📷 Liza Latta
Journalist: Amy Stewart
AMY: Hello and welcome back to SciSection! I'm your journalist Amy Stewart, for the SciSection radio show broadcasted on CFMU 93.3 FM radio station. We are here today with Dr. Lauren Kelly, a professor of pharmacology at the University of Manitoba and a researcher and clinical trial director of paediatric pharmacology. Thank you so much for joining us today, Dr. Kelly.
DR. KELLY: Thank you so much for having me.
AMY: So, to begin, tell us about your educational and career background and how you got started in your field?
DR. KELLY: Sure, so I did an undergraduate degree at Western in basic medical sciences. And so that’s where I had the opportunity to take a variety of different courses and where I fell in love with toxicology and pharmacology. I got some experiences in undergrad working in laboratories and I knew that really wasn’t the best fit for my skills and for my interests. And that I really preferred working with humans and so I got interested in clinical research and in clinical trials. I actually went to the UK to do my masters because they had a specific master’s in human toxicology. And so I came back to Canada and I started working in the field as a clinical researcher at a hospital in Toronto and I really got interested in furthering my skills as a researcher. And I sort of knew if I ever wanted to do my own research someday, I was going to need a doctorate degree, I was going to need more training and so I went back to Western and I did a PhD in pharmacology working on clinical research projects around opioid exposures in children. And that really solidified my passion for child health research and led me down a path of I did two postdocs after that, and I taught a little bit at a college, and we can maybe chat a little more about sort of some of those steps. And then I secured an academic appointment in September of 2017 so I’m just about 5 years now into my first academic appointment here at the University of Manitoba.
AMY: That’s an awesome career so far. It seems like you find your passion pretty early on and that’s very impressive that you were willing to move away for a program that you really liked. That’s very impressive. For my next question, I wanted to start talking about your research. So, you are the scientific director of the Canadian Childhood Cannabinoid Clinical Trials. Can you tell us what that is and the studies you’re looking to accomplish there?
DR. KELLY: Sure so, C4T is an academic research program, so it’s a group now of over 105 of physicians, pharmacists, nurses, parents, and scientists and we have some youth members as well and essentially
we’re just a grassroots group that came together identifying a huge gap in knowledge around cannabis products being used for medical reasons in children with epilepsy and children with cancer and children with really complex health concerns.
And so we started in 2018 and we do work alongside now the Canadian Paediatric Society and the Public Health Agency of Canada, and Health Canada and to provide really a place for researchers to come together and to collaborate with parents and youth on designing studies to help answer questions about cannabis. And I think in Canada it’s not a surprise that cannabis is being used in a lot of medical reasons and often times without oversight of a healthcare practitioner and so we worry about what products are being used, how much is being used, and in what cases is this actually a safe decisions and how can we support parents and youth in making these decisions and so this group we have a few funded studies right now, we have some funding from the Sick Kids foundation to look at youth with chronic, daily headaches so these are youth that are six months at less into treatment already and are refractory to other medications, so this is not someone’s first headache these are youth who are suffering who are not in school, who are not able to function because of chronic daily headaches - they have to have more than 25 headache days a month. These are severe cases and I think that’s something that we want to also highlight these are complex areas where there’s not good evidence for many of the drugs that we use. And so that’s kind of how our research program started and some of the work that are up too. We also have a team grant in cancer, so we do a lot of work with families right now and we have a study upcoming looking at managing symptoms in children who have been diagnosed with cancer and so that’s really the next study we’re going to be watching.
AMY: That is such a great example of academic collaboration. I love to hear how you have had so many researchers and clinicians to come together to - like you said - target a gap there’s been in treatment of children as well as I think educate people that it’s ok to use cannabis products as a potential treatment option.
