By Greg Basky for SHRF
Dr. Ali Rajput’s career-long drive to improve treatment of patients with Parkinson’s disease and other movement disorders all started at a supper meeting he hosted in Saskatoon back in 1968 – a year after he’d moved to the province. There, a Quebec researcher announced he was starting up a multi-centre trial that would involve patients with Parkinson’s in Montreal, Toronto, Winnipeg, and Vancouver.
“What’s wrong with us?” a young Rajput demanded to know. “We are three full-time neurologists here (At the time, Winnipeg had none and Vancouver only one). Don’t our patients deserve the same treatment?” His two Saskatoon colleagues weren’t overly excited by Rajput’s idea to start a made-in-Saskatchewan treatment and research program – one wasn’t interested in research and the other already had another research project on the go. But the pair promised to support him as best they could if he decided to proceed.
Over the next 50 plus years, Rajput – the 2021 recipient of SHRF’s Achievement Award – would go on to establish himself as one of the world’s top researchers and clinicians in the field of movement disorders. He’s among the University of Saskatchewan’s Top 10 researchers based on his productivity – having contributed to more than 200 peer-reviewed papers and more than 200 conference presentations – and Rajput’s name is on the latest version of a recent list from Stanford University of the world’s top 20% of most cited scientists in all disciplines.
Rajput an innovator in the study of Parkinson’s
Dr. Rajput moved to Saskatoon in 1967 based on recommendations from two individuals with ties to the province – Dr. Don Baxter, one of his examiners for the Royal College, worked here until 1962, and his boss in Kingston, Dr. Dave Robertson, grew up in Saskatchewan. In 1968 he established the Saskatchewan Movement Disorders Program at Royal University Hospital. Over the years, the program – which marries treatment of patients with research – would play host to a number of clinical trials that led to improvements in patient care.
Early on, Ali realized he was never going to compete on quantity with the researchers in bigger centres who could study and report on hundreds of patients. There simply weren’t enough people with Parkinson’s and other movement disorders that he could see. But he was determined to establish himself as a leader in the field. “There’s no allowance made for your weaknesses,” says Rajput. “Your handicap is not counted. I still had to compete with the Londons, the New Yorks, the Torontos.” He decided that what he lacked in patient numbers he’d make up for with richer, more comprehensive data.
His first big investment? A movie camera that he used to collect objective data on patients before and after treatment. “I made records on every consenting patient.” The practice, which would go on to become widely adopted, was innovative at the time, according to Dr. Haissam Haddad, Head of the University of Saskatchewan’s Department of Medicine and lead on Rajput’s nomination for the SHRF award. “A physician usually asks the patient, ‘how do you feel?’ They say, ‘I'm feeling better,’ That is subjective. Or they look at them and say, ‘I think you look better,’ But now he has a movie he can compare and see if the abnormality of any movement is improving or not.”
With the help of Saskatoon neuropathologist Dr. Bohdan Rozdilsky, Rajput created a biobank with tissue samples from his patients who consented for their brain to be studied after their death. He put himself on 24/7 unpaid call for autopsies. “He was really ahead of the curve,” says Haddad. “This will be a goldmine for future researchers who come after him.”
So now Rajput had the clinical data, the videos, and the brains. “When I put all of these together, it put me in an entirely different league,” says Rajput. “I knew I couldn’t compete with them (other researchers) head on. I didn’t have the money, the manpower or the machines. I knew I had to do something different, something that others would not find attractive because it required more time and harder work.”
“These are my people”
Dr. Rajput never shied away from challenging conventional wisdom in clinical practice or research. Back in the 1960’s and 70’s, leading clinicians in the world were treating patients with high doses of levodopa. Some Saskatchewan patients traveled to Minnesota or Montreal for treatment. Rajput didn’t like the side effects he was seeing in the patients on the high dosage regimen – in particular a condition called dyskinesia, which causes involuntary, erratic, writhing movements of the face, arms, legs or trunk. “I said to myself, am I making their life better or worse?’ No, I’m not going that route.”
When he started prescribing levodopa, it was at a dosage that was roughly a third of what was then common. His patients were experiencing the same benefits at the lower dosage; while it took longer for the medication’s full benefits to kick in, they also lasted longer. Savings to the health system were substantial, with fewer and shorter hospitalizations and an estimated $130 million reduction in drug costs alone over the years.
The move made him an outlier among neurologists at the time. “I just said to myself, ‘They’re smart, but I’m not dumb either,’” says Rajput. He would go on to publish a paper about his method in the prestigious journal Neurology in 1984. Then in 2013 a different group of researchers published their own study confirming that Rajput’s low-dose regimen was in fact the best approach for patients.
A young girl whose condition improved dramatically under Dr. Rajput’s care was part of the inspiration behind the Kinsmen Club creating the annual Telemiracle fundraiser; she was a featured guest on the service club’s first telethon in 1977.
Rajput says the biggest difference that separated him from others treating Parkinson’s sufferers was that, while they often saw patients once, recommended treatment, then passed their care back to a family doctor, he followed his patients over time. “These are my people. I was seeing what was happening with them today, tomorrow, a year from now, two years from now, 10 years from now.”
Rajput has a well-deserved reputation in North America and around the world for improving quality of life for people with Parkinson’s. Dr. Haddad recalls a story from 2018 of one Saskatchewan patient in his 60s. “He’s well off, so he goes to the Mayo Clinic to be treated for his Parkinson’s.” At that time the Clinic’s Center for Neurological Restoration was considered one of the top places in the world for medical and surgical management of movement disorders. “They said to him: ‘You have Dr. Rajput in Saskatchewan, and you’re coming here? Don’t waste your money (paying us to treat you). He will look after you.’”
Rajput ensuring pieces in place for work he started to continue
In 2008, Dr. Rajput founded his namesake $1.6 million Ali Rajput Endowment for Parkinson’s Disease and Movement Disorders at the Royal University Hospital. Investment income from the fund is used for special clinics and research. “It will support this clinic and research in perpetuity for this province,” says Rajput.
He has advised officials in government, the Health Ministry, and the Saskatchewan Health Authority that the province needs at least three specially trained movement disorder neurologists to preserve and push forward with the important work being done by the Movement Disorders Program. “If they want to keep it, maintain that for the best care of the patients in the province, and the best research of this kind in the world, they have to do that,” says Rajput. In addition to his son, Alex, a neurologist who joined the program in 2000, there is a neurology resident currently completing his final year of training; he is due to start a fellowship focused on movement disorders in July 2022. That still leaves one more spot to fill in the near future.
At the age of 87, Rajput continues to keep up a busy clinical practice – albeit seeing most patients virtually because of the pandemic. He plans to continue working as long he’s physically and mentally able to do so.
Haddad says his colleague’s passion and energy show no sign of waning. “He still behaves like he’s junior faculty, like he’s desperate” says Haddad with a chuckle. “It’s like he just started his career and everything is still important. He tells me he still needs to do this and this and this. And I’m telling him, ‘Ali, you’re established. You’ve already accomplished everything.’”