Faculty Spotlight on Andreas Laupacis
By: Jabir Mohamed
Andreas Laupacis, MD
Executive Director, Li Ka Shing Knowledge Institute, St. Michael’s Hospital
Professor, Department of Medicine, Faculty of Medicine, University of Toronto
Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto
There are a few things you need to know about Dr. Andreas Laupacis. The industrious professor of Health Policy and Management at the University of Toronto has a knack for timely publications. Consider these two articles:
We know that not everyone is helped by a drug or therapy—some get benefit, some are harmed, and others are unaffected. In the first publication, Andreas wondered if there was a better way to explain results of clinical trials to doctors and encourage them to base their treatments on good scientific evidence. Following discussions with two other clinical epidemiologists, he proposed the concept of “numbers needed to treat”, or for short, ‘NNT’. The NNT is a meaningful way of expressing the effectiveness of a specific intervention compared with a control. Despite turning 24 this year, this concept continues to be used by clinicians worldwide and has become a vital component in the clinical and research lexicon.
The next publication came in an era where economic evaluations and cost effective analyses of health care services were just starting to be produced. Andreas and his colleagues proposed a classification system to evaluate the cost-effectiveness of new technologies based on their methodological rigour and clinical benefit. For this work and contributions to health policy, Andreas has been recognized nationally and internationally; most notably, he received the 2010 Jill M. Sanders Award of Excellence in Health Technology Assessment, the 2011 Health Services Research Advancement Award, and the 2013 CIHR Barer-Flood Prize in Health Services and Policy Research.
Andreas is also known to engage citizens in making decisions about their health and health care. In a Canadian first, he led a team of researchers to identify the most important unanswered questions (or uncertainties) about the management of kidney failure using the James Lind Alliance (JLA) method—an approach that involves patients, their caregivers, and clinicians in determining research priorities. He also founded Healthy Debate (healthydebate.ca), a novel online platform that provides unbiased information about Canada’s health care system to the public.
Above all, Andreas is a well-respected general internist who currently practices palliative care at St. Michael’s Hospital. In 2015, he was included in the Medical Post’s “Power List” of the 30 most influential physicians in Canada. Here’s what the Medical Post had to say in September about Andreas: “It would be enough for any clinician with Laupacis’ research smarts to focus on building an ivory-tower career. An internist by training, he has gone beyond the walls of academe to reach out to the government and the public at large to translate clinical trial results into useful knowledge.”
And so, over two separate sessions—because one wasn’t enough—the IMS Magazine spoke with triple-threat physician Dr. Andreas Laupacis to learn more about his early research career, Healthy Debate, and general advice to students.
You started as a generalist, and at some point you enrolled in a Masters; do you remember what your MSc was about?
I did my Masters pretty early in my career. I took two years off during my residency to work with Calvin Stiller, a transplant nephrologist in London, Ontario. I had the opportunity to be involved in running a randomized trial of Cyclosporin in kidney transplantation, which turned out to be a terrific drug. That turned me on to doing clinical trials and to research actually, but I realized I needed some formal training in research methods and that’s why I went to McMaster at the end of my residency to complete a Masters [in clinical epidemiology].
Could you comment on the major trends in health service and policy research in the past decade? Are there any topics researchers have left behind or not approaching properly?
Wow—that’s a whole essay on its own! The complexities of doing research about the impact of health system interventions was the topic of a Healthy Debate article – http://healthydebate.ca/2016/03/topic/health-care-models-evaluation
Speaking of Healthy Debate, what led you to establish it?
I was always struck during the time of provincial and federal elections that Canadians would say that one of the most important things driving their vote was their health care system, yet the level and intelligence of discourse about the issues around health care was often incredibly low. I didn’t see a place where non-experts could easily access articles, [specifically ones] that weren’t simplistic. So the goal at Healthy Debate was to provide a thoughtful description of important health care issues that wasn’t excessively oversimplified or too technical.
Why the name Healthy Debate? How did you guys come up with that?
