We recently sat down with Dr. Alex Henri-Bhargava, the Clinical Skills Site Director for the Island Medical Program (IMP), to discuss his recent Walrus Talk, entitled “Dementia: the last frontier of quality of life.”
In his presentation, Dr. Henri-Bhargava calls for an interdisciplinary approach to brain medicine, as well as the implementation of a rapid learning healthcare system. If healthcare professions collaborate more closely with each other and with scientists, he argues, then we’ll be better equipped to understand and treat debilitating neurological disorders, like Alzheimer’s. See his full talk on YouTube.
What do you mean by the “last frontier” in the title of your talk?
Many people prepare for a certain quality of life. They make plans for saving up, downsizing, and ensuring their affairs are in order before they retire. Then dementia hits them. It’s the one thing they can’t do much about, and it has a devastating impact on their quality of life. But dementia is just one piece of a complicated puzzle – the puzzle of helping our aging population live well more generally.
You talk about a Rapid Learning Healthcare System – what is this and why is it important?
This refers to the way we deliver care. Right now, the way we acquire knowledge in medicine is very top-down. A bunch of smart people will make a discovery in a lab. Then that discovery – sometimes years later – moves into the clinical sphere, where it’s translated into a new surgery, for example, or a new drug.
But in a Rapid Learning Healthcare System, researchers have access to the patient information that doctors collect every day, which is then used to drive discoveries that can be quickly fed back to clinicians for immediate use. For example, neurologists across the country could use a standardized assessment to test for dementia. Many patients would take this assessment, meaning there’d be a large pool of data. Researchers, who would have access to this data, may discover that the first three questions of the assessment give neurologists all the information they need to make an accurate diagnosis, therefore cutting down the time required for assessment. This discovery is then shared with neurologists in real time, who can then implement it right away. This evolved healthcare system allows for faster discovery, less waste, and ultimately better treatment for patients.
What is the Interdisciplinary Brain Medicine initiative?
This is about the future education of healthcare professionals. There are many different types of brain conditions out there. How we diagnose and treat these conditions is rapidly expanding – but it’s expanding in medicinal silos. The Interdisciplinary Brain Medicine initiative wants to solve this by equipping specialists with the knowledge of other fields. For example, if I as a neurologist know more about mood disorders – treated by psychiatrists – then I’ll have a better idea of how to manage a patient with Parkinson’s who is also suffering from depression.
It’s been a challenging initiative to organize, but we submitted our application for the development of this program to the Royal College of Physicians and Surgeons of Canada in September. We’re focused on bringing together six feeder specialties – psychiatry, geriatric psychiatry, neurology, geriatric medicine, neurosurgery, and physical medicine rehabilitation.
Do you see the eradication of certain neurological disorders, perhaps all of them, within 50 years?
That’s a possibility – and if not the eradication, then a modification of the effects these diseases have on people. We’ll soon be testing the limits of human longevity. Some argue that many forms of later-life dementia are the bi-products of a degenerating brain: that is, the brain has a certain life expectancy, and eventually it outlives its cycle. But I don’t agree with that argument. There are many examples of people in their late 90s who are successful and cognitively intact without dementia. They may be outliers, and if they are, then we should try and push humanity towards that outlier status.
Do you see gene editing as a way to combat neurological conditions?
I don’t know about this yet for dementia, but gene editing is already becoming a reality for some conditions. For example, I have a close friend who has Hunter’s Syndrome – a rare genetic illness that afflicts maybe six other people in Canada. He’s been told multiple times that he’ll die within the year. One of the reasons he’s still alive is because he took part in an enzyme replacement trial. That medication has since been approved, and he still takes it. Now, he’s about to embark on a new clinical trial with a gene-altering tool, where they’ll program a virus to reinsert the gene that he’s missing. That’s very exciting. But there’s the dangers of gene editing – of playing God, essentially. That’s why the social sciences are important: we need to ensure the tools we develop are used in ethical and careful ways.
Dr. Henri-Bhargava completed his MD, CM and neurology residency at McGill University. He then completed a fellowship in behavioral neurology at the University of Toronto, where he’s currently completing a Masters in Health Practitioner Teacher Education. He moved back to Victoria in 2012, and has since built a successful clinical practice and participated in several clinical research projects.