#38 Pollution & Our Lungs

Ekaterina An [0:00] Hey listeners, it's Kat here. Welcome to another episode of Raw Talk, where scientists talk, and we listen. Before we jump into this episode, we wanted to share some exciting news. Raw Talk is going live. Join us May 30, at J Labs Toronto for a live podcast event. We'll be sitting down with a panel of experts to talk about how we can have better science through better public engagement. We'd love for you to come out, meet the team, and join in on the discussion on how science can be made more accessible for everyone. Head over to rawtalklive.com to register. Now, for this week's episode, I sat down with Dr. Chung-Wai Chow, respirologist and scientists at the Toronto General Hospital and Associate Professor in the Faculty of Medicine, the Dalla Lana School of Public Health in the Faculty of Applied Sciences and Engineering at the University of Toronto. Dr. Chow's work focuses on the health effects of air pollution of both the clinical and cellular level. In this episode, we chat about the wide range of techniques Dr. Chow's lab uses to assess the impact of environmental air pollution on our health, the importance of collaboration and science, and the role her mentors played in getting her to where she is today. So, let's get into it.

Dr. Chung-Wai Chow [1:33] I think that we overall air pollution is actually one of the biggest burdens in terms of health to the entire world. And, you know, the WHO has already has published findings suggests that it is responsible for something like 3 million premature deaths annually as a result of exposure to air pollution. And in Canada and in North America, we are very fortunate that we live with very good air quality. But despite that we are still impacted significantly by the health impacts of air pollution. And for us, in Canada, what we talk about in terms of air pollution is pollution from primarily from cars, vehicle emissions, but we're also impacted by a lot of global events, or even internal events. So you know, the 2016 Fort McMurray, wildfires affected not just the local environment, but because air pollution travels downwind it affects several communities 1000s of kilometers away. And in fact, there was a pollution advisory that was sent in Connecticut, that could be traced back directly to the Alberta wildfires. And so I think that we should always be ever vigilant. We coexist, obviously with all the things that produce pollution. And there's always a balance that has to be made. But I think we in Canada, we need to and for me in particular, is to look at what the implications are in terms of what actually causes air pollution. What causes air pollution? What are the impact in terms of the short term as well as those in the long term on the health of the population?

Ekaterina An [3:16] So what are those impacts on lung health?

Dr. Chung-Wai Chow [3:19] There's a lot of very good data that has shown that in terms of lung health, that it is responsible for worsening existing diseases. We're talking about asthma, COPD, as well as cystic fibrosis. And there has been publications arising from our group that chose that air pollution has an impact on terms of long term outcomes in lung transplant patients. And there are a number of studies now looking at healthy people to show that there is a decrease in lung function over time as a result of chronic exposure to air pollution. And lung function really is very much at the metric of functional capacity, and has been shown that over time that if your lung function drops below a certain amount, it has a real functional impact in terms of your ability to carry out your activities of daily living, your quality of life, and, and obviously, you know, mortality.

Ekaterina An [4:15] So you mentioned the 2016 forest fires at Fort McMurray. And you actually recently just returned from Alberta, where you are conducting a study looking at some of the health effects of exposure to forest fires. So do you want to tell us a little bit about what that project entails and where it's going and how it's going so far?

Dr. Chung-Wai Chow [4:35] Yeah, there have been a lot of studies in the past that have looked at the health impacts of wildfires. A lot of them have really looked at it in terms of the short term, and much of it is looking at health databases and looking at the Health Administration databases, looking at emergency room visits, physician visits and questionnaires that are sent to the community to ask about symptoms. And what was quite unusual about the wildfires in Alberta was the fact that it affected the entire town. You know, 88,000 people were evacuated, it is also 450 kilometers isolated from any other major city. And the other aspect of that wildfire is the fact that it mostly affects young, healthy Canadians who were attracted to an established family because of the economy. And so the the question that our team, my research team is looking at, is looking at what the long term, the longitudinal impact is, for people who live in the community that was affected by the fires. There are residual pollutants, ash, other toxins that are in the atmosphere, on the ground, and whether or not that actually has any long term impact. The other aspect of the team and I collaborate with a chemical engineer. Is that we are looking specifically at the indoor air pollutants of the homes in Fort McMurray, to see how long outdoor air pollution gets tracked indoors and hot, and how long the ash from the fires actually stay indoors. And whether or not those pollutants actually change over time and whether or not those they're toxic.

