The human face is one of the most amazing structures on the planet.
Yet, with the rise of virtual communication and advent of COVID-19 masks, the role of the face is changing when it comes to how we express emotions and connect with others.
What does this shift mean for medicine and research? What does it mean for our minds and bodies?
And, what can our faces teach us about ourselves?
Like lightning to the face. That’s how Professor Mojgan Hodaie (MSc ’94, PGME ’04) says her patients with trigeminal neuralgia describe their pain. Considered one of the most excruciating pain disorders, the condition involves the misfiring of powerful pain signals from the face to the brain.
In one case, a patient was completely debilitated when a single snowflake landed on his cheek during a winter stroll.
“The pain was so severe that he had to hold a lamppost for about 20 minutes before he could keep walking,” says Hodaie, a professor in the Department of Surgery at the Temerty Faculty of Medicine. “Everyday things like speaking, kissing, having a bite to eat — they all become time bombs because patients never know when they’ll be hit by a massive jolt of sharp pain.”
Roughly one in 20,000 people have trigeminal neuralgia. It is notoriously difficult to diagnose, and many people live with extreme pain for decades before receiving treatment. Researchers are exploring what the face can reveal about complex pain conditions.
For Hodaie and her colleagues at Temerty Medicine, that means developing advanced imaging techniques to pull back the curtain on “invisible” pain.
“When patients get surgery for a brain tumour or a broken bone, a surgeon can show you afterwards that the tumour is gone or the bone is fixed,” Hodaie explains. “When patients with trigeminal neuralgia ask if their pain will be gone after surgery, I only have general statistics to give them. In 2021, we owe our patients much more than that.”
Until relatively recently, medicine has tended to define and treat pain as a response to physical illness or injury. This narrow view has led to blind spots in care — from overprescribing short-term painkillers for long-term conditions, to undertreating people whose pain doesn’t have an obvious physical cause.
“We’ve been mismanaging chronic pain all these years because, for the most part, we were using acute pain management principles,” says Professor Tania Di Renna (PGME ’03), an assistant professor in Temerty Medicine’s Department of Anesthesiology and Pain Medicine.
Di Renna says there is growing recognition that persistent pain can be understood as a complex interaction between the body, mind and emotions.
“That emotional component has a huge overlay with how people perceive pain,” Di Renna says. Emerging neuroscience and psychological evidence show substantial similarities between physical and social pain, including shared inflammatory responses and neural pathways.
People in prolonged physical pain are more likely to develop mental disorders such as depression and anxiety, and emotional trauma in childhood increases the likelihood of developing chronic pain as an adult. Indeed, just looking at pained facial expressions can increase the perception of pain, while faking a smile can decrease it. This new understanding of pain requires an interdisciplinary approach to treatment, Di Renna says.
As the medical director of the Toronto Academic Pain Medicine Institute (TAPMI), Di Renna oversees a program in which doctors, nurses, physiotherapists, psychologists and other experts work together to support patients to “live a full life despite having pain.” In addition to medication, she says, “You need movement, you need physiotherapy, and you need psychological therapies.”
According to Professor Yasmine Hoydonckx (MSc ’21), a craniofacial pain specialist at TAPMI and an assistant professor in Temerty Medicine’s Department of Anesthesiology and Pain Medicine, different disciplines have a lot to learn from each other, especially when diagnosing complex pain. “It’s almost like a puzzle. If you’re lucky, the patient will give you five pieces, and by asking the right questions, you might get another 10 or 15 pieces to find the right diagnosis,” she says. “Together we know much more than apart.”
For people who have trigeminal neuralgia, it can be difficult to know which treatment will work best for a specific patient because the condition defies objective measurement.
By processing MRI images to pick out “tiny, tiny details” in the architecture of the trigeminal nerve, Hodaie’s team has identified factors that distinguish patients who may not benefit from the conventional surgical treatment.
“Now, when those patients come to me, the first option for treatment is neuromodulation,” which alters nerve activity by stimulating specific neural circuits, she says.
By combining advanced brain imaging and psychological tests, Hodaie’s team hopes to chart the relationship between these circuits and extreme facial pain. “Neurovascular contact between the nerve and the blood vessel does not fully explain the whole picture,” she says.
Facial expressions can be an important measure of pain, especially in situations in which patients cannot communicate what they’re feeling. But facial expressions may not be universal and are prone to misinterpretation, says Professor Jennifer Bryan (PGME ’12, PGME ’13). “We have stereotypes about what pain looks like — grimacing, crying, moaning,” says Bryan, an assistant professor in Temerty Medicine’s Department of Medicine.
However, the ways that people express pain may differ depending on cultural factors, their past experiences of pain and their prior interactions with health care providers.
“There are a lot of shorthand approaches to pain management and assessment that don’t work well for the patient,” says Bryan, who is also an emergency physician at University Health Network. Most people are not good at reading subtle expressions — a 2011 paper reported accuracy rates of only 35 to 48 per cent.
Racial and gender biases may further complicate the matter.
Recent research shows that white people have difficulty distinguishing emotions on Black people’s faces and tend to perceive them as angrier than people who are white.
Meanwhile, a 2016 paper found that medical trainees who held false beliefs about racial differences — for example, “Black skin is thicker than white” — were more likely to underestimate and undertreat Black patients’ pain.
Chronic pain patients, especially women and people of colour, report feeling pressured to express their pain in specific ways for health care professionals to believe them. And growing concern about opioid abuse has contributed to some doctors automatically distrusting patients’ reports as “drug seeking.”
“It has been a challenge for many people to come to grips with the fact that we have implicit and explicit biases, and we don’t leave those outside of our hospitals or clinics when we’re treating patients,” Bryan says. In the future, artificial intelligence may help cut through some of these biases, she noted.
Professor Babak Taati, a scientist at the University Health Network’s KITE Research Institute, has developed facial recognition technology to detect pain in long-term care residents with dementia. People with dementia often suffer from unrecognized pain for “days, weeks or months at a time,” says Taati, who is also an assistant professor of computer science at the University of Toronto. Although long-term care workers can assess patients’ pain, the frequency of these checks vary depending on staffing and local regulations.
Meanwhile, misunderstanding signs of distress may lead health care workers to prescribe antipsychotics instead of the pain medicines that patients need, Taati says.
“Violence and aggression are common in patients with dementia, and some of that is linked to untreated pain,” he says.
Sickle cell disease — a blood disorder that mainly affects Black people and can cause unpredictable, intense pain — is another perfect storm for misunderstanding.
“Oftentimes, folks with sickle cell have developed coping strategies to calm and distract themselves, like looking at their phones or having something to eat,” Bryan says.
Health care providers can misinterpret these strategies as signs that the person isn’t in pain.
