The field of medicine lacks diversity because applying to medical school is inaccessible

CW: ableism, racism, classism

Coming into university, I thought I was going to be a doctor. I got accepted into health sciences and thought that health was something I wanted to pursue. While I am still passionate about health care, I’ve come to many realizations during my undergraduate degree — with one of them being that I am unable to apply to medical school due to my disabilities.

It’s hard to face the reality that some things might be unattainable for you when there is this mindset pushed that if you work hard enough, you can achieve anything. I agree that it’s good to work hard and set goals for yourself, but becoming a doctor is a bit more complicated than simply “working hard.”

It’s hard to face the reality that some things might be unattainable for you when there is this mindset pushed that if you work hard enough, you can achieve anything. I agree that it’s good to work hard and set goals for yourself, but becoming a doctor is a bit more complicated than simply “working hard.”

The first barrier I came across was the lack of accessibility surrounding the application process. For most Canadian medical schools, you have to write the Medical College Admission Test in order to apply. The MCAT is a multiple choice examination that covers a wide variety of subjects such as physics, chemistry and biology, and assesses your critical thinking and problem solving skills. 

Typically, the MCAT is a seven hour and 30 minute-long test where you are not allowed to access water or food except for during the scheduled breaks. To allow for things such as extra time, a separate testing area or even water or food during the testing period, you have to apply for accommodations.

Accommodations for the MCAT are known to be notoriously difficult to access according to many applicants. You need to submit a profile, your condition, history, a personal statement that talks about your experiences and a comprehensive evaluation by a qualified professional. The problem with this is that many people with disabilities may not always have a “proper” diagnosis since many conditions are hard to diagnose and may even take years — it took five years and several doctors to diagnose my rare knee condition. In addition, folks may face barriers in accessing healthcare services due to long wait times, racism, classism or other forms of discrimination. 

The Association of American Medical Colleges, which administers the MCAT, is known to be strict on accommodations. Even if you have extensive documentation for your disability, you may be denied accommodations. Many have shared such experiences on platforms such as Reddit, detailing the hardships of accessing accommodations. If you’re given accommodations, it could not be what you requested for. As a result, many people decide to “power through” instead of applying for an accommodation. In addition, up until 2015, MCAT accommodations used to be flagged for being administered in a non-standard setting, which could have an impact on your medical school applications.

Even amidst a pandemic, the MCAT is still running in-person — they have shortened the test from seven hours and 30 minutes with two 10 minute breaks and one 30 minute break to five hours and 45 minutes with three 10 minute breaks. It’s ironic that MCAT testing is in-person and could potentially put test takers at risk, while other standardized tests like the Law School Admission Test is online to accommodate for the pandemic. 

It’s ironic that MCAT testing is in-person and could potentially put test takers at risk, while other standardized tests like the Law School Admission Test is online to accommodate for the pandemic. 

Ableism isn’t the only barrier people face in applying to medical school. A recent study found that McMaster University Medical School applicants often come from upper-class families, with the median income of $98,816 being almost $30,000 higher than the average Canadian. From those who were accepted into McMaster, the median income was $105,959. This creates a huge disparity in healthcare: low-income patients will often lose out on the opportunity to have a physician that can empathize with their experiences or fully understand conditions that disproportionately affect low-income people. 

Applying to medical school is difficult, but low-income students have it even harder because the cost of applying to medical school is high. Maintaining a high grade point average requires hard work and lots of studying, but when you’re juggling two or three jobs on top of that, it can be exceedingly difficult. Not to mention that while low-income students often have to work jobs, students that are more well-off can spend their time doing volunteer work or extracurricular activities that can boost their resume. Upper-class students can also pay for MCAT prep courses to help boost their scores, which can cost up to $2000. If you’ve received a medical school interview, you may also need to book a bus, train or plane ticket for the in-person interview depending on where the school is located.

Another disparity that has been very visible this year is the lack of Black and Indigenous medical students in Canada. Very few Black students have been admitted to McMaster Medical School for the past five years and other Canadian medical schools historically haven’t done much better with admitting Black and Indigenous students either.

Very few Black students have been admitted to McMaster Medical School for the past five years and other Canadian medical schools historically haven’t done much better with admitting Black and Indigenous students either.

