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leaders in health: dr. michael strong and the 30-year pursuit of a cure for als
11 minute read
dr. michael strong is the only canadian to ever win both the sheila essay award and the forbes norris award for als research.
allan lewis, schulich school of medicine & dentistry
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dr. michael strong knew he wanted to get into medicine after one of his high school teachers showed him and his class unique and intriguing innovations in biology.
because of his teacher’s unique approach to teaching human biology, dr. strong, now a distinguished university professor in the department of clinical neurological sciences at western university and arthur j. hudson chair in als research, got to work with a local pathologist, identifying different patterns of neuronal structure in all the various regions of the brain.
since then, his passion for what makes the brain tick and the different diseases that affect the neurological system has helped form his path from a budding student to a revered medical researcher and clinician.
following his high school career, he continued his studies at queens university in kingston, ontario, where his interest in amyotrophic lateral sclerosis (als) was sparked.
“the chief resident and i were invited by one of the senior neurologists, denis white, one of canada’s amazing foundation neurologists, to come up and see a case on the ward, and he said, ‘you’re never going to see this case again in your life, so come and have a look at it with me,’” dr. strong said. “and obviously, it was a case of als, and that left an indelible mark on me.”
with his passion for als growing and the end of his career at queens coming to a close, during his last semester, he was given the opportunity of a lifetime—an opportunity that would help shape the direction of his life’s work.
“in our final year, you had electives, which was very much typical, but we were allowed to take three months and go anywhere in the world that we wanted to study,” dr. strong said. “i ended up going to denmark.”
in a case of serendipity, his decision to go to denmark to finish out his studies landed him at the major als referral centre for the country at the time. when dr. strong made his way back to home soil, he finished his neurology training at western university in london, ontario, under the wing of dr. arthur j. hudson, als clinician and “one of the founding fathers of the als society in canada.”
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als society of canada (als canada)
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when dr. strong first examined a case of als, he thought that would be a one-off. it wasn’t until he returned to canada for his residency that he realized more and more people with the disease needed help, with patient after patient coming to see dr. hudson for help with the debilitating and fatal disease.
once dr. strong learned that the rare case he saw wasn’t that rare at all, he decided that he would be one of the many neurologists who dedicated their lives to the disease.
leaning into neuropathology
during his residency, dr. strong was given the unique opportunity to work in neuropathology, which is the study of diseases affecting the nervous system during autopsies or surgical biopsies.
“when i went into neuropathology, sadly i was seeing the cases that i’d seen during life, and looking at the spinal cords, and really, got taken under the wing by some great neuropathologists,” he said.
it was the mid-80s at the time, and although technology was nowhere near as advanced as it is today, dr. strong was able to play a role in the overall understanding of specific structures that lend a hand in the development of neurological diseases, such as als.
as the chief resident of neurology, he began settling into a career in community neurology, one of which his colleagues and mentors were not all that pleased about.
“(arthur) said to me that it was indefensible, that i would be wasting the rest of my life as a community neurologist and that i would regret not taking the opportunity to explore a research career,” dr. strong said.
switching gears to research
while dr. strong was already content with his current work, he made the switch into research when he landed at the national institutes of health in carlton gajdusek’s lab, a nobel prize winner and someone who, dr. strong admits, he didn’t like very much when he first met him.
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“i just didn’t like carlton at all initially,” he said, chuckling at his impression of the now-revered medical researcher who rapidly became a terrific mentor and colleague.
luckily, dr. strong was able to work under the supervision of another brilliant medical researcher, ralph garruto, who he referred to as an “amazing, amazing mentor.”
dr. strong was only meant to stay at nih for one year but was so enthralled by the experience that his time spent as a researcher for the organization spanned three.
“i just got the bug,” he said. “i just loved what we were doing.”
even though he had his hands in both the clinical care aspect and research piece of medicine, his heart didn’t lie with just one, but rather all of what he did and could do.
when asked to choose between working in a clinical or research setting, dr. strong admitted that he “wouldn’t choose.”
“you can’t. it’s the definition of what a clinician scientist is, is that you work across both domains.”
dr. strong believes that having experience in both sectors is great, and both jobs are equally important for advancing medical technologies that can make a fundamental change in the lives of those living with als.
“it’s a really challenging disorder for the obvious reasons, but it is amongst the most rewarding because it’s amazing families and their loved ones and just the sense that you become a part of that community and you’re working with them, so you don’t need the research to be able to do that,” he said. “by the same token, i absolutely believe that there must be individuals who are of the true clinician scientist mould.”
returning home to care for a mentor
after his time with the nih, dr. strong returned to london in 1990 to work with hudson more at the als clinic. they spent the next few years working alongside one another to help patients with als.
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sadly, in a stroke of twisted fate, hudson was diagnosed with als, which led to him switching roles from doctor to patient, leaving dr. strong to take over the clinic and help care for him while he dealt with the ins and outs of the disease he worked so hard to figure out.
“(i) took over the clinic from him, sadly looked after arthur when he developed als a few years later. and then have continued that pathway the rest of my career,” dr. strong said. “i had amazing mentors throughout my career. people who took their time to talk to me about what they thought would be something fascinating for my career.”
from humble beginnings to award-winning research
dr. strong’s decades-long career in the als space has not been wasted. as the only canadian to ever win both the sheila essay award and the forbes norris award for als research, his contributions have been nothing short of impressive, helping to advance the als research space to improve the lives of those living with the fatal disease.
of course, dr. strong doesn’t let any of it go to his head because he has a family system that “keeps him humble.” he tells a story of sitting around with his wife and children after learning he was going to receive the sheila essey award from the american academy of neurology.
