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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.”

Enlightened minds, illuminated research

How the AGO’s art inspires researchers at the Princess Margaret Cancer Centre

Enlightened minds, illuminated research

What does scientific discourse have to do with artistic expression? For a research team at the Princess Margaret Cancer Centre, the answer is “everything.”

We once thought of our right and left brains as separate forces responsible for logical and creative thought, respectively. But scientific progress has shown us otherwise, as mental processes require that the whole brain works together in harmony to approach a task.

Just as the corpus callosum brings our hemispheres together as a band of nerve fibres, so too should science and art harmonize — so believes Dr. Mathieu Lupien, a Senior Scientist at the Princess Margaret Cancer Centre. 

Lupien incorporates art into his professional sphere to generate creative discourse between his close-knit team of researchers. He offers a unique approach to team-building by inviting his team to take a stroll through the Art Gallery of Ontario.

Each team member takes the time to walk through and choose a piece of artwork that speaks to them. Lupien then has the team come together as a group to share their chosen piece and engage in dialogue about what inspired them.

“I get to see the world from their perspective and they get to see mine from theirs,” said Lupien in an interview with The Varsity. The process helps the researchers better understand how they see the world through different lenses.

Lupien expresses that this is an exercise in using something creative, like art, to share who we are as scientists. It gives the team a glimpse into each other’s worlds. For example, if a member really enjoys the intricate detail in a piece, we can understand that the fine details they reflect in their own work are something they value. This helps us interpret the work they do in a more meaningful way.

“Our imagination is the only way to explore the unknown,” said Lupien. “We are working in uncharted territory sometimes, so creating an environment that is conducive to open, creative thought is important for our work.”

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How can students integrate art and science into their own research methods?

Lupien describes that translating scientific works in an intelligible way is an art in itself. Science, technology, engineering, and mathematics can be highly complex areas, full of jargon which can be intimidating for many students interested in the field. Using creative expression is one way to translate complexities in an imaginative way.

He demonstrates this idea in his description of his research on epigenetics: the study of how the activity of our genes can change, without changing our DNA sequences. He describes the genome as six billion letters of DNA that form words that are different in nature. When they are organized into sentences, each of them tells a unique story.

In order to form specific parts of our body, such as muscle and brain tissue, we organize our genome, represented here as letters, in different ways to create distinct sentences. The folding process is guided by epigenetic events, or post-it notes, which highlight the regions of our genome that need to be read.

Perhaps we can say that art relates in the same way. Each stroke of the brush or strike of the pen creates a unique image, and the artist goes over certain areas of the painting with these tools to highlight parts of the piece. Sometimes this disrupts the image, which can create chaos. Other times, this enhances the image with clarity.

Like epigenetics, one must follow these fine lines or broad strokes to understand how the larger image, or genome, has come to be. Lupien emphasizes that fostering creative thought can open a world of possibilities for all walks of life. “Bringing these values into your everyday practice as a researcher can serve to nourish your approach to work,” he said.

Experiencing art can also serve as time for our ideas to incubate, perhaps creating a period of unconscious processing for approaching problems in research. Taking from the famous 1929 works of Graham Wallas, The Art of Thought, incubation allows us to process problems in a manner whereby no direct effort is exerted.

We can optimize the way we process pre-existing knowledge by exposing ourselves to creative mediums such as art. This may lead to new approaches in scientific work. Ultimately, generating a scientific discourse with the expression of art can bring forth creative magic that inspires research. 

“In research, there are two things of value — there is knowledge and creativity,” said Lupien.

“You need to have balance. Never shy away from engaging in creative thought. You never know where it will take you.”

Science Rendezvous Street Festival celebrates intersections between research and art

Festival aims to make science more accessible to the public

Science Rendezvous Street Festival celebrates intersections between research and art

On a cloudy afternoon on May 11, professors, students, parents, and children enjoyed the annual Science Rendezvous street festival at U of T’s St. George campus. The event let them celebrate and learn more about advancements and achievements in research.

The unifying theme of the festival this year was “S.T.E.A.M Big!”, which focused on the intersections between science, technology, engineering, art, and mathematics (STEAM). While art is often seen as separate from STEM disciplines, it is becoming increasingly common in the scientific community to encourage taking inspiration from the arts to drive innovative research.