In the class of 2020, I was the only Black medical student in my class! And my class was super amazing but I think it could of been better. Sign our open letter to the McMaster MD program to make huge improvements towards diversity and inclusion! https://t.co/GCJChL9kk6

— Oluwatobi Olaiya (@tobiolaiya_) June 20, 2020

Four years ago, I was also one of two Black students at #macmed. This letter and these demands are the culmination of years of work and advocacy, and I am so happy to see it put it into the universe. Sign and share. @MacHealthSci @MacMDAdmissions @JProfetto https://t.co/o7KqLlnqU8

— Sara Alavian (@Alavian_S) June 20, 2020

Although there have been some changes, such as Queen’s University changing their accelerated medical school route so that it is reserved for Black and Indigenous students only, many people have criticized these changes, as Black and Indigenous students will be entering an environment that may not be supportive. 

Although I appreciate the approach Queen's has begun to take, I do wish more was addressed on how these Black and Indigenous students will be properly supported at a school that is known to have blatant issues with racism especially for undergrads: https://t.co/Xy5SR4DSHb https://t.co/tVcg1bOfm4

— Iku Nwosu, MD (@IkuNwosu) July 24, 2020

I’ve always found it ironic that medical school is inaccessible in many facets — the fact that people with disabilities, low-income individuals and Black and Indigenous folks are disadvantaged when applying highlights the lack of doctors who belong to these identities. The best doctors that I’ve had are ones that can empathize with my experiences. But if the majority of doctors are abled, upper-class and not Black or Indigenous, you alienate a large group of people. 

By Olivia Fava, Contributor

Two of McMaster’s professors, Chandrima Chakraborty and  James MacKillop, have recently been named to the Royal Society of Canada’s College of New Scholars, Artists and Scientists.

Founded in 2014 and based in Ottawa, the College of New Scholars aims to gather the “emerging generation of Canadian intellectual leadership” from a broad range of disciplines. Recipients of the College’s title must have demonstrated exceptional achievement in the early stages of their career. By pooling together award recipients, irrespective of their disciplines, their goal is to encourage a dialogue between intellectuals with diverse perspectives, and hopefully inspire new insights. 

The College acknowledges five aspects of the current academic landscape that inform their mandate: the increasing use of new media in research communication; the emergence of interdisciplinary research; the majority of Canadian professors being recently hired; greater female representation in academia; and greater First Nations and visible minority representation in academia.

A clinical psychologist by training, MacKillop’s award-winning research focuses on addiction — the factors causing it, how it sustains itself and how it can be treated. He is currently the director of McMaster’s Peter Boris Centre for Addictions Research, and co-director of the Michael G. DeGroote Centre for Medicinal Cannabis Research. He studies both cannabis addiction and the potential risks of prescribing cannabis medically. He is a member of the department of psychology, neuroscience and behaviour. MacKillop was not available for comment.

Chakraborty, on the other hand, is part of the department of English & cultural studies. In the past, her work has focused on the relationship between religion, masculinity and nationalism in India, with an analysis of media and literature. Currently, she is focused on the 1985 Air India bombings and the post-9/11 targeting of South Asian populations.

Chakraborty was nominated by McMaster to become a member of the College. According to her, the nomination was formally initiated by the previous president, Patrick Deane. She considers the nomination not only personally significant to her, but also significant in its recognition of the value of research that engages the community.

“Much of my work straddles a number of different fields. History, memory studies, trauma studies, nationalism, masculinity … For me, this nomination is a recognition of that kind of work that crosses those kinds of disciplinary boundaries. I also think this recognition is important because my work is very much situated in the community,” she said. 

Specifically, Chakraborty referenced her current work on the Air India bombings, through which she has interviewed families of victims and collecting photographs. She has been learning from the community and recognizing them, in her own words, as “carriers of knowledge”. She works as a mediator to bring a seldom-recognized tragedy into the realm of public consciousness.

Chakraborty’s efforts have resulted in the first-ever public archive on the Air India tragedy. She emphasizes that this project is not simply about researchers writing about the tragedy but also about families sharing their stories on their own terms. The archive also engages questions of race, Canadian citizenship and public mourning.

