When it comes to innovations in health care and cross-disciplinary collaboration, the U of A is at the head of its class
No one would dispute that the decades ahead represent an era of extreme change and uncertainty in almost every aspect of world affairs, perhaps nowhere more so than in the field of human health. The world will confront environmental, social, political and economic challenges so complex they stand to radically change the way we live, work, play ... and die. At the forefront of this change is the role of health and health care systems in people’s lives.
The new world of health care will be confronted with an aging population, rising pollution levels and exponential population growth—eight billion worldwide by 2020. In Canada alone, the proportion of seniors is going to double within the next 20 years, with the over 80 demographic expanding the fastest. More and more children with chronic problems such as cerebral palsy, cystic fibrosis or acquired injuries are surviving long into adulthood and leading productive, vibrant lives. And once-terrifying conditions such as AIDS, tuberculosis, diabetes, heart disease and cancer continue to evolve from once-terminal conditions to ones patients can often learn to manage throughout their lives.
“The direction is increasingly to get out of our silos and focus on the problem at hand, not the discipline we are in.”
Gone are the days in which health care was about waiting until you are sick, going to the doctor when you have new symptoms, or using the emergency room to meet your ongoing needs. The challenges we are facing will quickly overwhelm a system like this, if they haven’t already. In fact, it is anticipated that unless we fundamentally shift the paradigm from a disease treatment model to one of keeping people well, unless we help people to become empowered managers of their own health, within a quarter century the majority of Canada’s provincial health care budgets will be consumed by the growing chronic disease population, and the health care system Canadians so treasure could be brought to its financial knees.
The notion of health needs to be brought out beyond the purview of a few narrow disciplines, and evolve into an ongoing national conversation in which everyone—not just those in the traditional medical disciplines—participates. More and more, the roles of technology, education, community health, spirituality, law, industrial design and public policy are being recognized as fundamental to addressing the problems facing us.
The University of Alberta is at the forefront of the health care debate and is recognized as a global innovator for the shifting health care paradigm. A key symbol of this commitment to excellence is the construction of the Edmonton Clinic Health Academy. This new building sets the tone for an ongoing integration of Alberta’s health sciences providers and its health educators, researchers and innovators across numerous disciplines.
Peter Gill,’09 BMS (right), the U of A’s 67th Rhodes Scholar, and Dr. Verna Yiu: “We must tap all the resources we have as innovators and researchers if we are going to get the breakthrough results we need.”
“It’s the start of great things to come,” says acting dean of medicine and dentistry Dr. Verna Yiu
, ’84 BMS, ’86 MD, about the building. “But in itself it’s just one aspect of a thrust at the U of A that will bring in more great minds from across the University and around the world to continue to tackle modern challenges in new and exciting ways. Many are realizing, especially with the rise of technology and the Internet, that disciplines in all parts of the University have so much to offer to health care’s evolution, and we must tap all the resources we have as innovators and researchers if we are going to get to the breakthrough results we need.”
In every corner of the University, important questions are being asked, not only about how we can cure disease, educate a new generation of health professionals, or make medical breakthroughs, but how we can design environments to facilitate chronically ill people staying at home? How can we reform health care to promote well-being and justice? How can hospitals and clinical spaces be re-imagined and designed to provide better and more humane health care? And how can communities help patients and families use medical and community resources to understand treatment options and better access care?
“The direction is increasingly to get out of our silos and focus on the problem at hand, not the discipline we are in,” explains Martin Ferguson-Pell, dean of rehabilitation medicine and chair of the U of A Health Sciences Council. “The big challenges of our time—aging, chronic disease, obesity, depression—are just too big and too complex for any one discipline. Our aim is to bring together the most creative thinkers and to give them freedom to cross conventional research lines in search of solutions no one else has ever thought of before. This requires a whole new language—a language of immersion—in which people with very different perspectives come together as they never have before to find a common discourse.”
Here are just a handful of examples of people from widely divergent disciplines coming together to collaborate on a new health care paradigm and create, as Ferguson-Pell says, “a language of immersion.”
Health Care by Design
Who would have thought an industrial designer would have a pivotal role to play in shaping the future of health care? But the work of Robert Lederer, ’98 MDes, associate professor of design studies, stands to do just that. Lederer is working with an interdisciplinary team of colleagues in the area of 3D modelling, both through building digital models with computers and in sculpting actual 3D prosthetics and models for patients. If a patient is missing an ear because of an infection, accident or birth defect, for example, Lederer works with medical practitioners and medical sculptors to digitally scan the “good” ear, and then build a prosthetic one that can be implanted to simulate bones, cartilage and flesh that is almost perfectly lifelike. Not only is the University becoming a leader in this area, the collaboration with surgeons is leading to new advances that can actually cut down the number of surgeries necessary for facial reconstruction.
