UTSG: Invisible Challenges in Medicine

Being a medical trainee is a great privilege but it also holds a certain weight of responsibility – late nights spent studying, never-ending exams, countless extracurricular commitments, and the persistent struggle to establish some sort of work-life balance. In addition to all of this, mistreatment of medical trainees is another phenomenon that has been shown to be prevalent (17-95%).

Has it ever crossed your mind that as a medical trainee, you might be subject to discrimination and mistreatment by residents, staff physicians, patients, or even peers simply because of a part of your identity you cannot control? This can be related to your race, ethnicity, gender, physical appearance, sexual orientation, religious views , a visible/invisible disability, etc. It is believed that such mistreatment can have a negative impact on medical trainees, which is why it is problematic and worrisome that we often don’t know how to respond or deal with such mistreatment.

The purpose of this conference is to not only expand the dialogue around mistreatment, discrmination, and allyship, but to empower medical trainees with strategies on how to respond to such mistreatment – ideally before it occurs. The conference will feature two keynote speakers ( Dr. Nanky Rai and Ms Chika Stacy Oriuwa), three workshops designed to be as interactive and engaging as possible, and a panel of medical trainees, residents, and staff physicians who will be speaking on their lived experiences and answering your burning questions!

As medical trainees, so much is expected of us. In order to perform to the best of our ability, we deserve to be able to learn and work in an environment that is supportive of our differences as individuals, and in the case that it is not, we should be able to thrive in such environments.

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Agenda;

9:30 am – 10:00 am: Arrival and Registration

10:00 am – 10:30 am: Keynote Speech: Dr. Nanky Rai

10:30 am – 12: 00 pm: Morning Workshop

12:00 pm – 1:00 pm: Lunch

1:00 pm – 1:30 pm: Keynote Speech: Ms. Chika Stacy Oriuwa

1:30 pm – 3:00 pm: Afternoon Workshop

3:00 pm – 4:00 pm: Panel

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Workshop Descriptions;

Morning Workshops – 10:30 AM:

Microaggression & Verbal Harassment: How to Respond

This workshop will be in the format of “Theatre of the Oppressed” . This is a technique which uses theatre to promote social change by inviting members of the audience to become actively engaged in, and interact with performers who are acting out scenarios that highlight microaggression and verbal harassment in the medical environment. Participants will be invited to interject and change the course of the scenario. Thus, participants will not only be able to witness these issues, but will actively engage with them, and in doing so will be able to better understand how they themselves might respond if found in such a situation.

Allyship: How to Practice It

The concept of allyship is becoming commonplace within medicine but it is sometimes difficult to know exactly how to practice allyship as medical trainees in an environment in which we are newly becoming accustomed to. This workshop will begin with a discussion on privilege, followed by tangible steps on how to practice allyship. Participants will get a chance to use these practical steps to play the role of an ally in scenarios that feature a medical trainee being mistreated or discriminated against based on race, gender, physical appearance, sexual orientation, religious views, a visible/invisible disability, etc.

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Afternoon Workshop – 1: 30 PM:

Intersectionality: Walk a Day in My Shoes

This workshop will be centered on an exercise where participants will go through their shift in the hospital as an individual who is seen as a visible/invisible minority. Participants will be encouraged to explore the challenges that may be associated with this ‘new identity’ and contrast it with how they may have walked through that space had they not identified as this individual or how this may be different from what they may be used to based on their own lived experiences. We understand that it would be impossible for us to fully understand the lived experiences of different groups of people, thus, we have made necessary efforts to collaborate with and seek assistance from various stakeholders to ensure that this workshop is as informed as respectful as possible.

A new tumour analysis technique could improve predictions for pancreatic cancer outcomes

Method could assist in developing treatment plans, reduce health care costs, says U of T-affiliated paper

A new tumour analysis technique could improve predictions for pancreatic cancer outcomes

A new tumour analysis technique has been created to tackle the most common type of pancreatic cancer, in a new U of T-affiliated study. This method could improve physicians’ ability to better predict how a patient will be affected by the cancer, as well as reduce the health care costs of this type of analysis.

