Michael Smith Foundation for Health Research/Lotte and John Hecht Memorial Foundation Post-Doctoral Fellowship Award
Placebo effects pose challenges to the conduct of clinical research. Double-blind randomized placebo-controlled trials can demonstrate superiority of an active intervention to a placebo. However, in some cases placebo control / complete blinding is difficult or impossible. For instance, in invasive or surgical interventions, placebo use raises ethical questions.
Susceptibility to placebo effects varies substantially across individuals: some experience pronounced placebo effects, while others show little or no response. Sources of this variation are poorly understood. Recent evidence from basic research has pointed to the role of reward expectancy and neural reactivity to rewards as key mechanisms of placebo response.
We seek to identify predictors of individual placebo responses in a sample of healthy volunteers, focusing on reward expectancy and reactivity. We will also examine individual variation in placebo response in an ongoing randomized controlled trial of an endovascular procedure in multiple sclerosis at UBC.
Understanding individual variation in placebo response could ultimately be used in clinical research:
- To model placebo-related variance of patients in clinical trials where placebo control is impossible or problematic
- To guide selection of patients for clinical trials
Lung cancer is the most common cause of cancer death with more than 1.3 million mortalities annually. Autofluorescence (AF) bronchoscopy is an established clinical technique that has proven to be extremely effective for early detection and staging of cancer by identifying high-risk areas where biopsies should be collected.
Currently, AF imaging is the most sensitive means of lung cancer detection. However, the improved sensitivity of AF broncoscopy comes at the cost of a decrease in specificity due to false-positive fluorescence in areas of inflammation or an increase in epithelial thickness. Moreover, performing biopsies and conducting histology on the removed tissue are costly and time-consuming.
The efficacy of the treatment would be significantly enhanced by differentiating carcinoma from other non-dangerous anomalies. OCT, the optical equivalent of ultrasound, enables high resolution in vivo imaging of airway morphology to study the high-risk tissue sites without performing biopsy and removing tissue. Therefore, when used in combination, AF-OCT imaging can provide rich biochemical information. The aim of Dr. Pahlevaninezhad’s research is to combine AF imaging and optical coherence tomography (OCT) to manage this disease through earlier detection. Dr. Pahlevaninezhad’s research method begins with combining the two modalities in free space to test ex vivo samples and to calibrate the system. The next step will be to build a fibre-based system for in vivo imaging of lung and to test the system on a small number of consenting patients.
Through the combination of these imaging techniques, Pahlevaninezhad’s research will provide both architectural and biochemical information which will aid in avoiding unnecessary biopsies. Significantly, the applications of the proposed device are not just limited to lung cancer; it also could target other applications like the oral cavity, considerably enhancing the ability to detect cancers effectively and efficiently.