“i’m sitting around the dinner table with my wife, and my three kids are there, and we’re chatting away, and i said, ‘hey, listen, guys, i just found out today that i’m going to get the sheila essay award,” he said. “my youngest guy, he must have been 9 or 10 at the time, he looks at me, and he goes, ‘why you?’”
as of writing, dr. strong has close to 20 awards under his belt for his clinical and research work in the neurology space, and with the latest research he’s doing on als, it appears that more may be in his future.
pivoting his way through setbacks
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just like other medical researchers, dr. strong is no stranger to setbacks. in scientific research, there is always a possibility that data won’t translate from theory to practice.
one such setback dr. strong has had to contend with is getting research grants, which is often difficult to do, even in the best circumstances. in some cases, it can even make the most motivated people want to give up.
“i’ve come close to that (giving up) a couple of times during my career,” he said. “early in my career … i was submitting grants to the cihr (canadian institutes of health research) at that time … and we weren’t getting funding from the major groups.”
“everybody loves to blame the system for the failure to get funding … (but) the grants weren’t very good. that’s the bottom line.”
when the going got tough when getting funding, dr. strong would practice temporarily giving up and return to the clinic to do that instead of focusing on the research side of his career. he recalls having another “arthur hudson” moment with another colleague, mark j. poznansky, when faced with the grant challenges, who also told him that he would be wasting his life if he didn’t follow through with his research.
“he said, ‘if you could bring anybody in the world here to spend time with you, to develop a research partnership and to help you move things forward in a different way, so you don’t have to change your research, you have to make a slight modification … who would you bring up?’” dr. strong said. “so, that was when joe beckman came up from alabama.”
dr. strong and joseph s. beckman, a renowned researcher in the area of oxidative stress and its effects in als, worked together to advance the research further. working with dr. beckman brought him a newfound appreciation for the often frustrating work, which led to him overcoming disappointments and keep striving forward.
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now, when faced with obstacles, dr. strong practices one lab rule that keeps things moving forward while allowing space for negative feelings to breathe.
“we have a rule of thumb here in the lab. you have 24 hours to whine about it and then go on with it,” he said. “that’s kind of been a bit of the coping mechanism.”
dr. strong also deals with setbacks like anyone else would by leaning on his loving and supportive family to help him through the tougher times.
“the other piece in there (coping with setbacks) is the support my wife has been,” he said. “she’s an amazing protein chemist and helped us with a lot of our isolations. the team that i’ve had, i’ve not got 12 people in the lab. they’re all really good, and my family’s been great, so there are times when you kind of want to walk away … but it’s not meant to be.”
creating a community for als advancement
while dr. strong continued his research, working with patients and their families was also at the forefront of his mind. for half a decade, he stepped away from the clinical side of things to take on the role of president of the canadian institutes of health for the federal government and overseeing canada’s health research funding agency, but he admits that without that patient piece, he was missing a part of his career that meant a lot to him.
“i missed that ability to say, you know, i continued my lab on during all of this. but for five years, i didn’t see any patients because i was in ottawa, and there was just a whole. it was a piece of my training, my life, that just didn’t seem right,” he said. “so, having them and being able to talk with them, being able to say this is what we’re doing, even though it fails sometimes, it’s good.”
along with creating a space for himself to get together with patients, he also acknowledges that where he is now in his research wouldn’t have been possible without his work with people living with als and their loved ones, along with the brilliant minds he got to work with throughout his career.
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his life’s work, although impressive in its own right, was not done without creating a community of people dedicated to helping people with als.
“there are so many colleagues internationally and here in canada that have been seminal, even in simple discussions over a beer sometimes,” he said. “that’s it. i think it’s all about the research, and i think it’s about that accomplishment going forward.”
what’s next for dr. strong?
dr. strong continues to research new ways to treat als, and a recent breakthrough in that research become the focal point of where he and his research team are headed. the breakthrough, the discovery of a protein that can counteract the action of the protein that drives als, was 30 years in the making.
he and his research team are working with the temerty family foundation over the next five years to bring the discovery to phase 1a trials to test its efficacy and, if all goes well, develop a new and viable way to treat als.
he also spends every tuesday working in the clinic, so he gets to experience the best of both worlds: research and dealing with patients directly. while he may have had to give up on other dreams in the process, getting to work with patients and continue with his research work is “kind of a balance of life right now that i have that i’m just loving,” he said.
“any hope that i had of joining the pga tour was completely demolished when i started golfing and didn’t get any better, so you’re stuck with me,” he said. “at the end of the day, you know, i love what i’m doing.”
when asked how it feels to be in the spotlight, dr. strong admitted to feeling comfortable with the praise and attention. still, he also acknowledges that with or without it, the work is consequential, and his enjoyment of it far outweighs anything else that comes with it.
“i’m very comfortable with it (being in the spotlight), but i also recognize that it’s just a moment in time. it’s effervescent,” he said. “you can screw up tomorrow just as bad as you did something well today, so just enjoy it. it’s fun. but at the same token, it’s just a moment. it’s about the research and the patients.”
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