The researchers investigated pancreatic ductal adenocarcinoma (PDAC), which is the fourth leading cause of cancer-related deaths in the world. It is predicted by scientists that PDAC could become the second leading cause of death by cancer by 2030.

The current system for analyzing tumours is flawed

Physicians currently use a three-tiered grading system to analyze tumours from PDAC. The system relies on the classification of tumours into three groups: well, moderate, and poorly differentiated.

The best tumours for pathological analysis are well differentiated, while the worst are poorly differentiated, according to Dr. Sangeetha Kalimuthu, an Assistant Professor at U of T’s Department of Laboratory Medicine & Pathobiology, in an interview with The Varsity.

Tumours in the middle of the scale are considered moderately differentiated. “Think of a well-formed ice cream,” she continued. “When it starts to melt, it gets all ugly and not really pretty to look at, so that’s in essence how a tumour behaves.

But a major problem with this current grading system is that most tumours from PDAC are identified as moderately differentiated. Tumours with this classification are of limited clinical utility, explained Kalimuthu, as they provide little useful prognostic information about the patient.

Recently, largescale studies have identified prognostically significant molecular subtypes in PDAC. Different subtypes of PDAC are associated with differing clinical outcomes.

However, direct identification of a patient’s molecular subtype of PDAC through molecular analysis is expensive and not readily available worldwide. 

New study offers cost-effective solution for overcoming limitation

The U of T-affiliated study, co-authored by Kalimuthu, identified specific structural — or morphological — patterns in PDAC tumours and presented a novel tumour classification system based on these patterns.

The new classification system presented in the paper correlates morphological patterns with the known subtypes of PDAC. This enabled physicians to identify the molecular subtype of PDAC without using costly molecular analysis.

Kalimuthu added that looking at tissue stains “is the standard bread and butter of pathology.”

“Taking a tiny piece of tissue that you get from a much larger tumour and sequencing it doesn’t give you a representation of the tumour,” she said.

“We look at these stains so we can actually get an idea of the tumour — nothing [such as other techniques like sequencing] gives you a better picture of [it].”

Future potential to integrate technique with artificial intelligence

An established procedure that provides precedent for this newly developed classification system for PDAC tumours is an existing grading system for prostate cancer tumours.

Researchers devised the system, called Gleason grading, in 1966. It similarly gave prognostic information for colon cancer patients.

Kalimuthu and her co-authors hope that their new tumour grading system can fulfill a similar role for PDAC.

In the future, Kalimuthu and her co-authors hope to validate the PDAC-based grading system with a larger cohort of pathologists, before incorporating the grading system into a clinical setting.

If they can achieve this, the improved system of prognosis could help guide physicians in developing treatment plans for patients with PDAC.

Since the new classification system is based on patterns, Kalimuthu believes it could one day be integrated with artificial intelligence.

“This classification system could be directly applicable with deep learning algorithms — so that’s the long-term goal.”

How physicians in Canada invent new surgeries

A conversation with Dr. Sunit Das on ethical oversight in surgery innovation

How physicians in Canada invent new surgeries

Taking risks and testing new ideas are the cornerstones of advancing science and technology. But when it comes to developing new surgical techniques, experimentation can be a matter of life or death for patients who volunteer.

To understand how and why surgeons innovate, The Varsity interviewed Dr. Sunit Das, an Assistant Professor at U of T’s Department of Surgery and neurosurgeon at St. Michael’s Hospital. 

Why innovate?

Although the practice of surgery has come a long way, there is considerable potential to improve surgeries in order to make them safer, quicker, more efficient, and less expensive.

“Engineers talk about the fact that it’s the existence of problems that drive their work,” explained Das. “And, in a way, surgical innovation could say much the same.”

Of course, innovation inevitably carries the risk of failure. Das explained that part of the ethical dilemma of surgical innovation stems from weighing the benefits of testing an unfamiliar technique against a proven and well-known procedure. 

