with two psychologists to do basic-science studies. As a
neuroscientist and acting head of the Division of Neurosciences in the Department
of Psychiatry, he works with colleagues whose approach has been to focus on one
or other neurological disease. For instance, Drs. Patrick and Edith McGeer have
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achieved international renown for their work on Alzheimer's. Within the division
there is room for both approaches to doing science. "I don't think scientists have
ever been or should ever be put in a position of having to justify their research in
terms of a disease. I think in many instances before we can ask sophisticated
questions about disease processes, we have far to go in just understanding the
basic mechanisms."
Understanding basic mechanisms was exactly what Dr. John Brown was doing
when he discovered the polypeptides motilin and GIP. Peptides are important
regulatory agents, the best known being insulin. "Not very many people have
discovered peptides," he explains. "And not very many have sequenced their
molecular chains. First of all you have to identify that there could be something
there. You have to get up a strategy to find it. Then you find it, purify it and
sequence it." He continues to do that sort of basic research, with the ultimate aim
of helping to create analogues that can be used therapeutically. "We take our work
up to the identification of the peptides, working out the physiology," says Dr.
Brown. "Then we start to work with the synthetic chemists outside to come up with
analogues." In a matter of five or 10 years, Dr. Brown thinks chemically
synthesized peptides will be available for treatment of inflammatory bowel disease,
idiopathic paralytic ileus (a decrease in or absence of contractions in the
intestines), maturity-onset diabetes, obesity and cardiovascular disease.
The latter is a new area of research for Dr. Brown and his four colleagues in
the Department of Physiology who are funded as a Medical Research Council
Group. "We and other people have identified that the heart, brain, lung and nerves
have these peptides. We don't know -what they do so it's a new venture — a
completely new area."
K^0czdec ^I/cce?iw& t>fe^?w &6da&6UA<m#?v& tm- (S^?^^
Located in three places on campus, the Biotechnology Laboratory is a
research organization set up to promote interaction bet-ween the basic and applied
sciences. It operates under the deans of five faculties — Science, Medicine, Applied
Science, Forestry and Agricultural Sciences — with more than 100 faculty, staff,
postdoctoral fellows and graduate students. The nine faculty members have teaching
responsibilities in the departments where they hold academic appointments.
Dr. Michael Smith, who directs the laboratory, hired its faculty. "One of the
successes of the Biotechnology Laboratory," he says, "was to recruit a number of
young Canadians who were the sort of people who would have normally been offered
and accepted very good jobs at American universities." They in turn were attracted
by the opportunity to establish collaborations with scientists in other disciplines.
Although not all the research at the Biotechnology Laboratory pertains to the
health sciences, much of it does:
Dr.  B.  Brett Finlay's research  is aimed at understanding how
BACTERIAL   PATHOGENS   ENTER   A   HOST   CELL   AND   HOW   THEY   SURVIVE   AND
MULTIPLY.   VIRULENT   SALMONELLA,   WHICH   CAUSES   SUCH    HEALTH   PROBLEMS
AS   FOOD   POISONING,   IS   A   FOCUS   OF   THIS   RESEARCH,   DONE   IN
COLLABORATION   WITH   A   COLLEAGUE   AT   THE   BRITISH   COLUMBIA   CANCER
AGENCY.   OTHER   COLLABORATIVE   PROJECTS   WITH    UBC   RESEARCHERS
INVOLVE   MENINGITIS   PATHOGENS   AND   GlARDIA,   WHICH   CAUSES   AN INFLAMMATORY   INTESTINAL   CONDITION.    DR.    FlNLAY   IS   WORKING   WITH   A
COLLEAGUE   AT   THE   WELLCOME    RESEARCH    LABORATORIES   ON   THE   USE   OF
SALMONELLA   MUTANTS   AS   ATTENUATED   VACCINES.
• DR.   TERRANCE   P.   SNUTCH   IS   WORKING   ON   THE   CENTRAL   NERVOUS   SYSTEM,
LOOKING   AT   THE   GENES   THAT   ENCODE   FOR   CALCIUM   CHANNELS   AND   NEURAL
RECEPTORS.    HE    IS   BUILDING   BRIDGES   WITH   ZOOLOGY   AND   WITH
N EU ROSCIENCES,   THE   LATTER   IN   A   PROJECT   THAT   MAY   HAVE   IMPLICATIONS
IN   THE   REGULATION   OF   DOPAMINE    RECEPTORS   WHICH   PLAY   A   ROLE   IN
PARKINSON'S   DISEASE.
• Dr. Wilfred A. Jefferies has appointments  in  Microbiology and
Medical Genetics.  He  is working on  how the  immune system  responds
to viral infections.  because  it  is hard to develop anti-viral agents
that are  not toxic to normal human cells, the  role of the  immune
system is important. dr. jefferies' work has relevance to chronic
obstructive pulmonary disease and rubella virus infections. he
collaborates with ubc faculty members at st. paul's hospital and
Children's  Hospital, and at the  biomedical Research Centre.
• Dr.  Michael Smith, who is a  Professor of Biochemistry,  is  involved
in  fundamental genetic engineering.  Using synthesized bits of DNA,
his lab  has developed a  method for  isolating and identifying genes
responsible  for  inherited defects.  Also  using synthetic  DNA,  his
LAB   HAS   DEVELOPED   A    METHOD   OF   CAUSING   SPECIFIC   MUTATIONS.   THESE
TWO   EXPERIMENTAL   TECHNIQUES   ARE   USED   EXTENSIVELY   BY   PEOPLE
STUDYING   HUMAN   DISEASE.
The Biotechnology Laboratory has several state-of-the-art facilities that it
makes available on a per-fee basis to researchers on and off campus: a Laser-
Scanning Confocal Microscope, a Pilot Plant Facility for the large-scale production
of cells or cell products, and an Oligonucleotide Synthesis Facility, which can
provide various types of fragments of DNA.
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It was a daunting proposal: to create the largest cyclotron in existence and
one of only three such advanced nuclear science research facilities in the world.
Eight years would pass before the cyclotron delivered its first high-energy pi-
meson beam in 1975. But in the decade and a half since, the TRIUMF Project at
the University of British Columbia has become Canada's national laboratory for'
subatomic physics research and the site of applied research programs that have
generated important new biomedical research tools.
TRIUMF — Tri-University Meson Facility — takes its name from the trio of
universities that first collaborated on its creation in 1967 and continue to operate it
as a joint venture: Victoria, Simon Fraser and UBC. Later they were joined by the
University of Alberta. The cyclotron, still the biggest, accelerates negatively
charged hydrogen ions to 75 per cent the speed of light; intense beams of protons
are then directed out of the cyclotron. At these energies, short-lived particles called
pi-mesons, or pions, can be created so efficiently that TRIUMF is often described
as a meson factory. These mesons explore the structure of matter, seek out nature's
basic building blocks and measure the fundamental forces between them.
The medical community quickly realized TRIUMF's potential; since 1961,
scientists had been considering the potential of pi-meson radiation in the
treatment of deep-seated tumors. Today, the cyclotron is being used for various
biomedical purposes at UBC that would have been unthinkable only a decade or
two ago. • RESEARCH OF RELEVANCE TO HEALTH GOES ON IN NINE OF OUR FACULTIES. II
INCLUDES CLINICAL RESEARCH IN HOSPITAL SETTINGS AND BASIC SCIENCE RESEARCH
IN LABORATORIES. IT IS AS FUNDAMENTAL AS THE PURSUIT OF POLYPEPTIDES AND AS
PRACTICAL AS THE DEVELOPMENT OF HEARING DEVICES. IT TOUCHES ON THE FOOC
WE     EAT,     THE     AIR    WE     BREATHE,     THE     H O Art E S     WE     INHABIT.     IT     SEEKS     TO     PROMOTI
XIII ^&e€e&A %y%tertsce< ^JveAetzsecA//i
As you might imagine, the bulk of our health sciences research is conducted
by investigators in the faculties of Medicine, Dentistry and Pharmaceutical
Sciences and the School of Nursing. Elsewhere in this report we describe their
major research endeavors. Here we present some highlights of health sciences
research in the faculties of Arts, Agricultural Sciences, Applied Science,
Commerce and Business Administration, Education and Science.
Representative of scientists in non-medical faculties is Dr. Robert
Hancock. Dr. Hancock is a basic scientist — a microbiologist in the Faculty of
Science. Not the type you'd expect to find at the bedside. But for many years his
research has been related to a bacterium that causes infections common in people
■with cystic fibrosis. Now, he is formally linked to the disease — as chair of the
Medical and Science Advisory Committee of the Canadian Cystic Fibrosis
Foundation. "Cystic fibrosis is one of those things that hooks you," he says. "It's a
tragic disease. Children now can grow into adults. But it's like they contain a time-
bomb. They know they are going to die young."
Today, because of Canadian research, the prospects of cystic fibrosis patients
are improving. With better antibiotics, better nutrition and better physiotherapy,
cystic fibrosis patients already live longer. In the past 10 years, life expectancy has
gone up by seven years. In Canada, where the CF Foundation has put a great deal
of money into research, the life expectancy is higher than anywhere else in the
world. A major breakthrough has been the discovery by researchers in Toronto of
the CF gene, creating the possibility of gene therapy as a cure.
Mean-while, Dr. Hancock is trying to defeat a bacterium that is a major cause
of death in CF patients. Healthy people aren't bothered by Pseudomonas aeruginosa,
which is so common that any shovelful of earth will contain it. However, in those
■who are ill or weak, it causes serious lung infections. It is a constant threat to
cystic fibrosis patients, whose respiratory system is a focus of their disease. And
it is the second major cause of death in North America from nosocomial — or
hospital-derived — infections. What makes it difficult to deal with is that it is
resistant to the disinfectants used in hospitals and to antibiotics.
Dr. Hancock explains that bacteria that once succumbed quite readily to
inexpensive antibiotics, such as tetracycline and penicillin, have suddenly become resistant. "These are cheap drugs," says Dr. Hancock. "Now we are moving to the
next line of compounds v/hich will cost tens of dollars a course. Knowing bacteria
as I do, they will eventually overcome those antibiotics and we'll move on to others
that cost hundreds of dollars. Suddenly, diseases that are epidemic in our society
will become much more frightening."
The focus of Dr. Hancock's research is the effort to overcome the resistance of
gram-negative bacteria, such as Pseudomonas, to antibiotics. He is one of only three
or four people in the world who are expert in the way gram-negative bacteria take
up antibiotics through their outer surfaces.
Microorganisms are classified gram-negative or -positive in a staining
technique named for the scientist who developed it. Gram-negative bacteria
have a protective outer coating that slows the rate at which antibiotics can get
in. Some bacteria, such as Escherichia coli, have thousands of channels through
their outer membranes. Pseudomonas has far fewer channels. Because the
antibiotics are entering slowly, the bacteria build up a secondary defence
mechanism that allows them to digest the drug. They also seem to have what
amounts to a program memory: once they have developed a resistance to one
drug, they readily resist another.
Dr. Hancock has filed a patent application on one possible way of getting
around the resistance of Pseudomonas. His patent involves a molecule known as
polymixin B nonapeptide. If PMBN is available, Pseudomonas will use it to build its
outer coating. Because PMBN is a large molecule, it produces gaps through which
antibiotics can enter. Dr. Hancock predicts that PMBN will be in clinical trials
within five years.
Meanwhile, he stresses the careful use of antibiotics .to maintain their
effectiveness. "If we start off with one bacteria in a person's body, we can have 10
to the 8th the next day. In that pool of bacteria, we will have a lot of mutants —
those that can overcome an antibiotic." Resistance can spread rapidly in a
population of bacteria, with the result that if one person becomes resistant to a
drug, everyone does.
"Bacteria evolve extremely rapidly. Human beings don't change that much over
time because -we take 40 years per generation. Bacteria take less than 40 minutes.
"I have an enormous respect for bacteria."
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'CCeSMCed-
in this Faculty's animal Science department, researchers studying
chickens may help solve two human health problems. Dr. Robert Blair studies
Sudden Death Syndrome, which kills about eight million broiler chickens a year in
Canada. Because the chickens exhibit respiratory distress before they suddenly die,
Dr. Blair suggests that the syndrome has parallels with crib death in sleeping
babies. Dr. Leslie Hart's study of the effect of reproductive hormones on the
strength of bone and egg shell in laying hens may provide information that will
assist in the treatment of osteoporosis in women.
Focused on keeping people healthy, UBC food scientists tackle such matters as
devising a method of quickly detecting paralytic shellfish poisoning in seafood;
developing   food-preservation   technology;   modifying   the   antigenic   and immunological properties of infant formula; and informing the public about safe
food-preserving and handling techniques.
Fundamental changes in international trade relations, coupled with advances
in food processing, have given a new urgency to food marketing and food quality.
UBC will take a leadership role in this area with the establishment of a Food
Research Centre, the first of its kind in Canada.
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Biomedical Engineering is one of the hidden activities in the health sciences.
The term covers the entire intersection of engineering and the health sciences. The
technological devices used in medicine are biomedical engineering devices.
Dr. Charles Laszlo, a professor of Electrical Engineering, is director of our
Clinical Engineering Program, which was the first post-graduate program in the
field in Canada. Graduates practise in hospitals, applying engineering principles to
patient-care and health-care technology. Biomedical engineers work at the B.C.
Cancer Agency, VGH (where 20 technicians are affiliated with UBC), British
Columbia's Children's Hospital and the G.F. Strong Rehabilitation Centre.
In Canada, UBC is the only place where devices for the hard-of-hearing and
the deaf are being developed. For instance, Dr. Laszlo has built a small vibrator
worn on the wrist which signals a hard-of-hearing person that a telephone is ringing
or a fire alarm has sounded.
Solving other kinds of problems, Dr. Laszlo is working with Dr. Andrew
McNab at Children's Hospital to develop ways of eliminating the detrimental effect
of noise on ailing children being transported long distances by road and by air.
With the Sexual Medicine Unit at University Hospital-Shaughnessy Site, he is
developing a portable unit that will cool the gonads of wheelchair-bound males
allowing them to father children.
A driving simulator, developed jointly by biomedical engineers at UBC and G.
F. Strong, has been sold to hospitals affiliated with the University of Toronto. This
unique device indicates if a patient who has suffered neurological damage has
recovered sufficiently to drive again.
A Biomedical Engineering Program at the masters and doctorate level, which
involves the departments of Electrical, Mechanical and Chemical Engineering, has
been approved by the UBC Senate. The objective is to train graduate engineers
capable of designing and developing new medical devices and related technology.
In the Department of Electrical Engineering, a number of faculty
members contribute significantly to aiding the disabled or to devising signal-based
methods of diagnosing various conditions:
• Emeritus Professor Dr.  Michael Beddoes developed a talking
stenograph  machine  used by blind people and also by b r a i n - d a m a g e d
children. he has contributed to the development of the phonetic
boswell keyboard, which is helpful in teaching dyslexics.
• dr.  mabo ito has worked with dr.  murray  morrison,  professor of
surgery, on the  use of signal processing to identify laryngeal
pathology, and with  electrical engineers at vgh  on a microprocessor-based system  for monitoring the perfori
anesthesiology al ventilators.
• adjuct professor dr. james mcewen, now in the electrical
engineering department at vgh,  did his phd thesis on computer-
assisted eeg analysis of human consciousness.  he has developed a
robot used in knee surgery to hold the limb steady.
• Dr.  Peter  Lawrence directs some of his research towards the use
of telerobotics to enhance the safety of operators of heavy
equipm ent.
• Dr.  Rabob Ward is collaborating with Dr.  Branco palcic at the
Cancer Research Centre on automated diagnosis of X-ray images
for cancer screening and detection.
• Dr.  Robin Turner, who is attached to the Biotechnology  Laboratory
on campus, seeks to understand the nature and causes of drift in
electrochemical biosensors.  his experience in this field comes from
the development of new membrane systems and instrumentation for
implantable  biomedical glucose sensors.
• Dr. Gary  Birch, Adjunct Professor,is Director of Research and
Development for the  Neil Squire  Foundation. The long-term goal of
his research  involves the use of brain-wave signals to control
external technical aids.
In the Department of mechanical Engineering, Dr. V. J. Modi is
working on evaluating heart valves. In the Department of Chemical Engineering,
Dr. Joel Bert, a chemical engineer, has close research links with our Pulmonary
Research Laboratory at St. Paul's Hospital. His research looks-at fluid and protein
distribution in the body. Dr. Bert, together with Dr. John Grace and the B.C.
