CPHS Fellows 2005-6

 Kirstin Borgerson | Julie Dergal | Lisa Forman | Delia Gavrus |  Jennifer Keelan | Carolyn McLeod | Kate Parizeau | Bianca Seaton |
 Kathryn Underwood | Leah Walz |

Kirstin Borgerson
CPHS Research Associate

“Understanding the Role of Scientific Evidence in Medicine”

Biography: Kirstin Borgerson is a doctoral candidate in the Department of Philosophy at the University of Toronto. She completed her MA at the U of T, and received her BA from the University of Saskatchewan. Kirstin’s research interests include philosophy of science, bioethics, feminist philosophy, and epistemology. She has done some teaching in the philosophy department, and has recently been invited to act as a guest editor for a special issue of the journal Perspectives in Biology and Medicine on evidence-based medicine. She is also a member of the U of T varsity women’s rowing team.

Project Abstract: The question of what counts as good evidence in medicine is of critical importance to both physicians and philosophers, and is vital to the future of health care. Given the current move toward ‘global bioethics’ and the need for standards of health-care treatments that can apply in a cross-cultural health care setting, determining what counts as good evidence is medicine is becoming more challenging. As a result of recent attention to ‘Evidence-based Medicine’, physicians have called for the development of a theory of evidence that encompasses the existence, nature and kinds of evidence, with particular attention to the medical field. Much work has been done in philosophy of science on the project of defining ‘good evidence’. At the same time, the question of what counts as good evidence in medicine, especially given the current medical context, has yet to be fully addressed by contemporary philosophers, who have tended to focus their contributions to the field of medicine on issues arising within the scope of bioethics. Borgerson’s research hopes to clarify the requirements of ‘good evidence’ in medicine through 1) an in-depth investigation of the philosophical origins of ‘evidence’ and 2) a critical analysis of the more recent writing done on the subject of evidence from within the medical community.

During her first two years of her PhD program at the University of Toronto, Borgerson applied herself to the task of understanding the philosophical issues at play in the contemporary debate over what counts as good evidence in medicine. Her current task, in the final two years of her program, is to research the specific challenges presented to scientists by practitioners of alternative medicine who claim to have different standards of evidence. Thesis chapters will address the philosophical foundations of evidence, the use and abuse of evidence in science and medicine, and the insights gained from the debate over the status of ‘alternative’ forms of evidence.

Julie Dergal
Lupina/OGS Doctoral Fellow

“Understanding Private Companions in Nursing Homes”

Biography: Julie Dergal is a doctoral candidate in the Faculty of Social Work, and a part of the Collaborative Program in Aging at the Institute for Life Course and Aging at the University of Toronto. She holds a Bachelor of Science in Biology from Dalhousie University, and a Master of Science in Community Health from the University of Calgary. She has worked at the Kunin-Lunenfeld Applied Research Unit, at the Baycrest Centre for Geriatric Care for the last six years. During the last four years, she has also been a teaching assistant for Quantitative Research Methods in the Faculty of Social Work. Her overall research focus is gerontology and health. Her specific interests include; caregiving for older people with dementia, quality of care in nursing homes, elder abuse, homelessness among older adults, and aging with a disability. Her work uses both quantitative and qualitative approaches. Her doctoral work examines the factors that lead family members to hire a private companion for their older relative living in a nursing home. In particular, she is interested in the role of the families’ perception of the quality of care in nursing homes, and the stress they may experience as a result of their relative living in an institution.

Project Abstract: The purpose of Dergal’s dissertation is to explore the phenomenon of private companions who are hired by family members to work with older adults living in nursing homes. From on-site observation, private companions tend to be involved in activities such as providing personal care, assisting with feeding, and providing social stimulation. Despite the presence of private companions in the long-term care sector, there are currently no studies that have been conducted in this area. Therefore, there is a lack of research to suggest why private companions are hired and what role they are fulfilling in long-term care. It is possible that family members may hire a private companion for a variety of reasons including concerns about quality of care provided by the institution, which may be burdensome for many family members. Private companions may also serve as surrogates for family members who are unable to visit frequently due to other responsibilities or geographic distance. This study will therefore use both quantitative and qualitative methods to examine the reasons family members hire private companions in nursing homes, and to understand their function from the family member’s perception. This study will be the first to provide empirical evidence for understanding private companions in nursing homes.

