The perpetual student

Dr. David Spence, MD'70, considers himself a perpetual student - much like what Sir William Osler described in his published work The Student Life - he is a "seeker after truth." For more than 50 years, Dr. Spence has been learning - first as a student, then as a professor, researcher and clinician at Western University.

His learning today comes from his ongoing research, his continued care of his patients and collaborations with peers at Western University and around the world.

That, along with his family, is what he is most passionate about. And it's what "makes his life fun."

Dr. Spence arrived at Western University in 1962 at the age of seventeen. He spent three years with the Faculty of Science, studying Zoology, completed a fourth year to achieve an honours degree standing, and then was accepted into medical school.

Attending medical school did more than just fulfill a dream for Dr. Spence; it is where he met his wife Ann. They caught each other's eye on registration day and in a few weeks were dating. Since then, they have shared a wonderful life together, which grew to include three sons, three daughters-in-law and nine grandchildren.

Following his undergraduate medical education he began his residency in neurology and had the good fortune to study with the renowned Dr. Henry Barnett. During his first two years as a resident he began to develop an interest in hypertension and stroke. This was no doubt a result of seeing more than 1,000 patients who suffered a stroke, half of them due to hypertension (high blood pressure).

He realized that these people and their families were being devastated by something completely preventable. It was then that he decided to focus his efforts on stroke prevention. Following his Neurology residency, he completed Internal Medicine at Western, followed by a fellowship in Clinical Pharmacology at the Cardiovascular Research Institute, University of California at San Francisco.

Upon his return to London, he opened a hypertension clinic at Victoria Hospital. Within a year of opening his clinic, the Department of Family Medicine at Schulich Medicine & Dentistry, under the leadership of the late Dr. Ian McWhinney mounted a community program to improve the detection and treatment of people with hypertension. Together, from 1978-83, they were able to reduce the rate of stroke in London by half.

At the time, Dr. Spence's research focused on the effects of anti-hypertensive drugs. And in doing so, his team became the first in the world to use ultrasound to track the amount of carotid artery plaque in patients. This work was advanced further through a collaboration with Dr. Aaron Fenster, Director of Imaging, Robarts Research Institute and Western alumna and associate professor Dr. Grace Parraga, beginning in 1994 with a prototype machine which measured 3D plaque volume. This partnership changed the direction of Dr. Spence's research focus; he left his hypertension clinic and opened a stroke prevention clinic.

It was in 2002 that Dr. Spence's research showed that the care being provided to stroke patients was in fact failing half of his patients. Within a year he changed his approach and began treating the arteries rather than the risk factors. The result was that the proportion of patients with plaque progression and regression flipped. Instead of seeing progression in half of the patient and regression in a quarter, they now see progression in a quarter and regression in half.

He is now moving this work to the clinical trial stage to compare usual care to this approach, which is termed "treating arteries."

Dr. Spence is proud of what he has been able to contribute to advance medical care. He estimates that during his career he has been able to directly prevent close to 7,000 strokes. He credits the outstanding medical education and training he received at Western University and the tremendous spirit of collaboration that exists amongst his colleagues on campus for a great deal of his success.

Like most students, however, there are still some things he wants to do. Currently, he is working with Dr. Gregor Reid, professor, Departments of Microbiology and Immunology, and Surgery and Dr. Greg Gloor, professor, Department of Biochemistry and focusing on the intestinal micro biome. They are working to determine how to replace the bad intestinal bacteria with good intestinal bacteria for those patients who are at the greatest risk of stroke and are resistant to other treatments.

He has also just received $100,000 from Grand Challenges Canada Stars in Global Health program to address the problem of resistant hypertension in Africa and is excited about the outcomes of this initiative.

This work, in addition to those topics, which his wife Ann fondly calls his "burning bushes," will continue to capture his attention and fuel his passion for learning.

To read more about Dr. David Spence's work, visit www.robarts.ca