Cancer Agency, is developing methods for ascertaining exposures to different
chemical and physical hazards in the workplace and a unique coding scheme which
can also be used in other health fields.
Dr. Douglas P. Romilly is actively involved in biomedical-related research
directed towards several areas including the analysis and optimization of pressure
profiles for pneumatic tourniquet cuffs, development of tongue force
measurement systems for the diagnosis and treatment of dysphagia (swallowing
disorders), and the development of a powered orthosis for patients with upper
limb dysfunction.
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The School of Social Work takes in an undergraduate class of 85 and has 94
graduate students in its MSW program. The school now participates in an
interdisciplinary PhD, involving Psychology, Anthropology and Sociology, and
Economics.
Among the school's more than 50 field placement agencies are many focusing
on mental health, and most of the faculty have a link in their teaching in that area.
Students spend two full days a week in one of these agencies. "Our students are
working with people classified as mental-health patients," says former Acting
Director Elaine  Stolar.  "While others tend to  separate out the mental and
H
ce
LU
u
o
(A Researchers at the
Terry Fox Laboratory
use the latest
techniques in the
fight against myeloid
leukemia. The staff
of 100 includes more
than 40 students and
post-doctoral fellows. emotional from the physical, we approach the complaint from a holistic —
interdisciplinary — point of view." Master's students introduce innovative
programs in their field placement agencies, such as an effective 10-week group
program for native Indian women attending a drug and alcohol clinic in
Vancouver. The school has recently begun an on-campus service providing therapy
for individuals, couples and children living in student housing or in residence.
Of the 16 faculty members in the School of Social Work, six are involved in
teaching health-centred courses or doing research in that area. Professor Stolar has
collaborated with Dr. Michael MacEntee, Faculty of Dentistry, and Dr. Frederick
Glick, Departments of Statistics, and Health Care and Epidemiology, on a survey
of 521 elderly people in Vancouver, identifying factors that influence oral health in
old age. The study found that most of the subjects had been to a dentist since the
age of 65, and that the cost of treatment was not a major concern to them.
However, those on low incomes went to the dentist only for relief of pain. Professor
Stolar has done projects -with mastectomy patients and their self-image attitudes, as
has Dr. Nancy Waxier-Morrison, -who has an appointment in Anthropology and
Sociology as well as in Social Work. Dr. Sharon Manson Willms is a faculty
associate with UBC's Centre for Human Settlements and the principal
investigator of a team conducting a national study of the housing needs
of Canadians infected with the HIV virus. The study was funded -with
more than $98,000 from Health and Welfare Canada.
Other health-related studies include those of Dr. Kathryn McCannell
on sex abuse and violence; Dr. Mary Russell on family violence; and Dr.
Paule McNichol on multi-cultural approaches to health care.
SIX   OUT   OF   THE
1 O    LEADING
CAUSES    OF
DEATH    IN
Six  out of the   IO  leading  causes of death in North America — ~" ■■"•c'-"0"^0
9
including heart disease and cancer  —  are related to nutrition.  Healthy
eating practices, reasonable body -weight, and sound exercise obviously
play a primary role in the prevention of and recovery from disease. Just
as obviously, well-trained dietitians and nutritionists perform a vital
service in educating the public and medical professionals alike. Not only
do the graduates of our School of Family and Nutritional Sciences work
with the public in community settings, but also most of the 500 Registered Dietitian
Nutritionists  (RDNs)  in  B.C.   —  the majority of them UBC graduates   —  are
involved in direct delivery of dietary therapy to patients in health-care facilities.
Meanwhile, researchers within the school are adding invaluable data to the world's
knowledge of dietary links to health in such areas as the measurement of cholesterol
production and the effects of nutritional intake on athletic performance.
Dietitians in particular may be involved in routine nutritional screening,
counselling and often follow-up of all new patients in an acute-care or long-term
health-care facility, as well as of those who have a high level of nutritional risk or
are restricted to special diets. Some dietitians are administrators in charge of food
production at hospitals. Others are in private practice. Nutritionists generally
work in such facilities as community public-health units. "At the community
level," says Dr. Susan Barr, director of the Dietetics Program, "the contribution to
health care may be more indirect, but certainly the education of mothers, children
and others to foster positive eating habits will, in the long run, make a difference
in health."
The BSc in Dietetics is a pre-professional program which, followed by a one-
year hospital-based internship,  qualifies graduates to become a member of the
EART   DISEASE
AND    CANCER
ARE    RELATED   TO
NUTRITION. Canadian Dietetic Association or the B.C. Dietitians' and Nutritionists'
Association, a prerequisite to professional employment. In the first two years, as
■well as studying nutrition, food chemistry, psychology and commerce, students take
many of the same courses in biology, chemistry, math, organic chemistry and
microbiology as pre-med and pharmaceutical students. In third year, the emphasis
on science continues -with biochemistry, physiology, nutrition and a nutrition lab.
Most applied courses are taken in fourth year.
The Human Nutrition Program, delivered in conjunction with the Faculty of
Science, also has a broad science base in its first two years, similar to those taken
by students in the life sciences. The final two years focus on nutrition courses,
covering cellular and organismal features of nutrition. Optional subjects range
from computer science to zoology. The program, introduced in recent years, is
intended for students interested in basic nutritional sciences who are preparing for
further academic studies and research. As Dr. Melvin Lee, the program's recently
retired coordinator, points out, "Many of the students use it as a route to dental
and medical studies and others go into research and graduate programs."
The  school's faculty and students are involved in research in both dietetics
and human nutrition.  Dr.  Susan Barr's major interest is the relationship between
nutrition  and physical  activity.  Working with  medical  collaborators,   she  is
studying dietary patterns  of athletes  and how they change with
*Ar,,v_ OF ™E different levels of activity, particularly in endurance sports, and the
longer-term effects  of reduced nutritional intake  by adolescents
who are active in such pursuits as gymnastics and ballet. Dr. Peter
A    ROUTE    TO    DENTAL r °^
Jones,   an  assistant professor  of Nutrition,   has  developed  a
procedure  that promises  to  revolutionize  the  -way  cholesterol
production in the human body is measured:  non-radioactive stable
into research isotopes  can be used safely to  measure  cholesterol  synthesis  in
place  of the  time-consuming and  inaccurate  method  of fecal
examination.  Dr.  Linda McCargar,  also an assistant professor of
programs." Nutrition,  is researching weight cycling  (or "yo-yo dieting")  and
the hypothesis that constant dieting followed by weight gain may
make it harder to shed pounds and easier to regain them. Graduate students are
investigating a variety of areas, including the out-patient use of low-protein diets
for advanced Parkinson's-disease patients, and the effects of a nutrition-education
program for kindergarten children.
Prospective medical and nursing students form a significant part of the
enrolment in some undergraduate courses in the Department of Anthropology and
Sociology. In these courses they become aware not only of ethnic cultures but also
of different values and ways of interacting among less obvious groups in our
society — such as the physically disabled or hard of hearing. Understanding that
these cultural values exist is particularly important for health-care givers.
A number of PhD students supervised by Dr. Elvi Whittaker have done or are
working on theses in the area of medical anthropology or sociology. These involve
studies of women -who survive breast cancer, of women 'who have AIDS, of
gerontology as a construct of people -who are not themselves aged, and of people
who recovered from inflammatory bowel disease. Dr. Whittaker, who completed a
long-term study of nursing education, is now doing theoretical work at the edges
of psychiatry — looking at what we do to ourselves when we reily concepts such
as the self.
STUDENTS    USE    II
AND    MEDICAL
STUDIES   AND   OTHERS
AND   GRADUATE Dr. Nancy Waxier-Morrison, who is an associate professor of Sociology and
Social Work, has done studies of women with breast cancer showing that the
survival rate is better among unmarried women who have a good support network.
She is a co-author with Dr. Joan Anderson, in the School of Nursing, and
Elizabeth Richardson, a social worker with the Ministry of Social Services and
Housing, of a handbook for health professionals who treat people from groups that
have recently immigrated to Western Canada. Attitudes to childbirth, mental
illness, dental care, hospitalization and death are examined. Recently in Sri Lanka
Dr. Waxier-Morrison has been studying people who use traditional doctors and
those who use western-trained doctors.
Recognizing that there are few studies of what is is like to be handicapped and
that there is a population of variously handicapped students on campus, Dr. Bill
McKellin is working with our disabilities centre to define projects for his students
who are taking a standard quantitative methods course. His own research recently
has looked at choices made by parents of children with severe to profound hearing
loss. He is interested in how parents choose an educational program — either a
signing program or an oral program — for their children. "The way parents
understand hearing impairment changes as their child goes to school," he says.
"The notion of what deafness is is shaped by what institution is chosen."
Others in the department conduct studies of mental health among Indian groups
in Washington State or of the availability of western medicine in Papua New Guinea.
The ubc Psychology Department is a major contributor to our research
effort in the health sciences. Approximately half the research done in the
department — involving 19 faculty members — is aimed at the solution of health-
related problems. Research is supported by the Medical Research Council of
Canada, the B.C. Health Care Research Foundation, the B.C. Alcohol and Drug
Commission, the National Health Research and Development Program, the
MacArthur Foundation, Ciba-Geigy Pharmaceuticals, the B.C. and Yukon Heart
and Stroke Foundation, the University Hospital Foundation, and the B.C.
Alzheimer's Society. In addition, faculty members hold Natural Sciences and
Engineering Research Council grants that have major health-science components.
Several faculty conduct research on memory deficits associated with
neurologic disorders.
Dr. John  Pinel: amnesia caused  by thiamine  deficiency  in animal
models, which  is related to  brain  damage  in chronic alcoholics.    •
Dr.  Peter Graf:  memory deficits of Alzheimer patients.    •    Dr.  Romuald
Lakowski: color vision of diabetic patients.    •    Dr.  Stanley  Rachman:
the etiology and  behavioral mechanisms of phobias.
In the area of psychoactive drugs, Dr. Anthony Phillips and Dr. Charles Blaha
study the mechanisms of action of antischizophrenic drugs, primarily dopamine
antagonists, in rodents. Dr. Boris Gorzalka has been looking at the effects on
human and animal sexual motivation of various hormones and serotonergic agents.
(Serotonin acts as a potent vasoconstrictor and as a neurotransmitter.)
Systems of diagnosis developed in the department include Dr. Robert Hare's
Psychopathy Checklist (a rating scale for the assessment of psychopathy in male
forensic populations); Dr. Stanley Coren's and Dr. Arthur Ralph Hakstian's
inventories for quickly, inexpensively and accurately screening adults for visual
acuity and color blindness;  and Dr.  Kenneth Craig's Neonatal Facial Coding
w System for objectively describing newborns' reactions to potentially painful events.
In evaluating treatment protocols, Dr. Charlotte Johnston studies the
effectiveness of drug treatments for attention-deficit disorders; Dr. Wolfgang
Linden evaluates the effectiveness of treatment programs for hypertension and
postmyocardial infarction; and Dr. Lynn Alden studies the effectiveness of the
treatment of severe shyness.
Several faculty members study the adverse effects of chronic illness on
psychosocial adaptation, and the services in the community — or lack thereof — to
deal with them. Dr. Anita DeLongis focuses on the psychosocial problems faced by
people suffering from arthritis and the traumatic loss of loved ones.
Dr. Peter Suedfeld does research that shows that Restricted Environmental
Stimulation can be used therapeutically to cure smoking, reduce high blood
pressure and assist in sleep disturbances.
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In the Policy Analysis Division, Dr. Peter N. Nemetz is a faculty associate
of our new Centre for Health Services and Policy Research. In addition, he is a
senior visiting scientist in the Department of Health Sciences Research at the
Mayo Clinic. His research activities fall into three general areas:
• THE    ROLE   OF   THE   AUTOPSY   IN    PROVIDING   ESSENTIAL   INFORMATION    FOR
HEALTH    POLICY   AND    MEDICAL   DECISION-MAKING:   WRITING    IN   THE
AMERICAN   JOURNAL   OF   PATHOLOGY,    DR.    NEMETZ   POINTS   OUT   THAT   THE
AUTOPSY    IS   A   VALUABLE    INSTRUMENT   FOR   ACHIEVING   COST-EFFECTIVE
HEALTH   CARE   AND   THE   EFFICIENT   ALLOCATION   OF   RESOURCES.   AUTOPSIES
PROVIDE   ACCURATE    INFORMATION   ON   THE   CAUSE   OF   DEATH   AND   THUS
FACILITATE   THE   PROCESS   OF   GENERATING   AND   TESTING   HYPOTHESES
CONCERNING   THE   PREVALENCE   OF   DISEASES.    HE    NOTES   THAT   THE    NUMBER
OF   AUTOPSIES   PERFORMED   IN   THE    U.S.    HAS   DROPPED   FROM   SO   PER   CENT   OF
ALL   DEATHS   IMMEDIATELY   AFTER   THE   SECOND   WORLD   WAR   TO    14.7   PER
CENT   IN    1980.
• Pharmacoepidemiology:  In this area, the principles of
epidemiological analysis are applied to the study of the  positive
and adverse effects of pharmaceuticals. this has  become an
increasingly  important topic,  especially  in the  united states,
because of the concern over  possible litigation arising  from
adverse  drug events.
• The oldest old: The  fastest-growing subset of the  population are
those over 85.  Little  is  known  about what causes  death  in this
group and what conditions co-exist at the time of death.  Dr.  Nemetz
is studying the oldest old to understand the  nature of their
medical needs and the costs of services they  require.
In the Division of Management Science, Dr. Martin Puterman is founder
and director of the Biostatistical Consulting Service at British Columbia's
Children's Hospital, and president of the Biostatistics Section of the Canadian
Statistical Society. Biostatistics is the application of statistical methods to the
design of clinical and laboratory studies and the analysis of the resulting data. Dr.
Puterman's statistical investigations have been in a wide variety of areas: infectious diseases, immunology, obstetrics, neonatology, nutrition, rheumatology, virology
and cardiology. In Pediatric Cardiology, for instance, he reported normal ranges for
variability in echocardiographic images, allowing cardiologists to determine non-
invasively when chemotherapy leads to deterioration of the heart. Currently he is
involved in clinical trials investigating the use of intravenous gammaglobulin as a
treatment for childhood seizures and the treatment of urinary tract infections in
patients with spinal cord injuries.
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Several departments — Counselling Psychology, Mathematics and Science
Education, and Educational Psychology and Special Education — as well as the
School of Physical Education and Recreation are active in health-related research.
Through the teachers we prepare for the public school system, we have a profound
effect on the health and lifestyles of young people.
Health education in the Department of Mathematics and Science Education
began in 1978 with funding from the Canadian Cancer Society to develop a cancer
education program for the secondary schools of Canada. In 1981, the program
introduced cancer education as part of the cross-Canada curriculum in such
subjects as social studies and senior biology. The department has since received
grants to develop programs in drug education for students from grades four to
nine. Out of these activities, a graduate program has developed, masters students
are creating education models related to smoking, alcohol, AIDS and the teacher's
role as an attachment figure for abused children. Work in AIDS education research
continues at the doctoral level. Dr. Kip Anastasiou heads the health education
group in the department.
Hearing loss among native Indian children in public and high schools in
central B.C. is the focus of research done by Dr. Perry Leslie, of the Department of
Educational Psychology and Special Education. His research partner is Dr.
Douglas Willms, of the Department of Social and Educational Studies. The two
suspect that among the Carrier-Sekani Indians some form of hearing impairment
may affect 30 per cent of students from kindergarten to Grade 12. The cause is
usually middle-ear infections brought on by colds caused by extreme temperature
changes. The hearing loss, which can cause a student to miss a great deal of what is
said in the classroom, comes and goes on a regular basis, confusing teachers who
think a child with an active infection has become a behavior problem. The research
is funded by the Social Sciences and Humanities Research Council.
Other Special Education faculty have research projects related to the mother-
child relationship when one or both are hearing-impaired, and to the effect on
hearing-impaired children of attending a school for the deaf or being in a classroom
with hearing children.
The  Department of  Educational  Psychology  and Special  Education
provides post-graduate, specialist training for teachers who will work with
hearing-impaired and visually-impaired children.  UBC has supplied teachers for w
the deaf for two-thirds of the school districts in the province, but there is still a
need for more such specialists.
