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 UBC MEDIC
Volume 2 Number 1 Fall 2005
Teaching & Technology
WHY THE FACULTY IS EARNING ALL THOSE KUDOS
THE EXTRAORDINARY DR. JAMES HOGG
GIFT OF A LIFETIME     10
<
^
I
UBCl
ggj5gg    A publication of the Faculty of Medicine'
at the University of British Columbia
4
\fe FACULTY  OF
MEDICINE
VISION
Through knowledge,
creating health
CONTENTS
FEATURES
3     The Anatomy of Distributed Learning
How the technology behind distributed learning is reconfiguring the anatomy of
medical education in BC.
MISSION
Together we create
knowledge and advance
learning that makes a
vital contribution to
the health of individuals
and communities
locally, nationally and
internationally
EDUCATION RESEARCH
COMMUNITY PEOPLE
SUSTAINABILITY
&   RENEWAL
UBC Medicine is published
twice a year by the Faculty of Medicine,
and provides news and information
about the activities of faculty members,
students, staff, alumni, and friends, and
their contributions to the health and
well-being of people and populations
locally, nationally and internationally.
Submissions are welcome.
Volume 2 Number 1 Fall 2005
Editor: Miro Kinch
Writers:
Tim Carlson
Barb Daniel
Miro Kinch
Kyle Kirkham
Mari-Louise Rowley,
Pro-Textual Communications
Design: Tandem Design
Associates Ltd.
Principal Photography:
Martin Dee
Additional Photography:
Darin Dueck
The James Hogg iCAPTURE Centre
Trasi Jang
Slides courtesy of:
The James Hogg iCAPTURE Centre
Dr. William Ovalle
Dr. Wayne Vogl
On the cover: Where old and new
technology meet—Dr. William Ovalle
and first-year histology students in the
new Multi-purpose Lab on the Point
Grey campus, where the state-of-the-art
virtual slide box is complemented by
traditional microscopes. See p. 3.
UBC Medicine Fall 2005
7     Pioneering Lung Research—A Lifetime of Achievement
In recognition of both his seminal work in pulmonary medicine and his role as an
educator, Dr. James Hogg has been chosen to receive the Faculty of Medicine's first
Lifetime Achievement Award.
9     The James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research
Established in 2000, the James Hogg iCAPTURE Centre at St. Paul's Hospital
has become world renowned for leading research to eliminate heart, lung and
blood vessel disease.
10     Gift of a Lifetime
This year the Faculty of Medicine honoured the sustained contributions of two
distinguished clinical faculty members, Dr. Graeme (Ted) Wilkins and
Dr. Barry Koehler, with the Career Award for Excellence in Clinical Teaching.
DEPARTMENTS
1 Dean's Message
2 Student Point of View: Balancing Act
The Faculty of Medicine
at UBC is a dynamic
component of one of
Canada's most exciting,
innovative public
universities, and the
home of British
Columbia's only
medical school.
Faculty members,
students, staff, and
alumni from fifteen
academic departments
and two schools—
Audiology & Speech
Sciences, and
Rehabilitation Sciences—
are actively engaged in
leading-edge research,
education and community
service on university
and hospital campuses
across the province. DEAN'S   MESSAGE
I am always pleased with the energy and excitement that accompanies
the start of a new academic year and the entry of a new class.
All of us have been students at some
time in our lives. Most of us still are; some
formally, others informally. Many of us
are teachers ourselves and all of us support
teaching and learning in some way, at
work, at home and/or in the community.
It is an enormous responsibility, a
tremendous honour and a great privilege to
be involved in teaching and learning, and
one I personally take very seriously. I have
never forgotten my discovery, in high
school, that the word "doctor" derives from
the Latin verb doceo, which means "to teach."
As a medical student, a resident and
a practising physician, I have been fortunate
to have had a number of gifted teachers
and mentors. Each one was distinguished by
the unique set of skills, interests and
abilities that they generously shared with
me, and their personal styles and teaching
methods were as individual and varied
as they were. What they all had in common,
however, was their passion for and commitment to their work, and a spirit of enquiry
that informed everything they did, in the
clinic and the classroom, at the bedside or
in the lab—something that can't be mandated, but that can so often make the difference
between good and great.
In this issue of UBC Medicine we have a
number of stories to tell about faculty members, students, staff and alumni who have that
spirit of enquiry and who demonstrate that
passion and commitment every day.
The men and women in these pages
are just the tip of the iceberg, however. With
almost 16,000 faculty members; students
and learners in undergraduate, graduate, residency and continuing education programs;
staff members; and alumni in communities
and on our academic and clinical campuses
across the province, we have a wealth of
talent to draw upon. There are stories
enough to last a lifetime. It will be our great
pleasure—and challenge—to choose some
of those stories to tell in this publication, on
our website, and in the media over the
next year.
£-/*>•
GAVIN  C.E. STUART, MD
Dean, Faculty of Medicine
Fall 2005 UBC Medicine       1 STUDENT    POINT    OF    VIEW
BALANCING    ACT
Medical Students Do It All—
with a Little Help from Their Friends
Medicine Undergraduate Society president Kyle Kirkham (Class of 2005) speaks from
the heart about students and student bursaries at the naming of the Donald B. Rix
Lecture Theatre in recognition of Dr. Rix's $2 million gift for medical student support.
It is my very great pleasure to be here today
to recognize Dr. Rix for his incredible
generosity. His gift will not only support a
number of medical students directly, it
will have the greater impact of ensuring this
important training is a real possibility for
students from any financial background and
from any region of our province.