“Why is it that if 329 people were on that plane, and about 280 of them were Canadian citizens or permanent residents, why do Canadians of [student] age, for instance, not know about this tragedy? How do certain griefs become part of the public realm and part of the national consciousness whereas certain other kinds are seen as local? … Is it ignorance, is it apathy, is it racism, what is it?” she asked. 

When asked what she would attribute her personal success in terms of this recognition, Chakraborty named her childhood experiences as a child of refugees as well as her experiences as an immigrant in Canada.

“I might be an English literature prof, but I don’t speak like white Canadians — accent and gender and race and all of those things. You learn to work harder than others … you always feel like ‘I really have to prove myself, because nothing is given to me,” said Chakraborty.

She also expressed gratitude to her teachers and family, her colleagues at McMaster for their support and the students who have expressed interest in her work.

The College of New Scholars summarizes its membership criteria as “excellence.” Congratulations to these two researchers for demonstrating the excellence of the McMaster community in a range of disciplines on the federal level.

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Graphic by Sukaina Imam

By: Julia Healy

“Sexually active” is an awkward phrase that many of us only hear in the doctor’s office. It is used in an attempt to bridge the intimate world of sex with the clinical and professional world of medicine, which is not an inherently harmful goal.

What is harmful is that whether or not one is sexually active is often the only question concerning sexual health that is asked during a doctor’s visit. And more often than not the answer is confined to heteronormative, penis-in-vagina penetrative sex between a cis man and a cis woman.

I recently had a negative experience that sums up how the use of this clinical language can lead to misunderstandings and humiliating experiences for LGBTQ2S+ individuals like myself. After having a bizarre 25-day period, I decided to go to the doctor.  He told me that a wide variety of problems could have caused this problem. He then referred me to an ultrasound clinic for testing.

At the clinic, I filled out my paperwork and waivers. One form asked if I was sexually active and left no space to elaborate.  I had to think about how to answer; I had had sex before, but it was with another woman, so what was this form actually asking about? Possibility of pregnancy? Exposure to STIs?

I decided to check ‘yes’ since I do consider myself to be sexually active and my doctor had mentioned that an STI could be a contributor to my problem.

Once I was inside the ultrasound room, lying on a table in a hospital gown, the technician noted that I was sexually active.  She then muttered under her breath that I would need to be to to get a transvaginal ultrasound, while picking up a large internal ultrasound wand.

Not having known that being sexually active in a heteronormative sense was a prerequisite to the procedure, I decided that now was a good time to clarify. I tried to phrase my predicament as delicately as possible, so I emphasised that I had never had penetrative sex before.

The technician became very frustrated and started to interrogate me, demanding me to explain.

I thought that a medical professional who specialized in sexual healthcare would understand my phrasing. I thought that she would at least consider that different people have different types of sex.

Instead I was there, lying half-naked on a table, being yelled at by somebody who did not seem to consider sexual differences. Humiliated, I said in a very small voice, “well… I’m a lesbian.”

The technician’s demeanor instantly changed. She became less aggressive and seemed embarrassed. She left and brought back new paperwork for me and indicated that I should write that I was not sexually active and that I did not consent to the tests that I had previously consented to.

I went home frustrated about being yelled at and ultimately denied the testing that was recommended by my doctor. I decided to follow up with the clinic and while the receptionist was sympathetic and said that they would follow up with the technician, they also defended the clinic’s position by saying, that I was technically a virgin and that I shouldn’t have indicated otherwise.

This entire situation was incredibly uncomfortable for me and it could have been avoided if only the original paperwork had been clear in its questions. If I had space to elaborate on my sexual experiences in the paperwork, I would have and would have spared myself from the frustration of the technician. If I had known that penetrative sex was a prerequisite to the test, I would not have signed the consent form.

However, even with these language changes, the clinic’s penetrative sex requirement is an inappropriate policy. Everyone with a vagina should have access to reliable ultrasound tests regardless of sexual activity.  Smaller ultrasound probes that can be used with less discomfort do exist, but unfortunately, not many ultrasound clinics use them. In my city of 600,000 people, you can only gain access to a smaller probe by going to the hospital.

When discussing barriers that lie between the LGBTQ2S+ community and healthcare, it’s not just about blatantly bigoted “bad apples” who refuse to treat queer patients.  Barriers are deeply ingrained in the language that is used and assumptions that are made about a patient’s experience.