An example of health-sciences research combined with community
service is the Alcohol Recovery Project, directed by Dr. John Friesen, of the
Department of Counselling Psychology. Developed over the past four years, the
15-week treatment is being offered to 150 families who have one or more children
age four or older, an alcohol-dependent father and a non-alcohol-dependent
mother. From an education-research point of view, Dr. Friesen and the 16
researchers involved are exploring the effectiveness of a treatment called
Experiential Systemic Therapy. The data gathered from questionnaires and 2,000
videotaped therapy sessions will be used to improve treatment in a variety of
government and private counselling agencies. Funded by the Ministry of Labor
and Consumer Services, the treatment is offered in Surrey and Duncan. The
Department of Counselling Psychology, which prepares school counsellors, now
offers a doctoral program.
The School of Physical Education and Recreation is a school within
the Faculty of Education. Researchers there, such as Dr. Kenneth Coutts, are
involved in the study of human activity. Dr. Coutts, who has connections with
our Disability Resource Centre and Sports Medicine Clinic, is now doing
research on wheelchair locomotion and propulsion. Having previously studied
wheelchair athletes and the upper limits of their ability to accelerate a
wheelchair, Dr. Coutts is now concerned with the demands made on the ordinary
person who must propel a wheelchair in the real world. With Dr. Donald
McKenzie, coordinator of research for the Division of Sports Medicine, and Dr.
Paul Rogers, professor of Pediatrics, Dr. Coutts is cooperating in studies of
fitness levels of children with spina bifida. In children undergoing treatment for
solid-tumor cancers, they are looking at the post-treatment effect of
chemotherapy on the heart and on endurance.
Dr. Angelo Belcastro, president of the B.C. Sports Medicine Council, has an
academic appointment in the School of Physical Education and Recreation. His
basic interest in diabetes and its effect on muscle has led to two paths of research.
For the past 15 years, he has collaborated with the University of Alberta team that
recently succeeded in transplanting islet cells into a diabetic. Dr. Belcastro's
contribution has been in studying islet cell function in animals. The second path
involves muscle wasting in diseases such as diabetes, dystrophy and myopathies.
He is studying the processes that control protein breakdown in muscle — in whole
organisms, in isolated cells and at the sub-cellular level.
Health promotion and wellness play key roles in the Health Sciences at
UBC. Initiatives include:
• RESEARCH   WITH   THE   VANCOUVER   SCHOOL   BOARD   ON   NUTRITION   AND   THE
DAILY   LUNCH   PROGRAM.
• RESEARCH   INVOLVING   EXERCISE   AND   PHYSICAL   ACTIVITY   AS   IT   RELATES   TO
THE   REDUCTION   OF   OBESITY   AND   OSTEOPORITIS   IN   ELDERLY   WOMEN.
THE   BUCHANAN   FITNESS   CENTRE   WHERE   HUNDREDS   OF   STUDENTS,   FACULTY
AND   MEMBERS   OF   THE   COMMUNITY   HAVE   THEIR   FITNESS   EVALUATED   AND   ARE
COUNSELLED   EVERY   YEAR. 'cceme
Health-sciences research is conducted in five departments Botany,
Chemistry, Microbiology, Zoology, and Statistics.
Vinblastine and vincristine — chemicals from the Madagascar periwinkle,
used to prevent the proliferation of malignant cells — were discovered in Canada in
the 1950s with some of the work being done at UBC. But today Dr. Neil Towers of
the Department of Botany is one of the few people in Canada interested in the
biological applications of chemicals found in plants. For their antibiotic potential in
the treatment of skin ailments, he is studying light-activated chemicals in marigolds
and members of the parsley family, and for their antibiotic potential against
pathogenic yeasts (such as Candida albicans}, he's looking at two local weeds —
ambrosia and rattlesnake tail. While the in vitro activity of St. John's Wort against
the HIV virus has been demonstrated by others. Dr. Towers has shown that this
activity is enhanced by light. Researchers in Dr. Towers' lab are trying to induce
cultured cells of the Pacific yew tree to produce Taxol, a drug now being tested on
ovarian-cancer patients in 23 Canadian medical centres.
Setting the pace for the Department of Chemistry's contribution to biomedical
research, Dr. David Dolphin, a professor in the department and former acting dean
of Science, was the 1990 health sciences winner of a B.C. Science and Engineering
gold medal. Dr. Dolphin is an expert in porphyrins, naturally occurring products
that react strongly when exposed to light. In cancer therapy, injected porphyrin-
based drugs accumulate in tissues where exposure to low-power laser light causes
them to convert oxygen into a toxic substance that destroys cancerous tissues
without damaging healthy tissue. Tests of Photofrin, a porphyrin-based drug, are
being conducted at Quadra Logic Technologies, a Vancouver biotechnology
company in which Dr. Dolphin holds an official position. Other light-sensitive
drugs developed by Dr. Dolphin can be used to cleanse donated blood of
potentially harmful viruses, such as HIV.
The main topic of Dr. Leslie Burtnick's research is the regulation of the
assembly and disassembly of actin, a protein that in muscles brings about
contraction and relaxation. In non-muscle systems, actin filaments act like girders
in a building, giving cells shape. When cells die or rupture, the filaments spill out
into the blood stream and are normally cleared away by scavengers. In conditions
where there is an excessive breaking up of cells, as in acute respiratory syndrome,
the system might not be able to cope with the overload of circulation-clogging
filaments. Funded now by the Natural Sciences and Engineering Research Council,
Dr. Burtnick has had Heart Foundation and B.C. Health Care Foundation support.
Inorganic chemist Dr. Chris Orvig has coined the term metallodrugs to
describe the compounds of metals he designs for use in diagnosis, involving nuclear
medicine, and in treatment. He is also interested in the chelation of biologically
active metal ions, an example of which is the potential involvement of aluminum in
Alzheimer's disease. Dr. Orvig has pharmaceutical company funding, as well as
grants from the National Cancer Institute in the U.S. and the Natural Sciences and
Engineering Research Council in Canada. His campus collaborations are with the
Faculty of Pharmaceutical Sciences. The Dean of Science, who is a professor in the Department of Microbiology,
personally exemplifies his faculty's contributions to health sciences research at
UBC. Dr. Barry McBride is an oral microbiologist who began his career in the
Faculty of Dentistry where he became head of the Department of Oral Biology. In
1986, he moved over to the Faculty of Science as head of Microbiology. Dean
since 1990, he retains his appointments in Oral Biology and Microbiology, where
his research involves understanding the disease-causing ability of two anaerobic
micro-organisms — Porphyromonas gingivalis and Treponema. Both are oral
pathogens. The former causes disease in the mouth, but given the right
circumstances can spread, causing lung and brain abscesses. Treponema, a
spirochete, can invade oral tissues, producing a host of damaging enzymes. His
research, conducted in part as a member of the Canadian Bacterial Diseases
Network, involves understanding how these organisms adhere to cell surfaces and
how it is that they cause disease when other oral organisms do not.
Statistical methodology is concerned with both the efficient use of
experimental resources and the appropriate analysis of data. Some medical research
groups on campus have recognized their need for statistics expertise to improve
their research programs. At present, interactions between medical researchers and
statisticians and biostatisticians occur informally.
Having taken sabbatical leave at the Harvard School of Public Health, Dr.
John Petkau, head of the Department of Statistics, began to establish interactions
with medical researchers at UBC to develop his research interest in designs for
clinical experiments, research that has expanded to include others in the
department (Dr. Nancy Heckman and a graduate student) and has evolved into
collaborative activity with UBC neuroscientists studying multiple sclerosis. The
department's Statistical Consulting and Research Laboratory has also been
involved. Two faculty members — Dr. Frederick Glick and Dr. Michael Schulzer —
have joint appointments in the Faculty of Medicine.
Research in the Department of Zoology falls into four broad categories:
cell and developmental biology; community and population biology; evolutionary
biology; and comparative physiology and biochemistry. The department harbors
several researchers whose projects have implications for human health, and it
has interdisciplinary research and teaching connections with the Cancer
Research Centre.
Working with fruit flies, Dr. Thomas Grigliatti is looking for genes that
package DNA into chromosomes and chromatin (the material within the cell
nucleus from which chromosomes are formed). These genes are important in
condensing chromosomes so they can go through normal cell division. "Whatever
we find for regulating chromosome structure in Drosophila is probably going to be at
work in humans," he says, adding that differences in chromosome packaging might
explain Fragile X syndrome, which produces mental retardation in humans. Dr.
Grigliatti is a member of the National Network of Centres of Excellence studying
Biotechnology for Insect Pest Management.
In the Neural Regeneration Network, Dr. John Steeves is contributing to
spinal cord research directed out of the University of Manitoba.
The research projects of Dr. Peter Hochachka clearly illustrate the interaction
of zoology and medicine. Dr. Hochachka is studying animals naturally able to
survive the stress of hypoxia — a deficiency of oxygen — and he has tested humans THE DISCOVERY OF INSULIN 70 YEARS AGO IN AN OUT-OF-THE-WAY LABORATORY AT
THE     UNIVERSITY    OF     TORONTO     REMAINS     THE     MOST     FAMOUS     EVENT     IN     CANADIAN
MEDICAL    RESEARCH.    IT    MAKES    AIM    APPEALING    STORY         A    DETERMINED    DOCTOR    AND
A STUDENT ASSISTANT WORKING FOR THE MOST PART ALONE, NOT ENTIRELY SURE
OF THEIR HYPOTHESIS, MAKING MISTAKES, GETTING DISCOURAGED, AND
EVENTUALLY   OBTAINING   THE    LIFE-SAVING    EXTRACT.
XIV. lyf/ve^os* y/MftWKSveAea/tcAs G>sie&€Z<iwse&
In the isolation of its heroes, the Banting and Best drama is not likely to
be re-enacted today. Synergy — the process of working together to enhance
effectiveness   —  is the watchword of modern science,  and in Canada synergy has
z
well-adapted to living and working at high altitudes. Now, he says, the scientific
meetings he attends include people working in related problem areas in medicine:
cerebral metabolism in stroke; hypoxia or ischemia (reduced blood supply) of the
heart; acute renal failure; and liver ischemia.
Since 1976, Dr. Hochachka has been going on two-month expeditions to the
Antarctic to monitor the biochemistry and physiology of voluntarily diving seals,
v/hich routinely breath-hold for 45 minutes. His colleague in this venture is an
American clinician, whose object has been to find a model system that protects
mammals from lack of oxygen in order to help save lung-injured patients.
Studying  Andean  Indians,  brought to Vancouver  for  the  purpose,   Dr. o
Hochachka and his colleagues solved a metabolic mystery known as the lactate
paradox. When humans 'work or exercise to capacity, tissues lack oxygen and
lactate is generated in the muscles. Fifty years ago, scientists noticed that Andean
natives made less rather than more lactate at any v/ork level. Now, the B.C. team
has demonstrated that, having a unique distribution of enzymes, Andeans don't
make lactate because they can't. Pointing out that an equivalent block occurs in the
hummingbird, Dr. Hochachka says, "My guess is that we've stumbled on a true
genetic level adaptation."
A current project with direct human-health connections involves the testing of
another group of Andeans with high-viscosity blood, v/hich can affect the delivery
of oxygen to the brain. Through PET scans at TRIUMF and MR spectroscopy in
Alberta, the researchers are trying to discover if there are regions of the brain
differentially protected or sensitive to limitations of oxygen. This research relates
to ischemic stroke and other kinds of cerebrovascular accidents."'
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been facilitated by national programs that link university and corporate scientists.
UBC health-sciences investigators have been chosen by international juries to
participate in these programs and, in several cases, to lead the entire national
effort. Their involvement is both an acknowledgement of the superiority of
research at this university and a stimulus to further discoveries.
Here we discuss the university's participation in National Networks of Centres
of Excellence; the Canadian Institute for Advanced Research; and the Canadian
HIV Trials Network.
^Va£c?tcz/'^^Vefajc>brt& tyfv5ew&ed tyft3az&d&nt?e
IN May, 1988, the federal government announced a competition to
establish cross-country, inter-disciplinary networks of scientists engaged in related
research projects. The program challenged researchers to devise projects that
would boost Canada's performance in science and technology and create
collaborations among university researchers and industry. By the closing date of
the competition, applications involving 4,000 researchers had been submitted.
These were judged by an international peer-review committee. The result was the
creation of 14 original — and eventually 15 — Networks of Centres of Excellence
with funding support of $240 million. The government of B.C. later added $20
million for network researchers in the province.
These networks and research projects represent the very best in Canadian
research, and it is a tribute to the breadth of excellent research at UBC that the
university was chosen to participate in 12 networks. Six of these are in
biotechnology or are dedicated to research that has implications for human health.
In recognition of UBC's leadership in health sciences research, three networks are
based here, with UBC faculty members as scientific directors, coordinating
research nodes across the country. In each case, national offices have been
established on campus. Their presence has meant an infusion of funds, which has
had an enormous impact on UBC's scientific capabilities. A networks building,
funded by the provincial government, has been constructed, expensive equipment
has been purchased, cross-country computer links have been established and jobs
have been created for research associates and assistants, post-doctoral fellows and
administrators.
The three networks headquartered at UBC are focusing on Bacterial Diseases,
the Genetic Basis of Human Disease and Protein Engineering.
UBC biomedical investigators are members of networks headquartered
elsewhere. They are focusing on Respiratory Health, Neural Regeneration and
Functional Recovery, and Biotechnology for Insect Pest Management. While the
research of the latter network is not directly relevant to disease, its objective — the
development of new and environmentally acceptable methods of pest control —
could have health benefits in improved crop production and reduced damage to the
environment. Dr. Thomas Grigliatti, professor of Zoology at UBC, leads a team
developing ways to transfer genetically engineered material into insects making use
of jumping genes — genes that spread rapidly through a population yet remain in
one species only.
All these  networks will  shrink barriers to  scientific  interchange  and enhance both problem-solving and the transfer of technology to the private
sector. Their success will be in the creation of patents and inventions that can
be developed by industry.
PENCE — THE PROTEIN ENGINEERING NETWORK of Centres of Excellence —links
eight UBC researchers with colleagues in two other universities, four research
laboratories and five companies. The network's substantial budget of $20 million
over four years will facilitate meetings among those whose complementary projects
are directed at a single objective.
"The whole idea of the network is to foster new and collaborative research,"
says Dr. Michael Smith, the network's scientific director. "The projects we made
the basis for our proposal were like that — new projects which involved distinct
collaborations, where different people did complementary things directed at a
single objective."
Protein Engineering uses a variety of techniques to understand the functioning
of proteins and to improve them by making changes in their
amino-acid building-block structure.  Improved proteins can be protein engineering
j    • i        r i    •      i •       •      i -i i • i Network of  Centres
used in the  rood industry,  in industrial products,  in the OF excellence
development of disease-resistant crops and in the treatment of _
* " Scientific  Director:
cancer and infectious diseases. prof^Vs^r'^e^o^h'em.'stry
/— r.      | |   ,       «. . , . Faculty of  Medicine
Or the network s rive current projects, one that is most
The UBC Centre:
relevant to human health is being conducted at UBC.  Drs. „   dr. Bouglas k.lburn,
d Professor of Microbiology
Brayer,  Clark-Lewis and Ziltener are studying cellular growth *CULTV OF
P . . l 1* r   l l • ^R'  Grant  Mauk,
ractors to gain a  better understanding or how these proteins professor of biochemistry
Faculty of  Medicine
control the development of the immune system. They hope to DR  Gary Brayer
dj.f     j ,     • 1   •     1_ *     1_ -l 1_ Al 1       J     » Associate  Professor of  Biochemistry
uce modiried proteins which might enhance the  body s faculty of medicine
ability to repel infections. They are focusing on a factor called d». r. a. j. warren,
^ - hW Professor of Microbiology
interleukin-3,    which    stimulates    bone-marrow    cells    to faculty of science
differentiate into red blood cells or lymphocytes — immune cells. professor of chemIstry
Faculty  of  Science
°
The work of Drs.  Kilburn, Withers and Warren involves EJ
Dr.   Ian   Clark-Lewis, ^
Assistant Professor of Biochemistry
Biomedical Research Centre
cellulases  —  a group of enzymes which break down cellulose.
Genetic engineering techniques can be used to extract parts of dr. Herman ziltener,
r. i. . Assistant  Professor  of  Patholc
those enzymes which might be useful in medicine   —  either as biomedical research centre
diagnostic agents or as tools to purify proteins.
The Canadian Bacterial Diseases Network comprises 50 people in eight
universities, 11 companies and two government agencies. In the area of human
health, researchers are investigating the causes of whooping cough, gonorrhea,
pelvic inflammatory disease, toxic shock syndrome, dental diseases, lung infections
in cystic fibrosis and hospital infections. The CBDN will receive $18.2 million from
the federal government over the next four years.
