Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Episode 1: Conversations in Pleural Medicine – with Professors Eleanor Mishra and Kevin Blyth
916 Plays5 months ago
Are you interested in pleural disease research but don’t know where to start? Listen to the inspirational career journey of Professors Eleanor Mishra and Kevin Blyth, two successful clinical academics in pleural disease, who candidly talk about their experience, challenges, ‘reinvention’ of their research career and what the future looks like. Whether you're a trainee, clinician, or simply curious about the field, this episode offers inspiration and personal insight from two of pleural medicine’s most respected figures.
Recommended
Transcript
Introduction to the UKPS Podcast
00:00:02
Speaker
Welcome to the UKPS podcast.
00:00:06
Speaker
I am Biniš, a Plural Research Fellow in Oxford, and I'm joined by my co-host Malvika. like I'm Malvika, I'm a Clinical Plural Fellow at Oxford as well. And we are excited to start this series to connect with everyone interested in plural disease.
00:00:20
Speaker
Hey, thank you,
Career Spotlight Series Announcement
00:00:21
Speaker
Malvika. So we are kicking off with our career spotlight series. We will be speaking with experts in the field, so stay tuned for an exciting lineup of talks.
Focus on Pleural Disease Research
00:00:29
Speaker
Today, our episode is about research in pleural disease. Our guests are Professor Eleanor Mishra and Professor Kevin Blythe, two eminent clinical academics who have conducted landmark trials shaping our clinical practice. We will hear from them about their academic career, their challenges, and what the future looks like.
00:00:48
Speaker
So welcome, Eleanor and Kevin. Could I
Eleanor & Kevin's Research Journeys
00:00:51
Speaker
ask you to introduce yourselves to our listeners, please? I'm Eleanor Mishra, and I am a respiratory consultant and plural lead at the Norfolk and Norwich University Hospital.
00:01:02
Speaker
And I'm also an associate professor at the University of East Anglia. ke I am Professor of Respiratory Medicine at the University of Glasgow. I run pleural disease service in the Queen Elizabeth University Hospital and I'm also National Clinical Lead for Musa Thulioma in Scotland.
00:01:23
Speaker
Thank you both of you. So I'm going to start with you, Elena, if that's okay. So would you briefly tell us about your academic journey? Yes. So I've always been interested in research.
00:01:36
Speaker
And as a medical student, I got involved with some research projects, both in the holidays and at university. i didn't have much opportunity as a house officer to do research. But when I was a senior house officer, so now that would be an IMT, by was working in the chess unit in Oxford.
00:01:57
Speaker
And at the time, Najra Abin was a registrar there, Rob Davies was lead for pleural disease, and Gary Lee was there as a visiting consultant as well.
00:02:09
Speaker
And Gary Lee had a very simple idea for a research project, which was looking at what influences pleural pH, And Naj and I very simply got some pleural fluid samples.
00:02:23
Speaker
We mixed them with a bit of lidocaine. We left them out in the air. We delayed how long it took for them to go to the lab. And we saw how this influenced pleural pH.
00:02:34
Speaker
And it was a really simple study, but it gave us important information and it got me involved with the plural service and got me interested in clinical research.
00:02:46
Speaker
Did you apply for any particular academic fellowships or how did you venture into research in the end then? At that time, there wasn't such a set research pathway.
00:02:57
Speaker
So there weren't academic trainee posts. And so I got a standard registrar number after that SHO post. And then after a couple of years, I came back to Oxford with a funded PhD.
00:03:11
Speaker
And that was running time three, which was a randomized trial of interpleural urokinase. for patients with septated malignant pleural effusions which weren't training.
00:03:23
Speaker
And I also helped finish off time two, which was a randomised trial comparing indwelling pleural catheter to chest strain and pleuronesis, which was about halfway recruited when I started in Oxford.
00:03:36
Speaker
And I helped finish off the recruitment and write it up. We'll move to you, Kevin, if that's OK. So do you want to tell us a bit about your academic journey? My journey is probably a bit different to...
00:03:49
Speaker
einor
Kevin's Shift to Academia
00:03:50
Speaker
I wasn't interested in research. I didn't really want to do re research. I'd done, I love clinical medicine. I love respiratory medicine and I wanted to do, I wanted to get a training number in respiratory medicine.