The difficulty of this decision depends on the effectiveness of existing procedures. When surgeons test a new technique against one that is rarely effective, ethically it might not be a costly risk to take. For example, according to Das, physicians can often test new chemotherapeutic agents with patients who have recurrent cancers, since there are usually no effective alternative therapies for their conditions.

New surgeries for these conditions are often worth the risks. It is much harder to try to innovate when a technique that is relatively safe and effective already exists.

For any innovative procedure, ethical practice requires doctors to fulfill certain responsibilities when offering experimental treatments to patients. Currently, there is a four-step process in place for approving new surgical techniques in Canada. 

The stages of surgical innovation

Surgical innovation begins with preclinical work and the development of a technique. Stage 1 follows, at which surgeons use the experimental technique for the first time on a human patient. In this early stage, the goal is to determine the safety and efficacy of the procedure in a small, select group of patients.

In Stage 2, surgeons apply the surgical procedure to a broader selection of patients to determine the reproducibility of Stage 1’s results. They also determine how to best apply the intervention, as well as develop the technique’s efficiency.

Throughout the development of any new surgery, patients and their caregivers must give special consent to receive it. This suspends or modifies the duty of surgeons to minimize harm. By the conclusion of Stage 3, the new surgery becomes a standard procedure, removing the need for physicians to require special consent from patients.

How do experimental surgeries receive ethical oversight?

Monitoring the progress of surgical innovation is critical — a lack of oversight could lead to mistakes that present patients with unnecessary risks.

For many hospitals, Research Ethics Boards (REBs) ensure experimental techniques meet ethical requirements. When surgeons intend to make an experimental procedure available for patients, they must submit a clearly defined protocol to an REB for approval.

However, there are drawbacks to placing an REB in charge of surgery. To start, REBs often do not have surgeons on them. Service on an REB is a time-consuming responsibility and “time is one of the things that surgeons tend to lack,” said Das.

An REB’s oversight can also substantially slow the development of a surgical technique, said Das, in ways he believes are unnecessary.

To develop a surgical technique, explained Das, researchers undergo a process that is iterative. That is, surgeons often apply an experimental technique, learn how they could improve it during the process of the surgery, and change the protocol to reflect the improvement.

“The nature of an REB is antagonistic to [iteration],” said Das. Under an REB’s oversight, each time the surgeons decide to alter their protocol, they need to apply for an amendment, causing their application to require review by the REB.

While Das noted that the additional review does ensure that the REB is on the same page as the surgeons, he believes that an alternative approval process could increase the efficiency of surgical innovation.

The Surgeon-in-Chief as an alternative source of oversight

Das believes in placing the burden of responsibility on the Surgeon-in-Chief of a hospital to ensure that experimental surgeries meet ethical requirements.

The expertise of the Surgeon-in-Chief addresses the first perceived shortfall of REBs — that such boards lack physicians directly experienced in surgery. He noted that “there are nuances to the idea of surgical innovation [that he believes] are more available to a Surgeon-in-Chief than they necessarily might be to an REB.”  This could allow the Surgeon-in-Chief to have a better grasp of how an experimental procedure works.

Das also addressed the issue of REBs reducing efficiency. He said that a Surgeon-in-Chief with the onus of responsibility would allow “a type of communication and a type of nimbleness to change that simply is not inherent to the way that something works with an REB” and would therefore support iterative development.

“I think Toronto has been a leader in the world in terms of thinking about this problem [of obstacles to iteration],” said Das. In fact, he noted that the model of placing the Surgeon-in-Chief of a hospital in charge of oversight, instead of an REB, evolved at Toronto General Hospital.

Since then, institutions, such as St. Michael’s Hospital and Toronto Western Hospital, have adopted this model of ethical approval. As an advocate of this approach, Das has co-authored a paper about this in The American Journal of Bioethics. 

He acknowledged, however, that the model does have shortfalls. “One of the inherent dangers to placing the oversight element to innovation with a Surgeon-in-Chief is that there might be [conflicts of interest] that could get in the way of proper oversight,” he said.