Lisa Forman
CPHS Research Fellow

“Integrating Human Rights Standards into
Trade Law and Policy: Theoretical Linkages
and Practical Mechanisms”

Biography: Lisa Forman qualified as a lawyer in South Africa with a BA and LLB from the University of the Witwatersrand. She received a Masters in Human Rights Studies from Columbia University, and will be shortly receiving her SJD from the University of Toronto, Faculty of Law. Her dissertation explores the role of human rights in increasing access to AIDS medicines, focusing on South Africa as a case study. For the past nine years, she has specialized in the area of human rights and HIV/AIDS, working on related projects in Johannesburg, Toronto, Lusaka, New York and Geneva.

Project Abstract: Forman's research focuses on international human rights law and constitutional rights relating to HIV/AIDS, health and medicines, and their normative and coercive power to ensure better public health outcomes. Her doctoral research explored this question from the perspective of essential AIDS medicines, an inquiry which also noted the impact of international and bilateral trade rules on medicines access, and the notable lack of interaction between these two bodies of international law. This research provided the groundwork for her current research project which will explore methods of ensuring this interaction and in particular, how human rights can be utilized to ensure better public health outcomes in the formulation and implementation of trade policies. Forman has published several academic articles and book chapters in these and related areas, and has presented her research at international and national conferences.

Delia Gavrus
Lupina/OGS Doctoral Fellow

“Neurology and Neurosurgery in the First Half of the Twentieth Century: Wilder Penfield and the Founding of the Montreal Neurological Institute”

Biography: Delia Gavrus is a doctoral candidate at the Institute for the History and Philosophy of Science and Technology. As an undergraduate student in psychology at the University of Toronto, Delia focused on the physiological basis of behavior, in particular visual perception. Apart from her BSc (Hons) degree, she holds an MA in science studies from New York University, where she completed a thesis on nineteenth-century psychiatry and its contribution to the eugenics movement. Delia’s current research interests include the history of neurology and neurosurgery and the history of behavioral sciences.

For the past year, Delia has been working with Dr. Jan Sargeant (Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University) on a project on microbial food safety policy research that involves analyzing data from qualitative surveys, focus groups, and interviews with stakeholders. The project also consisted of a multi-disciplinary workshop held in Ottawa on March 7th and 8th, 2005.

Delia loves teaching. Apart from being a teaching assistant, she has taught an undergraduate English literature course and has worked as a teacher for two years in Japan.

Project Abstract: Gavrus’ dissertation will explore the changes that occurred in neurology and neurosurgery in the first half of the twentieth century through the lens of the Montreal Neurological Institute (MNI) and the career of its first director, Wilder Penfield, a four-time Nobel Prize nominee. With the help of a grant from the Rockefeller Foundation, Penfield founded the MNI in 1934 as an institution “dedicated to the relief of sickness and pain and to the study of neurology.” This twofold aim reflected Penfield’s own ambition as a surgeon-scientist both to cure illness and to unlock the mysteries of the brain and of consciousness itself.

A substantial part of her dissertation will address the social dimensions of neurological research and intervention in the first half of the twentieth century. Garvus is interested in the way in which Penfield negotiated the sometimes-conflicting priorities of scientific research and patient treatment, and in the effect that this negotiation had on patient care, informed consent, and public perception of neurosurgery. Penfield was one of the first physicians to articulate a need for neurologically trained surgeons who could go beyond tumor-removal to the surgical treatment of neurological conditions such as epilepsy. This position put him at odds with old-school neurologists such as the British F.M.R. Walshe, who was suspicious of “American notions” of brain surgery. Despite this resistance, however, Penfield's work had a significant effect on the development of the profession and on the treatment of neurological disorders. Furthermore, Gavrus will investigate the role played by the social environment in the founding of the Institute and in Penfield's freedom to conduct the research he desired. Despite being offered prestigious positions at institutions in his native U.S., Penfield remained determined to stay in Montreal and to work toward his goal of establishing a neurological institute in this city. Certain features of Montreal's social and political landscape made it easier for Penfield to achieve his clinical and scientific goals, and Gavrus will explore these social factors in her dissertation.

