Professor James Angus AO
Professor James Angus has been an Honorary Professorial Fellow and Professor Emeritus of the Department of Pharmacology and Therapeutics, Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne since 2014. When this podcast was recorded he was the Dean, Faculty of Medicine, Dentistry and Health Sciences.
Ccentric conducted a series of podcast interviews with several leaders in healthcare and academia, all are currently available on the Ccentric knowledge page here.
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Wayne Bruce (WB): Jim, thanks very much for your time today. Can I start by asking you to perhaps tell us briefly about your career path, where it’s led to your current role and as part of that could you outline the most interesting job you’ve ever had?
Professor James Angus (JA): Thanks Wayne and thanks for the opportunity to answer some of these very interesting questions. I started life as a scientist at Sydney University doing a BSc degree thinking I always wanted to do research. I could have got into medical school, I had a maximum pass at the leaving certificate, but research was my goal and I thought I was going to be a biochemist. By the time I finished second year that was not what I wanted to do, I thought cleaning test tubes seven times over was not appropriate. So I looked in the handbook and there was this subject pharmacology so I completed the BSc with a major in pharmacology, went on and did honours and then enrolled in a PhD at the University of Sydney with a supervisor being a cardiologist from Macquarie Street, David Richmond and that opened my eyes to the wonderful relationship between basic science and clinical medicine particularly cardiovascular pharmacology. David gave up a day of his busy week to be in my laboratory. I had worked with a guy, Tony Goodman who developed an analogue myocardial contractility computer, so I was all set up for my PhD to measure myocardial contractility in the awake human in the cath lab. And this was pioneering stuff for Australia and possibly only one or two centres in the world was going along this path. So, I had a dream run and it was the mentors I had and the opportunities to work closely with clinicians.
I then was offered a job in Santos in Switzerland to head up pharmacology as a young postdoc but instead of that, Paul Korner, who was the director of cardiology at the Hallstrom Institute of Cardiology at Royal Prince Alfred Hospital said he wanted to see me and basically he said “What did you want to do in ten years’ time”, I finished up by saying that I guess I want to do research, “Where do you want to do it?” I said probably in Australia, he said “Right, come and work for me”. So, we didn’t go to Sandos, I had just been married and I worked as the first scientist in Paul Korner’s research lab in hypotension.
Within 18 months he was moving to take up the directorship of the Baker Medical Research Institute in Melbourne and he asked me to go with him. Then I won a prestigious C.J. Martin fellowship to work overseas and I chose to work with a man James Black who had discovered propranolol and cimetidine and he really was the leader in the world in analytical pharmacology. He had first said don’t come because we don’t do intact animal cardiovascular research, I said I know that, I want to learn something different and that was medicinal chemistry. And so, he said come along and I was the second only international student ever to work with James Blake, it was a fortunate choice because after I left him in 1984 he was awarded the Nobel Prize. So that really set my career up, the world was my oyster having worked with James Black. I was offered a wonderful job to work with Merck and with other drug companies, Genentech another one in San Francisco but my wife and I, and our small children decided we’d come back to Melbourne. So, I came back to the Baker Institute, headed up the cardiovascular laboratory and again under the leadership of Paul Korner we developed a wonderful small pharmacology research team closely interacting with the team across in the hospital in the cardiologists, Archer Broughton and Garry Jennings and others. I went up the totem pole became the deputy director of the Institute and a professor at Monash, I did a lot of work for the NHMRC as you do as a young fellow and then Paul Korner retired. The institute appointed John Funder is the new director, I worked there under him as a deputy director for two years and then was offered the Chair of pharmacology here at Melbourne. So, you might say that I’d already had a wonderful research career, with working in a great institution under a wonderful director, so what was left for J. Angus and with the opportunity coming to Melbourne was that David Pennington who was the Vice Chancellor in that day said that he wanted to extend the medical school to build new facilities for pharmacology. I accepted that and put two floors on here for 20 million and created what I believe is arguably the best cardiovascular facility and pharmacology department in the world. To thank the university, I was invited to be a board officer for the academic board, you have three years of two years of each being the deputy, then Vice and then the President of the academic board and that opened my eyes to the richness of this extraordinary institution. And so, by 2001 I was president, Alan Gilbert was the vice chancellor and Sally Walker was part time vice chancellor. But that showed me a much broader palette, if you like, of leadership both in quality in teaching and research which basically I could handle the research angle but to actually see the teaching and the knowledge transfer and other things we do in university was a great leadership opportunity. I then finished that term and I was invited to be the deputy Dean, Richard Larkins was the Dean, and soon after I came back to the faculty in that role, Richard was appointed Vice Chancellor of Monash, and so Alan Gilbert set in place a process to appoint a new dean. And I’ve been Dean since 2003. The faculty is huge. It’s a 450-million-dollar enterprise, it’s as large as some of the Go8 universities. My faculty itself is as large as the University of Adelaide. It’s very complex, we’ve completely restructured in the last 12 months. I spent a lot of my time, probably at least half, working with our stakeholders with medical research institute directors, with their boards, with hospitals, government both federal and state. So, it’s an absorbing, complex, exciting role. I don’t think you can be trained for it, I think you have to have a very fair-minded approach to everybody and seek advice and make decisions. So, has it been an interesting job? I wouldn’t swap it for anything, but I think at these very high-level positions you can’t do it for more than two terms and I’m just entered my seventh year out of out of a ten-year term.
