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Alin Danila

salted pretzels

Pass the salt: Average sodium intake proven safe, after all

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When it comes to salt consumption – an ever-controversial topic in the world of nutrition and health – the old adage “everything in moderation” has proven to be true. Researchers at the Population Health Research Institute (PHRI) of Hamilton Health Sciences and McMaster University have discovered that, for most people, sodium (a.k.a. salt) consumption does not increase the risk of health problems except for those who eat more than five grams a day, the equivalent of 2.5 teaspoons of salt.

Andrew Mente, an author of the study, and his colleagues at PHRI along with researchers from across countries found that salt intake above five grams, equal to 2.5 teaspoons, per day can increase a person’s risk of health problems like cardiovascular disease. But, fewer than five per cent of people who live in developed countries, including Canada, exceed that level. The average sodium consumption is between 3 to 5 grams – or 1.5 to 2.5 teaspoons – of salt per day.

The findings are part of a larger, long-term study led by PHRI looking at how nutrition impacts health in populations around the world. Last year, the same team found that a higher versus lower intake of fat can also reduce the risk of health problems and death. The findings are challenging global dietary guidelines, which Andrew and his team argue need to be revisited.

There’s only an associated risk of heart disease and stroke when a person’s average daily salt is greater than five grams.

“The World Health Organization recommends consumption of less than two grams of sodium – one teaspoon of salt – a day as a preventative measure against heart disease, but there is little evidence in terms of improved health outcomes that individuals ever achieve at such a low level,” says Andrew.

The study followed 94,000 people aged 35 to 70 from 18 countries around the world for an average of eight years. The results show that there’s only an associated risk of heart disease and stroke when a person’s average daily salt is greater than five grams. When the average intake is less than five grams, the evidence shows that there is no correlation between salt intake and risk of heart disease and death.

“Our findings show that community-level interventions to reduce salt intake should only target communities with high salt consumption, and should be embedded within approaches to improve overall dietary quality,” says Andrew.

Of all 18 countries involved in the study, China was the only country where the majority of people consume more than five grams of sodium a day.

The study findings have been published in The Lancet in August 2018. Click here to read the full article.

Acting VP Research, Ted Scott

BLOG: Redefining research

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By: Ted Scott, Acting Vice President Research & Chief Innovation Officer

The dictionary definition of “researcher” is painfully self-explanatory: “someone who conducts research.” Based on my experience at Hamilton Health Sciences (HHS) over the last few years, this description does no justice.

The word “research” itself has attracted a certain connotation that invokes images of anonymous individuals in lab coats analyzing samples in whitewashed, sterile rooms in the pursuit of some far-off, seemingly impossible discovery. Sure, some discovery happens that way. But, so often, it’s so much more than that.

At HHS, our researchers are so much more than people in lab coats. They are innovative, strategic, highly creative minds who translate complex data into new knowledge. Many of our researchers are also healthcare providers. Every day, they work alongside the patients who are the inspiration for their research pursuits. Their “labs” are patients’ rooms, clinics, and operating theatres. Every day, they’re on the front lines of our healthcare system, asking questions and solving problems. Their roles span the entire spectrum of healthcare professions: they’re surgeons, pediatricians, physiotherapists, nurses, students. They’re also our neighbours, friends, family members and, sometimes, they’re patients, too.

In my short time at HHS, I’ve learned that our researchers are also some of our community’s top innovators and collaborators. They’re forming networks across our city and region that are aimed at improving the way we provide healthcare, applying technology and expertise to make our healthcare system better. And, most importantly, their work has immense, tangible impact. Beyond the lab and the computer database, our nearly 2,000 researchers and research staff are discovering and implementing new knowledge that’s changing the way we care for people, in real-time.

For example, they’re testing in-home technology that our nurses and doctors can use to monitor patients once they go home after heart surgery. They’re working with tech innovators to find better ways of predicting outcomes for cancer therapies, so patients can make better decisions around their treatment options. They’re trialling the latest therapies to help make life easier for kids with chronic diseases, like inflammatory bowel disease (IBD).

This is just a sampling of the research happening at our hospitals, right now. It wouldn’t be possible without our researchers and research staff who are unwavering in their pursuit of making life better for people in our community, across our country, and around the world.

It’s this insatiable drive to know the unknown that I believe better defines a researcher.