A conflict of interest, said Das, could result from the promise of prestige of a successful innovation overshadowing the Surgeon-in-Chief’s responsibilities to the hospital, surgeons, and patients to ensure proper oversight when approving experimental procedures.

“For me, being involved in surgical innovation has had beneficial effects on my career and on my standing in the international community of neurosurgery. I gain prestige by work that I do as an innovator… and the hospital gains prestige from the work that I do,” said Das.

“There’s the danger that those risks, those responsibilities could be clouded by the possibility of benefit in terms of prestige to a surgeon and to a hospital by innovation.”

Always innovating

Surgeons think about research ethics to address the conflict between the goals of securing patient safety and improving patient outcomes by developing new procedures. They cannot advance what they offer patients without stepping outside a place that is comfortable and known. Taking risks is fundamental to making progress.

“Surgical innovation in a way is deciding to do something differently, despite knowing that we have a way of doing things safely and well,” said Das. “It’s simply that we think we can finally do something that, in a way, will be safer and be better.”

A surgeon’s account of physician burnout and depression

How the social dynamics of Canada’s health care system may obstruct patient care

A surgeon’s account of physician burnout and depression

The growth in mental health awareness and advocacy around the globe has exposed the psychological limits that individuals can reach in academic- and career-based paths. Terms like “burnout” — the intense emotional, physical, and mental exhaustion connected to excessive stress — are often linked to depression and anxiety.

In sensationalized careers like medicine, it might come as a surprise that burnout plagues the medical world to a staggering extent. A 2018 national survey by the Canadian Medical Association indicates that one in four physicians experience elevated levels of burnout, while one in three screen positive for depression.

In a recent editorial published in the Canadian Urological Association Journal, Dr. Martin Koyle, the Head of the Division of Urology at The Hospital for Sick Kids, recounted his personal experiences grappling with burnout and depression as a physician.

The Varsity sat down with Koyle to discuss his challenges with depression and burnout in his lifelong career in medicine. He contended that his experiences stem less from the practice of medicine itself and more from the bureaucracy and social dynamics entangled within the Canadian health care system.

Koyle’s experience in the medical system

Koyle’s recollections began in 1976, when, as a fresh medical school graduate, he moved from Canada to the United States to begin his long and accomplished career. He’s practiced medicine in Los Angeles, Texas, San Francisco, Denver, and Seattle. He was employed in positions varying from academic faculty to Chief of Pediatric Urology and Renal Transplantation.

While practicing in the United States, Dr. Koyle spoke highly of the Canadian universal single-payer health care system, placing it on an esteemed pedestal which he hoped the US could one day emulate. 

However, the intense public scrutiny that came along with his position as Division Chief at the Seattle Children’s Hospital, coupled with a personal family tragedy and a physical injury, led him to return to Canada in 2011. In Toronto, he began his practice as the Head of the Division of Urology at The Hospital for Sick Kids.

Upon returning to Canada, Koyle promptly realized that the Canadian health system was quite different than the romanticized version he had been promoting during his time in the US.

“I realized from day one that all that I was, was a number,” he said. The system, although advertised as universal, lacked strongly in quality of patient care and career gratification. In the US, Koyle discussed his feeling of belonging to a “community” and being “part of a family.” He personally knew other physicians, and trusted them with his patients when referring them to other specialists. He also felt a general feeling of gratification and mutual appreciation within this supportive network.

In Canada, however, this community aspect was lacking for Koyle. He especially felt uncertain of who would assess his patients in the future. “I didn’t know any of my patients. They didn’t know me. I didn’t know who would see them in follow up,” he said. These factors were further discouragement which added to the climate of emotional hardship.

Koyle also mentioned that the sense of entitlement to health care in Canada contrasts to that of the US, where patients failing to respect wait lines and no-shows are more common, causing other patients to wait longer in order to receive the care they need. To top it all off, recent intense hospital budgeting in Ontario has undercut the quality of patient care available, in ways such as limiting operation times for patients during surgery.

