Journalist: Kian Yousefi Kousha
Kian: Welcome to SciSection, I'm Kian and I'm bringing you this week's Scientist of the Week segment. We are honored today to have Dr. Mohit Bhandari, professor and associate chair of research at McMaster University’s Department of Surgery and Canada Research Chair in Evidence based Orthopedics. Thanks for coming to our show Dr. Bhandari!
Dr. Bhandari: I'm delighted to be here, Kian.
Kian: It's our pleasure. So let's start with some fun questions that our audience can get to know you better. Is that OK?
Dr. Bhandari: absolutely. Sure.
Kian: what makes you laugh the most?
Dr. Bhandari: Well, actually, I would say watching my 12 year old daughter, basically all the time.
I mean, I laugh a lot with her. So it brings me great joy to have her in my life.
Kian: That sounds awesome. And if you could meet or work with any scientist dead or alive, who would it be?
Dr. Bhandari: Let me think here, I would have to say I've been particularly interested, now I’m not by any means a neuroscientist, i’m not by any means a basic scientist but, Richard Feynman is someone that I have watched a lot of videos on, and I suspect your viewers know who he is. But for me, it was not a fact that he won the Nobel Prize in the early 1960’s I think, but it was the fact that he had so many other interests. I am a drummer and so I was very attracted to the fact that he enjoyed playing the drums and bongos and had all kinds of other creative interests. So for me, it was a lot of his creative side as well and his curiosity that excited me.
Kian: That sounds awesome. Moving on to your professional life, You're the founder of Ortho Evidence, which is a knowledge dissemination tool in orthopedics. Can you tell us why you decided to found OrthoEvidence and what is its importance for the orthopedic community?
Dr. Bhandari: Sure. You know, the big challenge that I had was I spent a big part of my life, working and developing research and publishing papers, and we would do all this research. We'd spent years and millions of dollars from government funding, and then we wouldn't have a portal to get that message out to the rest of the world. And the challenge we were facing was, and the most common question I get asked around the world when I presented the work was “Dr. Bandari, how do you keep up with information?”. It was fine 20, 30 years ago when there was a single journal, but, even yourself as a student, you realize that the volume of information now is 100 fold, 1000 fold and it continues to double every five years. So, Orthoevidence really was a tool to say, as there are other areas within orthopedics to say, let us do the heavy lifting. Let us look around the World Wide Web, let us find the best available scientific evidence. Let's filter it down, let's critique it, and let's make key summaries so people can get bite sized insights, but they can do it in a way that gives them a chance to keep up with the world literature. So let me just give you one other statement that I think puts in perspective, in modern day right now if we were to rely on a single journal and say, you know, we're going to get all our knowledge from a single journal in our field in orthopedic surgery, you would end up missing 90 percent of the best available science that's out there. So we can no longer rely on that, there are about one hundred and sixty some odd journals in orthopedic surgery alone, that one should be reading. It's impossible. So, the purpose was almost like, I wouldn't say close notes because some of your viewers probably don't know what close notes are. But it was a summarized version of scientific evidence, critiqued and appraised.
Kian: That sounds awesome and for sure it is important to have this knowledge about dissemination because a lot of times the public feels disconnected from science because of the reason that you mentioned, because it's too much information and they don't feel as if they have access to all of this information.
Dr. Bhandari: Absolutely.
Kian:So with regards to your career, we see a lot that it is evidence based, can you tell us about evidence based sciences and research?
Dr. Bhandari: Sure. If you look at COVID, what's happened in the recent months, we were part of what the WHO called an info epidemic. March 11th is when they declared the pandemic globally and they said, listen, there's going to be a lot of information coming out. We've got to get to the best stuff. So what is high quality evidence? And I think that's the purpose of evidence based medicine. That purpose of evidence based medicine is to ask questions that are going to be important to patients. But if you're talking about evidence in a broader sense of science, it's just asking important questions that matter to people. From that, you go backwards and you say, OK, what are the tools that we have at our display at this point to be able to answer these questions in the most valid way? We in experimental research use the word randomized clinical trial, that may be something that a lot of the viewers or a lot of your listeners may be interested in. But, you know, it is an experimental design that tries to limit bias. I mean, humans have a desire to say, I believe something. And, you know, in your own desire for something to happen can make it happen if we don't build in safeguards. So, so much evidence based practice and the way we think about it is to find high quality research towards signals and try to limit the degree of noise. There's lots of reasons, Kian, why noise infiltrates the system. And we just saw it in COVID. There’s many, many reasons, political, commercial, conflicts of interest, all sorts of things get in the way.
Kian: For sure, and especially important in these times that we are in with a lot of false information actually being moved from one hand to the other.
