The Canadian Child and Youth Health Coalition (CCYHC) is a collaboration of five major national child and youth health organizations working together to advance the cause of child and youth health in Canada.
Recently, the CCYHC asked its members across Canada the following question: "What is the most important Canadian discovery which has had the greatest impact, or has the greatest potential for impact, on health outcomes for children and youth in the last 100 years?"
The top ten responses were released during the annual meeting of the Canadian Association of Paediatric Health Centres in 2007. Some of the advances on the list are probably familiar to many, others not. The list has no particular order.
The top ten
AIDS drug 3TC
Developed by Francesco Bellini, Gervais Dionne, and Bernard Belleau, founders of Montreal-based BioChem Pharma, 3TC is today recognized as the most widely used drug in the world in the treatment of HIV. 3TC was developed in 1989. At the end of 2005, some 2.3 million children under the age of 15 years were estimated to be living with HIV/AIDS. The majority of these children acquired their infections through mother-to-child transmission during pregnancy, labour, or breastfeeding. 3TC lowers the amount of virus in the mother's body and can reduce the rates of mother-to-child transmission.
Transmission rates are as high as 35% when there is no intervention and below 5% when antiretroviral treatment, such as 3TC, and appropriate care are available. The development of this drug has saved and continues to save millions of children from getting AIDS.
The connection between HUS, E. Coli, and verotoxin
Hemolytic uremic syndrome (HUS) is a serious and, occasionally, devastating and deadly complication of a bacterial infection of the gut by Escherichia coli bacteria (E. coli). Dr. Mohamed Karmali led a team that discovered the role of verotoxins produced by E. coli in the development of the HUS. Before this discovery, the cause of HUS was unknown.
Since the 1980s, this new knowledge has led to important preventive measures to improve food safety and reduce the incidence of severe infections and HUS, which most often affects young children and the elderly. Dr. Karmali has worked for The Hospital for Sick Children (SickKids), McMaster University, and more recently Health Canada.
Type I diabetes was a death sentence until the discovery of insulin. In 1922, Drs. Frederick Banting, Charles Best, John MacLeod, and J.B. Collipp unlocked the mystery of diabetes and began to treat patients. Working at a University of Toronto laboratory in 1921, Banting and Best were able to make a pancreatic extract called insulin which had anti-diabetic characteristics. After learning how to purify the extract, patients were treated with spectacular success.
Children with type 1 diabetes now lead long, productive, and happy lives. This discovery has saved and continues to save millions of lives worldwide. Banting and McLeod later shared the Nobel Prize for the discovery.
Sometimes, children are born with defective hearts. So-called "Transposition of the Great Arteries" is one such defect. The condition means that blood does not circulate properly in the heart, leaving infants oxygen-starved. These 'blue babies' frequently died. On May 16th, 1963, Dr. William Mustard made medical history when 18-month-old Maria Surnoski of Whitby, Ontario became the first child to have what was to become known as the "Mustard operation" performed at SickKids.
By putting a new partition in one of the chambers of the heart, Dr. Mustard made the heart work backwards, yet circulate blood to the lungs as effectively as a normal heart. Dr. Mustard was invested as a member of the Order of Canada. By the time he died in 1987, his operation had saved more than 500 children at SickKids alone, and thousands worldwide.
Neonatal screening for congenital hypothyroidism
Babies born with congenital hypothyroidism (CH) do not produce enough thyroid hormone, which results in an extremely low metabolism. If not treated quickly and properly, the child can become mentally retarded. In 1974, Dr Jean Dussault and Dr. Paul Walfish developed a screening test for the condition that could immediately identify babies with this condition. As a result of this technology, thousands of children have been saved from mental retardation.
In 1931, three doctors from SickKids, Frederick Tisdall, Theodore Drake and Alan Brown, developed a remarkable innovation: Pablum. This baby food is a cereal fortified with all the essential nutrients, including minerals and vitamins A, B1, B2, D, and E. When introduced, Pablum decreased the period's high incidence of nutritional rickets, a serious disease that causes softening of the bones.
This new, quick-to-prepare, low-cost cereal became internationally famous as Pablum and the discovery improved nutrition for infants across the world.
In the first half of the twentieth century, polio was one of the most feared childhood diseases in the developed world. Canada played a critical role in the development, production, and licensing of the polio vaccine in 1955 - and the subsequent elimination of the disease. Under the efforts of researcher Jonas Salk, the Connaught Medical Research Laboratories at the University of Toronto enabled the polio virus to be cultivated and the vaccine produced in quantities large enough to facilitate Salk's massive trial, involving roughly 1.8 million children.
Between 1927 and 1953, Canada experienced roughly 47,000 cases of polio. With the licensing of the Salk vaccine in 1955, along with the active involvement of both provincial and federal governments, Canada reported its last case of polio infection in 1977.
Universal health insurance
Shortly after the Second World War, Tommy Douglas, Premier of Saskatchewan, began implementing measures in his province to provide medical insurance for all. After nearly two decades of political wrangling, including a strike by Canadian doctors who opposed universal health care, The Canada Health Act was made the law of the land in 1966.
No matter what blood type a person is, either A, B, AB, or O, each person's blood has a Rhesus (Rh) factor: either positive or negative. If a mother's blood is Rh negative and her developing fetus is Rh positive, a condition called alloimmunization (also called isoimmunization) can occur. Alloimmunization causes the mother to pass on antibodies into the baby that attack the baby's own red blood cells. Affected babies died in utero from hydrops fetalis, succumbed to cardiac failure, or survived following blood transfusions, sometimes with cerebral palsy and deafness.
In the 1980, Dr. Bruce Chown and Dr. Jack Bowman of the University of Manitoba developed Rhogam, which solved this problem. Rhogam, also called WinRho, contains antigens that counter the antigens of an Rh-negative mother. In many cases, it is effective in preventing Rh alloimmunization, saving thousands of lives. Today, Rhogam is distributed to over 40 countries. This was a triumph of knowledge translation, from bench to bedside to population.
Yuzpe regimen of emergency contraception
The Yuzpe regimen, named for Canadian Professor A. Albert Yuzpe, was introduced in 1977. Better known as a 'morning after pill,' this method of emergency contraception consists of oral contraceptive pills containing the hormones estrogen and progestin taken in two doses.
The Yuzpe regimen has been found to decrease the risk of pregnancy by 74.1% and remains the most commonly prescribed emergency birth control method in North America. The Yuzpe method has been further developed into emergency contraception around the world, resulting in fewer abortions and a reduction in untold numbers of unintended pregnancies.