Jennifer Keelan
CPHS & SSHRC Post-Doctoral Fellow

“In Pursuit of the Speckled Monster: Epidemiology, Authority, and Risk in the Debates Over Compulsory Smallpox Vaccination in Canada, Britain and the United States, 1890–1920”

Biography: Jennifer Keelan is a CPHS and SSHRC Postdoctoral Fellow. She completed her PhD in History of Science and Medicine at the University of Toronto’s Institute for the History and Philosophy of Science and Technology, under Professor Pauline Mazumdar. Her Ph.D. thesis focused on late nineteenth anti-vaccinationism and the social and medical factors involved in early epidemiological reasoning for compulsory vaccination including the calculations of risk, and public testimony about medical science. Her work examined the assessment of the various smallpox vaccination technologies in Canada and the United States in the context of late nineteenth century bacteriological sciences. Her postdoctoral research compares the attempts to repeal compulsory vaccination in the United States, Canada and the UK at the turn of the century. She is particularly interested in how diverse social groups experienced and understand risk and how this intersected with popular notions of medical authority and expertise in the public sphere. She recently co-organised an international conference in the history of immunology at the University of Toronto, and was a co-founder of the annual Joint Atlantic Seminar for the History of Medicine which will take place at Harvard October, 2004.

Project Abstract: Coming soon!

Carolyn McLeod
CPHS New Faculty Fellow

“The Ethics and Politics of Medical Conscience Clauses”

Biography: Carolyn McLeod has been an Assistant Professor of Philosophy at the University of Western Ontario since 2002. She came to Western from the University of Tennessee, Knoxville, where she was an Assistant Professor for one year. From 1999–2001, a Social Science and Humanities Research Council of Canada Postdoctoral Fellowship took her to the Center for Bioethics, University of Minnesota as well as the University of Western Ontario. In 1999–2000, she held a second postdoctoral fellowship from the Center for Bioethics itself.

Prior to being in Minnesota, she was completing her PhD in Philosophy at Dalhousie University. Her supervisor was Susan Sherwin, who was named Distinguished Woman Philosopher of the Year for 2004 by the Society for Women in Philosophy (U.S.). Carolyn received both her Master’s and Bachelor’s degrees in philosophy from Queen’s University.

Throughout her career, she has focused on philosophical issues in health care ethics. Both her PhD and Master’s dissertations were in reproductive ethics. With her recently published book, Self-Trust and Reproductive Autonomy (MIT Press 2002), she was able to bring together interests she has in reproductive ethics, philosophical moral psychology, and feminist theory. Other publications of Carolyn’s include papers on the nature of trust, integrity, autonomy, and objectification. These appear in such as places as the Canadian Journal of Philosophy, the Journal of Social Philosophy, and Health Care Ethics in Canada (Harcourt Brace 2004, 2nd edition). Carolyn also has a piece forthcoming in the Oxford Handbook of Bioethics on feminist objections to commodifying women’s bodies through various reproductive practices.

Project Abstract: Many ethical issues in health policy concern legitimate conflicts between the rights, needs or wishes of some and social justice for all. The issue McLeod will address is a case in point: the conscience of health care providers, or of institutions, versus social justice in health care (i.e., justice for social groups, such as women and people of colour).

McLeod’s general topic is conscience clauses in health policy, which exist to protect health care providers or institutions that make conscientious objections to performing certain medical services. Under this topic, she poses the following: Q1) What is a genuine conscience clause? Q2) When are genuine conscience clauses morally justified? Answering Q1 involves thinking about what conscience is, while answering Q2 requires careful reflection upon “the rights of some versus social justice for all” problem, as applied to conscience clauses.

Her project explores the impact of conscience clauses in one specific area: social justice for women in reproductive health care. Reasons for making this move include McLeod’s own expertise in reproductive ethics, along with the fact that conscience clauses appear to be significant determinants of women’s reproductive health, in Canada and the U.S., because of the controversial nature of many reproductive health care practices.

McLeod’s goals for the project are to try to influence policy on conscience in reproductive health care, and to complete a book manuscript on the ethics and politics of conscience clauses.