00:04:03
Speaker
And this was in the early 2000s. And at that time, it was so competitive that you had to have postgraduate degree to get a number.
00:04:15
Speaker
And so I somewhat reluctantly applied to do a research job. And I did a re research and I did research with someone who turned out to be a fantastic mentor in, you know, pulmonary hypertension, Andy Peacock.
00:04:30
Speaker
And I learned to do right heart caths. I learned lots of physiology and I did lots of and MRI imaging and biomarker things. I just loved it.
00:04:41
Speaker
And I then left there, did my registrar training and took up a consultant job in South Glasgow in an area that had lots of mesothelioma, lots of pleural disease.
00:04:57
Speaker
And again, i my focus was on developing a clinical service. really. And I set up the oracoscopy service and we got some regional mesothelioma things started and there was no other way to answer important questions than doing research.
00:05:14
Speaker
It probably started out as a means to an end. I wasn't really stunning for academia but it became obvious that was the way that we were going to make some progress and then things grew I think getting your first grant is quite important I think for your academic growth getting a bit of confidence getting your first fellow just to increase the
00:05:41
Speaker
Horsepower in the group is quite important. And so so I was an NHS consultant until well over 10 years and moved to the NHS. And I'm now obviously in an academic, clinical academic role and do lots of musically over-reserved research. It's probably more of what I do than clinical, but I didn't.
00:06:02
Speaker
my ah guess I guess my journey is just a little bit different to Eleanor's. Yeah,
Eleanor's Personal Challenges & Return to Research
00:06:07
Speaker
absolutely. Certainly sounds like it was the clinical route initially that sort of pushed you into the academia. And then would you say that recognising that there were so many unanswered questions in mesothelioma, that was a pivotal moment for you to switch in? Would you say that? When you look back in the last 10, 15 years, there's really been a bit of a golden age for plural re research and kind of explosion of the popularity of plural medicine and the development of thoracoscopy services and it and there were so many and still feels like that there are still so many questions that that exciting questions that we don't know the answers to and we've got a great community of people to help us answer them and it's very supportive and fantastic environment to
00:06:50
Speaker
to go and do research. And so it was a very fertile time and still is. And i think it's a fantastic space for young researchers to get involved and grow their own careers.
00:07:02
Speaker
That's quite inspiring, quite interesting because moving from primary hypertension to meso is probably not something that I would have thought of, but Ben and Kevin for that move. Coming to you, Elena, so were you always interested in malignant pluralefusion or was it more like you did some initial work in it and then you got interested?
00:07:22
Speaker
Was there any patient, any moment that made you think of MPE as a career in research? I think it was more working in Oxford at that time when there were so many people who were working there and it was a really in interesting time to be involved in pleural disease.
00:07:43
Speaker
So when I was there as an early registrar, very few people around the country were doing ultrasound, very few people were doing psorocoscopy, there was very little ultrasound guided pleural biopsy and it was a really innovative sense to be part of.
00:07:59
Speaker
and really exciting to be starting to use ultrasound and see how we could change practice. You must have faced challenges in your journey and I know that we want to talk some about from within your PhD journey and post.
00:08:19
Speaker
Do you want to talk us about that? Yes. When I was halfway through my PhD, my PhD supervisor, Rob Davies, died very suddenly.
00:08:30
Speaker
At the time, i was about 36 weeks pregnant. And so my son was born about a month later. And those two things really, i't think I had a bit of a crisis in my research career.
00:08:45
Speaker
And before I'd had my son, I had planned to go back to research at six months. I was going to go back full time. I was going to become a clinical academic.
00:08:56
Speaker
And I really ended up questioning that a lot. And I wanted to focus on being a mother and I wanted to spend much more time with my son.
00:09:06
Speaker
And so I ended up taking a year off and coming back part-time. But I really did think about even giving up my PhD, giving up medicine. And it was a lot of soul searching that made me realize that, no, I've come this
Balancing Clinical Duties with Research
00:09:21
Speaker
far. I want to to finish it off and see it through.
00:09:24
Speaker
And I finished my PhD But I then just went back into clinical training and for a long time, I didn't plan on going back into research.
00:09:36
Speaker
I had my daughter. it was very difficult finishing off registrar training with two young children and juggling different on-calls. My husband is a surgeon and he was working away and then got a consultant post on the other side of the country.
