Meet veteran expert in vitamin D and diabetes Dr Barbara Boucher

Dr Barbara Boucher spent a long and extremely busy career as a physician at the (Royal) London Hospital and its medical school, and was amongst the first post-NHS cohorts of female medical students. She has made important contributions to the field of diabetes, with a number of discoveries on the adverse health effects of vitamin D deficiency and on the addictive habit of chewing betel-nut. Despite being retired, she is still helping to advance her scientific field and will be presenting at this year’s SfE BES annual conference. We spoke to her ahead of the conference to hear more about her long career and research interests.

Could you tell us about your current position and your research?

I am now long retired but have maintained interests in two major research areas: vitamin D deficiency and betel nut chewing. Since 1970, I have worked on adverse health effects of vitamin D deficiency and how deficiency can be avoided. My main hope now is to see deficiency abolished at the population level, as has been done in Finland. Betel nut chewing is very common in all South Asian countries and causes many major health problems. It has been confirmed for many years now that this habit – the 4th most common globally – causes many cancers, but I am interested in the role it has in causing metabolic syndrome, both in chewers and across generations.

Can you tell us a little bit about your career path and what you are most proud of?

I was accepted by the London Hospital Medical College where I studied medicine and anatomy, soon after the NHS first started requiring medical schools to take women. I completed my training in medicine and worked for various firms, as well as the academic medical unit after I qualified, and eventually I was appointed as an academic/NHS physician.

I was the first female consultant physician at the (Royal) London Hospital, which was a very interesting experience, though initially rather unpleasant since most of the consultant body back then weren’t keen on women in medicine. I spent most of my career working there and carrying out research, mainly focused on diabetes and endocrinology.

There are three things throughout my career that I feel especially pleased with. One is a diagnosis I made in a young woman with Lyme disease, the first case I’d ever come across. She had seen consultants in six different departments to try to determine what was wrong with her, before I made the diagnosis. We managed to get her the necessary antibiotics just in time for her to make a full recovery and throw away a wheelchair and two hearing aids.

I am also glad that I have persisted in pursuing the idea that lack of vitamin D might worsen metabolic syndrome and increase the risk of type 2 diabetes since, and that I have lived long enough to see both mechanistic and clinical evidence to suggest that this could be true.

The third thing I am proud of is publishing a series of papers about South Asian men who chew betel-nut and how they, and their children, have increased risks of metabolic syndrome, heart disease, type 2 diabetes, and liver disease. Ten years later, it has just been shown that betel chewers are also dying early due to these health conditions. Next, we’re hoping to look at how many years it takes, after stopping chewing, for the risks to decrease to the same levels as are seen in never-chewers.

What will you be presenting at your SfE BES 2019 lecture?

My talk will be about the known health benefits of vitamin D and the importance for vitamin D supplementation trials to be properly designed. There have been many trials analysing the effect of vitamin D supplementation in people who are not deficient, or were not adequately supplemented, resulting in statements that vitamin D doesn’t affect general health, despite all the other evidence to show that it does.

What are you most looking forward to at this year’s conference?

I would like to see that young endocrinologists are still as enthusiastic about what they are doing as my generation were, as I sometimes wonder how medicine, let alone research, is surviving with all the constraints placed on how people work these days.

What are the biggest challenges in your research area?

One of the biggest challenges in my area is getting future randomised, controlled trials right and stopping them from obscuring things that are true. It is important that researchers doing such trials understand the mechanistic data and plan with this in mind, which has not always been the case. I think this is a problem, at least in part, because in modern medicine people don’t meet together or get to chat to each other as much as they used to, and also because researchers and clinicians may not always collaborate as closely in these areas as should.

What do you think will be the next breakthrough in your field?

One obvious breakthrough would be getting any future trials designed to provide optimal conditions for testing health benefits of vitamin D. But the best breakthrough would be the abolition of the deficiency.

The next development for the risks of betel-chewing will be obtaining data on the people who stop chewing, to see if mortality risks then fall. This would encourage more people who chew to give up the habit.

What do you enjoy most about your work?

I enjoy getting to the bottom of things and seeing bits of work come through that make sense and provide additions to current knowledge. However, if something comes through that proves something I thought matters, doesn’t matter, that’s okay too!

Who do you admire most professionally and why?

Professor Wilson, who was the Professor of Medicine at the London Hospital, was an excellent role model to me in my student days. He was always prepared to sit down with students to work out a problem and was never didactic, which a lot of consultants were in those days. He was also a very good ‘detective’.

Another person I learnt a lot from was Dr Stuart Mason, who was the senior endocrinologist at the time I worked with him. One of the most important things he taught me was how to look after people and how to work with patients and provide the best care. He was a physician who cared deeply about his patients and would always talk to them as human beings, answer their questions honestly and look them in the face, all of which were very uncommon traits at that time.

Do you have any words of wisdom for aspiring endocrinologists?

In order to survive, make sure you’re working on something you enjoy. If you don’t enjoy your work, you won’t do it well and you should look for something else. If you have a hunch and you are able to follow it up, go for it. You never know; some hunches are good, some aren’t, but it’s always worth pursuing where there is a basis for some new approach. I would also say that if you want happy and satisfied patients, act as their mentors and advisors and find ways of talking to them and looking them in the face rather than always looking at the ubiquitous computer screens!

