Interview: Eric Espiner talks about A Physician's Journey

Since graduating from the University of Otago Medical School in 1957, Eric Espiner has been at the forefront of endocrinology both in New Zealand and worldwide. He has received numerous awards and authored more than 350 peer-reviewed publications. He has also been heavily involved with training, teaching and mentoring both endocrinologists and research scientists. Now, in his tenth decade, when not dreaming of the next research project, he can be found hiking, biking or striking tennis balls. He also restores perspective through a lifelong passion for classical music of all genres. Eric talks to NZ Booklovers.

Tell us a little about A Physician’s Journey.

It is a remarkable story of how a small group of clinicians working with scientists in a community hospital developed methods for the measurement of hormones -initially to aide diagnosis and management of many endocrine disorders –but later expanded to study a variety of other disorders such as heart failure, skeletal growth and Parkinson’s disease. It illustrates the value of how careful clinical observations- linking hormones or biomarkers measurable in the blood stream with impaired organ function- may lead to new approaches in diagnosis and management of global significance.

What inspired you to write this book?

Being there on the ground floor -when this coupling of science with specific disorders was instituted by my mentor Donald Beaven (later knighted for his many contributions to Diabetes and Obesity)- gave me a bird's-eye view of the enormous flowering of clinical research that followed over the next six decades. The crucial ingredients of this success were the sustained commitment of professionals in seeking answers to the many factors underpinning disorders of health, the importance of accuracy and specificity in measuring individual hormones, and the ability to work across disciplines as new findings emerged from basic research in experimental animals. These advances occurred as part of “organic growth”-in contrast to research which targets, for example, the causes of lung cancer- and were largely drawn from careful observations in subjects admitted to a community hospital. This combination of “agencies” is unusual in medical research and for this reason needs to be aired with other groups undertaking research or its funding. But more than a dry compendium of facts, the narrative describes the influence of chance, serendipity, and vagaries involved in obtaining funding or patent protection of discoveries. All these wild cards add colour to the story and never appear in reports published in the scientific literature.

What research was involved?

The bones of the narrative were hard wired in my memory- all the forks in the road such as new findings from basic research relevant to our work, arrival and timing of key clinicians or scientists adding strength to the group, or the ups and downs as support from big Pharma came in -then faded away overnight in some cases. Some “research” relating to names and key dates or sequence or events required checking but the actual writing was free flow by and large. 

What was your routine or process when writing this book?

I first made a list of the key people contributing to the story, and the key developments that changed the course of the journey. For example, it all started with the way the adrenal gland was regulated by the pituitary gland at the base of the brain, then how hormones from the kidneys regulated the adrenal gland's role in regulating salt balance and blood pressure. After that, how the study of these hormones in people with heart failure led to treatments that greatly improved outcomes by blocking these hormones. A major fork in the road followed our discovery that in humans, the heart itself was an endocrine gland, from which much else followed, as shown graphically in the book cover design.

I always hand-wrote these sections, later transcribing them onto my laptop, adjusting and correcting the flow or descriptions as appropriate to the topic. Spaces were left open for citations or dates to be filled later. In this way, the flow of the narrative was maintained.

What did you enjoy the most about writing this book?

It was a delight to recognise the enormous contributions made by so many outstanding individuals over the course of some 65 years of engrossing research. People who were crucial to the enterprise but often not sufficiently acknowledged.

What are some key things you hope people take away from reading?

First, the importance of developing accurate, precise and fully validated methods of measuring the hormone or biomarker of interest. The former is a product that is secreted into the bloodstream to regulate the function of distinct tissues, and the latter is usually an inactive product of a tissue-based hormone that only acts at the source. Today, many commercial kits are advertised for use but have not been fully validated, and even though the instructions state” for research only “are used by the research community to study their role in tissues or experimental animals with quite misleading results.

Second, the importance of sustained funding for productive groups. Much of our work in recent decades has not been funded by NZ agencies and was only made possible by support from the private de bono Christchurch Heart Institute.

Third how collaboration across disciplines – and across national boundaries is crucial to successful outcomes. Too often research is conducted in silos without input from other disciplines. The way the body works tells us of the many interconnecting signalling pathways, yet any one research project can only inform on a small component of the many interacting forces.

Fourth, the need for improved professional advice and action from Patent lawyers who need to be closely connected to those discovering the new technology and its subsequent dissemination. 

What did you do to celebrate finishing this book?

Nothing special as there is still much to do in communicating the message to the public. It was a thrill to finally receive the finished item in the hand, and flick through the pages but no corks were popped. Maybe when things slow down -and I can savour the experience with close friends and relations – there will be an opportunity to celebrate.

What is the favourite book you have read so far this year and why?

It is a toss-up among Nexus (Harari), How the body works (Philip Ball) and Determined (Robert Sapolsky). I think the latter wins because the book makes an excellent case in explaining our behaviour which is largely outside our control. And importantly sets the stage for the role society should play in administering justice and minimising unrest and confrontation.

What’s next on the agenda for you?

Even though one may meet an objective and have new findings published, research is never done as more questions arise that need addressing. In the pipeline is a study of heart-related hormones in a large group of subjects recruited in the USA with congenital disorders of bone growth. Some of these conditions appear to lack the heart-related hormone and could benefit from treatment that removes the deficiency.  There is also a large follow-up study of healthy volunteers at middle age, re-studied 15 years later. Here we will examine how well measurements of the heart hormones at 50 predict cardiovascular health at age 65.

Between times, I hope to scramble over the port hills, cycle around the city environs and listen to some great music when not outdoors.

Quentin Wilson Publishing