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.