Street stalls and displays exhibited the relationship between art and science

Displays that exemplified the relationship between art and science included outdoor music and dancing, as well as a visual art gallery inspired by math and science.

The focal points were the stalls and displays lining all of St. George Street. These exhibits presented some of the hottest topics and projects in science today, focusing on big interdisciplinary innovations found at the intersections of these rapidly advancing fields.

Over 80 faculties and community organizations set up exhibits. Highlights included displays of solar-powered cars, rockets, robots, and a wide array of other projects that would fascinate even those who have a passing interest in scientific inquiry.

This wide range and diversity of subjects represented by the participating volunteers brought the 2019 theme of STEAM to vibrant life.

Booths and demonstrations were highlights of the festival

The street festival included over 100 fascinating and interactive booths. Some leaned toward the classic science fair vibe, such as displaying glowing bacteria and allowing patrons to look through a solar telescope. Others opted to take a more creative approach, such as the station inviting attendees to paint with acids, bases, and plant juices.

Some displayed student innovations, such as the demonstration set up by U of T Blue Sky Solar Racing, an undergraduate team that designs, builds, and races solar powered vehicles. There was also a plethora of digital demonstrations interspersed between all the other projects, ranging from virtual reality tours of archeological sites to demos of the many student-made video games.

Street fairs like Science Rendezvous increase engagement with science

One of the goals of the festival was to raise interest in U of T’s science programs, as many high school students attended and participated in the event. An example was the molecular genetics-focused science fair that took place in Bahen Centre for Information Technology.

Besides attracting prospective students, the festival is intended to improve public involvement and investment in STEAM fields. From the number of students competing in the science fair, sporting U of T shirts with palpable excitement on their faces, to the sizeable crowds drawn in by the street festival, it is safe to say that both of these goals were achieved.

A rendezvous is a meeting or an appointment. In a way, St. George Street is a science rendezvous every day, with labs, classes, and seminars running regularly. What was special about this festival was that it took experiences that are often inaccessible and presented them in a way that could appeal to all.

The pretension and exclusivity that often seems to follow research was stripped away, and all that was left was mystery, excitement, and curiosity. This contributed to why the event drew in hundreds of people, and why volunteers and attendees come back year after year.

Who knew cannibalism could be sexy?

The male redback spider has evolved to offer himself to females as a post-sex meal

Who knew cannibalism could be sexy?

During sperm transfer and climax, the male redback spider does a somersault of sorts, placing his abdomen in the perfect position for the female to eat, and more often than not, she goes for it.

Whether you think it romantic or horrific, there is something captivating about this ultimate sacrifice during the moment of climax. But because of this, the female redback may remain a lonely single after sex, albeit a little less hungry.

Black widows are also members of the Latrodectus genus to which redbacks belong.

This act of sexual sacrifice, called ‘terminal investment,’ has been extensively studied by the lab of Dr. Maydianne Andrade at UTSC, where thousands of black widows — notorious for their highly potent and neurotoxic venom — share refuge.

However, if you think it romantic, perhaps the male spider’s reasoning for sacrifice may make you think again. It appears that the male redback’s terminal investment serves an evolutionary, or depending on how you look at it, selfish purpose.

Though it may seem counterproductive for a male spider to sacrifice his entire existence for just a single shot at producing progeny, there are several adaptive advantages that he gains by taking this risk.

Self-sacrifice serves to enhance male paternity both by increasing the number of eggs the male spider fertilizes and by decreasing the chance that their female partner will mate with another competitor.

Andrade’s team found that six out of nine females that cannibalized their partners refused to mate with a second male, while only one in 23 females that didn’t have the pleasure of consuming their mates did the same.

Also, the chance that the male could mate again if he escapes the fangs of his lover is meagre. Therefore, his self-sacrifice offers a way to give it all he’s got by partaking in the ultimate act of evolutionary fitness.

Though female redbacks can be violent in their courtship, they do offer some mercy to the fittest of their male counterparts.

‘Premature cannibalism’ — which occurs before copulation is complete — is much less common if the male offers courtship for over 100 minutes, a marathon of sorts for the reward of paternity. However, males that are ready for this marathon must be wary of cheating competitors that can sneak in at the finish line, disguise themselves as the winner, and avoid being prematurely eaten.

