Contents

• Want to be Immune to the "Don't know what I'm doing" Syndrome
• Dealing with Mortality
• Welcome to the World of Pharmacology & Toxicology

Pre-Med Society News

Want to be Immune to the "Don't know what I'm doing" Syndrome
by Cath Lam and Douglas Wan 

Do you plod from class to class having no idea where you're headed in the long run?  Here are some pearls of wisdom & inspiration from an interview with Dr. B.H. Barber, Professor & Immunology Specialist Undergraduate Secretary 

"To serve your education well, your effort as students shouldn't end with lecture material, but begin with them.  A nice-looking transcript may not take you where you want to go!  How do you decide between pharmacology and biochemistry?  It's hard to gain a true reflection of a field from first-year lectures or even some second-year courses -- the only way is to inform yourself! It's the students who take the initiative to read journals and papers that not only know what field they want to pursue and why, but the ones that go on to succeed in them!" 

What sets immunology apart from the crowd of other studies? 
"Immunology is in itself interdisciplinary; it covers not only transgenic xenotransplants, AIDS, HIV, and allergies but also X-ray crystallography, antibodies, molecular mediators of the immune response and the circulation of cells in intact animals.  The program allows its students to choose from many possible venues.  These research areas are all quite different, which are studied right here on campus.  Immunology is very powerful in terms of the new technology and procedures possible.  Growth can be quite rapid, too -- things like kidney transplants that used to be as outrageous as Star Wars in the 1970s are now routinely successful procedures." 

What advice do you have for first and second-year students trying to decide on their field? 

"First and foremost, read.  If you're interested in immunology, start with basic immunology texts.  Beyond that, there's a variety of, if you want, "popular" science publications.  There's no good in picking up the Journal of Immunology to start off -- not surprisingly, you'll find it meaningless.  Find your own level of entry.  The Scientific American is well-known, of course, but there are also very good magazines like the New Scientist, which is published weekly and discusses the red hot frontiers of everything from astrophysics to molecular biology.  You may get the mechanics in BIO 150, but to really get a sense of the excitement and perspectives in a field you need to go beyond your lectures.  See what sparks your interest, then seek advice to coach and focus your reading.  There's a huge resource of faculty and staff available to give informal advice, and that's one of the major advantages of being at U of T that students don't often take note of.  If someone knocks on my door and asks me to tell them about the "wonders of immunology," where would I start?  But if students come and they have obviously done some research, we'll definitely help you get started, answer some questions or point you towards a grad student working on a related project, and so on." 

What does the department look for in summer research student candidates?  (i.e. How can we get through the door?!) 
"We don't make work for students to scrub and label -- with scarce research funds, we are looking for students with the knowledge base that lets them contribute and understand the context of what they are doing in the labs.  Almost all of the 20 or so selected from a pool of about 200 applicants annually (hint for next year -- deadlines were in January!)  have finished third year, taken their first course in immunology and understand some of the specialized terminology.  Generally even fourth-year students aren't all that appealing, because we want those who have a genuine interest in research and are not just looking for a job to fill the gap before they move on to graduate school or something else." 

MYTHS 101Y:  a two-minute course in what not to believe about Immunology 

What are some of the myths and misconceptions students have about the Immunology program? 

"The public really gets very little exposure to what the program is about, even if you're a third-year science student.  If I meet someone on the street and they ask me what I do and what is immunology, I tend to tell them about the transplants and the vaccines, because those things are what the public can relate to, maybe has experienced, or read about in the news.  But are they the sole core and essence of immunology?  Definitely not. 
“Neighbours at street parties always say, 'Everyone in the immunology department must be working on AIDS...'  In fact, of the 50 or so members of the faculty, no more than a few would claim to be involved in directly related medical applications.  Everyone is working toward building fundamental understanding and gaining insights into basic biology -- but many immunologists are not studying this field for its inherent potential to alter the state of human health, but just to examine and solve interesting developmental biology puzzles.  Although some of what we uncover may end up being useful applications in terms of therapy and disease prevention, that's not the absolute central focus or goal of this program. 

It's important to see, I believe, that the more heavily applied aspects of vaccines and immunotherapies and the basic studies of respiratory mechanisms, for example, feed on one another -- working more on one aspect doesn't mean diminishing the efforts of the other, and you need both." 

OOH la la!!  Immunology has nothing to do with getting into medical school? 

"Here's a pretty solid myth for you:  whoever gets into immunology has a ticket to med school.  No!  The two are totally unrelated, in terms of getting in or in what you study!  Immunology in itself does not have to deal with medicine.  While there's a high rate of immunology students enrolling in med school from immunology, along with the law students, Rhodes scholars and Olympic medalists, their success is a result of the student's excellence to begin with." 
(i.e. DO NOT choose immunology because you think it will lead you to med school!) 

For a student, what is the best thing about being in the immunology program? 