Dr. Bhandari: Oh, and you know what I'll do. So, I'd like you to take a guess, you know, an educated guess on how many papers do you think were published between January one and end of March? Well, that first three month period, just under twelve weeks or so when we were in the peak of the COVID. Now, how many papers do you think on COVID were published during that three month period from start to beginning?
Kian: I assume many scientists might have been aware of it. So probably around 100?
Dr. Bhandari: 100! So would you be shocked that it was seventeen hundred and forty three papers were published 12 weeks, and by the way, if you've ever submitted a paper for publication, you will realize that the process itself can often take a year to get. And then for the paper to actually make it into the journal can sometimes be 18 months, sometimes even two years, so it can be long. These papers from the time they were submitted to the time they were in the journal, on average were 10 days. So when things are rushed, what happens? Right, there's risk of problems. So that's when noise gets into the system. It was a hot topic and everyone was jumping on board. And that is really the reason why we have to be really cautious, especially in times of crisis where information is everywhere. And then you as an individual have to say, how do I figure out what is true and what is not.
Kian: For sure when it comes to science, usually we are dealing with uncertainty. So when it comes, for example, to finding that if eating breakfast in the morning is useful or not, when the public is certainly not really interested in science, wants to get the answer, they try to look for the answer, but they find conflicting solutions to the problem. So with regards to breakfast, some sources say that you have to have breakfast. Some say it's not necessary. And that is kind of the nature of science, that uncertainty. So is there any solution for this, so the public doesn't get bored with this uncertainty in sciences and at the same time, we can also have a nice solution for them?
Dr. Bhandari: Well, I wish there was a solution, because what we have seen historically is, you know, one type of nutritional supplement or diet approach is in favor. There's lots of publications and then a secondary approach comes forward and it debunks the first one and then people start questioning it. The biggest challenge right now is we should be very, very cautious in a single study to ever make the leap to say we have answered the question. I don't believe that happens very often. In fact, most studies that were conducted, especially those that are conducted in patients or whether it's in humans, in human research, clinical research, we say requires reproducibility. That's the big part of it. Also small studies of a few hundred patients often have very different findings from studies of 1000 or 10000 patients. And there's lots of reasons why that is. But the fundamental point is that we often cherry pick or the media, let's say as an example, could cherry pick ideas that are either newsworthy but also hit a narrative. They know that this is going to strike a chord and they will use that narrative. We've seen that happen in COVID a lot where one treatment works and then one doesn’t. So the big thing here is we need to see enough history of reproducibility. It needs to be reproduced in many, many different populations as well as in many different countries and many different types of studies. So, the more we see the more comfort we get this may in fact be a true signal over the noise.
Kian: For sure, and with your experience in regards with evidence based research do you think the public can trust in evidence based research and their procedures, since sometimes a lot of us may be comfortable with what has been done before compared to what research says?
Dr. Bhandari: Well, I think the whole paradigm of why evidence based medicine was created was to be more skeptical on exactly what the experts are saying, so if you look at Silicon Valley for example, look at the entrepreneurs, they look at experts as kind of problematic, they say well the experts predicting the future, they’re actually looking at their own last 15 cases and they say, look I do well with this procedure cause you see I’ve had no problems. There are a lot of inherent biases where these approaches work since we don’t have a control. The power that evidence based medicine came on and said you know what, there are different hierarchies at the way we look at information, there is the expert, which we would consider to be, quite frankly, one of the lower levels of evidence, then there might be the series of patients. So the expert says, OK, don't just believe me. Look, I have fifteen hundred, I have five hundred patients that I've treated with this problem. And look, they've all been successful. That's one level up in terms of quality, because you said, OK, at least now we have a series of patients in which not just your belief. One level up as well, you have out of control will listen in patients who got this treatment here the outcomes were. But patients who didn't get this treatment here were the outcomes. And in fact, you can see my treatment led to better outcomes. OK, that's still better than not. But the very, very most powerful tool we have, and I mentioned it to you already, was randomization, which is that the doc and the patient don't know what they've received. It's hard in surgery because you have to do the procedure.But I would say it was a pill. Let's say it was one of the treatments for COVID. You'd want that that you'd want the patient not to know what they received and the physician not to know what they received because we call it a blinded study. And in doing that, if there is a difference, you can attribute for the most part, that difference hopefully to the fact that they received, you know, an active or a placebo treatment. That's a very powerful design and was one of the big reasons why the movement itself has been so strong. So I would say that patients, community members, you know, scientists typically believe in that same paradigm, which is a good scientific experiment, leading to a result far more than here's what I did before and it seems to work.
Kian: That sounds awesome and it's really interesting to see where this evidence based research goes in the future and what the future holds for it. Now, moving on to your personal life.I’m sure you lead a very busy life. What activities do you rely on to balance your professional life?