I'd like to take a moment to try and
show you a little more about what these
bursaries will mean.
Helen Rosenauer is a colleague of mine
in the class of 2006. She was born in rural
BC, but travelled to Vancouver to pursue an
honours BSc in Chemistry and Math here
at UBC. She completed the Professional
Development Program in Education at SFU
and became a high school teacher and community counsellor. She has lived in Golden
and Hazelton and has worked in Hazelton,
Gitsegukla and Kitwanga. Somewhere along
the way she met and married her husband
Stewart and they had two children, Cara and
Christopher. While Stewart knew that
coming to Vancouver would mean giving up
his job in the forest industry, I wonder if
the kids at two and four years old had any
idea what they were getting into. In fact,
her youngest was probably just happy to be
breastfed during the short breaks while
Helen wrote the MCAT entrance exam.
Their family endured significant culture
shock with the transition to Vancouver,
learning first-hand the premium we all pay
UBC Medicine Fall 2005
to live in this beautiful city. Her husband
has found his earning potential decimated
by the move, and it has been more valuable
for them to have a stay-at-home parent.
Within their first year here, they exhausted
their savings and have relied on support
from sources such as UBC bursaries to see
them through. In addition to her role as
medical student, Helen has had to balance
the demands of being a parent and a
partner—and find enough of her own time
to keep her sanity. Helen hopes to pursue
residency training in either Psychiatry or
Family Medicine, and to return to rural BC
to focus on adolescent populations.
Clara Tan turned 30 this year. She has
been in school forever, she tells me. She
already has a bachelor's and a master's degree
to her credit and is currently in her fifth
year with the Faculty of Medicine, working
toward a combined MD/PhD degree.
After five years with us, she is still exploring
her residency options, but knows that
research will play a significant part in her
future. Her research areas include:
inflammation and angiogenesis, blood and
thrombosis, pediatric palliative care education
at Canuck Place, and MRSA and burns.
Clara actively encourages other medical
students to pursue research because she
feels that" If we stop thinking of ways to
improve care, we risk becoming more
like computers with diagnostic algorithms."
She says, "it is a great privilege to be
given the opportunity to work towards
making a positive impact, not only on your
own patients, but also future patients." She
balances this work with her commitment
to her partner, her work at the student clinic
downtown, and her leadership in the
student community. Clara is perhaps the
biggest champion of the fine arts I know
and has tirelessly worked to create more
opportunities for medical students to express
their talents in this area.
There is no single focus for medical
students during our program. We all know
coming in that academics will take our
full commitment. But most of us have other
responsibilities that we cannot leave behind
or passions that we choose to balance.
Medical students' minds should be set on
improving our patients' health and
maintaining our own. Too often, though,
life gets in the way—and money is a
big part of life when you have no opportunity to earn any.
Dr. Rix's contribution will mean that
students like Helen can go home at night
and play with her kids with greater peace of
mind. That those of us who uproot to join
this program, forcing families to move
with us and throwing relationships into turmoil, may have a better chance at coming
out intact after four years because finances
are not distracting us at every turn. That
students like Clara, who are passionately
committed to their research and to the huge
range of other activities that got us all
into medicine in the first place, will feel
more freedom to continue with their
volunteerism, their leadership, their mentorship, and the curiosity-driven investigation
that advances our field.
Thank
you
Dr. Rix. 1
The Anatomy of Distributed Learning
Reconfiguring Medical Education in BC
First-year medical students study a slice of kidney using both
microscopes and computer screens in a new high-tech laboratory at
UBC. A traditional microscope view is augmented with digital versions of the tissue samples in the "virtual slide box," a UBC-developed
database that is revolutionizing the study of microscopic anatomy. Via
high-speed video-conferencing technology, the students and instructors maintain a live, interactive connection with their classmates and
counterparts in labs at the University of Victoria and the University
of Northern BC in Prince George.
Gross anatomy is wired into the universities' distributed learning
circuitry as well. A complex matrix of lights, cameras, robotics and
audiovisual control systems delivers precision imagery into each lab.
The goal, after all, is to give students at each site an identical experience— as if they were all around the same table as the instructor
opens up the cadaver and takes them on a tour inside the chest cavity.
These are just two examples of how the technology behind
distributed learning is reconfiguring the anatomy of medical education in BC. Innovative solutions have been demanded from teams of
medical faculty, clinicians and technicians since planning began in
2001. The results are impressive.
"In terms of medical education programs this is absolutely cutting
edge," says Dan Zollmann, an engineer and project manager with
AMBiT, a Vancouver-based consulting firm. Zollmann acts as "inter-
site technology lead" in the distributed learning program.
Already the work here at UBC has set a new standard and is making an impact at other Canadian medical schools. Delegations from
the University of Western Ontario (UWO), which plans a similar partnership with the University of Windsor, and from l'Universite de
Sherbrooke, which is moving ahead with a program in partnership
with l'Universite de Moncton and l'Universite du Quebec a
Chicoutimi, visited BC in the spring. Both are looking at adapting
components of the UBC system to their programs.
"It was almost overwhelming to see the marriage of careful
thought and technology," says Jim Silcox, advisor for the Schulich
School of Medicine and Dentistry at UWO. "What really hit home
was that the technology really worked to preserve the cohesion of
the group even though the students are on three different campuses."