As Koyle summed up his contrasting experience practicing in Canada: “My support from the institution is very different, my control in my environment is very different, my relationship with my patients and with their families and with their providers is very different, and the outcomes are very different in that in the States where my primary physician… was the quarterback in the system in that patient’s care.”

“Here, the buck stops at me… I’m not providing the healthcare that I want to provide to people [due to these social dynamics of the Canadian health care system].”

Koyle’s experiences in a wider context

Although Koyle emphasizes that these experiences are his own, and that some aspects of his burnout and depression are connected to personal challenges faced in his life, he is most certainly not alone in his experiences with mental health challenges in medical careers.

A recent review underscores the factors contributing to Koyle’s burnout: most cases of physician burnout in Canada are neither related to patient care, nor to the practice of medicine itself. Factors such as bureaucracy in the health care system, as well as negative social dynamics with other health care professionals and coworkers, play a more prominent role. 

Factors such as bureaucracy in the health care system, as well as negative social dynamics with other health care professionals and coworkers, play a more prominent role [in physician burnout, compared to the practice of medicine itself].

Notably, with physicians expected to constantly project a “healthy” image, it’s not surprising that studies show that only eight per cent of urologists suffering from burnout seek professional help. This strikes a chord for Koyle, who recalled his own hesitation and fear in initiating regular appointments with his now-psychiatrist.

“You’re afraid that somebody will find out, that you’ll go in and somebody will say, ‘he’s crazy.’” But Koyle, who is now open to discussing his appointments, has found that his psychiatrist has helped him to a great extent, in addition to his yoga and practice of meditation. Today, he is a strong mental health advocate, and encourages those battling with burnout and depression to seek the help that they need.

When asked about his thoughts on hope for the future, Koyle is cautiously optimistic. Having recently finished a Master’s degree in Quality Improvement Patient Safety, with another Master’s connected to international health policy and leadership underway, he aims to develop a skillset to change the climate of the system he works in — both for the benefit of patients under the system’s care, as well as for physicians who impart treatment.

New surgical technique allows doctors to add more organs to the donor pool

Two types of light-based therapies can sterilize donor organs prior to transplantation

New surgical technique allows doctors to add more organs to the donor pool

A new technique co-developed by U of T researchers uses light-based therapy to kill viruses in organs meant for transplantation. The method lets physicians treat human donor lungs infected with Hepatitis C, preventing viral transmission to the organ recipient.

The co-authors of the procedure, published in Nature, are hopeful that it could vastly increase the number of organs eligible for transplantation in North America.

The new surgical technique is based on existing methods

This technique uses an existing procedure known as ex-vivo lung perfusion. Here, after retrieval by practitioners, the lungs are placed in a chamber with a circuit and specific liquids flow through the organs’ vasculature.

During this circuit the solution passes through the lungs, washing out a lot of viruses. The newly developed technique uses a machine with two light-based therapies — namely, ultraviolet C irradiation and photodynamic therapy — to eventually sterilize the organs before the transplantation.

The research team developed a customized illumination device which is attached to the machine where perfused liquid passes through, irradiating the virus and therefore inactivating it with light.

The researchers aim to further develop the technique by treating the lungs themselves with light, not just the liquid that passes through them. To achieve this, more research is needed on the optical properties of the lungs to engineer new technology to illuminate them.

Adding organs to the donor pool

Co-author Dr. Marcos Galasso, a U of T thoracic surgeon and ex-vivo lung perfusion specialist, stressed the importance of this new technique in an interview with The Varsity.

“There is a great need for donor organs,” he said, “[which has led] to some people dying on the waiting list for transplantation.”

Galasso added that treating Hepatitis C-infected donor lungs alone could make a huge impact on the donor pool due to the opioid crisis gripping North America. He noted that most patients who die from drug overdoses test positive for the virus.

According to Galasso, if health care practitioners could add volunteers infected with Hepatitis C to the donor pool, there could between 1000 to 2000 new lung donors eligible per year in North America.

