COVER

PRESSURE TO FIND A CURE

JOHN BARBER March 30 1987
COVER

PRESSURE TO FIND A CURE

JOHN BARBER March 30 1987

PRESSURE TO FIND A CURE

COVER

Jocelyn Lovell was Canada’s best bicycle racer before a dump truck ran over him and crushed his spine while he was riding near his Toronto-area home in 1983. His agonizing adjustment to life as a quadriplegic-paralysed below the neck but with limited use of his upper arms—reached a low point last year when he and his wife, former Olympic speed skater Sylvia Burka, separated. Lovell has accepted the crumbling of his marriage, but he refuses to become what he calls “a good cripple.” Although he copes heroically-living alone in a specially designed house in Port Credit, Ont.—he calls his wheelchair confinement “rolling death” and angrily refuses to accept his fate. He considers Rick Hansen’s optimistic message—that despite their limitations disabled people have amazing potential—to be a cruel hoax. Instead, Lovell clings to a more radical hope: that some day he will be cured. Asked Lovell: “Is it a world full of professional cripples we want or to get rid of this hideous affliction?”

Militant: Both men were exceptional athletes, both have defied their paralysis and become articulate spokesmen for the disabled: there is uncanny symmetry to the lives of Jocelyn Lovell and Rick Hansen. But unlike Hansen, Lovell is not a team player; he never was. And his message, which reflects a growing division among disabled groups, is disturbing rather than uplifting. Lovell speaks for a small, militant movement that is intolerant of any work—including Hansen’s—that they say is devoted to “making do in wheelchairs.” Lovell says that he believes that such efforts divert funds for research away from the ultimate goal of developing a cure for spinal cord injuries. Declared Lovell: “I don’t want to make the whole world wheelchair-accessible. That is not the answer. When will people wake up and spend one per cent of the money they’ve spent on all that crap on cure research instead?”

That fierce hope has placed a tremendous burden on the shoulders of a few researchers. Indeed, there are only about six laboratories in Canada investigating spinal cord rejuvenation. But according to Anne Foerster, a neuroscience assistant professor at McMaster University in Hamilton, Ont., an “explosion of knowledge” in neuroscience indicates that a cure for severe spinal injuries may indeed be possible. Foer-

ster said that she is cautious about making predictions because they produce “heartbreaking letters from people we can’t help at the moment.” But she added: “The hope is valid—there is so much happening now. And the more hope there is, the better the climate will be for breakthroughs to happen.” Until recently, most neurologists said that damage to nerve fibres in the central nervous system, which comprises the brain and spinal cord, was irreversible. But recent research has discovered that axons, or nerve fibres in the spinal cord and brain, can grow. Indeed, Foerster has evidence that severed nerve fi-

bres can grow around a cut in an adult rat’s brain—and she is now trying to discover whether they can also connect on the other side. Said Foerster: “They always seem to find the right pathway. For an adult brain, that is amazing.” Vigor: By demonstrating the unsuspected vigor of spontaneous regeneration in the central nervous system, Foerster said that she hopes to spur new research. One established approach, pioneered by Dr. Albert Aguayo at the Montreal General Hospital, is to graft a segment of nerve from the leg of a rat to replace a surgically removed section of the animal’s spinal

cord. Aguayo and his colleagues reported that, in such circumstances, previously inactive spinal axons on either side of the graft grow through it, bridging gaps of more than an inch. But the researchers are still trying to find out why the new fibres stopped growing and failed to connect together when they had closed the gap.

Aguayo’s work has set off a search for biochemical factors that may be inhibiting regeneration in the central nervous system. At the same time, others have found that electrical impulses stimulate regeneration. A team led by Dr. Charles Tator, chief of neurosurgery at Toronto’s Western Hospital, has developed tiny devices similar to heart pacemakers to create electrical fields across gaps in the severed spinal cords of rats. They have found that implanting one electrode on either side of the injury can stimulate the growth of spinal fibres across the injury site. But as yet the researchers do not know whether the new fibres actually reconnect the severed cord.