The distributed education program demanded specialized infrastructure—beginning with bricks and mortar, moving through to the
computer network, and on to the audiovisual and information technology components.
First, "There were major architectural considerations," says
network strategist Stan Shaw, who, with a doctorate in molecular biochemistry as well as network industry experience, brought both
scientific and technological expertise to the enterprise. "In any videoconferencing environment you have to take into consideration the
acoustics and lighting in order to make it work properly—it's a production facility." The state-of-the-art interactive lecture theatres and
laboratories in the Medical Sciences Building in Victoria, the Life
Fall 2005 UBC Medicine Sciences Building at UBC, and the Dr. Donald Rix Northern Health
Sciences Centre at UNBC were the result.
Next, they had to design a network fast enough to deliver
exceptionally crisp video. Image quality is essential in the context of
medical education for reasons that go far beyond an attempt to
look pretty. Zollmann says the guiding principle was that "we're training the students' eyes as well as their minds. One of the critical
aspects of what we train and hire doctors to do is to use their eyes	
If an instructor was showing an MRI scan in a lecture, it would
be meaningless if the remote learner saw a jittering, distorted image
at the other end."
To get around the problem of other Internet traffic slowing down
the medical school's video conferencing, explains Shaw, "We took a
slice of the Internet on BCNET, isolated it and gave it priority over
other traffic on the system network." The result is a system built for
speed: at three megabits per second, the network transmits video five
to six times faster than the industry average.
This solved the delivery problem, but each component of the
program made its own particular demands. For Zollmann, the gross
anatomy lab offered one of the most interesting challenges in the
design of the "remote presentation technology."
Imagine three labs, one in each of Vancouver, Victoria and Prince
George, where students are gathered in an operating room-type
setting, cadavers on the table. At two of the sites, students watch the
anatomist deliver the lecture on large LCD or plasma monitors,
with clinicians on hand for consultation.
At the third site, the anatomist not only presents the lecture and
proceeds with the dissection, but also controls the outgoing video
imagery. The lecturer operates the switching system for cameras that
are trained on him when he's speaking directly to the students and
for cameras allowing both macro and micro views of the dissection.
He also has to keep his eyes on a lectern where a pair of "confidence"
monitors show the imagery that is seen at the remote sites, as well
as the students asking questions from those sites.
The system development required experimentation. Zollmann,
the other technologists and the anatomists identified problems during
demonstrations of a prototype system in early 2004: the controls
were wall-mounted and out of the anatomist's reach; the touch-screen
control was not sensitive to a gloved hand; the images were often in
shadow because the lighting did not adjust to the camera angle and
focus; and there were motion control issues.
"There were a couple of demonstrations where people were getting ill, not because of the subject matter—everyone in the room was
comfortable seeing organs on display—but because the motion of
the tour through the chest cavity was so erratic that people couldn't
maintain orientation," Zollmann says. "It was clear we couldn't actually teach students with that particular configuration of technology."
Video and lighting systems used in hospital operating rooms
proved not to be the answer as they are extremely expensive and
meant to be controlled by a dedicated operator.
"What we did instead was adapt off-the-shelf camera equipment
and very high-powered lights," Zollmann says. "One is a $30,000 camera, ceiling-mounted and with a robotic control that works in sync
with the lights to make sure the specimens are not in shadow, and are
consistently illuminated and clear. It's completely motorized, which
allows for very close zoom or magnification without shaking or jittering. With a very simple joystick, the anatomists were controlling the
camera like a pro in about 90 seconds."
The second camera is a $3,000 miniature camera mounted on an
adjustable stem that can be angled or twisted in any direction—it
looks like a flashlight on a gooseneck microphone. The anatomist can
place it inside the chest cavity and focus in on details that are not
captured by the ceiling-mounted camera.
"What made it exciting is that we had a group of anatomists who
didn't know technology, and technologists who didn't know anatomy
and we educated each other to the point where we created something
that made everyone extremely happy," Zollmann says.
The use of video technology has gradually entered into the teaching of anatomy over the past decade. Says Zollmann, "This system
expands its capability—it's an evolutionary rather than a revolutionary
thing. What's happening in histology, however, is revolutionary."
The virtual slide box is an online version of the set of 200 slides
students study in their first- and second-year histology courses. Each
digital image is a whopping 5.9 gigabytes, which renders a perfectly
sharp image on large computer screens, even when looking at a detail
magnified 4Ox.
"The students are of a generation that has grown up with computers and they love this kind of interactivity with the computer
screen," says Dr. William Ovalle, UBC's medical histology course
director. "They can look at it at home; review on their own time."
The virtual slide box is one of the components of the distributed
learning program that most impressed the recent delegation from
the University of Western Ontario, Zollmann says. "When Dr. Ovalle
and I took them through the histology multi-purpose labs and
showed them the virtual slide box, their chins hit the table. They
could not believe it. They all instantly recognized that what
we're doing in histology will transform the way the subject is taught."
UWO's Silcox, who recalls his own struggles with the
microscope as a student, agrees with Zollmann. "The histology lab
demo was breathtaking," Silcox says. "The virtual slide box, in
fact, almost makes the microscope obsolete."
Ovalle, who has taught histology at UBC for 33 years, says it's still
important for students to be skilled with both the old and the new
UBC Medicine Fall 2005 technology. "Some people ask,'Doesn't this replace the microscope?' In
our view, it supplements the microscope. It's important to have both."
