I enjoyed doing a few small projects as a registrar but I felt that I needed to experience and learn more about research when I finished my clinical training. I travelled to the UK and worked in Nottingham with a view to undertaking respiratory research with Professor Anne Tattersfield, a leading expert in asthma. During my time there I worked in a very active, stimulating, and cohesive research unit and my research was on the effect of inhaled steroids on bone mineral density. Everyone was very supportive and helpful. It was a very formative, enjoyable, and interesting period of my life.
Can you tell us about the most stand-out experience you had in doing research?
Research provides many highs and lows. I think the most exciting time for me was in 2012, after the results of our EMBRACE trial were available. The trial was to the first study to show that macrolides (azithromycin) are effective in reducing exacerbations of bronchiectasis. EMBRACE was my first large investigator-led clinical trial at Middlemore Hospital and took over 5 years to complete. I learned a lot from those in our study team and particularly from Cecilia Tong, who was our impressive and highly-skilled project manager.
What are your core research principles (i.e. what drives you into doing research?)
Research is interesting because it allows me to speculate about possibilities. It’s fun to look at a clinical question and try to devise studies that might help to answer the question.
I’m largely driven by a desire to improve clinical care for patients with respiratory conditions – particularly those with bronchiectasis. When I first arrived at Middlemore Hospital at the end of 1999, it struck me that bronchiectasis was much commoner here than in the UK. It was also disappointing that we had only a few treatment options. A lot of progress has been made in terms of knowledge about bronchiectasis since, but evidence-based treatments remain limited. Hence my interest is in looking at novel or re-positioned medications (Drug repositioning is the process of identifying new uses for drugs outside the scope of their original medical indication) that have the potential to be used in the near future. An example is clonidine, an older blood pressure medication that has potent anti-inflammatory properties.
I consider research a fun hobby. This mind-set allows me to take a long term approach and I don’t worry about periods of slow activity. For me, good ideas are sporadic and can be spaced by long intervals.
Important principles in research include:
Working with a cohesive team that has people with relevant skills. Developing successful ideas requires robust feedback from interested and knowledgeable team members.
Research needs a long term horizon.
The PI is the person who coordinates the study and provides the passion to drive the study but doesn’t need have expertise in all or many areas.
Persistence is important. Failures are inevitable in research but if the idea is good, it is worthwhile persisting.
It is important to seek collaboration with other research groups.
The future of Respiratory research – open ended question. For example; where do you think the future lies in Respiratory research? How do you think the research ecosystem at CM Health could be improved (if at all?)
The general future of respiratory research is excellent. There are many questions yet to be resolved in respiratory medicine. Worldwide the respiratory research community is very active and collaborative. I’m very confident about the future of respiratory research.
The immediate future of respiratory medicine seems to be focussed on Covid-19. The success of social distancing suggests that we should pay much more attention to this factor in the management of patients with chronic respiratory conditions.
Locally, research could be fostered by greater funding of research training positions (including PhD posts). It will be important to create an environment that spurs younger clinicians and researchers to include research as a career option. At present, my belief is that many young clinicians in NZ don’t see research as a viable career option because few SMOs are able or allowed to do research as a key component of their jobs. So creating attractive senior posts with a primary research component will be just as important as increasing research fellow posts.
Funding drives research. The funding that CMH and Ko Awatea have been providing for research projects in recent years is a great initiative. I look forward to seeing the growth of research and researchers at Middlemore Hospital in coming years.
Any other thoughts you’d like to portray – here we could talk about the Resveratrol trial?
Resveratrol is a naturally-occurring antioxidant with anti-inflammatory and antiviral activity. It is found in red wine, grapes, blueberries, nuts, and a variety of other plants. Ben Diggins has been our research fellow from the UK for the past few years. He developed the idea of using resveratrol to reduce the airway inflammation in patients with bronchiectasis. We’re very fortunate and grateful to have secured funding from Ko Awatea and HRC for the study. However, we had to dust ourselves off a few times after 3 grant rejections before securing our final funding. This reminded us that persistence can pay off!