DR. KELLY: That’s the big question, right, is that we’re not really sure that it’s ok. And we are looking to answer those questions and really, we haven’t studied cannabis that way, right, a lot of the literature on cannabis is around recreational use or chronic use in adults that might be using for pain or might be smoking and that’s not really what anyone would recommend for paediatrics in a medical indication. We know that CBD has been approved in the US, Europe, Australia, to treat seizures. We know that there is evidence that it can reduce seizures in kids with Dravet syndrome and complex epilepsy and the problem in Canada is that we don’t have that drug available like you can get a prescription for CBD in Canada because that drug doesn’t exist here so the only way they can access CBD is through the medical cannabis system which is obviously not set up for paediatric patients and family so that where
we’re trying to fill the gap with how can we maybe help policy-makers too, think more about families as they’re sort of revising all of the cannabis legislation here to both incentivize research but also, like you said, education is a huge one
and we really are against parents having to get advice about cannabis from google or storefronts, right. This advice should come from physicians and scientists and experts in the field. So, we really have to bridge that gap for sure.
AMY: That is great, that there’s definitely going to be some sound research behind it before parents go and try it for their child, that’s really great to hear. My next question about your research is that your lab also investigates opioid use in pregnancy, can you tell us a little bit about that and how your research is going in that domain?
DR. KELLY: Yeah so, I have a couple of different areas and obviously the medical cannabis and opioids are the two main areas that our lab focuses on. So, we’ve been studying opioid exposures in pregnancy for a while and working with families affected by opioid use in pregnancy to identify what outcomes are important for that. When we’re doing research, what do you want to know and how do you know, how do you know that your baby is either doing better or worse and what should we include in research that is important to families because everyone has different priorities, and we need to make sure their voices are heard when we’re are designing research. And so, some of the studies we have ongoing are using administrative data to look at long term health outcomes so trying to tease out babies who were exposed to opioids only versus babies that are exposed to opioids and other substances nicotine, alcohol, other prescriptions that might influence long term outcomes. And so we also have a project under review right now that will be the first observational cohort study in pregnancy so we’re really interested in looking at how opioids transfer to breast milk, looking at how we can support breastfeeding and chestfeeding in people who are using opioids in pregnancy, and how we can better care for infants, and how we can better prepares families once infants are born, there is a likelihood they can develop withdrawal the same way that if you discontinue opioids in adults that’s been exposed to opioids, they can develop withdrawal and the same thing, we know what can happen at birth. And so I think there’s not only a lot of research about what maybe babies are more likely to develop withdrawal and how we manage withdrawal there’s actually a lot of science that is missing around like what the actual impact of withdrawal is on the brain, the neonatal brain and different treatment options. So, in the states there’s a few other treatment options that we don’t have available here in Canada. And it kind of underpins another theme of my research programs is we are studying off-label medications in some of smallest and most vulnerable patients and that’s really because we don’t have those kinds of formulations approved here and so my kind of research program and long-term strategy in both of those is really to advocate for some regulatory incentives for paediatric care development.
AMY: That is again another fascinating area of research, I feel like the idea of looking at the effects of opioids on infants and young children is like pretty unheard of, I feel like people would think that it’s kind of counterintuitive to look at the after affects as opposed to treating the person who has the addiction, but I think it’s a lot more of a realistic and kind of helpful way to approach that kind of problem and the outcome afterwards. For my next question, in all your research you’ve investigated topics that affect so many vulnerable communities, like we just talked about, mothers, fetuses, people who are addicted to drugs, what are some challenges you face when designing clinical trials and studies for these people?
DR. KELLY: I mean there’s all kinds of challenges and I would say that I don’t know that they’re necessarily specific to some of the populations I work with. I think that representing patient voices in clinical trial design is a bit of a shift for all trialists I think. In just, no longer is it acceptable to have one patient tell you that your trial is a good idea, we’re really looking at actual methods like how do we integrate multiple voices of different and diverse backgrounds that are affected. No more is it just like that one patient-partner that every team has that does all the advising but how to meaningfully do that. So, we recently set up a payment advisory group for our opioids in pregnancy project. And even just things like how do we pay people and well not everyone has a fixed address and so not everyone can accept a cheque and some people may require pickup or drop off. And just being flexible with how we approach administrative policy, and pushing back on a lot of the things that have been set up that are conducive to more of the modern world. So, a lot of administrative policies have been in place for a long time before things like virtual gift cards and e-transfers were really possible and so I think challenging some of the systems around how we compensate and engage with these communities is really something that has been a side passion project as we’ve been doing some of this work. And then of course making sure that everyone feels safe and is protected, so things like you know instead of signing a letter of support individually, but they can sign it as a group. Those kinds of things.
