- What is your job title and affiliation?
I am a Consultant Clinical Scientist in the UK National Health Service – the NHS - and work in the Department of Clinical Biochemistry in the Royal Infirmary of Edinburgh, which is a major teaching hospital. I also direct one of the UK National External Quality Assessment Service (UK NEQAS) centres and I am an Honorary Senior Lecturer at the University of Edinburgh.
- Briefly tell us about your educational and career background.
I was born in South Africa but spent most of my childhood in Ann Arbor, Michigan. I moved with my family to the UK immediately after graduating from Ann Arbor Pioneer High School. I then studied for a B.Sc. in Chemistry at the University of Birmingham, and for my Ph.D. in the Protein Chemistry laboratory at the same university before spending a year and a half as a post-doctoral fellow at the Howard Hughes Medical Institute at the University of Miami, working on an NIH grant on starch digestion in mammals. I returned to the UK to take up another post-doctoral fellowship in the Department of Clinical Biochemistry at the University of Edinburgh. After my children were born I worked part-time until they graduated from high school. During that period I moved to the NHS and gradually progressed from senior biochemist through principal biochemist to consultant in the same Department.
- What are your Board certifications?
The system is slightly different in the UK. For clinical biochemists, Fellowship of the Royal College of Pathologists – which is achieved either by examination or (less often) on the basis of published work – is the ultimate professional qualification. In addition, scientists working in clinical laboratories must be registered with the Health Professions Council – so I am registered with the HPC and am also a Fellow of the Royal College.
- With which professional societies/organizations (e.g. AACC) are you involved?
Although I belong to a number of professional societies, the ones most relevant to my day-to-day work are the AACC and its scientific wing, the National Academy of Clinical Biochemistry (NACB), the UK Association of Clinical Biochemists (ACB), the International Society for Oncology and Biomarkers (ISOBM), the European Group on Tumor Markers (EGTM) and the International Society for Enzymology (ISE), which we are working to revitalize – we would be delighted to hear from any enthusiastic potential new members!
I am also actively involved in the Scientific Division of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). IFCC membership is for countries rather than individuals, but there are many exciting opportunities for individual scientists to contribute to the work of the IFCC through participation in its committees and working groups, with involvement from young scientists especially welcome!
- Just for fun, tell us a few interesting facts about yourself:
I am incredibly lucky to have a very large and happy extended family with relatives spread across five continents! I have two grown-up children of my own and three stepchildren. Four are married and two have two children, so when we are all together - as we were last summer in Melbourne, Australia - it’s quite a clan! My late husband Bob is still with us all in spirit – he was a fantastic family person, always interested in and encouraging of everyone’s varied activities.
- Favorite activities/hobbies
I like gardening and I am a very enthusiastic birdfeeder. I also often listen to music of all kinds and remain a faithful fan of Joan Baez, Judy Collins, Leonard Cohen and others whom I first heard as a teenager! I have always liked photography and would love to become better at it.
- Favorite places you have traveled
I have been extremely lucky to have had the opportunity to do quite a lot of traveling but it is impossible to choose favorite places – there has been something special about every place I have been!
- Favorite book/movie
The novel “Pride and Prejudice”, the Johnny Cash movie “Walk the line” and Wallace and Gromit’s “Curse of the Were-Rabbit” are among my favorites!
- Most fun/adventurous thing you’ve ever done
A ranger-led trek through the “River of grass” followed by a night out in the open on a hardwood hammock (the small island – not the bed!) in the Everglades National Park is something I would love to do again. It is such a fabulous Park which I got to know really well while working in Miami.
- What area(s) do you specialize in?
Oncology (particularly serum tumor markers) and endocrinology (particularly reproductive hormones) and provision of external quality assessment (EQA) / proficiency testing (PT) for laboratory tests in these areas.
- What initiated your interest in this (these) area(s) and how did you eventually choose this (these) area(s) for your career?
My post-doctoral project in clinical biochemistry was to establish an early radioimmunoassay for CEA and my interest in tumor markers developed from there. I was working in a specialist unit which also provided a regional immunoassay service for reproductive hormones and I still find the interpretation of these tests fascinating. Both are areas in which laboratory-clinic interaction is particularly important. I became involved in EQA/PT when I was asked to set up EQA schemes for AFP, hCG and CEA.
- What are your clinical and research interests?
My main interests are in working to improve the quality of laboratory testing, particularly in oncology and endocrinology, through development and implementation of guidelines, improved standardization, and educational EQA/PT provision. I am also a grant holder on a National Institute of Health Research (NIHR) project which is exploring how best to identify and validate new tests that will improve patient outcome, with the aim of fast-tracking them into routine clinical practice.
- What, in your opinion, has been the most important contribution you have made to the field of laboratory medicine?
Probably facilitating several collaborative projects – development of the NACB guidelines on tumor markers and the IFCC/ISOBM initiatives towards improved standardization of hCG – which demonstrate how clinical laboratorians can contribute proactively to improving agreement about how tests should be used in clinical practice as well as their analytical comparability.
- Are there specific aspects of practicing laboratory medicine that you find unappealing?
It is difficult to say! I have perhaps been particularly lucky as I have loved everything I have been required to do in the post I have.
- What were some of the most rewarding and/or challenging moments of your career?
Possibly the most challenging and ultimately most rewarding moments of my career thus far relate to opportunities I have had to facilitate international projects that have required well-coordinated multidisciplinary team working. These have included the on-going NACB tumour marker guidelines project, preparation by the IFCC hCG Working Group of six WHO International Reference Reagents for hCG calibrated in molar units, and organization of ISOBM 2003, an international conference on tumor markers, in Edinburgh.