And when it comes to being eaten by their mate, size does matter. Females are less likely to prematurely cannibalize a large marathon runner than a small sprinter.

However, more importantly, a male is less likely to be eaten by his female counterpart if she is well-fed — he only offers a meal sized at one or two per cent of her body mass.

Unfortunately for him, food is typically a rare commodity for a plump female redback in her native Australian habitat, so she may well take the meal that he offers in addition to her potential future offspring.

While this extreme sacrificial gesture and its violent ending could be seen as a spider’s ultimate Valentine’s Day gift, in the end, it is neither the life of the female nor the male redback that is rewarded, but their offspring that ultimately earn the gift of life — and go on to do the same.

How did flowering plants become wind-pollinated?

PhD candidate David Timerman led research that examines the basis for the transition

How did flowering plants become wind-pollinated?

A recent study conducted by PhD candidate David Timerman and Professor Spencer Barrett in the Department of Ecology and Evolutionary Biology sought to understand the transition from insect pollination to wind pollination in angiosperms, or flowering plants.

A 2002 paper reported that although most flowering species enable insect pollination, around 18 per cent of angiosperms use wind pollination. These transitions are thought to occur when changes to the environment cause a reduction in the number of available insect pollinators. The two forms of pollination differ in their pollen dispersal method as well as the characteristics of their stamens, or pollen-producing organs.

Timerman and Barrett’s research explains the underlying mechanism behind this transition.

In environments characterized by the absence of insect pollinators, a lower natural frequency of stamens is favoured for wind pollination, which becomes essential to reproduction. The researchers linked this lower frequency to an increased release of pollen. These outcomes have important implications for the current understanding of the prevalence and evolution of wind pollination and the role of stamen as a direct mediator of pollen dispersal.

These findings could also help researchers understand how climate change — an agent responsible for the pollinator crisis — could affect this transition in future generations.

Timerman and Barrett examined wind-induced pollen release in Thalictrum pubescens, also known as the king of the meadow, which uses both insect and wind pollination.

They speculated that this species may be currently undergoing the insect- to wind-based pollination transition, and could be used to measure important changes in the early stages of the evolution.

Using a custom-built wind tunnel, Timerman placed individual flowers onto a vibrating table and exposed them to a fixed interval of wind. He then recorded videos of the motion of the stamens in the wind tunnel, and measured the dispersal of pollen onto a sticky microscope slide down-wind from the flowers.

“The videos permitted me to determine the vibration frequency of stamens and their acceleration in wind which I then related to pollen release,” Timerman wrote in an email to The Varsity.

When the stamens’ natural frequency was lower, there was an increase in pollen release. However, this advantage was limited to the absence of pollinators. When pollinators were present, the increased pollen release and fitness of a lower stamen frequency was not observed.

Likewise, in the absence of pollinators, female plants that were paired with males which had low stamen natural frequencies produced a higher proportion of seed. This effect was not seen when pollinators were available.

Timerman and Barrett’s findings highlight the important fitness consequences along the evolution from insect to wind pollination. Without the availability of pollinators, plants may evolve lower stamen natural frequencies that optimize pollen dispersal in wind.

Over time, wind-pollinated lineages lose traits such as showy petals and fragrances that attract insects, but become structurally optimized for pollen transport in air streams.

“My research shows that the stamens have evolved to harness wind energy causing stamens to vibrate and release pollen efficiently,” wrote Timerman.

Currently, Timerman is working on a project that compares pollen release biomechanics across different wind and insect pollinated species of the Thalictrum genus.

“I am interested in this genus because wind pollination has evolved from insect pollination independently on several occasions,” he explained. “Each of these transitions represents an independent evolutionary experiment, thus providing the replication needed to determine whether a reduction in stamen natural frequency is consistently associated with or driving transitions from insect to wind pollination.”

Editor’s Note: This article’s previous headline incorrectly described flowering plants as insect pollinators.

The double standard of retractions

A growing database of retractions reveals scientific research’s commitment to accountability but highlights flaws in its enforcement

The double standard of retractions

What’s in a word?