Ekaterina An [6:26] And what stage of this project are you at now?

Dr. Chung-Wai Chow [6:30] So we've enrolled our first 45 participants. I just came back in in the middle of February. And we will be back in early April to enroll another, you know, our next set and also to follow these participants. So what we're doing is, we're following a lot of these participants, all the participants with lung function over time. So we're conducting spirometry, we're also conducting and collecting samples from breath, from urine and cell phone wipes, to look at what the exposures are over time. And so we have some preliminary sort of data from that. We call it the home dust sampling team. This is the chemical engineering team that is sampling the homes. We've conducted 85 home samples, and we've been very fortunate that we have been welcomed into the homes of a lot of the footprint very residents. And there, they've also started some preliminary analysis in the dust samples. And we are I'm back in April, there'll be back with us in July for another large sampling campaign. The community obviously is very engaged, they're obviously concerned. So we've had a lot of, a huge enthusiastic response from the community.

Ekaterina An [7:48] How did this project come about? You said that there's a lot of collaboration with engineers at U of T. And this is happening all the way in Alberta. So where did the idea for this kind of study come from?

Dr. Chung-Wai Chow [7:58] Well, Arthur Chan, who is the engineer and I have been collaborating for quite some time. We are both, very much of our lab, both of our labs are very much focused on some of the very fundamental science behind air pollution. And he and I had been collaborating for a couple of years now looking at secondary organic aerosol. So these are the pollutants that are in the atmosphere, that are chemically changed by transit in the atmosphere. And so we've been doing studies using animal models, we've been doing studies using cell lines. And he's also been developing a model of actually developing atmospheric chamber that simulates what happens in the outside atmosphere. And so we've we've been doing a lot of this together for some time. And then right after the wildfires, a request for applications came out. And when we looked at it, we said, oh my goodness, this is exactly like what we do and we were, at that time, looking at mostly vehicular exhaust and looking at sort of how that changes over time. We sort of thought, well, we would be crazy if we didn't actually suddenly have an application for this because everything that we want to do is exactly what is mirrored. And so we were very fortunate we got that grant. And I also applied for a second grant that allowed me to sort of initiate the Health Study. And it's like any other sort of research team when you find good collaborators, who really truly complement each other because we do different things, but with a similar goal, it really works very well. And Arthur's team and my team have been out together in Fort McMurray twice. We, you know, work together we actually end up living together. And it's been a really wonderful collaboration and when I initially brought forth the idea to the people I work with and invited them to come out to Fort McMurray, particularly in the winter, I wasn't sure that I was going to get very much of a response. And but, you know, the team was very enthusiastic and before we left Fort McMurray, February, I knew that I had some dates already to go back. And without my even asking, they all volunteered. I'm available. And I think it really speaks very well of both the the research because it's interesting, it speaks very well of the team. And it also speaks very well of the the people of Fort McMurray, because I think the, you know, I'm also physician. And so what I do, always has to have a human application. And obviously, it's it's a lot easier and it becomes much more poignant, perhaps, to, to work with people who are really engaged in what's happening in wanting to be part of your research question and your research endeavor because you're invested in it. And I think that we saw that when we were in Fort McMurray, and it dispelled a lot of, you know, sort of ideas of what it's like to be living in the northern town to.

Ekaterina An [11:14] Yeah. It sounds like an incredibly fortunate and fruitful partnership that you have. And I think it's always really great to have participants who seem just as invested in the work as you are.

Marija Zivcevska [11:28] Hi, Raw Talk listeners, it's Marija. And for this segment, I really wanted to have a conversation with students across the University of Toronto, about perceptions and thoughts regarding air pollution. I talked with students within departments, including medicine, engineering, immunology, and even talked to a student visiting from Queens University who was just in Toronto for the week. So I first wanted to see how students felt Canada compared with the rest of the world in terms of air pollution, and specifically, how Toronto compared with the rest of Canada.

