American Association for Clinical Chemistry
Better health through laboratory medicine
April 2009 Mentor of the Month Q&A Session: William Winter
Welcome to SYCL's Mentor of the Month.  Questions and Answers will be displayed below...

You have had a successful career doing research, service and teaching. It seems that more and more academic medical centers are functioning with only one clinical chemist to oversee large lab operations that may have previously had 3 or 4 directors. Do you think this will impact the future of clinical chemist lab directors who are trying to do research? Is it possible to do all three in this situation?
Houston, TX

William Winter
Let me begin by saying that if you want to engage in externally-funded research, you must negotiate with your chair for time to pursue such research as well as a start-up package. This negotiation should occur before you are hired. If you are on service more than 60 to 70% of the year, it will be difficult at a junior level to be competitive for NIH-sponsored research grants. It is easy to let clinical service requirements take up all of your time - but this will deter you from being involved with research. On another note, I would suggest that to be successful in academics, it would be advantageous if the PhD clinical chemist could oversee more than just clinical chemistry. For example Roger Bertholf, PhD at the University of Florida in Jacksonville is director of clinical chemistry and is director of point-of-care testing. At our institute, Neil Harris, MD is director of our core lab covering chemistry, hematology and coagulation testing. If you can oversee multiple areas, possibly your institution can afford to have more than 1 clinical chemist. At the University of Florida, we have 3 MD clinical chemists. In addition to Dr. Harris and me, Glen Hortin, MD is now on our faculty. From an academic point of view, never miss an opportunity to teach either residents or medical students. About half of my time is spent in education. I am the course director of the second year medical student’s pathology course which starts in August and ends in late February. Another way to "afford" more clinical chemists at your institution is to fund part of your own salary through external grants. More than 20% of my salary is supported through my NIH grant where I am the principle investigator of the Type 1 Diabetes TrialNet ICA Core laboratory. Good luck.

Dr. Winter- I was wondering your thoughts about any potentially promising genetic markers for diabetes that have come out of GWA studies?
Madison, WI

William Winter
Both type 1 (T1DM) and type 2 (T2DM) diabetes are polygenic conditions where alleles at multiple loci collectively increase one''s risk for developing the disease. Nevertheless for each type of diabetes, an environmental trigger (or triggers) is required for the development of diabetes. In T1DM the triggers are unknown. In T2DM, the trigger is most commonly exogenous obesity. The most powerful predictor of T1DM is heterozygosity for HLA-DQB1*0201 and HLA-DQB1*0302. There is no single genetic locus that provides as much susceptibility to T2DM as HLA provides to T1DM. The GWA studies can help identify candidate genes or novel genes that could influence diabetogenesis. These discoveries may lead to novel therapies or improved prediction. At the present time for T1DM, we can better predict diabetes based upon islet autoantibody testing and metabolic testing. See: Patrick Concannon, Ph.D., Stephen S. Rich, Ph.D., and Gerald T. Nepom, M.D., Ph.D. Genetics of Type 1A Diabetes. NEJM 2009, 360:1646-1654.