“We could actually have a massive impact in the organ donation environment in North America [with this surgical technique].”

The promise of ketamine in overcoming treatment-resistant depression

Therapeutic potential of ketamine discussed in review by U of T medical researchers

The promise of ketamine in overcoming treatment-resistant depression

Content warning: Discussions of suicide in the context of treating major depressive disorder.

Ketamine is a promising medication that brings hope to patients struggling with severe depression, offering potential therapeutic effects for those who are non-responsive to standard antidepressants.

The dissociative anesthetic is currently used by physicians and veterinarians to cause fast-acting insensitivity to pain during medical procedures. It is also used illicitly as a recreational drug, causing feelings of disconnection and relaxation among users.

Yet in controlled settings, ketamine also shows potential as a medication to help patients who are suffering from major depressive disorder. In April, a research review by U of T researchers found that ketamine offers significant effects as an antidepressant.

The lead author of the paper, Dr. Joshua Rosenblat, discussed the review’s findings with The Varsity. As a clinician-scientist in the Department of Psychiatry, Rosenblat is currently studying the antidepressant effects of ketamine.

He explained three major effects that differentiate ketamine from standard antidepressants: a different mechanism of action, a rapid onset of effects, and a response in patients who are not positively affected by commonly prescribed antidepressants.

Ketamine affects depression via a novel mechanism of action

For the past several decades, standard antidepressants have worked by affecting levels of serotonin, norepinephrine, and dopamine, explained Rosenblat.

In generalized terms, serotonin is a chemical messenger thought to regulate mood, while norepinephrine controls alertness and arousal. Dopamine affects attention and emotion.

But ketamine affects the brain differently. Rather than targeting these neurotransmitters, it instead changes levels of glutamate – the main excitatory messenger in the brain.

Ketamine’s unique mechanism of action could therefore explain why it may positively affect patients suffering from treatment-resistant depression, who do not respond to standard antidepressants.

Ketamine could provide a more rapid onset of affects, versus standard antidepressants

Ketamine also provides a rapid onset of effects. Standard antidepressants, said Rosenblat, usually take two months of prescribed usage to take effect.

He explained that with ketamine, alleviation of depressive symptoms can appear within two hours of consumption. This is especially promising as an option for patients suffering from suicidal thoughts.

A decrease in suicidal thoughts can plausibly reduce the number of suicidal attempts; however, Rosenblat noted that the evidence is currently too limited to make a conclusion. He explained that studies are lacking, as only a small percentage of patients affected by such thoughts attempt to commit suicide.

Ketamine could also be used for special applications. Depression is very common among patients facing terminal cancer, explained Rosenblat.

“If you were to start them on an antidepressant and they only have one month left to live, for example, [the patients may] only experience the side effects, and never get the benefits.”

Rosenblat is currently leading a clinical trial at Princess Margaret Hospital to research the use of ketamine for improving the final months of life for patients affected by terminal cancer.

The risks and drawbacks of ketamine as an antidepressant

While the prospect of applying ketamine for treating depression is promising, there are several discouraging factors to its application.

To start, ketamine carries the risk of substance abuse. While ketamine is not strongly addictive, said Rosenblat, recreational users of the drug can develop a dependence.

Ketamine may also be prohibitively expensive for potential patients, as it is not covered by OHIP. Furthermore, as a medicine that is only available for research study or private use, it cannot currently be prescribed by most physicians.

There are also limited studies on the rare side effects of ketamine. In the short-term, the main known side effects are disassociation, a daydream-like state, and nausea which may occur during the administration of ketamine.

“We don’t know what we don’t know,” said Rosenblat. It is unclear whether ketamine may cause rare, adverse reactions in some patients. Long-term side effects of ketamine are also unclear.

Rosenblat therefore does not encourage self-medication for U of T students suffering from mental health challenges, as ketamine is not sufficiently studied.

Only a “very small percentage” would likely positively benefit from ketamine, explained Rosenblat, compared to standard treatment options supported by a much wider body of research.