Student 1 [12:00] Hi, I'm third year, double majoring physiology, immunology. I am from the Islamic Republic of Iran.

Marija Zivcevska [12:08] So how do you think Toronto compares in terms of pollution with other cities around the world? Well,

Student 1 [12:14] I think the weather's pretty clean, compared to where I come from a controller pretty well, I'm not really that into it. But I think it's it's okay. It's not that bad. So where are you from? Well, I come from the capital there. And it's really into really, really polluted and and some days, you can just look at the the weather and it's it's just black. That's how bad it is.

Student 2 [12:37] I come directly from Kingston to Toronto, and like a span of three hours. So I guess the comparison is pretty stark. I think mostly though what I noticed is just the lack of greenery. And like, I don't know if that makes me more aware of the poor air quality here or the pollution or if that's just something I associate with more pollution is like more concrete and less, less. Yeah, like foliage. But I think that's what everyone notices when they come to Toronto

Student 3 [13:11] Yeah, I think it's polluted for sure. And I know especially and since I go to the Mississauga campus for UofT and when I commute during rush hour, just the traffic and the smoke, and the kind of haziness in the air on the Gardiner during rush hour is crazy when you're just standing there. And you actually feel it in the air and you see like a layer of smoke. So I think it's definitely an issue in Toronto.

Student 4 [13:37] Air pollution in Iran is like pretty bad. So like, compared to that Toronto is pretty good. But maybe compared to other North American cities, maybe it's not as good. So I don't know if like, it's as good as maybe Vancouver or like Calgary.

Marija Zivcevska [13:49] So hearing everyone's responses, it's clear that Canada in relation to the rest of the world is not so bad. We had two students from Iran that mentioned the significant difference in air quality between Iran and Canada. And in fact, when I did a little bit of research, I found that the city with the highest pollution exposure in the world is about Iran, with approximately 270 micrograms of pollution per cubic meter. Now, just to give you some background, this is 20 times greater than what the World Health Organization considers healthy. And one of the reasons for such high rates of pollution in the city is due to wetlands that are drying out and subsequent large amounts of dust in the air. Now we had some students that mentioned how Toronto is particularly polluted. So this brought me to investigate how much pollution we're actually exposed to in Toronto on a daily basis. And interestingly, Toronto due to its large population density and urban design has a 1.3 times greater exposure rate than the national average in Canada, which is about 7.05 micrograms of pollution per cubic meter. Although pollution exposure in Canada is not as bad as the rest of the world, we too are exposed to large amounts in our daily lives. And so this brought me to my next question where I wanted to see what students thought about the way that pollution actually affects our overall health.

Student 1 [15:16] The real challenge with pollution and its effect on health is that a lot of the effects are, are chronic and are only seen far down the road. And it's difficult to study that kind of relationship. So the public's not incentivized to take action against that, which makes it difficult.

Marija Zivcevska [15:40] Absolutely. And in fact, air pollution can increase risks for asthma and other respiratory diseases, as well as risk for heart disease and cancer, particularly in children, the elderly, and those with pre existing medical conditions. So clearly, there's this huge effect on health. And something that came up during our conversation was that as a society, we're not really incentivized to deal with pollution related negative consequences. And so I wanted to delve a bit deeper and ask how can we increase awareness of this issue and incentivize students to take action?

Student 1 [16:16] Yeah, increasing research. And if we had a better idea of what those downstream effects were, you know, let's say you had a family member that that suffered some disease that was very clearly attributable to pollution. I think, you know, that might motivate people. If there was some sort of case that came out of a person that that really was relatable to the public, that might be something that I could see a lot of people rallying around. But again, it's it's tough, I can't think of any.

Marija Zivcevska [16:49] How do you think we can increase awareness about pollution in general? And how do we make it exciting for the everyday student that might not find it as interesting?

Student 5 [16:59] Definitely, I feel like social media would be a really good platform, because you know, there's Instagram, there's Twitter, if they put out more like celebrities on it, I feel like a lot of people would be more aware of the issue and like, how to change it.