I admire their persistence, their patience, and their will to keep exploring, even when the answers aren’t clear. And especially when competing commitments – of being doctors, nurses, allied health professionals, students – are as demanding as they are in our very busy health system.

It’s this insatiable drive to know the unknown that I believe better defines a researcher, no matter how big or small the issue at hand.
At HHS, we’re redefining what “research” means to our community, and to the world.

We’re not just researchers. We are explorers. It’s in our DNA.

Read our stories here.

Dr. Harriette Van Spall, Explorer, cardiologist at Hamilton Health Sciences

Helping those with heart failure live long healthy lives

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Carol has been an avid clogger for the past 20 years. What’s clogging, you ask? It’s a folk dance similar to tap dancing. Carol is part of a clogging group that travels all over the United States for workshops and conventions. Clogging is about more than exercise and socializing for Carol. It’s part of who she is.

In the fall of 2017 Carol started to notice an unsteadiness in her legs. Despite using her asthma inhalers, she also had a cough that wouldn’t go away. Both issues were starting to affect her life, including her clogging.

“My legs would get wobbly when I was clogging, so I’d sit down and take a break. Then when I stood up they’d be wobbly again and it would take me a minute to reorient myself. I just couldn’t keep up anymore,” she recalls.

As advised by her family doctor, Carol went to the emergency department at Hamilton Health Sciences’ Juravinski Hospital and Cancer Centre. She was in heart failure.

Heart failure is one of the most common causes of hospitalization in older adults.

Heart failure occurs when damage to the heart makes it too weak or stiff to work properly. Common causes include heart attacks, high blood pressure and other conditions that affect the heart. When someone is in heart failure, their heart must work much harder to pump blood through the body.

Carol is not alone. There are about 600,000 Canadians living with heart failure. It’s one of the most common causes of hospitalization in older adults. For about a month after they leave the hospital, these patients have a higher risk of their symptoms becoming worse. One in four patients return to the hospital during this period.

A Hamilton doctor is on a mission to change this.

Finding a way for heart failure patients to live long healthy lives

Dr. Harriette Van Spall, a cardiologist at Hamilton Health Sciences and researcher at Population Health Research Institute, is exploring how improving services for heart failure patients can benefit their health. She has led the Patient-centered Care Transitions in Heart Failure (PACT-HF) clinical trial, which is investigating how education and access to resources following hospital discharge can help patients like Carol avoid another hospital admission.

Her prior research shows certain services, like regular nurse visits and multidisciplinary clinics, can reduce readmissions in heart failure patients. These services require collaboration among multiple health care settings and professionals, which makes them difficult to implement. The PACT-HF study is bringing everyone together to set patients up for success.

“Heart failure requires lifelong management,” says Dr. Van Spall. “Supporting these patients when they’re most vulnerable is a key way to ensuring they’re well equipped to manage their condition. And, if managed with appropriate services, they can live long healthy lives and stay out of hospitals.”

“If managed with appropriate services, they can live long healthy lives and stay out of hospitals.”

Dr. Van Spall and her team have worked with hospitals, home care agencies, and clinics in participating regions in Ontario to coordinate education and care. Before leaving the hospital, a nurse navigator teaches patients and their caregivers how to recognize and manage symptoms, and what to do if things get worse at home. Patients who need additional support are referred to specialized clinics in the community. They also receive regular nurse visits in the month after they’re home to ensure their recovery is on track.

“Dr. Van Spall understood how important it was to me to return to clogging so she told me about her study. Now, I’m thrilled to be back to clogging three times a week,” says Carol.

The primary goal of the study is to reduce hospital visits after discharge, but Dr. Van Spall hopes to accomplish that and more.

“We’re hoping we also find that patients felt more prepared for their recovery process and ongoing management once they’re home,” she says.

Dr. Van Spall developed the program so it can be easily integrated on a more permanent basis. If it proves effective, she hopes to make it a routine part of care for heart failure patients at Hamilton Health Sciences.

Dr. Harriette Van Spall, Explorer, cardiologist at Hamilton Health Sciences

Dr. Van Spall will present results of the PACT-HF study at a Late Breaking Clinical Trials session at the European Society of Cardiology Congress in August 2018.

Click here for more stories of our explorations.