In the scientific community, the word ‘retraction’ carries with it a pervasive stigma, often conflated with the idea of an academic death penalty. Retractions, or the pulling of a paper from publication, can tarnish a researcher’s reputation, call into question the legitimacy of a lifetime of work, and dismantle careers.

Outside of the personal realm, retractions alter public perceptions of science.

Last month, the Retraction Watch blog released a Retraction Watch Database. The database is a comprehensive list of retractions in scientific journals since 1923. Out of the 18,000 retractions and notes available on the database, 63 are affiliated with U of T.

What constitutes a retraction?

Science prides itself on being self-correcting, and retractions are a powerful mechanism for that self-correction.

When errors are relatively minor and restricted to a small portion of a publication, a complete withdrawal of the scientific finding is unnecessary and a correction may be issued.

The World Association of Medical Editors defines scientific misconduct as including the falsification, distortion, and omission of data; failure to report misconduct; and the destruction of information relevant to a publication.

Retractions are issued to correct the scientific literature and alert readers of the unreliable conclusions of a paper. According to the Committee on Publication Ethics (COPE), they are “[not] to punish authors who misbehave.”

Yet intent and outcome are not always synchronous. The closure of Toronto-based researchers Dr. Sylvia Asa’s and Dr. Shereen Ezzat’s labs, and the termination of their positions within the University Health Network (UHN), is evidence of how retractions can pose dire consequences to academics’ careers.

Retraction guidelines are inconsistent and could be misinterpreted

Husband-wife duo Asa and Ezzat account for four of U of T’s retractions listed on the Retraction Watch Database. Asa and Ezzat’s cases of scientific misconduct made headlines in the Toronto Star in 2015 and 2016.

They were found responsible for scientific misconduct in the form of material non-compliance. They failed, as principal investigators, to disclose alterations to images and provide preliminary data that matched the published ones in a number of cases of published work.

Asa lost her position as the head of UHN’s Laboratory Medicine Program, the largest program of its kind in Canada, and the UHN imposed sanctions against Asa and Ezzat.

Regarding her 2002 paper, which was one of her articles that was later retracted, Asa told The Varsity that “this was a paper that was almost five years of work. Most of my research starts with a clinical problem, and one of the things I’ve studied is pituitary [tumours].”

“[UHN] claim that two images [of the electrophoresis gels] came from the same one and had been manipulated,” said Asa. “The fact is that we had all the raw data, we had all the original data.”

“Nothing changes anything in that paper, based on the fact that the image was wrong. Patients who have pituitary tumours, for all the people who were involved in the research, all the work that we did is still true,” said Asa. “The results of that paper are no different today.”

The journals in which Asa published her findings were alerted to the irregularities in her research via an outside source.

UHN opened an investigation into Asa’s publications as a result of these allegations, and implicated the pathobiologist in the fabrication and falsification of images. These allegations were challenged in court by Asa and Ezzat, where it was ultimately found that they could not prove who tampered with the images, based on the evidence.

Asa told The Varsity that she felt targeted by the retraction process.

“The retraction process is interesting. It’s definitely necessary. But it has limitations… There have been mechanisms put in place in a lot of different parts of the world, to be more objective and have more standardized criteria for how an investigation is done,” said Asa.

But in a case almost identical to Asa’s, a Montréal researcher was given the opportunity to issue a correction instead of having to retract the entire article.

Cases like this demonstrate the wildly different implementation of retraction guidelines across institutions.

An article in Science suggested that this may be because it is ultimately up to the editors and institutions to determine whether the paper is withdrawn, as COPE only provides guidelines to clarify when a paper should be retracted.

In addition, a study in BMJ Open revealed that retraction notices did not adhere to COPE guidelines in BioMed Central journals. In 11 per cent of retracted articles, the reason for retraction was unclear — six per cent did not state who was retracting the article, while four per cent were retracted simply because not all authors were aware of the paper submission.

The stigma around retractions

A common misconception is that a retraction is invariably associated with data fabrication or scientific misconduct. Yet, of the 63 U of T affiliated papers listed on the Retraction Watch database, only seven are listed for misconduct and eight are listed for fabrication. Fourteen publications have been retracted due to errors in data, attributed to honest error.

