12 January 2016

The ‘four seasons’ of a clinical academic without borders

Welcome to the first medical education blog of 2016. This month we are pleased that we have a series of four weekly blogs from Warwick Medical School’s own Franco Cappuccio, Professor of Cardiovascular Medicine & Epidemiology who will take us on a journey through the ‘four seasons’ of his career to date as a clinical academic which we hope will inspire and delight you and hopefully encourage some of you to follow suit in this challenging but fulfilling medical career path.

Part 1. The Foundation Season (1975-1988) by Professor Franco Cappuccio

No human story is alike. We’re all different. Different in ambitions, abilities, preferences, resilience, fears, beliefs, motivations, strengths, weaknesses. Furthermore, serendipity is often around the corner to change our lives. Yet, patterns exist that may repeat themselves over years and generations, so that we can all learn from someone else’s experiences. I have been asked to write a blog about my profession for those of you who have started on the path to become a physician. I am not sure how many of you will find my reflections relevant to your own circumstances. The very fact that I am writing and that you are reading, however, fulfils the primary objective: sharing experiences.

Pietro Fabris ~1760 (Compton Verney, Warwickshire) 
A basic biography is necessary to grasp the nuances of my tale. I was born in a city that has inspired many over the centuries, struck by its beauty and its startling contrasts of wealth and poverty, affluence and despair. The typical scene of Neapolitan peasant life, painted by Pietro Fabris, includes musicians, card players and a wine seller, as seen through the mouth of a cave by the Bay of Naples with the Castel dell’Ovo and Vesuvius in the distance.  
On the left is Naples as it looked almost two centuries ago, with the beautiful sea front promenade and the Vesuvius in the background, and below, as it is now. A familiar view to those who have been there!

The reason for this long-winded preface is that the most common question I have had to answer in the past thirty years is ‘why on earth did you come to Britain?’ 

I started medical school in 1975 in Naples. The curriculum was made of three pre-clinical years followed by three clinical ones. At the beginning of year 4, I had the option to choose what type of dissertation to prepare for the finals. In those days, the dissertation was not a formality but contributed significantly to the final mark. I could have opted for a ‘descriptive’ piece on a chosen subject or for a more challenging ‘research’ piece. The latter would require practical work for the following two years, in parallel to completing the busy curriculum of subjects and exams. Whilst I had shown some early interest in orthopaedic surgery, after 6 months of frequenting orthopaedic theatres and ward rounds, I decided that I would never become a surgeon!

Instead I became fascinated with general medicine. The first act of serendipity was to apply for a research placement in the Academic Department of Medicine when they granted me a ‘research’ dissertation in the broad subject of hypertension. It was 1978! That episode steered most of my future career. I studied the effects of alpha-beta adrenergic blockade on the peripheral vasculature of patients with hypertension using strain-gauge plethysmography of the lower limbs. I completed the study on time, wrote up the dissertation and got the highest marks at finals. 

Federico II University of Naples Medical School 
Whilst enrolled in a Specialty MD I became involved in the Olivetti Heart Study, an epidemiological study of cardiovascular risk factors and hypertension in the male workforce of a local factory near Naples. The major objective of my project was to explore a possible association between blood pressure and 24h urinary sodium excretion, a biomarker of salt consumption. This project too saw a successful completion with my first international publication

Charing Cross Hospital in Fulham 

During this time, I became fascinated with the ‘salt story’ as a possible cause of high blood pressure. The opportunity to spend some time abroad with a fellowship provided by my supervisor gave me the chance of my life (so to speak!) and I joined the Charing Cross Hospital in Fulham where Hugh de Wardener and Graham MacGregor had developed a hypothesis that would dominate the next 15 years of research in the field.   

Six months into my first research job, a rare opportunity came from the Italian Ministry of Health for a research fellowship to be spent at a foreign institution. I went for it without realising that it was a national contest with over 1,200 candidates competing for only 49 awards! My colleagues considered this an utterly unrealistic and foolish attempt. However, in order to succeed - I guess - we have to have some dose of self-belief and be determined. To cut the story short, I endured a stepwise selection with two written tests and a viva and, to everyone’s disbelief, I was awarded a fellowship. This gave me enough funds to stay three years at Charing Cross and to get married as well. These were three fantastic foundation years. I learnt a great deal about what clinical research is, how it is done, how to produce good research papers, and I began travelling the world presenting research results and developing a true passion for the subject. During this time I produced my first author paper, first BMJ paper, first Lancet paper, and first international oral presentation. 

Next time: The Growth Season. If you have any questions or comments for Professor Cappuccio please post below. 

Career learning points:

  • Follow your interest and passion.
  • Keep an open mind.
  • Be positive, things will happen.

What did my research show about salt?

  • There is a significant and graded relationship between the level of salt intake and the level of blood pressure. 
  • The kidneys are central on how sodium is handled by the body.
  • The renin-angiotensin-aldosterone system is pivotal in regulating the blood pressure response to changes in salt intake. 
  • First randomized controlled evidence that reducing salt intake reduces blood pressure

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