Development of the technology used in the distributed program
continues. For example, Zollmann says, the future is in refining
the current distributed-learning technologies for greater portability—
for sites even further removed from special facilities at universities
or hospitals.
"What I think is going to be the next frontier for us is exploring
video conferencing between potentially many sites. Traditional video
conferencing maxes out at four locations. After that they stop
working the way we need them to work—we lose the ability to view
people at all the sites. Our next challenge is to have large numbers
of sites connecting and distributing to sites with just one or two people at them.The other areas we're now starting to research and test
are fully functioning laptop systems that can connect with traditional
video-conferencing systems."
There is more innovation on the way in the delivery of medical
education, and UBC is clearly on the cutting edge.
The virtual slide box and the remote
presentation technology support the
delivery of the Faculty of Medicine's
MD Undergraduate program on three
university campuses. This "distributed" program, developed in collaboration with UNBC, UVic, the regional
health authorities and the provincial
government, is an innovative
response to the alarming shortage of
doctors in BC's rural communities
The evidence suggests that
training doctors in or close to the
communities they come from, and/or
hope to serve, helps to keep them
there. "This may attract students who
wouldn't otherwise consider
medicine because they don't want
to relocate to larger centres," says
Dr. Angela Towle, associate dean,
MD Undergraduate Curriculum. "The
distributed program, with the
technology, makes it more acceptable, more doable."
In recognition of this innovation
and collaboration, the Faculty's
Distributed Medical Education team,
Drs. Joanna Bates, Angela Towle,
Oscar Casiro, and David Snadden,
were named winners in the
Leadership category at the seventh
annual BC Innovation Awards in
Educational Technology this spring
For more about the awards, please go
to www.bccampus.ca.
Technology offers solutions, but
it also makes demands. The web of
fibre-optic cable, circuitry and
lenses that brings together three
campuses requires teachers to
rethink their techniques
"Teaching's always been a
performance for me; that's what
I've always loved about it," says Dr
William Ovalle, a 33-year veteran
of the classroom. Now he has to
adapt his style to multiple cameras
and remote audiences as well as
run PowerPoint projections and direct
the use of the virtual slide box
"When I first heard about the distributed program I thought, 'Oh no,
this is going to be impossibly hard
work, and we'll lose the sense of personal touch.' But I found that that's
not the case. We are in touch; we're
communicating. It's incredible. We're
all in the room together."
Ovalle is enthusiastic about the
new technology. "I thought I would
get swamped, but I find it revitalizing.
We are incorporating traditional
ways of teaching, but we have new
methodologies as well. We have
the best of both worlds."
For Niamh Kelly, UBC's foundations
of medicine course director, the
technological component of the distributed program will set medical
students up for the technological
advances and continuous learning
that will be an ongoing part of
their practice
"To me, technology means
better connectedness and that means
better communication," she says
"Look at the work life of a medical
practitioner: they qualify at age 25;
on average, they have 40 years of
practice. Look at the rate of change
of knowledge over four decades,
and it's a given that they will have
to continually upgrade
"How will they get that
knowledge if they could be working
anywhere from an urban centre
to a remote village? Technology is
the answer. It's all about up-to-the-
minute connectedness. It makes sense
that our undergraduate students
embrace technology, expect it, learn
to use it and make it the forerunner
of their continuous learning."
Faculty of Medicine professor
Wayne Vogl has a runaway international success on his hands with
Cray's Anatomy for Students, the
textbook he co-authored with
Richard Drake and Adam Mitchell
The book, which features access
to an online searchable text, an
nteractive surface anatomy component, downloads of more than
1,000 illustrations, and a test bank, is
an ideal complement to the gross
anatomy courses in the Faculty's distributed medical program. Among
the many other medical schools using
the text are Johns Hopkins, Yale
and UCLA.
Student end-users were
nvolved in every step of the book's
development. Publisher Elsevier sent
mock-ups of each chapter—including
options for artwork—to student
groups around the world. "We paid
ncredible attention to student
feedback," Dr. Vogl says
Professor Vogl and Richard
Drake, director of Anatomy at
Cleveland Clinic Lerner College
of Medicine, each bring 25 years
experience teaching in the lab to this
project. Mr. Mitchell, MBBS, FRCS,
FRCR, a consultant radiologist at
Charing Cross Hospital, Imperial
School of Medicine, London, England,
provided the clinical expertise
Fall 2005 UBC Medicine ■ F
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6       UBC Medicine Fall 2005 Pioneering Lung Research—
a Lifetime of Achievement
Pulmonary pathologist Dr. James Hogg is the recipient of the first UBC Faculty of Medicine
Lifetime Achievement Award for his pivotal and extensive contributions in the understanding of
chronic obstructive pulmonary disease—the fifth most common cause of death in North America.
Imagine not being able to catch your breath—ever. Professor
Emeritus of Pathology at UBC, Dr. James Hogg has dedicated his life
to the study of chronic obstructive pulmonary disease (COPD). He
has also made major contributions to understanding the mechanism of
airway hyper-responsiveness in asthmatic patients, how viruses and
bacteria worsen airway diseases, and how white blood cells are attracted to the lung, where they can cause damage. In recognition of both
his seminal work in pulmonary medicine and his role as an educator,
Dr. Hogg has been chosen to receive the Faculty of Medicine's first
Lifetime Achievement Award.