"The network allows us to interact with drug companies on terms that are
reasonable for us. It provides links across the country, and within the university, it
provides great collaboration. By forming a consortium, you expand the possibilities
that your own research will come to something," says Dr.  Robert Hancock, the x
network's scientific director.
Dr. Hancock's research involves overcoming the resistance of bacteria to
antibiotics  —  a phenomenon that has reduced the effectiveness of wonder drugs
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such as penicillin and tetracycline. Dr. Hancock is one of only three or four people
in the world who are expert in the way gram-negative bacteria take up antibiotics
through their outer surfaces. Gram-negative bacteria — such as Pseudomonas
aeruginosa, v/hich is a major cause of death in children with cystic fibrosis — have a
protective outer coating that slows the rate at which antibiotics can get in. Because
the antibiotics are entering slowly, the bacteria build up a secondary defence
mechanism that allows them to digest the drug. Several people in the network are
looking at ways of attacking this defence mechanism.
While Dr. Iwama's 'work relates to animal science, the investigations of the
other node members have implications for human health.
Dr. Anthony Chow is one of a few Canadians -working on gram-positive
bacteria. His project in the network relates to the pathogenesis of toxic shock
produced by gram-positive organisms in the genital tract.
Dr. Barry McBride, who was chair of the Department of Oral Biology in the
Faculty of Dentistry,  is also a member of the  Department of Microbiology doing
basic-science  studies  of two  oral  pathogens.   The  focus  of his  research  on
Porphyromonas gingivalis and Treponema is understanding how these micro-organisms
_ „ adhere to cell surfaces and grow.
Canadian   Bacterial °
diseases network Dr.   Donald   Brooks,   the   first   Canadian   to   have   put
scientific director: experiments  on  a space  shuttle,   is  an  expert  in  methods  of
Dr.   Robert   Hancock, t
professor of microbiology biophysically separating one liquid from another. His experiments
Faculty  of  Science x.      ^ ^ l v ± x
Vancouver coord,nator: are   aimed   at   using   the   zero   gravity   of   space   to   purify
Dr.  Anthony  Chow, , ,        c u 1 . j    . , ,.      j.
professor of medicine pharmaceuticals  raster.   He  is  also  interested in the   binding
Faculty  of  Medicine t
properties of bacteria. Whether bacteria bind to cell surfaces or
U BC   Centre: r        r
of. o?Rpat>h°0Nlo:gyBaRn0d0cShem,sTry do not has implications in their ability to cause disease.
:ulties  of   Medicine  and   Science y^. ^ tt     l l'l 1 p   • ill
Dr.  rirett r inlay works in the general area ol intracellular
Dr.   Brett  Finlay, # ...
assistant professor pathogens, with a particular interest in those bacteria that cause
Biotechnology  Laboratory l ° L
dr. barry McBride, salmonellosis,  a disease that costs  society billions  of dollars a
Professor   of   Microbiology . p  , , TT. ,      . 1
dean of science year in terms ol lost productivity, riis research is also important
dr. George iwama, to  diarrheal  disease  in  our  society and  shigellosis,  an  acute
bacterial   infection   of  the   bowel   common   in   third-world
countries.  Dr.  Finlay has  shown that Salmonella must interact
O Asst.   Professor   of  Animal  Science
m faculty of agricultural sciences bacterial   infection   of  the   bowel   common   in   third-world
Dr.   David  Speert,
Professor  of  Pediatrics
Faculty  of  Medicine t •   1      i«     1 n r l    •       1
with epithelial cell surfaces and induce the synthesis of several
new surface proteins before it can enter host cells. If the cell surfaces are
chemically altered, these proteins are not induced and the bacteria do not enter.
He has applied for a patent on his method of inhibiting the uptake of intracellular
pathogens into human cells.
A pediatrician, Dr. David Speert is a scientist whose experience in clinical care
of children is invaluable to the node. His project involves phagocytes — cells that are
able to surround, engulf and digest micro-organisms. He is studying the mechanisms
bacteria use to enter phagocytic cells and outwit their defenses, with the idea of
making phagocytes more effective in killing bacteria.
t&awezcz&ziv ^ie?ze£c ^^eiieaSeA ^yye^iivi^
THIS NETWORK COMPRISES 22  scientists from  eight universities and hospitals,
working with five pharmaceutical and biotechnology companies. Among the areas of
>< study are the defective genes that cause muscular dystrophy,  cystic fibrosis and
Huntington's disease, and the genes that create an increased susceptibility to
diabetes, heart disease or cancer. The goal of the network is to determine the
biological function of each of the relevant genes and to discover how mutations in each cause disease. This innovative research will lead to a new industry in Canada
related to the diagnosis, prevention and treatment of genetic disease, resulting in
fewer affected persons and reduced health-care costs for Canadians.
"What we're doing is breaking down institutional barriers and departmental
barriers," says Scientific Director Dr. Michael Hayden. "We really feel as though
we have colleagues across this country — as if they're in the lab next door."
A key aspect of the network has been the development of facilities that provide
technological and analytical services for all the investigators so that they can
concentrate on their research. Four of these core facilities are on the UBC campus.
Dr. Gregory Lee directs the operation of a hybridoma facility at University
Hospital—UBC Site. The facility is now producing monoclonal antibodies for some
of the proteins that are coded by the genes being studied in the network. These
monoclonal antibodies are important in understanding the cellular and subcellular
organization of the proteins, allowing researchers to study why disturbed cells are
not effective. The facility has produced antibodies against many human proteins,
tumor markers and surface antigens.
Dr. Paul Goodfellow directs a somatic cell hybrid facility at UBC, which is
able to determine -where a particular gene is in the human gene
Complex. Canadian   Genetic
At the Biomedical Research Centre,  Dr.  Jamey Marth is
running a gene targeting facility and Dr. Frank Jirik directs the dr'EmIchTel'haJden,'
~        ... t^i 1*1 11 ll*" 1 Professor   of  Medical  Genetics
transgenic facility.  Both are high-technology additions to the faculty of medicine
province's research capabilities in terms of understanding the „ T"E UB,!r CENTRE
£ T: o DR.   Paul  Goodfelli
mechanisms underlying genetic diseases and in developing
therapies. Researchers in these facilities v/ill create animal models
of human genetic diseases.  By knocking out specific genes, they _     gynecology
o J D r o J Faculty  of   Medi
will be able to produce individuals v/ith abnormalities similar to
abnormalities in humans and to study their development.
Dr.  Ruedi Aebersold directs a protein analysis facility at biomedical research centre:
^ J J Dr.   Ruedi  Aebersold,
,1 d* l* ID „    1_    (~* .„ T'L.        C        ' 1 ' j. '    j. C       — Asst.   Professor  of  Biochemistf
the  rJiomedical  Research  Centre,   the  racility consists  or an faculty of medicine
analytical laboratory able to do ultra-high  sensitivity protein dr. frank jirik,
sequencing. Protein patterns can be digitized and stored in
computer memory, so tha^t changes in patterns in pathological
states can be studied.
Dr.   Paul  Goodfellow,
Asst.   Professor   of   Medical  Genetics
Faculty  of   Medicine
Dr.   Gregory   Lee,
Asst.   Professor   Obstetrics   8t
Gynecology
Faculty  of   Medicine
Dr.  Jamey   Marth,
Professor   of  Medical  Genetics
Faculty  of   Medicine
Asst.   Professor  of  Medicine
Faculty  of   Medicine
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THE RESPIRATORY HEALTH NETWORK of Centres of Excellence is headquartered at
McGill University. The network has taken on five projects involving diseases that
cause airways obstruction. These include asthma, cystic fibrosis, chronic bronchitis
and emphysema, and occupational and environmental lung diseases.
The Pulmonary Research Laboratory at St. Paul's Hospital in Vancouver,
directed by Dr. James Hogg, is functioning as the administrative centre for UBC's
contribution, v/hich involves four of the five major projects. Dr. Hogg is the
principal investigator for tv/o projects. His study, with Dr. Peter Pare, of the
structure and function of the lung is aimed at identifying the earliest pathological
abnormalities that occur in the lungs exposed to cigarette smoke, atmospheric
pollution or specific allergens in order to develop a fuller understanding of the ><
mechanism of disease production — and, from that, a strategy for therapeutic
intervention., Using dissected specimens from lung-cancer or other lung-pathology
operations,  the investigators make detailed measurements of airways' and lung
> airspaces' structural abnormalities, -which are then correlated -with lung-function
abnormalities determined before the operations. Because these assessments require
an enormous number of quantitative measurements on microscopic section, the
group is using an image-analysis system developed by Infrascan Corporation of
Richmond, B.C. A spin-off v/ill be the manufacturing by Infrascan of an automatic
image digitizer that -will retail at half the cost of current models and -will have
applications in fields such as physics, geology and cell biology -where quantification
of structure is important.
Dr. Hogg's second network project involves establishing a molecular biology
laboratory within the UBC pulmonary research group at St. Paul's Hospital to
investigate the role of viral infections in the pathogenesis of chronic obstructive
lung disease. There is considerable evidence that respiratory tract viral infections
in early life, even prior to the age of two, are associated -with airways obstruction
in adulthood. Dr. Hogg's ultimate goal is to test the hypothesis that the 20 per cent
of heavy smokers who develop airways obstruction do so because they have active
or chronic latent viral infections.
Dr.   Moira   Chan-Yeung   is   responsible   for   the   UBC
Respiratory  Health
Network of Centres contribution to two projects:   Environmental  Home Air and
xcellence Asthma.  UBC investigators  Salari,  Schellenberg and  Chan-
TdHrE jaIhIs'hooV' Yeung are on the team seeking new pharmacological therapies
faculty of medicine for asthma,  a health problem that affects about  10 per cent of
dr. Sidney katz, Canadians.  Their study of the  role  of a biologically active
Professor  of  Pharmacology ^ ° ^
faculty of^haIma'c^u^cIl sciences compound known as Platelet Activating Factor is basic to the
dr. moira chan-yeung, team's goal of developing new drugs to reverse the airway
Professor  of   Medicine _
■■ faculty of medicine inflammation in  asthma.   Drs.   Chan-Yeung and  Salari are
** Assoc,atDe%rSo7ePsHsEoNr^AfMmedicine measuring the role of PAF in western red cedar asthma.
Faculty  of  Medicine j~. pi v • i    • • f J    T-v
Dr.  Lhan-Yeung is a co-principal investigator ol and  Dr.
Dr.   Peter   Pare, ii. i r ■
w professor of medicine Sverre Vedal is a member ol the group seeking to identify the
^ Faculty  ofMedicine a l o ./
- dr. Hassan salari, determinants of ill health in indoor environments.  The  UBC
—' Assistant   Professor   of  Medicine • ., . i ., 1 l , l r   n    n r\ n
faculty of medicine in ve s tigat o r s  are  assessing the  respiratory health  ol  z,UUU
50 dr. Robert schellenberg, elementary school children in 12 schools in the coastal pulp mill
>
Faculty  of  Medicine
Dr. Sverre Vedal,
ate Professor of M
Faculty  of  Medicine
town of Port Alberni,  and testing the hypothesis that wheezing
associate professor of medicine syndromes and airway hyperresponsiveness are related to the
type and amount of aero-allergen in the  home  environment.
Among the team's objectives is the testing of an ultra-violet air
sterilizer as a means of reducing allergen load in homes.
Pharmacologist Dr. Sidney Katz is a member of the cystic fibrosis team. It is
estimated that 13,000 Canadian children have this disease, which leads inevitably
to premature death. Although the basic defect in CF is understood, current
therapies are directed against the manifestations of the disease in the lungs and
intestines. The network is trying to develop therapeutic agents to treat the
underlying cellular abnormality in cystic fibrosis.
Dr. George Davidson, professor of Pediatrics, and Dr. David Walker, assistant
professor of Pathology, are network consultants.
^yeettezciZsteaerietezifow and\seiMC&cwiez(^sZsccn*efrM ^refaj&lwtyz&axxdtence
x MAJOR ADVANCES HAVE BEEN MADE recently in uncovering the unsuspected ability
of the nervous system to re-grow after injury. The goal of this net-work,
headquartered at McGill University, is to promote regeneration in the nervous
system and recovery of function in people who have suffered strokes, spinal cord injury or retinal damage or who have Alzheimer's disease, dyslexia or amblyopia.
The strength of the network in molecular biology and microelectronics could lead
to the discovery of new drugs and the development of new devices to assist in the
recovery of neural function after injury.
The UBC centre, coordinated by Dr. Cynader, is studying visual function after
early deprivation or damage. Using animal models, the group will seek new
methods to re-create connections -within the visual centres in the brain.
As part of the University of Toronto node, Dr. Snutch -will be -working with
transgenic mice to investigate the role of neurotransmitter receptors and ion
channels in re-establishing the functioning of nerves during recovery from damage.
Dr.   Steeves  is  a member of the  spinal  cord  node which  is  based at the
University of Manitoba.  His  research interests are  in the development and
regeneration of the central nervous system, in central nervous system control of
locomotion  in  vertebrates,   and in the  effects  of environmental toxins  on the
development of the central nervous system. He has recently established that the
transected spinal cord of an embryonic chick will functionally repair all damage if
the  injury occurs  early enough in the  developmental period.
This  exciting finding   —   an  example  of true  regeneration  of _
° ° r ° Neural  Regeneration  and
damaged    axons    —    will   lead   to   the    examination    of   how Functional  Recovery  Network
regeneration occurs and what inhibits it. A new Chair in Spinal the ubc centre:
. ..... . Dr.   Max  Cynader,
Cord Regeneration will aid in this research. professor of ophthalmology
^ Faculty  of   Medicine
Dr.  Cynader's group is part of a second network   —  the DR   RoBERT M. DouGLAS,
T -^ c n      1 It.     11* j_    O _l /TT»TO\       Til Associate   Professor  of  Ophthalmology
Institute  lor  Robotics  and  Intelligent  bystems   (IKlb).   Ihe faculty of medicine
objective  of this  UBC node,  led by Dr.  Alan Mackworth, dr. joanne a. matsubara,
" Associate Professor of Ophthalmology
professor of Computer Science,  is to build machines that can faculty of medicine
W* , 1      , 1       ■        1 ii r   l   •     l • 1 11 • 1 Dr.   Nicholas  Swindale,
ith their knowledge  ol  biological and  human  visual        assistant professor of ophthalmology
CArin tv    I-, ir     KA t r\ i r- i hi c
systems, Dr. Cynader and his team will be able to contribute to
the improved organization of robotic systems.
UBC   Members  at Toronto   Node:
Dr.   Terrance   Snutch,
Assistant   Professor   of   Psychiatry
Biotechnology   Laborato ry
(^?//7   ^// . Cls^r /p r*\/Y S s(fj/) /P UBC   Members  at   Manitoba   Node:
Dr.  John   Steeves,
<v^  £E<2^2c%2%^< t-yW^^^fsyw J^^wMWiyfetofew
Dr.  Kenneth  Baimbridge, _i
Associate   Professor   of   Physiology
Faculty  of   Medicine t_)
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Professor  of  Zoology
Faculty  of  Science
A   private,   non-profit  organization,   The Canadian Institute for Advanced
Research is a Canada-wide research enterprise with international scope. Launched
in  1982, the institute has put together five networking programs with members in
Canadian  universities  and  research-based institutions,  and now including
individuals in other countries.  The institute funds salaries of program members,
who remain in their home institutions.  It also funds the costs of interaction  —
workshops, working visitations, the exchange of graduate students and electronic
communications. There are three categories of appointment to the institute: fellows
are outstanding scientists or scholars, -who are appointed for five years and receive
full salary support; associates are chosen according to similar criteria as fellows
but do not receive salary support; scholars are young researchers whose salaries
are paid for terms of three to five years. Of the five institute programs in which
UBC participates,  two  are  in the  health-sciences  field   —   the  Program in ><
Evolutionary Biology and the Program in Population Health.
> K^fteatozm cin (Z5tx>6ud6&?i(Zfru-*->0ei*
EVOLUTIONARY BIOLOGISTS trace genealogical relationships and deduce
mechanisms by which evolutionary change occurs. With advances in molecular
biology, scientists will be able to understand the beginnings of life, the process of
mutation and selection, the evolutionary structure and functions of proteins, and
ultimately the human genome — the complete set of genes in our chromosomes.