You can hear Dr Boucher’s talk, “Potential benefits of better vitamin D status for non-bony disorders?” on Tuesday 12 November at 17:45. Find out more about the scientific programme for SfE BES 2019.

Meet the 2019 winner of the Clinical Endocrinology Trust Basic Science Abstract prize

Professor Fadil Hannan, Director of the Oxford Centre for the Endocrinology of Human Lactation, is this year’s well-deserved winner of the Clinical Endocrinology Trust Basic Science Abstract prize. His research focusses on the endocrine control of lactation and bone and mineral disorders. In this interview, Prof Hannan tells us more about his research and what he will be presenting at SfE BES 2019.

Can you tell us about your current position and research?

I’m based at the University of Oxford and have recently been appointed as the Director of the Oxford Centre for the Endocrinology of Human Lactation (OCEHL). I also work on characterising the genetic basis of bone and mineral disorders. In addition, I am an honorary consultant chemical pathologist at the John Radcliffe Hospital in Oxford.

Please tell us a little about your career path so far, and what you are most proud of?

My background is in chemical pathology – this is a small, clinical discipline with very few academics. I decided to become an academic chemical pathologist after undertaking a PhD in the lab of Prof Rajesh Thakker FRS, at the University of Oxford. My proudest achievements include the discovery of disease-causing mutations in the GNA11 and AP2S1 genes, which has led to insights in the genetic basis of parathyroid gland function.

What are you presenting at your Medal Lecture at SfE BES 2019?

I am presenting data on a mouse model for a disorder known as familial hypocalciuric hypercalcaemia type 3 (FHH3). This is a recently identified disorder and we are utilising this model to better understand the phenotype of FHH3, and also to evaluate targeted drug therapy.

Is there anything you are particularly looking forward to at this year’s conference and you would recommend to others?

I’m looking forward to the nature versus nature debate for body weight. Clearly both influences are important but it’ll be nice to hear the arguments in favour of each contribution. 

What do you think are the biggest challenges in your research area right now?

I think more funding is needed to support curiosity-driven research, as this is the type of research that is most likely to lead to substantial advances in our understanding of biology.

What do you think will be the next major breakthrough in your field?

This is difficult to predict, however, I hope that suitable cellular models can be developed to allow us to study complex physiological processes, such as lactation.

What do you enjoy most about your work?

I really enjoy coming up with a scientific idea and then going ahead and testing whether this idea has any merit or not. This process pretty much sums up what science is about.

Who do you most admire professionally, or otherwise, and why?

I have many scientific heroes, so will mention just a couple of them. I have huge admiration for Rajesh Thakker, who is my mentor. He is always on hand to provide helpful advice and I have really enjoyed our robust scientific discussions over the years. In addition, Carl Sagan has made a great impression on me. He was a true scientific visionary and one of the great communicators of science. I always wish that I’d had the chance to meet him.

Any words of wisdom for aspiring endocrinologists out there?

If you’re interested in working in an intellectually fascinating field, which involves interactions between many tissues and organs and includes a wealth of cutting-edge science, then endocrinology is the specialty for you!

You can hear Prof Hannan’s presentation, “Mice harbouring a germline heterozygous AP2S1 mutation, Arg15Leu, are a model for familial hypocalciuric hypercalcaemia type 3 (FHH3)” on Tuesday 12 November at 10:25. Find out more about the scientific programme for SfE BES 2019.

Meet the winner of the 2019 Society for Endocrinology Medal

Prof Philippa Saunders is Chair of Reproductive Steroids at the University of Edinburgh and proud winner of the Society for Endocrinology Medal. Prof Saunders speaks to us about her research and career, ahead of her Medal Lecture at SfE BES 2019.

Can you tell us about your current position and research?

I lead a research team based in the Centre for Inflammation Research at the University of Edinburgh. Our work is focussed on exploring the role(s) of steroids and their receptors in the endometrium, so that we can develop better medical therapies to treat endometrial disorders including endometriosis, infertility and heavy periods, which affect millions of women in the UK and world-wide.

Please tell us a little about your career path so far, and what you are most proud of?

My first degree was in microbiology – the recent explosion of interest in the microbiome has made this more useful than previously. After graduation I was unsure what to do and took a job in Cambridge examining the role of uterine factors in supporting development of the pig blastocyst – this turned out to be an absolutely fasinating topic and I made it the basis of my PhD project. I spent 3 years as a postdoc in the USA, which was pivotal in convincing me that I wanted to become a successful principal investigator (PI), leading my own team. After a brief period working in London, I moved to Edinburgh where I was fortunate to have the chance to start my own lab within the MRC Human Reproductive Biology Unit. I was made a Professor in 2005 and have taken on a number of leadership roles including Head of Centre and Director of Postgraduate Research. I am proud of my successful application for the MRC Centre for Reproductive Health and the work my team have done to advance our understanding of the impact of oestrogens and androgens on endometrial health and disease.

What more specifically are you presenting at your Medal Lecture at SfE BES 2019?

I am going to be talking about our most recent work exploring the impact of steroids on endometrial function – this has a strong translational focus and benefits from access to human samples, as well as bespoke mouse models.

Is there anything you are particularly looking forward to at this year’s conference and you would recommend to others?

I am really looking forward to the Basic Physiology Workshop: Modelling endocrinology in vitro, in vivo & in silico and hearing about the exciting work done by the early career researchers.

What are the biggest challenges in your research area right now?