Dr. Hogg continues to teach, mentor graduate and summer students, and do research at his namesake, the James Hogg iCAPTURE
Centre for Cardiovascular and Pulmonary Research at St. Paul's
Hospital. "Teaching has been one of the most satisfying aspects of my
job because you see people grow from students to colleagues," he
says. The Research in Progress summer school program initiated by
Dr. Hogg in 1978 now involves 25 medical and pre-med students
from all over the world.
"Dr. Hogg is an original thinker, an outstanding teacher
and a stimulating colleague. His laboratory provides
an active intellectual milieu for young physician-scientists,
and he has trained some excellent young people, who
contribute significantly in their own right."
Reuben M. Cherniak, MD, Distinguished Professor of Medicine
National Jewish Medical and Research Center
University of Colorado Health Sciences Center
Controlling COPD
COPD refers to lung disorders that obstruct the airways—commonly
a combination of chronic bronchitis and emphysema. It takes a
long time to develop, and occurs as a result of inhaling toxic gases or
particles such as cigarette smoke, or exposure to chemical fumes,
pollutants and dusts from grain, wood and minerals.
People suffering from COPD are unable to fully expel the air in
their lungs, limiting new air intake and the amount of fresh oxygen
circulating in the bloodstream. In chronic bronchitis, the lungs are
unable to clear mucous. In the latter stages of emphysema, the lungs
are riddled with holes and scar tissue. One of the mysteries of the
disease is that not all smokers develop it, and only 10 to 15 percent
of heavy smokers do. Unlike asthma, which occurs in young, healthy
individuals, COPD occurs in older people, usually in their 50s or
60s. Asthma can be effectively controlled, but there is still no cure
for COPD, and it is the only major cause of death that is rising
in prevalence.
Dr. Hogg made his first major contribution to understanding
the nature of COPD in 1968 when working with colleague and
mentor Dr. Peter Macklem at McGill University in Montreal. In normal human subjects, the vast majority of the resistance to airflow is
in the large airways of the lungs. However, they found that in patients
with obstructive lung disease, most of the resistance was in the
smaller airways, those less than two millimetres in internal diameter.
This research altered the course of investigation of COPD. The
discovery that the significant pathology was in the small airways also
led to the realization that considerable disease could be present
before ever being diagnosed.
Since coming to UBC in 1977, Dr. Hogg has worked closely
with Dr. Peter Pare and other iCAPTURE scientists on small
airway research. The group recently published a landmark paper
detailing the anatomic and cellular basis for the increased
resistance to airflow in small airways—quantifying three decades
of investigation and discovery.
Understanding Neutrophil Kinetics
Dr. Hogg's expertise in pathology and physiology advanced the
understanding of how inflammatory cells and fluids enter the lung.
His research has provided new insights into the migration of
neutrofils, inflammatory cells that provide the "first line of defence"
against infection or injury by attacking bacteria, fungi, protozoa,
viruses, and tumour cells. When the body is exercised or stressed, neutrophils are released en masse, elevating the white blood cell count.
The time it takes neutrophils to traverse the pulmonary capillary network is 30 to 40 seconds, whereas red blood cells take only one
second. "This difference in travel time produces an accumulation of
Fall 2005 UBC Medicine neutrophils in the lung," notes Dr. Hogg. In the 1980s his innovative
work on the effect of cigarette smoking on neutrophil kinetics in the
lungs led to new insights into the pathophysiology of emphysema.
More recently, Dr. Hogg and colleague Stephen van Eden—with
the consent of cardiopulmonary bypass patients—were able to
measure neutrophil levels during surgery. They expected the counts
to remain level, but instead, neutrophil levels soared. They discovered
that bone marrow leaks neutrophils when the body encounters a
traumatic or invasive stimulus, such as surgery. This work was pivotal
to understanding the communication between lung cells and bone
marrow and the role this has in several systems and organs. It also shed
light on the progression of atherosclerosis.
" Perhaps the most interesting thing we found is that air pollution
stimulates the bone marrow and your white cell count goes up,"
says Hogg. He and Stephen van Eden used data collected by Japanese
colleague Dr.Yuki Sato when he was on a scientific expedition to the
South Pole. His group measured neutrophil levels of the researchers
while they were living in this relatively pristine environment, and
then again when they returned to more polluted cities. "As the
number of particles in the air decreased, the white cell count fell
and stayed down the entire year that they were away," explains Hogg.
"When they returned, their white cell count went back up."
Harnessing the Immune Response
In a recent study published in the New England Journal of Medicine
(Vol. 350, No. 26, June 2004), Dr. Hogg and colleagues were the
first group of researchers to demonstrate the long-suspected hypothesis that COPD is caused, in part, by the body's own inflammatory
immune response. Their data suggested that the lung's natural defences
may initiate an exaggerated response to colonization and infection
by a variety of bacteria and viruses. The repair process then forms scar
tissue that thickens the airway walls and passages, producing irreversible obstruction. "Two things happen in the lung," explains Dr.
Hogg. "The airway walls thicken and the lung parenchyma
(alveoli and capillaries) are destroyed, so there is both a proliferative
response and a destructive response." Understanding how these
immune responses are triggered in COPD could lead to novel therapeutic interventions.
Dr. Hogg is also working to understand the mucosal inflammatory
response of the lower respiratory tract, characteristic of chronic
bronchitis. "It is the inflammation of the mucous glands in the major
bronchi that causes chronic bronchitis," he notes. "Whereas, it is
the inflammation of the peripheral areas of the lung (the alveoli) that
causes emphysema." Why the same stimulus produces different
responses, causing different disease phenotypes, is a focus of his current research.