Barriers include failing to take LGBTQ2S+ experiences into account when designing medical procedures and failing to provide access medical equipment that works for all bodies, regardless of previous sexual activity.  Barriers also arise when medical staff are ill-informed about the language that groups use to describe themselves and their experiences, and when this language is challenged in a hostile way.

Sexual health is incredibly important. However, encouraging people to  take control of their sexual health only does so much if one’s identity and experiences are not incorporated into our healthcare systems.

 

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Photo by Kyle West

By: Youssef El-Sayes

Choosing a degree and career path is not an easy task. Students pursuing a degree in science have a wide variety of available career options. These range from positions in research, industry, medicine, illustration and so much more. It almost seems like the possibilities are endless.

But how does one truly understand their goals without experiencing their options? Many professionals end up with a job that they thought would interest them but eventually learn otherwise.

This issue has become so commonplace that institutions like McMaster University have developed strategies to help students gain a variety of experiences outside of their chosen undergraduate program. A great example are the interdisciplinary experience courses, offered by the school of interdisciplinary science.

For a full credit, students can choose from a wide array of IE courses that cover topics such as three-dimensional printing, visiting Kentucky for a caving fieldtrip or hiking Algonquin park while learning about Canadian history, geography and literature.

IE courses serve the purpose of introducing students to a variety of disciplines that will help broaden their perspectives and opinions towards science. By providing students with active learning opportunities, they can develop a personal connection and a deep motivation for the subject.

The idea of active learning has been studied for decades. In essence, active learning requires students to be engaged with the delivered content while critically thinking about the activities they are working on.

Current research suggests that fostering engagement in class activities is more likely to improve student learning compared to simply spending extra time on a topic. This is why IE courses available at McMaster University consist of short workshops, field trips or tutorials that keep students motivated and prove that learning does not need to be time consuming.

These experiences are especially rewarding for students because they earn a credit for their work. The results of IE courses are also long-lasting. For example, upon completion of IE courses, many students often undertake related volunteer positions and internships, in order to put what they have learned into practice.

Aside from personal growth, IE courses also provide a multitude of professional benefits. Due to the small class sizes, students can engage in one-on-one interactions with instructors or guest speakers and build valuable networking skills.

These experiences also set students apart by giving them something distinct and unique to include on a resume. Overall, IE courses allow students to build on their academic, personal and professional qualities and become multi-faceted individuals.

McMaster University has always led the path for innovative teaching and learning, and offering IE courses is no exception. Students should always challenge themselves to step outside of their comfort zone in order to find their real interests and ambitions. By doing so, students can become professionals in their fields that truly love what they do.

It is clear that experiential and active learning opportunities are able to foster skilled and competent individuals who are willing to create a brighter future, and this is exactly what McMaster has been striving to do. So the next time you are enroling for courses, consider taking an IE class.

 

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What began on the McMaster campus has developed into an international protocol for evidence-based medicine, an approach piloted by professor of clinical epidemiology and biostatistics Gordon Guyatt. Awarded a position in the Canadian Medical Hall of Fame for his work, Guyatt’s influence has spread throughout the western world.

“Throughout North America and Europe, bodies that accredit medical schools and training programs for physicians after they finish medical school have all adopted evidence-based medicine [into their curriculum],” said Guyatt, who sustains that evidence-based medicine bridges empirical data with clinical treatment.

“Evidence-based medicine has to do with being aware of the best available evidence… and being able to put that best evidence in the context of people’s values, preferences and circumstances relevant to choices that patients have to make,” he explained.

Currently more than 90 organizations worldwide abide by the policies and values of the Grading of Recommendations Assessment, Development and Evaluation, a system developed by Guyatt in what was a collaborative effort. GRADE became the epicenter of a cultural shift that has taken place over the last 20 years towards a formal clinical process in patient treatment. GRADE encourages physicians to adhere to guidelines that implement ideals that mesh well with evidence-based medicine. It has allowed for a system where evidence is appropriated before it can be applied.

Guyatt attributes the genesis of the evidence-based method to the community at McMaster.

“This could only have happened within a unique cultural environment that exists [at McMaster]. McMaster is known worldwide as the place where evidence-based medicine got started,” said Guyatt.