Funding! We are trying to better understand the mechanisms that predispose some, but not all, women to develop endometriosis, a chronic condition that can cause severe pain as well as subfertility. Even though up to 10% of women are affected during their reproductive years, it is incredibly challenging to get money to fund basic research into the aetiology of this condidition. Endometriosis and women’s health charities have little money and funders with deeper pockets have many equally important claims on their funds. We are looking at alternative sources of funding and have been happy to receive several small donations and philanthropic funding.  

What do you think will be the next major breakthrough in your field?

I am excited about the use of new technologies such as single cell sequencing and advanced in situ image analysis, as I believe these will give us the tools to study spatial and temporal changes in cell function within complex tissues, such as the endometrium.

What do you enjoy most about your work?

I enjoy working with my team and clinical collaborators, all of whom are focused on doing their best to improve the lives of women. One of the best aspects of the job is helping junior colleagues advance their careers by encouraging them to be ambitious and open to new ideas. I have also been fortunate to use my position as a Fellow of the Academy of Medical Sciences to support a number of initiatives that are supporting junior PIs to achieve their full potential – these include chairing the Springboard grants panel, acting as a mentor and as co-chair of the Team Science project.

Who do you most admire professionally, or otherwise, and why?

I have huge admiration for my clinical academic colleagues (Andrew Horne, Hilary Critchley) who are dealing with the challenges of running multicentre clinical trials. These trials are vital if we are to improve the lives of women who are at risk of hormone-dependent disorders but involve many hours of work, both to obtain funding and also to manage a diverse team based in multiple locations.

Any words of wisdom for aspiring endocrinologists out there?

Endocrinology is a really important topic so please continue to work in the field and promote it to others. In your own work please consider the impact of hormones on health and disease, across the life course and in different genders, so that your results will be relevant to as many people as possible.

You can hear Prof Saunders’ Society for Endocrinology Medal Lecture, Sex steroids and the endometrium: dynamics and disorders” on Wednesday 13 November at 16:50. Find out more about the scientific programme for SfE BES 2019.

Meet the winner of the 2019 Society for Endocrinology European Medal

Prof Felix Beuschlein is head of the Department of Endocrinology, Diabetology and Clinical Nutrition at the University of Zurich and winner of the Society for Endocrinology European Medal. He has carried out ground-breaking work in adrenal research for many years, now with a focus on endocrine tumours and hormonally-induced hypertension. In our interview, Prof Beuschlein tells us more about his research, career and his prize lecture at SfE BES 2019.

Could you tell us about your current position and your research?

I’m the head of the Department of Endocrinology, Diabetology and Clinical Nutrition at the University of Zurich clinic in Switzerland. I have been in the field of adrenal research since the start of my career, and my research has two broad directions. The first is on endocrine hypertension and everything to do with endocrine cardiovascular research, and the other is on endocrine tumours. 

Can you tell us a little more about your career path and what you are most proud of?

I specialised in adrenal research for my doctoral thesis, then moved several times within Germany and to the U.S. during my medical career, before moving to Switzerland. As you can imagine, moving so often was not always appreciated by my family and it can make friendships more difficult. However, you also get to engage with many different people from your field, sharing new ideas and opportunities all the time. So I view these moves as an enrichment of my career, rather than a challenge.

I am most proud of the very good and broad network of people, from all the different places I have worked and beyond. I have many colleagues in Europe and all over the globe, who I can rely on and trust, which has led to many interesting collaborations. I am also proud to be a co-founder of the European Network for the Study of Adrenal Tumours.

What will you be presenting at your SfE BES 2019 Medal Lecture?

My lecture will tell the story of how tiny little deviations that start off in the genome of a single cell can lead to a myriad of changes in the human body. There are very specific genetic changes that we, and others have identified, that predispose for adrenal tumours by causing small modifications in biological pathways. For example, hypercortisolism or excessive secretion of aldosterone, causes many changes in target organs, which then affect metabolism and lead to metabolic changes that define the phenotype witnessed by medical doctors.

Is there anything that you are particularly looking forward to at the conference?

Usually when I go to meetings like this I don’t prepare too much and like to just see what’s happening – maybe by chance I will find a brilliant talk, which I might have otherwise missed. In general, I like intersecting fields that are not immediately apparent to be endocrine-related but encourage us to think outside the box, opening our field to new ideas and new thinking.

What do you think have been the biggest challenges so far in your research area?

Right now one of the biggest problems is the maintenance of good registries and biobanks for clinical research. It is a major challenge to find funding to build and maintain them, to keep them going for a long period of time, so that you can build a cohort of patients with very rare diseases, and then follow up on them. Another challenge is keeping up awareness of particular topics, be it from the patient perspective, or that research is necessary. Then of course there is the challenge of Brexit and nations drifting apart and not knowing how that will turn out.

What do you think will be the next major breakthrough in your field?

I would say pattern recognition and artificial intelligence. As an endocrinologist this would mean not measuring one hormone, but rather looking for patterns of different hormones. ‘Omics technologies make it possible not only to measure one particular analyte, but a whole bunch. This means we can generate large datasets, over longer periods of time. Not a human being, nor an endocrinologist, nor a doctor are able to digest this information by themselves but computerised analysis of this data can indicate if disease is present or not. I think these possibilities will not only change science but also how we diagnose patients. Although this may be seen as frightening from some doctors’ perspectives, I think it will happen in the near future. We are already able to generate so much more data, but making sense out of it is the real challenge.