Honouring a Very Distinguished Career
Dr. James Hogg has received numerous awards over the course of his
career, including:
Izaak Walton Killam Research Prize
Distinguished Scientist Award, Canadian Society for Clinical Investigation
Fellow, Royal Society of Canada
Fleischner Medal
Science Council of British Columbia Gold Medal, Health Sciences
American Thoracic Society Scientific Accomplishment Award
Ochsner Award, American College of Chest Physicians
Burns Ambersom Lecture, American Thoracic Society
Henry Friesen Award, Royal College of Physicians and Surgeons of Canada
Chugai Award for Excellence in Mentorship and Scholarship, American
Society for Investigative Pathology
2004
2005
Lifetime Achievement Award, Pulmonary Pathology Society
Order of Canada
Viral Triggers to COPD and Asthma
While on sabbatical in 1987 at Merton College in Oxford, Dr. Hogg
studied the principles of molecular biology. Over the past fifteen
years he has applied this knowledge to investigating the role of latent
viral respiratory infections in the development of COPD. This work
has provided clues to the riddle of why only a minority of smokers
develop obstructive lung disease. It has also furthered understanding
of the role that viral infections play in the worsening of asthma.
As a member of the Global Initiative for Chronic Obstructive
Lung Disease (GOLD), Dr. Hogg says a main goal of the initiative is
early diagnosis. With 30 percent of the population still smoking
and industrial and air pollution increasing, Dr. Hogg doesn't believe
the number of COPD sufferers will decrease very soon. Early
detection could make a huge difference in the effectiveness and cost
of treatment, and in the near future he would like to see simple,
self-administered breathing tests available at community clinics or
drugstores, similar to current blood pressure tests.
After nearly four decades, James Hogg is as enthusiastic about
his research as when he was a graduate student. "I feel extremely fortunate to have been able to go to medical school. There have been
many highlights in my career, but it really has been the whole ride—
with colleagues, staff and students. To be able to continue to work
is a great bonus."
UBC Medicine Fall 2005 THE  JAMES   HOG G •
iCAPTURE Centre
for Cardiovascular and Pulmonary Research
Established in 2000, the James Hogg iCAPTURE Centre at St.
Paul's Hospital has become world renowned for leading research
to eliminate heart, lung and blood vessel disease.
The James Hogg iCAPTURE Centre
for Cardiovascular and Pulmonary Research,
a 50,000 sq. ft. state-of-the-art facility
developed collaboratively by the UBC
Faculty of Medicine and Providence Health
Care, is home to the foremost scientists
in the field of genetic and environmental
cardiopulmonary research. The centre
was built with $21 million in infrastructure
funding from the Canada Foundation for
Innovation, BC Knowledge Development
Fund and other partners, including the
BC Lung Association and the Heart and
Stroke Foundation of BC and Yukon.
The iCAPTURE Centre is one of the
best-equipped facilities of its kind in the
world, and a magnet for the brightest
young researchers in the field. Currently, 29
principal investigators, eight associate investigators, and a team of over 200 staff and
trainees work in the centre's four overlapping
areas: Molecular Phenotyping, Ultrastructural
Imaging, Dynamic Cellular Imaging and
Biophysics, and Organ Pathophysiology
and Imaging.
"iCAPTURE research involves a
conjunction of clinical insight, computational
science, modern biological tools such as
genomics and proteomics, and a strong
team-based approach that draws on the best
of everyone's skills from a wide range
of knowledge domains," says Dr. Bruce
McManus, centre co-director with Dr.
Peter Pare.
Capturing and Understanding
Mountains of Data
The technological tools Dr. McManus
refers to include a Biowave machine that can
isolate antigens from cells and process tissues
for electron microscopy—in two hours
rather than two days. An atomic force microscope (AFM) allows researchers to study
live cells at the nanometre level and to follow molecular events. The centre's new
electron microscope delivers 95,000x
magnification and has a 3-D function. Other
imaging equipment includes a new confocal
microscope, a CT scanner, and an MRI
(shared with Vancouver Hospital and Health
Sciences Centre).
In addition, the iCAPTURE Registry
provides computerized catalogues of
multi-institutional patient data integrated
with banked tissue samples for molecular
and pathobiological studies. A computer
room stacked with fourteen servers and
banks of storage units processes and stores all
the data—well in excess of ten gigabytes a
day. And then there is the challenge of turning data into knowledge. iCAPTURE
researchers include computer scientists, statisticians and others working in bioinformatics
and health informatics, who are developing
specific algorithms and computational tools
to ensure the robust analysis of complex and
diverse medical data.
Transforming Research into Treatment
There are currently seventeen major research
studies and fifteen clinical trials underway at
iCAPTURE. In a current project funded by
Genome Canada, Genome BC, Novartis
Pharmaceuticals, and IBM, researchers are
working in a community-wide team to
identify biomarkers in blood or other body
fluids, which can be used to diagnose and
predict organ rejection and immunotherapy
response in transplant patients. At present,
patients have to undergo invasive and expensive biopsies on a regular basis. In addition,
understanding individual responses to
immunotherapy will help physicians personalize treatment to reduce side effects and
over-prescribing of expensive immunosuppressive drugs.