Quick: Despite such promising developments, research devoted to the regeneration of severed spinal cord nerves is still in a preliminary state. By contrast, work on quick treatments designed to minimize the long-term effects of spinal injuries is more advanced. Doctors now know that in most spinal cord injuries, the nerves are crushed, not severed, and that the outer layers of the nerve cord remain alive for as long as eight hours after the initial injury. According to Dr. Michael Fehlings of Toronto, an impaired blood flow to the nerves in the first few hours after an accident causes most of the damage in spinal cord injuries.

Fehlings is a member of the Western Hospital team that is currently testing a promising treatment designed to revive injured nerves by using drugs that dilate vessels and thin the blood, making it flow more easily. Until recently the team had been unable to correlate improved blood flow with restored nerve function. But its development of a machine that can monitor nerve function—

in itself “a significant advance,” according to Fehlings—has suggested that the drugs do in fact revive severely damaged nerves. A definitive study of the technique is now in progress, but meanwhile the researchers are hopeful. Declared Fehlings: “Even saving a few of those nerve cells could be very impor-

tant. Only 10 per cent of spinal nerves are needed for a person to walk.” Fehlings described spinal cord research as “one of the most exciting areas of neuroscience.” Still, researchers in the field say that they desperately need more money to continue. Said Fehlings: “In Canada we have some of the foremost neuroscientists in the world right under our nose, and we have some of the worst funding in the world. It’s a joke.” According to Fehlings, total federal funding for basic spinal cord research amounted to only $300,000 last year. But 10,000 people suffer disabling spinal injuries in the United States and

Canada each year, and each of those people will require at least $1.5 million worth of rehabilitation and care during his lifetime.

Shot: Fehlings acknowledges that a grant from the Man in Motion World Tour trust fund would be “a major shot in the arm” for his research. But Lovell and the 5,000 members of the Minnesota-based Spinal Cord Society (SCS) expressed concern that only a small fraction of the Hansen trust may be used to fund research toward a cure—with most of the money raised spent on rehabilitation and wheelchair sports. Declared SCS president Charles E. Carson: “I am sorry to sound radical and harsh, but things like this do an awful lot of damage to the cause in terms of the kind of attitudes they reinforce.”

But Man in Motion officials insist that such criticisms are misguided. The rules of the trust stipulate that only interest from the revenues produced by the fund—as much as $800,000 annually if Hansen meets his goal of raising $10 million—will be disbursed every year. Hansen set out guidelines before he left Vancouver two years ago, calling for half the money generated to be spent on research and the remainder marked for rehabilitation and awareness programs. Still, Man in Motion accounts supervisor Edith Ehlers acknowledged that detailed plans for the spending are now “a little nebulous.” The reason: Hansen wants to appoint a scientific advisory committee to decide how to spend the money. Meanwhile, Stephen Little, the Toronto-based managing director of the Canadian Paraplegic Association, dismissed SCS complaints as “unrealistic” and stressed that his organization endorsed the Man in Motion tour. Said Little: “There are a lot of people out there in the disabled community who are very happy with what is happening. Why put it down like that?”

Rage: For Lovell, the answer is complex and rooted in a mixture of obstinate hope and rage. Said Lovell: “I sit here with 90 per cent of my body dead and I’m supposed to be happy? To have some guy ram it down my throat that I should recognize the amazing potential of being crippled when I’m 90-per-cent paralysed—I don’t like it. And nobody is going to tell me that I should like it—or accept it.” But Lovell insists that he is not bitter. He said that he will do anything, “even praise Rick Hansen,” to speed a cure. Increased funding for research would likely speed that event—and reconcile the supporters and opponents of Hansen’s marathon. Added Lovell: “I feel like I’m out on a lonely limb—but I’m not coming in.”

-JOHN BARBER with ANNE STEACY in Port Credit

ANNE STEACYZ