Guyatt was the director of Residency Program in Internal Medicine at McMaster in 1990. It was here that he first implemented the term evidence-based medicine. Caught up in the environment of the then new medical school at McMaster, and under the mentorship of clinical epidemiologist Dave Saket, he was inspired to explore an unconventional approach to health care.

“When McMaster Medical School started it was a revolutionary idea of a medical school. There were no tests, no examinations. Everything was based on problem-based learning. There was a great innovative spirit where challenging existing norms and values was highly valued,” Guyatt said.

The British Medical Journal ranked evidence-based learning as seventh among the most important changes in medicine in the last 50 years. Other developments on the list included computers, public health and anesthesiology.

Guyatt’s induction into the Canadian Medical Hall of fame is another notch in a long history of recognition.

“For me personally it’s nice, but more importantly than for me personally, it’s a recognition of the importance of the way that evidence-based medicine has impacted the medical practice.”

When asked about the future of evidence-based medicine, Guyatt likened it to the metaphor of turning an ocean liner around.

“It takes time,” Guyatt acknowledged. “It’s been 24 years since the term was coined, and we have been pushing and pushing and pushing. Eventually, if you’re in the right time, place and cultural environment, things will change. The ocean liner is just halfway turned around, now we just need to keep pushing until it turns all the way.”

Photo Credit: Jeff Comber

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In 2014, Mick Bhatia and his team discovered that adult stem cells are hardwired to remember the type of cell they were originally. His breakthrough has not gone unnoticed. In December, the Canadian Cancer Society listed Bhatia’s research as one of the top ten discoveries of the year.

“We’ve known for several years now that you can take human skin cells and turn them into [pluripotent] stem cells that are almost identical to embryonic stem cells…[if] you’re taking cells from an individual, you can transplant those cells back in without fear of rejection,” Bhatia explained.

As he and his team learned however, the practice of reprogramming adult cells need not be restricted to skin tissue.

“We found…that you can take blood cells and turn them into pluripotent stem cells, but when you do that, it turns out these blood cells remember. So the stem cells derived from blood remember that they were blood,” Dr. Bhatia said.

When this observation was first recorded, Dr. Bhatia admits it was ignored.

“But then we started to notice a pattern and we started getting patients where we asked to take some blood and then asked to take some skin,” he said. By removing the patient as a variable, the researchers discerned that the cell origin determined how the new pluripotent stem cells would differentiate.

There are many areas in the medical field that will benefit from this advance in stem cell research; however the most prominent and immediately applicable is regenerative medicine. Since this work has only been done with blood so far, leukemia will be one of the first diseases to be treated in this manner.

“You give a drug like chemotherapy to kill the leukemia, but what happens is you kill the normal blood system. So if you can get a supply of the patient’s own blood cells and keep giving that to them at the same time as the chemotherapy, that actually allows the patient to undergo chemotherapy treatment for a longer period of time, which we know improves survival,” Bhatia explained.

Researchers can easily separate leukemic cells from healthy cells and reprogram the latter to stem cells capable of producing ten times as many blood cells.

Bhatia’s research can also be applied to cystic fibrosis. He explained that the complications associated with generating enough lung tissue would inhibit the process of testing new drugs to combat the disease. However, thanks to this development in stem cell technology, healthy lung tissue samples can be taken from CF patients and reprogrammed to lung-inclined stem cells.

Despite the implications of his work, Bhatia is as excited about his colleagues as he is about the research itself.

“What I love about this particular field that we’re in now is that…we’re working with chemists, we’re working with robotics specialists—these are people who don’t do anything with cell biology, but it’s so nice to work with people in other disciplines to solve a problem,” he said. “There’s nobody in the world doing this kind of work specifically.”

Rachel Faber
The Silhouette

On the first day of class, the course outline for Health Sciences 4ZZ3 was thrown away. Instead of learning about advocacy, students would be practicing it.

Though the course has been running for four years at McMaster, this is the first year that experiential education has been a part of the curriculum.

Lead by professor Steven Hoffman, this class takes a problem based learning approach and applies it to global health advocacy. Hoffman explained that this benefits students by pushing them out of their comfort zones and into “doing things they have never done and probably didn’t think they ever would be doing.”