📷 McMaster Surgery
Dr. Bhandari: Well, you know, let me tell you this. I have for the last probably two years changed the paradigm with which I tend to work. I used to believe and I suspect there are many early career students that are graduate students. And there are probably lots and lots of people just working, you know, early career profs who have the same belief, which is success comes from doing more of the same. Just if, you know, if I write five publications, I should write five hundred since five hundred can be better than five. The more I write, the better I'm going to get. And that approach of doing more of the same. So if a little bit of work got me success, more work will give me more, eventually will plateau. And I came to that realization about two years ago and because of that I switched out the way I think. And if you'll indulge me, I'll tell you a little bit about what I do now, which is I think for me personally, fundamentally changed the way I work, but also fundamentally improved the enjoyment with which my work habits. So I use this acronym now called THINK, the ‘T’ for me is to try new things.
So I now am looking for new activities, new things to try. I don't have to be great at them, I don’t have to be very good at them. I just have to be able to try them and experience different things, whether it's new people, new collaborations, working with new students, traveling, you know, all the different things that could be out there, including being a bit more risk taking in the work I do. It's easy to say, but hard to do is ultimately you have to have fun, if you don't enjoy what you do in your day to day life, it will absolutely impact you and will impact the people around you. So rather than, say, passion, I think that word is overused and probably under- appreciated. But the fact is you have to enjoy what you do. So you've chosen a career path. Who knows where life will take you. But the truth of the matter is the minute it becomes real disheartening to wake up and go to work or wake up and do the thing you do, you have to think, why am I doing this? So for me, it was more about readjusting things and to find areas where I really enjoy.
Because when you have fun, you're more curious. When you're more curious, you ask interesting questions. We ask interesting questions. You get interesting answers. And that allows, you know, to become more and more successful.
I was going to say also that the ‘I’ part of it for me is invest. you may have heard of something called the parental principle and if you've heard of that term. But the principle basically is, you know, is based on an economist some years ago or decades and decades ago who had talked about this one theory, which is the 2080 rule, basically. Right. So I frame it the following way:
identify 20 percent of the things in your life that give you 80 percent of your joy. And usually it's a couple of things. It's not like 20. If you have 20 things, your list is way too big. If you have nothing, you need to start thinking about things, you know, and rearranging your life a bit. But find those two or three things. And so for me, it was, you know, meaningful relationships. It was a sense of adventure, I quite like art. So you know, I said, I'm gonna invest more in that and I'll see. I like data and I like data driven decisions. I want to make sure that in my work I'm making sure I get lots of opportunities to be using data to help make decisions.
The ‘N’ part is failure, never fear failure. So you know, the challenge I see in my 12 year old and a challenge I see in myself often is sometimes it's much easier as it is to take the easy road than to take the higher, the more risky route. And again, finding those opportunities for stretch experiences, experiences where I would say, you know, you can probably do it, but you've never tried it, but you're within your skill level. That's what you have to be pushing every single year to try something. So whatever that may be, I think it's really important. I think for me, starting in 2018, you know, at that time I was forty nine years of age. I was just coming up to half a century. So, you know, you have these moments. I was sitting in Nepal with a friend. That in itself was another story, but we were staring out of these mountains. I'm saying how it is that I lived this long and not experienced this, this feeling of being at 10000, some are nine hundred feet above sea level, staring out at the Himalayan, you know, and just, you know, breathing in that air. And it I felt at that point it's things have to change.
So the last part of the ‘K’ is, to know it's OK to start again. So if you're early in your career, you can always start and think of new avenues for your life. If you're a senior and you think your career is over, you can start again. There's so many examples of individuals who have ultimately reinvented themselves. And so I think we often get this fearful concept that we don't have time. All we have is time. So how we manage that time and how we use it, I think is particularly important. that is the principal and I have a lot of belief why I think building this concept, Kian, of a creative mindset is so important. In science, it’s probably the penultimate of importance because if you look at Nobel laureates, the majority of Nobel laureates have an artistic or a humanities based hobby, whether they're poets, whether they like narrative writing, whether they're artists or they like music, you know, whether they're interested in sports, whatever that may be. They do other things, more so than you think, actually. And it's because they do those things and it gives them an edge, I believe, over everybody else around them.
Kian: Thank you for sharing that, I'm sure students appreciate that and I personally actually learned more about this topic through one of your articles, which was about fear, and how it interferes with our life.
Dr. Bhandari: Oh, right. Right, yes, right. It's a big motivator.
Kian:I really suggest everyone to follow you on LinkedIn because it is a great source of inspiration for everyone for sure.
Dr. Bhandari: I mean, it's always nice to meet someone who actually reads those, put it out there. I must say, you know what it is? I started doing that sort of creative writing, Kian, for myself. This became like, oh, I'm going to write. And, you know, I'm happy if someone else finds it helpful, but I really do do them for myself in a way that it's almost therapeutic to write like that because it makes you think about those issues.