The future of ketamine research

Although ketamine is not fully studied and is currently only used in special situations, it still brings “a message of hope,” said Rosenblat.

While ketamine is still not approved as an antidepressant, the U.S. Food and Drug Administration has approved esketamine, a structurally similar compound, as a nasal spray antidepressant. This became the first antidepressant of its kind to be used in the United States.

While Rosenblat notes that much more future research needs to be done with ketamine, he agrees that preliminary results are “very promising.” With a new avenue of research in treating severe depression, the future of research in the field seems optimistic.

Greater risk of heart attacks the day after Super Bowl, cardiologists find

Psychological stress, increased consumption of alcohol and salty foods are possible causes

Greater risk of heart attacks the day after Super Bowl, cardiologists find

The broadcast of the Super Bowl has been linked to a heightened risk of cardiac events in Ontario, including heart attacks and heart failures, according to a recent U of T-affiliated study.

The NFL’s annual championship game, the Super Bowl, is frequently the most viewed television spectacle in Canada each year.

Using data drawn from health care records in Ontario, the researchers analyzed the number of emergency department visits and hospitalizations for heart attacks, heart failures, and atrial fibrillation — rapid, irregular heartbeat rhythm — over 10 years of Super Bowl weeks from 2008 to 2017.

The analysis showed that on the Monday following each Super Bowl, there is a marked increased risk of heart attacks in Ontario. For patients younger than 65, the risk of heart failure also spiked on the following Monday.

Interestingly, the researchers did not find a statistically significant increase in the relative risk of heart attacks, heart failures, and irregular heart rhythms on the day of the Super Bowl.

Possible explanations for the spike in cardiac events

Dr. Sheldon Singh, a cardiologist and cardiac electrophysiologist at Sunnybrook Health Sciences Centre, wrote to The Varsity that this finding may arise from the complex relationship between stress and cardiac events.

“Prior work has shown that stress can have residual effects with [heart attacks] occurring hours after a clearly identified stressor,” wrote Singh.

“In addition… there may also be issues with patients delaying when they seek medical care — such as ignoring symptoms when they occur hoping they will pass, misinterpreting symptoms, or not wanting to disrupt any social gathering they are at.”

“It’s also important to remember that Super Bowls occur late on Sunday evenings,” noted Singh, “so it would not be unexpected to see an increase in events on [the] following Monday.”

Psychological stress experienced by spectators, as well as an increased consumption of alcohol and salty foods are further factors that may contribute to the amplified risk of cardiac events during the Super Bowl.

However, Singh added that there may be other contributing factors that the study failed to identify due to its design.

“Our work is at a population level, not individual level, which makes it challenging to tease out the exact mechanism of the observed association,” wrote Singh.

Previous studies have shown that heart rates of Montreal Canadiens’ fans increase during hockey games. A spike in cardiac events have also been reported during FIFA World Cup soccer matches by other studies.

Singh wrote that it’s possible to generalize the findings for Super Bowl viewers to those of other sporting events, but it’s important to remember the distinction between a single critical match versus a series when making such assumptions.

Stress levels are more concentrated when the outcomes of a championship, such as the Super Bowl, depend on a single game.

However, the stress experienced during other types of sporting events, such as with hockey or baseball, is generally more distributed because the final outcome often depends on the best of a series.

“We have to appreciate that [increased] cardiac events also have been reported with single catastrophic or stressful events, such as severe snowstorms… earthquakes, and other natural disasters,” wrote Singh.

Health care providers may be able to better plan for a spike in admissions for cardiac-related events around the Super Bowl each year using the study’s findings.

Moreover, Singh believes that educating individuals on the association between emotional stress and dietary indiscretion on one’s overall health will have important implications for public health.

“Given the popularity of the Super Bowl, there is an opportunity for health care practitioners to reach a broad segment of the population, which may have impacts not only during the Super Bowl, but with other events as well,” wrote Singh.

