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The following editorial was provided to Post Media by Dr. David Hill, scientific director, Lawson Health Research Institute. 

Last week the Nobel Prizes for 2017 were announced, recognizing incredible advances in science that will impact all our lives for the better. If you were looking for Canadian scientists amongst the teams, you would be disappointed.

According to a federal government report commissioned by the minister of science titled Investing in Canada’s Future — Strengthening the Foundations of Canadian Research and released in April, Canada’s momentum in the sciences has never been worse.

Our country’s investment in key emerging areas such as artificial intelligence, clean technology, nanotechnology, immunotherapy, bioinformatics or bio-engineering is flat-lined or declining, and falling seriously behind competitor nations.

We are not talking about matching the United States or Germany. Canada invests less in science research and development relative to gross domestic product than does Taiwan or Singapore.

Why should we care?

Because smart science delivers technologies we take for granted every day, such as Siri on our iPhones, minimally invasive surgery and secure online banking.

Science also creates companies, delivers high-paying and rewarding jobs, and is the backbone of the economy.

In London, Ont., jobs that depend on advancing science include those at Lawson Health Research Institute, the research institute of London Health Sciences Centre and St. Joseph’s Health Care London and where I work; academic institutions such as Western University and Fanshawe College; and local businesses generating health devices, computer software and engineered products. A lack of investment in science could be devastating to our city.

This report places the failure to invest in science at the door of successive federal governments during the past decade.

Of course, it is not only government that should invest in science. It is industry that takes proven scientific findings and translates them into products we all consume.

But these innovative products need to start somewhere, most often in the laboratory. Fostering high risk, fundamental discovery science should be a core responsibility of government in a knowledge-driven economy.

In Canada, the contribution of federal funds to discovery science is now below 25 per cent of the total research investment, and lower than most of our competitor nations. Consequently, research funds are scarce, laboratories are closing, fewer students are receiving advanced training, and fewer new businesses are emerging.

It is not too late.

The report provides evidence to show that Canadian scientists are still respected leaders in their fields. The engine simply needs fuel.

To return Canada’s discovery science enterprise back to 2006 productivity levels, we require an additional investment of $1.3 billion during four years, representing 0.1 per cent of the entire federal budget for each of those years.

The investment quickly pays for itself. Every $1 invested in fundamental research has been calculated to return $2.20 to $2.50 in direct and indirect economic activity.

Next year’s federal budget is being put together right now in Ottawa, and we have an opportunity to reclaim our past reputation as a discovery nation; a nation that brought the world insulin, the Canadarm, Pablum, canola and the electron microscope.

The journey toward that next Canadian Nobel Prize needs to start now.
 

Dr. David Hill
Scientific Director
Lawson Health Research Institute

Feeling emotions based on the interactions we have with other people is a common part of daily life, yet we know very little about how these emotions are experienced in the body.

Chloe Stewart, a PhD candidate at Lawson Health Research Institute (Lawson) and Western University’s Schulich School of Medicine & Dentistry, has been awarded a Lawson Internal Research Fund (IRF) Studentship to conduct the first study to comprehensively explore the physical experience of social emotions. The study will be supervised by Dr. Elizabeth Finger, a Lawson scientist, neurologist at St. Joseph’s Health Care London’s Parkwood Institute, and associate professor at Schulich Medicine & Dentistry.

“We feel social emotions based on our awareness, interpretation or anticipation of the thoughts and feelings of others. For example, we feel embarrassment not only because we have done something potentially embarrassing, but also because we know that another person is aware of it, or could become aware of it. Other social emotions include pride, empathy and guilt,” explains Stewart.

“These are distinct from basic emotions, such as anger and happiness, which only require us to be aware of how we ourselves are feeling and can occur completely independently of other people. Whether it’s your heart beating faster when you’re angry or the lump in your throat when you’re sad, the ways that our bodies experience basic emotions are very well understood. However, we do not have a good understanding of what happens to our bodies when we feel social emotions,” she adds.

Unhealthy levels of certain social emotions are associated with many conditions, including certain kinds of dementia, obsessive compulsive disorder and psychopathy. The results of the study, which will be conducted at Parkwood Institute, could help in developing potential interventions or treatment approaches to restore these emotions to healthy levels.