- How would you recommend achieving an optimal work/life balance?
I certainly don’t think I’m an expert on this! However, I think there are different priorities at different stages of a career. I will always be grateful to the hospital I work in for having enabled me to work part-time for so long and I wish such flexibility could be available to all.
- What excites you about practicing laboratory medicine everyday?
The opportunity to contribute to patient care (it is estimated that 70 to 80% of medical decisions depend on laboratory results), the variety (every day in the lab is different) and the feeling that we contribute to multidisciplinary teams throughout the hospital. I still feel it is a privilege to be entrusted with authorizing clinical reports when I am duty biochemist.
- What are your predictions for advances in laboratory medicine and/or your area over the next ten years?
Introduction of new technologies and new biomarkers will require new ways of working. I think ensuring that tests are only requested if they make a difference to patient outcome and are both clinically- and cost-effective will become even more important. Changes in patient pathways are likely to encourage more point-of-care testing and will require high class information technology and connectivity. Successfully achieving all this will require innovative thinking and excellent and proactive communication –between clinical and laboratory staff and among staff from different laboratory disciplines, as well as with experts in informatics, statistics, health economics and health policy. I think it is really exciting that some of the inter-disciplinary boundaries are already beginning to fade as we start sharing automated analyzers and molecular techniques become increasingly important, particularly in oncology.
- What do you see as the challenges facing young scientists in laboratory medicine?
A major challenge for us all is to raise the profile of laboratory medicine so as to ensure that young scientists continue to have the same kind of opportunities that I and my contemporaries have been privileged to have. This means taking every chance to publicize the major contribution laboratory medicine makes to patient care and the added value that well-trained and highly motivated scientists can give to clinical services.
- What specific goals would you recommend that young scientists in your discipline set for themselves? Any suggestions on how to achieve them?
Developing a special interest or expertise is extremely helpful, particularly if different strands can gradually be woven around it. For me, optimizing that early CEA assay meant that I learned about both immunoassay and tumor markers, which ultimately led to an interest in and understanding of EQA/PT and standardization. Undertaking research and publishing in peer reviewed journals is highly desirable – I’m proud that there is only one year in which I have not had some kind of publication - as is keeping up with relevant current literature. Learning how to give clear and interesting presentations and how to prepare papers is also really important. It is amazing what unexpected opportunities can arise from a single publication!
- Describe how you have been able to give back or contribute to the organizations and the profession in general through your involvement in AACC.
I feel I have returned a small part of what I owe the AACC through involvement in the NACB tumor marker guideline project. The NACB guidelines provide an excellent foundation for development and implementation of local guidelines to improve the use of serum tumor markers, which are often not “good news” tests and which are often mis-used. Parts of the guidelines have been translated into other languages, including Chinese, and they were further publicized in an invited review which became a cover article in the British Medical Journal in 2009. I also feel very privileged to be involved in the exciting new AACC Global Harmonization initiative which aims to improve comparability of results of complex analytes for which there are no reference measurement procedures. In terms of the profession in general I feel I have put something back through invited talks at conferences or educational workshops in more than thirty countries.
- How did you get started in these organizations and what advice do you have for young people wanting to get involved?
Early in my career we were always encouraged to submit abstracts for poster presentations at regional and national meetings of the ACB. The associated carrot was that if the abstract was accepted, our Department would support and fund attendance of the first author. I can still remember the excitement if an abstract was accepted and – in that pre-Powerpoint era – putting posters together with glue and scissors on the floor of the lab the Sunday before the conference began! Although I was already a member of the AACC – the associated subscription to Clinical Chemistry being an extremely attractive aspect of membership – the first AACC meeting I attended was the excellent joint AACC/IFCC conference in San Francisco, where I presented a poster on EQA of tumor markers.
I would definitely encourage young scientists to take every opportunity to attend meetings (including relevant clinical conferences) regularly –locally and regionally as well as nationally and internationally – partly of course because of the talks, but perhaps even more importantly because of the opportunities to network with colleagues, discuss ideas, learn what is going on in other laboratories or in clinical practice, and (if one is lucky) meet leaders in the fields one is interested in. I regularly attend the annual meetings of the ISOBM and it was through one of those that I first met Eleftherios Diamandis, to whom I owe my involvement in the AACC/NACB tumor marker guideline project.
I also owe involvement with the IFCC to conference attendance. Having met Ulf-Håkan Stenman, a world expert on hCG, at an EQA meeting in Wales, he later asked me to speak on EQA for hCG at an IFCC EuroMedLab conference in Tampere, Finland. After the symposium I was invited to a closed meeting of the IFCC Working Group for hCG which was being held at the same conference and this led to my becoming secretary of the Working Group and later its chairman. I would never have imagined earlier in my career that I would ever be working with world class scientists and clinicians such as those involved in both the NACB and the IFCC projects.
Publications – including good review articles – can also make a major difference to a career. Even before I became active in the ISOBM, I sent a report on our EQA schemes to an Austrian clinician I had never met but who I knew – from an article I had read – was interested in the quality of tumor marker assays. To my astonishment, he then invited me to give what was my first international talk on the EQA of tumor markers at a meeting he was organizing in Nice, which is where I met Professor Morton Schwartz - to whom the field of tumor markers owes so much - for the first time.
- Do you have any other specific comments or advice that you like to provide to the members of SYCL?
My advice would be to think positively, be enthusiastic, engage with laboratory and clinical colleagues in your own hospital as well as regionally and nationally, and proactively seek and take advantage of any opportunities to get involved and make a difference! The major developments predicted for laboratory medicine over the next few decades make this a really exciting time to be a young clinical laboratorian.