Summer 2022 (Volume 32, Number 2)

The CRA's 2022 Distinguished Rheumatologist:
Dr. John G. Hanly

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Why did you become a rheumatologist? What or who influenced you along the way to do so?
My reasons for deciding to become a rheumatologist are in large part due to the influence of Professor Barry Bresnihan, with whom I worked for two years (1982-1984) in Dublin, Ireland. He was my role model, and his mentorship has sustained me throughout my career. Steadfast in his commitment to advancing care for patients with rheumatic diseases through research, he overcame significant professional challenges in his own career. Moreover, he inspired a cadre of rheumatology fellows to pursue an academic career track and most went on to establish independent research programs in Ireland or abroad. On a personal note, he was also great fun to be with and treated me as an equal despite the gap in seniority.

Born in Ireland and having obtained your medical degree from the National University of Ireland in 1978, you began your medical career in Dublin where you pursued a two-year Rheumatology Research Fellowship with Professor Barry Bresnihan in Dublin. This was focused on the clinical efficacy and immunomodulatory effects of total lymphoid irradiation in patients with severe rheumatoid arthritis. In 1984, you emigrated to Canada and undertook clinical fellowships in rheumatology and immunology at the University of Toronto and McMaster University.

a) From where did your passion and interest for rheumatology stem?

There are many attractive features to our specialty, both from a clinical and scientific perspective. These include the diversity in the types and severity of clinical disease, the opportunity to link basic science observations to the patient and the eventual translation of basic science to meaningful therapies, as a few examples.

b) Can you tell us more about your professional journey from Ireland to Canada and why you made the decision to move to Canada?
When I left Ireland in 1984 it was customary to pursue subspecialty training outside the country, either in the UK or in North America. My twin brother, who is a respirologist, had relocated to Canada a couple of years earlier, so that was one reason. The other was that there were opportunities for both my wife (also a physician) and me, in Canada, at McMaster University and the University of Toronto, respectively.

In addition to your clinical and teaching activities you are also a respected clinical investigator. As a researcher you have received continuous peer-reviewed funding from the Canadian Institutes of Health Research (CIHR) since 2002. Your focus has been the study of pathogenic mechanisms of systemic lupus erythematosus and their clinical outcomes. Your most significant contributions have related to the effects of lupus on the brain and other parts of the nervous system. Your publication record on neuropsychiatric lupus is internationally recognized. Can you tell us more about your research and its impact on our understanding of SLE and its implications for patients?
My decision to focus on nervous system lupus in the early part of my career was somewhat fortuitous and assisted by the support of colleagues during my training and at my home institution in Halifax. Early work contributed to our understanding of pathogenetic mechanisms and the clinical course of cognitive dysfunction, one of the most common forms of nervous system lupus. In the last 20 years I have been able to extend this work to a large, international inception cohort of SLE patients. This effort has received long-term funding from CIHR, resulted in several high-profile publications and fostered many collaborations with colleagues across Canada and the world. The messages for patients are that only 30% of all nervous system events in SLE patients are attributable to lupus, the outcome of these events is frequently very good, and we are steadily advancing our understanding of how lupus affects the brain and other parts of the nervous system.

On an international level, you are Past Chair of the Systemic Lupus International Collaborating Clinics (SLICC), an international research network of lupus investigators in 16 countries. Through your ongoing membership of national and international networks involved in clinical studies of lupus, you continue to be a productive contributor to this field. How has international collaboration helped shape the field of rheumatology, and specifically SLE, here and elsewhere?
SLE is a relatively rare disease, so collaborative research is important to achieve success. The Canadian centers involved in SLICC have contributed substantially through leadership of the organization, championing individual research projects and patient recruitment. Over the past 30 years the collective success of SLICC has greatly exceeded what any individual SLICC center could have achieved in isolation. Knowledge gained has been translated to improvements in SLE patient care.

What is the greatest professional and organizational challenge you have faced, and how did you address/ overcome this challenge?
All clinician researchers are challenged to protect their time for research while fulfilling their other clinical and academic responsibilities. The goodwill of local colleagues, a supportive academic environment and a steadfast belief and commitment to the mission are key to success.

What major changes to the landscape of rheumatology have you witnessed over the course of your career?
The emergence of new diagnostic and therapeutic modalities in the advancement of clinical care, and the value of research collaboration as a key component to scientific advancement and success.

What do you foresee as challenges to Canadian rheumatologists in the future and what can individual rheumatologists and the CRA do to meet these challenges?
In clinical practice, the administrative burden involved in securing access to new medications for patients is ever increasing. Clinician-researcher positions in academic rheumatology centers have not kept pace with expanding rheumatology resources and “hard” funding for such positions is diminishing. The CRA is the profession’s advocate to address both issues.

You are the recipient of numerous awards in recognition of your achievements in lupus research, including the ACR Edmund L. Dubois Memorial Award, the CRA Distinguished Investigator Award and the Ira Goldstein Honoree Award from New York University. Furthermore, you have also been designated a Master by both the CRA and ACR. What was your first thought when you learned that you would be receiving the CRA Distinguished Rheumatologist Award?
I was flattered, grateful and humbled to receive the award. It was an honour to join the list of outstanding rheumatologists who had previously received the award.

Dr. Hanly receiving the CRA Distinguished Rheumatologist Award during
the virtual gala in February 2022.

What do you believe are the qualities of a distinguished rheumatologist?
I hope that the designation would apply to one who has contributed to advancing the care of patients with rheumatic diseases.

What is your favourite food or cuisine?
My wife’s!

What are your dream vacation destinations?
Safari in Kenya and visiting New Zealand.

How many cups of coffee does it take to make a productive day?

We understand you have an identical twin who is also a distinguished physician, now in Canada. How were your career paths intertwined and how did you help each other to achieve professional success?
The bond between identical twins is special and probably unique among siblings. My brother and I have both pursued an academic career track in medicine, albeit in different specialties. We have had shared experiences navigating this route and been able to advise each other at different junctures — be that in the academic or political spheres. We are both married to wonderful and inspiring spouses who are also academic physicians and have enjoyed great success in their own careers. My brother and I continue to share similar interests outside of work — gardening, fly fishing and rugby (enduring life-long supporters of Munster Rugby and Ireland).

John G. Hanly, MD, FRCPC
Professor of Medicine and Pathology,
Research Director, Division of Rheumatology
Department of Medicine,
Dalhousie University and
Queen Elizabeth II Health Sciences Center,
Halifax, Nova Scotia


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