Dr. Peter Jüni, Director of the Applied Health Research Centre at St. Michael’s Hospital and professor in the Department of Medicine, has co-authored such a paper.

The publication, a network meta-analysis on the effectiveness of nonsteroidal anti-inflammatory drugs for treating osteoarthritis, was published in March 2017 and retracted in July 2017.

A network meta-analysis compares multiple treatment interventions for a condition directly, using existing comparisons of the interventions in published trials, and indirectly, across different trials.

According to Jüni, research assistants in his team had unknowingly incorporated a duplicate article that had “slightly different results extracted twice” to build their meta-analysis.

“The authors published twice, but they didn’t make it clear that these are the results describing the same population with light differences,” said Jüni. “My colleagues decided to re-run the analysis… and eliminate the duplicate article and… add two new articles that were brought up by colleagues.”

“Now if you include all of those… in an integrated analysis… your numbers will change very slightly,” explained Jüni. “The conclusions of the paper didn’t change at all.”

Jüni recognized the duplicated paper, and the authors were alerted to the two missed trials via colleagues in Ottawa.

Although the error was minimal in nature, The Lancet and the authors agreed it was more feasible to retract and republish the article, as the error ran through different parts of the results and several portions of the paper.

Jüni recognized a flaw in the retraction process that could be exacerbated by the associated stigma of retraction.

“If this is not indexed properly, which was happening at the beginning — the National Library of Medicine just pointed to the retracted article, but it was not clear in PubMed or Medline that this was basically paired with a republication — then it could mean potential questions regarding your reputation,” said Jüni. “The question is then, should we call it differently?”

“Would I prefer to have another label associated with it? Yes, because of the associated stigma — but I don’t think it will happen and I think the important part is that the indexing system changes their way of reporting it. It’s not optimal, but honestly, I can live with it. And obviously I have to live with it,” continued Jüni.

Despite the sting of retractions and the potential fallout, Jüni believes that researchers have an obligation to self-report mistakes.

“You need to live as a leader, in a culture where everybody admits [they don’t] know or [made] a mistake. I need to start with that as the Director of Applied Health Research — if I don’t live it, my people don’t dare admit mistakes. We need that to make research better. That’s part of the quality assurance process.”

It is clear that the retraction process is flawed — it holds too much stigma, does not implement guidelines consistently, and fails on many occasions to communicate to the public the reasons for paper withdrawal. However, it is currently the only system we have to correct the literature and protect scientific endeavours.

What implications do retractions have for scientific research?

Trudo Lemmens, professor and chair of the Department of Health Law and Policy at the Faculty of Law, believes that the increase in the number of retractions may be due to a growing concern around scientific integrity due to a growth in scientific publications over the years.

Science reports that an increase in retractions could be attributed to more comprehensive oversight from scientific journals. Though editorial practices differ from journal to journal, a rise in retractions hints at stricter editorial practices.

In 2009, COPE published guidelines that suggest a publication should be retracted if the findings are unreliable due to scientific misconduct, plagiarism, duplication, or honest error. By 2015, these guidelines were adopted by two-thirds of 147 high-impact journals, and have helped standardize the retraction process.

Editor’s Note (November 27): A previous version of this article incorrectly suggested that Jüni’s assistants were the ones to discover the duplicate.

The Screen Project slashes wait times for breast cancer screening

Women’s College Hospital initiative tests for BRCA1 and BRCA2 gene mutations

The Screen Project slashes wait times for breast cancer screening

Government-sponsored screening for breast and ovarian cancer in Canada can take up to a year to occur and can be denied based on a patient’s risk profile. To shorten wait times and offer universal testing, the Familial Breast Cancer Research Unit at Women’s College Hospital (WCH) has introduced The Screen Project initiative, which aims to make screening universally accessible to patients over 18 in Canada, and hopefully produce better patient outcomes.

The Screen Project has discounted its regular screening price to $99 USD for October, which is Breast Cancer Awareness Month. Ordinarily, the research unit screens patients for $165 USD. Results are expected within two to four weeks.

Why isn’t government-funded screening universal?

According to Dr. Steven Narod, Director of the Familial Breast Cancer Research Unit at WCH, screening through Canada’s universal healthcare system costs around $2,000–3,000 and wait times can last up to one year. As a result, as little as three per cent of women are eligible for the test per year.

