Wednesday, 29 August 2012

RAVINDER MAINI

 Guy’s and life thereafter.
           A Guy’s alumnus, Sir John Croot, Senior Surgeon at Mulago Hospital, Kampala, Uganda, a friend of my parents whom I greatly admired, was influential in my application to Guy’s upon completion of my 3 year pre-clinical studies in Cambridge. During my long vacations back home I was privileged to spend time on wards and operating theatres with Sir John who had devoted a life time to developing the ‘jewel in the crown’ healthcare faculty at Mulago, the first teaching hospital at Makerere University in East Africa to train medical students.

 My arrival at Guy’s and it environment, still displaying signs of bomb damage, and my initial damp and cold digs in Tulse Hill, were a shock after the comforts of protected life amongst scholars in arts and science, surrounded by the lovely heritage buildings and pleasures of a student life at Cambridge. Later, living in the Guy’s hostel in Long Lane amongst Bermondsey locals, provided a happy and lively home. All of us from Cambridge started an introductory course closeted with Dr George Scott, an inspiring teacher, on the top floor of Hunt’s House. Fellow students included Tim Northfield, Nick Cohen, Greg Stewart, Colin Binnie, Mike Bright, Mary Rossiter, Bobbie Gumpert, Rob Jago and Mike Crowe. Although a minority group of students amongst the large Guy’s pre-clinical entry, we soon integrated into the rich community life of Guy’s and I became convinced that I had chosen the right place to learn and pursue my career.

 The 3 years as clinical student were memorable for the inspiring teachers amongst them, just to mention a few , Seniors such as John Butterfield, Charles Baker, Willie Mann, Charles Joiner, John Trounce, Christopher Hardwicke, Randy Beard, Guy Blackburn, Sam Wass, Hedley Atkins, Russell Brock, and equally important, the Registrars including Tony Trafford (the first medic I knew who went on to become a successful MP, famously involved in the emergency care of Tories residing in the Grand Hotel in Brighton bombed by the IRA) , Maurice Lessof, Bob Knight, Ian McColl and John Gazet. John Butterfield had the greatest impact on my choice of an academic career by allowing me ‘hands on’ experience in his lab in a failed attempt to induce diabetes in rats by feeding them vegetable oil based on the theory that a dietary factor was implicated in the high incidence of Type 2 Diabetes in Asians in the UK.

                                                                           
 After qualifying I spent a year as HS to Randy Beard, 3 months as Casualty Officer and 6 months as HP on the Baker, Joiner and Trounce firm with Tony Trafford as SR. My initial choice of specialist training was in Cardiology and following a stint at the Brompton as SHO in cardiology and Respiratory Medicine, I returned as Junior Registrar to Charles Baker and Dennis Deuchar and under the tutelage of Hywel Davies, I became immersed in the catheter lab studying patients with heart disease, many destined for the pioneering and often heroic surgery by the Lord Brock and Donald Ross team.

2 years of ‘invasive cardiology’ convinced me that I was not enjoying physiology-based medicine and that I should explore whether a deeper understanding of biology and experimental cell-based medicine might provide a life time interest. Immunology applied to solving medical problems was beginning to open up and Guy’s could have been the place to stay as Gorer and Batchelor were doing seminal work in the transplantation field. However, by a stroke of good luck I ended up in an immunological subject that was closer to the practice of general medicine. Mentoring by Charles Baker had led me to a Registrar post in General medicine for 2 years at the Charing Cross Hospital, where Dr Tom Scott, a Rheumatologist, opened the door to my interest in autoimmune rheumatic diseases. With his encouragement and support, I succeeded in winning a Fellowship in 1968 to work in a immunology laboratory at St Mary’s and later at the Kennedy Institute of Rheumatology, investigating cell mediated immunity in autoimmune diseases. In 1969, I was fortunate enough to have a first author paper accepted for publication based on my lab work in Nature, the die was cast and I was launched in a career as a clinician-scientist.

 In 1970 I was appointed as a Consultant in General medicine and Rheumatology variously at West London, Charing Cross, St Mary Abbot’s and St Stephen’s Hospitals, with an immunological laboratory and a technician at the Kennedy Institute. In 1979 I was awarded a London University Title of Professor of Immunology of Rheumatic Diseases at Charing Cross Hospital, with 5 research sessions supported by the Arthritis and Rheumatism Council at the Kennedy Institute of Rheumatology. By 1990 Charing Cross and Westminster Hospitals had merged and I was appointed to a University Chair of Rheumatology and Head of the Department of Rheumatology at Charing Cross Hospital, simultaneously with being appointment as Director of the Kennedy Institute. Merger with Imperial College followed, and in 2000 I was appointed Head of The Kennedy Division in the Imperial Collage School of Medicine until my retirement in 2002.

 I have been immensely fortunate in being able to combine clinical practice and laboratory studies throughout my career in ‘translational research’. The emerging molecular concepts of disease and the biological technological revolution in the 70s and 80s which provided access to monoclonal antibodies and recombinant cDNA probes to be applied to human tissues was key to the progress of research into pathogenesis and treatment of rheumatoid arthitis. Equally important was the sustained, synergistic and influential partnership with Marc Feldmann, an Australian immunologist at UCL whom I persuaded to join our group at the Kennedy Institute, which began in 1985 and endured for my the rest of my working life.

 A combination of being in the right place at the right time, good luck and unique opportunities our pre-clinical research was rewarded by the identification of a molecule, a cytokine, known as Tumour Necrosis Factor (TNF) as a key driver of immunological and inflammatory response in rheumatoid arthritis. The discovery led to the successful development of the first monoclonal antibody-based therapy for autoimmune disease. It is a cause of great satisfaction that this revolutionised the treatment of a painful disabling disease. In recognition of the work Feldmann and I have shared prizes such as the Lasker Prize awarded by the USA and were elected as Fellows of the Royal Society, the Academy of Medical Sciences and Foreign associates of the Academy of Sciences of the USA. In 2002 I received a Knighthood from Queen Elizabeth, as my father did in 1956, alas too late for him to witness the happy coincidence.

 In my retirement I continue to serve on Medical Charities, am Co-Editor-in-Chief of a rheumatological research journal, write educational articles and have served as a member of the Advisory Boards of Biotechnology and Pharmaceutical Companies.. The pain of a loss of a son aged 14 from a cardiac arrhythmia in 1979 has been compensated by the happiness of my marriage to a fellow-rheumatologist, Geraldine Room, and the satisfaction of witnessing the success of my children: Mala, trained at Guys and a Professor at UCL; Ashwin, a lawyer specialising in Corporate Governance; Alexander a first year HP at UCH; and Justin, in his final year medical pre-clinical course at Jesus College, Cambridge. Since my retirement, I am learning to make more quality time for my shared interest in travel and music with my wife and seeing more of my 4 children and 5 grandchildren.                  Ravinder Maini.

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