What do you enjoy most about your work?

My work in general is very varied, from seeing patients every day, to doing administrative things, to doing research. I also enjoy engaging with my network of scientists, talking and discussing with bright minds all over the globe. This is particularly rewarding, very interesting and is probably among the best things about research. Regardless of nationality, religious beliefs or any other differences, you come together and find common ground for discussion.

Who do you admire most professionally and why?

I have had a number of colleagues over the years who I see as role models but there are two that stand out most Martin Reincke has been a colleague and friend for over many decades and has followed my career very closely. The other important person is Bruno Allolio who was my mentor and teacher early in my career. He unfortunately passed away far too early but I remember him in many aspects of my scientific and medical career.

Do you have any words of wisdom for aspiring endocrinologists?

When I think back to what I have enjoyed the most and what I am most proud of in my career, I think it’s important for young endocrinologists to get connected with colleagues and other researchers. These networks are the fertile ground for all your future projects and career path. Endocrinology is a close community, so it is likely you will meet the same people again, which is also a great starting point for new friendships. It is also important professionally to have these networks to help you start multi-disciplinary or multi-centric projects.

You can hear Prof Beuschlein’s plenary Medal Lecture, “Mechanisms and consequences of endocrine autonomy – lessons learned from the adrenal cortex” on Tuesday 12 November at 18:20. Find out more about the scientific programme for SfE BES 2019.

Misleading medical reporting in the media: Over-diagnosis of low testosterone levels in men

A story published on Monday 9 September in the Guardian has provoked outrage at the Society for Endocrinology.

Dr Richard Quinton, Dr Channa Jayasena and Dr Ahmed Al-Sharefi, three of our expert Media Ambassadors, contacted the Society Press Office to express their concerns over the lack of accuracy and impartiality in the article: ‘My energy is back: how testosterone replacement therapy is changing men’s lives’ by .

They feel that this article is written and presented in an irresponsible manner that is misleading to the reader and potentially exploitative. The Society is committed to helping promote accurate and responsible reporting of endocrinology-related topics in the media, so we have backed their concerns, in the form of the open letter below, as our official position, and call on the Guardian to retract the article, pending appropriate revisions.

“Dear Guardian,

This article published in the Guardian addresses the important issue of treating hypogonadism. However, we are concerned that the article will (inadvertently) serve as an advertisement for “fringe” private medical healthcare services that contradict the advice and experience of qualified NHS specialists, who have specifically trained in hormone medicine (endocrinology),  with no platform offered to provide a more informed viewpoint.

It is easy to do a blood test for testosterone but it is equally easy for a non-specialist doctor (such as those quoted in the article) to misinterpret the result, and thereby misdiagnose hypogonadism.  In healthy, normal men, testosterone levels peak in the early morning and fall during the day; they also fall after meals, so it’s vital for accurate diagnosis that the blood test (preferably 2 of them on different days) be performed fasted and before 10-11 am. Moreover, testosterone levels also fall naturally below “normal” after a sleepless night, or during any form of illness, and men who are overweight or obese typically have low levels of the testosterone-binding protein, such that their levels of biologically-active free testosterone may be normal, even when total testosterone is slightly low.

What doctors lacking training in hormone medicine may also fail to appreciate is that properly documenting two separate low testosterone levels (total and calculated-free) is not a final diagnosis in itself, but rather an entry point to making a proper diagnosis, which may even involve MRI scanning the pituitary gland. Thus, just starting a man with “low testosterone” on testosterone replacement, not only exposes them to the risks of unnecessary treatment – testosterone-induced infertility, shrinkage of testes, or an abnormal rise in haemoglobin that can predispose to heart attacks, along with the costs to them or the NHS of drugs and monitoring blood tests – but also to the risk of a serious underlying condition being missed, such as a pituitary gland tumour, which could expand and cause blindness.

There has been an explosion in testosterone prescribing in the UK over the past 20 years, much of which has been exploitative of the vulnerabilities and insecurities of middle-aged and older men, but which has sadly passed other men completely by, whose genuine hypogonadism has not yet come to specialist medical attention.

We therefore highlight, four simple red flag features that should make any doctor take the finding of a low testosterone level (fasted & early morning) that much more seriously and refer to an appropriately qualified specialist:

– the presence of anaemia or low haemoglobin
– a history of osteoporosis or fracture
– a history of infertility
– raised levels of pituitary hormones LH or prolactin”

Dr Richard Quinton MA MD FRCP(Edin), Consultant Endocrinologist, Newcastle-upon-Tyne Hospitals & University 

Dr Channa N. Jayasena PhD FRCP FRCPath, Clinical Senior Lecturer in Endocrinology, Imperial College London

Dr Ahmed Al-Sharefi MBChB , MRCP (UK), Senior higher specialty trainee in endocrinology, The Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation trust

Declaration: Both Richard Quinton and Channa Jayasena are Investigators on the National Institute of Healthcare Research (NIHR) funded Testosterone Efficacy and Safety (TestES) Consortium, and Media Ambassadors for the Society for Endocrinology*

Our Media Ambassadors have successfully worked with Health and Science correspondents at the Guardian in the past to ensure accurate and responsible reporting, and we look forward to continuing to work with them on endocrine-related stories in the future.