Student 6 [17:13] Yeah, I'm not sure as a student, how much air pollution I actually caused. So I think some if I had more awareness on that I could actually reduce things that I unknowingly do because we don't drive we take public transit regardless. Yeah, it's really hard to say I guess, like even the plastic products and stuff that we buy, we buy things with more packaging. We know it has caused air pollution while being produced and packaged. So I would try to reduce that in the future. But it's not something that I advocate towards right now. Or that I'm actively trying to reduce my carbon footprint.

Student 2 [17:51] I would, yeah, I would say, particularly for students, I know so many people are really invested in like building up their resume and kind of looking towards the future and things that will help them get jobs. So I think if maybe there was more awareness about how important environmental issues have become, and like the actual business world, and in government and politics, they might be more invested in spending time curating like those initiatives and those skills, knowing that it'll help them get a job or experience in the future. Because I think a lot of people assume it's more of like a hobby to pursue these initiatives rather than a true, concrete plan for the future. So that's what I would say.

Marija Zivcevska [18:39] From our conversation, there seems to be a lot that we can still do to raise awareness, especially within our local community. On my end, I know as a graduate student, air pollution is something that I don't really think about on a daily basis, I have a long commute and oftentimes convenience trumps what is best for the environment. As someone mentioned in our conversation earlier, direct effects of air pollution can be sometimes hard to track and can be chronic so not seeing these effects right away can cloud the issue. This is precisely why think research in this field is of particular importance and value, because it gives a quantifiable number to these effects. So what can you do to make an impact? One way is to conserve energy. To remember to turn off lights, computers, and electrical appliances, when not in use. Whenever possible, carpool, ride a bike, and/or walk. And lastly, get informed with the issues at hand. All right, let's get back to the main discussion.

Ekaterina An [19:39] And you know, you didn't mention that you're a physician. And so you are a clinician scientist, you both hold a medical degree and a PhD. Is this, the kind of work that you're doing now, is this something that you've always wanted to do to dabble in both worlds of research and clinical care?

Dr. Chung-Wai Chow [19:53] Very much. I mean, the one of the things that I knew going into medical school was I didn't just want to be a practicing physician. There, there's nothing. You know, there are a lot of people who do that but I knew that this is not what I wanted to do. And I wanted to, you know, being a physician is looking after people making sure that they, you know, they continue to live fruitful with good lives. But I think the other part of me was, you know, it needed to understand what causes diseases and what it is, and how can we prevent disease. And throughout my training, or my, you know, my undergrad, and then subsequent graduate years, I looked for different opportunities. And it's always a lot easier to sort of rule out the things that you don't like, once you've done it, and, and then, you know, and then sort of figure out as you sort of do things, what, what it is that you really, really like, and, and I think I've been very fortunate that, you know, I have been able to acquire the skill sets to do both, and to be able to understand both worlds really well.

Ekaterina An [21:04] So was your interest in research something that was sparked as an undergrad? Or was it even going back to before that?

Dr. Chung-Wai Chow [21:11] Oh, I think even before that, I think my father will tell you that there was nothing that I wasn't interested in as a child,

Ekaterina An [21:17] are there any stories from when you were a kid trying to play scientist or anything like that?

Dr. Chung-Wai Chow [21:24] Not so much. But I there were a lot of stories about how I would try to devise ways of cracking different types of nuts. Anywhere from you know, trying to pry them open to you know, you tried to stomp them.

Ekaterina An [21:42] Very problem solving oriented there. So, it sounds like you clearly knew that you wanted to do research. And then I guess my next question is why research and why clinical work in this field of respirology?

Dr. Chung-Wai Chow [21:59] I think it's a, it's that that's sort of evolved, I became a respirologist, because during my medical school training, I had encountered a number of really wonderful respirologists who were mentors in different ways. I mean, not because they had a career path that is sort of what I have subsequently done. But because they were so engaged, they were enthusiastic about what they did, they were fabulous teachers, and there was the whole sense of, I think of all the mentors that I've had, the one that I you know, have held in highest esteem, are the people who have always maintained their integrity, while at the same time, you know, conducting their clinical duties and the administrative or their research duties. And they have served as inspirations in terms of what I do. That's on a much sort of higher level but, I think on a more granular level, some of these mentors of people who I've worked with in different research projects, and I've said, oh, you know, this is not the type of research I really liked. And so I went during my training, and sort of went from different types of research experiences, from clinical research, to basic research, and to other things.