00:09:53
Speaker
So it's a very difficult time and I didn't have the mental space to do research as well. And so when I got my consultant post in Norwich, I wasn't planning to do any research. I wanted to be be a clinician, run a plural service, and that was enough.
00:10:10
Speaker
And it was only when my daughter started at school where things became easier and I had a couple more days. And at that point, I started to get involved in research again.
00:10:22
Speaker
And it started off very much just recruiting to other people's clinical trials. So Nick Maskell contacted me about whether we could recruit to Target and Robert Wintel was interested in getting Norwich more involved in lung cancer research.
00:10:38
Speaker
So I started doing some lung cancer studies with him and it's grown out of that. That sounds quite challenging. And I feel like many females, including myself, can probably resonate the same feelings because I feel clinical, maybe it's harder, but there are still clear boundaries compared to research permeates into your life. And you have to keep thinking about things even in your free time, as Kevin mentioned about grants and other things you worry about. So it really requires a good headspace. Kevin, what do you think in your journey? What quite challenges, personal or clinical or academic actually, have you faced and how have you overcome them?
00:11:20
Speaker
think Eleanor's story is a very good example of how you can get to an amazing place by a variety of different routes. And guess my route is...
00:11:34
Speaker
Also a bit different in that I started out and spent the first few years establishing myself as a consultant and a good colleague. And I think that is and that's that's such a difficult time. as The time at which we lose so many people from research.
00:11:52
Speaker
So when you've done your PhD and you you have that period where you need to become a good consultant colleague and you have to be trusted by the people around you and you want to you want to do your best and look after your patients and very difficult to be disciplined enough or even just to have the physical time in the day to actually develop anything. So I think that is actually the biggest challenge is that sense of inertia just to get that things going. and And I guess the biggest challenge for me was finding a route back to research.
00:12:27
Speaker
So having done my postgraduate degree which was in ph and i'd done some plural stuff and at the same time it wasn't part of my thesis and then i'd established a plural service but then to get back into research time and to prove yourself again as in a neuro as a as a an academic is hard and i think it's important that
00:12:53
Speaker
folk are exploring whatever options are are available to them and are aware that all of those options are fine. just need a way. For me, there was a scheme in Scotland called NRS, which is a bit like an NIHR scheme, which gives you a fellowship, gives you a day a week, and you can develop something. It's still not enough because, as we've said, research never ends. You're thinking about it in the evenings and the weekends, and
Mentorship and Local Support in Research
00:13:19
Speaker
that's you have to make a decision early on. on Is that...
00:13:22
Speaker
how you want to be and it's okay not to do that. That's also important to emphasize. I think that was the biggest challenge was finding a way back. I remember speaking to people at the time saying, I don't want you give me and appointment really i just want you to give me route if you give me a way to get there I can get there and so I think it's just finding finding that road map and maybe finding a couple of key people in your local environment couple of key mentors or facilitators or supporters that you can learn from get some juice from and those are the kind of things that aren't that unlocked it for me i think
00:14:00
Speaker
You mentioned about mentors. So don't know, coming to you that you had, you found your way back into research, but were you were there any mentors that help you in this decision-making or are there the PhD level or during your clinical consultant role that maybe this is a good time or this is a good way most coming back to research So to start with, I don't think so. and I think losing my PhD supervisor was really difficult because I think your supervisor is someone who provides that sort of mentorship and helps you
00:14:42
Speaker
progress your research career. and When I started in Norwich, it was not a very research active hospital. and say Although I wanted to do research, for a long time I felt like I was stumbling in the dark trying to find a way to do research.
00:15:01
Speaker
and And then as things have got progressed, I've found more of a way. And I think there's been a culture change within my hospital where research has been supported a lot more.
00:15:15
Speaker
And there's an academic mentorship group to help. And I got an associate professor role, which came with a day, a week research time. And there's been other schemes which have helped for as well. For example, I had some green shoots funding from the CRN.
00:15:32
Speaker
So I think that I went through a time where I didn't have mentors and I did struggle quite a lot, but things have changed and there are now people locally who help me, but also Najra Arman has been very supportive and he and I catch up regularly and talk about where I'm going. And so he's a very supportive mentor to have.