The Society is committed to engaging journalists, patients and the public with hormone science to encourage informed health decisions, and to demonstrate the value of endocrinology to the wider world. Our Media Ambassadors are experts that work alongside the press office to help provide expertise, context and analysis to promote accurate and responsible reporting.

If you are interested in helping to improve the quality of science and health reporting, read our Media Ambassador guide or email media@endocrinology.org to find out how you can get involved.

Resolving Uncertainties in Diagnosis & Management of Thyroid Neoplasia

CARLA MORAN WEB IMAGES 1 (3)Dr Carla Moran is a Consultant Endocrinologist at the University of Cambridge and a convenor of the Society’s Thyroid Endocrine Network. In 2017 she was awarded a Society Themed Scientific Meeting Grant to hold the one-day meeting, Resolving Uncertainties in Diagnosis & Management of Thyroid Neoplasia, on 8 March 2019 at Churchill College in Cambridge. The meeting brought together international and UK experts, as well as practicing clinicians and non-clinical scientists, to discuss advances in the field. Here Carla gives us a report of the day.

Need for the meeting
The landscape of investigation for thyroid neoplasia and management of low risk thyroid cancer is changing. Overascertainment of thyroid nodules has fuelled an epidemic of thyroid neoplasia but the death rate from thyroid cancer is unchanged. Many of these nodules are unnecessarily over-investigated, and if cancer is detected, may be overtreated. It has been suggested that more than 200,000 cases of thyroid cancer have been unnecessarily detected in the USA between 1988 and 2007, and the UK has not avoided this phenomenon of overdiagnosis[1]. In addition, in the UK, almost all radiologically and cytologically indeterminate nodules undergo surgery for diagnosis, resulting in high rates of unnecessary surgery for benign disease. Although our international colleagues are using RNA and DNA diagnostic techniques to stratify the likelihood of malignancy in these nodules, such tests have not been evaluated in UK clinical practice. Pathological definitions of thyroid neoplasia are being revised, such as redesignation of follicular variant of papillary thyroid cancer to noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP). Lastly, management of thyroid cancer is evolving, with surgical extent, radioiodine use and dose and TSH suppression all being tailored to disease risk. This suggests that a stratified approach, with use of better markers (radiological, cytological, molecular) to select nodules for investigation and treatment, is required.

Overview of the day
Current guidelines advocate a multidisciplinary approach to thyroid nodules and cancer, with input from endocrinologists, radiologists, pathologists, surgeons, oncologists and nurse specialists, however no national meetings are held with all these disciplines in attendance. Led by the Society Thyroid network, in partnership with the British Thyroid Association and UK Endocrine Pathology Society, this meeting gathered international and UK experts in all these disciplines, as well as practicing clinicians and non-clinical scientists, to discuss current UK practice and advances in the field. Invitations extended to members of other societies (e.g British Association of Endocrine and Thyroid Surgeons) and patient groups (British Thyroid Foundation, Butterfly Thyroid Cancer Trust) interested in the field.

Topics reviewed included: the thyroid cancer epidemic (Krishna Chatterjee, Cambridge), ultrasonographic classification (Steve Colley, Birmingham), cytological categorisation (Sarah Johnson, Newcastle), molecular pathogenesis (Chris McCabe, Birmingham), nodule molecular diagnostics (Bryan McIver, USA), pathological risk stratification (David Poller, Portsmouth), surgical management of low risk tumours (Dae Kim, London), papillary microcarcinoma (Carla Moran, Cambridge) and stratified management of thyroid cancer (Jonathan Wadsley, Sheffield). Oral presentations demonstrated that high quality UK research is being performed in this field.

Collaboration is key
Collaboration between disciplines was essential for this meeting; the primary speciality leading diagnosis & management of nodules varies widely between centres across the UK, such that specialist society (e.g. endocrine, surgery, pathology, radiology) meetings often exclude many interested professionals; it is exceptionally rare for all relevant disciplines to meet to discuss the topic. Discussing areas of uncertainty identified by all specialties allowed us to compare approaches. Internationally, variation in practice variation is also substantial, most notably with regard to the use of molecular diagnostic techniques. Clinicians in the UK do not have any significant experience of using such diagnostic tools, such that Dr McIver’s experience and opinion of this area was highly informative. Lastly, attendees were individuals experienced and interested in the field; this ensured that discussions were highly applicable and informative.

Funding was crucial
When organising this meeting, funding received from the Society for Endocrinology was invaluable; without it we would not have been able to attract such high-quality speakers from the UK and US. Feedback from the meeting was universally strongly positive, with many attendees expressing a desire to attend a similar meeting in future.

Future
A unique aspect of the meeting was the workshop held the day after the main programme, attended by those interested in pursuing research aiming to identify solutions to challenging areas of current practice. We hope the meeting will inform scientific design of a UK-wide, multicentre, prospective study to evaluate diagnostic utility of new molecular technologies alongside current cytological/pathological practice. In addition, participants in this meeting are likely to be key members of a working group which will formulate national guidance on the diagnosis & management of thyroid nodules in the UK.

References
1. Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L. N Engl J Med. 2016 Aug 18;375(7):614-7.