The three evolutionary biology program laboratories at UBC study the
evolution of unicellular organisms by using molecular techniques to -work out the
exact structure of selected genes. Dr. Cavalier-Smith is studying the evolution of
protozoa and other single-celled living organisms -whose cells have nuclei. He is
determining the DNA sequence of certain genes in numerous living organisms in
order to work out a detailed evolutionary tree of all the major branches of life and
to understand the evolution of human genes and those of our unicellular ancestors.
He is also studying the molecular basis of cell structure in Giardia, -which is not
only a major cause of human disease but also a living relic of a stage in evolution
passed through  by our  own ancestors  over a thousand
Program   in   Evolutionary  Biology million years ago.
ubc investigators: Dr. Dennis is studying gene structure in archaebacteria,
)r.  Thomas  Cavalier-Smith,   Fellow **        o   o
Pfa3cultSy°of°sc°enceV a kingdom of unusual bacteria related to eukaryotes, which
dr. Patrick p. Dennis, fellow are cells with nuclei, capable of forming complex multicellular
Professor of Biochemistry .
faculty of medicine organisms including plants and animals. The purpose of Dr.
is,:•TARNrp:orEsRslRFoVDB^o^CH^crsTRY Dennis's research is to reconstruct a history of evolution by
gathering together informative pieces of DNA nucleotide^
  sequence information from contemporary organisms.
Program   in   Population   Health Dr.   Redfield's   Study   is   related   to   One   of  the   biggest
ubc investigators: unsolved problems in biology: why human beings and most
DR.  Robert G. Evans,
manufacturers' Life fellow other organisms large enough to see reproduce sexually  —
Professor of Economics ooo j: »/
faculty of arts that is, by combining two sets of chromosomes,  one from
associate, ciar vice-president each parent.  Studies in her laboratory involve Haemophilus
Professor of Medical Genetics
faculty of medicine influenzae   —   a   bacterium   that   takes   up   chromosome
" soc,atDeRprMo0fes'sSor'ofAmeaLth care fragments  from its  environment and inserts them into its
faculty of medicine own chromosomes. How and why that happens may explain
2 dr. Clyde hertzman, scholar the origin of sexual reproduction in our earliest unicellular
_ Professor of Health Care ° r
and Epidemiology ancestors
J Faculty of Medicine dntesioib.
ul
5 Medical advances have enabled the prevention and cure of some dissases
* and have eased symptoms in many chronic illnesses, but it is clear that health in
ul populations and individuals is  not entirely a factor of medical  care.  The
determinants of health are broad. Genetic inheritance, housing, pollution, family
z structure, -work environment and psychological makeup interact in a complex way
o
h to determine how healthy people are.
z Dr. Evans is the director of this program which brings together 14 Canadian
o and  three   international   members.   Their   expertise   in   genetics,   medicine,
^ epidemiology, sociology, political science, economics and statistics will be dedicated
to understanding the complex factors that determine health and to developing a
* more illuminating intellectual framework for thinking about the relationships
between organism and environment, health and disease, and the role of health care.
With CIAR fellow Dr. Gregory Stoddart of McMaster University, Dr. Evans
has written a working paper that is the basis for the book the program will produce for policy-makers. Producing Health, Consuming Health Care develops a conceptual
framework for the examination of evidence and hypotheses about a broad range of
determinants of health and the relationships among these determinants. The
authors argue, in eloquent prose, that the understanding of the determinants of
population health and the discussion and formulation of health policy have been
seriously impeded by the perpetuation of an incomplete, obsolete and misleading
framework. A more adequate framework would accommodate distinctions among
disease (as defined and treated by the health-care system), health and function (as
perceived and experienced by individuals), and well-being (a still broader concept
to which health is an important, but not the only, contributor). The framework
would recognize and foster identification of the economic trade-offs involved in the
allocation of scarce resources to health care instead of to other activities (for
example, the stimulation of economic performance) which may contribute to health
and -well-being.
Dr. Evans is a faculty member of our Centre for Health Services and Policy
Research and a member of the British Columbia Royal Commission on Health
Care and Costs.
t_y^e v^czMacevam- C^Ly/^K^^a/^«_ 'Ve&w?kft>
The Canadian   HIV Trials  Network
Principal  Investigators:
  .1 Dr.   Martin   Schecter,
THIS   NATIONAL.   NETWORK   OF   EIGHT   CENTRES   acrOSS  the Assoc.  Prof, of Health C
Assoc. Prof, of Health Care
and Epidemiology
Dr. John   Ruedy,
Professor  of  Medicine
Head  of  Department  of  Medicine,
St.   Paul's   Hospital
Assistant  Professor  of  Medicine
Faculty of  Medicine
country  is   based  at   UBC  and   St.   Paul s,   one   or  the faculty of medicine
university's teaching hospitals.  B.C. has always had the
highest cumulative incidence of AIDS in Canada, and St.
Paul's Hospital has had the highest caseload of AIDS of any "«■ Julio montaner,
c '-' " Assistant   Professor   of  Me
single hospital in the country.
The network is funded by a three-year National Health
and Welfare grant of $10.2  million to  UBC.  Its mission is to allow Canada to
rapidly set up trials of new HIV/AIDS therapies and to provide patients the
broadest possible access to these trials.
At the time of its official opening in January, 1991, the centre was conducting
a two-year trial comparing the use of dideoxyinosine (ddl) and AZT in 430
patients. AZT is the approved drug treatment for HIV disease, but it is thought
that patients develop a resistance to it. Dideoxyinosine, the next generation of antiviral agents, is being used on patients who cannot tolerate AZT or who are failing
on it. The investigators are trying to determine whether it is better to switch earlier
or later from AZT to ddl.
Linked by computer to centres elsewhere in Canada and receiving up-to-the-
minute data on hundreds of patients, the UBC investigators are able to monitor trials
of new drugs and respond quickly to reported side-effects and complications. •
^
o
m
Z>
>
X ESTABLISHED IN 1969, THE MEDICAL RESEARCH COUNCIL OF CANADA IS THE MAJOR
FEDERAL. AGENCY FUNDING MEDICAL RESEARCH IN THE COUNTRY. IT SUPPORTS
RESEARCH A IM D RESEARCH TRAINING I IM HEALTH SCIENCES I IM UNIVERSITIES AND
THEIR AFFILIATED HOSPITALS AND INSTITUTES. IN 19S9-90, UBC RECEIVED
$16,328,000 IN MEDICAL RESEARCH COUNCIL FUNDING, THE F O U RT H - H I G H E ST
AMOUNT   AMONG   3 1    INSTITUTIONS.
XV.   i/P&tgt&S* tyW^mt/fc^s^W
In operating grants to individuals, in spite of its smaller size, UBC placed
third in the country, receiving more than $10 million, and it ranks among the top
three or four in funding of career investigators, MRC scientists and scholars.
mrc regulatory Peptide Group As wel1 as funding individual investigators,  the MRC
supports collaborative research programs through  Program
Leader:
Dr. John  C.   Brown, an(J   QrOUp   Grants.
Professor  of  Physiology
Faculty of  Medicine
An MRC Group is considered a centre of excellence for
dr. Alison m. j. buchan, research  and training in the  health-science  field.  A grant
Associate.   Professor  of  Physiology <"3 <-J
faculty of medicine supports teams  of four or more  accomplished investigators
Dr.   Yin   Nam   Kwok, n ii     i i ■       1 T • 11
Assistant  Professor  of  Physiology lOT   COllaOOratlVe   WOrK    OVer   a   period    Ot   years    in    especially
rArin  TV    f% c     KA c r* i r* i hi c
important and potentially productive areas. The MRC funds
only  13  groups  in  the  country,   one  of which  is  the  five-
Dr.   Christopher   H.   S.   McIntosh
Professor   of  Physiology
Faculty  of  Medicine
dr. Raymond a. pederson, member Regulatory Peptide Group in UBC's Department of
Professor  of  Physiology
Faculty  of  Medicine Physiology.
Program Grants go to multidisciplinary research activities
involving three or more investigators. There are 28 in the country, of which UBC has
four — three in the field of neuroscience, and one that brings together pharmaceutical
sciences and medicine.
>
x
THE REGULATORY PEPTIDE GROUP WAS FORMED IN 1986 with a six-year commitment
from the MRC to pay for salaries, supplies and expenses. In 1990-91 that amounted
to more than $800,000.
Peptides are important regulatory agents, insulin being the best example.
Unravelling the role of peptides in controlling functions of the stomach, intestines and
pancreas in health and disease is the goal of this project. Once Dr. Brown and his
colleagues have isolated and characterized a peptide, they will -work with
pharmaceutical companies to create analogues that can be used to treat diseases such
as inflammatory bowel disease, Type 2 diabetes and conditions such as obesity. Until a
few years ago, the use of peptides as drugs was prohibitive because it was difficult
and expensive to synthesize a peptide molecule's chain of amino acids. Recent
advances in chemical synthesis have allowed chemists to create analogues -with a
shorter chain of amino acids but still able to perform the biological activity. The Program in Degenerative Disorders of the Motor Pathways has the largest
medical research grant ever given UBC —  $6.1  million over five years. The grant
recognizes the international reputations of many of the team members and the
excellence of the UBC PET program, initiated in the late 70s by Dr. Brian Pate when
he -was associate director of TRIUMF.
This complex grant involves  11  full-time faculty members -with eight part-time
faculty researchers in six separate projects, and includes data
analysis at the University of Wisconsin and collaboration mrc program
with a former UBC faculty member now at the University of IN degenerative Disorders
of the  Motor  Pathways
Alberta. The team has an administrative location provided by
University Hospital—UBC Site.  The laboratories in the dr. Donald b. calne,
Professor  of   Medicine
University Hospital are linked to TRIUMF by pneumatic Dl,ISIOK OF neurology
tube which can deliver samples in 90 seconds. DR. m"ceh»el""adam,
, 1 ,   .. . 1 1        r . Research   Scientist
Directed  by Dr.  Donald Calne,  head or Neurology at triumf
University Hospital's UBC site, the multidisciplinary team Act,ngDheaTd%%Wt.EofEmed,c,nE
p , 1 1 . » 1 . i Professor,   Division   of   Neurology
is    rocusing    on    three    neurodegenerative    disorders:
n       1   • >        1- tt '        1* 1 1   • Dr'   Seung   Kim,
Parkinson s disease,  Huntington s disease and amyotrophic professor of medicine
Division   of  Neurology
lateral sclerosis   —  Lou Gehrig's disease.  Researchers are Dr  Charles Kbieger
,1 c i ii      1 .1      • .1 Associate   Professor  of   Medicine
examining the process or selective nerve cell death in the division of neurology
motor path-ways of patients with these diseases. dr. edi™ mcgeer,
Professor   Emerita  of  Psychiatry
The  Parkinson's  disease project will look  for pre- faculty of medicine
clinical markers; analyze the rate of progress of the disease; pbofessob'o" mVdVcine
1 l'l'i t-i1* * 1 l Faculty  of  Medicine
explore the relationship  between  Parkinson s and normal
Dr.  Tom   Ruth,
aging and between  Parkinson's  and ALS;  and explore director ofth^pet program
Dr.   Barry  Snow,
Associate   Professor  of   Neurology
Faculty  of  Medicine
Dr.  Joseph  Tsui,
drUflfS. Assistant   Professor  of   Medicine
Division   of   Neurology
treatments to retard the pathogenesis of Parkinson's. dr. Michael schulzer,
1 ... l • r • Professor   of  Statistics  and   Medico
The ALS group is doing studies or motor neurons in faculties of science and medicine
culture,   studies  of preclinical  and  clinical  ALS,   and
conducting therapeutic trials of antioxidant and antiexcitant
igs
The Huntington's group is following the preclinical and
clinical course of the disease in patients with DNA markers              mrc program: the kinetics, ^
associated   with   the   Huntington's   gene;   testing   new         Effects and Toxicology of drugs □
.                                                                             During  Pregnancy, the  Newborn U
treatments to retard the progression ol the disease;  and                    period and childhood x
investigating a more sensitive indicator of the disease.                                               coordinator: a
*~.    i                         ■                  •             l                l                            1*1                        •                                                               Dr. James   E.   Axelson, m
Other projects involve pharmacological experiments,                   professor of pharmaceutics m
t                                                   t                                                                AND   B iopharmaceutics UJ
the  development of radiopharmaceuticals  for use  in the              faculty of pharmaceutical sciences q:
program's experiments, and post-mortem and tissue culture              AssoclatedPRoFAeNssorRofAobstetr,cs <
studies to corroborate the data obtained in the PET studies                           faculty of medicine S
LU
and to test factors contributing to degeneration.                                                        DR- frank abbott, 2
*-J '-' Professor  of   Pharmaceutical  Chemistry
Faculty  of   Pharmaceutical   Sciences £E
O
. (£>/~          >?                a?                                                                Dr.   Kevin   Farrell, ~J
Associate   Professor   of   Pediatrics
Faculty   of   Medicine ^
Dr.   Wayne   Riggs, >
Assistant  Professor  of  Clinical   Pharmacy
Faculty  of   Pharmaceutical  Sciences
THIS PROGRAM GRANT, which took effect in October, 1990, will give these five
investigators $2.7 million over five years. Working together and individually, they
were previously funded by the MRC, the B.C. Health Care Foundation, the
Canadian Heart and Stroke Foundation, the Kidney Foundation of Canada and by
drug companies to do basic science studies.
x Despite a greater awareness of the potential hazards, drugs are widely used
during pregnancy. Almost a quarter of pregnant women take preparations that
contain antihistamines. Others are prescribed drugs for heart disease, epilepsy,
hypertensive disorders and complications of pregnancy. Increasingly, fetal
disorders are treated by administering drugs to the mother. Premature infants and
young children -with medical problems also receive extensive drug treatments. The
objective of this MRC program is to expand research into the effects and
toxicology of drugs in pregnancy, in newborns and in the young child.
<y&U /ZS? <_y*^&s%?2-.- «_>v&i tAVetet&M»dyw cy^0e^?^z^^C'rp^a^n^/ze
cw
WITH $2 MILLION MRC BACKING, this team is investigating the function of two
major groups of neurons in the brain — acetylcholine-containing cells in the basal
forebrain and dopamine-containing cells in the mesencephalon (the mid-brain).
Using  new  laboratory  techniques,   the  group   is   measuring  the   release   of
acetylcholine and dopamine in discrete regions of the living
mrc Program: brain.  The  research  could provide  important knowledge
The  Neurobiology i . A i    1      • 'J- r>       1   • 'J'
_ „ „ about      Alzheimer s      disease,       Parkinson s      disease,
of  Central  Dopamine  Systems
in Normal and schizophrenia, and severe depression.
Pathological  Behavior
Coordi N ator:
Dr.  Christian   Fibiger,
Acting   Head,   Department  of  Psychiatry
Faculty  of  Medicine
Dr.  Anthony  Phillips,
Professor,   Department  of  Psychology
Faculty  of  Arts
O
U
Dr. CYNADER AND Dr. Shaw share this four-year, $1.2-million
dr. Charles blaha, grant with two colleagues, one at the University of Montreal
Sessional  Lecturer,   Dept.   of  Psychology .....
faculty of arts and one at Dalhousie University.
~"~~ Strabismus   is   the   medical   term   for   crossed   eyes.
mrc Program: Amblyopia, a Greek work meaning "dull eye," is a condition
Neural   Mechanisms   Underlying , 1   •    1        1 • l 1 1
amblyopia and Strabismus in which  there  is  reduced vision  in  an  eye  that  appears
structurally normal -when examined with an ophthalmoscope.
Coordinator: v t l
professor oAfXopENtAhDaEl',mology, The group's research is aimed at understanding how it is that
Psychiatry  and   Psychology 1 1 • • 1 • 1 c    *1 1
faculties of medicine and arts an eye developing in a sub-optimal environment rails to make
dr. Christopher shaw, proper connections to the brain. V
jfessor   of  Ophthalmology r        r ~
Professor   of  Ophthalmology
Faculty  of   Medicine
>
X THE UNIVERSITY AND AFFILIATED RESEARCH INSTITUTIONS GENERATE MORE THAN 60
PER CENT OF ALL PUBLIC AND PRIVATE RESEARCH ACTIVITY IN THE PROVINCE.
DURING THE LAST TWO DECADES, SUCH RESEARCH HAS CREATED 87 SPIN-OFF
COMPANIES EMPLOYING MORE THAN 4,600 PEOPLE AND PRODUCING REVENUES I ISI
EXCESS OF $824 MILLION A YEAR. UBC HAS DEVELOPED THE MOST ACTIVE
TECHNOLOGY   TRANSFER   PROGRAMS   OF   ANY   UNIVERSITY   IN   CANADA.