00:15:54
Speaker
And I think it is very helpful to have someone like that to talk, not just about research projects, but to talk about struggles and how to supervise people and just more about how you work as an academic rather than the specifics of research projects.
Competitive Academia and Collaboration
00:16:11
Speaker
It's a broad-term mentor, isn't it? you can There are some mentors that are really quite hands-on and can really shape you. I mean, there are others that are more kind of influencers, someone who kind of inspires you or you look up to, maybe they just give you energy and give you enthusiasm and inspiration. And I probably had mentors that were a bit more like that, that that gave me lots of encouragement. Randy Peacock was a PhD physician. He was one of those. He was, he was great fun.
00:16:41
Speaker
think that's important. but yeah Clinical academia is, there's no getting around it. It's hard. It's hard. It's evenings and there's weekends and it's, there's pressure. or If it's not fun, it's really, e it's not probably worth it.
00:16:56
Speaker
It has to be, you has to be working with people that you have great time with and just friends that you can share the journey with and learn on a bit from each other.
00:17:07
Speaker
And I think those people are quite important, but I think it's also important to have someone in your institution who can unlock things because What i found was that as I did more things, other people knew what I did outside Glasgow because they went to the plural session and at X or Y or they read the paper or whatever.
00:17:30
Speaker
Nobody in your own hospital knows what you do because they are asthma docs and TB docs and yeah pneumonia folk and or they're cardiologists or they're the vascular surgeon who happens to be in charge of the research facility.
00:17:43
Speaker
They have no idea. Nobody has any idea locally what you do So actually you need to build relationships in different ways locally because it's those local people that will unlock doors and work can help support the sessions.
00:17:56
Speaker
And sometimes that means that you... And I think that's the general point is, I think it's important to be prepared to do things that are not immediately helpful to you.
00:18:07
Speaker
So that might mean that you do, you recruit to an asthma trial because that's the priority for the local research facility or you support, and we all did a lot COVID research, that was for different reasons. Those, I think those other relationships, which aren't mentorships, they're more
00:18:26
Speaker
relationships that can move things forward for you those are really important as well Sure. Okay. That's interesting. yeah Yeah, it is. And I think that very nicely brings us to our next question, which is people think that academia fiercely competitive and which is, course, not very healthy for research. you're You are competing with others in the same field and we know poor disease it research is still evolving.
00:18:52
Speaker
So do you believe that this is true, that academia is really fierce and hard to get into or what do you think is it is competition or collaboration that is more healthy and healthy?
00:19:05
Speaker
I think things have changed a lot since Kevin and I started. And as Kevin alluded to earlier, and when we were looking for numbers, training numbers, then everyone did research and it was almost to write a rite of passage that you would do an MD or a PhD.
00:19:21
Speaker
But then very few of those people went on to stay as academics. And I think that's changed now and it's much more difficult to do an MD or PhD. And there seems to be a lot less funding around that.
Clinicians in Research and Collaborative Culture
00:19:36
Speaker
So I think it is very competitive to be a full-time academic or have a significant time commitment. But I don't think that means that everyone can't do research.
00:19:47
Speaker
And I'm a great believer that we should all be involved in clinical research. And there are lots of other opportunities to get involved in research apart from doing a higher degree or becoming an academic.
00:20:00
Speaker
Most centers will be recruiting to clinical trials and there'll usually be options to be an associate PI or just to recruit to the trials and be involved that way.
00:20:12
Speaker
I do you think that it's competitive, but i also think that everyone should be involved in research. I think it is competitive and it should be competitive, certainly to get funded to do research projects.
00:20:26
Speaker
And because that needs to be of the highest quality and resources are finite and becoming increasingly so, but it's impossible to do anything meaningful on your own, I would argue.
00:20:40
Speaker
And I think we've shown that actually across the UK, we've kind of led the way in answering many of the big questions. And we've done that because we've got an incredibly collaborative network.
00:20:51
Speaker
And I think there is a culture that I think it's really important that we continue to foster, which is one of having respect for other people's ideas and giving people space to develop an idea and to let that be their idea.
00:21:08
Speaker
And I think that spirit of collaboration is has been a major driver of the success of many of the units and many of the trials. And agree with Eleanor that I think it's really important that research should be part of the ward round. It should be part of the clinic. which should be if you and unless you can cure that Unless you know the answer to the question that you're posed with in the clinic or with a patient, then there should be a research is a research angle because you don't know something. Something could be better.