“I am hopeful the general public will access information from our study and public health agencies use this to launch health care campaigns promoting healthy lifestyles.”

Where computers and clinics intersect

Raw Talk Podcast hosts expert panel discussions about AI’s role in healthcare

Where computers and clinics intersect

Experts in medicine, academia, and industry explored the promises and perils of the applications of artificial intelligence (AI) in health care during panel discussions with the Raw Talk Podcast on May 7. The event was organized by graduate students of U of T’s Institute of Medical Science.

The two panels, collectively named “Medicine Meets Machine: The Emerging Role of AI in Healthcare,” aimed to demystify sensationalism and clarify misconceptions about the growing field of study.

“On one hand, it seems like everyone has heard about [AI],” said Co-executive Producer Grace Jacobs. “But on the other hand, it seems like there’s a lot of misunderstanding and misconceptions that are quite common.”

How AI is used in health care

While discussing the reality of AI, several panelists emphasized that it should be viewed and treated as a tool. “It is statistics where you don’t have to predefine your model exactly,” said Dr. Jason Lerch of the University of Oxford.

Other speakers agreed that AI is an expansion of — or a replacement for — traditional statistics, image processing, and risk scores, as it can provide doctors with more robust and accurate information. However, final health care recommendations and decisions remain in the hands of doctors and patients.

“You always need a pilot,” said Dr. Marzyeh Ghassemi, a U of T assistant professor of computer science and medicine.

But what advantages can this tool provide? Ghassemi thinks it can assimilate clues from a wider range of patients’ conditions to predict treatment outcomes, replacing the experience-based intuition that doctors currently rely on.

Speaking on her time in the Intensive Care Unit as an MIT PhD student, Ghassemi said, “A patient would come in, and I swear they would look to me exactly the same as prior patients, and the… senior doctors would call it. They would say, ‘oh, this one’s not going to make it. They’re going to die.’ And I would say, ‘Okay… why?’ And they said, ‘I’m not sure. I have a sense.’”

“They used different words — gestalt, sense — but they all essentially said the same thing. ‘I just — I have a sense.'”

Doctors develop this sense by seeing many cases during their training, but they can intuit only the cases that they had personally experienced; AI algorithms can potentially understand many more cases using a wider dataset.

Accessing those cases requires access to patient data, and access to data requires conversations about consent and privacy. Ghassemi and Dr. Sunit Das, a neurosurgeon at St. Michael’s Hospital and Scientist at the Keenan Research Centre for Biomedical Science, said that “de-identification” — the removal of information that can be traced back to individual identities — protects privacy.

Large de-identified datasets from the United States and the United Kingdom are available for AI research, but generally, Canada lags behind these countries in making health data available for this purpose.

Dr. Alison Paprica, Vice-President of Health Strategy and Partnerships at the Vector Institute, agreed that data should be used for research, but argued that de-identification alone does not eliminate risk.

“You’re not just giving a dataset to anybody,” she said. “You’re giving a dataset to people who are extremely skilled at finding relationships and patterns and maybe piecing together information in ways that most people couldn’t. So I think there’s going to be heightened sensitivity around re-identification risk.”

Society must manage this risk and balance it against the benefits. “How do we balance that?” Paprica asked. She suggested that consulting all involved stakeholders could help strike that equilibrium.

Advice for scientists aiming to use AI in their research

So what advice did the panelists have for scientists hoping to harness the power of AI in their own research?

Ghassemi stressed the importance of knowing what you’re doing: researchers have created many tools that make AI research easy to implement, but conscientious scientists need to know the statistical and training principles behind the methods.

“If you’re not aware of how these things are trained,” she said, “it’s really easy to misuse them. Like, shockingly easy to misuse them.”

Other panelists advised users to take care when choosing data to train the algorithms. “A learning algorithm can’t overcome bad data that goes in, or can’t completely overcome it,” said Lerch.

Moderator Dr. Shreejoy Tripathy summed up a key takeaway on applying AI to health care: “Understand your data… And understand your algorithms.”