Blog – Patients, Practice and the Research Mindset
How did I get into clinical research? That is a different question to why I got into clinical research and a long story. My career it is so long that when I was a medical student cimetidine was a new drug. My student dissertation was about whether this drug could help the Zollinger-Ellison syndrome, a type of multiple ulceration of the GI tract for which surgery was the first line treatment.
What that taught me was that the key question in clinical research was about how the patient could derive the most benefit from medical interventions. Move forward a few years to my early days in psychiatry and a very small involvement in the Nithsdale Schizophrenia Survey. This taught me several things. First, the value of detailed study of multiple aspects of patients’ lives, and importantly as a whole how people with long-term conditions were not really all that much different to the general population in many aspects of their life, something which would become important as the drive to move people away from hospitals and re-integrate them into communities began to gather pace. Secondly, I learned that what people might tell you in the clinic in the morning differed somewhat to what they might tell you as part of our research study the very same afternoon! Thirdly, and importantly, it showed me that a very well-motivated NHS psychiatrist could undertake some aspects of clinical research alongside what was a very busy role for them as a clinician in charge of a catchment area
Move forward to my first exposure to old age psychiatry and two very valuable teachers from whom I learned that it was possible to plan future services based on detailed examination of how the population was changing. Promotion led to my first exposure to drug trials, looking at the effect of methylene blue on people who had severe depressive illnesses. The first study which I led was based on a letter in the Lancet, which described how 200 people had been given zinc supplementation during depressive episodes and how they had all improved. To me, this seemed unlikely. I then set up, under guidance, a project looking at zinc supplementation versus placebo in people who were in a dedicated Affective Disorders Research Ward. Although zinc supplementation had no effect on recovery rates, what it did show was changes in white cells zinc levels preceding recovery, which merited further study but, sadly, there was no time to do this.
On taking up a consultant post, there were limited options for involvement in research, but a carefully conducted audit and re-audit exercise on the use of antipsychotic medication in long stay wards demonstrated how their use could be reduced and practice improved by concentrating on their use for particular clusters of symptoms, shaping practice in the community and in care homes long before the stimulus of the Bannerjee report to do so. The advent of cholinesterase inhibitors brought with it the opportunity to do an MD, part of which was a small trial of the effect of folic acid on response rates to these drugs. This trial showed a positive effect, but not one that was translated into practice, partly because of the very restrictive nature of treatment guidelines around that time.
Toward the end of my clinical career, trials of anti-amyloid agents began to come into being, but the assumption that these were too complex to be undertaken within the NHS was dispelled by constant questioning from a colleague about the differences between private sector memory clinics and what we were able to run locally. Suffice to say that with the support of some very dedicated and enthusiastic colleagues, each of whom who brought their individual skills to make up a highly effective research team, led to as successfully undertaking these studies and the eventual hope that some positive treatment options might emerge.
So what are the messages from this rather rambling account? Well, first, there are many opportunities to participate in clinical research, no matter what stage of your career you might be at. Secondly, not all clinical research is highly detailed and beyond the scope of NHS clinician. Third, many research projects come from observation of the patients with whom you are involved, or from reports in literature which you think are well worth challenging. Fourth, the discipline of being involved in clinical research gets fed back into the way that you treat your patients in normal clinical practice and allows you to reflect and challenge yourself on whether you are managing your patients with best practice.
Looking back was it worth it? Absolutely.
Dr Peter Connelly
Author
Dr Peter Connelly is a retired Old Age Psychiatrist who spent much of his career in Tayside, helping to establish clinical trials for dementia and neuroprogressive disorders in Scotland. Now working with the Scottish Neuroprogressive and Dementia Network, he combines professional insight with personal experience as a former carer. In retirement, he enjoys music, golf, and time with his grandchildren.