Working life: Professor Janet Darbyshire
Professor Janet Darbyshire worked in medicine and then clinical trial based research from the early 1970s. Playing an instrumental role in the development of HIV treatment, she’s worked on and coordinated many clinical trial programmes in the UK and Africa. Last month we celebrated her achievements at a ceremony held within the Houses of Parliament, awarding Janet our most prestigious award, the MRC Millennium Medal. Here Janet tells us about her early memories of medicine, giraffes in Africa and the changes she’s seen her research make to people’s lives.
Career in brief
- Qualified in medicine at The University of Manchester in 1970
- MSc in Epidemiology from the London School of Hygiene and Tropical Medicine 1990
- Became head of the MRC HIV Clinical Trials Centre in London in 1989
- In 1998 established, and became director of, the MRC Clinical Trials Unit (CTU)
- Awarded an OBE in 1996 and a CBE in 2010 for services to clinical sciences
I was interested in public health at the very beginning. My father was a public health inspector, and worked very closely with the medical officer of health. He used to take me to the pathology lab with him, and although I mostly remember the dreadful smell, it did spark my interest in medicine.
It’s serendipity that I specialised in respiratory medicine. I applied for a job at the Whittington Hospital in London and was allocated to jobs in chest medicine and neurology. I didn’t want to do geriatrics or pediatrics, and I discovered that respiratory medicine was really interesting. So I went on to train in this area at the Royal Brompton Hospital.
Then, after that, some more serendipity. I decided I’d try and move into a research job and the MRC Tuberculosis and Chest Diseases Unit, directed by Professor Wallace Fox, happened to be located at Brompton Hospital and a vacancy arose just at the right time.
The person who made me a proper epidemiologist was Geoffrey Rose who was a wonderful epidemiologist. I’d been working at the MRC unit doing trials and epidemiological studies for over 10 years when it closed on Wallace Fox’s retirement. Geoffrey suggested I do a Master’s degree in epidemiology because, although I knew my stuff, thanks to Wallace, I really didn’t have strong theoretical underpinning.
The first clinical study I was involved in was a survey in 1974, looking at tuberculosis in Kenya and the impact of treatment. After that I became involved in some of the short course chemotherapy trials. One of the first ones I was responsible for was called Study X. The trial was stopped very early because we had tried to shorten the treatment to four months, and it wasn’t long enough. A lot of patients didn’t do well and we learned that with the drugs available 6 months was the minimum for effective tuberculosis treatment.
I was lucky because when I started working in Africa there was already a well-established collaboration with what was the East African Medical Research Council. There were staff based in Kenya, Tanzania, Uganda, and Zambia. I used to go and visit all the clinical sites with the local people.
In the early days, the hospitals and trials there were running very well. As time went on and the East African community broke up it became more difficult. I think the biggest problem was having sufficient funds to keep things going in the district hospitals. The first request I would often have is, “Can we have some more money for petrol?”. It was the practical side of running the trials on a day to day basis that was the most difficult but the results of the trials have had an impact worldwide.
I fondly remember my experiences of working in Kenya; the smells, the colours, the most amazing view of the Great Rift Valley, the giraffes and the mountains, Kilimanjaro and Kenya. When my husband was visiting and we went to a lodge we had a family of elephants walk right in front of us. I’ll never forget how very friendly and hard working the people I worked with were.
When I first got involved in HIV research in the late ‘80s It was an almost universally fatal disease. Now people with HIV can have a near normal lifespan provided they remember to take the drugs and are able to manage the side effects.
It’s often not one clinical trial that makes a huge difference. It’s more that each trial added to our understanding of HIV and improved treatment. The first HIV trial we did with a single drug was disappointing, because it showed that giving one drug very early didn’t improve survival. But it did show that giving one drug led to resistance, like in tuberculosis. We went on to find that two drugs were better than one, and three drugs better than two, and that’s the way that the therapy has moved on.
Once the cost of drugs to treat HIV had come down we set up a rather different trial, the DART trial, with a tremendous international collaboration between the UK, Uganda and Zimbabwe, two beautiful African countries that I had not visited before.
We wanted to know if treatment for HIV could be safely given without the expensive laboratory tests that were routine the UK. DART demonstrated that HIV treatment could be given safely and successfully without routine tests, which meant for the same budget it could be delivered to more people and closer to their homes through local clinics.
Seeing the change my research has made to people’s lives is fantastic. When I first used to go to Uganda, during the HIV epidemic, we’d drive into Kampala from the airport and everyone was making coffins at the side of the road. When I went back some years later, they’d gone back to making furniture. The hospitals used to be completely full of patients with HIV/AIDS, but now things are very, very different.
I have been very inspired by those people, who continued to work under amazingly difficult circumstances in Africa, at the peak of the HIV epidemic, looking after very sick patients. They inspired me by their ability to say, “Yes, we’ll do research to improve future health, as well as treat our patients”. Their capacity is amazing and the results of their efforts have helped millions.
As told to Petra Kiviniemi