One Hundred Years of Insulin

The 1923 Nobel Prize in Physiology or Medicine was awarded jointly to Canadian physician Frederick Grant Banting (1891-1941) and Scottish biochemist and physiologist John James Macleod (1876-1935) “for the discovery of insulin”. It was a remarkable finding since diabetes mellitus was an untreatable and often lethal disease until then. Much has been written about Banting and Macleod’s breakthrough research conducted at the University of Toronto starting in November 1920, including the key roles played by their trustworthy assistants, medical student Charles Best and biochemist James Collip. On the other hand, much less has been written about the pioneering research of Romanian physiologist Nicolae Paulescu (1869-1931), whose work on the metabolic effects of canine pancreatic extracts predates that of Banting and Macleod but was interrupted by World War I. Should Best, Collip, or Paulescu have also shared the Nobel Prize?

Evolving Paradigm of Precision Medicine in Cardiovascular Disease.

In the year 1892, Sir William Osler, the legendary Canadian physician and one of the four founding professors of Johns Hopkins Hospital, said “If it were not for the great variability among individuals, medicine might as well be a science and not an art”. It is this heterogeneity among patients with seemingly homogenous medical conditions, that form the basis of what we today refer to as precision medicine. The fundamental of precision medicine is based on the tenets of ‘The right drug for the right patient at the right time’. Personalized or precision medicine found immense popularity in oncology. With the completion of Human Genome Project and the advent of genomics, big data and artificial intelligence, 21st century saw rapid progress of precision medicine in predicting, diagnosing and treating cancer. However, the same has not happened to cardiovascular diseases, the biggest killer of humanity. In this review article, we aim to address the concepts, components, outcomes and applications of precision medicine in general, and to review the evolving paradigm of how precision medicine is shaping the management of cardiovascular diseases. We delve deep into the aspects of risk prediction, preventative measures, and targeted therapeutic approaches for cardiovascular diseases. We also look at the recent trends and current applications of precision medicine in this area, the problems they solve and the challenges they possess, and what is in store for the future. Finally, we review the application of artificial intelligence specific to cardiovascular diseases, and the role of precision medicine in interventional cardiology.

Beyond Last Words: Patterns of Linguistic and Interactional Behavior in a Historical Sample of Dying Hospital Patients

Patterns of linguistic and interactional behavior by people at the very end of their lives are not well described, partly because data is difficult to obtain. This paper analyzes descriptions of 486 deaths gathered from 1900 to 1904 in the first-ever clinical study of dying by noted Canadian physician, Sir William Osler. Only 16 patients were noted speaking, and only four canonical last words were reported. The most frequent observation by medical staff was that the deaths were quiet ( n = 30), though range of other behaviors were noted (e.g., moaning, delirium, seeming intention to speak). Osler's problematic study left behind data whose analysis is a small step toward empirically characterizing the linguistic and interactional details of a previously under-described phenomena as well as the importance of the social context in which they occur.

Challenges and opportunities for future Canadian physician-scientists: Perspectives of four experts

In this series of interviews, the Clinical and Investigative Medicine editorial team gathered expert opinions on the future of physician-scientist training and career prospects in Canada. This was inspired by recent publications that voiced concerns over the diminishing support for the physician-scientist in Canada and the United States. For this editorial, the term physician-scientist was intentionally broad and inclusive; referring to individuals who identify both clinical work and biomedical or healthcare research as major components of their career. The following leaders in medical research or research funding shared their perspectives: Roderick R. McInnes; Michel G. Bergeron; Thomas J. Marrie; and Bev J. Holmes.

Osler Centenary Papers: Osler as medical leader

The Canadian physician Sir William Osler is a key figure in the history of modern medicine. He encouraged lifelong learning for doctors, starting with bedside teaching. Contemporary with Old World figures such as Pasteur in Paris and Virchow in Berlin, he played a major role in raising awareness among clinicians of the importance of the scientific basis for the practice of medicine. He championed a rational approach to treatment and did much to encourage avoidance of ‘unnecessary drugging’ by prescribers. He is credited with playing a key role in improving education of medical students and postgraduate education of doctors, with important benefits for the care of hospital patients. He also had a major influence on his medical colleagues through founding and leading medical societies. A century on from his death in December 1919, his specific contributions and how he achieved them are not well known. The aim of this article is to consider the evidence that Osler was an influential medical leader and to reflect on the extent to which the achievements which resulted from his leadership are relevant to modern clinical medicine. Questions of interest include his leadership style, what made for his success as a leader, his medical achievements both in North America and in England, his own insight into leadership and how he was viewed by his peers.