Another example of translational or
bench-to-bedside research is a huge interdisciplinary study led by Dr. Peter Pare and
funded by the Canadian Institutes of Health
Research and the Heart and Stroke
Foundation of Canada. The research group
is working to identify roughly 100 genes
related to inflammation, or to immunity and
repair following injury, and which trigger
the development and progression of obstructive lung disease, asthma, atherosclerosis,
degenerative heart valve disease, and systemic
inflammatory response syndrome.
Groundbreaking work by Dr. McManus
and colleagues has shown how certain drugs
used for weight loss damage heart valves.
Dr. James Hogg and Stephen Van Eden are
studying how air pollutants affect immune
response and cause plaque in arteries to
become unstable, a process which is linked
to sudden cardiac arrest.
" Each of us has a different capacity to
respond to injury or to avert disease," says
Dr. McManus. Working to understand the
mechanisms involved in such responses is a
central component of iCAPTURE research.
Better diagnosis and more personalized
treatment is the ultimate goal.
Fall 2005 UBC Medicine GIFT ofa LIFETIME
In UBC's Faculty of Medicine, more than 2,800 talented,
dedicated—and busy—practising health professionals annually take
on the responsibility for ensuring that the highest standards
and best practices of their profession are passed on to the next
generation. By making their expertise available to students
and learners at many different stages of professional development,
they give an invaluable gift to the people in British Columbia,
across Canada and elsewhere in the
WOrid ine   DeSl  OOClOrS,   aUCIIOIOglSlS, This year the Faculty of Medicine
.. i       i honoured the sustained contributions of
r O        O      r O ~  '   ' two distinguished clinical faculty
occupational and physical therapists, and    members'Dr-Graemeo^)™"5^
Dr. Barry Koehler, with the Career Award
midwiVeS,   nOW   and   in   the  futUre. for Excellence in Clinical Teaching. The
award recognizes the major impact each
. ■ ■■ ■■ I.     .    . , has had on their students' acquisition of
Along the way, these clinicians report,
'-' J ' clinical knowledge, skills and judgment—
they  Often   find   themSelveS  energized andattimesontheircareerchoices.lt
celebrates their contribution as role models
and inspired by the interaction with a and sources of nfeiong inspiration for «,e
di I .        r impressive roster of health professionals
iverse and ever-changing set of
'-'      '-' they have taught over the years.
Along the way, these clinicians report,
they often find themselves energized
and inspired by the interaction with a
diverse and ever-changing set of
fresh minds and new ideas.
10     UBC Medicine Fall 200! Dr. Ted Wilkins
is a
clinical professor in UBC's Division
of Endocrinology—and a graduate
of UBC's Faculty of Medicine
(Class of 1965).
As founder of the Division of
Endocrinology at St. Paul's Hospital and
head for sixteen years, Dr. Wilkins played
a key role in developing educational programs for the division. He was chairman
of the Internal Medicine Residency
Training Program at St. Paul's, and has
consistently integrated residents into
his private practice. He also extended his
skills and knowledge to physicians
further advanced in their careers through
the Faculty's Division of Continuing
Medical Education.
No stranger to awards, particularly
teaching awards, Dr. Wilkins has been honoured many times over the years. "Ted
was widely viewed among house staff as one
of the best teachers in the hospital and
was a perennial winner of the interns' teaching award," says Dr. John Ward, who came
to St. Paul's as an intern in 1983. "As a resident and later as the Internal Medicine
Residency Program director, I recall the
Endocrinology rotation being the very
best-rated rotation in Vancouver for many
years—in no small part because of the
experience of working with Ted." His contribution "extends well beyond the education
of house staff," Dr. Ward continues. "As a staff
member at St. Paul's I have always felt his
■
rounds presentations to be superb, and I
have continued to benefit and learn from
Ted for over 20 years."
"The people you work with as a student
have a huge impact—seen and unseen—
on where you end up," Dr. Wilkins says. Dr.
Abraham Rapoport, his clinical fellowship
supervisor at the University of Toronto, is a
case in point. "What fascinated me about
endocrinology was the marriage of science
in the lab and patient care in the clinic," says
Dr. Wilkins, "Dr. Rapoport was head of the
Metabolic Unit at Toronto Western Hospital,
and not only ran a sophisticated lab, but was
also an excellent clinician."
Dr. Rapoport was an "amazingly talented" teacher. "His knowledge of the literature
was encyclopedic. He didn't teach didactically; he sent you to the literature. He always
asked 'Have you thought about why?"
"a. perennial winner
n
Dr. Rapoport's students were expected to be
rigorous in validating their observations and
lab results. "That sort of discipline encodes
in your DNA," says Dr. Wilkins. "It's seminal
in my approach to teaching."
For Dr. Wilkins, teaching and learning
are often synonymous. "Teaching is a
tremendous responsibility—you'd better
know what you're talking about. It's an extra
motivator for me to keep up on the literature and maintain my knowledge base. And
the residents teach me. I'll bring something
I've read to their attention and challenge
them to do the research, and they bring me
new information in response. It truly is a
two-way street."
Dr. Wilkins' enthusiasm, energy and
high standards in patient care and teaching
are consistently cited by his former
students as hallmarks of his teaching excellence. What motivates him to continue? "It's
the pleasure of seeing people pick up new
concepts and grow in knowledge and ability
in patient care," he says. "That's my reward
for teaching."
Fall 2005 UBC Medicine     11 ii
wish I could clone
Dr. Barry Koehler"
A clinical professor in the
Division of Rheumatology,
Dr. Barry Koehler
not only teaches Rheumatology
Fellows and MD students, but
also helps educate Internal Medicine
residents, physiotherapists,
occupational therapists, and psychologists. In 2002 he won the Canadian
Rheumatology Association's
Distinguished Rheumatologist
Award—the highest rheumatology
award in the country—for his
teaching and clinical excellence.