Meet the editor – Professor Martin Haluzík

Meet Professor Martin Haluzík, Professor of Internal Medicine at the Charles University in Prague, Deputy Head of Centre for Experimental Medicine and Head of the Department of Experimental Diabetology at the Institute for Clinical and Experimental Medicine in Prague, Czech Republic. Professor Haluzík is a deputy editor of the Journal of Endocrinology and Journal of Molecular Endocrinology. His major research focus is on the etiopathogenesis of obesity, insulin resistance and type 2 diabetes. In this interview, Professor Haluzík tells us more about his research and career.

Tell us about your particular field and research?

Our lab explores the etiopathogenesis of obesity and type 2 diabetes aiming to find preventive and treatment strategies. We are particularly interested in bariatric surgery and endoscopic methods of treatment along with novel pharmaceutical targets. Our research is both experimental and clinical, involving patients with obesity and type 2 diabetes.

What techniques do you use in your research?

At the moment, a lot of our research is focused on immunometabolism/subclinical inflammation in adipose tissue using flow cytometry and continuously trying to refine it. We are also using metabolomic and proteomic methods in collaboration with other laboratories. In patients, we often use glucose clamps to characterise insulin sensitivity before and after interventions. We are also testing numerous novel endoscopic methods for treatment of obesity/type 2 diabetes in both experimental models and in patients.

What inspired you into endocrinology?

It was primarily my mentor, Professor Vratislav Schreiber, who was a leading, internationally-recognised, experimental endocrinologist. His primary focus was hypothalamus/hypophysis research but he was the one who, after discovery of adipose tissue hormone leptin, came up with the idea that we should focus on the endocrine function of fat.

What do you enjoy most about work?

I really enjoy its variability – doing both experimental and clinical research brings some challenges but this combination is never boring. I very much like scientific discussion with my colleagues about our results and brainstorming how to explain it and put it into context. I also like writing the papers, especially when nobody is calling and I have a couple of hours to focus on thinking about data and writing.

What does your day-to-day work life involve?

I do both clinical work (seeing patients with diabetes/endocrine diseases) and experimental research. Nevertheless, I have to admit that I am not very useful in the lab anymore. My job is mostly to write grant applications, organize things, write and refine the papers and support my colleagues and PhD students.

What are you most looking forward to in becoming an editor?

I am very much looking forward to a chance to contribute to shaping and refining the focus of such well-respected journals of Journal of Endocrinology and Journal of Molecular Endocrinology. Also, I really like interaction with the Editorial Board and other members of the team that bring most interesting ideas that help us to improve the journal.

Who/what research has inspired you the most?

My first mentor, Professor Vratislav Schreiber, who contributed to the discovery of TRH. He was very inspiring by a combination of being extremely smart and modest at the same time, while having an unforgettable sense of humour.

What is the best feedback or advice you have ever received?

“Work smart not hard” although I am still learning how to do it, which involves a lot of hard work.

Is there any advice you can give to someone just starting off in science?

Go for it! I would make the same choice again if I could start over. It is a lot of work but you don’t really need any other hobbies. You can think about science all the time.

Tackling inaccurate and misleading reporting on science in the media

A story published on Saturday in The Times has provoked outrage amongst some Society members.

Dr Richard Quinton and Dr Channa Jayasena, two of our expert Media Ambassadors, contacted the Society Press Office to express their grave concerns over the article: The £195 hormone cream that’s changed my life by Olivia Falcon.

Both Dr Quinton and Dr Jayasena feel that this article is written and presented in an irresponsible way that is misleading to the reader, on a potentially unsafe and improperly tested product. The Society is committed to helping promote accurate and responsible reporting of endocrinology-related topics in the media, so we passed their concerns, in the form of the open letter below, to The Times.

Dear Editor

In 1916, a $20 fine was levied in Rhode Island, USA for the misbranding of Clark Stanley’s Snake Oil Liniment to treat rheumatism and bunions and animal bites. The term ‘snake oil salesman’ is still used today to describe someone who knowingly sells fraudulent goods. Anti-ageing products are in ever-increasing demand. Whereas, cosmetic (i.e. non-medicinal) products are established in the market, there is growing speculation that hormone (endocrine) supplementation could provide additional benefit for older men and women. However, it is critical to understand that products claiming to alter the endocrine (hormone) system should be termed drugs, and are quite rightly subject to rigorous safety regulation. Crucially, the websites from which Endo-Test cream can be purchased explicitly state that “it is for scientific or laboratory use only and not for human consumption”.

Endo-Test cream described in last Saturday’s edition claims to ‘increase testosterone levels dramatically’ and nearly double sperm count and The Times’ journalist reported that these claims were based on an independent study by the manufacturer. However, we were unable to find any evidence of scientific peer review or publication of these findings. Furthermore, there is currently no medication in existence known to increase a man’s sperm count, so the findings appear improbable.

Interestingly, whereas The Times’ journalist correctly described Endo-Test cream as a “hormone cream”, the AQ company website claims prominently that Endo-Test is “hormone-Free”. For the record, the cited ingredients include a human androgen (testosterone-precursor) hormone (DHEA), a major insect moulting hormone (20-hydroxyecdysone) and a synthetic hormone (Gonadorelin) whose clinical application in humans is to shut down reproductive hormones entirely for men with prostate cancer and women with endometriosis, or as part of hormone treatment of trans-gender individuals. The extent to which these are absorbed through the skin, as opposed to through their conventional routes of administration, has likewise not been substantiated. 

To protect the interests of the public, it is important that manufacturers make substantiated claims and that journalists scrutinise evidence of these claims prior to publication. Without this, how would people know whether or not ‘snake oil’ was indeed the fountain of youth?