INCREASINGLY,    THE    TECHNOLOGY    BEING    TRANSFERRED    results   from
research originating in our biomedical laboratories — from DNA-Probe
"fingerprinting" technology to the commercialization of photosensitive drugs that
are activated by light.
These spin-off companies owe their origin, directly or indirectly, to research or
expertise that began at UBC. They may be formed either by faculty, staff or students
who use their acquired know-how to produce goods and services for the marketplace,
or through the direct commercial licensing of a technology. Our policies pertaining to
the  creation of spin-off commercial companies have been the models  for other
universities and should guide future health-science research in B.C. In addition to a M
new agreement signed -with each of the teaching hospitals, we have recently signed a ^
research agreement with Children's Hospital that will be helpful in this process.
By sharing our discovered knowledge in the biomedical field, UBC contributes w
to  solving problems  in the  real -world,  creates  income  for the university,  and i
stimulates local, regional and national economies. Canada, with its relatively small ^
industrial  base,   must  rely on  universities  like  ours  to  supply much  of its u
technological innovations and entrepreneurs for a global marketplace. Aggressive £
competition demands that research and development be intensified to shorten the
gap bet-ween discovery and application. As Dr. Geraldine Kenney-Wallace wrote as °-
chair of the  Science  Council of Canada,  "We need to integrate people,  ideas, _,
<
opportunities,  markets and capital in new and effective ways.  The most urgently <±
needed linkages are those bet-ween the research community within the universities «
and the private sector. A new sense of strategic partnership must become a reality." 2
At UBC, we have long recognized the benefits of such a partnership.
Commercialization of our publicly funded research was originally overseen by the >
Office of Research Administration, which handled patent disclosures, applications
and licences. In 1981, UBC began patenting inventions on behalf of our
researchers; two years later we opened the Office of University-Industry Liaison,
which by '85 -was operating on a five-year major grant from the federal and
provincial governments. Technology transfer through the creation of spin-off
companies became focused in 1986. The first survey of its kind identified
companies that existed because of research conducted on campus, including those
formed by individuals using technical expertise gained -while studying or teaching
here; through licensing patents or know-how from UBC; or as second- or third-
generation enterprises from original university spin-offs. In 1991, the university formed UBC Research Enterprises (UBC/RE) as a
spin-off from the Industry Liaison Office to oversee prototype development,
market assessment and the formation of companies based on campus research. The
goal is to attract financing and support from private industry, investors and
government agencies for a more coordinated approach to commercializing
technology. While the Industry Liaison Office continues to handle the majority of
technology transfers, UBC/RE offers market assessments, industrial contacts,
financing and preparation of business plans for prototype, development.
Royalties from UBC's spin-off companies have grown from $5,000 a year in
1983 to nearly $750,000 in 1990. For each dollar received from licensed companies,
half goes to the inventor, a sixth to the inventor's faculty or department, and the
remainder to the university.
The financial spin-offs from these companies multiply dramatically. In the last
decade alone, nine B.C. biomedical companies, -which had their origins in research
at UBC, created 144 jobs and now have multi-million-dollar annual revenues. The
most prominent is Quadra Logic Technologies Inc. of Vancouver, which was
founded on the research of two UBC scientists, Dr. Julia Levy and Dr. David
Dolphin, in Photodynamic Technology (PDT). The technology, licensed from UBC,
uses light-activated drugs for the diagnosis and treatment of such diseases as
cancer, viral inactivation in blood, atherosclerosis, and sexually-transmitted
diseases. Quadra Logic, which employs 60 people, maintains a close -working
relationship with the departments of Microbiology and Chemistry and much of its
research occurs at the university in collaboration with scientists in these areas.
Other UBC biomedical spin-off companies include:
• FMG   INTEGRATED   BlOTECHNICAL   LABS   LTD.   OF   RICHMOND,   B.C.,   WHOSE
PRINCIPAL.   INTEREST   IS   IN   DEVELOPING   NEW   PRODUCTS   AND   PROCESSES   FOR
THE   AQUACULTURE   INDUSTRY   WORLDWIDE   AND   IN   THE   HUMAN   AND   ANIMAL
HEALTH-CARE   INDUSTRIES.
UJ
z • Helix  Biotech Corporation of Richmond, which  is engaged in the
<
°- RESEARCH,   DEVELOPMENT   AND   MANUFACTURE   OF   HIGH-QUALITY   DIAGNOSTIC
O COMPONENTS   AND   SYSTEMS   FOR   USE   IN   THE   CLINICAL,   VETERINARY   AND
O _
aquaculture  industries;  it owns the canadian and patent rights to
DMA-Probe technology (fingerprinting).
• Intrinsic Research and Development,  Inc. of Richmond, which  is
Q.
(/) INVOLVED   IN   THE   RESEARCH   AND   DEVELOPMENT   OF   PHARMACEUTICALS   USED
-I IN   CANCER   TREATMENT.
O
Q •   LlPEX   BlOMEMBRANES,    INC.   OF   VANCOUVER,   WHICH   PRINCIPALLY   PRODUCES
UJ
£ AN EXTRUDER FOR RAPID AND REPRODUCIBLE PREPARATION OF A SYSTEM TO
O
- FORM   LIPIDS   (FATTY   ACIDS)   INTO   SMALL   BUBBLES   FOR   THE   DELIVERY   OF
m
DRUGS   TO   SPECIFIC   CELLS   IN   THE   BODY.
>
x rutland biotech  limited of burnaby,  b.c., a research,  marketing
and sales company with a growing base of advanced technology in
personal and professional health-care products including oral
health, skin-care  lubricants and cleansers.
• shape technologies inc. of north vancouver, marketer and
distributor of a computer aided design/computer aided
manufacture software package for the design and manufacture of
artificial limbs for amputees; and also conducts contract softwar
development for cad/cam applied to medicine.
Vorum   Research  Corporation  of Vancouver, which  is  involved in
software development and systems integration for medical cad/cam
applications in generating anatomical shapes. m
WM DR. WILLIAM C. GIBSON, PROFESSOR EMERITUS AND FORMER HEAD OF THE DIVISION
OF THE HISTORY OF MEDICINE AND SCIENCE, LIKES TO RECALL A PARTICULAR MEETING
HE HAD OVER BRANDIED MILK WITH P. A. WOODWARD, THE BENEFACTOR OF THE
WOODWARD   BIOMEDICAL   LIBRARY.
XVII tjfyyi&s*/ C%swice4< esi &€w?i/iei&
When Dr. Gibson told the department-store magnate about the possibility
of acquiring an important collection of rare medical books, Mr. Wood-ward said
excitedly, "I don't -want to build a book cemetery. I -want the milestones of science —
the first time any new discovery was published. I want the students to see these, and to
appreciate that UBC has them. I -want them displayed in glass cases, day and night."
"And," Dr. Gibson says, "so evolved our method of teaching the history of
medicine and related sciences by displays of the great books."
Thanks to the Mr. and Mrs. P. A. Woodward Foundation and matching federal
grants, the university now has the second-largest library in the UBC system, which
houses many milestones of medical science amid the largest health-sciences
collection in Western Canada: more than 340,000 volumes in the health and life
sciences, biology, botany, dentistry, medicine, nursing, nutrition, pharmaceutical
sciences, zoology and related subjects. The library is also the hub of the Health
Sciences Library Network, -which was designed to meet the specific needs of the
health scientists in the UBC teaching hospitals. As a result, the Woodward
collection is conveniently accessible to every physician in the province.
The collection had its origins in 1915, when Nobel Prize winner Sir Charles
Sherrington gave Dr. Frank Wesbrook, the university's founding president, a
surprise gift of the copper-plate first edition of Bidloo's classic Anatomia, published in
1685. The number of medical volumes slowly increased; by 1951, when the first full-
time Biomedical Librarian was appointed, there were 8,000 in the Main Library's
Medical Reading Room. With the enrolment of the inaugural class in the Faculty of
Medicine, a Biomedical Branch Library opened at Vancouver General Hospital.
The Biomedical Library itself opened in 1964. A dozen years later it doubled
in size through a second gift from the same donors, while the Instructional
Resources Centre opened next door. Another Woodward Foundation grant funded
the first on-line informational retrieval system; by 1978, the old card catalogue
system was a thing of the past. x
Douglas Mclnnes, recently retired head of the Woodward, was a central figure
in planning a net-work of provincial medical libraries to serve health practitioners
throughout B.C. The Health Sciences Network was launched in 1982: sharing their
resources and providing next-day delivery of about 50,000 volumes a year to
library users are the Woodward Library, the Biomedical Branch at VGH, St. Paul's
Hospital's Library and the Eric Hamber Library at Shaughnessy Hospital.
The Wood-ward, close to full working capacity, seats 950 in its 60,000 square
feet. Its annual circulation is -well over 200,000 loans; its staff answers nearly
50,000 reference questions and makes 3,000-plus computer searches for patrons
each year.
> >
The Charles Woodward Memorial Room, dedicated to B.C.'s pioneer
physicians, holds an outstanding collection of more than 6,000 volumes on the
history of medicine and the natural sciences. The holdings — named for Dr.William
C. Gibson — rank second in importance in Canada, attracting scholars from around
the world. Among treasures in the climate-controlled library is a 1628 first edition
of William Harvey's De motu cordis, describing his discovery of blood circulation;
and the autographed letters of such significant scientific and medical figures as
Charles Darwin and Florence Nightingale.
The Nightingale letters were essentially shanghaied by the library on their
way to California. As Dr. Gibson remembers, a book dealer from Boston was trying
to circumvent an American airline strike by flying across Canada to Vancouver and
then -wending his way south. In Vancouver, he called the only person he knew in
town, Woodward librarian Basil Stuart-Stubbs, who suggested he stay overnight at
the Faculty Club. Helping the dealer with his suitcases, the librarian remarked on
their weight. "Oh," said the Bostonian, "they're filled with Florence Nightingale
letters I hope to sell in California." Mr. Stuart-Stubbs immediately called Dr.
Gibson at home, asking if he had any Scotch in stock. He had, and librarian and
dealer came to visit, luggage in hand. "Suffice it to say," Dr. Gibson recalls, "that
by 3 a.m. we had acquired all the contents of the suitcases  We told him not to
bother, in the future, going to California but to bring his wares directly to UBC."
The adjacent Sherrington Room is used for seminars and small meetings.
Hearing of the university's plans to create this area, Sir Charles' son, Carr
Sherrington, sent the Woodward library all his father's honorary degrees, his
portrait, Nobel Prize citation, Order of Merit medal from the Crown, Royal
Society regalia, and even his dining-room chairs.
The Memorial Room area has a small collection of artifacts, including
historical infant feeders and surgical instruments, and displays three extraordinary
contemporary tapestries. One, -woven in the People's Republic in China, depicts the
Canadian surgeon Dr. Norman Bethune operating during the Eighth Route Army
campaign in China. The other are post-war French works: Masters of Science, done
by the young Gobelin tapissier Roland, and Masters of the Spirit.
Again, Dr. Gibson has a good story to tell about acquiring Masters of the Spirit.
On a visit in France to the art patron who had commissioned Masters of Science,
he noticed a tapestry portraying great philosophers and writers. The patron said
one of his oldest tapissiers had been half-way through its creation -when he suffered
a cerebral haemorrhage; because the right half was badly done, the patron didn't
want to sell it for fear its creator's work would be mocked. "I explained that I was
a neurologist with scientific interest in this amazing result," Dr. Gibson says.
"Finally he agreed that in those circumstances we could buy it.... Many physicians
x and psychologists have come to see it since."
tZ/axdenJE
The complexities of contemporary student life — from stress to drug
abuse to sexually-related diseases — have made compelling new demands on the
university's Student Health Service. For UBC's 27,000 students, particularly the
4,500 who are single and living in residence, the staff at the Health Service may be ACUTE-CARE    UNIT
OF   THE    UNIVERSITY
HOSPITAL   ON
the only medical people they ever know during their time at university. This makes
it all the more vital that the service offers psychiatric consulting to handle
students' stress and other emotional upheavals and runs an annual Drug and
Alcohol Awareness Week and a safer-sex education program.
Located in the acute-care unit of the University Hospital on campus, the
service fields 38,000 clinical visits a year. Dr. Donald J. Farquhar has succeeded
Dr. CA. Brumwell as medical director, heading a full- and part-time staff that
ranges from physicians with special training in sports medicine to a psychologist
and a dermatologist. Collectively, they offer doctor's office care, including medical
and psychiatric services, travel advice, immunizations and allergy injections, and
referrals to consultative services in many specialty areas throughout the hospital.
Affiliated -with the clinic is the Ambulatory Care Pharmacy in the hospital lobby;
the Department of Radiology's x-ray, ultrasound and imaging services; and
specialists in physiotherapy, nuclear medicine, nutritional counselling and
diagnostic cardiology, neurology and respiratory areas.
During the academic year, a health education and wellness promotion
program features -workshops, health fairs, talks in residence, and a monthly
newsletter for students. Special programs include the drug and alcohol awareness
project, mounted yearly since 1987, for which Outreach Nurse Margaret Johnston
recently won an award from the Insurance Corporation of B.C. She
has also  coordinated the  safer-sex education project, which brings located in the
experts together -with students to focus on AIDS and other sexually
related diseases; last year's three-day event included a board game
called Sexploration to prompt learning and discussion about sex,
drugs and alcohol. WfM
From the beginning —  since the university's inception in 1912 campus, the mw
—   we  have  made  a  commitment  to  the  health   of our  student service fields
population.  Dr.   Harold White,  medical director of the Vancouver m
38,OOO   CLINICAL =1
School Board, became UBC's founding medical examiner, assessing ^
all  first-time  students  as  well  as women participating  in  major visits a year. ^
athletics  programs.  With the  university's  move  to  Point  Grey in *
1925,   Dr.   H.W.  Hill,  head  of the  Bacteriology  Department,  became  medical </>
health officer;  two years later Mrs.  CA.  Lucas -was appointed our first public -
health  nurse.   In   1938,  -we  began  offering consultative psychiatric  services  to "
students. And by 1951, the Health Service had its first full-time medical director,
Dr. A.K. Young. £
At that time, the service offered care to university staff and faculty as well as °-
students.   It operated  out of the Wesbrook Building, -which housed a 26-bed w
infirmary in the  University Health  Service  Hospital.  Although  surgical and —
obstetrical cases -were referred to city hospitals, the campus hospital ministered to x
a variety of ailments, including communicable diseases, handled in special isolation
facilities. A live-in resident cared for emergency cases overnight and -weekends. In
1959 a full-time resident from the Department of Psychiatry came on staff and, six
years later, a full-time physiotherapist. By then, there were three full-time
physicians, two sessional and two part-time doctors, and two psychiatric residents
as well as full-time and part-time consultant psychiatrists.
When the Health Service Hospital closed in 1980, the service moved from the
Wesbrook Building into its present quarters in the University Hospital—UBC Site.
Today, the staff includes seven full-time-equivalent general practitioners, 5.5 full-
time-equivalent psychiatrists and two psychiatric residents, as -well as four nurses and an outreach nurse, and an administrative assistant. Consultants and specialists
include three orthopedic surgeons, two plastic surgeons, a dermatologist working
with two residents, and a psychologist.
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SECONDARY   INSTITUTIONS
IAVE   TO   OFFER
The dream goes well beyond the borders of UBC. The Disability
Resource Centre — the first of its kind in the world — opened in early 1991 with
an initial mandate of evaluating how this university handles physical and functional
accessibility, employment equity, curriculum, research and many other issues
related to disabled men and -women in the campus community. But, led by two
people who themselves have disabilities, the centre sees itself a prototype -with the
goal of making post-secondary education across Canada more accessible to
students, faculty, staff and visitors.
From the start, all phases of the centre — from feasibility studies to planning and
actual operation, have been guided by persons with disabilities.
The new director is Ruth Warick, a former director in the
Saskatchewan Public Service. Hard of hearing since birth, she is a
founding member of the Canadian Hard of Hearing Association
and the National Forum of the Deaf and Hard of Hearing. She is
collaborating with Rick Hansen, the disabled Canadian athlete
whose Man in Motion World Tour electrified this nation over two
years. He is now the first incumbent of the federally and
provincially funded Rick Hansen National Fellow, which was
founded to ensure the continuance of his ideals and values and to
provide administrative funding to advocate nationally and
internationally for positive social change relating to disability.