Dr. Koehler also shares his expertise with
the general public through his activities with
the Arthritis Society. As the medical director
for the British Columbia and Yukon Division
for five years, he developed and delivered
some of the popular public information sessions that have made such a difference to
patients and their families.
"I wish I could clone Dr. Barry
Koehler," says Dr. John Esdaile, professor and
head of UBC's Division of Rheumatology.
" Many of us have the knowledge base and
clinical skills, but few have the ability that
he has to excite a student or a trainee
and make them aware of both the drama
and intellectual challenges of a career in
rheumatology."
Dr. Koehler has seen tremendous
changes in the teaching of medicine and
particularly, rheumatology. "When I was
a resident, it was an apprenticeship program,"
he says." There were no organized
academic programs for house staff. Now,
residents are treated more like students."
He began his teaching career in Thunder
Bay, where he helped develop the McMaster
University-based Northwest Ontario
Medical Program and welcomed its students
into his clinic. Over the years, many of
his students have chosen to follow in his
footsteps. "Some of the people who spent
time with me switched their careers to
rheumatology, including two of the residents
in Thunder Bay. That was very rewarding,"
says Dr. Koehler. "They are now my friends
and colleagues."
What comes to mind about his own
teachers and mentors? Dr. Koehler doesn't
hesitate for a second. "They loved what they
did," he says. "It was the joy they took in
teaching and in the specialty they practised.
They influenced me so much—I still find
myself emulating them."
Dr. Metro Ogryzlo, founder of the
Journal of Rheumatology, was one his more
colourful mentors." He loved to walk
along the corridor with us, throw out a controversial statement about an approach to
treatment, and stand back and watch the fireworks," Dr Koehler remembers." He taught
by anecdote, and analogy, and made unexpected comparisons—he never stopped challenging us to think."
Dr. Koehler gets the greatest satisfaction
from watching his students develop their
clinical skills and confidence in their own
observations and abilities." Rheumatology
is very much a bedside specialty. It's all about
seeing the patient and making observations,"
he says. "The more clinical skills you impart,
the more you see the trainees' confidence
growing. The penny drops—they discover
they don't have to order a bunch of tests
in order to understand what's going on; they
can actually rely on their own observations.
That's exciting."
12      UBC Medicine Fall 2005 CONGRATULATIONS
Dr. James Hogg
on being the recipient
of the first
UBC Faculty of Medicine
Lifetime Achievement Award
GlaxoSmithKline CONGRATULATIONS
to the over 200 members of the Faculty of Medicine who received
awards for their contributions to education, research and community service,
and to the Faculty's eighteen new full-time and clinical professors.
The photos below capture a few of the Faculty's honourees and guests at both the annual Awards Reception
and the New Professors' Dinner held this spring.
Professors Emeriti Drs. Edith
McGeer, OC, OBC, Patrick McGeer,
OC, OBC (Alzheimer's Association's
Henry Wisniewski Award) and
Patricia Baird, OC, OBC (Canadian
College of Medical Geneticists
Founders Award)
Professor Ross MacGillvray,
chair of the Faculty's Awards
Committee
Dr. Yvonne Lefebvre, the
Faculty's assistant dean, Research,
and vice-president, Research
and Academic Affairs, Providence
Health Care
PAR-BC President Dr. Kevin McLeod
and Vice-President Dr. Jason Kur,
with Dr. Richard Klasa (Residents'
Advocate Award) and Dr. Jane
Buxton (Award for Excellence in
Teaching)
Drs. Katherine Paton and Joanna
Bates, with Dr. Paul Kliffer, one of
the Faculty's three Excellence in
Clinical Teaching Award winners
Newly gowned professors, I to r: Drs. Adrian White (Anesthesia), Richard Schreiber and Robert J. Adderley
(Pediatrics), Stuart Smith, Edward Gofton, and Peter Dolman (Ophthalmology), Derek Blackstock (Anesthesia),
Ritchie Younger (Surgery), Shafique Pirani (Orthopedics), Richard Hegele (Pathology), Carolyn Brown (Medical
Genetics), Timothy Murphy and Lynne Raymond (Psychiatry), Wendy Robinson (Medical Genetics)
Absent: Drs. Piotr Blachut (Orthopedics), Simon Holland (Ophthalmology), Emlene Murphy (Psychiatry),
Juliette Prendiville (Pediatrics)
Dr. Judith Johnston (Honors of
the Association, American
Speech-Language-Hearing
Association), Catherine Backman
(Health Professional Investigator
Award, American College of
Rheumatology Research and
Education Foundation)
Killam University Teaching Prize
winners Drs. Eric Webber, Joanne
Weinberg and Richard Barton
For more information and/or
to request additional copies of
UBC Medicine contact us at:
Faculty of Medicine
The University of
British Columbia
317-2194 Health Sciences Mall
Vancouver BC
Canada V6T 1Z3
T 604-822-2421
F 604-822-6061
www.med.ubc.ca
PUBLICATIONS MAIL AGREEMENT NO. 41020503 RETURN UNDELIVERABLE CANADIAN ADDRESSES TO UBC FACULTY OF MEDICINE 317-2194 HEALTH
SCIENCES MALL VANCOUVER BCV6T 1Z3

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