"It's a good environment -- it's a very high-achieving group of individuals in a solid and rigorous program; you learn from one another and share experiences regarding each other’s research.  The small number enrolled helps, too -- what works for a setting with 40 students may not work if there were 180." 

In your opinion, is there a high level of satisfaction amongst students in the program? 
"From what I can see...for those who really immerse themselves in the program and dig into the research, I'd say, yes." 

Do you find there to be a shift in the focus of the department these days? 

"Well, I don't know if it is shifting much, but there are somewhat more applied linkages and relations to major federal efforts because of funding pressure.  There are people who think that we may be stepping on a slippery slope and that university research will become commercialized "handmaidens of the industry," but it doesn't have to be that way.  So long as we pay close attention to make sure the initiatives are academically driven and the relationship is balanced, it is a win-win situation.  Nothing is ever going to be made in our lab and be ready for someone to use on St. George -- we have the innovative resources and insight to think up ideas in our labs, but to harvest the idea, scale it up and make it something of functional benefit to the general public, we need the commercial sector." 

So, now you have your free immunization shot against the "don't-know-what-I'm-doing-and-how-will-I-get-there" syndrome.  How your immune system responds is up to you...

Dealing with Mortality
By Henry Cheng 

“We’re dying the day that we were born”

This paradox may sound absurd, yet, like all paradoxes, it holds a certain element of truth. Death is inevitable and the time separating our birth to the hour of our death is finite. The exact time period varies with each person, yet the difference does not change the fact that we are constantly dying. 

Of course, most of us do not ponder our own deaths, and most people in this modern age live for relatively long lives. The reason behind longer lives lies in advances in medicine, health care, and general hygiene.   However, we are no closer to immortality than our ancient primitive ancestors. Disease, pain, injury and illness still plague our lives in various forms. On most occasions they are not deadly and life is prolonged with the aid of modern medicine. There are occasions  when medicine and treatment fail and it is no longer possible to relieve a patient’s suffering from a particular disease, injury or other. Examples of such cases include people with severe physical injuries, HIV sufferers, cancer patients and those suffering from old age or poor health. When such a situation arises, there are generally three types of people involved: the patient; the doctor, who, despite his or her knowledge and expertise, is unable to aid the patient; and loved ones who hold the life of the patient as precious and dear. 

The first person to be addressed in such a situation is the doctor. A doctor’s role is precarious indeed when dealing with the death of a patient. Kai  Y. NG, ACP Medical Student Member, says it is “like you have nothing left to give.” A doctor is armed normally with extensive knowledge of the medical arts, yet when dealing with the fact that those arts have failed, one comes to rely on something not provided in medical school namely, the individuality and personality of the doctor. Doctors are professionals, yet they are also human beings, and when tackling such a situation, many difficulties arise. 

Generally, the first course of action is to alleviate the situation of a dying patient. As Lois Snyder, JD, ACP’s Counsel for Ethics and Legal Affairs puts it: “Cure, yes, whenever possible, but comfort and care always.” The tools available to a doctor consist of pain killers such as morphine if the patient is in intense physical pain, physical treatments, and various drugs. However, a doctor is really not trained for such a situation, because a patient facing death requires attention, consolation and knowledge of his own situation. If one is conscious and faced with the prospect of death a patient will begin to contemplate his life, but most difficult of all is acceptance of the fact that death is imminent. A doctor may be knowledgeable in most situations, except in expressing and conveying the disturbing fact to the patient himself. A patient is a stranger, yet a doctor holds vital and sensitive information pertaining to that patient. Generally, the natural inclination for most people would be comforting words, yet that destroys the ability of the patient to face the basic facts, and it also alienates the doctor from the patient, since the patient still considers the doctor a professional with information, and not as a loved one. A doctor should convey the exact nature of the patient’s imminent death, including what degree of pain to expect, and in the process reassure him that he would provide all possible aid. This way, the patient receives reassurance and confidence from the physician. 

 In this discussion we have neglected the fact that a doctor is still human. Whether one is a doctor or not, facing the death of an individual can be a traumatic event. The difference is that a doctor encounters the event more often than most people. For example, pediatricians tend to encounter babies who are born prematurely and many of which die within hours of birth. The baby may die of weak lungs or general physical failures that are beyond the doctor’s control. Yet when encountering events that occur so often, there can be a numbing effect. As pediatrician Dr. Juan Chuy of Chicago General Hospital puts it, “You see the situation so often that one tends not to think about it.  It might also affect your performance.” The situation must be accepted and the physician just moves on. Yet a physician’s duty is to care for patients with whatever skills they possess. Dr. Chuy says “Many patients come to me because there is a large Hispanic population and my ability to speak Spanish allows for better communication and comfort.” Communication might be the best treatment available. 

