News & Media

May 2010
Director's Corner: Forks and Hope, Thimbles and Care

The arduous path up to the summit of Mt. Everest is littered with discarded survival equipment, and marked by the bodies of more than 150 climbers who succumbed and died during the ascent to the top. They lie, forever frozen, vivid testimonials to how the noblest hopes and aspirations of those with a mission can go awfully wrong.

Analogously, the arduous path towards the implementation of effective treatments for the diseases that afflict us is littered with trial drugs and procedures that have failed when rigorously tested. They fail because the initial promise of the lab research does not pan out in the end. Most fail early on in the testing process, and some fail during clinical trials, either because they are ineffective for the purpose for which they were originally designed, or they induce unacceptable side effects. Unfortunately, a few make it to market and are only then discovered to be harmful. A terrible case in point was the administration of the sedative thalidomide to pregnant women in the 1950’s. Worldwide, 15,000 infants were born with deformed limbs as a direct result.

The thalidomide tragedy led to the development of highly rigorous, formalized rules for drug testing that are legislated and regulated by government agencies. A potential new treatment must first have a strong rational underpinning, and then the testing – exhaustive, unbiased testing – must show that a seemingly effective new drug is safe in therapeutic doses, and that the effect is reproducible in the patient population. This requires extraordinary discipline in experimental design (you cannot, or should not, just inject stem cells into a patient and hope for a cure, no matter how many patients are willing to volunteer for this…). And as best as one can, variables that may affect drug efficacy must be tested. Is it better to take drug X in the morning, or before bed? With or without food? Will alcohol interfere with its function? And so on.

New surgical treatments rather than drugs are very hard, even impossible to evaluate in this way, because surgery is infinitely more complex and subjective than the delivery of a measured dose of a drug; and one surgeon’s judgment and capabilities differ from his or her peers.

It is not surprising that the time frame from discovery at the lab bench to the pharmacy is long, the cost of investigating new drugs is high, and…the patients are impatient. Frustrated and impatient.

Of course they are! Many have endured chronic ailments for a long time, experiencing a spiraling downhill course that is unresponsive to available treatments. But they still have hope that a cure will be found. A miracle cure.

And so out of frustration, and desperation, they seek out short cuts to cures, relying more and more on anecdotal evidence from other patients to identify novel compounds and procedures that will heal them. Many of these compounds and procedures receive rapid, intense grassroots support from the public that cannot be ignored, ignited by a few isolated success stories. The internet has made the organization of this support explosively fast.

Always, always public pressure generates a positive response by the funding agencies, with the diversion of large sums of research funds to test the new idea, demanded by a public that simply does not have the background to do a proper evaluation. Especially difficult to test are claims that Condition X is caused by…well, whatever. Rumors, fear-inspired at times, take on a wide and media-focused reality that commands attention – childhood vaccination – or living in Silicon Valley - leads to autism. Cause and correlation are frequently confused in the public mind. Viruses cause colds, but there exists the correlation that if you are pregnant and have private health insurance in the USA, you are much more likely to have a Caesarean section than the uninsured prospective mom.

The well-informed, objective clinicians and scientists know that the grassroots-driven “new approach” cannot pan out if not rationally based. But how do they know this? How can the scientists be so depressingly and discouragingly sure? A thoughtful, cautious response from researchers raises suspicions. The patients accuse the researchers of being too slow, too cautious, too unimaginative, too willing to reject out of hand the alternative therapy that the blog said cured Mrs. Smith with a single liberating treatment after 25 years of debilitating illness, too willing to destroy all of their new hopes. Scientists keep secrets locked up in their labs! After all, if they cure us, they put themselves out of business! The number of compounds that have commanded attention in this way – all of which failed critical examination and turned out to be desperate, even dangerous, diversions is staggering. Remember Laetrile from apricot pits, and megadoses of vitamin C as cancer cures?

Hypothetically, how should scientists react to a grassroots notion that a gluten-free diet will treat all major degenerative neurological diseases, based on a few case studies of patients with either Multiple Sclerosis, Parkinson’s Disease, or Amyotrophic Lateral Sclerosis whose disease level seems to be affected by the amount of gluten in their diets? It has been stated that to a man with a hammer, everything looks like a nail. So although a gluten-free diet is essential for patients with celiac disease, this does not mean that such a diet will be effective at all in neurological diseases. But what if a massively galvanized public demanded that large resources be allocated so that this new dietary approach be tested, and that our government should set aside special funds to do large scale testing? What are the clinician’s and scientist’s obligations to the public we serve?

