Observations BMJ Confidential

Joanna Poulton: Research is in my DNA

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5467 (Published 06 December 2017) Cite this as: BMJ 2017;359:j5467

Biography

Joanna Poulton is professor and honorary consultant in mitochondrial genetics at Oxford, where she works on diseases caused by mutant mitochondrial DNA. Such mutations, passed down the female line, can cause a range of conditions including deafness, blindness, diabetes, and heart and liver failure. In most cases people have a mixture of normal and damaged DNA (heteroplasmy), and the severity of the condition depends on the proportions of each. Her data on the transmission of mitochondrial DNA (the “bottleneck”) were a breakthrough for mitochondrial prenatal diagnosis and ultimately for high profile mitochondrial replacement therapy. Poulton hopes that drugs may help harness a natural cellular quality control system to alter this balance favourably and reduce disease severity.

What was your earliest ambition?

To be a fairy, with wings and a magic wand.

Who has been your biggest inspiration?

My parents: my mother, who got her Cambridge MD at age 90; and my father, who taught all of us scientific method and critical thinking.

What was your best career move?

Leaving my job as a temporary lecturer in paediatrics to start my first research job as an action research training fellow. This gave me freedom from clinical work and the time to think and learn the tools of the trade. My supervisor, Mark Gardiner, suggested courses, training opportunities, and challenges. When the British Paediatric Neurology Association refused my application for membership he suggested that I put in for the association’s Ronnie MacKeith prize. When I won it they had to let me in!

What was the worst mistake in your career?

When my supervisor was headhunted for a chair in London I should have followed him and commuted from Oxford. But my second child had just arrived, and I was heading for six months in Stanford, USA, on a generous Medical Research Council travelling fellowship followed by a Wellcome senior research fellowship in clinical science. We both thought that I should stand on my own feet, but I struggled without his mentoring and became the odd (wo)man out in a department with different interests. But it was the right choice for my family life and my wonderful husband (also an Oxford academic).

How is your work-life balance?

Improved by music. I sing in the Cathedral Singers of Christ Church, Oxford. This fabulous music transports me out of disappointments and into heavenly inspiration.

How do you keep fit and healthy?

Cycling to work, trampolining, gentle running (more of a waddle), and walking holidays.

What single change would you like to see made to the NHS?

Better resources, supplied by a genuinely engaged government minister.

What do you wish that you had known when you were younger?

Two things. Firstly, that there’s a glass ceiling: I didn’t know this until I hit it. My parents were so egalitarian that I didn’t even realise the world assumes that most women failed to get promotion. Secondly, that I’d benefit by stepping out of my comfort zone to access available resources. My move as a paediatrician/geneticist to the supportive Nuffield Department of Obstetrics and Gynaecology is one such example—I got collaborators, placentas, and oocytes for fundamental studies of mitochondrial DNA transmission; but again, if you’re a greying woman over 50 you should expect to be overlooked as a meeting chair or speaker unless you’re superlative or have links with the organiser. The only way to be involved in discussion is to sit at the front and ask the best questions.

Do doctors get paid enough?

Yes. In a grant crisis I went from a medical salary to a science salary for doing the same clinical research job, and my salary dropped by 45%. It’s crazy that the clinical and non-clinical scales differ by so much.

To whom would you most like to apologise?

Team members whose papers and grant funding stalled because of repeated failures: twice I had uninterrupted runs of 15 unfunded grant applications. One paper took 17 submissions over seven years and was then the editors’ choice.

What do you usually wear to work?

First it must be comfortable, second stylish, third in sufficient condition (not too many holes).

Which living doctor do you most admire, and why?

Victor Dubowitz, because of his clinical skill, intelligence, originality, energy, and ability to overcome obstacles and encourage others.

What is the worst job you have done?

I wasn’t right for community paediatrics. I couldn’t engage with the patients’ problems.

What single unheralded change has made the most difference in your field in your lifetime?

The polymerase chain reaction, a simple way of copying DNA, revolutionised molecular work.

What new technology or development are you most looking forward to?

Bioinformatics that are really accessible, so that we can immediately understand output of next generation sequencing.

What book should every doctor read?

Animal Farm by George Orwell. Becoming a powerful baron in any field can corrupt the best of intentions.

What is your guiltiest pleasure?

Not “guiltiest,” but most secret: finding that my ADHD (something that I’d suspected but not confirmed until well into my 50s), and my disorganisation that sabotaged grant applications and papers, responds to medication. I start to function efficiently, and I can even stay focused in outpatients.

Where are or when were you happiest?

Having both a family and a vibrant team for my research, funded at different times by Wellcome and the MRC. When the research went badly the family were rewarding. When the kids were problematic the research was great.

What television programmes do you like?

Fawlty Towers: grains of truth about ourselves in John Cleese.

What personal ambition do you still have?

To get another Wellcome grant. I have research questions I must answer.

Summarise your personality in three words

Original, tenacious, disorganised.

What is your pet hate?

In discussions about patients, using numbers instead of names for the sake of confidentiality. Mistakes are bound to be made and families sent the wrong information, no matter how careful we are. The risk and damage done by muddling exceeds that from possible breaches of confidentiality: all are about children who have died—none are about highly confidential issues such as venereal disease or paternity. The patients who risk confidentiality by asking me questions in emails have got it right: this excessive zeal for confidentiality is madness.

What would be on the menu for your last supper?

Bread and wine in a choral Eucharist at Christ Church Cathedral.

What poem, song, or of prose would you like mourners at your funeral to hear?

“Come, my Way, my Truth, my Life,” by George Herbert. He praises “such a truth as ends all strife . . .” In science, truth sets you free; people who misrepresent data make themselves prisoners.

Do you believe in doctor assisted suicide?

Depressed people who feel guilty about being a burden can be pressurised into making these requests prematurely. A dear friend of my mother’s seemed hurried out on his morphine drip, without saying farewell to my mother—for whom he was a joy, not a burden.

Is the thought of retirement a dream or a nightmare?

Although I’ll miss the scientific questions and ideas patients pose, I’m looking forward to giving up clinical work so that I can focus on research.

If you weren’t in your present position what would you be doing instead?

I’d be a research scientist in some other field.

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