But in 2017, the Familial Breast Cancer Research Unit found that commercial genetic testing could be completed in a shorter amount of time and for a fraction of the cost by sending samples to Veritas Genetics, an American genetic sequencing laboratory with whom the Unit has partnered for The Screen Project.

Veritas Genetics tests for BRCA1 and BRCA2, which are gene mutations associated with breast cancer. Women with a BRCA mutation have up to an 80 per cent lifetime risk of breast cancer and a 40 per cent lifetime risk of ovarian cancer versus a 12 per cent and a 1.3 per cent lifetime risk for women without the mutation, respectively.

How does the project work?

To provide a genetic sample for testing, patients order a genetic test kit from Veritas Genetics, provide a saliva sample, and then ship the kit and sample back to the Veritas Genetics lab. The lab tests the sample and releases the results to the patient and the Familial Breast Cancer Research Unit.

Patients with a negative test result receive an email or letter of notification. But patients who produce a positive test result receive an email or letter, as well as a personal phone call from a genetic counsellor at the Familial Breast Cancer Research Unit.

According to Narod, The Screen Project’s offer of “genetic testing for breast and genetic testing for ovarian cancer” for $165 USD is “ethical and wise,” since it is affordable for most Canadians.

However, Narod notes that the results of The Screen Project raise an ethical concern of whether it is “proper, right, and ethical to offer healthcare services outside of what’s insured by the public healthcare system.”

As The Screen Project continues, Narod plans to track the interest in genetic testing for breast and ovarian cancer in Canada, patient satisfaction afterward, and the actions that the project and patients choose to take to reduce their risk of breast and ovarian cancer following a positive test result.

For dance flies, size does matter

UTM study shines light on sexual differences in animal mating behaviour

For dance flies, size does matter

For female North American dance flies, size definitely matters.

A recent UTM study discovered that, for North American male dance flies, sexual attraction is highest when female mates display large inflatable abdominal sacs. 

The study was published in Proceedings of the Royal Society B by UTM postdoctoral fellow Rosalind Murray, UTM biology professor Darryl Gwynne, U of T biology lecturer Jill Wheeler, and University of Stirling biologist Luc Bussiere.

To attract male dance flies for fertilization, the researchers found that female flies display signs of sexual ornamentation. The female flies use valuable energy reservoirs to expand their abdominal sacs, which is appealing to their male counterparts. 

In cases where female dance flies have smaller abdominal sacs, they attract males flies through larger leg scales.  

When discussing the reasoning behind her study, Murray said she “wanted to do an experiment to see if these ornaments were actually attracting the males and if they were working in the same way we typically see male ornaments — so, bigger is better.”

Why are the female flies using large amounts of energy to attract their male counterparts? 

According to Murray, the male flies provide them with a “food gift,” because the female flies have lost their ability to hunt, “so the males go hunting and they bring, usually another fly or insect. They kill it and they present it to the female in exchange for mating.”

The research took place over a 10-day period on an island in Credit River last June. North American dance flies are peculiar creatures that only appear for one hour at dawn and another hour at dusk.

As such, to complete the field research, Murray would wake up before sunrise to study the flies for an hour when they came out.  

During the day, Murray would analyze the data collected from the morning, and then she would venture out again at 8:30 pm to study the flies until sundown.

To test her theory, Murray created models that imitate female shapes and examined the impact of the two ornament types.

The research is particularly significant because it demonstrates a stark shift in our understanding of the animal kingdom. 

Typically, research has suggested that male animals use their energy to attract female counterparts. Much of Charles Darwin’s research, for example, focused on this phenomenon of sexual selection between mates.

However, Murray and Gwynne’s research turns this idea on its head.

“There are certain ways across animal kingdoms that males and females behave… It’s rare that you do find the vice versa, whereas in these flies, the subject of the paper, females are displaying very male-like traits,” Gwynne said. “They have reversed roles.”

Within the field of evolutionary biology, Murray’s study is the first that demonstrates this kind of female sexual ornamentation. “It’s such a bizarre system,” Murray said. 

“We’re looking at similar questions among many species of dance flies, thinking about how different species have evolved these ornaments.” 

With files from Srivindhya Kolluru