Dr Richard Quinton MA MD FRCP, Consultant Endocrinologist, Newcastle-upon-Tyne Hospitals

Dr Channa N. Jayasena PhD FRCP FRCPath, Clinical Senior Lecturer in Endocrinology, Imperial College London

Declaration: Both are Investigators on the National Institute of Healthcare Research (NIHR) funded Testosterone Efficacy and Safety (TestES) Consortium, and Media Ambassadors for the Society for Endocrinology*

*Please note these views are of expert members Channa Jayasena and Richard Quinton, and do not necessarily reflect the official position of the Society for Endocrinology.

The Times is now looking into the matter and will report back to us on how this will be addressed shortly. Our Media Ambassadors have successfully worked with Health and Science correspondents at The Times in the past to ensure accurate and responsible reporting, and we look forward to continuing to work with them on endocrine-related stories in the future.

UPDATE 8 March 2019 – The Times have now taken this article down, we thank them for their assistance with this matter and taking this positive action.

The Society is committed to engaging journalists, patients and the public with hormone science to encourage informed health decisions, and to demonstrate the value of endocrinology to the wider world. Our Media Ambassadors are experts that work alongside the press office to help provide expertise, context and analysis to promote accurate and responsible reporting.

If you are interested in helping to improve the quality of science and health reporting, read our Media Ambassador guide or email media@endocrinology.org to find out how you can get involved.

 

 

 

 

 

 

How an endocrine disease may have shaped British history

At SfE BES, Ashley Grossman, Professor of Endocrinology at the Oxford Centre for Diabetes, Endocrinology and Metabolism, gave a presentation entitled, ‘What killed Queen Mary’. In our latest interview, he tells us about his investigation into the unclassified illness that plagued Queen Mary and ultimately led to her premature death, and what we can learn from her tragic story.

Can you tell us why you think Queen Mary’s death was endocrine related?

Reading through Mary’s life history, which is quite a sad story, it seemed to me that something endocrine-related may have been going on and I came up with some interesting conclusions about her death. Mary was unfortunately plagued with illness throughout her life and her documented symptoms included her periods stopping, she starting to lactate, suffered from increasingly bad headaches and, just before Mary died, she began to go blind. All of these symptoms suggest she was suffering from an expanding prolactin-secreting pituitary tumour. Increased prolactin levels would explain her lactation and amenorrhoea. As the tumour expanded it would have compressed the brain, including the optic nerve leading to blindness. It may also have made her infertile explaining her failure to produce an heir. Ultimately, as the tumour expanded it likely placed pressure on vital areas within her brain  that may have been the cause of her early death in 1558 at age 42.

What sparked your interest in Queen Mary?

 I confess, initially I did not know much about history or Queen Mary. However, when my third daughter pursued history as an undergraduate and then as a Master’s degree student, it sparked my interest. I delved in and began reading books on the Tudors and Mary seemed quite fascinating. The fact that she died so young and childless was pivotal, as it completely altered the course of British History. If she had produced a child, then Britain would have remained catholic and Phillip II would have become King, dramatically changing history, with no future Elizabeth I on the throne.

Is there any way we could prove your theory?

Of course, the conclusion that Mary died from a pituitary tumour remains speculation. However, renowned Austrian physician – Victor Cornelius Medvei, whose passion for endocrinology led him to write the definitive textbook – A History of Endocrinology – also investigated the death of Queen Mary in some detail. To my delight his conclusions, discussed with Prof. Howard Jacobs, matched my own and reading his research really firmed up what I thought.

Mary’s buried in Westminster Abbey, so we could do a computerised tomography scan of her coffin to see whether or not her pituitary was indeed enlarged. However, I don’t think the monarchy would be very happy for anyone dig up her coffin and do that! To make a diagnosis on someone who lived hundreds of years ago is not hard science, but it is amazing to think that a pituitary tumour changed the course of British history.

What can we learn from your research?

Although historical, I think there certainly are things people can learn from Mary’s tragic story. I believe it’s important that people recognise how much life has been transformed by modern medicine, and how lucky we are to have treatments to disorders that just a few hundred years ago were highly debilitating or even lethal. For example, what destroyed the catholic British monarchy can now be treated simply with a few tablets and the disease might virtually disappear.

Ashley Grossman presented ‘What killed Queen Mary’ at the annual SfE BES conference in Glasgow on 20 December 2018. Discover more about the work of endocrinologists in our Meet the Endocrinologist series of blog interviews.

Meet the Endocrinologist: Joseph Takahashi, expert on the genetic and molecular basis of circadian rhythms

Meet Joseph Takahashi, Professor of Neuroscience at the Howard Hughes Medical Institute at UT Southwestern Medical Centre. His research focuses on the genetic and molecular basis of the circadian clock in mammals. He has been awarded the SfE Transatlantic Medal and will be delivering his Medal Lecture at SfE BES 2018, 19-21 November in Glasgow. In our latest interview, he tells us more about his career, research and what he is looking forward to at the SfE BES 2018 conference. 

Can you tell us a little about your current position and research?

I’m an Investigator in the Howard Hughes Medical Institute, and Professor and Chair of the Department of Neuroscience at the University of Texas Southwestern Medical Center in Dallas, Texas. My lab studies the genetic and molecular basis of the circadian clock in mammals. More broadly we are interested in the genetic basis of behavior. My lab is known for discovering the first circadian gene in mammals known as the Clock gene.