Research at Hamilton Health Sciences is conducted in partnership with McMaster University.

researcher analyzing a brain scan after a stroke

Creating a world without stroke

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For decades, our teams have been tackling stroke head-on. Their discoveries have set the compass for how we treat and prevent stroke worldwide.

Cutting stroke in half

Can you imagine a world without stroke? Dr. Jackie Bosch can, and she’s leading a mission to make that vision a reality.

While research has made great strides in finding new and better ways to treat stroke, prevention is even more important. Dr. Bosch has led worldwide studies showing that certain safe, inexpensive, easily accessible medications (e.g. blood pressure-lowering and cholesterol-lowering drugs) are better at reducing the risk of stroke than previously believed. Together, these medications have the potential to prevent 50 per cent of all strokes, which equates to tens of thousands of lives saved each year.

Stopping stroke in its tracks, sooner

When a stroke happens, millions of brain cells die with each minute that passes. In other words, the quicker a person receives emergency treatment, the less likely they are to suffer severe, potentially disabling brain damage. In recent years, the discovery of clot-busting drugs and special clot removal procedures have benefited countless patients by limiting the effects of stroke once it happens, but their effectiveness depends on how quickly the person receives treatment. Dr. Michael Sharma and his team are testing new drugs that act even faster and more effectively against a stroke to limit progression, giving more stroke victims a chance at life and, for many, a full recovery.

Treating the worst strokes, better

Strokes are devastating, but some are worse than others. Hemorrhagic strokes, which happen when blood vessels rupture and cause bleeding in the brain, are more likely to lead to death and severe disability, yet fewer researchers have ventured into understanding them. Dr. Ashkan Shoamanesh is one of those few, and he leads a Canada-wide research group aimed at exploring how to prevent hemorrhagic strokes and to better treat people who suffer from them.

HHS & McMaster researchers find “simple” methods to prevent heart attack & stroke

Three simple methods to prevent heart attack and stroke have been proven by an international team led by Hamilton Health Sciences (HHS) and McMaster University researchers.

The research team, based at the Population Health Research Institute of HHS and McMaster, studied more than 12,000 patients from 21 countries to evaluate drugs that can prevent cardiovascular disease (CVD), which cause 18 million deaths and about 50 million heart attacks and strokes around the world each year.

“These are incredibly important findings with potential for significant global impact,” says Dr. Salim Yusuf, principal investigator and executive director of PHRI. “If just 10 per cent of the world’s population at intermediate risk of CVD is impacted, we’re talking about 20 to 30 million people who could be helped by these drugs.”

The study, “HOPE-3”, examined three methods using two forms of therapy: Statins, a group of cholesterol-lowering drugs, and antihypertensives, a class of drugs used to treat high blood pressure. In addition, a combination of statins and antihypertensives was reviewed.

Statins proved to significantly and safely reduce CVD events by 25 per cent in patients at intermediate risk without CVD. Antihypertensives did not reduce major CVD events overall in the population studied, but did reduce such events in the group of people with hypertension, but not in those without hypertension. When combined, statins and antihypertensives reduced CVD events by 30 per cent—with a 40 per cent benefit in those with hypertension, suggesting that patients with hypertension should not only lower their BP but also consider taking a statin.

“These simple methods can be used practically everywhere in the world, and the drugs will become even cheaper as more and more systems and people adopt these therapies,” he said.


This article is featured in the latest Explorers publication.

Dr. Alexandra Papaioannou by the YMCA swimming pool

Pre-surgery program for better post-surgery results

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Age hasn’t slowed Annette Atwood down. She’s never been one to sit around in front of the TV, even now in her 70’s, unless perhaps if Wimbledon is on.

When she started to notice a dull constant pain in her hip, she chalked it up to getting older. But when her hip started to frequently give out causing her to fall, she realized it was more than just old age. Annette was in need of a hip replacement.

Being the outgoing person that she is, Annette wasn’t going to let the wait for surgery slow her down. She still went out and about, making sure to always bring a walker or cane with her.

“It’s not just about ensuring our patients get the surgery they need, but ensuring it improves their quality of life.”

