Great names in Quebec medicine

Going beyond the limits of what is possible

Although his parents dreamt of seeing one of their children become a physician one day, for years our Great Name resisted the idea (even though he knew deep down he would choose a career in science). At that time, all around the world, the student movement brought about important changes to the paradigms that would disrupt society. Gerald Batist knew he wanted to be at the heart of these social transformations which is why he decided to leave Montreal, the city of his birth, to live and study in New York. He registered at Columbia University in sciences and, with thirty of so friends, young men from Columbia and young women from Barnard College, they founded their own commune. They first succeeded in obtaining an entire floor in the Paris Hotel which they renamed the Paris Commune. Then, they tried to convince the University to grant them educational credits towards their degrees for this experience. Columbia accepted their request and appointed a contact person. This happened to be Kate Millett, who was then a Ph.D. candidate and who would later become a writer, a film-maker and a feminine activist, author of Sexual Politics.

Even if everyone advocated freedom of thought and action within the commune, Gerald Batist maintained his direction and completed his bachelor's degree in science. It's at this point that his interest for medicine came to the fore. He decided to try his luck and register in medicine, but this time not in New York, as the cost of living and studying there was too high for him. So he came back (for the first time) to the city of his birth. During the process of applying for admission to McGill, he was asked to supply examples of his previous work. Not having much, in his opinion, that would be right for this venerable university, he decided to send in a dissertation dealing with traditional oriental medicine. His nonconformism seemed to please the person in charge who gave him a chance and accepted his candidacy.

His return to Montreal was easy, but he missed the effervescence of large American cities. He would take every opportunity to go back. A clinical training period became available at St-Vincent's Hospital Centre in New York; then, there was a program centered on nutrition at the New England Deaconess Hospital in Boston. This was where he completed his medical residency and where he undertook his postdoctoral training in clinical research. This first fellowship made him discover nutrition in the context of cancer, a disease against which U.S. President Nixon declared war in 1971, promising its total eradication for… 1990 ! During his training, after a few cases, he realized that the disease went way beyond the knowledge of the times, that the psychological, social, intellectual and emotional aspects also had a non negligible effect. "Our knowledge of cancer looks like all the other biological and scientific advances. With better knowledge of what doesn't work, we get a better understanding of what is normal," he explains. He also observed that patients with cancer have a particular personal "openness" and they have an uncommon will to understand and to help science. This observation interested him a lot.

In 1981, Dr Batist then joined the National Cancer Institute in Bethesda (northwest of Washington, D.C.) where he pursued another postdoctoral training in medical oncology and in molecular pharmacology. From that point on, his projects multiplied rapidly, but one research subject fascinated him above all : how tumours resists therapy. He wanted to know why tumours that responded well to chemotherapy could start, from one day to the next, to resist it completely. He discovered the presence of an enzyme in the cell that resists toxins. This enzyme interacts differently in the presence or absence of "selenium," a rare metal. Thus began an investigation into the activity of several enzymes which allowed him to discover that some of them appeared to be under the control of a master regulator for which a single molecule can block every form of resistance.

Over a period of four years, projects were numerous and captivating, but Dr Batist wanted to come home to Montreal. As he wasn't able to "move the NCI to Montreal," he managed to obtain a research grant from them that allowed him to open his own clinical research laboratory, but on this side of the border. Thus, he was able to pursue the research projects he had started in Bethesda, in particular on tumour resistance to treatment, a subject that is still at the core of his research, close to 35 years later.

However, this new return was more complicated than he had foreseen. At the time, medical oncology was not recognized as a medical specialty in Quebec as it was elsewhere, in Europe, the United States or even in the rest of Canada. Here, at that time, it was hematologists who practised oncology.

Dr Batist decided, with the help of several colleagues who, like him, were trained in the large European or American oncology centres, to write to the President of the Corporation professionnelle des médecins du Québec (now the CMQ), Dr Augustin Roy, to ask for their specialty to be recognized.