According to one 2020 study, patients with sickle cell often struggle to quantify their pain using clinical scales. Mutual distrust shapes how they communicate with providers, too, further complicating clinical assessments.
“If we think we can understand someone’s pain just by looking at them, we risk underestimating them, undertreating them and really losing their trust,” says Bryan. “The gold standard for assessing pain is simply asking, ‘How much pain are you having right now?’” ▲
Story by John Lorinc
Professor Kang Lee wants to find out.
He peers at his smart phone and triggers an app — in this case, a diagnostic tool called Anura based on a technology invented by him and a postdoctoral fellow. It uses the cellphone’s camera to measure vital signs. The image on the phone shows Lee’s face in the middle of a circle. A dotted line plots its way clockwise around the circumference. Four small charts pop up at the edges, and then a number in a heart shaped graphic appears at the bottom.
After 30 seconds, Anura serves up a full menu of metrics — vital signs, such as heart rate and breathing rate; a stress index; body mass index; waist-to-height ratio; and an overall wellness score out of 100. The newest version, which Lee’s startup Nuralogix released in January 2021, also measures blood pressure, and Lee says it’s the first smartphone-based, contactless app to do so.
The technology, he explains, is based on the camera’s finely honed optical sensors and, specifically, its ability to analyze light waves reflected by the hemoglobin in the blood circulating beneath the skin on various parts of the face.
“The physics is quite simple,” says Lee, a professor at the Ontario Institute for Studies in Education at the University of Toronto.
Fitness tracking watches apply sensors to a small area on the wrist with simple vasculature, says Lee. But the Anura app takes readings of the whole face, which has a far more complex structure, he says.
“It’s hard to look under the hood,” he jokes. “The more complex the structure that is analyzed, the more information gathered about our physiological system.”
The idea is that Anura’s video, operating at 30 frames per second, can track changes in the pulsing ebb and flow of the blood — the technical description for this is “transdermal optical imaging.” The data is sent to a cloud and fed into an artificial intelligence (AI) algorithm that Lee and his researchers developed, based on decades of medical research and anonymized data from hundreds of thousands of patients of different races.
“You capture all the changes on your face and then from there, you can learn a lot about your physiological and psychological states,” he says.
The AI’s back end serves up long-term predictions — going out 20 years — about the likelihood of cardiac disease, hypertension and Type 2 diabetes. Anura also provides patients with information they can use now to improve their wellness, both physical and mental.
In an article that Lee’s team wrote for an American Heart Association journal, they point out that the improved convenience and ease of use of such a tool “could revolutionize hypertension diagnosis and management and begin to address the incredible burden of cardiovascular disease worldwide.”
So, what are the chances that a tool like Lee’s is the face of the future? Anura is one of hundreds of thousands of health-oriented smartphone apps now available online. Many apps are fitness oriented and for general use. Others are highly technical, FDA-approved apps for everything from hematology uses, to diagnostic tools that rely on AI to identify skin cancers and retinal disorders.
Researchers laud the democratizing benefits of these innovations, which, in many cases, provide comparable results to expensive and far less portable testing machinery.
“The development of portable and integrated solutions for delivering diagnostics at the point of care (POC) has become a cornerstone to decentralize medical care,” say the authors of a 2019 Journal of Internal Medicine paper on smartphone-based clinical diagnostics.
Some tools, however, have caveats: Studies on smartphone blood-pressure apps that require users to press their thumb against the camera lens, for example, do not provide accurate results.
Professor Yasbanoo Moayedi (PGME ’17), a cardiologist studying the use of mobile technologies to monitor heart failure and heart transplants, points to another application for cardiac patients. Her team is experimenting with Food Rx, a smartphone-based app that monitors diet.
“We’re doing a pilot study where patients would take pictures of their meals, three times a day,” says Moayedi, who is with the Translational Research Program at the Temerty Faculty of Medicine. “They’ll take a picture of whatever they’re eating. And then the app, using AI technology, will tell them what their calorie intake is, what their potassium intake is, [and] whether they’re above or below the recommendations.”
Lee’s focus on the diagnostic potential in the human face comes from an entirely different realm of research. He is not a medical researcher. Rather, his field is developmental neuroscience. Much of his earlier work involved the analysis of children’s facial expressions, particularly to assess whether they were telling the truth or lying.
In adults, such tests can be conducted using electrodes, but electrodes are ineffective in children because they squirm, Lee explains, adding that he developed video techniques to evaluate the physiology of children’s dishonesty.
An AI-driven app that relies on reading faces does, of course, raise important questions about well-recognized problems with facial recognition, among them racial biases in training data that cause such apps to produce biased results and protect the security of the information.
Jessica Ojiaku (MHI ’21), a graduate of U of T’s Institute of Health Policy Management and Evaluation who now works in cybersecurity, says that with health and diagnostic apps, it’s important to ensure algorithmic transparency. It’s also crucial to obtain patient consent and implement rigorous security mechanisms.
In general, she adds, hidden biases in the data used to train a health algorithm may result in misdiagnoses, triggering potential downstream health issues in the future.
“There really needs to be very careful consideration of what the risks are to using these types of tools,” she says.
Lee points out that the data Anura draws on to generate predictions is from populations that are evenly divided in terms of race. What’s more, he adds, the app is not programmed to record faces, but rather subcutaneous blood flow.
At the moment, several research teams are looking at the use of contactless vital sign monitoring in physiological, obstetric and even surgical settings.
Professor Frances Chung, an anesthesiologist at Toronto Western Hospital, is doing a randomized clinical trial to compare the accuracy of Anura’s vital sign monitoring with conventional techniques.
The motivation for the study, she says, has to do with the COVID-19 pandemic. Internationally, hundreds of health care workers died during the pandemic, and the app provides a way for medical staff to obtain patients’ vital signs without coming into physical contact with them.
“If we can use the camera at a distance,” explains Chung, “then the nurse doesn’t have to go so close to the patient.”
Chung, a professor in Temerty Medicine’s Department of Anesthesiology and Pain Medicine, says the trial is still recruiting participants, and the results will likely be published next year.
Lee envisions other applications as well, such as the use of this kind of app for telehealth appointments and monitoring the stress levels of women during pregnancy.
Mostly, he sees the tool as a way of modifying lifestyle by giving people an easy way to get not only core information about their vitals, but predictions about the long-range implications — all served up to provide a way for individuals to “course correct.”
When Lee began developing Anura, the app showed his systolic blood pressure to be almost 140 mmHg and detected occasional arrhythmias because he drank too much coffee.
“I said, ‘This is no good.’ And I immediately changed my lifestyle. I quit drinking beer and coffee. Now, my systolic blood pressure level is in the neighbourhood of 117, 118 mmHg,” says Lee. “We hope we can give the users incentive to start to work on healthier behaviours.” ▲
Illustration by Michael Luberry
Story by Julie Traves
They describe themselves as ugly, deformed, even monstrous. On average, they spend anywhere from three to eight hours a day on mirror checks and grooming. (Let that sink in.) Some cannot leave the house. They miss school. They lose jobs. Many are suicidal. And yet, as Professor Jamie Feusner explains, “These are people who look like everyone else.”