When she went for an appointment with her surgeon, he told her about a research study called Fit Joints that’s exploring whether participation in a pre-surgery program, which includes exercise, nutrition, medication review and goal setting, can help patients undergoing hip and knee replacements recover better. It’s well-known that the healthier a person is before surgery, the more likely they are to have a positive outcome. Researchers at the Geriatric Education and Research in Aging Sciences (GERAS) Centre of Hamilton Health Sciences (HHS) and McMaster University are applying that same concept through the Fit Joints study.

“Since many patients in need of hip or knee replacements are frail, surgery may not be as effective,” says Dr. Alexandra Papaioannou, geriatrician at HHS, executive director at the GERAS Centre and Fit Joints study lead. “But, there’s growing evidence showing that frailty can be treated through proper diet and exercise. This means our study could not only better prepare our patients for surgery, but also improve their frailty and reduce their chance of falling. The goal is to help patients get back to the life that they enjoy.”

Swimming instructor teaching Annette Attwood's aquatics class

Study participants are given an exercise plan, a food intake log and vitamin D and protein supplementation. With help from the Les Chater YMCA, participants can attend aquatic classes and receive coaching in the gym. They’re also given gentle exercises to complete at home. Since it’s a fairly big change for people who don’t exercise regularly, study coordinators provide ongoing guidance with monthly home visits. The program continues as long as patients have to wait for their surgery.

“As healthcare providers, it’s not just about ensuring our patients get the surgery they need, but ensuring it improves their quality of life,” says Dr. Papaioannou. “Regardless of the complexity, surgery can be hard on the body. So, we’re hoping this program can help patients’ recover well and enjoy the benefits of their new hip or knee.”

If the study is successful, the team at the GERAS Centre hopes the program can become a routine part of care for all joint replacement patients across Ontario.

Annette Attwood in the swimming pool at the YMCA

As for Annette, one year post hip replacement, she’s still swimming at the YMCA twice each week.

“I loved the program as soon as I started it before my surgery,” she says. “But now, it’s not just exercise, it’s a social outing.”

Annette Attwood speaking to study coordinator Ahmed Negm

Explorer Dr. Alexandra Papaioannou

Research at Hamilton Health Sciences is conducted in partnership with McMaster University.

This story was featured in our community report. Click to read the full report.

An HHS geriatrician meeting with a patient

Helping people age better

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We’re living longer than ever before, and that’s a good thing. But, are we aging well? Our researchers are exploring ways to help people live better, longer by tackling aging early on.

Getting a grip on frailty and aging

Can the strength of your grip reveal how well you’ll age? According to Dr. Darryl Leong and his colleagues at the Hamilton Health Sciences and McMaster University Population Health Research Institute, it can. They’re using data from 200,000 people in 25 countries around the world to better understand what factors affect longevity, but also how frailty can be avoided through early intervention. Hamilton is also home to the Canadian Longitudinal Study on Aging (CLSA) at McMaster University, where Parminder Raina and his team have established a robust data platform to better understand the biological, clinical, social, psychological, economic and environmental aspects of aging. The CLSA will follow over 50,000 Canadians between the ages of 45 and 85 for the next 20 years to gain insight in to why some people age well, and some others don’t.

By identifying how a young person’s eating and exercise habits, as well as their genes, affects their muscle strength and physical functioning down the line, we can learn how to delay, and even prevent, disease and frailty before they take hold.

Patient-driven aging research: A living lab

Despite their best efforts, frailty will remain a reality for some people as they grow older. In their “living laboratory”, Dr. Alexandra Papaioannou and her colleagues at the Geriatric Education and Research in Aging Sciences (GERAS) Centre at Hamilton Health Sciences’ St. Peter’s Hospital combine patient care with research to create innovative healthcare solutions based on the needs and lived experiences of their patients. Current projects include a new mobile app that will allow clinicians to quickly identify patients at risk for frailty; a wireless bed that uses artificial intelligence will anticipate patients’ needs; and a dance program for seniors to promote mobility and mental ability.


This article is featured in the latest Explorers publication.

Researcher and lab technician removing study samples from a nitrogen tank in the biobank

Preventing disease, everywhere

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One third of all global deaths are caused by heart attacks and strokes, and most of them in lower income countries. We’re finding solutions to prevent these deadly diseases – solutions that are available to people in every corner of the globe.

Discovery without boundaries

Cardiovascular disease knows no bounds. Despite common belief, heart attacks and strokes aren’t issues specific to the Western world. In fact, they claim the most lives from low and middle income countries. Our teams are focused on finding solutions to heart attack and stroke that can benefit people everywhere — people who are rich or are poor, people of different ethnic backgrounds and cultures, and people in all parts of the world.