"UBC is probably as good as most universities right now,"
Rick Hansen says, "but from where we could be, there's a long
way to go. Once UBC is brought up to speed, then we can begin to work on a plan to
move outside this campus and start interacting -with other universities and colleges."
Ruth Warick is hiring six coordinators to oversee areas of barrier-free access,
advocacy, employment, information, service and research as they affect people with
mobility, visual, hearing, learning and mental disabilities. The centre -will set up
databases of national and international contacts to pinpoint information on
disability issues and has already distributed information packages about its unique
role to 170 Canadian academic institutions, seeking their cooperation.
As its director points out, the centre's mission is to ensure that all people with
disabilities be given equal opportunity to benefit from, and participate fully in, all
that post-secondary institutions have to offer. It will encourage the university to
channel important leadership resources back into the community in terms of
education, awareness and research in the field of disability.
AS   ITS   DIRECTOR   POINTS
3UT,   THE   CENTRE'S   MISSION
IS   TO    ENSURE    THAT   ALL
PEOPLE   WITH   DISABILITIES
BE   GIVEN   EOUAL
OPPORTUNITY  TO   BENEFIT
FROM,   AND   PARTICIPATE
FULLY
ALL   THAT    POST-
The Centre and the National Fellow have similar yet distinct mandates
and -were funded separately. The B.C. and federal governments, corporate and
individual donors have created a $6.4 million endowment fund to finance the centre
and permanently house it in the new Student Services Building in L992. Earlier, the two senior levels of government had provided $4 million to endow the fellowship.
Among Rick Hansen's priorities is to see the integration of disabled athletes at
such multi-sports competitions as the Commonwealth and Olympic Games; he
heads an international committee on that issue. He is chair of Independence '92, an
international congress on disability scheduled for Vancouver in April, 1992, an
event expected to attract nearly 8,000 participants from around the globe. He also
chairs the Planning Committee for the International Conference on Post-Secondary
Education being planned for 1994-95.
As chair of the Advisory Committee to the Disability Resource Centre, Rick
Hansen says, "Our greatest human-resource potential exists in universities and
colleges across Canada. We need to develop a process that will instill a greater
sense of responsibility and commitment to the issues of disability. The impact of
this centre over the next decade, as it relates to the independence, self-esteem and
dignity of people with disabilities will be profound."
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For  many years,   UBC  has  been graduating First Nations students in law,
education and other professions. But until recently there has been virtually no one
of Native Indian ancestry involved in any of the health-science disciplines; of 35
First Nations doctors in Canada, not one originates from B.C. Now, however, the
university has launched an active First Nations Health Care Professions Program wm
and at least 17 students are enrolled in relevant departments. ™
There are four students in Social Work and Nursing, six in Science (five pre-
meds and one pre-dentistry), and one in third-year medicine who will be the first «
Native to graduate from UBC's Faculty of Medicine.  In addition, there are two |
graduate  students who are setting precedents:  one  candidate is  completing a o
Master's in Health Administration and the other has just started the PhD program g
in Counselling Psychology. «
Angie Todd-Dennis, a member of the Carrier Nation, is coordinator of the If
program -which began in 1988. She earned her Bachelor of Education in UBC's Native
Indian Teacher Education Program; a former mayoralty candidate in Vancouver, she
received the Professional Native Women's Association Gold Feather Award for her
work in the Native community and as founding president of the association.
The pilot project, fully funded under the President's Office, falls under the
umbrella of UBC's First Nations House of Learning, which has been offering
counsel and support for all Native students on campus while forging links with *
First Nations people in the community. The coordinator works with an advisory
committee composed of community representatives, university faculty and
interested health professionals. An admissions review committee is exploring
reasons why Native students are under-represented in the Faculty of Medicine. A
curriculum committee recommendation has led to the launch of a credit course in
biology that will focus on First Nations health and science issues.
Mentors are a vital part of this program. Dr. Bruce Crawford of the
Department of Anatomy volunteers his time as campus mentor to medical and pre-
med students. The Faculty of Science's Associate Dean, David Holm, offers
academic advice to potential First Nations science students and is the faculty
> advisor to the newly formed Canadian chapter of the American Indian Science and
Engineering Society. A B.C-wide mentor program is expanding with more healthcare professionals encouraging First Nations youth to enrol in the health sciences.
Angie Todd-Dennis travels throughout the province to talk to leaders of
Native communities and make presentations and conduct workshops in schools and
colleges with significant First Nations enrolments.
One result is the Summer Science project, an annual residential program that
brings teenagers to the university for five-day sessions to pursue studies in such
areas as science in the natural world. Another is Scientists in the Schools, a
Ministry of Advanced Education program that uses UBC scientists and others to
promote general science and technology awareness in British Columbia high
schools, including First Nations communities.
The coordinator has also collaborated with the Vancouver Native Health
Society to present a two-day event, Native Health Awareness Days, to educate and
sensitize health-care students to Native issues and to present Native youth with
First Nations health professionals as role models. Among those speaking was Dr.
Thom Alcoze of Laurentian University, who inspires students with his description
of the role of Native medicine:
"The ability of the earth to heal is only now starting to be recognized. This is
where Native medicine begins, integrating that knowledge about the earth into a
consistent integrated -whole. Our -whole existence as Native people, our economy,
politics, social customs, language and values, depend upon how nature, or the
earth, functions. Our strength is our bond with the earth. Reclaim it!"
amcvt^/a/t
U INCREASINGLY   CONCERNED   ABOUT   THE    HEALTH    AND    SAFETY   of the   campUS
* community, the university formed a special department to oversee these vital areas
w in 1985. The challenges facing the Department of Occupational Health and Safety
° range over several fields, from biohazardous materials, chemicals and radiation to
Z occupational hygiene and diving, first aid and hearing conservation.
Under the direction of Dr. M.  Wayne  Greene, the department provides
o programs, services, assistance and guidance to the university community on all
°- these aspects, based on regulations by outside agencies that govern the -working
w environment and the use of hazardous materials.  It works closely with standing
university committees that make recommendations on health and safety issues:
• The  University  Health and Safety Committee, with   18  members from
across the campus, recommends safety policy in compliance with
Industrial health and Safety Regulations. The committee publishes
a newsletter on safety topics and sponsors an annual  health and
Safety Week on campus.
• Faculty Advisory committees focus on  four specialized areas:
radioisotopes and radiation hazards; biosafety; chemical safety;
and underwater diving.
• 87 smaller department/area/building safety committees monitor
each  local unit's safety program, conduct inspections,  investigate
accidents and make recommendations on safety issues to their
heads or directors. The department's Biosafety Office evaluates potential risks in research
projects involving biohazardous materials, trains technicians and principal
investigators in biosafety, and certifies laboratory equipment as -well as consulting
on the design of laboratories and selecting equipment.
The Chemical Safety Program promotes the safe handling and storage of
chemicals and offers information and guidance on regulations and the accepted
practices for proper chemical use through such measures as a laboratory
chemical safety course delivered at least twice a year. A Chemical Waste
Processing Facility collects and disposes of UBC's chemical and biohazardous
■waste in accordance -with local and federal regulations.
A safety program for university personnel involved in occupational diving —
in such departments as Oceanography, Botany, Zoology and Occupational Health
and Safety — evaluates divers medically, assesses their fitness, checks them out in
open -water, reviews their rescue capabilities, orients them to available emergency
equipment and UBC procedures, and gives them a comprehensive written exam.
The Occupational Hygiene Program recognizes, evaluates
and controls those workplace environmental factors  such as the depari
chemical or noise exposure that can affect faculty, staff or
students. Among its activities: asbestos control; training in a
variety of areas, from back injury prevention to respiratory
protection; indoor air quality control; and an annual
performance survey of laboratory fume hoods.
The Radiation Protection Program helps ensure the safe
and knowledgeable use of radiation sources in research,
teaching and the university environment, licensing research
areas on and off the campus; monitoring personnel for
radioactive-iodine contamination; and training staff, laborers,
fire fighters and summer students.
The department is committed to providing everyone on
campus -with access to First Aid facilities. Among the
highlights of this program: training of hundreds of faculty and
staff as Survival First Aid attendants; ensuring of nurses and
industrial First Aid attendants in Student Health Services, the
Chemistry Department and Plant Operations; and publishing
of a quarterly newsletter, Vital Signs, to keep the university community current.
Using the department's own hearing booth and audiometer, the Hearing
Conservation Program tests UBC workers and University Hospital maintenance
employees and offers advice on hearing-protection equipment.
BIOSAFETY   OFFICE
EVALUATES    POTENTIAL    RISKS
IN   RESEARCH   PROJECTS
INVOLVING    BIOHAZARDOUS
MATERIALS,   TRAINS
TECHNICIANS   AND
PRINCIPAL   INVESTIGATORS
IN    BIOSAFETY,   AND    CERTIFIES
LABORATORY    EQUIPMENT   AS
WELL   AS   CONSULTING   ON
THE    DESIGN    OF
LABORATORIES   AND
SELECTING   EQUIPMENT.
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It was a remarkable first for the Biomedical Communications Department:
In 1986, the department transmitted a heart operation and knee surgery by satellite
from the UBC Medical Centre to 250 physicians in Jinan, China. The two-hour
transmission, which cost $6,000, demonstrated anew that UBC has one of the most
sophisticated health-care communications systems in the world.
The department has sent video images of x-rays,  CAT-scans and ultrasound images via telephone to such distant centres as Toronto, with the quality better
than the original because contrast and brightness could be controlled. It has
produced videotapes for cancer patients, an award-winning series on epilepsy and
a five-part series on blind children. And its video communications system in the
Northwest Territories promises to bring better health care to more than 50
remote communities.
As a media production facility within the Faculty of Medicine, Biomedical
Communications has units on site in each of UBC's teaching hospitals, and a
professional staff provides medical and graphic art, and photographic, audiovisual
and television services.
The Art Division provides a range of graphic services to meet the teaching,
publication and presentation needs of the health-sciences community, from desktop
publishing to medical illustrations of new surgical techniques for use as teaching
slides, journal and text publications, TV and film. Computer-generated 35-mm
bioslides can be created from virtually any graphics software package on state-of-
the-art imaging equipment.
The department's professional photography staff do clinical and surgical
documentation and such educational and administrative-related work as
audiovisual productions and annual reports. The AV division's staff in each
teaching hospital provides technical equipment and expertise for audio-visual
presentations and viewing; duplicates video, film and slides; and repairs
equipment. A television production division creates media programs (video, slide
or audio) for research and in-service purposes and patient-education programs for
the teaching hospitals and UBC Health Sciences. And a biomedical media library
mp collection, Healthmedia, includes more than 800 existing programs on various
^^ health-related topics.
The Special Projects Division produces health-care videos — from
documentary and public information to training and professional development
^ programs  —  for such clients as pharmaceutical companies, the Canadian National
u Institute for the Blind and the B.C. Ministry of Health. Among its programs that
r have -won top prizes in international video festivals are Cancer: Its Treatment and Cure
in and One in a Hundred, about childhood epilepsy.
UJ
1 Director  Ian  Cameron says  Biomedical  Communications' strength is in
2 delivering information to health professionals in a hurry through two-way audio
and visual links among teaching hospitals. Recently, a color video fax has been
o transmitting high-resolution signals between nurse-practitioners in the far north
and hospitals in Yellowknife, NWT, and Vancouver. The images are so clear that
nurses can transmit live images of patients for dermatology exams or send x-rays
for immediate analysis. "Patients are often sent to Yellowknife by medivac flight
>< and that can cost between $5,000 and $25,000 a trip," the director says. "With the
color video fax system, the diagnosis can be done remotely, saving thousands of
dollars. Officials in the Northwest Territories view its potential as a major
breakthrough in health-care communications."*
to
> XVIII Bessie/\J&€tt&tw^ tW /Ae 3$e€tdM S%/esice£
The world of Opportunity Campaign
to raise funds for UBC began in 1988
and will continue in an active phase until
the end of 1992. By then we expect to
have reached a campaign goal of $250-
million in private donations and matching provincial government funds. In the
realm of the health sciences, we have
raised funds for academic chairs and
scholarships in many disciplines and for
building projects. Some of these endeavors are fully funded and we plan to have
the rest funded before the campaign
ends. We will then continue our annual
fund-raising activities, in such important
areas as the health sciences, in collaboration with the UBC faculties. The private,
corporate and institutional gifts described below have been matched by the
Province of B.C. University Matching
Program.
Neuroscience has had a long and distinguished history at UBC and continues to
be a focus of research, bringing in $7
million a year in research grants. The
Faculty of Medicine will develop a Brain
Research Centre on campus, building on
strengths at the University Hospital—UBC Site and in the faculties of
Pharmaceutical Sciences, Science, Arts
and Dentistry. Four chairs in neuroscience -will enhance the centre's research activity.
JACK BELL
CHAIR IN  SCHIZOPHRENIA
In 1987, UBC researchers found the
first chromosomal abnormality in
schizophrenic patients, a finding that
launched investigations elsewhere in
the -world into the genetic components
of the disease.  Now,  funds contributed
by Jack Bell, Robin Endres and the
B.C. Friends of Schizophrenics will
endow this Chair to expand research
and teaching programs in the diagnosis
and treatment of schizophrenia.
LOUISE A.  BROWN
NEUROSCIENCES  RESEARCH CHAIR
MARIANNE KOERNER
CHAIR IN BRAIN DISEASES
The  establishment  of these  two  Chairs
will allow the university to strengthen,
consolidate and expand its internationally recognized program in brain research.
The  Louise A.  Brown Chair has been
endowed by an anonymous donor. The
Marianne Koerner Chair has been endowed by Walter Koerner.
ALCAN CHAIR
IN NEUROSCIENCES
This Chair, funded by Alcan Aluminum,
■will be a major force in helping to
establish the Brain Research Centre
with its mission of understanding a host
of diseases affecting the nervous system
and developing better ways to manage
these illnesses.
CHAIR IN CARDIOLOGY
Cardiovascular diseases still account for
more than half the deaths in Canada
despite recent improvements in treatment and prevention. The Chair has
been endowed by gifts from the B.C. and
Yukon Heart Foundation, the Pacific
Open Heart Foundation and members of
UBC's Division of Cardiology.
SAUDER FAMILY CHAIR
IN PEDIATRIC INFECTIOUS DISEASES
This  Chair will ensure the  continuing
success   of UBC's  work  to   diagnose,
treat and prevent serious infections in
children. It will also permit the appoint-
V
>
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X
ment of a senior scientist to provide
leadership to the University's Vaccine
Evaluation Centre. The William Sauder
family in partnership with International
Forest Products Ltd. has fully endowed
the Chair.
CN. WOODWARD
CHAIR IN SURGERY
This Chair will foster more active participation of surgeons in new and innovative research and enable them to continue to improve patient care. Potential
specific areas of research include:
transplantation surgery; trauma; cancer;
cardiovascular disease; burns; plastic
and reconstructive surgery; pediatric
surgery; neurosurgery; and urology.
The Chair is fully endowed by gifts
from the Woodward family and the
Vancouver Foundation.
E.W.  HAMBER
CHAIR IN MEDICINE
Created for the head of the Department
of Medicine and previously funded by
annual donations from the Hamber
Foundation, the Chair has been converted into an endowment.
DR.  JEAN TEMPLETON HUGILL
CHAIR IN ANESTHESIA
High-risk patients in teaching hospitals
require sophisticated techniques for the
careful monitoring of vital signs, the
administration of anesthetics, and the
management of pain. This Chair -will
provide a focus for anesthesiology
research and will facilitate the development of exemplary programs of teaching
and research. It has been fully endowed
by gifts from an anonymous donor.
MARY PACK - ARTHRITIS  SOCIETY
CHAIR IN RHEUMATOLOGY
This Chair will allow the Rheumatic
Disease Unit at UBC and the Division of
Rheumatology in the Faculty of Medicine
to hire a clinical scientist who will foster
increased understanding of the scientific
basis for clinical management of the
rheumatologic diseases. The Chair has
been funded by the Arthritis Society.
HAROLD ROBINSON -
ARTHRITIS  SOCIETY CHAIR IN
ARTHRITIC DISEASES
A 1987 report, commissioned by the
Arthritis Society, concluded that there
was not enough rheumatological
research in Canada by scientists in professional fields allied to medicine. This
Chair -will allow us to hire a clinical scientist to conduct research within the
School of Rehabilitation Medicine and
to promote collaborative research with
other scientists and clinicians. The Chair
has been funded by the Arthritis Society.