What they suffer from is body dysmorphic disorder (BDD), a condition that can distort how people see their face as well as their physique.
“People with BDD perceive that they have defects, most often to do with their skin, their hair or their nose. But these perceived defects are just not there, or barely noticeable to anyone else,” says Feusner, a professor in the Department of Psychiatry at the Temerty Faculty of Medicine.
BDD occurs in about one in 40 people — making it more prevalent than schizophrenia. But many people with BDD never get help. They believe they have a physical problem, not a mental health condition. And when they do seek counselling, psychiatrists don’t always recognize the symptoms of BDD.
“It’s really understudied and often missed by health care professionals,” Feusner says.
It’s hard not to wonder whether social media use might at least be a risk factor for BDD. On the discussion website Reddit, there’s a thread called “Am I Ugly?” Its 232,000 members post selfies, mostly of their face, captured on different days and at different angles and then, well, await judgment.
Writes one 17-year-old boy: “Am I ugly? I have really bad anxiety and I just want some honest opinions as to how good/bad I look to other people.”
A post from a 16-year-old girl reads: “I have been struggle [sic] with depression and I have no concept of what I look like.” A number of users actually name-check “body dysmorphia.” “It’s one hell of a drug,” one teenager exclaims.
The disorder’s onset is generally adolescence, which could explain why there are also BDD videos on TikTok that have generated millions of views. But there’s no evidence (yet) that the prevalence of BDD is increasing among Gen Z. Nor have the last 18 months of Zoom calls led to a surge in cases among adults.
Peggy Richter is an associate professor with Temerty Medicine’s Department of Psychiatry.
She also leads the obsessive compulsive disorders program at Sunnybrook Health Sciences Centre and runs therapy groups for people with BDD. “I haven’t seen an uptick in BDD during the pandemic,” she says.
If anything, some of her patients find virtual socializing (not to mention masking) a relief. One such patient is a woman in her 30s who feels she’s “repulsive” because, like many people her age, she has some slight skin discoloration. Before the pandemic, she had stopped attending her kids’ school events because she didn’t want to be seen in daylight.
“For her, Zoom is extremely comfortable,” says Richter, “because she can set it up with lower light.”
Culture affects the particulars of BDD; fixations on body shape vary by geography. North American men, for example, are more likely to covet a bulky, muscular frame than their European counterparts, says Feusner. A focus on the hips, buttocks and thighs is more common among women in South America than in North America, he adds. But the chief preoccupation for people with BDD is their face or head.
One paper indicates that more than 70 per cent of people focus on their skin, more than 50 per cent are concerned with their hair, and about one-third are preoccupied with their noses. Some aspects of what makes one face more beautiful than another are universal, says Feusner.
“Smooth skin and facial symmetry are perceived as attractive by all humans,” he says. “Even infants will look longer at images that are symmetric.”
Richter describes a patient who, after a blow to his nose, became plagued by the belief that it looked “very off and asymmetric. He would take photographs of himself multiple times a day to see what he looked like to others, and he was constantly checking his nose and touching it,” she says. That a vast majority of people with BDD — between 71 and 76 per cent — seek plastic surgery to fix such “defects” is hardly surprising.
Professor Jamil Ahmad (BSc ’99, PGME ’10) is the director of research and education at The Plastic Surgery Clinic in Mississauga, Ontario. He says he can “count on one hand” the number of patients he’s seen in 11 years of practice who “clearly have BDD.”
Rhinoplasty is their most common request. But they usually present with concerns about what Ahmad says are perfectly fine noses. “There’s literally nothing I could do to improve them,” he says, adding that he’s declined patient requests to operate in these cases.
Cosmetic surgeons who do proceed with surgery on patients with BDD soon find that the patients are “profoundly unhappy” with any results, he says.
“I don’t think any reputable or self-respecting plastic surgeon wants to operate on a patient they know they can never make happy,” says Ahmad, an assistant professor in Temerty Medicine’s Department of Surgery. “It’s a hopeless situation.”
Richter’s patient never sought a nose job. But in his 30s, he was offered a Botox injection to reduce the creases in his forehead. Instead of making him feel better about his face, it simply shifted his focus from his nose to his forehead. Now he compulsively checks and photographs his forehead, and wears hats to camouflage his appearance. Richter says that treatment can help relieve the pain that people with BDD experience — shame, self-loathing, anxiety and depression. A number of studies have shown that serotonin reuptake inhibitors reduce the intensity and frequency of worries about appearance.
Cognitive behavioural therapy (CBT) helps people with BDD identify “maladaptive thoughts” such as all-or-nothing thinking, mind-reading and personalization. It also reduces compulsive behaviours, such as mirror-checking, which make the disorder worse. As Richter points out, though, “Many patients with BDD have limited insight into their illness.” Some are convinced they have defects one day but not the next.
New research conducted by Feusner and six other scientists may offer further understanding of what causes such profound distortions of perception in people with BDD. Feusner’s work focuses on visual processing systems in the brain.
To make sense of the images we see, there are two different streams that start in the visual cortex, he explains. One is the dorsal pathway, which leads to the parietal lobe; the other is the ventral pathway, which leads to the temporal lobe.
The dorsal stream acts as a sort of template for visual information, allowing us to quickly process the global or holistic aspects of what we see, as well as their relationship to one another, says Feusner, “OK, oval shape — it’s a face. Eyes are above the nose …”
In parallel, the ventral stream fills in the details: These are lines. Those are pores. That’s hair. This is an eyelash.
A number of studies suggest that in people with BDD, both visual systems in the brain may not be working at equal capacity. The brains of people with BDD may do an all right job of processing details, using the ventral pathway. But the dorsal stream may be less successful in grasping the bigger picture. In other words, their fixation on specific aspects of their face and body may be a perceptual, not just psychological, problem.
To learn more, a recent pilot study by Feusner used repetitive transcranial magnetic stimulation (rTMS). This non-invasive technique applies magnetic fields to the scalp to carry electrical currents to the brain. In this case, the researchers induced currents on the scalps of 14 people with BDD. The area targeted by researchers was in the dorsal visual pathways of the participants’ brains. Half received full intensity “bursts.” The other half were given low-intensity “sham” stimulation.
Shortly after rTMS, researchers measured how satisfied participants felt with their appearance. Those who received full bursts experienced “a significant improvement in body image,” says Feusner. This adds weight to conjectures that BDD may be a problem of global (dorsal) visual processing and suggests that rTMS treatments may help. As Feusner is quick to point out, though, the experiment was only a pilot study.