Kate Parizeau
Lupina/OGS Doctoral Fellow

“Social Capital and Environmental Health: A Study of Waste Pickers in Mexico City”

Biography: Kate Parizeau is beginning her PhD studies in Geography with the Centre for Environment’s collaborative program in Environmental Health. Her research interests are waste management, international development, and health-related issues. Kate has recently received her Master’s degree in Planning from the University of Toronto, where she specialized in Social and Environmental Planning. Her Master’s research involved a feasibility study on the potential for community-based waste management in an area of Siem Reap, Cambodia that does not currently receive municipal waste services. Kate received her undergraduate degree in Arts and Science from McMaster University, where she had the opportunity to work with the McMaster Institute for Environment and Health. Her undergraduate thesis was a characterization of four neighbourhoods in Hamilton, which was part of a preliminary investigation for a study on the determinants of health in the city.

Both work and holidays have offered Kate the opportunity to travel, and she has greatly enjoyed her international experiences. She plans to conduct her Doctoral research in Latin America, where she will study the effects of socio-economic status on the ability to identify and mediate environmental health risks within the waste management sector.

Project Abstract: Mexico City’s population produces an enormous amount of waste, which provides both a source of income and an undeniable environmental health hazard to some of its most vulnerable citizens, namely the city’s waste pickers. Waste picking in the streets and at dumpsites not only provides employment for many marginalized people, but has become a mainstay of the informal system in many developing countries and is now an inextricable (and cost-saving) part of municipal waste diversion and material recovery.

There is an established relationship between waste-picking behaviour and multiple health risks, including disease exposure, chemical inhalation, infection, parasite contraction, physical injury, and animal bites. It is plausible that certain social resources may help to mediate these physical environmental risks faced by waste pickers in their work. Parizeau’s research question is as follows: How does socio-economic status affect waste pickers’ ability to identify and cope with environmental health threats?

Complex social structures have emerged in Mexico City’s dumpsites. Waste pickers participate in numerous hierarchical and reciprocal relationships for reasons of economic gain and personal safety. Some of these relationships are exploitative, but many are also economically and socially beneficial. Parizeau posits that those who are ensconced in the lowest levels of these hierarchies (and therefore have the most dangerous work environments at the dumpsites) are those who are the most vulnerable to environmental health risks.

The research hypotheses will be tested with a survey of waste pickers in Mexico City. Case studies of work environments will also be conducted to identify environmental health hazards.

M. Bianca Seaton
Lupina/OGS Doctoral Fellow

“Health Care Workers and Health Care Work in the Context of Occupational Risk and the Reemergence of Infectious Disease”

Biography: M. Bianca Seaton is a doctoral candidate in the Department of Public Health Sciences at the University of Toronto. She holds a Master of Science in Public Health Sciences (Social Science and Health/Collaborative Women’s Studies Program) from the University of Toronto, and a Bachelor of Arts and Science from McMaster University. Bianca is a qualitative researcher with an interest in women’s health and women’s work, sociological approaches to the study of health “risk” and the body, and the relationship between knowledge and practice in health research. She has worked as a researcher at the Centre for Gerontological Studies and the Community Care Research Centre at McMaster University, and contributed to a variety of collaborative, interdisciplinary research projects on the work, occupational health, and well-being of hospital-based nurses and other health care workers. Bianca has published and presented past research and graduate projects including the occupational health of women in non-standard forms of employment and the experiences of nurses with work-related injuries, and is currently exploring her theoretical interest in the methodological practice of reflexivity in qualitative research.

Project Abstract: Hospital-based health care workers, and registered nurses (RNs) in particular, are at high risk for work-related injury and illness. Musculoskeletal disorders (MSK) (soft-tissue damage) are especially prevalent among nurses, and as the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) in Ontario illuminated, the health of hospital-based nurses can be threatened by workplace exposure to potentially deadly microbes. Research dedicated to MSK in health care workers is still in its early stages, as is research related to the recent re-emergence of infectious diseases (such as SARS and tuberculosis) as a threat to health care workers in hospitals. There is a paucity of literature on individuals’ subjective perceptions and understandings of the health risks associated with health care work in general and infectious disease care in particular. Knowledge is also lacking on how such risks affect nurses and the functioning of health care teams, and on the impact of perceptions of risk on the work-related experiences and behaviour of health care workers. Such knowledge is relevant both to the scholarly understanding of work-related health, and to occupational health policy and practice.

Seaton’s doctoral research focuses on RNs and their perceptions, understanding, and attitudes towards occupational health risks (in particular the risk of MSK and those associated with infectious disease care) in the context of their work practices and the social relations of work on nursing wards in order to draw out the core social dimension of each type of occupational risk.