From a simple request, a long saga resulted. Dr Batist and his colleagues had to show the Corporation why this recognition was so important, in particular for patients. Training differed from one centre to another and, especially, from one country to another. The battle was longer than expected: it was not only the issue of a "liquid or solid" cancer, as several attempted to explain. The desired recognition meant many changes : Dr Batist wanted most of all to ensure a uniform training which was in line with medicine's highest standards. In spite of all the difficulties, this period allowed him to weave links with colleagues in several universities with whom he would later pursue research projects and clinical collaborations.

Research Projects Without End

The battle against cancer proved to be much larger than many may have thought. Each day, Dr Batist takes up new research paths and their counterparts. His knowledge of molecular pharmacology, picked up at the National Institute of Health (NIH), allowed him to prove that each tumour is unique, as much by its molecular signature as by its reaction to the treatments and drugs used. This observation relates to personalized medicine, where paradigms change as rapidly as research evolves. The alteration of cell functions attributable to cancer, the resistance to the various treatments used, the role and interactions of certain enzymes are so many pathways that keep him busy and that fuel discussions with his colleagues, with clinicians and with researchers. These exchanges are crucial and the idea of building a network to share and collaborate takes shape little by little in his mind.

In 2007, Dr Batist and the late Dr Luc Bélanger (formerly Director of the Cancer Research Centre at Laval University) were the founders of the Consortium panquébécois de recherche en oncologie clinique du Québec (Q-ROC), in order to provide a research platform and tools for researchers, but also to create links between researchers and clinicians, surgeons and oncologists as well as everyone one else interested by medical oncology. Q-ROC becomes the lift-off stage for the creation of numerous research projects such as the Personalized Medicine Partnership for Cancer (PMPC), born within the framework of the Stratégie québécoise de la recherche et de l'innovation. Not only has Q-ROC been instrumental in obtaining financing for research, it has also propelled Quebec to the front of the stage. "Q-ROC has in particular allowed us to go and get significant sums dedicated to research, money that would have gone elsewhere than Quebec," he explains.

A Plea in Favour of Clinical Research

If Dr Batist has been able to advance clinical research as much as he did, it's because he was able to appreciate its benefits elsewhere. According to him, all physicians, no matter what their medical specialty is, need to understand that the best care involves before all else a component of clinical research. He preaches this vision every day: "We have exceptional clinicians and researchers in Quebec. I love working as much in a network as in an interdisciplinary approach : I learn and I benefit from the contribution of each," he adds.

Clinical research is not the prerogative of physicians only or of interest to patients only. The entire population benefits in the end. If the word "guinea pig" scares some people, Dr Batist takes the time to explain how the risks taken are identical, whether we try new molecules or if we limit ourselves to standard chemotherapy. "I know in advance there is a large part of the unknown in clinical research, but this unknown, is it not also a source hope ?" he states with conviction.

Over the years, Dr Batist has lead hundreds of research projects with the aim of improving the molecules used in oncological treatments. His work is at the basis of some 300 scientific articles, book chapters or summaries; they have led him to give hundreds of conferences and workshops around the world. His reputation goes far beyond our borders, and the major pharmaceutical firms are not the only ones interested by his vision and his work.

Always More !

With the sequencing of the human genome came personalized medicine. A real plus in the universe he knows so well! With twice the enthusiasm, Dr Batist became scientific director of the Centre national d'excellence en médecine personnalisée Exactis Innovation. He is setting up a mega clinical and biological specimen database there. This longitudinal prospective registry is used as much to look for new molecules as it is to find the ideal treatment for a patient to whom he can offer experimental molecules that couldn't have been available otherwise. With the help of these biological specimens and of all the data acquired on current and experimental molecules, he can now conjugate the data ad infinitum. So many projects to look forward to !

Will he be one of those who will finally end the battle against cancer? Who knows ? Dr Batist prefers to keep his eye on the goal and to concentrate on his work. What counts for him is the patients he loves so much and to whom he wants to offer a cure; those for whom he collects all sorts of personal data, to engage in a conversation during a forthcoming meeting and to show he remembers them well; those who never hesitate to give a bit of themselves to help advance the research; those who push him to do more and to never give up. It's also thanks to them that he has received important awards and distinctions like the Ordre national du Québec and the Order of Canada. He still has a lot of work on his desk. He even has a novel that needs just a bit of attention and time to be published...