Our research over the last two decades has included over one million people in 101 countries. By studying how diets, activity, genetics, social and environmental factors interact with each other to influence the development of cardiovascular disease, diabetes, and other chronic diseases, we’ve identified new ways to prevent heart attacks and strokes. Trials of innovative treatments have also discovered new ways to prevent deaths, recurrent heart attacks, or strokes once people have cardiovascular disease. Our discoveries have improved the way people with heart disease and stroke are cared for worldwide. The health of people in Canada matters, but so does the health of people around the globe. Disease knows no bounds, and neither does our research.

Canada’s largest biobank

Hamilton Health Sciences is home to Canada’s largest research biobank, a literal vault of human DNA housing more than three million samples collected from patients around the globe. The facility provides an information-rich, cellular and molecular database that supports our researchers in solving some of the world’s greatest health challenges, including heart disease and stroke.

With more than 100 international studies being led by Hamilton Health Sciences and McMaster University researchers at any given time, the biobank – developed over 20 years – has become an invaluable knowledge repository. It can provide our researchers with key information on half a million patients, at their fingertips. These samples are used for analysis of genetic biomarkers that predict the development of various diseases and provide new insight in to the causes of heart attacks, strokes, heart failure, cancer, diabetes and dementia. Samples are stored in liquid nitrogen so that they can be used for decades to come.


This article is featured in the latest Explorers publication.

Surgeon performing open heart surgery

Making surgery safer

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The last one hundred years have seen life-saving advancements in surgery. Still, it’s not without its risks. Our researchers are leading a new wave of exploration aimed at making surgery safer for people around the globe.

As simple as a blood test

Surgery is stressful on our body. The heart is susceptible to strain from surgery and can suffer damage as a result. This damage can give way to bigger problems like stroke, heart attack, blood clots, and even death. Dr. P.J. Devereaux and his team at Hamilton Health Sciences’ and McMaster University’s Population Health Research Institute (PHRI) have found that many of these complications are symptomless and go undetected by patients and doctors alike. But, they can surface down the line as serious health issues.

In a groundbreaking study, the team discovered that a simple, quick and inexpensive blood test can detect damage to the heart caused by surgery, triggering doctors to take action to prevent bigger problems. They were also the first to find that a blood thinner can help to prevent some of these problems, a discovery that could benefit millions of people each year.

Bridging the gap between hospital and home

Can technology help patients recover better after surgery? Dr. Mike McGillion and his team at PHRI and the McMaster University School of Nursing are testing a novel technology by Phillips Healthcare that wirelessly monitors a patient’s vital signs after an operation, and for one month after they leave hospital. If an abnormality is detected, the hospital team is alerted to check in on the patient. It’s a leading-edge example of a not so far-off future where technology bridges the gap between the hospital and home.

Treating hip fractures like heart attacks

What do broken hips and heart attacks have in common? Like a heart attack, a hip fracture is a medical emergency but has not been considered as one until now. A hip fracture puts a lot of stress on the body, creating the potential for a number of life-threatening issues. Yet, these patients aren’t treated with the same level of urgency as other emergencies and often have to wait several days for surgery.

Dr. Mohit Bhandari and his team at PHRI are testing the theory that hip fracture patients who receive surgery quickly – within 24 hours of their fracture – have a better recovery and experience fewer issues. It also means patients spend less time in hospital, reducing health care costs and making room for more patients to receive the care they need, sooner.


This article is featured in the latest Explorers publication.

Dr. Devereaux, Researcher, Explorer

This discovery will save lives after surgery

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Researchers at Hamilton Health Sciences have discovered that a blood-thinning drug, dabigatran, significantly reduces the risk of death, heart attack, stroke, and other heart or blood-vessel complications in patients following major, non-cardiac surgery.

Every year, approximately eight million people world-wide develop a condition called “myocardial injury after non-cardiac surgery” (MINS), which refers to damage incurred to the tissue of the heart in response to the stress of surgery on the body. The condition affects patients undergoing major procedures such as a hip or knee replacement, bowel resection, or abdominal aortic aneurysm repair, and can lead to severe complications including heart attack, stroke, blood clots, amputations, and even death.