Kian: For sure, and they can definitely help us out as students who are taking the steps in our career and we can for sure use your advice in these early steps.
Dr. Bhandari: Well, here. You know what? I actually have a couple of stature for that. I think it might be useful just stating the point that it's really important in your science or in your field to focus on what you do to be good at it. But when you look at Nobel laureates over other highly successful scientists, you know, if you look at 40 scientists, which a group of them get Nobel laureates, here's how they differentiate themselves. Nobel laureates are 22 times more likely than typical scientists to perform, to sing or act in their spare time. They're 12 times more likely to write creatively, whether it's fiction or whether it's poetry or short stories, they’re seven and a half times more likely to love crafting, woodturning, mechanics', glassblowing, working with their hands and finally, seven times more likely to enjoy designing, painting, drawing and sculpting. Now, that isn't at least sub-data to help us think about, you know, being a bit broader and exploring the things that we enjoyed as children. What else could be? I imagine, you know, to anyone listening and you ask yourself this,name one thing or more than one thing that you loved to do in your childhood that you have just given up and we could make a list and you’d start saying, why? And you’d go back and try to re-invent those things in your life when you have more time, well that's all we have so we should be prioritizing that more and it will help us in our work.
Kian: Definitely, and as our final question, a lot of us as students usually get fascinated by success without knowing all the challenges that they are faced with along the way, I’m sure being in your position right now, being the Canada Research Chair in Evidence Based Orthopedics and a professor and associate chair of research at McMaster University’s Department of Surgery, these do not happen easily. Can you tell us about some of the challenges that you faced along the way as a student?
Dr. Bhandari: Sure, I mean, the hardest challenge that you’ll face is finding something you really love to do. The majority of people that I’ve come across in life, have been successful, but they don’t love what they do. They’re just successful because they’re bright and talented, that happens in University as well. A lot of bright and talented individuals who do very well, but don’t necessarily love what they do. So find something you are actually passionate about and quite frankly you are good at and that is a big part of moving forward.
Second thing is, you have to be willing to take a lot of risks, So, I’ll give you an example, in 1994 I started my orthopedic surgical training, I graduated from the University of Toronto and I have come to McMaster and right around then was this whole movement of evidence based medicine was happening, now McMaster’s department and division of orthopedic surgery never had prior a trainee in their program that has taken time away to pursue research, it hadn't happen. You are in the surgical training program you will do what you will do and you will finish off. It wasn’t that they were angry, they were simply saying that it has never happened so you shouldn’t do it. Had I listened to my mentors at that point in time telling me, don’t do this, it’s not going to go anywhere for you, I would have made a grave error. So, it was something inside that said I got to do this and it was the only reason I did it quite frankly, was because I had this desire to do it, it was burning to want to do it so I found ways to take a year, it ended up being three years away from surgical training and it has never been done in our program.
I was pretty much considered to have left orthopedic surgery and to never come back and in fact I came back and finished. But, we came back stronger. This movement of evidence based surgery, would have never happened Kian, if I didn’t follow my heart. And so, I think those are the challenges that we face are often the internal demons, so to speak, which is intellectual I know I should do this, I don’t love to do that but I should, versus, here’s really what I want to do, this is the person I want to become. If you could figure that out, I mean that’s the hardest thing to do, you figure that out everything else is easy.
Kian: For sure, Thank you for sharing that. students would definitely appreciate hearing that, especially that it’s something that we all struggle with from time to time, having those internal voices, maybe telling us that we’re not good enough. But, at the same time, we want to follow what we really like and our passions.
Dr. Bhandari: Well listen, and I’ll give you an example, I had the great honour of being inducted into the Order of Canada a few years ago and I remember going there and just standing in awe of the other recipients and the one thing I learned about those individuals which I think goes back to the question you just asked, which is not one of them ever set out to get the Order of Canada, nobody there did, they just loved what they are doing, whether they were a world class athlete, a world class artist, a scientist, or someone who spent their life in the service of others through voluntourism. They just loved it, in fact, they were there, incredulous that they have been given this honour, they just did that because they don’t need this honour. That to me is the epidemy of what we are all trying to find, that one thing that just drives you where you don’t need external stimuli to do well, you just do it because you know it’s the right thing to do for you, that to me epidemizes it all.
Kian: For sure, thank you so much Dr. Bhandari for taking the time to meet with me today. It was a really awesome interview and I’m sure that the students will love this interview and all the advice that you gave. For all of you guys listening, make sure to check out our podcasts available on iHeartRadio, Spotify, Apple Podcasts, and make sure to check out our social media @SciSection for the latest updates on our events, projects and interviews, see you all next week!