00:21:40
Speaker
And so we should be embedding that in routine care. So we all need to be thinking like that. And
Future Directions in Pleural Disease Research
00:21:47
Speaker
more junior colleagues should get involved in research because it's great fun.
00:21:52
Speaker
And certainly in clinical trials, there there's not much more exciting than seeing a patient respond to a treatment in a trial that you know that you think might be really meaningful or see a really surprising result or look at your own data and find something for the first time.
00:22:11
Speaker
That is incredibly exciting and it makes all the ethics applications and the evenings and the email and the all the other stuff worth it. And with regards to now that you've already alluded to, that there's a change in the landscape of research, where do you think the disease research is heading now?
00:22:33
Speaker
Because we have done researches on pathways, on comparing one brain ah one drainage method to another, for many of different subtypes of pleural disease.
00:22:44
Speaker
I think there's still many questions unanswered. I think you're right. There's been quite a lot of studies on the optimal way to drain pleural effusions, for example. And I think that the future of research is going to come from out of more translational work that will stimulate an understanding of the underlying mechanisms and that will lead through to new research clinical trials aimed at not just managing pleural effusions, whether they're malignant or infected, but actually stopping them before they start and really changing the paradigm of how we manage pleural effusions.
00:23:25
Speaker
And I think it's a case of looking at the translational research we can do to generate new approaches to treatment. And once we've got those ideas, then we're ideally set to run clinical trials because, as Kevin says, we've got this wonderful collaborative network of plural centers, which is ideally placed to run that sort of practice-changing clinical trial.
00:23:48
Speaker
I mean, obviously, my main research interest is in pleural malignancy, and particularly mesothelioma. You'll pardon me if my answer's a bit biased towards things.
00:23:59
Speaker
I think in malignant infusion generally, i think the biggest the biggest unanswered question i would argue is actually... non-expansal lung because it's the biggest reason that patients fail definitive management. It's the biggest uncertainty in the decision that we have to make between an IPC and tyloidosis.
00:24:20
Speaker
And I think there's lots of interesting ways that we might tackle that. In mesothelioma, if folk are interested interested in what we're doing, then they can go to predictmeso.com and that's a Cancer Research UK funded accelerator network which is focused on understanding the biology of how metafilioma develops from asbestos-related inflammation.
00:24:45
Speaker
and moving treatment of mesothelioma into that earlier stage of disease progression, I think is the future. ah think we, because of the nature of how the disease develops and it only presents when the patients got big effusion, by which time they have very large volumes of tumour, unfortunately patients don't have the outcomes we would want them to have at the moment. But if we can understand how disease develops,
00:25:12
Speaker
and we can develop therapies that are effective in those earlier stages of disease, then we can have a very distant outcome for mesotheloma patients in the future. And so Hupredict Meso has got a huge amount of work identifying, collecting tissues, performing multi-omic characterisation to identify targets,
00:25:33
Speaker
doing lots of drug screening. We've got ah preclinical models of early stage disease that we're trying to validate new treatments. And hopefully in the next few years, that amazing network that we've got of UK sites that for us are collecting early stage mesothelioma tissues, we'll be able to offer patients with pre-mesothelioma or very early stage mesothelioma some new therapies. So that I think is this kind of exciting future that I think is was ahead in the next few years, hopefully.
00:26:07
Speaker
I just want to ask one question from that. do you think there's anything that is limiting rural disease research at the moment? Because we see big trials in Airways, ILD and others, and our numbers are usually small and our trials are usually limited.
00:26:24
Speaker
Is there anything you feel that we haven't really explored or expanded that could be changed?
00:26:31
Speaker
Maybe don't know first. That's a difficult question. I think you need to go go to Kevin and give me some time to think about it. like Yeah, I think that is some, and it's a function I think of the kind of trials that we've done is,
00:26:46
Speaker
One of the big accelerators for research investment and also drug development is obviously the involvement of industry and particularly pharmaceutical companies. And we've not, because we've rightly, i think, focused on some of the kind of fundamental questions about how you manage symptomatic effusion and through infection and your thorax.
