Thinking With The Heart

Some Royal College Surgical Research Fellows Talk to Julian Rees

Research is the foundation of good surgical practice. A recent publication by the Royal College of Surgeons emphasises this. ‘Research forms an essential source of knowledge for the surgeon, and over the past 50 years has probably done more than research in any other field to reduce mortality and disease and improve the quality of life for patients.’
     Surgical research and Freemasonry have gone hand in hand since at least 1966, when the Earl of Scarborough, then Grand Master, launched an appeal to found the Grand Lodge 250th Fund, which has donated more than £3.5 million to surgical research projects, and is the largest contributor to the College’s research programme. In the Royal College’s Report 2008-09, no less than six Research Fellows received funding from the Grand Lodge Fund. Freemasonry Today decided to go and see how the money is being spent.

Organ Transplants

I went to Addenbrookes Hospital, Cambridge, to meet Reza Motalleb-Zadeh. It’s 10 in the morning. An energetic figure in green surgical scrubs bursts through the swing doors. ‘Sorry I’m a little late – I’ve just finished assisting at a liver transplant operation.’ He’s been up all night, so after a decent break to allow him to restore himself, we install ourselves in his completely unpretentious office surrounded by files of research projects.
     ‘After my house officer year I came here to do my basic surgical training. One of the specialisms I did was cardiothoracic. It was the first time I had actually got my hands dirty doing operations. I wanted to do a research degree in cardiac surgery and a research position came up at St George’s in London for an MD degree, so I was there for a two-year research fellowship, of which one year was funded by the Freemasons. With the experience I gained I then switched into transplantation. I’m actually very happy now doing abdominal surgery. The research I’m doing now is about chronic rejection of organs after transplant.
     ‘For my research I did at St George’s I presented at many meetings relating to cardiac surgery, Vienna and Philadelphia were two. One of the things I have done is to set up a collaboration with Yale University. I spent a month there last year in the department of immunobiology, cooperating on aspects of the research we are doing here.
     ‘You’re not a Freemason,’ I asked, ‘how do you feel about Freemasonry funding your projects?’ ‘I was delighted when I heard that I’d got funding from the Freemasons. People in my family were Freemasons, and I know of the immense philanthropic work they have done. I had relatives in Iran who were Freemasons before the revolution. One of them was an uncle on my mothers side.’
     I asked him what was the aim of his present research. ‘This is very pioneering work, so it’s early to talk about it. Work on chronic rejection of organs is not particularly well-established. So we need to show that this is an important mechanism and find a way to block it. In this work, almost everything we find, there’s a new question that lies behind it. So there’s a tremendous amount of work that this type of research generates. I’m only looking at one piece of the jigsaw – there are so many other pieces in something as complicated as transplant immunology.’

Pancreatic Cancer

I spoke also with Adnan Sheikh, Research Fellow at Liverpool University Hospital, who is at the cutting edge of his specialism, pancreatic cancer. ‘This is the fifth most common cause of cancer death in the UK,’ he tells me, ‘with the lowest survival rate – only 3% of those diagnosed survive five years or more. The problem with pancreatic cancer is, it presents so late that when the patient shows symptoms, it is already too late to treat it. The key is early diagnosis. Now, we are trying to look for specific protein markers in the blood, in the same way that we look for indications in the blood of prostate cancer. So the hottest topic in pancreatic research is a biomarker. Another group of researchers are working on chemotherapeutic agents for advanced cancer or early cancer.
     Then there are those like me who are working at producing agents which will prevent the spread of the disease or at least increase the life expectancy of the patient.
     ‘I have been looking at proteins present in pancreatic cancer and also proteins present in the normal cells surrounding the cancer, because research indicates that cancer cells utilise the normal cells which surround them for their advantage, to allow them to spread and to disseminate through the body. Because the cancer cell itself cannot produce every different type of protein or biomolecule needed, it utilises some of the other cells which are specialised in producing these types of protein. These proteins produce movement in the cancer cells, not only pancreatic cancer but also other types. The next step is to understand this mechanism, how does the cancer cause an increase in these proteins around itself and how does this cancer use these proteins.’
     Adnan feels very privileged to be a beneficiary of masonic funding. ‘I was certainly aware of the good that Freemasonry does, but when I got the funding I went and read up about it. Then I presented at the Clerkenwell Lodge of Installed Masters in April 2008.’
     I asked him what motivated him. ‘I believe that if you work hard you can get the answer to anything, and that life rewards you according to the amount of work you do. But also, medicine is a profession in which ethics is right at the top, and without a good ethical and moral background, it’s very difficult to attain a good practice. Success in any field in life is according to the amount of effort you put in.
     ‘One of the obstacles we have is the European Working Time Directive. This has to be sorted out. If the patient’s operation has not gone well, if there are some complications, then you can’t just stop and say “Ok, I have to go home now”. If there is a whole queue of people in A&E waiting to be seen, then I have to see them, I can’t simply say, “Sorry, I have to stop – the Directive says so”. The medical profession and the politicians have never sat easily with each other, and I think it’s because people in medicine think with their heart, whereas politicians think with their mind. If you think with your heart, then you think what’s best for the patient.’
     Surgeons and Freemasons together display an impressive capacity for fruitful cooperation, and it is indeed significant that what is ‘best for the patient’ coincides with the place that all Freemasons start from.

THE ROYAL COLLEGE OF SURGEONS: EAGLE PROJECT

The Eagle Project is a three-phased project to transform the education facilities of the Royal College into a national centre of excellence for surgical education, training and assessment by 2010. It will be a hub for the promotion of safe surgery for patients.
     Phase II, The Clinical Skills Unit, was opened by HRH Princess Anne on 18 March 2009 and houses state-of-the-art technology which will revolutionise surgical training for surgical professionals; such as theatre nurses, surgical care practitioners and radiologists.
     The centre uses computer simulation technology to teach and evaluate surgical techniques such as removing a virtual gall bladder using keyhole surgery. In addition, virtual reality training will provide trainees in remote sites with access to learning via the Internet.
     In the fully functioning mock operating theatre, team interaction and role-playing can be recorded and video debrief techniques employed to enhance the learning experience. For the very first time, it is possible to develop and teach professional surgical teamworking skills by using simulated mannequins and multimedia facilities.
     The Royal College aspires to remain at the forefront of surgical education, and with this centre they can now make the most of technological innovation, including robotics, endoscopy and computer-aided navigation.