Kathryn Underwood
Lupina/OGS Doctoral Fellow

“A Case for Inclusive Education as a Social Determinant of Health”

Biography: Kathryn Underwood is a doctoral candidate at the Ontario Institute for Studies in Education at the University of Toronto. Kathryn’s research interests include human rights and educational practice particularly with regard to disability rights and inclusive education. Her previous research has included a comparative study of parent attitudes toward disability in Ontario, Canada, and New Delhi, India, under the Rosemary F. Dybwad Fellowship. She has also worked on projects examing effective teaching practices and a review of inclusion research in Canada. Prior to her graduate work, Kathryn worked for the Canadian Abilities Foundation and as an ESL teacher.

Project Abstract: In this study, using existing research, a case is made that people with disabilities who have had access to inclusive education are more likely to have improved social conditions including better long-term health and access to health through reduced poverty, higher employment and social inclusion. These social conditions are referred to as social determinants of health, meaning “the economic and social conditions that influence the health of individuals, communities, and jurisdictions as a whole” (Raphael, 2005, p. 1). This study addresses a gap in knowledge about the
outcomes of inclusive education by examining long range outcomes of education policy.
I will begin with an introduction to the literature on education policy for students with disabilities and outline the connections to be found in the literature on social determinants of health. The Social Determinants of Health approach to the study of populations is applied to educational research. This builds on my doctoral dissertation, A theoretical and practical analysis of teacher and parent beliefs about disabling barriers in education, which identified some of the barriers to inclusive practice
according to teachers and parents of children with disabilities in five Ontario school boards. The barriers identified in my dissertation included education policies that did not promote inclusion or that did not provide adequate supports, in addition to attitudes of teachers and parents themselves.

Leah Walz
Lupina/OGS Doctoral Fellow

“Malta, Motherhood, and Infant Mortality: Integrating Biological and Sociocultural Insights”

Biography: Leah Walz is a PhD candidate in the department of Anthropology at the University of Toronto. As an undergraduate student at the University of Manitoba, Leah began to develop an interest in both the biological and sociocultural aspects of medical anthropology, which has carried over into her doctoral studies. Her current research interests include examining the social, cultural, and biological determinants of health; the impact of colonialism, globalization, and other global forces on patterns of health and disease; and exploring past and present medical systems and perceptions of health and illness.

Under the supervision of Dr. L.A. Sawchuk, a medical anthropologist and head of Health Studies at the University of Toronto at Scarborough, Leah has been involved in a number of projects looking at historical and contemporary aspects of health and disease. Current research includes: examining the contexts and determinants of adolescent substance use in Gibraltar, exploring discourses on prostitution and venereal disease in early 20th century Malta, and tracing the progress and effects of past epidemics of yellow fever in the Mediterranean.

In addition, Leah has had the opportunity to develop and teach a new course at UTSC, entitled ‘Health, Aging, and the Life Cycle’, which takes an interdisciplinary approach to the examination of (so-called) normal and pathological aspects of the aging process.

Project Abstract: A central aim of Leah’s thesis project is to explore how the social milieu, political economy, and historical context informed and influenced the discourses surrounding—and the experiences of—infant mortality in the Maltese Islands. In her approach to this complex historical question, her objectives are as follows:

1. To employ the techniques of biomedicine to explore infant mortality: to utilize conventional biomedical analyses and indices to establish the level of infant mortality for Malta over time (1900–1950), the causes of the observed mortality, as well as the magnitude and nature of its spatial variation.
2. To examine some of the factors that may be involved in these trends in mortality, such as presence of health services, environmental health conditions, socioeconomic status, and education, and to measure the strength of the relations. She places great emphasis on ascertaining the role played by culturally rooted practices, such as breast-feeding, age and season of weaning, birth spacing, and family size, in the expression of infant survivorship—to thereby demonstrate the ways in which patterns of health, disease, and death reflect the interdigitation of cultural and biological phenomenon in human populations.
3. To interrogate these biomedical analyses by placing the statistical findings within the larger context of colonial domination: the political, economic, and social marginalization of the Maltese people—as captured by colonial discourses surrounding the Maltese, mothering, and the infant mortality rate—to show how this mediated colonial responses to infant death.