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About the Institute

Profile of Paul Nathan

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Dr. Paul Nathan

Dr. Paul Nathan, MD, M.Sc., FRCPC

  • Senior Associate Scientist, Child Health Evaluative Sciences
  • Director, Aftercare Program, Haematology/Oncology
  • Staff Oncologist, Haematology/Oncology
  • Professor, Paediatrics and Health Policy, Management & Evaluation, University of Toronto

1. Where are you from?/Where did you study?
I’m originally from South Africa but immigrated to Canada as a teenager, so I completed all of my training here. I went to the University of Toronto for medical school and did a residency in paediatrics and a fellowship in haematology/oncology at SickKids. During my fellowship I completed a Master’s in health research methodology at McMaster in Hamilton. At the end of my fellowship I spent a year at the National Institutes of Health (NIH) in Bethesda, Maryland doing a clinical research fellowship in paediatric oncology.

2. What are you researching right now?
My main interest is long-term outcomes in children and teenagers who have survived cancer. We know that about 80 per cent of children diagnosed with cancer will become long-term survivors. Unfortunately many of them develop long-term side-effects, usually from the therapies we use, such as chemotherapy or radiation. My focus is on determining the particular long-term side-effects these survivors develop, and on figuring out how we can prevent them. A child that is cured of leukemia at age 5 will hopefully have many many years of life ahead of them. My research focuses on ensuring that they are as healthy as possible for that long life, and that its quality is as good as possible.

We’ve just started a five-year study examining cardiac outcomes in childhood cancer survivors. We know that many children treated with a certain class of chemotherapy agents known as anthracyclines are at high risk for developing heart failure as adults. What we’re not sure of is which kids will and which kids won’t ultimately develop these life-threatening complications. Our current research is trying to determine if there are any genetic predictors of why one child or teenager treated with anthracyclines will go on to develop terrible heart disease and why another patient treated with the exact same dose of the drug won’t. We are also looking to find better tools to detect heart disease earlier, such as imaging techniques and blood biomarkers. That’s just one of our projects out of several that are all focused on cancer survivors.

3. Who is your all-time favourite scientist, and why?
I really admire people who can solve problems in their head. I am always amazed when I read about Albert Einstein’s history and the fact that he could understand so much about how the universe works just by doing thought experiments. I’m not sure that I have a favourite scientist, but I admire the way that certain scientists can imagine the unimaginable. This is a fantastic skill.  

4. What in your opinion is the single most important scientific breakthrough, and why?
I think that once we understood DNA and the role that our genes play in causing or modifying disease as well as in determining how we respond to our environment, so much of what we didn’t understand about health and disease became clearer. In my research, the ability to figure out why one patient will develop a life-threatening late effect such as heart disease or a second cancer while another patient exposed to the exact same treatment will not, will be pretty powerful. At some point in the not too distant future we hope that these tools will allow us to personalize the cancer treatment received by each patient – giving just the right type and amount of a drug to kill the tumour while minimizing the risks of long-term side effects.

5. What are your major interests outside the lab?
I’m a runner. I run marathons and I’m actually training for one right now. That means a lot of early mornings. Currently, running is my big passion. I also read a lot, fiction and non-fiction and I’m a family guy. I work a lot so whenever I’m not at work I like to be with my family. One day I’d like to learn to do photography. I have a camera, just not the talent.   

6. Why science?
I think that I chose to be a physician first and a researcher second.

I always liked the idea of being able to work with people and have an impact on their lives and on their health and well-being. There are few more impactful relationships you can have. I gravitated towards a field where patients are quite sick. Paediatric oncology is obviously an area where kids are going through the most difficult experience that one can imagine. To be able to make a difference in this field was something that I found an irresistible calling. Not just in terms of being able to cure patients, which fortunately we can now do for many kids with cancer, but also realizing that there are some kids for who the journey won’t end well, but you can still be a positive light and a support through that difficult journey, both for the child and the family.

Having realized that I liked the clinical side, I also realized that there are so many questions that haven’t been answered. No matter how much progress we make in medicine, we can always do more. I think we’ve got a medical culture that deals a lot with treating disease and very little in terms of promoting health. Realizing that many children who survive cancer will go on to develop other illnesses as a result of the treatment we give them, creates a tremendous opportunity – we can always do better for our patients, and research is one path we need to take to get there.

