more_vertConvergence science is a transdisciplinary approach for framing research questions. A 2016 report from the Massachusetts Institute of Technology (MIT) described convergence science as “an approach to problem solving that integrates expertise from life sciences with physical, mathematical, and computational sciences as well as engineering to form comprehensive frameworks that merge areas of knowledge from multiple fields to address specific challenges”.1 The report examined four priority areas in which convergence strategies, applied systematically, can impact biomedicine: cancer; infection and immunity; brain disorders and injuries; and heart disease, diabetes, and inherited genetic disease.
Preference: Statistics, epidemiology and research design
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[Correspondence] Can Shoulder Arthroscopy Work? (CSAW) trial – Authors’ reply
We thank Sawalha and Waseem, and Wang and colleagues for their comments about our study.1 Patient selection criteria were applied as universally as possible for a pragmatic surgical trial. Variation in the numbers recruited by site does not per se indicate that there was variation in patient selection, with many factors, such as available research time and support, surgical list size, site policies, and set-up all contributing to the resultant recruitment numbers. Some minor variation in patient selection between surgeons is inevitable but also reflective of clinical practice.
Access, the key to success
Family Doctor Week
Victoria – Dr Jim Glaspole
In the eastern part of Melbourne, not too far from the CBD, is a busy clinic that is so much part of the local community that locals can’t remember it not being there.
Dr Jim Glaspole joined the Vermont Medical Clinic in 2002. His father joined in 1965.
“I was part of my father’s recruiting efforts, but he left two years after I joined,” Dr Glaspole said.
“I came along as the fourth partner and there have been a number changes since. It is now solely my practice.
“The clinic opened in 1960 and this is its third location in 58 years.”
The current location Dr Glaspole refers to is as part of the Vermont South Medical Centre complex, which the clinic moved into in May last year.
“We moved from a five-consulting room practice to an 18-consulting room practice,” he said.
“There are now nine doctors.
“The nature of my practice is that it’s very busy most of the time. I inherited a lot of patients from doctors who have gone before me, so my practice does skewer a lot towards the old aged group. I deal with a lot of chronic disease management.
“I am very often treating second and third generations. I do a lot of aged care visiting – at least once a week and quite often more often.
“I also do a lot of skin cancer work and research through Monash University.”
An average full day at the clinic would see Dr Glaspole treating about 34 patients.
His work is varied and he takes great satisfaction in knowing that he and his clinic have built a good reputation for providing high quality medical attention.
He is a local and so is his clinic.
“This practice has been part of the community for more than 50 years,” he said. “I went to the local primary school because I grew up in the area.
“Even though they move away from the area, many still choose to come to this clinic.
“The way that I see it is there’s the person access as well as the disease access. It’s the combination of both those aspects that makes medicine interesting.”
CHRIS JOHNSON
Family Doctor Week highlights effective role of GPs
AMA Family Doctor Week recognises the work and dedication of Australia’s 36,000 general practitioners who treat families and individuals with a range of health issues day in and day out.
“Australia’s health system is one of the best in the world, and it all begins with the GP-led primary care system,” AMA President Dr Tony Bartone said.
“Eight out of 10 Australians see their family doctor once a year, and more than nine in 10 always go to the same general practice, with 65 per cent of people surveyed reporting that they had been going to their family doctor for five years or more.
“People who have a regular family doctor tend to have better health outcomes, with new research from the United Kingdom suggesting that seeing the same doctor each time you need medical care might even reduce your risk of death.
“Patients who need urgent medical care can usually obtain an appointment on the day they call, with nearly two-thirds reporting that they were seen by a family doctor within four hours of making an appointment.”
Dr Bartone stressed that GPs are specialists in their field, with a minimum of 10 to 15 years training, and they manage 90 per cent of the problems they encounter.
They are the leaders in preventive health care, early diagnosis and treatment, and comprehensive care.
“Australians rely on their trusted relationship with their family doctor,” he said.
“It’s a partnership with someone who knows their medical history, who they can talk to about their health concerns, who can advise them on how to reduce their health risks, who can assist them in managing their health, who can help them to feel well, and who can listen to them and guide them when it all starts to get too much.
“This continuity of care underpins quality health care, and is fundamental to better health outcomes.”
As part of Family Doctor Week, the AMA produced a series of videos showcasing how your family doctor is there for you. They can be viewed on the Family Doctor Week Website family-doctor-week-2018 .
Here, the Australian Medicine feature pages profile dedicated family doctors from each Australian State and Territory.
CHRS JOHNSON
Advances in treating breast cancer
A world-first study has revealed that triple negative breast tumours can be treated with a drug that cuts the communication between normal cells and tumour cells.
Triple negative breast tumours are the most aggressive and have the fewest treatment options, but Australian researchers were part of a team that has found what is described as a secret hotline between breast cancers and the normal cells surrounding them.
This two-way communication was uncovered in mouse models of disease and investigated further in people. In a Phase I clinical trial, a drug known as SMOi was used to block the communication, resulting in promising clinical responses in several breast cancer patients.