Honestly, I’m not super good at finding titles but frankly, we did want a healthy debate and it was about health care. However, the tagline—unbiased facts, informed opinions—has its own story worth sharing. I was reading the obituary in the New Yorker of Daniel Patrick Moynihan, a highly respected American politician from New York. The quote if I remember correctly, is that he said, “Everyone is entitled to their own opinions but not their own facts.” And I loved that because the facts are kind of the facts; for example, people in Northern Ontario don’t live as long as people in Southern Ontario, and that’s a fact. What we do about that—the approach to increase longevity—is really informed by opinions, by where someone comes from, and what they think.
Staff write the Articles but Opinions can be written by anyone. What should a prospective writer keep in mind if they would like to get published on Healthy Debate? What are the main reasons that an Opinion piece gets rejected? Gets accepted?
Two main issues – the topic and the writing. For the topic, it should be one that is of broad interest to readers, including those who don’t work in health care. An opinion piece about the details of how ophthalmologists are paid compared to how geriatricians are paid might be important to those two specialties, but isn’t a great topic for Healthy Debate. Folks thinking of writing an opinion piece can send us an email and tell us the topic they are thinking of writing about, and we can tell them if it would be of interest. Regarding writing, it’s important that the writing is crisp, clear and not too technical. We do sometimes provide considerable editing to a piece to make it suitable for publication, but sometimes the writing is just too bad for it to ever be publishable.
You’ve recently introduced Faces of Health Care to Healthy Debate. What was the inspiration?
My wife and I were at the Tenement Museum in NYC and we ended up in their bookstore where I saw the book, Humans of New York (http://humansofnewyork.com). I’m embarrassed to say, but I hadn’t heard of it before and I just loved it as soon as I saw it. I guess what I loved about it was the quality of the photographs, and Brandon Stanton, the author is very good interviewer as well. So, I basically looked at it and thought, “I’d love to do something like this for healthcare in Ontario,” and that was really the genesis of Faces of Healthcare (FOH).
Most, if not all Faces featured are remarkable. How do you decide on whom to spotlight?
So far, it’s been largely word of mouth. We strive for broad coverage of people and topics; we don’t want to only have faces limited to downtown Toronto, and we don’t want to only focus on specific health care experiences. That’s why we have done interviews in the Ottawa valley, Shawville Quebec and Kingston. Regarding the people we interview, we try to get people who are able to articulate their positive and negative experiences of the health care system.
Are there particular faces/scenarios you feel are currently underrepresented and want to give a voice through your platform?
We do sometimes look at the site and say whoa, you know, there are whole experiences we’re missing. As an example, we don’t have a single story on the site that has a First Nation or Aboriginal perspective. So two weeks ago, one of the photographers and I spent two days in Marathon, Ontario, interviewing First Nations people. Similarly, there are very few people from Regent Park [represented on the site] and we’re going to do two interviews with people who have been raised or lived there within the next month.
What’s next for Healthy Debate?
The website has done us very well for the first four and half years, but I think it’s time for a refresh. It’s also time to integrate the Faces of Healthcare more into the site. We now have the new web site up that allows us to do that. I’d like to see us integrate the FOH into curricula in nursing schools and medical schools across the province. We’ve been supported recently by the Associated Medical Services, which is a group in Ontario that focuses on increasing humanities in medicine at the six medical schools across the province. We’re hoping to work with them to maybe introduce Faces into the curriculum.
And finally, a lot of our readers are graduate students who may aspire to drive change in health care one day. Do you have any advice as to how they could get involved in health policy or health service initiatives?
I am a clinician, and one of the things I think has made me at least quasi-credible is that I was a pretty decent clinician. This gave me credibility with my colleagues and policy folks, and also gave me all sorts of research ideas from the front lines that I never would have had otherwise. The opportunities to get involved in policy happened gradually and without a lot of planning—they just came up. If the graduate student is a clinician, my first piece of advice is to spend the time needed to become a really good doctor or nurse or physiotherapist—that’s harder to learn than the policy stuff. Not sure I have great advice for the non-clinicians because I am not one.