What led you to a career in pulmonary pathophysiology?
My personal sporting journey drove my initial interest in human physiology. As a schoolgirl, I represented my county in hockey. I also played a variety of different sports and therefore appreciated the importance of having a highly tuned body. I became particularly interested in the development of the cardiorespiratory system, so pursued this route in my training and joined the National Health Service (NHS), where I was able to use physiological and biochemical principles to study how disease affects the respiratory system.
One turning point in my career was completing a PhD in basic science that was sponsored by, and closely linked to, industry. During my career in academia, I learned the importance of not only aligning basic research with routine care, but also working with industry on drug discovery and clinical trials. In addition, while working at University Hospital Birmingham, I led several service development and transformation projects, where I saw things from a service management and delivery perspective. When I started at the Department of Health in 2002, I brought all these elements together into the role of Chief Scientific Officer for England. There, I’m involved in everything from combining service management and planning with transformational change, right through to aligning research with routine care to drive improvement in healthcare.
What lessons have you learned about taking research to the clinic?
The first thing to consider is the basic science perspective. The crucial part here is finding the right question and ensuring that the methodology is suitable to answer that question. It’s also important to be prepared to adjust the hypothesis and methodology if necessary, and to make sure everything is clearly documented. The other part is the significance of the research in terms of eventual implementation, specifically when going from basic science to the possible translational research questions that arise from initial results. Whether we’re using evidence in policy to set a strategic direction or carrying out a basic science project, it’s always about truly understanding the question that we’re trying to answer, how we see it providing benefit, and what needs to be done to translate it. My belief is that, unless you look at it broadly from one end to the other, it’s very difficult to understand where you’re going to have an impact.
We’ve followed the above rules in genomic research in recent years. From a policy perspective, we have taken scientific evidence from research such as the 100,000 Genomes Project and applied it to clinical care so that we can drive change quickly. Our main challenge has been going from a microcosm within a single organization to implementing these changes across a very large, complex system.
What skills are required for the role of Chief Scientific Officer?
I think science is all about the spread of best knowledge and expertise. Leading scientific research projects and being involved in delivering policies to health services demands effective leadership skills – great knowledge, expertise, and the ability to influence. I think I draw a lot of my leadership skills from the lessons I learned growing up in a small village in the Cotswolds and playing sports. To get a team performing effectively in hockey, for example, you have to work with individual members of that group and build a community. I believe that, as a leader, you must have a single-mindedness. I’ve always been able to see and set a vision – and then take people with me on a journey based on the ultimate goal. Whether that’s winning the hockey championship or leading a major transformational project in the NHS, it’s the same set of principles.
Where do you see pathology and genomics going in the future?
There’s no doubt that both genomic and pathologic investigations are going to be at the heart of improving disease characterization through producing an individualized set of objective measurements for patients. I think pathology and genomics are moving toward more personalization and targeted treatments, but we will only achieve the best outcomes if all of this information can be integrated. With cancer, for example, we need to integrate the histopathology findings with a breadth of other indicators; for instance, biochemical markers or diagnostic investigations, such as liver function tests.
Starting with genomics – and looking specifically at DNA – will give us a greater understanding of the underlying drivers of disease, enabling us to be more proactive and prognostic in our approach. We will continue to produce world-leading infrastructure and work toward the availability of whole genome sequencing as part of a diagnostic repertoire. I think part of the challenge is to make sure that, with genomics at the cutting edge of technology, the rest of pathology keeps up and works hand in glove to support genomics where it needs to, providing an integrated picture of an individual patient.
If you could go back to the start of your career and offer yourself advice, what would you say?
As a woman working in what, at times, has been quite a male-dominated field, one of the things I would tell myself is to be resilient. Resilience is key to being a great leader. I would also say to have fun, and always to focus on the end goal – which, for me, has always been the patient.
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