BDD occurs in about one in 40 people — making it more prevalent than schizophrenia
Feusner says it’s also possible that the behaviour of people with BDD may actually alter their brains. They might become self-conscious, start scrutinizing their faces, then, as this focus is repeated again and again and again, develop a stronger capacity to process detail and weaken global processing in the dorsal stream.
Ultimately, says Feusner, “What someone is seeing in the mirror may not be ‘reality’ — we don’t know the objective reality about the way we look, and there really isn’t one.”
Most of us are not bothered by this, beyond the occasional dissatisfaction with photos of ourselves taken at unusual angles, say, or what we believe is not our best side. But for people with BDD, the gap between how they see themselves and what’s really there is less like a crack and more like a horrifying chasm.
Up to 60 per cent of people with BDD have beliefs about their appearance that reach delusional levels. About 25 per cent of people with the disorder try to take their own lives.
Says Feusner, “There are no clear solutions yet, but if we can understand the brain well enough, we may be able to develop treatments that will remediate abnormalities.”
There is certainly an unmet need for additional treatment options, says Richter. BDD is incurable.
“While CBT can be very helpful, there are many people with BDD who are not prepared or willing for the challenges CBT presents,” she says. “The majority will continue to suffer.” ▲
Photography by Anita Gairns
Story by Gabrielle Giroday
If you ask Kat Butler, a medical resident at the Temerty Faculty of Medicine, the answer is complex.
“Faces are such important ways that humans connect with each other, and they’re also places of vulnerability, particularly for trans people, because people read a lot in our faces and then read whatever they see in our face with the way the rest of us is presented.”
“This information can lead people to make different assumptions and different decisions about who they think you are when they look at your face and the rest of you,” says Butler, a third-year resident in the Department of Anesthesiology and Pain Medicine, who uses they/them pronouns.
Butler’s research into the experiences of people who identify as trans and non binary (TNB) at medical schools indicates there are miles to go to achieve inclusive education.
In 2017 and 2018, Butler and their colleagues interviewed seven people who identify as TNB at medical schools across Canada.
(For context, the research paper cites a 2012 survey of students from four Canadian medical schools in which only 0.2 per cent didn’t identify with the gender on their birth certificate. That contrasts with another estimate that trans people are 0.5 to 1.2 per cent of the population.)
Butler and the researchers heard from people interviewed there are “many different manifestations of a medical culture that marginalizes the existence of TNB people in general and TNB learners in particular.”
“Transphobia and misogyny and other biases are present in medicine and medical education. There are structural ways that unconscious bias exists,” says Butler.
“It’s present in the way we ask medical school applicants to complete their applications, like asking people to fill out every activity they’ve participated in since they were 16 years old, even though for people who are trans, the teenage years are a crucial time when they’re navigating their gender identity and sexuality. This means their grades may be affected, or their activities, or their housing.
“Bias also exists in the process of getting through interviews and meeting with people who are members of that profession, who then rank you.”
In 2021, Butler published further research in the Bulletin of the World Health Organization with Temerty Medicine colleagues Tommy Hana (MD ’21), June Sing Hong Lam (PGME ’20), and Professor Trevor Young (PGME ’88, MSc ’89, PhD ’95), the Faculty’s dean.
The authors concluded that “data from across the globe demonstrate that physicians and postgraduate and undergraduate medical students are not fully equipped to provide high-quality and comprehensive care to transgender and gender-diverse patients.”
“Our recommendations for comprehensive education on transgender health include cultural humility and anti-oppression training; involvement of transgender and gender-diverse community members; integration of transgender and gender-diverse health into curricula; practice-focused and in situ training; staff development in medical schools; and improving access to careers in medicine for transgender and gender-diverse people,” says the research.
On top of medical education reform, more challenges are on the horizon. Take technology. Research from 2019 indicated that facial analysis tools aren’t working as well for trans people and when tested, were “universally unable to classify non-binary genders.”
Butler says, “We have to think about how technologies use binary tools that reflect how we have designated gender in our society into two categories, and how that ends up reproducing harm for trans people.”
For Butler, the research is personal.
“I’m an extrovert. I love chatting with people. I was an emergency room nurse before I was a physician. I can make small talk with anyone. For me, it’s relatively easy because I’m white, and because being trans-masculine is something that is much more normatively accepted than being trans-feminine,” they say.
“Because of who I am, and my face — even if people have doubts — they may accept me because there’s still this white, smiley person who is ready to engage. So, I’m the embodiment of a lot of privilege. I’m one of the most privileged versions of trans people, and I don’t think it’s an accident I got into medical training.” ▲
Video by Erin Howe
Standardized patients simulate the affects and symptoms of patients to support teaching and assessment of health professions learners. Two standardized patients share what drew them to the work and how they’ve adapted to virtual simulations.
You’ve seen the headlines, and they aren’t pretty. The use of facial recognition software can be rife with privacy concerns.
For many, when the topic of facial recognition software comes up, they think of an app on their phone, scanning their face and collecting images.
This has led some to think of facial recognition software in the context of personal data being collected and misused.
But what about facial analysis? Could tools that track facial movements hold promising advancements for the future of medicine?
The answer is … quite possibly yes.
Imagine someone you love.
They develop a neurological disorder.
Every morning when they wake up, they carefully go over to their dresser, and press a button hidden between their moisturizer, bottle of pills and hairbrush.
As they stand performing a set of standard face movements, a sensor in the mirror is activated and starts analyzing their face.
The scan begins to track the important points of their face as they smile, a key movement characteristic.
The data is then analyzed by a computer that has software to capture photos and video, and emails the results to a clinician.
From there, the clinician tries to discern if the patient’s disease is changing or if the rehabilitation is working.
This isn’t facial recognition — it’s facial analysis.
And while this exact tool doesn’t exist yet, experts say facial analysis technology may be suffering from a case of mistaken identity — people mix up potentially valuable software that assesses faces with facial recognition, which tries to identify who a face belongs to.
Facial analysis could improve medical assessments of people who have neurodegenerative diseases such as Parkinson’s disease or Amyotrophic lateral sclerosis (ALS).
“Facial movements are part of your daily life. But for people who have neurological disorders, movements in the face can change — like having a drooping lip or unexpressive eyebrows. We need tools to plan the best rehabilitation for these issues,” says Andrea Bandini, who was, until recently, a postdoctoral fellow at the University Health Network’s KITE Research Institute.
Bandini’s research at KITE, which he conducted with the Temerty Faculty of Medicine’s Department of Speech-Language Pathology, focused on creating machine learning tools to help people with neurological disorders.
So, how do these tools work?
Let’s say a stroke patient with facial asymmetry is doing facial exercises and speech therapy to improve their ability to communicate.