In the first randomized controlled trial to evaluate a treatment for MINS, Dr. P.J. Devereaux, scientific lead for perioperative research at Hamilton Health Sciences’ and McMaster University’s Population Health Research Institute (PHRI) and principal investigator for the MANAGE trial, found that patients who had MINS and received dabigatran twice daily were 28 per cent less likely to suffer a major vascular complication during an average of 16 months of follow-up.

“We now have an option for improving outcomes for a large population of people who have a heart injury after surgery each year,” says Dr. Devereaux.

The study enrolled 1,754 patients in 19 countries, 51 percent of whom were male, with an average age of 70 years. After an average follow-up of 16 months, 11 percent of patients treated with dabigatran experienced a MINS-related event, compared with 15 percent of patients who received a placebo. This translates to a 28 percent reduction in risk for patients receiving dabigatran.
An increased risk of bleeding is an expected complication of treatment with a blood-thinning medication; however, there was no significant difference between the two groups in terms of life-threatening, major, or critical organ bleeding.

The MANAGE study builds on the discovery made by Dr. Devereaux and his colleagues last year which showed that a simple blood test could identify patients with MINS following surgery and alert clinicians to intervene before complications occurred.

“Patients with evidence of even mild damage to the heart after surgery are at high risk of adverse events in the long term,” says Dr. Salim Yusuf, chair of the MANAGE trial and executive director of PHRI. ”It appears that this risk can be mitigated by antithrombotic therapy. Future studies can explore additional ways to reduce these risks.”

“This is an important issue that affects thousands of people around the world,” says Dr. Devereaux. “This discovery marks an important step in the journey to improve outcomes for patients who suffer MINS after surgery.”

holding cannabis buds

Are there long-term effects to cannabis users?

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Before the end of 2018, many Canadians will be able to legally purchase cannabis for recreational use in their communities. But, despite its impending widespread availability, there’s very little known about the long-term physical, psychological and social effects of cannabis, leaving the medical community at odds with the drive to legalize the drug.

Researchers at Hamilton Health Sciences (HHS) and McMaster University have established the Database for Cannabis Consumption and Study, or “DataCann”, to help inform knowledge and use of cannabis in clinical settings.

Once the database is complete, researchers can begin to look for answers around who’s using medical cannabis and why, the benefits and risks, the specific compounds used, the impact on healthcare resources, and further education requirements. Ultimately the hope is that the data collected will impact healthcare guidelines and prescribing practices to ensure optimal outcomes for patients.

Ultimately the hope is that the data collected will impact healthcare guidelines and prescribing practices.

“This database will give us the opportunity to explore a lot of unanswered questions around the medical use of cannabis,” says Dr. Ramesh Zacharias, DataCann co-principal investigator and medical director of the Michael G. DeGroote Pain Clinic at HHS. “We need to know who benefits from cannabis and why to ensure we can provide the most appropriate treatment plans to patients. More importantly, we need to know if there are any long-term risks.”

The team is looking to recruit at least 1,000 participants from across Canada who are using cannabis and have chronic, non-cancer pain. Participants are required to complete an online survey for the first two, eight and twelve months, then every six months thereafter until the database is complete. The project is expected to take five years to complete.

Michael G. DeGroote Pain Clinic patient and regular cannabis user, Kelly was more than willing to participate in the study. She says filling out a survey every few months is the least she can do to help doctors better understand cannabis. All she knows is that the cannabis oil she takes has made a huge difference in managing her pain from Lupus and has allowed her to reduce the amount of medication she takes. The team hopes that information like this will provide some insight into the drug.

“More importantly, we need to know if there are any long-term risks.”

“We have the potential to create the largest medical database on cannabis,” says Dr. Zacharias. “Not only does it give us a strong starting point, but it will provide the foundation upon which to conduct more research in the years to come.”

The DataCann project is a partnership between Hamilton Health Sciences’ Michael G. DeGroote Pain Clinic, McMaster University’s Michael G. DeGroote Institute for Pain Research and Care, and the Michael G. DeGroote Centre for Medical Cannabis Research. Currently, hospital and clinical partners in Toronto, Thunder Bay, Winnipeg and Vancouver are supporting patient recruitment efforts, with a goal to bring in additional partners from across Canada as the project unfolds.