Through this hands-on approach, students have been speaking to Members of Parliament, civil society leaders, and key stakeholders about the policy options that they have been formulating. In prednisone 100 mg order to make their ideas effective and politically feasible, the students have formed an organization called Global Access to Medicines, to advocate for change and engage in global health policy issues.

Their mission is to facilitate Canada’s role in access to medicine, introducing an initiative into the existing “Orphan Drug Framework”, which regulates drugs for rare diseases.

The students saw a policy window in Canada, which has created an opportunity for them to actually make a difference. The students are proposing to give more incentive to pharmaceutical companies with something called “Priority Review Vouchers”, which will allow companies to release drugs onto the market 12 months earlier than they would normally be able to.

Orphan Drugs are expensive to invest in, and this new idea would mean huge revenue for the drug companies and large strides in the research of these important drugs for rare diseases.

Some students from the class attended a conference on Nov. 11 and 12, to which they were invited by the Canadian Organization for Rare Disorders. The goal of this conference was to make any last minute changes to the Orphan Drug Framework that CORD will be presenting to the House of Commons this winter.

The students had the opportunity to present their idea about Priority Review Vouchers in Canada, which has already been a success in the United States. They were the youngest people at the conference by a landslide, and they had a lot of great responses from academics and pharmaceutical companies who attended.

This opportunity to attend the conference has given the students “a real seat at the table,” according to fourth-year Arts and Science student Sarah Silverberg.

The students feel that the most valuable thing they are learning from this course is how to advocate, reach out and talk to stakeholders who can help them reach their policy goals. The students expressed that the process is long and tedious, and are learning just how difficult it is to form policies.

“I’ve been so excited to see my students get more confident in themselves as advocates…this is very much their campaign, not mine,” said Hoffman. The students have been surprised at the positive reactions that they are getting from MPs, Industry Canada and Health Canada.

In December, three students will be heading to Ottawa to meet with more lobbyists from Industry Canada to further discuss their ideas. These important individuals have given the students advice to shape their campaign moving forward.

Hoffman notes that this allows his students to become a part of the public discourse, “their voice is a legitimate voice.” Overwhelmingly, the students in the class admit that this course was not what they were expecting.

“I think we’ve all been surprised at how seriously everyone takes us, if we take ourselves seriously,” said Silverberg.

Hoffman explained that experiential education still remains an experiment, about whether this is the best way to deliver a course on global health advocacy, but the results have been extremely promising.

Said Hoffman, “It’s amazing to be at McMaster where this type of really innovative and wacky educational experiment is not only supported but celebrated.”

 

Initiative for Global Access to Medicines
Global Health Advocacy 4ZZ3

 

Ten years ago this week, the Canadian Access to Medicines Regime was created. Its purpose was to improve global access to medicines by allowing Canadian generic pharmaceutical companies to reproduce patented medicines at a lower cost, which could then be distributed to countries where these medicines are inaccessible.

In doing this, Canada was a global leader and tried to set an international precedent to use inexpensive generic drug manufacturing to improve access to lifesaving drugs worldwide.

Unfortunately, Canada’s leadership was short-lived. In its ten-year existence, CAMR has only been used once, highlighting its failure. CAMR procedures were found to be too cumbersome, and the only generic pharmaceutical company to ever use CAMR vowed never to try it again.

Last year, Canada had a chance to plug the holes in the original legislation. Although petty politics got in the way of the Canadian government’s chance to where to get azithromycin fix CAMR, there is still hope for improving global access to medicines. There is another option for Canada to use its strong pharmaceutical sector for the global good.

The Orphan Drug Regulatory Framework, a set of incentives meant to encourage research and development for rare and neglected diseases, is being brought to Parliament in Winter 2014. Rare diseases are those that affect less than five in 10,000 Canadians, while neglected diseases are those that disproportionately affect low- and middle-income countries, but receive little research funding. The ODRF legislation is a key opportunity for Canada to address the global disease burden.

Right now, Canadian pharmaceutical companies are not motivated to perform research on drugs for the diseases that most affect the developing world. The ODRF does not do enough to help stimulate such interest, particularly in the case for ultra-rare and neglected diseases. An additional incentive is needed so that researching these drugs is profitable for Canadian companies.

