We are delighted to interview Professor Rosalind L Smyth MAE about her work as a clinician and academic at the UCL Great Ormond St Institute of Child Health, her commitment to Open Access and her views on gender equality in science.
You are both a clinician and an academic. You have previously said that research would have to be a component in whatever you do. Could you tell us about the benefits and challenges of undertaking both roles?
The reason I decided, at a young age, to pursue a medical career was because I wanted to make a tangible difference to people’s lives. I also realised, before I went to medical school, that I wanted to be a paediatrician. This was partly because I enjoy working with children and young people, but also because, by intervening early, with prevention or treatments, there is a much greater chance of making a difference to the quality and, indeed the length, of someone’s life. Clinical training is long and can be challenging, but it is an enormous privilege to work with children and help them recover from acute problems and manage more long-term chronic conditions.
My pathway into research was more serendipitous. I was married to another hospital doctor and managing two such careers meant, at that time, we were likely to have to move around the UK. I felt I needed to make sure my CV was as strong as possible and, when we moved to Cambridge, I should look to spend some time as a research fellow to add something extra to my resumé. Like many young women I lacked confidence. At that point, my one goal was someday to become a paediatric consultant. My time in research at Cambridge completely changed my perspectives. I was working in heart-lung transplantation and, in the patient group with which I worked, there were so many questions related to opportunistic infections, physiology and host defence and much more, which needed to be answered. I learnt how to formulate the right questions and how to begin to develop the methods to answer them. I was working in a very successful, dynamic group, where everyone wanted to become a professor (except me), but I slowly became more confident and then more ambitious.
At the end of my research post, my medical husband was appointed to a consultant post in Liverpool and we moved to that city for the next 23 years. I could no longer pursue heart-lung transplantation, but I used some of my ideas and training to consider viral/host defence in condition which had a very high incidence in babies in Liverpool, respiratory syncytial virus bronchiolitis. I was appointed, first of all as a respiratory paediatrician at Alder Hey, the large children’s hospital in Liverpool, but after two years in this role, moved into a clinical senior lectureship at the University of Liverpool and Alder Hey, to pursue a clinical academic career. The challenges of being a competent, committed clinician and an excellent researcher are considerable, but, for me, it is the best job in the world! In terms of challenges, the balance between time spent looking after patients and time devoted to research is an obvious problem all clinical academics face. Patients have to take priority, so one needs a clear structure to ensure that, one’s research time is “ring-fenced” so that other members of the clinical team are able provide appropriate care when the academic is not available.
The quality of the team approach is critical; one absolutely has to fulfil the agreed clinical commitments, but the full-time clinicians should recognise the important academic requirements of their clinical academic colleagues. Clinical academia provides the opportunity for one to have unique insights into the clinical problems and develop the means whereby to answer these questions.
There are many ways in which we can improve patient care, but most of them require careful investigation into the aetiology of health and disease and rigorous clinical studies. In my field, the results make a very real difference to the lives of children, the adults they will become and their families. That is what has always motivated me.
Could you tell us more about your latest research?
My current research continues to address RSV bronchiolitis. When I was in Liverpool, we made important observations about neutrophils, which are recruited to the airways during RSV infection. Studies in these small very sick babies are difficult and so, to investigate the role of neutrophils and whether and how they are contributing to recovery from infection, has required the development of new model systems. We have been able to grow airway epithelial cells taken from healthy volunteers, at an air liquid interface, where they differentiate into cells seen in the airway. We have been able to add neutrophils to the basolateral membrane of the epithelial cells, so that they migrate through to the apical membrane, which lines the airway, in life. By using this system, we are able to study the effects of neutrophil migration and RSV infection on the airway epithelium and on the neutrophils, which has improved our understanding of how these cells respond in the clinical condition.
However, most of my time is spent as Director of the UCL Great Ormond Street Institute of Child Health. My colleagues work across a very broad range of research questions relevant to child health, including developing treatments for a number of rare childhood diseases where there are no specific treatments and understanding how the circumstances into which a child is born can affect their chances of developing disease and living a long and healthy life. I have incredibly talented and committed colleagues and every day I am reminded about how important their work is to children across the world.
You have a strong commitment to Open Access and UCL Great Ormond Street Institute of Child Health was the first to launch an institute-focused publishing platform with F1000. Why is this so important to you? What are your thoughts about Plan S?
I have long felt that the old-fashioned model of publishing model was unsustainable in the age of the internet. As a scientist, one makes available for publication the reports of scientific investigation, which is usually publicly funded. One (usually freely) provides quality assurance of these processes by peer review and then one is invited to buy back the product of the endeavour by subscriptions to scientific journals. This impedes scientific progress, as information is not readily available and studies may be duplicated or not developed as a consequence. However it is not only the scientists who are missing out. The public, whose taxes and donations have paid for publicly funded research will not have access to the results of these studies. In my area of research patients and families will also be denied the opportunity of reading studies which may be relevant to them. There is the issue that some research findings may be misleading or flawed and this might cause harm, particularly if, for example, patients are misled about the effects of treatment. However, some publishers, such as F1000 are publishing all of the reviews of the work, with the reviewers identified and the author’s rebuttal(s). This transparency helps to ensure that limitations in the work are identified and the findings can be interpreted more appropriately.
I was a member of the Board of Directors of the Public Library of Science (PLOS) for 10 years. During that time, PLOS was at the vanguard of open access publishing. Since leaving PLOS I have continued to pursue these interests.
I’m generally very supportive of the principles of Plan S. I know that some have found them to be radical and the implementation is over a short time. However, I think that the academic and publishing community has had a chance to consider these matters for a long time and now is the time to act.
You are passionate about gender equality in science and you actively encourage young women to put themselves forward for senior positions. What positive steps do you think have been made in this area?
Things are a lot better, but diversity in academic leadership still has a long way to go. Earlier I referred to lack of confidence among young women, early in their research and academic careers. There are very many talented individuals, who don’t believe that they can “make it” with an academic career. While role models are important, practical issues may also be a deterrent. For example, many people are trying to make the transition to independence, with all of the requirements to publish well and obtain grant income, when they are in their 30s and starting a family, with all of the joys and stresses which that provides. Often all that is needed is a facilitatory environment, the right sort of encouragement and, of course, a supportive family.
There is very good evidence that when women apply for fellowships, are nominated for Academy Fellowships, etc., they are at least as successful as men, the problem is that they don’t apply.
So, I have been involved in many initiatives to encourage and support women to apply for these positions and these have led to notable successes. For example, there are now many more female Fellows of the Academy of Medical Sciences than was the case 5-10 years ago.