Ekaterina An [23:10] From our previous conversations, it sounds like you had kind of gotten your clinical degree and then went and did a PhD and delved more in depth into the world of research. And I remember you told me that you did a postdoc fellowship at Max Planck in Germany and there's something that you said that really stuck out. So your PhD was in cell biology but then in your postdoc, the lab that you went to work with was in molecular biology. Which for our listeners, is very distinct from cell biology. And you did that despite having very little experience in molecular biology. And that just really struck me as something so gutsy to do to just go and apply for a lab where you know that you're maybe not the most experienced candidate. So what what was your reasoning behind that decision? And what really pushed you to do that?

Dr. Chung-Wai Chow [23:56] I think, for me to be a successful scientist, I need to have sufficient skillsets to understand and know how to ask the questions. And I think we've now evolved to the point that as a PI may not know, all the methodologies and the details of methodologies that are involved in some of the techniques that are being used, but I need to understand what the concepts are. And I think that I will continue to learn new fields, new things so that I can actually evolve my research. And it's interesting that you thought that it was gutsy applying to a postdoc in a molecular lab, actually, what I think, was gutsy was actually to show up at Sergio Grinstene's lab, and after having finished my clinical training, yeah. And of course, at that point, I was about eight years, maybe nine years after my initial undergrad science and I didn't even know what an organic and inorganic compound was anymore. And so sort of sort of walked directly into a pure so biology lab. That was, for me, that was like the biggest cultural difference. And and I think that if you're never afraid to learn, if you're never afraid to say, I don't know. But if you know to ask, then I think that, for me is like that that defines what a scientist should be. Because if I continue just doing research in the fields that I was trained in 20 years ago, I don't think that I would be moving the field forward very much.

Ekaterina An [25:44] So, Sergio Grinstein, was your PhD supervisor?

Dr. Chung-Wai Chow [25:47] Yes.

Ekaterina An [25:48] Okay. What was that experience, like being a grad student, after so many years of clinical training and being in school for seemingly forever?

Dr. Chung-Wai Chow [25:56] It was, that, in my clinical fellowship in respirology, was the happiest time in my life.

Ekaterina An [26:03] Really?

Dr. Chung-Wai Chow [26:04] It was. And, and I will have to say that that was interspersed with a couple of sub months of feeling like the biggest idiot on in the world. When I first started in research

Ekaterina An [26:14] I think all grad students can relate

Dr. Chung-Wai Chow [26:16] I mean, I just, I mean, I felt like, you know, Sergio, and this is something I've tried to adopt. But Sergio met with all his trainees for an hour every week. And he must have thought he was talking to a stone wall. for the first year. But it was the happiest like that. The clinical training in my fellowship was really happy. because I was in a field medicine I really loved, I had a pretty good idea at that point, what I wanted to do in terms of research, not so much a research area, but I had a pretty a pretty good idea of sort of what, what field of research in respirology. And then that time, in aSergios's Lab as a PhD student, was completely new, it was all sorts of different things, different ways of thinking, I was now interacting with basic scientists, graduate students, postdocs that was so very different than the clinical part of things. It was so exciting. And also at the same time, I now realize it's in retrospect, was I had no responsibilities, I had no responsibilities to, you know, I now have responsibility to my students, to my staff, to my patients, I havd no responsibilities. At that time, my only responsibility was to learn.

Ekaterina An [27:36] Yeah, we've, we had a couple of guests who have done a similar thing, they've gone through clinical training, and then went back and got a graduate degree. And they've said something along the same lines of, they really liked having that protected time, they really liked having just time to learn and absorb and not be beholden to all these other responsibilities in groups. So it is the best time of your life, and everyone keeps telling me, but it's really true. Being a student is great. So you mentioned that you are always looking to develop new skills and new skill sets. And that's what kind of motivated you to to go to different labs, what kind of new skills have you learned as a PI and through your collaborations with with others, like the engineering group?