7. Why SickKids?
Why not SickKids? Since I’ve been at SickKids, I’ve had the opportunity to visit quite a few other institutions and I think there is no place quite like this anywhere. Certainly as a paediatric hospital, it’s world class. As a research institute, not just compared to other paediatric research institutes, but compared to all research institutes in big medical settings, it’s world class.

However, I really think that on top of being a world-class institution, it’s the people at SickKids who make the place. This is just a good place to work. The people are supportive, they are collegial and they clearly love what they’re doing. I think there is a culture at SickKids that makes you proud to be a part of it. To be able to treat patients and do science and feel good about coming to work every day is pretty special.

On top of all this, you can never underestimate what a great city Toronto is. It has so many of the advantages of any big North American city but so few of the disadvantages. It’s clean and it’s safe and it’s vibrant. There’s culture and there’s arts. To be able to work at a place like this, in a city like this, is perfect.  

8. What is the most controversial question in your field right now?
I’m not sure whether this is controversial, but I would say that the realization that some of the therapies that we use for cancer cause considerable harm to the patients is intensely difficult. It is not infrequent that we are faced with a young patient, a baby or a toddler, who we know we have treatments that can cure their cancer, chemotherapy, often radiation, but we know that those treatments are going to come with considerable long term costs. For example, we can now cure the majority of kids with brain tumours but some of them will have very poor long-term outcomes – they may never be able to live or work independently.

I think the difficulty of trying to balance what I think is everyone’s inherent desire, to preserve life, while having the knowledge that sometimes those kids and their families are going to face considerable long-term challenges is very tough. Sitting down with families and trying to paint an honest picture, when all they want is for their child to survive is very difficult and we wrestle with this all the time. I think sometimes there are therapies that we don’t offer because we know how devastating they’ll be and that’s hard too because you’ve maybe taken away a chance of cure because you know the consequences of that cure. The question, at least from a medical standpoint, and I think the research feeds into that, is ‘Can we treat kids in a way that we get the cures that we want to get without the long-term repercussions?’

9. What are you reading right now?
I just finished a great book called Destiny of the Republic: A tale of Madness, Medicine and the Murder of a President by Candice Millard. It is the story of James Garfield, a little known president of the United States in 1880 who was shot by a schizophrenic man just a few months into his presidency. It’s a biography, but it’s written in a really compelling way. It tells the story of how medical incompetence was probably far more likely to have been the cause of his death than the bullet itself and how far we’ve come since then in terms of our understanding of illness and disease.

It was also a fascinating insight into US politics in the late 1800s. The presidents of that time basically walked around unescorted. There was no security and no one ever imagined that people might shoot a president. Lincoln had been shot 20 years earlier but no one thought it would happen again. The Secret Service existed, but their focus was on preventing counterfeiting.

10. If you could give one piece of advice to someone considering a research career, what would it be?
I think researchers come at research from different directions. Some come at it from a pure research standpoint. I came at it as a clinician first. I think it’s really important to make sure that your clinical interests and your research interests are aligned because what you see on the ward and in the clinic everyday are probably the greatest resources for coming up with research questions. So if you can find a way to marry those two things, if you are going to be a clinician-scientist, I think the research constantly feeds your clinical practice and your clinical practice constantly generates new research questions.

11. What does the SickKids Centre for Research and Learning mean to you?
For a very long time, SickKids has had a tremendous clinical service and a tremendous Research Institute. I think what has not happened as well as it could is the integration of these two things. Our hope is that the SickKids Centre for Research and Learning will be a place where clinicians and researchers and everyone in between can come together and share a common vision. Often the people in the clinical trenches seeing patients are not researchers and don’t know what the researchers are doing and vice versa. This will be a breeding ground where ideas can be exchanged.

The other key piece of the tower is the learning component and the ability to continue to grow education as a science – not just the recognition that education is important and that we need to teach, but that how we teach can always be improved. The tower will give us an even greater opportunity to be creative and innovative and to bring it all together in one place.

I can see the building going up from my office window and I’m amazed at how quickly it’s rising. There are exciting things to come. 

March 2012

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