By Susan Watts
Professor Sir Robert Lechler delivered this year’s Hammersmith Campus Distinguished Lecture, entitled: “The Future of medical science: harnessing the revolution.”
He describes himself as an optimist, and Sir Robert’s view of the future of medicine is certainly a positive one. Some might say too positive, even rosy. He told his audience that the future is “more opportunity than threat”, and chose an illustration close to his own speciality, transplantation and rejection, to illustrate his talk, a painting that he said is “all about optimism”.
This was the 15th century depiction by Fra Angelico of an apparent leg transplant undertaken by Cosmos and Damian, twin physicians and saints. The optimism, Sir Robert said, lies not only in the surgery itself, of a healthy leg from an Ethiopian donor to replace the ulcerated limb of the recipient, but also in the two tiny shoes to the left of the bed: “presumably an assumption that the patient would later walk away”.
Sir Robert spoke of the UK’s outstanding track record and current strength in biomedicine. Life sciences, he said, will be a key component of the emerging Industrial Strategy. “We are participants in biomedical revolution, and it’s a really exciting time to be in biomedical research.”
He acknowledged, however, that it has been a turbulent six months for the UK. The June referendum; a largely new government; commitment to an industrial strategy; re-arrangement of research funding; a struggling health care system and recent political events in the US and Italy had all added to this, he said.
At a recent meeting with Government, Sir Robert was asked “What are you going to do for the regions..?” In reply he said he’d emphasised the value of the “cluster” model of collaborative centres – in London and the south east, but also in the south west, the midlands, the north east and north west and northern Ireland. He elaborated on the point later.
“As we know, the Government is reeling from the divide revealed by the Brexit vote. They see the divide between the ‘haves’ and the ‘have nots’, with a strong geographical overlay, as a threat to stability and their future electability. Hence the obsession with ‘place-based strategies’. The best that I can offer is on the one hand to build on the cluster model, which would have a geographic distribution, and with good infrastructure it should be possible for clusters to reach out and embrace surrounding regions. Second, some industries don’t need a complex infrastructure, such as digital and manufacturing. These could happen even in more remote areas. Having said all of that, I retain the view that we must not sacrifice a pursuit of excellence, and our competitiveness depends on investing in and capitalizing on our really excellent centres such as those in the greater south east.”
And there are major challenges ahead, he said, with no new class of psychiatric drugs for 30 years, no effective treatment for dementia, increasing resistance to antibiotics, no success in promoting tissue regeneration in situ, and the pandemic of obesity marching on.
He set out his keys to success: maintaining a balanced science base; fostering university-NHS partnerships; establishing a sustainable healthcare system; fostering partnerships with industry; attracting the most able scientists; clinical and non-clinical into biomedical research careers; effective public engagement and marshaling the arguments for increased investment.
He quoted Carl Sagan’s thoughts on the question of whether curiosity-driven research is an unaffordable luxury. “Cutting off fundamental curiosity-driven science is like eating the seed corn. We may have a little more to eat next winter but what will we plant so we and our children will have enough to get through the winters to come?”
At the same time he stressed the importance of ensuring a scientific culture that has “line of sight” from discovery to application. Close relationships with “users” of research such as the NHS, patients, business, cultural industries, and defence; partnerships with pharma, biotech and medtech; and policy impact all help to ensure that research conducted in a clinical academic environment is successful in making a difference.
He expressed concern that universities and their hospital partners risk being driven apart by the target and management culture of the NHS, the RAE and REF emphasis on basic science, and by intense financial pressures. Which is where the Academic Heath Sciences Centres come in, he said, to help drive innovation by being vehicles to integrate the universities and their partner NHS Trusts.
He talked about his own plans to bring physical and mental health specialists closer together, and highlighted some disturbing facts: that about a third of patients with long term conditions are depressed, two thirds of those referred to a cardiologist with chest pain have nothing wrong with their heart (often anxiety-related), and that patients with long term mental illness die 17 years prematurely. What’s needed now is clinical innovation to address these challenges, Sir Robert said, as well as training programmes to create what he called “amphibious” professionals who can work in both settings (physical and mental healthcare) and further insights into the mechanisms behind ill health. Shifting the emphasis from treatment to prevention is vital, Sir Robert concluded, within a new form of truly public health that might be heralded by the digital revolution in healthcare that is already upon us.
Professor Sir Robert Lechler became one of three new advocates for the LMS Chain-Florey Clinical Research Scheme in 2016, along with Professor Sir Keith Peters and Professor Robert Souhami.
His clinical and research career has been focused on the pursuit of tolerance in clinical transplantation. Most recently he has been helping to lead first in man trials of cell therapy to promote immune tolerance in recipients of kidney and liver organ transplants.
He has a long-standing connection with Hammersmith Hospital, where his career in academic medicine began in 1979 at the Royal Postgraduate Medical School, as a Medical Research Council Training Fellow. In 2003 he was made Head of the Division of Medicine of Imperial College London’s Faculty of Medicine before moving to King’s College London, where he is Vice Principal (Health) and Executive Director of King’s Health Partners.
Sir Robert is the current president of the Academy of Medical Sciences. He is also a Trustee of the British Heart Foundation, a founding member of MedCity, which fosters the South East England cluster, and has served on the Mayor of London’s Health Board.