Bandini explains that if software can do a facial analysis of a patient, doctors can measure how effective the patient’s rehabilitation is.
Professor Yana Yunusova says in her Vocal Tract Visualization Lab at KITE, the use of facial analysis of patients is currently only research based.
“We are trying to show the data that’s collected can be clinically useful and what purpose it can serve,” says Yunusova, a professor in Temerty Medicine’s Department of Speech-Language Pathology and Bandini’s supervisor.
In Yunusova’s lab, researchers study data of patients’ facial and speech movements to estimate the severity of their neurological impairment.
“The purpose of analyzing facial and speech movements could be disease detection. It could be disease tracking over time. It could be responsiveness to certain drugs. Our job is to show that models and measures based on facial and speech analysis are useful for a clinical goal,” she says.
Part of successfully implementing the technologies is being aware of the risks.
Noah Crampton (PGME ’18), a lecturer in Temerty Medicine’s Department of Family and Community Medicine, says leaning too heavily on facial analysis tools that use artificial intelligence (AI) could create inaccurate diagnoses, and doctors must be aware of this.
“When doctors have limited time and don’t have a chance to compare the AI analysis with the information they gather on their own during a patient examination, they may become overly reliant on a machine and come up with an incorrect diagnosis,” says Crampton, who is also a clinician investigator with Toronto Western Hospital’s Family Health Team.
Crampton says it could take years before facial analysis tools are implemented in clinical settings.
Bias in AI algorithms that power facial analysis tools could also happen, says Alaa Youssef (PhD ’21).
Algorithms can reproduce racial and gender disparities because sometimes the datasets used to build algorithms don’t accurately reflect the entire population, says Youssef.
“Algorithms based on faulty datasets are just reproducing existing biases,” says Youssef, a postdoctoral fellow at Stanford University’s Center for Artificial Intelligence in Medicine & Imaging.
So, where’s the promise in these tools?
For Tina Felfeli (MD ’19), a resident physician in Temerty Medicine’s Department of Ophthalmology and Vision Sciences, facial analysis could change lives for people with vision loss.
“In ophthalmology, it could be helpful in detecting some conditions earlier. I could see something like this being used for infants, if there are changes in the shapes of their eyes or there’s an abnormality in the alignment of eyes, we might be able to detect issues earlier,” she says.
Professor Shazeen Suleman (BSc ’06, MSc ’08, PGME ’16), an assistant professor in Temerty Medicine’s Department of Paediatrics, agrees.
“When we work with babies in the neonatal intensive care unit, the challenge is determining when a baby is in pain. Using facial analysis tools might actually allow us to better pinpoint when babies are in pain,” says Suleman, a staff physician with Unity Health Toronto’s Women and Children’s Program.
Facial analysis could also be used to measure emotional expression or youthfulness after reconstructive or aesthetic surgery.
Kevin Zuo (MASc ’19), a surgical resident in Temerty Medicine’s Division of Plastic, Reconstructive & Aesthetic Surgery, says a facial analysis tool may be able to objectively quantify the success of a surgery.
“It’s a potential way of calibrating something that we as humans aren’t able to quantify. If someone has facial paralysis surgery, are they able to better express their emotions? If someone has a facelift, how many years younger do they look post-surgery?” he asks.
Success can be defined in many ways in plastic surgery, he says.
And, the clash of objective analysis with subjective experience is part of the inherent limitation of such a tool.
“If you ask the patient how they feel about the surgery and they’re super happy, but the computer says they haven’t improved, then I would argue that a computer doesn’t matter as much as what the patient thinks,” he says. ▲
Otolaryngology is very intimate in terms of how we form relationships and ultimately treat our patients. It’s very important for us to be able to examine the patient thoroughly because it can change our treatment plan.
Right now, I think we’re seeing a transition in medicine from the old school to the new school. There’s a range of ways we respond — from the clinical information gathered during a physical exam, to more innovative methods of diagnosis and treatment, like the endoscopes and robotic tools we use in surgery.
Something I do fairly regularly in my work is a nasal endoscopy, where I put a small camera in a patient’s nose. This is so I can evaluate their sinonasal cavity as well as the throat area. To make an assessment, this requires the specialist being in the same physical space as the patient.
But let’s say that in the future, a patient is living in a remote community. And, imagine that a practitioner there is able to use a camera and attach a device that records or streams the exam. Then, the same type of examination could be done from a distance.
Amr Hamour is a fourth-year resident in Temerty Faculty of Medicine’s Department of Otolaryngology Head and Neck Surgery.
To me, the face is the Everest of the craniofacial surgical world. My goal is to help someone who was born with a significant facial difference and make them blend into society in a way that nobody would ever be able to tell that they’ve even had surgery. I call it “the supermarket test.” Could they walk through a supermarket, after surgery, without anyone noticing the facial difference that originally led them to seek help?
For this type of work, I like working with advanced technology. I can show patients what they will look like after surgery, using computer-assisted design and virtual surgical planning.
For example, I often do surgical work on patients’ jaws. I move people’s upper and lower jaws around to improve their facial balance and to bring their teeth into a better position.
Advanced technology means I can measure the face objectively on its balance and symmetry, pre- and post-surgery. I want more tools like this.
Christopher Forrest (BSc ’79, MD ’83, MSc ’90, PGME ’91) is a professor in and the chair of the Division of Plastic, Reconstructive & Aesthetic Surgery in the Temerty Faculty of Medicine’s Department of Surgery.
I’m a young resident. One of the things I think holds a lot of promise is the ability to use patients’ faces to provide personalized medicine.
Using the face, you could build identification tools to track patients as they move through the health care system.
That being said, I think we need to watch out for a disappearing human connection.
In the future, we don’t want to have hospitals where patients go in, scan their face, and some medication just pops out of a machine. I think medicine, at its best, is very holistic. We’re looking at a patient’s physical health, mental health and spiritual health, as well as their social circumstances.
It’s also key to remember that comfort using new technologies varies. It needs to include people who are older, and people who don’t have smartphones and who don’t use apps.
Rina Huo (MD ’21) is a graduate of the Temerty Faculty of Medicine and a first-year internal medicine resident at the University of Calgary.
I’m the first congenitally blind biomedical research scientist in the world. In my experience, people might unconsciously or subconsciously use our faces and what we look like as a way to define the kind of medical care we get.
This ties into intersectional identity, and the unconscious biases that exist if a patient or research participant doesn’t look like you. Nobody asked to be born blind.
Our faces — and the organs in our faces — are used to taking in information, but if you’re a patient who has a visual disability, what kind of impression does your health care practitioner have of you?
People sometimes feel justified using their eyes to make snap judgments about someone else. Eighty-three per cent of sense information comes in through our eyes.
COVID-19 has taught us that what people look like substantially impacts the type of help they receive. Who gets vaccinated, and when they get vaccinated. Who gets tested, and when they get tested. Who gets treated, and when they get treated.