Canada should look to the United States’ in its innovative creation of Priority Review Vouchers. To provide further incentives to the ODRF, priority review vouchers can be awarded to pharmaceutical companies that develop rare and neglected disease therapies. In the regular review process, it takes Health Canada an average of 18 months to review and approve a new drug. Most of this time is spent waiting in line to begin the testing process. But under the priority review, certain drugs, such as those that target life-threatening diseases, are reviewed in just 3 months.

Priority review ensures that drugs complete the same approval processes and pass the same safety and quality testing, but without waiting in line. Priority review vouchers — which would allow companies to redeem these priority reviews for any drug — could be worth up to $300 million dollars in profits for pharmaceutical companies, since they allow for earlier market introduction of drugs.

This is a low-cost solution for the Canadian government that will increase profits for pharmaceutical companies, thus making it a financially sustainable enterprise.

Priority review vouchers will have a significant impact not only for Canadians living with rare and ultra-rare diseases, but can also have implications on global access to medicines. By incentivizing research and development on treatments for neglected diseases in addition to rare disorders, Canadian pharmaceutical companies will also be targeting the issue of availability of essential drugs to people in the developing world.

Canada has come a long way, but it still has a ways to go to fulfill its global commitments. Although the ODRF is an important step forward, but Canada needs to include priority review vouchers if it is to improve global drug access.

Canada was once a leader in access to medicines, and Canada can re-establish this role on the world stage once again.

 

Contributors: Asha Behdinan, Justina Ellery, Anna Foster, Esaba Kashem, Jennifer Romano, Sarah Silverberg.

 

Avrilynn Ding
The Meducator

Although antibiotic resistance has been identified as a problem since the first introduction of penicillin, it has recently emerged as a serious public health concern.

Currently, one in 12 adults in Canadian hospitals are infected with bacterial microbes that are immune to most or all available sildenafil antibiotics. A report released by the Ontario Medical Association in March recommended governments to establish regulations to combat antibiotics overuse in medicine and agriculture. Ironically, while antibiotic resistance is a growing threat, the pharmaceutical industry largely abandoned antibiotics development in favour of researching treatments for other diseases. The majority of antibiotics used today were discovered before 1960, and target limited pathways in bacteria.

To address the issue, researchers at McMaster University recently developed a novel approach to screening for new antibiotics. Dr. Eric Brown, a professor in the Department of Biochemistry and Biomedical Sciences, led the study, published in Nature Chemical Biology. Rather than searching for antibiotics under conventional nutrient-rich conditions in the laboratory, researchers targeted bacteria growth under nutrient-limited conditions that closer resemble conditions in the human body that bacteria face during infections.

“Convention says you try to kill bacteria under the richest growth condition that you can create in the laboratory,” Brown said.

“And yet we know that life is not that kind to bacteria when they are infecting the human body. They actually struggle quite a bit.”

The study focused on antibiotics against Escherichia coli, a common bacterium used in research. The researchers used a medium containing four salts, supplemented by 0.4% glucose and 20mM ammonium chloride, to create a growth environment lacking the vitamins and amino acids the bacteria require. They then screened for antibacterial compounds by shifting through a library of 30,000 synthetic molecules and testing for chemicals that can block E. coli’s ability to synthesize its own essential nutrients.

Using the method, the research team discovered and characterized three new antibacterial compounds, designated as MAC168425, MAC173979 and MAC13772. Each chemical acts on a different pathway in E. coli to disrupt its ability to create or use a particular nutrient. MAC168425 interferes with the metabolism of glycine, a major amino acid used to build many proteins. MAC173979 prevents E. coli from making vitamin B9 by decreasing the biosynthesis of an intermediary molecule, while MAC173979 prevents the biosynthesis of vitamin B7 by inhibiting a key enzyme. In addition to the three molecules, researchers also identified 68 other chemicals that showed active antibiotic properties in nutrient-limited medium.

Brown’s findings have great implications in pharmaceutics by demonstrating the possibility and feasibility of a new method for antibiotic development. Not only does it suggest an alternative process for identifying antibiotic chemicals, it also opens research to a new class of antibiotics that target the nutrient synthesis mechanisms of bacteria. Although further research is required to transform the three antibiotic compounds into antibiotics, the study’s approach to discovering antibiotic chemicals has great potential to address antibiotic resistance.