00:27:06
Speaker
is that we've not really generated the sorts of data sets that might excite industry partners in pharma and facilitate target identification, drug screening, drug development.
00:27:19
Speaker
So again, from a mesothelioma perspective, we are prioritising that in a big way to try and bring industry into, especially meso, which is a rare cancer.
Challenges in Attracting Pharmaceutical Interest
00:27:30
Speaker
Do you have to make it as attractive as possible for industry because they're going to for reasons that are obvious they're going to maybe go for high volume cancers, bigger markets, etc. So we want to, we've got Panic Mezzo is working very hard to enable very agile sharing of multi-omic data sets and pushing them into the cloud and into environments and industry can interact with. them
00:27:56
Speaker
use AI or other tools to <unk> identify phenotypes of interest, test their models, et cetera. And we're doing the same in lung cancer. We've got a project called Living Lab, the Living Laboratory in Glasgow, which is creating a cloud-based trusted research environment for industry to interact with.
00:28:13
Speaker
these sorts of data sets. So I think we we do fantastic academic research amongst our clinical network, but we do need to get a little bit better at engaging with industry because they are, we can accelerate the pipeline so much by bringing their resources.
00:28:31
Speaker
Yeah, that's a very fair point because I really agree until we tackle the basics of disease and why, what is happening. You can't develop up new targets that would be interesting for industry to invest in. And it's probably, I think, other fields within respiratory medicine like Airways and ILD have done successfully. So we have a role model to follow. Okay, coming to you, Elena, what do you think?
00:28:56
Speaker
I think one of the challenges is that pleural disease can often be quite an acute event. So things like pneumothorax or pleural infection, it happens acutely when the patient comes into the hospital and then it's resolved.
00:29:10
Speaker
And that makes it challenging to recruit patients because recruiting you know hospital is always much more difficult. They tend to be quite difficult. rare diseases and it doesn't attract pharma in the same way as a chronic disease that's going to be a long-term treatment that someone's going to take.
00:29:29
Speaker
So I think those are big challenges to overcome and to interest pharma into the work that we do. And even things like malignant pleural effusions outside mesothelioma, often it's treated by treating the underlying condition, whether that's breast cancer or lung cancer.
Advice for Trainees Entering Research
00:29:48
Speaker
And so, although we focus on malignant pleural effusions as a group, but other people, they're seen as separate. They're seen as the breast cancer or the lung cancer or mesothelioma.
00:29:59
Speaker
That's very important point as well. And thank you both for sharing all this information. exciting ideas and breakthroughs of your in your research. And hopefully I think our aspiring doctors and researchers can take a lot out of it.
00:30:14
Speaker
So I think if you had to give a single piece of advice to trainees aspiring for or at the beginning of their academic career in pleural disease, what would this be? I know I'm making this tough just to say a single piece of advice.
00:30:27
Speaker
My key advice is to get involved with whatever projects are going on and in your local hospital. It doesn't have to be pleural disease. It can be any sort of research.
00:30:38
Speaker
Kevin's shown how you can move from one research area to another, but also get involved with things like audits and quality improvement projects because it's the same key skills that you use in research.
00:30:50
Speaker
in terms of planning a project, carrying it out, writing it out, disseminating that learning. And so just get involved with the opportunities that are around.
00:31:01
Speaker
I was lucky as I found people that inspired me and and i really enjoyed spending time with them. I gave i had fun and I would advise folk to have a look around and find someone that you you like the kind of things they do, you maybe like their there area of research.
00:31:22
Speaker
Maybe try and have a chat with them. I'm not uncommonly have very brief Zoom chats with people who want to chat about research or whatever. And just dip your toe in, maybe with a person. And as Eleanor says, it doesn't need to be in pleural disease. It could be a cardiologist who's a really good person locally or a rheumatologist.
00:31:41
Speaker
And you can just, someone that you can get excited about and just get you started. Great. Thank you very much, both of you. That was absolutely exciting and fabulous talk. Great insight into research. And I hope our listeners can take a lot out of it.
00:31:57
Speaker
Yeah. All right. So
Closing Remarks and Future Insights
00:31:59
Speaker
I think that wraps up all of our questions. And thank you very much for being here, Eleanor and Kevin. And that's it. And hopefully we will speak to our listeners in our next episode.
00:32:10
Speaker
Thank you.