People think other peoples’ faces will tell them all sorts of useful information, like gender, or culture, or ability. But faces don’t actually accurately convey that at all.
In my mind, the important role that faces will play in the future of medicine and research is for us to get to the point where faces don’t matter.
Mahadeo Sukhai (BSc ’98, MSc ’01, PhD ’07) is the director of research, and the chief inclusion and accessibility officer at the Canadian National Institute for the Blind.
During my residency, I went on an Operation Smile trip to India with David Fisher, who is now my clinical partner at The Hospital for Sick Children.
We did cleft lip and cleft palate repairs on more than 160 children.
The surgery changed the patients’ appearance and their speech, and that had implications on how they lived their lives.
Operation Smile made me think about how we needed a way to measure the impact of our work. At the time, we didn’t have a way to measure how patients felt after the procedure.
That’s why we launched CLEFT-Q in 2017.
CLEFT-Q is a series of questions that allow patients to tell us how they feel about the facial reconstruction they’ve had and how it has affected their speech and appearance.
It’s now used in more than 40 countries around the world, at 200-plus sites. It’s shown me the value of quantitative tools.
One thing missing right now, particularly in plastic surgery, is detailed information about a patient’s appearance in their medical records.
To protect patient privacy, there are strict rules about photography during and after surgery.
After we operate on a patient’s face, it would be helpful to have an objective, standardized way of assessing aesthetic changes.
A tool that can analyze a person’s appearance would be useful for surgeons, such as myself, and our patients.
Karen Wong (BSc ’00, MSc ’02, MD ’06, PGME ’13) is an assistant professor in the Division of Plastic, Reconstructive & Aesthetic Surgery in the Temerty Faculty of Medicine’s Department of Surgery.
Photography by Jacklyn Atlas
Story by Kariym Joachim, as told to Hilary Caton
What do you see when you look at someone’s face? My emotions? My history? My life?
I definitely don’t have a regular story. But I do have experiences that have led me to a life of research and to helping build a community that’s commonly misunderstood.
In 1987, I was officially diagnosed with Treacher Collins Syndrome, a rare genetic disorder that affects one in as many as 50,000 babies. This rare disorder affects the way a baby’s cheekbones, jaws, ears and eyelids develop before birth, leading to impacts on breathing, swallowing, chewing, hearing and speech. I prefer when people refer to the syndrome as a facial difference.
For me, the difference started early. After I was born, the hospital staff initially suspected I had a problem with my ears. It wasn’t until I was three months old that my parents received the diagnosis of Treacher Collins Syndrome, or TCS for short.
For me, TCS has resulted in hearing loss, consistently watery eyes and sleep apnea. I also have trouble in opening my mouth wide, which leads to challenges with eating and dental examinations. Having TCS meant that throughout my childhood, many people tried to set limits on what I could do. These limitations, which most people with a facial difference encounter, are often based on misconceptions; and growing up with a facial difference in Pickering, Ont., had its fair share of misconceptions.
I first realized I looked different at the age of five and asked my mother why. From that moment, I became acutely aware that I am different from my peers, my friends and my family — simply because I’m the only one with TCS.
Other children noticed, too. I dealt with bullying and teasing, particularly in elementary school. There were even teachers in both elementary and high school who assumed that due to my difference, I had a cognitive delay. That’s just wrong. My intellect and character aren’t tied to my facial difference. But, those early experiences pushed me to be the best version of myself.
As an adult, I’ve dealt with my fair share of whispers, stares and pointing.
This feels diminishing. I am grateful for my parents and younger sister who pushed back against stares or answered questions when I wasn’t up to dealing with them.
After diagnosing me, our paediatrician referred us to the Hospital for Sick Children, where I met a talented team of doctors who would later inspire me to embark on a research career.
During my care at SickKids — I was seen by people from several departments. Much of my time was spent with Professor Christopher Forrest, the chair of Temerty Medicine’s Division of Plastic, Reconstructive & Aesthetic Surgery. As my primary surgeon, he coordinated with my other doctors and always took the time to talk to me about what was going to happen with each plastic surgery.
Each of these doctors knew how to make me smile. They made me feel like a person and not a condition. I wanted to be that person for someone else. But it hasn’t been easy. Growing up, the lack of information about my condition was overwhelming at times.
Over the years, I’ve had more than 20 reconstructive surgeries for my ears, cheekbones, jaw and eyes. I received a bone-anchored hearing aid when I was 12 years old. During the course of these surgeries, my parents had their worries about what kind of life I would lead. Would I have friends? A job? Relationships? The answer has turned out to be yes, but it wasn’t always so clear back then. I try to focus on the good.
In November 2000, when I was 12, I spoke at the University of Toronto about my experience of living with TCS. In Convocation Hall, I got up in front of hundreds of medical students waiting for a kid to share his story. It was such an honour to stand there and speak to future clinicians and encourage them to be hopeful, communicative, and kind to their patients and families. It was a formative moment for me because I felt comfortable and accepted. I thought to myself, “This is where I belong.” I belong among academics and medical professionals. I promised myself that I would come back to U of T as a student because in that space, when they looked at me, they didn’t see me for my facial difference. They looked at me for who I was and what I was able to accomplish. They saw me in a similar way that I saw myself.
My love of research and interest in medicine led me to graduate with an honours bachelor of science from U of T, and I’m now doing my doctoral studies at the Temerty Faculty of Medicine.
For me, being part of the charity AboutFace also changed my life. I was introduced to the organization when I was very young, and we’ve been connected ever since. AboutFace provides support and resources to members of the facial difference community across the country. Last year, we worked with more than 1,300 people. It has given me a way to connect with other people who have lived experiences of what it’s like navigating facial differences. It has also built my self-esteem and self-advocacy skills. The organization helped me so much that I worked for it as a volunteer for 20 years. Now, I serve as its board president and chairperson.
As we continue to have conversations around how our society treats gender, race and disability, it’s important to include people with facial differences. As a Black man with a facial difference and hearing loss, I wish people to acknowledge and accept me as I am. I know that not all people with a facial difference mirror my experience. Some experience micro-aggressions, while others are subjected to severe bullying, harassment or discrimination — just based on their appearance. I want to help change things for others.
When I was close to finishing my undergraduate degree, I went to Christopher Forrest for career advice. He recognized my growing passion for research and encouraged me to follow it. My experiences inspired me to pursue my dream of research in craniofacial health outcomes. Today, I am a clinical research project manager at SickKids, and Christopher Forrest is my PhD supervisor. My doctoral work will look at the barriers to cleft lip and palate care for paediatric patients.