Care and hope are forever in the balance. In “The Hunting of the Snark,” Lewis Carroll writes that the adventurers courageously first pursued the elusive Snark with “forks and hope,” but then, after several tragic encounters, more soberly sought it with ‘thimbles and care.” A fork, like a scalpel, can be an effective exploratory tool, while a thimble is a practical, protective device. Dare we say to a desperate public that there is no hope along this path, you must continue to be patient, because there is hope along that path and that other one? Should we tell them that there is no simply miraculous, liberating, surgical cure? Should we tell them that it is unconscionable to term a “novel” surgical procedure for an unequivocally immunological disease “a miracle,” and “liberating”? Who are we to kill new hopes by being thuddingly, dispassionately rational while they are suffering so?

Please send any comments about the Director's Corner to David Colman

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Recent News

George Karpati remembered for his devotion to patients and science
More than 200 colleagues from around the world gathered at the Karpati symposium to talk science and to recall the important contributions of George Karpati, neurologist and neuromuscular expert at The Neuro for 30 years. Many funny and touching stories were told but perhaps the most compelling was that of a poor Sri Lankan woman observed caring for her son who was disabled by muscular dystrophy. When asked about her remarkable devotion, she opened a small box with her few precious possessions and withdrew a hand written letter from Dr. Karpati. He had kindly and simply explained the condition and the lack of any treatment for it – as always, George reached out in hopes of bringing comfort and answers to patients with neuromuscular disease.

Accolades for Brenda Milner
Brenda Milner was honored by the Society of Experimental Psychologists who awarded her the Norman A. Anderson Lifetime Achievement Award for outstanding contributions throughout her career. Elected in 1988, Milner is among the psychologists who trained or worked at McGill to hold SEP membership, including Herbert Jasper, D.O. Hebb, James Olds and Morris Moscovitch. Even casual psychology students know B.F. Skinner, Harry Harlow and Leon Festinger in the group that numbers fewer than 400 since the founding of SEP in 1929.

Our commitment to The Neuro
Faculty and staff demonstrated their commitment to The Neuro by giving more than $103,000 to support the clinical and research mission. With more than 200 donors stepping forward, the fourth annual Faculty and Staff Campaign was a great success. Thanks to all who gave, to the many volunteers who helped, and to co-chairs Edith Hamel and Mark Angle who spearheaded the effort.

A new Partnership in Neuroscience Research between McGill University and Imperial College London
As part of an effort to strengthen and expand Neuroscience research programs on campus, McGill recently announced the establishment of a Neuroscience Research Partnership with Imperial College London (UK). This initiative was spearheaded by Dr. Stefano Stifani, a Neuro faculty member who also brought forth a formal Student Exchange Agreement between McGill and Imperial College. Under this new Partnership, funded by in part by the Neuro, the two Institutions have agreed to work together to consolidate existing scientific collaborations and provide new support in order to create a framework for regular academic interactions in areas such as, brain development, mechanisms of brain degeneration and repair, neuromuscular diseases, neuroinflammatory disorders such as multiple sclerosis, systems neuroscience, brain imaging, and cognitive neuroscience. Imperial College is a science-based Institution rated among the world’s best universities (rated 3rd in Europe and 5th in the world in 2009).

Prof. Stefano Stifani (Montreal Neurological Institute), Prof. Julia Buckingham (Pro-Rector, Education, Imperial College), Prof. Heather Munroe-Blum (Principal, McGill University), Sir Keith O’Nions (Rector, Imperial College), Prof. Mary Ritter (Pro-Rector, Postgraduate and International Affairs, Imperial College).

The Neuro’s Time Capsule: Ready for prime time in 2085
As part of The Neuro’s 75th anniversary celebrations, hundreds of Grade 5 and 6 students across Montreal made suggestions about what should be in the Neuro’s new time capsule. Michelle Courchesne, Quebec Minister of Education, Leisure and Sport and children of all ages enjoyed milk and cookies while they learned what will be locked away until The Neuro’s 150th anniversary. Global News report

Outstanding clinical care: Nursing Awards of Excellence
National Nursing Week was marked by the 19th annual Awards of Excellence ceremony. Diane Lowden, Clinical Nurse Specialist in the Multiple Sclerosis Program, received the Nursing Research Award, and Claire Nehme, Clinical Nurse Specialist in the Neuro Pain Program, received the Nursing Leadership Award. The Award for Excellence in Nursing Practice went to Suzanne Do-Davoll, Staff Nurse on 4 Surgery at The Neuro, and to Rocio Del Buey, Staff Nurse 14th floor Neuro Unit at the Montreal General Hospital. Patricia McAslan, Unit Coordinator on 3 North-East and Debbie Bhoop, Patient Attendant, 3 North-East were honoured with Partner-in-Practice Awards.