“One of the most exciting things happening here is that we are learning to leave the language of our own disciplines at the door, and that helps break down barriers."
The U of A’s 3D modelling lab was the first of its kind at any university in Canada and is now playing a lead role at the heart of a fast-growing Institute for Reconstructive Sciences in Medicine. Based at Edmonton’s Misericordia Hospital, this fully integrated environment merges clinical care, research, education and training in reconstructive medicine and technology, combining advances in disciplines such as surgery, medicine, dentistry, rehabilitation medicine, industrial design, engineering and computing science.
“One of the most exciting things happening here,” says Lederer, “is that we are learning to leave the language of our own disciplines at the door, and that helps break down barriers. I walk into rooms full of some of the greatest minds in medicine and a host of other disciplines, and I can say—‘so you need us to help you design one of those flappy bits to implant where she’s lost that bit there,’ and whether or not we all know the correct medical term, we’re committed to getting past that, to finding a common language so we can create something truly magnificent together on behalf of these patients.”
Laying Down the Law
What is the responsibility of Canadian health care providers when patients go overseas to seek treatment through what has become known as medical tourism? How are patients misinformed when they search online for information about critical health care decisions? How is the way food is represented and talked about in advertising and the popular media contributing to the obesity epidemic? These are just a few of the kinds of questions being looked at by researchers in two unlikely departments: U of A’s Health Law Institute, and the School of Library and Information Studies.
In one example, Timothy Caulfield, ’87 BSc, ’90 LLB, a U of A Canada Research Chair in health law and policy, is looking at some of the important legal and societal implications of the fast-growing, complex and contentious phenomenon of stem cell tourism. While there is much excitement surrounding the potential that stem cell research can lead to significant developments in regenerative medicine—including treatments for conditions like Alzheimer’s, cancer, diabetes and brainstem injuries—this research is still largely in its infancy, and there is insufficient evidence as yet regarding safety and efficacy. Nonetheless, desperate patients and parents are already travelling around the world to pursue unproven stem cell treatments unavailable at home. “When competent adults elect to pursue these treatments, a whole range of concerns arise, including issues of public policy,” explains Caulfield. “But when desperate parents elect to make medical decisions on behalf of their children, the legal and ethical implications are very complex indeed.”
Timothy Caulfield: “The legal and ethical implications are very complex indeed.”
The work of Caulfield and his colleagues is forcing new discussions about the public’s right to reliable and accurate information, how resources and information should be tailored for physicians and parents, and how Canadian regulators should respond in the face of questions that span the work of economists, philosophers, sociologists, psychologists and linguists and that straddle the intersections of media, public policy, law and communications.
In another example, professor Tami Oliphant, ’94 BA, ’01 MLS, of the School of Library and Information Studies, is looking at how people suffering from depression access information online and via other informal networks, and subsequently make decisions to alter their treatment or engage in complementary or alternative therapies.
Many people would wonder why this critical health issue would be of concern to library and information science researchers, but in today’s media-rich world, more and more people are going online seeking information about personal health decisions. Seeing how these various online threads come together to construct convincing arguments on why individuals should take natural herbs or oils instead of the drugs they were prescribed, or whether an alternative therapy is proven to be effective, is at the heart of Oliphant’s work. Whether or not alternative therapies are actually an effective option is less her focus than how people receive information online and come to conclusions about the credibility of health advice.
Oliphant’s research suggests that a key benefit to going online for people suffering from depression is the emotional support they find there. “The emotional part of giving and receiving information and how people assess what is credible is an important aspect of how individuals make decisions and manage their own care,” she explains. “The Internet is an effective, powerful mechanism for sharing important health care information, but we need to better understand how we can help citizens engage with it in the best way possible.”
Working Out a New Model
U of A researchers in physiology, rehab medicine, kinesiology and the Faculty of Physical Education and Recreation are engaged in exciting and novel inquiries at the intersection of exercise and medicine. “We are fundamentally broadening our conception of what physical education is and what role it plays in health and well-being,” explains Kerry Courneya, a Canada Research Chair in exercise, physiology and cancer. “It’s not just about sport any more—it’s about public health, well-being and the management of both illness and wellness. In a host of chronic problems such as obesity, cardiac disease, depression, and disability, exercise is a critical driver in enhancing quality of life, elevating mood and social interaction, controlling symptoms, and—in some cases—reversing the effects of certain conditions.”