Cleft lip and palate is the most common facial difference in Canada; every year, it affects 400 to 500 infants. The way people with cleft lip and palate receive care can depend on a variety of factors, which range from socioeconomic status, to ethnicity, to their distance from a primary care centre. I plan to explore how each factor impacts patients in Ontario, and how it affects the timing of their surgeries.
More than two million people in Canada live with a facial difference. That’s two million people who desire acceptance and equity. With that in mind, I am driven to educate the public about facial differences, and empower the people who have them. It’s important to recognize that our facial differences are part of who we are. But, it’s not all that we are. Look at me. ▲
Kariym Joachim (BSc ’10) is a PhD student at Temerty Medicine’s Institute of Medical Science.
Story by Jim Oldfield
The human face has no match as a source of deep and fast information. The face can convey age, sex and ethnicity, and moods such as happy and sad along with subtler feelings like pride, regret, and even a propensity for stress or joy — all in an instant.
Perception of these details is crucial for social interaction. So, it is perhaps not a surprise that we have evolved complex neural networks that span several brain regions to process faces and their many cues.
Neuroimaging studies have shown that those networks share remarkable similarities across research populations, and at specific points in development from infancy through to adulthood.
But many of those studies have also revealed differences in how people see faces — prompting new ways of thinking about cognitive development, and pointing toward better diagnoses and treatments for neurological disorders in people of all ages.
“Faces offer a huge range of information, and they are a very salient stimulus that children can focus on,” says Margot Taylor, a professor in the Departments of Medical Imaging, Paediatrics and Psychology at the University of Toronto. “That allows us to link face processing stimuli to brain function, and to compare neural activity in children with and without developmental conditions.”
Professor Taylor, who is also a senior scientist at The Hospital for Sick Children, began to incorporate face processing in her research during the 1990s, after she moved to France and shifted away from language-based tasks that had limited her work to children who could read in English.
When Taylor returned to Toronto in 2004 as the director of functional neuroimaging at SickKids, she stuck with face processing and its extension to social cognition, in part because it allowed her to study more children with varied abilities.
Since then, the understanding of how we process faces has changed — especially relative to speed.
“We used to talk about registering emotion in 400 milliseconds, or just under half a second,” Taylor says. “But a lot of processing happens within 100 milliseconds. Faces come blazing through far faster than most other information.”
Taylor and her lab use several types of imaging to track face processing, but prefer magnetoencephalography (MEG) to capture brain activity in the first milliseconds.
Her group has used MEG in very-low birthweight children to show patterns of reduced neural connectivity in response to angry faces, and in soldiers with post-traumatic stress disorder to show neural hyperconnectivity when they viewed threatening faces.
The group is now planning studies in children and toddlers with optically pumped magnetometry (OPM-MEG), after SickKids became the first site globally to receive a commercial version of the technology this summer.
Taylor’s lab also works with functional magnetic resonance imaging (fMRI), which provides high spatial resolution and works with moving or “dynamic” faces.
Marlee Vandewouw (MASc ’16) is a doctoral student at U of T’s Institute of Biomedical Engineering and a former research analyst/engineer on Taylor’s team. She co-led a study published last year using fMRI in children and adolescents.
The research showed striking similarities in brain function among those with autism, attention deficit hyperactivity disorder and obsessive-compulsive disorder when they looked at dynamic faces and flowers.
“There is a major trend to stop looking at these disorders from the classic diagnostic boundaries,” says Vandewouw. “People now understand that if there is an overlap in behaviour, there is likely overlap in underlying biology.”
Tomáš Paus is a professor of psychiatry and psychology at U of T. He has studied the brain and development for over 30 years using different types of imaging, and he is increasingly focused on large research cohorts.
Professor Paus and his doctoral student Zhijie Liao published a paper this fall with global collaborators, using dynamic face processing data from fMRI in several hundred people. Participants were children, adolescents and adults who presented at first without identifiable medical conditions.
Paus and his colleagues found that collectively, participants shared a “canonical” profile of connectivity across populations and ages. They later determined that individually, deviations from the canonical correlated somewhat to the presence and degree of psychopathology.
“This is pure speculation, but it could be that if you are not very canonical, your brain is organized in a slightly different way,” says Paus, who is also a faculty member at the University of Montreal. “You may see things others don’t or respond differently, and that may put you on a spectrum of risk for psychological issues.”
As population data sets become larger and more robust, Paus says we should be able to place more individuals on a continuum relative to the norm.
“The advantages of population-level data have become clearer than ever during COVID-19, to answer questions about risk of severe disease, hospitalizations and health system capacity,” Paus says.
“I’m excited about combining face processing and other measures of the brain with big science on social environments, for example at the neighbourhood scale. That’s the next frontier.” ▲
Story by Heather McCall
The year is 1974. Stuart Tanz, 15 years old, sits at a weekly Sunday dinner with his family, including his parents, Mark (BA ’52, Hon LLD ’90) and Gilda (BA ’52); his siblings Bernard, Russell and Melanie; and his grandparents, Gertrude and Louis. Gertrude was the driving force behind this tradition. It was a chance for her to check in on the grandkids.
“She would ask, ‘Are you listening to your parents? Have you told your brother you love him?’” recalls Stuart. “She was a woman of integrity and honesty. She wanted us to be good in every sense of the word.”
Gertrude — a college-educated Polish emigrant — came to Toronto with her husband, Louis, in 1924, when she was 20 years old. Over the years, the couple built a thriving life together that included establishing a successful fur business at Bay and Dundas with clients across the city. Louis ran sales and marketing with his business partner, and Gertrude did the books and taxes. As the years progressed, Gertrude became active in Toronto’s Jewish community, donating time and considerable energy to local organizations.
But perhaps her most cherished roles were as a mother and grandmother. Gertrude strove to keep the extended Tanz family connected, including at the weekly meals. In 1974, at age 70, Gertrude was still organizing charity events and taking every opportunity to spend time with her children and grandchildren.
However, things started to shift three years later.
Gertrude’s family noticed changes in her behaviour. She started forgetting things. She couldn’t remember where her keys were. And, she missed taking her medication. It was a clear sign that something was wrong.
“Gertrude was a very disciplined individual, so when she started having memory issues it was noticeable immediately,” says Stuart. “She began calling me by my brother’s name. She recognized my face but couldn’t remember who I was.”
In 1981, Gertrude was diagnosed with Alzheimer’s disease. Alzheimer’s is a chronic neurodegenerative disease that destroys brain cells, causing thinking abilities and memory to deteriorate over time. It is not a normal part of aging, and the cause is unknown. The memories that Gertrude had worked so hard to make, for herself and her family, were slowly being erased.
The impact of Alzheimer’s disease is devastating — it slowly progresses until bodily functions are lost, leading to death. Life expectancy after diagnosis is three to nine years. The Alzheimer’s diagnosis was a rally cry for the Tanz family. They started researching the disease, which was largely unknown to them.