One of the initial surprises from cloning the mammalian clock genes was that they are ubiquitously expressed. This eventually led to the discovery that the circadian clock is cell autonomous and that virtually every cell in the body has the capacity for circadian oscillation. Thus, all of our major organ systems contain intrinsic circadian oscillators. This has led to a revolution in studies aimed at understanding the role of clocks in peripheral tissues as well as studies focused on understanding the systems level organisation of the multiple clocks in the body. The core circadian molecular pathway regulates thousands of genes in mammals, and this has led to the discovery of direct molecular links to a myriad of molecular, cellular and physiological pathways. These include direct links to endocrinology, metabolism, immune function, cell growth and cancer.

Can you tell us about your career path, and what you are most proud of?

I have been incredibly fortunate to have had great mentors and colleagues as well as research institutions and funding agencies that have supported me throughout my career.  In college, I was interested in biology, but did not know what careers one could pursue except for med school. Later I had the good fortune to do an independent research project and learned that one could go to graduate school in biology(!). That was the beginning of my research career.  I took a post-baccalaureate year to work with Patricia DeCoursey, one of the pioneers in mammalian circadian rhythms, and then went to work with Michael Menaker for graduate studies. Menaker was the perfect mentor for me. He had a free and open lab environment that encouraged creativity, independence and scale and automation. We pioneered long-term ex vivo culture of tissues that contained and expressed circadian rhythms in the late 1970’s. These initial forays continue to pay off decades later as the entire circadian field uses large-scale data collection, automation and long-term in vitro circadian models.

After graduate school, I did a 2-year post doc with Martin Zatz at the NIH where we worked on the pharmacology circadian rhythms in the chick pineal in vitro.  I was then recruited to Northwestern University by Fred Turek. As an independent faculty member at Northwestern, my lab focused on reductionist dissection of the circadian oscillator in the chick pineal.  In addition to pharmacology, we worked on the biochemistry of various circadian pathways in the pineal.  However, eventually we were stymied, and my interest in the molecular biology and genetics of circadian rhythms was growing.  We knew that molecules and genes had to be important for mammalian circadian rhythms, but how to get there?  That was the beginning of my ‘second career’ as a geneticist.  Ironically as an undergraduate, I was not very interested in molecular biology or genetics (I was interested in animal behavior), but luckily I ‘had’ to take these courses.

In 1990, Larry Pinto, Fred Turek and I decided to use mouse genetics to try to find circadian rhythm mutants. We collaborated with William Dove at the University of Wisconsin-Madison, and Martha Vitaterna conducted our first screen of mice that were ENU mutagenised in the Dove lab.  In our first screen, we isolated the Clock mutant mouse which has a 28-hour period length and a loss-of-rhythm phenotype in circadian activity.  This mutant mouse then provided the means to identify the Clock gene by positional cloning. The isolation of the Clock mutant and the positional cloning of gene was the crowning achievement of my lab.

What are you presenting in your Medal Lecture at SfE BES 2018?

I plan on giving an historical account of our forward genetic approach to finding clock genes in mammals. The effort to clone Clock was massive.  Ten members of my lab worked together as a team for three years to complete the project. In the 1990’s there was no genome sequence. The Clock gene turned out to be huge: it had 24 exons and covered over 90 kB of genomic DNA. Then I will discuss more recent molecular and genomic analyses of the circadian clock gene network. Finally, I will describe our new work on the importance of time and caloric restriction for aging and longevity.

What are you looking forward to at this year’s conference?

I am very much looking forward to seeing all the advances in the field of endocrinology as well as the plenary lectures.

What do you think are the biggest challenges in research right now?

It is of paramount importance to support research in basic science. It is very important to translate these basic science discoveries, but one must remember where these advances had their beginnings.  It is impossible to predict new discoveries and how they will impact medicine in the future.

What do you think will be the next major breakthrough in your field?

Many important breakthroughs in the circadian field will be their connections to all aspects of cell biology, cancer and metabolism. New views of metabolism and longevity are already being linked to circadian biology.

What do you enjoy most about your work?

I love the fact that we are supported to pursue knowledge and discovery of biological systems.  Making scientific discoveries is like a treasure hunt for adults.  It never gets old, and one discovery always opens the door to countless new questions.  Also, as an academic, we have intellectual freedom that is rare in other professions.

Who do you most admire professionally?

My role models have been: Seymour Benzer at CalTech, who pioneered genetic approaches to complex behaviors; Eric Kandel at Columbia, whose systematic and scholarly approach to understanding learning and memory in simple model systems was fundamental; and Denis Baylor at Stanford, whose biophysical analysis of phototransduction was a thing of beauty.

Any words of wisdom for aspiring researchers out there?

My mantra is:  Always begin with first principles. What I mean by this is that you must understand what you are doing. To an electrophysiologist or biophysicist this is self-evident. But in today’s world of molecular biology and informatics, the kits that you use in the lab and the computer programs that you employ are frequently applied without a fundamental understanding what they are doing and how they work.

 

You can hear Professor Takahashi’s SfE Transatlantic Medal Lecture, “Circadian Clock Genes and the Transcriptional Architecture of the Clock Mechanism” on Monday 19 November, in the Lomond Auditorium at 18:00. Find out more about the scientific programme for SfE BES 2018.