Dr. Chung-Wai Chow [28:20] I think, on a sort of a broader level, I think the the skill sets I've learned is sort of trying to connect dots. And to look at the possibilities of collaborations in different ways. You know, Arthur Chan and I started collaborating through, actually, because we we met, and we were talking about what we each did, but we didn't really have a good visual visualization of what what it is that we were doing. And so our first collaboration started when, you know, he was describing his atmospheric chamber to me, and I had in my mind, you know, thought there was some glass bubble, and in the end, you know, I asked to see it. And it turned out that it was a very small apparatus that when I first looked at it, I thought, well, this is something that we could adapt to an animal exposure system that we had. And so that was how we first started collaborating. And I think that, I don't want to speak for him, but I think he also really wasn't quite sure what you know what I did when I talked about doing animal studies and conducting lung function and looking at inflammation. And so he came over and looked at my lab and looked at how we did things. And that was how we started. I'm beginning to learn you know, I'll continue to learn but you know, that there are other people who might work with and once you start talking with them, there may be possibilities of doing things together. The one of the big things that I am learning right now is, and this is something that I've never done before, is looking at genomics and genome wide analysis and what that really entails. And, and and that I think is, you know, I, that will be sort of, for me the next big sort of knowledge skill that I am going to develop. And I'm sure that five years from now, there will be another big knowledge skill that I would need to develop in order for me to understand what I'm doing.

Ekaterina An [30:24] Absolutely. And sounds like the more research questions you ask, the more maybe new methods you need to think of and develop. So maybe switching gears a little bit and getting a little bit more into the science? How do you study exposure to air pollution in both animal models and with patients or healthy individuals?

Dr. Chung-Wai Chow [30:44] Animals are obviously a little bit easier, because we can control for what we do. And I mentioned the fact that Arthur Chan, and I, you know, have developed this atmospheric simulation chamber that we can expose mice to. And so what we can do with that, is we can, whatever the research question is, so one of our research questions now, for example, is, does air pollution predispose or worsens the outcomes from a pulmonary infection? And so what we can do was using this atmospheric simulation reactor ASR for short, we are able to titrate the amount and the types of air pollution to simulate what is ambient, normal street level for Torontonians, for example. And compare that with filter air control, and then we can then, you know, initiate infection and we can subsequently measure outcomes. And that's very discrete because you can you can answer the questions of, you know, what happens when you have pollution versus no pollution, or pollution without infection, pollution, with no infection and what the outcome metrics are, which is looking at lung function, and, you know, illness score. That is very, I don't want to want to use the word easy, but it's, it's it's much more controlled. What's much more difficult, obviously, is looking at it in people. There are a few places where one can conduct control exposures in humans, but obviously, you know, there are some some limitations in terms of what you what you do, you know, typically, a lot of these exposures are one time only, usually with concentrations that are higher than ambient, because and so the other level of looking at it is looking at it from a cohort or population level, and then it is based on whatever is happening in real world. And the way that we try to control for that, or we try to answer the question better, except when the Fort McMurray study is that we are conducting pollution analysis in the indoor environment, and personal environment of the participants whom we're studying. And we're also collecting at the same time, biological fluids so that we can tie together the exogenous level of air pollutants with actually what's endogenous? And obviously, the, you know, the hypothesis is that whatever is absorbed systemically is what causes harm. And, and that sort of question is really important to answer but obviously takes a lot longer. It is not as clear cut, we have to take a lot of different, you know confounders and a lot of other things into consideration when we do things like that. And that's sort of where the biostatistics and the expertise of other people are really important in terms of making sure that we have the right sample size, to answer the question that we want to answer.

