Gideon Koren

Early life and academic background

Born in 1947 in Tel Aviv in the British Mandate of Palestine, just prior to the establishment of the State of Israel, Gideon Koren was raised in the neighbouring little town of Kiryat Ono. His father was the chief engineer of Reading Power Station of the Israel Electric Corporation. In his childhood he played French horn in the orchestra of the premilitary youth Gadna.

Koren received his Doctor of Medicine from the Sackler School of Medicine at Tel Aviv University in 1973. After a period of military service, he pursued postgraduate clinical studies in pediatrics and pediatric nephrology, and research training in pediatric toxicology and pharmacology and membrane biology at the Hospital for Sick Children and the University of Toronto. He joined the staff of the university and hospital and rose rapidly through the ranks to full professorship in pediatrics, pharmacology and medicine, won a Career Scientist Award from the Ontario Ministry of Health and established an international reputation as an expert in the field of clinical pharmacology and toxicology. He had a role in a controversial hospital dispute. He was later awarded the endowed Ivey Chair in Molecular Toxicology at the Schulich School of Medicine at The University of Western Ontario. At UWO, he heads the establishment of a national program in human toxicology in parallel to his continuing work at the University of Toronto and the Hospital for Sick Children.

Arts background

In parallel to his academic career, Gideon Koren is an established, award-winning composer and author. In 1971, while studying medicine at TAU, Gideon “Gidi” Koren founded the Israeli musical group, The Brothers & the Sisters (ha'achim veha'achayot). Koren’s songs and the group’s unique Israeli folk/country style put them at the top of the charts and of Israel’s popular annual song competitions for over a decade. The band performed many of Gideon Koren’s classic songs and musical plays for children.

In 1974, in collaboration with Israeli superstar Shlomo Artzi, Koren composed a record album based on his grandmother Keri's story, A Journey to Noteland, introducing the world of music to children. A musical based on the book and CD of A Journey to Noteland had its stage debut in Israel in 2008 and continues to be performed for elementary school children throughout the country.

In 1992 he founded the Bear Theatre at the Hospital for Sick Children in Toronto, the only such theatre worldwide where health professionals perform weekly for hospitalized children and their families. The musical "Tails" — script, songs, direction and children's book by Koren — has served as a model for other hospitals. In July 2007 the theatre celebrated 15 years and 750 shows. At the hospital, Koren goes by the nickname "Gidi" and takes pride in wearing eccentric hats to the performances of "Tails."

In 2004, Koren's band, The Brothers and the Sisters, reunited by popular demand with the composer’s active support. In 2005, they toured North America following the publication of a commemorative Hebrew-English book of the beloved Israeli poet Natan Yonatan’s poetry accompanied by a CD of his songs set to music by Koren and performed by the band. Since then The Brothers and the Sisters have continued to appear throughout Israel in programs featuring Koren’s hit songs, many of which were written to the words of Israel’s foremost poets, including Yehudah Amichai, Leah Goldberg, Rachel, Natan Yonatan, Amir Gilboa, and Ze’ev Jabotinsky. In 2008, NMC released a double CD and documentary booklet of 44 of the band’s favorites. 42 of these songs had music and/or lyrics and arrangements by Koren, as well as his participation as musician in early recorded accompaniments. Celebrating this collection and the band’s comeback, Israel’s Channel One dedicated a one-hour holiday TV special to The Brothers and the Sisters, who performed old favorites and new songs by Gidi Koren.

Professional contributions

In 1985, Koren founded The Hospital for Sick Children's Motherisk Program in Toronto, Ontario, Canada, which he directed until his retirement in June 2015. The program has since been shut down amid controversy.

Since 1986, Koren has trained physicians from over 30 countries, and over 80 graduate students in pharmacology, making his program the largest worldwide.

Koren has been a Senior Scientist of the Canadian Institutes of Health Research (CIHR). In 2004, Koren was appointed by the National Institutes of Health (NIH) of the United States Department of Health and Human Services as the inaugural chairperson of the Steering Committee for the newly created Obstetric-Fetal Pharmacology Research Unit Network. Since 2005, Koren has been the Course Director of the Annual Summer Institute in Maternal-Fetal Pharmacology, a collaboration between the National Institutes of Health and Canadian Institutes of Health Research.

Research

Koren's research in maternal–fetal and pediatric pharmacology and toxicology has focused on understanding the complex interactions between drugs, both illicit and medicinal, and the developing human being. These include the effects of drugs taken by the mother on her unborn baby, the role of the placenta in modulating fetal damage, and the way babies and children handle drugs. Koren and his colleagues use research approaches ranging from those of molecular and cell biology to whole-body pharmacokinetic or dynamic experiments and population studies. They collaborate with specialists in the field of psychology in order to measure the neurobehavioural effects of drugs on infants and children.

Together with colleagues at the University of Western Ontario, Koren is studying ecological system toxicology with a focus on the health risks to aboriginal Canadians residing near oil refineries in Western Ontario.