The findings have been published in international journal Nature Communications and are the result of a collaboration between researchers at the Garvan Institute of Medical Research in Sydney, the Centre for Cancer Biology in Adelaide, and GEICAM, a translational breast cancer research group Spain.
The research focused on triple negative breast cancer, where treatment options lag far behind other breast cancer types. Triple negative breast cancer is hard to treat because its cells lack crucial landmarks that are used as targets for medical treatment in other breast cancers.
The researchers investigated the role of non-cancerous cells, which along with cancer cells are a part of every breast tumour. They then analysed the genetic output of thousands of individual cells within the tumour.
Importantly, they found that cancer cells send signals to neighbouring non-cancerous cells (known as cancer-associated fibroblasts or CAFs). And CAFs talk back: they send back their own signals that help the cancer cells become drug-resistant and to enter a dangerous state the researchers call stem-like.
The researchers disrupted the hotline between CAFs and cancer cells by using the drug, which targets CAFs and stops them from pushing tumour cells towards a stem-like state. In mouse models of triple negative breast cancer, treatment with the drug reduced the spread of cancer, slowed tumour growth, increased sensitivity to chemotherapy and improved survival.
Following the success in mice, The Garvan Institute’s Associate Professor Alex Swarbrick, who led the research, worked with the Spanish translational breast cancer group GEICAM to carry out a Phase I clinical trial in 12 triple negative patients, in which several patients saw measurable responses to the drug.
One patient, who had an aggressive, metastatic triple negative breast cancer that was unresponsive to several other treatments, achieved a ‘complete response’ – her metastatic tumour shrank and became undetectable.
Professor Swarbrick said the research has led to a major step forward in our understanding of how CAFs can drive aggressive cancer.
“It’s the stem-like cells in breast tumours that are particularly bad players, as they can travel to distant parts of the body to create new tumours and are resistant to treatment,” he said.
“We knew that CAFs played a role in turning cancer cells into a stem-like state, but now we know exactly how they communicate with tumours – and how to stop them talking to one another.
“We found that when they received signals from cancer cells, CAFs produced large amounts of collagen, a protein that forms a dense scaffold in the tumour, which increased its stiffness and helped to maintain the stem-like state of the cancer cells.
“When we disrupted the hotline in our models and also in our patients, collagen density was reduced, and the cancer cells weren’t as stem-like anymore.”
Phase I clinical trials in a small number of patients are now complete. The results have been so promising that Professor Swarbrick and his medical collaborators are currently working on designing and funding Phase II trials to test the effectiveness of this treatment in a larger group of patients.
This work was supported by funding from the National Health and Medical Research Council, Love Your Sister, John and Deborah McMurtrie, the National Breast Cancer Foundation, RT Hall Trust and Novartis.
The Centre for Cancer Biology is an alliance between the University of South Australia and SA Pathology.
CHRIS JOHNSON
[Comment] Global child and adolescent health: a call for papers
The Lancet and The Lancet Child & Adolescent Health invite submission of high-quality research papers on any area of global child or adolescent health for consideration for our special issues timed to coincide with the 29th International Pediatric Association Congress in Panama City, Panama, on March 17–21, 2019.
[Editorial] UK life science research: time to burst the biomedical bubble
In November, 2017, as part of her long-awaited industrial strategy, UK Prime Minister Theresa May committed to raise investment in research and development (R&D) to 2·4% of gross domestic product by 2027. Life sciences featured prominently in the industrial strategy, described as one of the dominant economic sectors in the UK. A new strategic funding agency—UK Research and Innovation (UKRI)—was created to oversee the allocation of these funds, bringing seven research councils together in a major shake-up of the UK’s funding structure.
[Correspondence] Equity in the gender equality movement in global health
In recent years, social media campaigns aiming to showcase women working at the forefront of global health have resulted in lists like 300 Women Leaders in Global Health.1 This movement inspired a global organisation called Women in Global Health (WGH) that promotes gender equality in global health leadership. The momentum and support of this movement are spreading with multiple initiatives to acknowledge, research, and act on gender bias and discrimination in the field of global health, including The Lancet’s call for papers for a special issue on women in science, medicine, and global health to explore best practices for change.
[Obituary] Ogobara Doumbo
Leading malaria researcher. Born in the Dogon region of Mali, Africa, on Jan 1, 1956, he died after complications from surgery in Marseille, France, on June 9, 2018, aged 62 years.
[Seminar] Sepsis and septic shock
Sepsis is a common condition that is associated with unacceptably high mortality and, for many of those who survive, long-term morbidity. Increased awareness of the condition resulting from ongoing campaigns and the evidence arising from research in the past 10 years have increased understanding of this problem among clinicians and lay people, and have led to improved outcomes. The World Health Assembly and WHO made sepsis a global health priority in 2017 and have adopted a resolution to improve the prevention, diagnosis, and management of sepsis.