“At that time, very few people knew anything about Alzheimer’s,” says Stuart. “There was not a lot of information about it, at least not that my family could find.”
The diagnosis was especially difficult for Gertrude’s son Mark, a real estate developer, who was very close with his mother and not accustomed to facing unsolvable problems. After Gertrude’s diagnosis, Mark contacted his high school friend Lionel Schipper (BA ’53, LLB ’56, Hon LLD ’00), whose mother had suffered from Alzheimer’s and died in 1982. Mark and Lionel caught up over coffee, and then Mark got right to the point.
“Mark said, ‘I think Alzheimer’s is going to be a disaster for the world. Shouldn’t we do something about it?’ And then, we had a conversation about what it would take to find a cure,” recalls Lionel. It was an emotionally charged heart-to-heart.
“We both cried through it,” says Lionel.
By the end of the conversation, Lionel agreed to join Mark in making a significant donation that would eventually found the Tanz Centre for Research in Neurodegenerative Diseases at the University of Toronto’s Faculty of Medicine, now Temerty Faculty of Medicine.
Gertrude passed away in 1986, a year before the Tanz Centre was founded. Yet, Mark’s commitment to try to find a cure for Alzheimer’s continued, as did his support of the Tanz Centre. He went on to donate considerable amounts of time and money to the centre.
In the years since the Tanz Centre’s founding, scientists have made remarkable discoveries in neurodegenerative disease research. Yet, no cure exists — to date.
Mark’s own health began to fail in 2014 at the hands of another neurodegenerative disease, Parkinson’s.
After his diagnosis, Mark asked his son Stuart to take over as chair of the Tanz Centre’s Volunteer Steering Committee and “get across the finish line” in the fight against Alzheimer’s. Mark also asked Stuart to encourage his siblings to get involved, to continue their father’s and grandmother’s legacy of giving back. They all now have active roles with the Tanz Centre.
Mark Tanz died in 2021 without seeing his dream of a cure for Alzheimer’s realized. In memory of his father, Stuart’s half-brother and the youngest of Mark’s children, Jonathan, 20, made his very first significant philanthropic donation – to Parkinson’s research – in memory of his father. Stuart says the Tanz family is more hopeful than ever that a breakthrough could occur.
“I feel like at this point, the focus across the globe on dementia and related diseases has increased significantly, even from 10 years ago,” says Stuart. “With the work of the Tanz Centre, I believe the push to fulfil Mark’s wishes and find a cure continues.” ▲
Story by Emily Kulin
When COVID-19 hit, Elaine Chin (MD ’88, PGME ’89, MBA ’94) experienced a surge of anxiety, due to events from years before.
“In 2003, my then-husband was a physician working at a SARS-designated hospital in Toronto, St. Michael’s Hospital,” says Chin. “I had a family practice office located inside Trillium Health Centre’s Mississauga site — another hot spot.
“Our son, Robert, was four years old. We kept him home from preschool. We self-isolated in the house. My husband ate by himself and slept in a separate room each night for months. And yes, we updated our wills. It was very scary.”
In February 2020, Chin was closely watching COVID-19’s spread and advising her patients on how to manage at home and at their businesses.
At first, the founder of Innovation Health Group, the Bespoke Wellness Club and the Executive Health Centre hoped the virus could be contained.
But, reality quickly set in.
An early sign of trouble came when a patient who was about to start radiation therapy for cancer approached Chin, and told her they were having difficulty sourcing a single box of medical-grade face masks.
By March, Chin was hearing of shortages of personal protective equipment (PPE) impacting hospital staff.
Chin was horrified at reports of frontline health care workers fashioning gowns out of garbage bags and using scarves as makeshift masks.
“I was crying every night, thinking of them,” says Chin. “Even at the worst of SARS, we never had to deal with anything like this.”
“Robert, who returned home from his American university when borders closed, walked in on me one day as I was watching the news. He told me to pull myself together and that I shouldn’t be crying every night. He told me that because I wasn’t one of these doctors and these weren’t my patients, I should just ignore it.”
“He didn’t understand. These health care workers could die and leave their kids without parents.”
Inspired by the experience of her mask-seeking patient and what was happening in hospitals, Chin decided to transform her rekindled fears and anxiety into action.
“The best way to motivate me,” says Chin, “is to say something can’t be done.”
In April, she launched the Masking Together Challenge in support of the University of Toronto’s Faculty of Medicine — now Temerty Faculty of Medicine — and its work to protect frontline health care workers.
The challenge quickly gained support — raising nearly $200,000 within three months.
Funds were deployed to three priorities: providing PPE for health care workers; giving short-term accommodation for medical trainees serving on the frontlines who needed to isolate from family or roommates; as well as funding urgent research into the SARS-CoV-2 virus and COVID-19.
But Chin’s commitment to helping frontline workers didn’t end there. It eventually expanded and evolved into two additional campaigns.
In the fall of 2020, Chin launched a second challenge to support what she calls “the invisible frontline” — raising funds for and providing PPE to medical professionals and other staff caring for the homeless and other vulnerable populations in shelters and on the street.
And now, Chin is looking to help once again through her new “Un-masking” Challenge.
Her book Welcome Back! is a wellness guide that provides science-based guidance on how to rebound and thrive in a post-pandemic world.
A portion of the proceeds from the sale of her book will be directed to UNICEF’s COVID-19 Vaccine Fund.
More than 2,000 books have also been generously donated by her clients to frontline health care workers.
“I knew at the beginning of the pandemic that I wouldn’t be on the frontlines. I was working in an office, not in a hospital. But together with my patients, clients and members of the public, we were still able to make a difference,” she says. “Together, we did something bigger than each of us ever could have done alone.” ▲
I’m fascinated, and disconcerted, by the possibilities of facial recognition. Diagnosis by selfie could save lives — or ruin them. Blush and beware.
Julie Traves is a senior editor and writer. In Reflection Perception, she explores what happens in the brain when we look at ourselves, and why some people see a monster looking back.
I could see a future in which doctors and researchers use facial scans that employ biometrics. Whether patients concerned with data privacy consent to this brave new world is another question. Personally, it makes me nervous. I would need to know exactly how my data would be protected.
Hilary Caton is a journalist and strategic communicator based in Toronto who worked with Kariym Joachim to tell his story, Driven by Difference.
Faces offer us a reflection of both our past history and present reality. As health research and medicine moves towards a more holistic approach, I hope we’ll be able to use faces to better understand how environment factors and trauma show up in our bodies.
Anita Gairns is a queer feminist photographer who worked with Kat Butler for Written On the Body.
My interest in portraiture comes from the variety of faces that surround us. I’m hopeful that future health research and medicine will continue to be more and more diverse and inclusive.
Michael Luberry is an artist and illustrator based in Berlin. He created the visuals for Reflection Perception.