Ekaterina An [33:45] And I remember from a while ago, now that we had sat down for that interview for the magazine, you had mentioned, one of the ways that you study exposure to various pollutants is you give participants a pollution, a personal like pollution monitor, and it just captures all the different air particulates that they're exposed to. And we were actually wondering, we were thinking it would be great for a segment for this episode to have, if possible, where this pollution monitor for a day and then maybe see what she was exposed to I don't know how realistic that is, or?

Dr. Chung-Wai Chow [34:17] Well, no, I think that's possible. I think the other the other way, the other way to do this, and this is a new method that we've adopted, and this is from going back to your previous questions of sort of, how do you find or how do collaborations, you know, recurrent is, you know, obviously by talking people, one of my collaborators in arts and science has been doing a number of studies looking at cell phone wipes. And, and if you think about sort of what sort of thing is the best monitor of personal exposure? We are now never without our cell phones and we wash our hands but we don't often wash your phones. And there have been a number of studies now, and Miriam Diamond is one of the people who's been leading some of this, to look at cell phone wipes, to look at what the what the chemical composition is to give you an idea of sort of what you've been exposed to over time. And that we would certainly be open to that. The other thing that Miriam is doing that we to adopt for the Fort McMurray study is silicone wristbands. So the silicone wristbands also, you know, on your dominant hand is obviously exposed to what you're exposed to. And so we're able to also do some analysis with those. And we certainly would be open to do that.

Ekaterina An [35:44] Great. Maybe we can discuss some details further after this. And so just wrapping up, and maybe going back to our very first question around the effects of air pollution and population health. So what would you say the implications of your work is on on public health and on policy?

Dr. Chung-Wai Chow [36:02] I think that it's difficult to translate policy from animal studies, it is a lot easier to look at epidemiology or look at some of the other population studies to look at. And I think what's important about the Fort McMurray study is the fact that these are, on the whole young, healthy Canadians with young families who are generally healthy, and they chose to return to Fort McMurray because they want to continue to live there. They their families are there, that's, that's home. And if there is even a small increment of disease that develops in this otherwise healthy population, it has huge implications in terms of Canadian economics, because it has a lot of implications in terms of social, economic, as well as health burden and so for that reason, I think it's really important that we study that. But I think it's also very, it's a unique opportunity, because of its isolation, is that there are other wildfires, and I'm sure that in whatever we study will be applicable. But to find a population in Southern California, for example, in the interior of BC, that is so settled, and to be able to follow them over time, I don't think that it's really possible to do that. Or it will become even more challenging. I mean, there are obviously a lot of challenges in terms of doing research so far away, but I think it would be even more challenging to look in to a geographic area where people are able to move and live, 100-200 kilometers away, there isn't that possibility in Fort McMurray.

Ekaterina An [37:57] There's a whole added layer of complexity when you're looking at more dense populations. So I think maybe that's what we'll wrap up. And I thank you so much for sitting down with us again, I definitely learned a lot more than I had preconceptions about in terms of pollution. And I wish you the best of luck with your Fort McMurray study, it sounds like an incredible opportunity. And maybe we'll hear an update when thanks so much.

Dr. Samir Gupta [38:33] What a lot of people find counterintuitive, and it's a good news story, right is that the burden of mortality, childhood mortality attributable to infectious disease and low middle income countries has dramatically descended over the last 10, 20, 30 years. And if you think about it, the leading cause of disease related deaths in children in North America is cancer. So that's the natural state isn't the right word. But you know when you take infectious disease out of the picture or predominantly out of the picture, that's the next cause.

Ekaterina An [39:07] Raw Talk podcast is a student presentation of the Institute of Medical Science at the University of Toronto. The opinions expressed on the show are not not necessarily those of the IMS, the faculty of medicine, or the university. To learn more about the show, visit our website at rawtalkpodcast.com and stay up to date by following us on Twitter, Instagram and Facebook @rawtalkpodcast. Support the show by using the affiliate link on our site when you shop on Amazon. Also, don't forget to subscribe on iTunes, Google Play and Stitcher and rate us five stars. Until next time, keep it raw.

Dr. Chung-Wai Chow [39:39] All the mentors that I've had, the one that I you know have held in highest esteem are the people who have always maintained their integrity while at the same time conducting their clinical duties and their administrative or their research duties.