# Michael Seth Silverman

Michael Seth Silverman is a Canadian specialist in HIV/AIDS and infectious disease and Chief of Infectious Diseases at Saint Joseph’s Health Centre and London Health Sciences Centre, at the University of Western Ontario, in London, Ontario, Canada.

## Work in Guyana

Between 1994 and 2012, Silverman travelled to Guyana to lead medical teams offering free medical treatment to the country's residents when their health system was not able to serve those in remote communities. For the first few years Silverman's work was accomplished through Ve'ahavta, a Jewish humanitarian organization based out of Toronto. He was the original director of medical operations with the organization. A team of doctors, a pharmacist, nurses, and administrators from Canada and the US travelled for two weeks to the remote area of southern Guyana. They provided medical care to impoverished villagers and taught basic healthcare skills.
Silverman demonstrated that the high prevalence of malaria in some regions of Guyana was leading to widespread use of antimalarial drugs, which then caused bacteria to become resistant to important antibiotics (the quinolones). Malarial control using bednets and other non-antibiotic means could then help prevent the loss of utility of these antibiotics.
Through his work in Guyana, Silverman was among the team that discovered the relationship between Yaws in the New World and the outbreak of syphilis in Europe after the discovery of America by Christopher Columbus. According to the study, Columbus and his men would have carried the nonvenereal tropical bacteria home, where the organisms may have mutated into a more deadly form in the different conditions of Europe.

## Work in Africa

Silverman’s research in Africa into the use of a HAART regimen during pregnancy and breastfeeding showed that it appeared to significantly prevent the transmission of HIV from mothers to infants. Similarly, Silverman undertook his humanitarian work in Zimbabwe, through Ve'ahavta.
Silverman worked in Africa to treat mothers during pregnancy and their newborn babies noting that treatment for H.I.V., syphilis, malaria and high blood pressure, can make enormous differences in whether mother and baby survive the birth. Many African women relied on traditional healers during pregnancy and only went to clinics during labor. In order to entice them to visit doctors during pregnancy, he instituted a program of ultrasounds with the promise that the women could see their unborn baby. This was a tremendous incentive and caused a jump in antenatal clinic visits by pregnant women. in 1997, Ve'ahavta's founder, Avrum Rosensweig, arranged for $12,000 in donated medicine and pharmaceuticals from Apotex and Novopharm and arranged for emergency supplied once Silverman and is team encountered malaria and typhoid in children.
Silverman also led a study linking the rise of tuberculosis with food shortages in Zimbabwe following the economic collapse. Locals were particularly susceptible to infectious diseases including HIV.
The economic collapse also led to a decrease in HIV infections. Silverman pointed to the fact that sex workers could not ply their trade if people had no money to employ them.

## Treatment of C. difficile with fecal transplantation

Silverman was one of the first North American physicians to use fecal transplantation in the treatment of recurrent C. difficile infection. He demonstrated that the procedure could be both efficacious and made simple enough for patients to do on their own at home. He also studies ways to try to reduce the overuse of antibiotics in the community. This may help reduce the incidence of C. difficile.

## Fecal microbiota transplantation plus anti-PD-1 immunotherapy in advanced melanoma: a phase I trial

In a world-first clinical trial published in the journal Nature Medicine, a multi-centre study from Lawson Health Research Institute, the Centre hospitalier de l'Université de Montréal (CHUM) and the Jewish General Hospital (JGH) has found fecal microbiota transplants (FMT) from healthy donors are safe and show promise in improving response to immunotherapy in patients with advanced melanoma.

## Treatment of metabolic disease and weight gain with fecal transplantation

In a Canadian study where Silverman served as principal investigator, the effects of fecal transplants on liver fat in people with fatty liver disease showed changes in the recipients’ guts, making the gut membrane less permeable, or “leaky.”
"This is important because one hypothesis for how an abnormal microbiome could contribute to metabolic disease and weight gain is by damaging the gut barrier that keeps toxins and pathogens from crossing into the bloodstream. When this occurs, it can set off a cascade of inflammation, contributing to insulin resistance, cardiovascular disease and autoimmune conditions, said Dr. Michael Silverman, the lead author of the study and the chairman of infectious diseases at Western University in Ontario”, the New York Times reported.

### World's first advanced pancreatic cancer treatment trials using fecal transplant pills

With the lower survival rates of advanced pancreatic cancer, Doctor's Silverman, Malecki, and Lenehan have started a trial using fecal transplant pills to work concurrently with chemotherapy treatments at the Lawson Research Institute of St. Joseph’s Health Care London and London Health Sciences Centre Research Institute (LHSCRI). Fecal transplant pills are donated from healthy-gut candidates. Silverman explained that they need to screen 43 individuals to find one who qualifies, which makes it challenging finding suitable fecal donors.
“We’re involved in more studies with lung cancer, and we’re hoping to start a further one with lung cancer and early stages of the study impact on lymphoma,” said Silverman, who is the leader of the Fecal Microbiota Transplantation (FMT) team.

## Work to protect injection drug Users from infection

Silverman is involved in trying to reduce the incidence of life-threatening infections such as HIV, hepatitis and endocarditis (a heart valve infection) in people who inject drugs.
He demonstrated that the sharing of equipment used to inject drugs could help to spread HIV and Hepatitis C. The reuse of the equipment could also help to lead to bacterial contamination and then endocarditis, an infection with a high mortality. He demonstrated that this was especially problematic when long acting opiates were used. He initiated a novel community program to “cook your wash” and thus partially sterilize the fluid which would be injected using a cigarette lighter. This program helped to end an HIV outbreak in London, Ontario
Silverman also showed that starting addiction counselling while in hospital (as opposed to after their release) for persons who inject drugs with heart valve infections, was associated with a reduced risk of death, possibly because patients were more receptive to change when they realized the lethal potential of this highly fatal complication.

## Canada’s Response to COVID-19

In December 2020, Silverman co-authored an article published in the American Journal of Health titled “Did Lessons from SARS Help Canada’s Response to COVID-19?"
In the article, Silverman, Michael Clarke, and Saverio Stranges compared other countries’ responses to Canada’s, starting with the mortality rate, which was remarkably lower than that of the UK, Europe, and the United States. Silverman remarked that lockdown measures in Canada “flattened the curve” by implementing them on March 16, 2020, even though cases in Canada (measured in cases per million) were lower than in some US states. Canadians complying with these orders made a difference.
Looking back at Canada’s response to severe acute respiratory syndrome (SARS), people in long-term care (LTC) were among the most affected. The authors stated that this pandemic helped to prepare the country for the COVID-19 pandemic by upgrading equipment, training staff, and stockpiling certain emergency supplies.
In conclusion, Silverman and his co-authors wrote, “Overall, Canada learned a great deal from the SARS epidemic, with improvements in public health organization, laboratory infrastructure, and hospital infection prevention and control. Unfortunately, in areas where SARS did not affect Canada, such as the LTC sector and a collapsing supply chain, vulnerabilities remained, resulting in major challenges in the COVID-19 response."

## Awards

For his contributions to the fight against the global AIDS epidemic, Silverman was honoured by Ve'ahavta with the Tikkun olam award for medicine in 2010.