- Clinical epidemiology of respiratory diseases
- Pharmacoepidemiology and health services research in chronic obstructive pulmonary disease (COPD)
- Health effects of tobacco control policies, tobacco use and related products such as electronic cigarettes
- The role of medical journals in knowledge translation and health advocacy
- Medical journalology, peer review research and journal impact metrics
- Education of medical trainees and researchers in critical appraisal and scientific communication
Creative Professional Activity
Physicians have a professional expectation to enact the role of health advocate. Such advocacy can be leveraged with greatest impact when physicians work collectively through national or international organizations. The Canadian Medical Association Journal (CMAJ) is a leading international general medical journal and one of the most prominent platforms for physicians nationally and globally. The CMAJ editorial-writing group regularly expresses the position of the journal on clinical and health policy issues of interest and relevance to a broad public and professional audience. As a Deputy Editor of CMAJ since 2007, I have written or co-authored over 100 editorials on topics including pharmaceutical policy, public health, smoking, research quality and integrity, and clinical medicine. Interviews and media coverage nationally and internationally arising from these have included The Daily Show, The New York Times, CBC television and radio, the Globe and Mail and the National Post. This advocacy work raises awareness and stimulates debate. In some cases, advocacy by CMAJ together with others has been followed by health policy changes. Key examples include include the shutdown of the Canadian asbestos industry after over a century of continuous production, enactment of redesigned warning labels for cigarette packages and public funding for smoking cessation pharmacotherapy, increased public awareness of adverse health consequences of e-cigarettes and energy drinks, and recognition by the judicial system that federal changes to refugee health coverage violate the Canadian Charter of Rights and Freedoms and that Tasers can cause adverse and sometimes lethal health effects.
Chronic obstructive pulmonary disease (COPD) is the 4th leading cause of death in North America and a major cause of morbidity and health resource utilization. Accurate diagnosis of COPD requires direct measurement of lung function (spirometry), but this remains widely underused in clinical practice and we have shown that most patients diagnosed with COPD have never received this testing. We (with key collaborators Kenneth Chapman and Roger Goldstein) have conducted prospective studies to explore more optimal use of pulmonary function testing for diagnosing COPD, particularly in primary care, and to identify factors associated with underdiagnosis and overdiagnosis of COPD. Also, most existing randomized trials have lacked power to demonstrate reductions in mortality with drug therapies currently used in COPD. We (with key collaborators Andrea Gershon and Teresa To) are conducting large observational studies using population health services databases to compare effectiveness of COPD pharmacotherapies in real-world clinical practice. Key findings to date include similar associations of long-acting beta-agonist and long-acting anticholinergic bronchodilators with small increases in risk of cardiovascular events and uncertainty as to which may be more effective for COPD compared to results of randomized trials.
Medical residents are required to undergo training in critical appraisal of the medical literature. Respirology Journal Club, a mandatory component of the Division of Respirology`s residency training program, provides residents with learning and practice in advanced skills of evaluating clinical evidence related to respiratory disorders. At monthly sessions, trainees individually select studies for discussion based on their personal interests while ensuring a breadth of clinical and methodological topics over the year. The trainee prepares a written summary of the study and their critical appraisal of it and presents this orally to the group, followed by a general discussion. A methodological expert serves as faculty advisor (a capacity in which I have served since 2002), facilitates discussion among the trainees and highlights important learning points. A clinical expert drawn from among the Division faculty is often invited to enhance the discussion as well. Since 2013, opportunity to participate in Journal Club has been expanded beyond U of T residents to the world as summaries of discussions are now shared live via Twitter. This initiative has successfully attracted the broader input of faculty locally as well as a large international following. Through Journal Club, trainees acquire and refine the skills they will use for the rest of their medical careers to scrutinize reports of new research and judge whether and how it should change their clinical practice.
- Kenneth R. Wilson Memorial Award for Best Editorial (winner, 2009; nominated on 4 other occasions)
- Division of Respirology Faculty Teaching Award (2014, 2007, 2004)
- Co-Investigator. Respiratory population-based outcomes network: Studies and evaluations (RESPONSE). Canadian Institutes of Health Research (CIHR). (2008-2011)
- Co-Investigator. Establishing and validating evidence-based algorithms and indicators for longitudinal chronic respiratory disease surveillance. Public Health Agency of Canada (PHAC). (2008)
- Co-Principal Investigator. Death in chronic obstructive pulmonary disease (COPD) in the Ontario population. Ontario Thoracic Society. (2007-2009)
- Principal Investigator. Validation of the diagnosis of asthma in the emergency department. Ontario Thoracic Society. (2005-2006)
- Staff Physician, University Health Network
- Associate Professor, Division of Respirology, Department of Medicine
- Researcher, Institute for Clinical Evaluative Sciences (ICES)
- Deputy Editor, Canadian Medical Association Journal (CMAJ)
- Associate Editor, ACP Journal Club
Thesis Supervision (2011+)
- Robert Gabriel Varadi. Beta-blocker Use and Morbidity from Chronic Lung Disease in Patients Undertaking Pulmonary Rehabilitation (2014)