The first phase of the study will look at the physical experience of social emotion in healthy adults. Noninvasive electrodes will be attached to participants’ torso, hands and throat. The electrodes are connected by wires to receivers, which in turn send signals to a computer. The researchers can assess how the signals change based on the stimulus the participant is looking at. Stewart expects the emotions will influence several different physical responses, including heart rate, swallowing rate and movement of the stomach muscles.

The research team will then extend the study to patients with frontotemporal dementia, which can impair social functioning. They will compare the physical experience of social emotions in these participants to participants with Alzheimer’s disease and dementia with Lewy bodies. Patients with Alzheimer’s disease or dementia with Lewy bodies usually have healthy levels of social emotions, but those who have dementia with Lewy bodies often have impaired physiological functioning while those with Alzheimer’s do not.

Their goal is to compare how social emotions look in healthy adults to what happens in the body when social functioning is impaired.

The IRF is designed to provide Lawson scientists and students the opportunity to obtain start-up funds for new projects with the potential to obtain larger funding, be published in a high-impact journal, or provide a clinical benefit to patients. Funding is provided by the clinical departments of London Health Sciences Centre and St. Joseph’s Health Care London, as well as the hospital foundations (London Health Sciences Foundation and St. Joseph’s Health Care Foundation).

Dr. Blayne Welk, a urologist at St. Joseph’s Health Care London, noticed that some of his patients were experiencing depression and other issues following complications related to pelvic mesh-based slings.

“A lot of patients were very emotional telling their story,” notes Dr. Welk.

“They told me about a lot of frustrations related to treatment options for complications. A lot of patients manage for years with problems and didn’t know the source of the issue, or that there is something that can be done to address it. Unfortunately, there are some cases where we can’t fix all the complications, but there are things that we can do to improve the situation. I think a lot of women get frustrated along the journey of finding that solution.” 

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Dr. Welk is also an adjunct scientist with ICES, associate scientist at Lawson Health Research Institute and assistant professor at Western University’s Schulich School of Medicine & Dentistry. Following his observations in the clinic, he led a research project to study the impact of the complications some women were facing. 

“There have been regulatory warnings and lawsuits related to significant transvaginal mesh complications. We wanted to quantify the serious psychological complications that can occur in women as a result of complications from transvaginal midurethral slings,” said Dr. Welk.

Complications are rare but when they happen they can be difficult and challenging to fix, as well as quite impactful for patient lives. They can experience chronic pain, new or changing urinary symptoms and erosions where some of the mesh becomes exposed in surrounding tissue. 

To determine whether women who experience midurethral sling mesh complications requiring surgical intervention have an increased risk of depression or self-harm behaviour, Welk's team tracked the number of Ontario women who needed a follow-up surgery to remove or fix a mesh implant and if they received treatment for depression or self-harm. The study, published in the journal JAMA Surgery, included almost 60,000 women who had the procedure January 2004 through December 2015.

The researchers found that 2. 8 per cent (1586 women) underwent a surgical procedure for a mesh complication. Of those women, 11 per cent (175 women) were treated for depression compared to eight per cent of women (4,470) who didn’t have corrective surgery. Of the women who needed corrective surgery, 2.77 per cent of women suffered from self-harm behaviour compared to only 1.15 per cent of women who did not need corrective surgery. These risks were highest in younger women, in particular those 46 years old and younger.

“Younger women are the ones who are most at risk of these mental health complications. We suspect that’s because of a stronger negative association between the complications and intimacy among this age group. They are also more likely to still be working full-time and raising children.”

The study reinforces some of the consequences that can occur from slings, and that those can be quite serious. 

“It is important to note that a lot of women are going into these operations to improve their quality of life. It’s not necessarily a dangerous condition when you have stress incontinence. There is a decision made to treat it. I think that in those rare cases when someone does experience severe complications, it can lead to decisional regret.”

There is often not an easy solution, with patients often requiring multiple different therapies to address the complications. This can include pain management, surgery, consultations with pain specialists and psychological support along the way. In some cases, removing the mesh does not resolve the pain and it can be very difficult to identify which individuals will benefit from what therapy, including surgery, notes Dr. Welk. 

The researchers add that when women experience midurethral sling complications, both they and their surgeons should be aware of the potential serious psychological impact of these complications.

The article “Midurethral sling complications and the risk of new onset depression or self-harm” is published in JAMA Surgery.

Author block: Blayne Welk, Jennifer Reid, Erin Kelly, You (Maria) Wu.