Courneya’s research focuses on the areas of kinesiology and oncology, two areas that have not traditionally been brought together in the field of cancer research. Courneya is co-leading a study aiming to prove that exercise can reduce the risk of a cancer’s recurrence. The aptly named CHALLENGE trial is tracking 1,000 colon cancer survivors in Canada and Australia over 10 years—as well as supporting half of them in increasing their activity levels through a state-of-the-art program of supervised exercise and behavioural support sessions designed by Courneya. The trial is attempting to determine if colon cancer recurs less often in people who increase and maintain an exercise regime. “The ultimate goal’” says Courneya, “is to find out as best we can what is the exact right exercise prescription to help prevent cancer, manage the effects of treatment when it’s diagnosed, and help prevent recurrence in the future.”
Donna Goodwin (right) with a student: “We’re helping to shape a whole new generation.”
, ’78 BPE, ’80 MA, ’00 PhD, director of the U of A’s Steadward Centre for Personal and Physical Achievement
, is also exploring ways more people with disabilities can participate in physical activity. “They need ways to participate in the community, to exercise, and to be seen as the healthy—but disabled—people they are,” says Goodwin. Her work exploring disability as a social construction, the impact of societal attitudes on the participation of the disabled in physical activity, and in capturing the experiences of persons with disabilities in physical activity settings is beginning to have meaningful impacts in a wide range of community settings.
“The reasons people with impairments are not exercising have to do with a wide range of variables. It’s part social psychology, part epidemiology, part about the built environments, part about public perceptions and media, and part about emotions. Sometimes what we find is as simple as the fact that a person with a severe physical disability doesn’t want to undress in a locker room in front of a bunch of people that are ‘ripped.’
“We’re helping to shape a whole new generation,” continues Goodwin. “Our students are learning to be catalysts for change in the community. The disabled people who work with us are becoming role models and teachers for others, and the facilities that are stepping forward to work with us are taking the bold step of opening hearts and minds about an important health care issue in our communities.”
The Art of the Matter: Putting Humanity Back
Can reading great literature, visiting an art gallery, or writing memoirs help doctors and other health care practitioners be better at what they do? U of A’s Pamela Brett-MacLean—and a growing cohort of scholars from around the world—think the answer is yes. Brett-MacLean is co-director (with clinical advisor Dr. Verna Yiu) of U of A’s groundbreaking Arts and Humanities in Health and Medicine program.
The program, one of the most comprehensive of its kind in Canada, recognizes that with increasing specialization and the overwhelming patient loads most practitioners manage day to day, medicine is at risk of becoming depersonalized. Medical Humanities is a groundbreaking and relatively new interdisciplinary field combining humanities, social science, and the arts as they apply to the whole field of medical education and practice.
“Essential to great practice is not only the science, but the ability to have insight into the human condition,” explains Brett-MacLean. “Attention to literature and the arts helps to develop and nurture skills of observation, analysis, empathy and self-reflection—skills that are essential for humane medical care and its grounding in questions of suffering, personhood and our responsibility to each other.” The program, which often includes offerings open to the broader community and the general public, uses arts and artists to support medical students in learning to better relate to patients, understand patient stories, and translate science in relation to human experience.
“Essential to great practice is not only the science, but the ability to have insight into the human condition.”
Brett-MacLean explains that the intersections of the arts, humanities and medicine are many and continue to be explored in a wide range of contexts. Students may watch movies about illness and discuss how they reflect the way illness is perceived in the culture. They may attend gallery tours and speaker series looking at how these forms of art and discourse reflect the culture and stories physicians and their patients live by. They may role-play or write about an emotional story they’ve experienced as it relates to the care they are involved with.
“This program explicitly recognizes that clinical practice is both an art and a science, requiring an appreciation of both the objective and the subjective aspects of medicine. It’s a big part of what we are trying to do here at U of A—creating practitioners who are reflective, thoughtful and humane, as well as technically and scientifically excellent. It’s a testament to how forward-thinking our students and faculty are that so many are embracing this vitally important part of our work as caregivers, health providers, and forward-thinking innovators.”
As the University of Alberta takes its place as a global health leader, researchers across the University continue to recognize that the complex questions they face will demand input from all parts of the community and new kinds of research partnerships. Building a culture in which individuals have the means, mechanisms and willingness to have new kinds of conversations means the U of A is poised to seek out creative solutions to complex issues. That can only occur when people look outside what they already know and imagine the new worlds that can be created outside of their current boundaries, at the creative intersections of all the disciplines.