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Upcoming Events

Neuropsychology Day and The Brenda Milner Lecture, May 17
John O’Keefe from University College London will deliver the 13th annual Brenda Milner Lecture entitled The Development of Spatial Representations in the Hippocampal Formation of Infant Rats. This lecture, in the Jeanne Timmins Amphitheatre at 4:30, will follow a scientific poster session from 2-4 pm. All are welcome to drop by to talk with the students and fellows about the exciting research being done in the Cognitive Neuroscience Unit

Parkinson’s Disease: Public Education Conference, May 19
As part of an on-going series of public education sessions, The Neuro will host a Parkinson’s Disease Public Education Conference on Wednesday, May 19 from 4-7 pm in the Jeanne Timmins Amphitheatre. Neurologists Anne-Louise Lafontaine and Ted Fon, experts in Parkinson’s disease, will welcome colleagues who will speak about the disease and strategies to manage it. All are welcome at this free, bilingual public event. For more information, contact Lucie Lachance or 514-934-1934 local 42944 or to RSVP, please contact Merissa Tomney or 514 934-8026.

Neuro Convocation, May 26
The Neuro community will gather for the annual Convocation to honor colleagues and friends whose work has made a difference. Eva Andermann and Patricia O'Connor will be recognized with Lifetime Achievement awards; Peter McPherson with a Mid-Career Achievement award and a special tribute will honour Ernst Meyer (1942 - 2009). Outstanding Team Awards will be given to the staff of the Preston Robb Neurological Day Centre and the Animal Care Facility. Please come to celebrate these awards with your friends at 3 pm, Wednesday, May 26, in the Jeanne Timmins Amphitheatre.

Neurology Day and Donald Baxter Lecture, June 3
Frances Jenson, Professor of Neurology at Harvard University Medical School, will present the Donald Baxter Lecture entitled Epilespy Spectrum Disorder: Interaction of mechanisms underlying the ictal and non-ictal manifestations in the Jeanne Timmins Amphitheatre at 4 pm. At 2 pm, research presentations will be given by the neurology residents. All are welcome to attend this program recognizing the contributions of Don Baxter, who arrived at McGill in 1962 and served as Neurologist-in-Chief, Chairman of the Department of Neurology and Neurosurgery, and as Director of the Neuro from 1984 to 1992 and again from 2000 to 2002.

Don’t miss it! Neuro Family Day, June 19
Bring the family and enjoy the fun at The Neuro Family Day on Saturday, June 19. Join us for a good, old fashioned ‘picnic in the park’ from noon-5 pm in Pierre Elliott Trudeau Park in the city of Cote Saint-Luc (6975 Mackle Road, near Cavendish Mall). We’ll bring the food if you bring the toys! Plan for softball, soccer, Frisbee, kickball, basketball, badminton, roller hockey, riding toys, sand toys and more. For more details and to let us know how many burgers and dogs you’ll need, visit Neuro Events web site or contact Debbie Rashcovsky, 514-398-6047.

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Congratulations to ...

Jacques Bougie, OC, Co-Chair of the Neuro's Thinking Ahead Campaign and Advisory Board member, who will receive an honorary Doctor of Laws from McGill University on May 28 at 2:30 p.m.(Macdonald campus). As a prominent leader in business and philanthropy, Mr. Bougie has made a deep commitment of service to The Neuro, McGill and other organizations to secure their longevity and future strength.

Rolando Del Maestro, neurosurgeon, and Dominic D’Alessandro, Neuro Campaign Co-chair and former Manulife CEO who were inducted into the Ordine al Merito of the Canadian Italian community by the National Congress of Italian-Canadians, Quebec chapter. D’Alessandro and Del Maestro will also appear in the upcoming in the ‘Rich Histories Fuel Brilliant Futures’ poster campaign organized by the Congress.

Jason Hamlin, PhD candidate with Dr. Peter McPherson and 2009 recipient of the ALS Society/CIHR Doctoral Award, whose work is profiled in the recent issue of the Northern Neuron, the newsletter of the ALS Society.

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Condolences to ...

Friends and family of Mary Waller Robb, wife of Professor Emeritus and former Neurologist-in-Chief James Preston Robb (1914-2004) who died at the age of 94. Mary was head nurse at the Montreal General Hospital prior to her marriage. Mother of the 4 Robb children, Mary was known for the kind help she offered the families of young neurologists who came to The Neuro for advanced training.

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Director - David R. Colman, PhD
Senior Management - Martine Alfonso; Mark Angle, MD; Phil Barker, PhD; Rob Dunn, PhD; Lucia Fabijan; Tom Gevas; Elizabeth Kofron, PhD; Catherine Rowe; Donatella Tampieri, MD
Neuro News: Elizabeth Kofron, PhD & Sandra McPherson, PhD

Please send any items for the Neuro News to Sandra McPherson or Beth Kofron.

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