RHEUMATOLOGY
RESEARCH ENDOWMENT
Historically there have been close ties
between UBC and the Arthritis Society,
-which operates an Arthritis Centre
whose professional staff members have
clinical appointments in the Faculty of
Medicine. The centre has provided rotations for hundreds of students in
medicine and the allied health sciences.
Staff at the centre have cooperated with
clinical scientists in the Rheumatic
Disease Unit at UBC in fostering interdisciplinary research. This Endowment,
created with a gift from the Arthritis
Society, will support activities associated
-with the Harold Robinson Chair.
PROFESSORSHIPS IN OCCUPATIONAL
AND  ENVIRONMENTAL HEALTH
These two Professorships will enable the
Department of Health Care and Epidemiology to expand its teaching and
research, strengthening the epidemiological component of health studies for
graduate students.
CHAIR IN AIDS
Together, UBC and St. Paul's Hospital
have created a leading national and
international research program in AIDS. This Chair at UBC, likely the first in
Canada, will allow the recruitment of a
leading scientist to further our AIDS
treatment, research and teaching.
CHAIR IN AUDIOLOGY
AND SPEECH SCIENCES
The Chair will have two mandates: to
implement research and training in adult
language disorders and to strengthen the
reputation of the School of Audiology
and Speech Sciences for scholarship in
communication disorders.
'cee^tced-
CHAIR IN PHARMACY
ADMINISTRATION
In recent years, the Faculty of Pharmaceutical Sciences has begun to shift its
resources to give greater emphasis to
instruction and research in pharmacy
administration. This Chair will permit
the recruitment of a new faculty member
and the initiation of a graduate program
in this area of pharmaceutical education.
S.M. DRANCE CHAIR
IN OPHTHALMOLOGY
Members of the UBC Department of
Ophthalmology proposed this Chair to
honor the achievements of Dr. Stephen
Drance, who was head of the department
during the critical stages of its development. Because of Dr. Drance's longstanding interest in research, it is
planned that the Chair will bridge the
gap bet-ween basic and clinical sciences.
DR. S. WAH LEUNG ENDOWMENT
In honor of its first dean, the Faculty of
Dentistry has established this Endowment
to support the educational and research
programs begun by Dr. Leung, with
emphasis on caring for the special needs
of students, encouraging new and innovative approaches to teaching and research,
and promoting measures to improve dental health throughout the world.
CHAIR IN  GERIATRIC DENTISTRY
The Chair in Geriatric Dentistry is a
major clinical and research effort to
understand the effect of aging on oral
tissues, improve diagnostic and treatment procedures for oral cancer and
other oral lesions and develop new
materials for dental restoration. This
Chair is an essential step in achieving
these goals.
THE  SHOPPERS  DRUG MART
PROFESSORSHIPS  IN
CLINICAL  PHARMACY
These two Professorships provide the
Faculty of Pharmaceutical Sciences the
opportunity to expand clinical research
in the treatment and prevention of
childhood diseases. The persons named
to the Professorships -will interact
bet-ween the Faculty of Pharmaceutical
Sciences and the Department of Pediatrics in the Faculty of Medicine. The
Professorships have been funded by
Imasco to enhance the education of
B.C.'s community pharmacists.
«_^*^ *Jscn0c^eyz<^Vevt<l&??^
ELIZABETH  KENNY MCCANN
CHAIR OR PROFESSORSHIP  IN
NURSING PRACTICE AND  RESEARCH
Established in recognition of a former
faculty member and acting director of
the School of Nursing, this chair or Professorship will influence all of the
school's programs. In particular, it -will
enhance the school's developing program
of research and the scope and quality of
the doctoral program.
DOROTHY LAM CHAIR
IN  SPECIAL EDUCATION
Children with  special needs,  whether in
special schools or mainstreamed in regu-
>
x 83
>
X
lar classes, have the right to be educated
to the best of their abilities and in the
least restrictive environment possible.
The Chair will initiate and coordinate
research programs in the Faculty of
Education and in other relevant departments, with a view to addressing the
effects of mainstreaming on the intellectual and social development of all
school-aged children. The Chair has
been endowed by gifts from David Lam
and the Faculty of Education.
CHRIS  SPENCER FOUNDATION
PROFESSORSHIP  IN DYSLEXIA
Recognizing the need for more comprehensive study in the changing field of
dyslexia, the university has approved
this Professorship. The incumbent will
develop liaisons with the Faculty of
Medicine and the School of Rehabilitation Medicine to coordinate research
activities and will work -within the school
system to develop programs that will
effectively meet the needs of dyslexic
children. The Professorship has been
funded by the Chris Spencer Foundation.
FOOD QUALITY
AND MANAGEMENT CENTRE
This centre will be created to focus
research, technology transfer and professional education programs in areas
critical to enhancing the quality, safety
and marketability of food products
both domestically and internationally.
The following two Chairs will be part
of the centre.
CHAIR IN  FOOD  PROTECTION
The incumbent for this Chair will undertake research and teaching programs on
food microbiology, toxicology and nutritional value as these pertain to food processing, manufacturing, wholesaling,
retailing and serving.
CHAIR IN FOOD MARKETING
Research and teaching programs in the
management aspects of food processing,
wholesaling and retailing will be the
mandate of this Chair. The incumbent
■will coordinate training and management
courses for food-industry executives and
managers.
«_^V^ CsjyGce tTfa™? v5cwtetentz&&
CENTRE FOR HEALTH SERVICES
AND POLICY RESEARCH
This centre, described in detail elsewhere in this report, is seeking a $3-mil-
lion endowment.
?Jy%&«2%s4
PROFESSORSHIP
IN HEALTH  PROMOTION
This Professorship is being established
to examine non-medical factors that
affect health. Its purposes are to determine how environmental, lifestyle,
social and economic factors combine
with biomedical factors in causing illness, and to develop methods for promoting health through education and
behavior modification.
WORKERS' COMPENSATION
BOARD APPLIED  RESEARCH AND
EDUCATION ENDOWMENT FUND
The Workers' Compensation Board has
funded this endowment to create three
Chairs   in   the   Faculty   of   Graduate
Studies.   The   balance   of  the   annual
income from the Fund -will provide the
operating   capital   for   programs   and
research   in   occupational   safety  and
health. The first project will be a masters
program in Occupational Hygiene. <~yA& i^/<zctwc%& tyevj/cce
SAUDER FAMILY CHAIR
IN VIRAL  DISEASES  OF  CHILDREN
Endowed by gifts from the Sauder family in partnership with International
Forest Products Ltd., this Chair will
allow UBC to make progress in its
search for treatments for the debilitating viral diseases that affect children.
CHAIR IN
SPINAL CORD  PHYSIOLOGY
Since UBC is ideally positioned to
become an international centre for the
repair of brain and spinal cord injuries,
this Chair will attract an outstanding
neuroscientist to pursue research in
spinal cord regeneration.
GOBIND KHORANA CHAIR
IN BIOLOGICAL CHEMISTRY
Named for Nobel Prize winner Dr.
Gobind Khorana, who did his early
research on the genetic code at UBC and
at the B.C. Research Council, this Chair
will foster interdisciplinary research in
biochemistry, chemistry, biotechnology
and biomedicine.
The Centre for Applied Ethics, funded
by an endowment from the Bentall
Foundation, Western Pulp Limited
Partnership and George O'Leary, will
comprise three academic Chairs and an
endowment to support research and
special projects. Funding is being
sought for a Chair in Biomedical
Ethics, but the following two Chairs
are fully funded.
PATRICIA F.  RODGERS
CHAIR IN APPLIED  ETHICS
Issues of applied ethics are rapidly gaining international attention, with increasing concerns expressed in the medical-
science areas of biotechnology and
genetic engineering. This Chair has been
funded by Robert C. Rodgers in memory
of his -wife.
MAURICE YOUNG
CHAIR IN APPLIED  ETHICS
Dr. Michael McDonald, a member of the
board of directors of the Canadian
Centre for Ethics and Corporate Policy
established in Toronto by leading members of the business community, is the
holder of this Chair, -which is the gift of
W. Maurice Young.
DISABILITY RESOURCE CENTRE
AND  THE RICK HANSEN
NATIONAL FELLOW ENDOWMENT
The B.C. and federal governments and
corporate and individual donors have
created an endowment fund to finance
the Disability Resource Centre and permanently house it in the new Student
Services Building in 1992. The two levels of government have also endowed
the Rick Hansen Fellowship, providing
funds to pay the salary of the incumbent and administrative funds so that he
can advocate nationally and internationally for positive social changes
relating to disability.*
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In this report I have placed before you the
PANORAMA OF OUR HEALTH-SCIENCES RESEARCH
AND TEACHING. THE HEALTH SCIENCES AT UBC
— IN WHICH I INCLUDE BIOMEDICAL RESEARCH
ON THE ONE HAND AND HEALTH CARING ON THE
OTHER — RANGE WIDELY OVER 10 FACULTIES
AND FIVE SCHOOLS. THEY INVOLVE SEVEN
TEACHING HOSPITALS WITH WHICH WE HAVE
REWARDING AFFILIATIONS. THEY KNOW NO ACADEMIC BOUNDARY, BEING THE CONCERN OF
MANY DISCIPLINES AND DEPARTMENTS. They are fostered by
multi-disciplinary collaborations which exist on our campus
as formal networks, centres and
institutes and in the informal
associations of colleagues with
similar interests. but most
important, they spring from faculty members whose desire to
diminish the unknown is the source of
investigation that propels our teaching
programs, our research, our service to the
community and our contribution to
human well-being. the teaching and
research ranges from basic, fundamental
science to applied science, and each
informs the other in a continuous spectrum, the teaching and research also
ranges from biological science to social
science and, again, there is no boundary as
each informs the other.
When we consider what has been accom-
4 cendke
PLISHED IN A VERY FEW DECADES IN OUR FACULTIES of Medicine, Dentistry and Pharmaceutical Sciences, complemented by the
activities in other faculties like graduate
Studies and Science; when we contemplate
the long-standing achievements of our
School of Nursing and the more recent
contributions of our schools of rehabiliTATION Medicine, Audiology and Speech
Sciences, Social Work, and Family and
Nutritional Sciences,- when we
see our faculty members chosen
for prestigious national scientific networks, we can say with
confidence that we are truly
B.C.'s centre of teaching and
research in the health sciences.
Our five-year World of Opportunity Campaign, launched in
1988, has already had a major
impact on our biomedical and health-care
research and teaching, helping us to reinforce what is already excellent. as
numerous chairs, professorships and
endowments were funded by generous
individuals, corporations and societies
and with matching provincial government
funds, we have begun to fill these newly
created faculty positions with world-calibre scientists whose expertise will help us
build on our strengths. before the campaign ends, we expect to have funded close
to 24 chairs, six professorships and five
tee&med. endowments in health sciences disciplines.
Intellectual endeavor and scientific
research require space, and our planned
physical development takes that into
ACCOUNT:
• As part of Biotechnology Phase 1, the
Centres of Excellence Building is now
open. The provincial government is providing generous infrastructure support
for the National Networks of Centres of
Excellence, which will lease ^
space there for the three netWORKS HEADQUARTERED on campus.
• We have launched a $ 1 .2-million        ^
renovation to and expansion of
the facilities of the faculty of
Dentistry.
• When the Jack Bell Research
Centre at Vancouver General
Hospital is transferred to the
university, it will be incorporated in our 10-year plan for capital development and require additional support to
complete its development.
• The second phase of the Biotechnology
Laboratory is expected to begin in 1993 as
part of ubc's capital plan, now submitted
to the provincial government.
• as part of the biotechnology laboratory, we plan to build an extension to
house a National University of Singapore
research-exchange laboratory.
• as early as 1996, our capital plans, sub
mitted to the government, call for a
major expansion of our health sciences
facilities to make better use of existing
space and to provide suitable accommodation for both biomedical research and
the health-caring disciplines.
• With hospitals increasingly involved in
teaching and research, we will help them
plan for any additional space that they
may need to fulfil their role as full partners in the endeavor with the
university. Financial support for
such space will come from the
Ministry of Health, the hospitals THEMSELVES AND THEIR FOUN-
<ka>
A^e^eikk>Mn^^ amc/
dations.  This  space will be
DEVELOPED IN ACCORD WITH THE
ACADEMIC PLANS NOW BEING DEVEL-
^Sconced OPED BY THE DEAN IN CONSULTATION
with all those involved and its
integration will be subject to
annual review and approval by the dean.
as well as these developments, other proposals to expand our health sciences
facilities are under active consideration,
the newly created ubc real estate corporation is conducting a feasibility study
for an ambulatory care centre that would
be fully or partially self-funding. significant changes are contemplated at the
Biomedical Research Centre on campus as
it is being fully integrated into the university, it will continue to focus on its
G
o
cn
X
X WM
o
Ol
o
or
Lu
s
Ul
Z
X
X
ORIGINAL MISSION TO ENHANCE PHARMACEUTICAL RESEARCH IN THE PROVINCE. AND DISCOVERY Parks — originally envisaged to
develop the intellectual property of ubc
professors in facilities adjacent to the
university — is now in our control; we
plan to develop the park with such
endeavors as the reinforcement and
expansion of pharmaceutical research.
Concurrently with these major developments, WE ARE WORKING WITH THE
...&a
PROVINCIAL GOVERNMENT TO ENSURE
THAT IN FUTURE UBC IS REIMBURSED, cteaJe
as universities are in other canadian jurisdictions, for the substantial clinical services we provide to
the teaching hospitals and to the
provincial health-care system.
The people of British Columbia
have recently told the b.c. royal
Commission on Health Care and Costs
that the province has a good health-care
system, but that it needs fine-tuning to
make it fairer and more responsive to the
needs of the people of the province. the
university's role in this system is to conduct health sciences research and teaching, in making this important contribution,
WE WILL MAINTAIN A BALANCE. On THE ONE
HAND, WE SUPPORT AND TRAIN THOSE WHO
EXPLORE THE DIAGNOSTIC USES OF HIGH TECHNOLOGY AND DEVELOP THE DRAMATIC REMEDIAL PROCEDURES THAT SAVE THE SERIOUSLY ILL.
ON THE OTHER, WE SUPPORT AND TRAIN THOSE
WHO SEEK PRAGMATIC WAYS TO SAVE COSTS, TO
MAKE HEALTH CARE ACCESSIBLE, TO PROMOTE
HEALTH AND TO IMPROVE THE CARE OF THE ILL
AND DISABLED.
IN THE FINAL ANALYSIS, OUR GOAL IS TO CREATE
A GREAT, COMPREHENSIVE HEALTH SCIENCES
TEACHING AND RESEARCH CENTRE IN B.C.
WHERE THE PURSUIT OF SCIENTIFIC KNOWLEDGE
IS IN EQUILIBRIUM WITH THE PURSUIT OF COMPASSIONATE wisdom. With the
RESOURCES OF UBC AND WITH THE
ijaeaei CLOSE    COLLABORATION    OF    THE
TEACHING HOSPITALS, THERE CAN BE
SUCH A CENTRE IN B.C. To THIS END,
•'OSXZ(t& fa
dce&nced
WE HAVE JUST SIGNED NEW AGREE-
faaeAifoa am/
ments with our teaching hospitals and have developed a new
research agreement with b.c.'s
Children's Hospital that will be a
model for others. we are exploring the
question of linkages with other hospitals
to ensure that quality medical care is
available to all in the province. buoyed by
this renewed spirit of cooperation and
collaboration,we look forward to playing
our role in the coming decade to ensure
that the people of this province enjoy the
best possible health and health care. ^y&CMswe0/e€dpe&ian&>
The university of British Columbia:
b.c.'s centre or teaching and
research in the health sciences
was produced by
the UBC Community relations office
Writer:
Audrey grescoe
Editor:
Stephen Crombie
Production:
Christopher Miller
Photography:
David Gray
P.  1 1, P. 22, P. 37, P. 69
PERRY ZAVITZ
P. 53
David Chan, Exposures unlimited
P. 86
Flysheet:
Detail from Gobelin Tapestry (1948)
on the History of medicine and Science
in the memorial room,
woodward Biomedical Library
Special thanks to:
Chris Hives, Archivist
UBC Archives
Dr. lee Perry, Librarian
Memorial Room -
Woodward biomedical Library
Design:
The Design Works
Additional copies of this report
and information about ubc
are available through:
the ubc Community relations office
The university of British Columbia,
Vancouver, British Columbia
Canada V6T 1Z2
telephone: (604) 822-3131
Facsimile: (604) 822-2684   

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