Just trying to learn as we go and really listen more maybe than we decide, I think would probably be my best advice when working with vulnerable populations. If you’re not listening more than you’re talking then you’re probably doing it wrong.
AMY: That is some very good advice, I also like how you mentioned it applies to all clinical trials like you’re setting a precedent by being more accessible and flexible as opposed to just offering these options to these people in these vulnerable groups because you don’t always know what’s going on in someone’s personal situation.
At the end of the day, clinical trials are only going to answer meaningful questions if we can recruit the people and we can keep them in the trail to collect the data. So, if we’re not designing good trials that are meaningful to the people involved, what incentivizes them to stay in our trail and to give us their information. Participating in clinical trials is a huge burden right, we’re asking for data all the time, sometimes daily in our studies. And so, I just think that we need to do a better job and I think that whether they’re vulnerable or not this applies to really everyone.
AMY: That’s very exciting to see research that is done in such an ethical and considering way and taking into account that the people we’re getting the data from are the most important part of the study and it’s not just the data we get form them but how we treat them is very important. For my last question, I wanted to know What is some advice you would offer to your undergraduate self? I mean a lot of our viewers are undergraduate students who wish to pursue a career potentially similar to yours, so what would you offer advice to yourself about?
DR. KELLY: I think I would say that you don’t have to work in a wet lab. Like all science isn’t mice experiments and if benchwork is not for you there is still a huge potential for you to be involved in science and I think that’s something I wish that I knew earlier because I was fortunate to have a lecture by someone that I stalked after class to then find out about working with because that was the first time I heard someone say “oh we look at this in human hair and that’s how we’re answering this question”. And I thought “oh wait, so I could work with people” and I think that’s something undergraduate students maybe don’t necessarily get a lot of exposure to. There’s a whole like, hospitals, research institutes, we all hire clinical research associates, research coordinators that get to be patient facing, that get to design recruitment materials and work on communications. And so, I think that I would sort of tell myself to trust that I could find a different path that could still have me contributing to the field in a meaningful way but that was better suited to my skills and interests. And so, I think my best advice would be to, yes move overseas, move towns, that’s another piece of good advice is to just trust your gut and if there is something that you’re passionate about make that path work for you.
AMY: That is some very good advice, I think you make a great point I feel like a lot of students feel that have to pick between the MD route and the research route because they fear if they become a researcher, they won’t be patient facing as you said, it has that more stereotypical “always in the lab”, secluded kind of vibe.
DR. KELLY: Yeah, and that’s not the case and I mean our team works virtually too, a lot of my team doesn’t live where I live and now with the pandemic too, I think that’s opening up to a lot more remote working options which can hopefully give people also that may not be in more clinical research environments or more rural, remote settings, the opportunity to pursue some of these careers too. So hopefully we see some decentralization happening in the next few years.
AMY: Well thank you so much for joining us today, Dr. Kelly, it was so great to hear about all of the difficult questions you’re answering and how you’re prioritizing ethical science and ethical research. I think you make a great role model for so many students out there and other researchers who wish to follow in your footsteps.
DR. KELLY: Well thank you so much for inviting me and I’m happy to chat with anyone who’s interested, you can find me online and hopefully you can share my contact info.
AMY: That’s it for this week of SciSection! I'm your host Amy Stewart and check out our website humans and science and podcast platforms to hear our other interviews.
Reach out to Dr. Kelly with any questions @PharmaLauren on twitter!