 

The years spent in university are often said to be those where we first come face-to-face with the “real world”, characterized by a transitioning period from teenage angst, to even more angst, to grappling with who we are and, finally, shaking hands with the real world as the person we want to be. A myriad of experiences will come together to shape us into this person. It does not happen overnight, nor will it happen easily, but each of these experiences is vital in challenging us to discover who we really are.

The key word here is challenge. Highlight this word. Cut out this word. Be friends with this word. Because to overcome something that you are afraid of is to be able to look back and say, “I persevered, and now my mark is here.”

And these people who have left their mark, despite challenges, are all around us. Some write about it, some talk about it, some wait for the right moment before discussing it at all. McMaster University is the home to a plethora of individuals with such stories. But the story of Lisa Pope is one we are privileged enough to share with you, and, in fact, it’s not so much a story as it is an invitation to challenge yourself.

Lisa Pope, a graduating Honours Life Sciences student, dedicated her summer to the Kalu Yala Independent Study Abroad and Entrepreneurial Internships in Panama this past summer. Drawing people from across the world, Lisa was one of the only individuals from Canada. This diversity, however, encouraged the integration of distinct ideas that could build towards the common goal that was uniting them all: the creation of Kalu Yala, and thus developing the world’s most sustainable town.

The program is incredibly unique among international outreach initiatives in that it gives each team member an opportunity to be highly independent in how they choose to take part in the creation of Kalu Yala. Lisa was a member of the Agriculture team, made up of thirty students who came to get their hands just about as dirty as an outreach program can get them. Living in a jungle for three months, all while putting in both labour of the body and mind into a personally developed initiative, can take physical and psychological tolls on any team member. Lisa, however, took on a challenge perhaps more brutal than the typical member due to a recent diagnosis with symptoms of Crohn’s disease,

Crohn’s disease is an inflammatory bowel disease, where those affected are subject to severe abdominal pain, bowel disruptions, and even malnutrition. Given the strenuous nature of this program, another set of challenges could appear more repellent than enticing; instead of allowing her symptoms to hold her back, Lisa used her pain as a catalyst for unparalleled personal growth.

“I’m 23 years old living with a chronic disease and it’s something that’s never going to go away,” said Pope. “At this point, you decide to live your life or not, and this was my summer to do that. I decided to go and be in control of my disease.” In a location far removed from any Western world comforts or distractions, Lisa delved into a project that would eventually lead to a 75-page document, building a vast medicinal garden with her own hands, and leaving behind her own mark in a community that will forever leave an indelible imprint on her.

By planting over 300 different edible species of plants and trees, the impact her project will have upon the community in ten, or even five years, is momentous. Approximately 150 people will be fed daily as a result of her own hardships and hard work. And yet, perhaps the most striking message Lisa has taken home with her is not only the acceptance of failure at Kalu Yala, but also the desire for it.

“We love to fail at Kula Yala,” Pope said. Coming from a Science degree, where marks are snatched up without a second thought for any mistakes, and there is no gray area between the black and white of correct or wrong, this was a breath of fresh air. To fail was to succeed, and this paradoxical message can resonate with most students as wholly liberating. With failure, the members of Kalu Yala would not look at such a position as the defeated finish line, but rather an opportunity to start again, and allotting their knowledge of what won’t work as a propelling force towards success.

“If that means shooting for the stars and failing, that’s fine,” said Pope. “We shot for the stars and we realized that didn’t work so well, so we just have to figure out what we can do next time to make it better.”

In an eight-hour day, with four spent in the morning working alongside a director of the team, and the afternoon dedicated to the dirty work, there were three unmistakable qualities of the interns at Kalu Yala Independent Study Abroad and Entrepreneurial Internships: passionate, positive, and pursuing. Lisa Pope is an embodiment of such qualities, and although her self-proclaimed “invisible disease” has inevitably placed a series of unforgiving obstacles in her path, these qualities are in the foundation of the new path she’s building herself.

Every path a student will take in university is distinct from the next, and the obstacles just as varied, but the lesson to be taken from Lisa Pope and Kalu Yala is that no challenge can act as a barrier to leaving your mark in the world, but that challenges are forces that will leave your mark even more palpable.

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