FASD focus

Gideon Koren is the founder of the FACE (Fetal Alcohol Canadian Expertise) Network and founding editor of the peer-reviewed Journal of FAS International (Fetal Alcohol Syndrome). At the forefront of FASD (Fetal Alcohol Spectrum Disorder) research and the development of screening and diagnostic techniques, he is also committed to outreach to medical professionals and community workers in the Northwest Territories and around the globe, both in person and through electronic media.

Publications

Gideon Koren is a reviewer and editor for journals and has published over 1000 peer-reviewed articles and 15 medical books, among them:

Preventing renal damage

Koren has found a way to prevent severe kidney damage caused by the cancer drug ifosfamide by using the antidote n-acetyl cysteine. The drug ifosfamide can save the lives of children with certain cancers, but often at the grim price of damaging the kidneys. Koren’s discovery may save the kidneys and have a major impact on the lives of these children.

Codeine during breastfeeding

Koren described a breastfed infant who died from opioid toxicity following the use of codeine by his mother. This was the first described death of an infant by a drug in breastfeeding, secondary to the genetic predisposition of the mother to produce more morphine from codeine. Further research by his group has shown that this is not a rare phenomenon.

FAEE

Using the baby’s first bowel movement (meconium), Koren’s group showed that, by measuring a by-product of alcohol (FAEE), they could detect objectively babies exposed to excessive maternal drinking in pregnancy.

Folic acid

Koren’s group has shown that the fortification of flour with folic acid in Canada has resulted in a dramatic decrease in neuroblastoma, an early and very dangerous cancer in young children.

Drugs in pregnancy

Through over 500 research papers on drugs in pregnancy, Koren has identified drugs and chemicals that are damaging to the fetus (e.g., organic solvents, corticosteroids, lithium, misoprostol), and those that are safe to take (e.g., paxil, calcium channel blockers, prozac).

Nausea and vomiting in pregnancy (NVP)

Koren and coauthors analyzed the estimated cost and actual burden to society caused by nausea with and without vomiting among the pregnant woman associated with the Hospital for Sick Children's Motherisk program. However, a later study of NVP conducted by the research group concluded that "NVP has an enhancing effect on later child outcome" but can be safely treated with diclectin.

Long-term safety

Koren established the only group worldwide that systematically studies brain development in children exposed in utero to drugs. The group has tested IQ, language, attention and behavior in children exposed during pregnancy to antidepressants, cocaine, cyclosporine, antiepileptics, and many other drugs.

Neonatal pain

Koren and his group documented in 1997, for the first time, that neonates remember the pain of circumcision 6 months later, as evidenced by enhanced response to vaccination. This has been marked as a breakthrough in the understanding of the long-term effects of early pain.

Drugs that can kill toddlers

Koren established, for the first time, a list of drugs that can kill a toddler even with only one adult tablet. Dr. Koren suggests that this list needs to be acknowledged by physicians because toddlers often accidentally consume adult medication.

Publication bias

Koren’s group claims to have pioneered the research into sources of misinformation and bias in information given to pregnant women. This has led to major changes in the methods of counseling pregnant women.

time.

Koren, a clinical pharmacologist, was not qualified to be MDTL’s director, “Dr. Koren saw himself as an expert in the interpretation of [hair-testing] results,” though he “never had formal training in forensic toxicology or any experience in a forensic toxicology laboratory.” Moreover, “it is clear that [Koren] did not understand the basic elements of forensic toxicology that are necessary to provide interpretations of test results.” Koren also “was not trained to testify as an expert” in court, Lang writes. http://www.macleans.ca/society/health/explosive-judicial-review-puts-lens-on-gideon-koren-and-sickkids/

Deferiprone controversy

In 1996, a controversy erupted with regard to the safety and effectiveness of deferiprone. Koren believed the drug was effective for certain patients. Olivieri of Toronto believed the drug was unsafe and ineffective. Following the initial controversy surrounding this drug trial in Toronto, Koren sent five anonymous harassing letters to colleagues and later denied having done so. Two independent inquiries by the CAUT and CPSO found that Koren had lied about sending the anonymous letters and only admitted guilt when confronted with DNA evidence against him. Both also found academic misconduct with respect to the way in which he published the research article cited above on the safety and effectiveness of deferiprone. CAUT accepted "the parties’ submissions that this misconduct should not be represented as fraudulent" and further remarked that "It was the behaviour that preceded the research misconduct that the Committee found most unsettling."

A later study using more data than in the Olivieri study found no evidence of that long-term therapy with deferiprone caused progression of hepatic fibrosis. Cumulative worldwide experience has confirmed Koren's position on deferiprone, indicating that deferiprone is safe and effective for some patients. As a direct result of Olivieri’s public media campaign, approval for the medication was stalled, meaning that North American children continued to be denied a medication which had since been approved around the world in dozens of countries and could be the only hope for survival for some children.

Awards and distinctions

Positions

Selected list of positions held as of 2010 Koren retired from the Hospital for Sick Children in June 2015.: