What was my biggest obstacle?
Well, there's no question that there were lots of obstacles along the way. The word "stress" carries with it a lot of baggage. So, at the beginning, when I started to talk about stress and the immune system to scientific audiences, I was actually afraid to use the word "stress." And I began to get up some courage, probably in 1996 and 1997, to ask the question to a scientific audience, "How many of you believe that stress can make you sick?" I would say most of the scientists in the audience kind of looked to one side and other, and...raised their hands very slowly, and then hid them, just in case their colleagues might notice that they had raised their hands. So \they were afraid to admit that they actually believed that stress could make you sick. Even using the word "stress" in a scientific workshop or meeting would cause great consternation. I mean, the scientists became very stressed when they heard the word "stress," but they didn't want to admit that they believed that there was such a thing as stress; so that was the culture.
The reason for it was, I think, that for so many thousands of years, the popular culture believed that stress could make you sick; that believing could make you well. And people believe what they feel. But scientists need evidence. And there really wasn't any good, solid scientific evidence to prove these connections; nor was they're a good way to measure them. And scientists only believe what they can actually measure.
So it took another 50 years to develop those scientific tools, to really be able to prove these concepts to hard-core scientists. And so I would say that there was a real sea change in acceptance of these concepts, probably around ... somewhere between, 1996 and 2000. It was in that short window.
Even though the research was being done for the previous ten to fifteen years, more and more in neuroscience and immunologyit took a critical mass of really hard, solid, molecular and nueroanatomical studies, immunological cellular studies, to really prove to both of these disciplinesto the neuroscientists and the immunologiststhat a) these connections existed; and b) that if you break the connections, disease results.
And once those two facts were established, the dam burst, and everyone accepted the notion. But there was a lot of resistance at first. And this field was kind of marginalized, and I think all of us felt it. Everybody doing research in this area felt marginalized, and, really rejected. We were not just ignored by our colleagues; we were laughed at, and rejected. And that hurt, actually.
How do I make a difference?
Well, I guess the thing that gives me the most passion is knowing that what I do makes a difference. That it makes a difference to people's lives in many different ways.
It's hard, you know, when you make a discoveryand I have made in my career three discoveries that I know have changed the way disease is viewed, or treated. But that's a very, very, abstract thing. It's really hard to say: "Okay, I've a discovery, and I know I've helped thousands of people, or millions of people." It's when you see the one patient that really has benefited from that discovery that you really know that you've helped.
You know, when the family can come up to you and say, "Thank you." You know, "You helped ... save my mother." That really makes a difference. And I think that's what motivated me from the beginning when I started seeing patients on a one-on-one basis, when you know that you've saved a life. And then if you make a discovery in the lab, in a rat, that you know can be applied to saving many livesthat really is tremendously rewarding.
So there are many different aspects of medicine that are wonderful and that I loved. One is interacting with people; one is seeing that you can really help them. There's nothing more gratifying than knowing that you saved a life. It doesn't happen very often in a medical career. I can count the number of times that I know I saved a person's life...I can count them on one hand. But when it happens, it is THE greatest feeling that you can ever have.
But there are other kinds of rewards that you get from different aspects of a medical career, and the research career, the day-to-day... what is involved in day-to-day research, involves really, detective work. Figuring out: How do I find the answer to this mystery, in a systematic way.
Who was my mentor?
My father was a doctor; he was a physician and a research scientist. My aunt is a professor of physiology at McGill University in Montreal. I grew up in Montreal. And so scientists and a physician surrounded me. I guess my father was my physician role model. And I took for granted the lifestyle of a physician-researcher-scientist, but I didn't explicitly think I wanted to go into medicine.
I remember the doctor's show at the time on TV was "Ben Casey," or you could also watch "Dr. Kildare." It sort of was the equivalent of "E.R." And I remember when I would think of myself as graduating from medical school, I kind of visualized myself turning into Dr. Kildare. So I think without realizing it, didn't have a female physician role model.
How has my career evolved over time?
I was trained originally as a rheumatologist. I actually started, when I finished my medical training, going into general practice, in Montreal. So I did all my medical training at McGill in Montreal, and then I went into general practice. I loved it. I loved seeing patients; I loved taking care of families, and children, and grandmothers, and seeing the whole family together, and helping them get through rough times.
But after about two year in general practice, I realized that I needed to know more about the diseases that I was seeing in most of my patientsand most of my patients had some sort of joint problem. Some arthritis, some aches and pains. So I went back and I trained as a rheumatologist; that is a specialist in different forms of arthritis.
And I was intending to go back and be the rheumatologist in the family practice clinic where I had worked; but in the last year of my residency I saw a patient who had developed a horrible scarring, very painful rheumatologic disease, where his arms were flexed, he couldn't extend them fully, and his skin was very painfulhe had to have the bed sheets tented up over his legs, and he was really in extreme pain. And he had developed this rheumatologic disease while being given an experimental drug for a very severe form of epilepsy that he had.
Now, this patient was between a rock and a hard place, because he needed the drug to live, because his epilepsy was so severe, but he developed this arthritis kind of disease; and the question that was asked to me when I saw the patient was: Is this drug that's changing brain serotoninthat was what the drug did is it causing this autoimmune inflammatory disease?
And so at that time, which was 1978 to 1979, I didn't know the answer to the question. There was no answer actually in the literature; and I realized that in order to answer the question, I had to do the research my self.
So it was in the course of doing that research, trying to figure out: how it is that changing brain serotonin can lead to, or be associated with an arthritis-like disease, an inflammatory disease, that I stumbled on the finding that then really changed the course of my research career.
So first of all, seeing that patient changed the course of my career. Because I was originally going to go into clinical practice seeing that patient completely shifted me onto a research career. Because in studying that patient, I began to realize that I loved the detective work that's involved in research.