 Of course we cannot neglect the two other groups involved, namely the patient himself and loved ones. This is beyond the realm of medical science and services since it boils down to the fact that patients require support and attention. Loneliness and alienation, coupled with misunderstanding, tend to aggravate the situation. Medical services can only provide social counseling, which is an area not fully developed.  The psychology can be varied, but one serious, complex and controversial issue that has risen is assisted suicide. A patient has full knowledge of his death and prefers a shorter path; the only person who can provide that option is the physician. This issue is beyond the scope of this paper, but it reveals the fact that a patient wishes mainly to remove the physical pain that might be involved in death, an area in which a physician has the capability, since it is a clinical procedure. 

 Loved ones are a vital factor, since they are the ones who receive the information. If the patient is a baby, or is not physically conscious in any way, then the loved ones are the only ones aware of the impending death. Delivery of such devastating news is generally not assigned to a doctor but rather to a trained counselor though the physician still plays an integral part. The same rules apply, including straightforward communication of basic facts combined with psychological counseling. Communication and plain contact between loved ones and the patient can remove much of the emotional and physical pain involved. Simple acts like holding hands, final words and arrangements after death can provide more comfort to a patient than pain killers and drugs. 

 The death of an individual involves more people than the individual himself. Doctors, counselors, nurses, relatives, and friends must also endure the ordeal. Each group must cope with a terminal situation to one’s best ability. As Heraclitus put it: “We are living each other’s death, dying each other’s life.” 

Source:  http://www.acponline.org/journals/news/oct96/care4die.htm

Welcome to the World of Pharmacology & Toxicology
By Soo Jin Seung with William Cheng and Clinton Wong 

Pharmacology is a relatively new discipline that stems from physiology.  Nowadays, we find ourselves bridging the gap between biochemistry and physiology.  Toxicology, itself a branch of pharmacology, has become its own discipline. 

 Many students wonder what exactly pharmacology and toxicology are.  First of all, pharmacology is not pharmacy.  While pharmacists spend their lives counting drugs and making up prescriptions, pharmacologists are on the frontier of discovering new drugs and charting their effects on our bodies.  But what would a degree in pharmacology get you?  Qualified pharmacologists are in high demand in universities, hospitals, pharmaceutical companies, and government agencies. 

 Toxicology, on the other hand, deals with the harmful biological effects caused by chemicals.  These chemicals can be drugs, synthetic compounds, or agents originating from nature itself.  However, current studies emphasize the problems derived from overabundant chemical use in society.  Qualified toxicologists are also sought out by companies in pharmaceuticals,  agencies, and academia. 

 At the University of Toronto, both Pharmacology and Toxicology are offered as four-year specialist programs.  But the university also offers a unique five-year double specialist program in these two fields.  For more information, you can contact the Undergraduate Secretary Dr. D. Kadar, or drop by his office on the fourth floor of the Medical Sciences Building. 

Now that the educational protocol has been dealt with, on to the inside stuff, brought to you by a double specialist in her fourth year of the program.  No other program in the Basic Medical Sciences comes close to Pharm/Tox when it comes to diversity and degree of application, not to mention the phenomenal professors who work in the department.  To begin there are two lab courses, Biochemical Techniques and Mammalian Physiology (BCH 370H and PSL372H), which introduce Pharm students to the laboratory skills required in today’s labs.  Meanwhile, Tox students get their first taste of Pathobiology  (PCL 363F and PCL 364S) and will surely get hooked.  Is there anything more interesting than the mechanism of disease and neoplasia (cancer)?  Then, there is the perennial favourite Biological Principles of Pharmacology (PCL 360Y).  Even if you go insane and decide Pharm/Tox is not for you, this course is highly recommended just because of all of the fascinating, obscure facts you’ll learn. 

 If you continue to knock on the Pharm/Tox door, three major courses remain in your way. 
Systems Pharmacology (PCL 470Y) is a jammed-packed course with information set out in a lecture-style setting, (i.e. multiple choice tests), while Interdisciplinary Toxicology (PCL 473Y) involves detailed assignments and a wide range of speakers, such as professionals in forensic toxicology and environment toxicology.  And the lab component, PCL 471Y, keeps you on your toes in terms of laboratory skills as well as knowledge. 

 And in case you find yourself stranded like being without old tests or being too intimidated to approach a particular prof, there is the Pharmacology / Toxicology Association (PTA) to lend a hand.  Soo Jin Seung is this year’s president and already the PTA held a Professor Luncheon.  Feel free to visit the PTA’s website at http://www library.utoronto.ca/www/pta or drop us a line in our Course League mailbox in MSB 4207. 

Pre-Med Society News
By Bhavana Sawhney 
President of the Pre-Med Society at U of T 

Pre-Med students are constantly seeking answers to questions with regards to Medical School Admissions.  To ease the lives of the U of T pre-med population, HBSU (Human Biology Student Union) in association with the Pre-Med Society, arranged an Ontario Medical School Admission Symposium on March 12 and 13. 

Here is an outline of the basic requirements for 1998 admissions for those of you who could not make it to the meeting:

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