WB: Very Interesting. Jim where do you see the medical research sector heading over the next five or 10 years, given the extensive history you’ve had within it?
JA: It’s this, if I was a young scientist starting off today there is the most exciting opportunities I think in molecular science that we’ve ever had of course but it’s both at the molecular level with all the wonderful opportunities with new technologies, with the genome, with the control of genes and the RNA now and the sort of junk RNA and DNA that we thought was around has certainly got very important roles to play. So, I think that’s very exciting but let’s not forget the systems biology that we have to put this knowledge back into an integrated system. And as James Black rightly said, “whatever you discover at the molecular level has to come back into the integrated body which at the higher level of organisation will trump the information below”, if you can use that analogy from a card game, and I think that’s where pharmacology and science comes together. We love it as scientists to be able to think about A plus B equals C the molecular level. But if we don’t understand systems biology then we will not be able to translate this science, wonderful science and opportunities, into true translation to healthcare. That for me today is that we must do both, it’s not one or the other, we’ve got to put our limited resources in keeping the basic science driving but also getting the integrated systems, and of course, the translation and then into policy and how we can effectively use and test through evidence based medicine very important clinical trial work and that leadership has to be with the clinical scientists working closely day by day with the base scientists. Both have to work together and know each other’s business and that to me is the greatest risk we have at the moment, if we turn to a risk for a moment, that have we actually got enough resource to get the clinical researchers working, if you like, with protected time apart from their busy schedules of saving lives and the clinical medicine, can they actually delivered in clinical research. That to me is a real pressure point at the moment and funding of research in this country.
WB: Do you think that’s one that’s easily solved?
JA: We have to make politicians and the grant bodies aware of this gap. It’s communication and getting them to understand this is not, should not be political. This is about the future of healthcare and we have to be a lot smarter. We bring in new devices, bring in new drugs, unless we properly find their needs, it’s going to waste resources. But you know who’s going to pay for those clinical trials? Who’s going to be the engine room to the trials and analyse them? We need a real rich mix of skills to do so.
WB: And I guess you know with institutions like Bio21, which I know the university is involved with, and it’s a key thing the Victorian Government’s been focusing on, I mean the whole biomedical sector is a potentially huge industry of the future for Australia, given our sort of competitive advantages in that area. Do you have a view on how we capitalise on that as a country?
JA: Well I mean, there’s no doubt we punch above our weight. The announcement on Monday night of Elizabeth Blackburn winning the Nobel Prize, this is a wonderful focus now on the science method or the science process. It starts of course with very good solid education and that desire, that spark that can be turned into a bushfire as she had from chemistry back in Launceston. I mean this is, you know, where’s that spark in the schools? Where does it start in the kindergarten? The inquiry. We’ve got to be at all levels, we can’t wait until the university, it has got a start, as it did for me, like it did for Elizabeth, back in the garden shed at home where I used to fill up balloons with hydrogen gas, all sorts of things, pull cocks apart. This is what it’s doing science is about. And we’ve got to make sure that we have the teachers who can actually stimulate the children right through school.
WB: And where do you see or what do you see as the key issues affecting healthcare at present?
JA: I think it is the limit of resources, where there is a finite, we have to make choices and unless we’ve got the evidence to make those choices we are going to waste resources. The other one of course is in preventative medicine. I think with the Health and Hospital Reform Commission report that’s out, this increasing resource into staying well and taking the individual taking responsibility for it are key issues. If we don’t get that out and everybody’s looking for someone else to prop them up when they are ill then we are not going to get the appropriate outcomes we’re looking for. We have a fabulous health system in this country, there’s no doubt about that, and we want to maintain it and actually make it even better. It’s probably one or two in the world.
WB: The University of Melbourne and the Faculty of Medicine and Dentistry Health Sciences has recently changed from undergraduate to a postgraduate model for its medical degrees. What do you see is the benefit of doing this?
JA: Well over the last 10 years or so we’ve had a dual degree pathway where both school leavers and graduates could take an MBBS degree, so we were running them in parallel and in fact they were joining in lectures and in classes together, the two cohorts, but for the one degree and examined under the same conditions. These students coming out of school also had one year of research called the ‘Advanced Medical Science Year’ and gave them all a compulsory taste of doing either basic or clinical research and we thought that was very valuable for them for the particular medical graduate that we want to produce.
We now feel that we’re moving to another stage and that as you rightly say is graduate only entry into medicine but it’s not going to be as it was before. It’s going to rely on the first degree being in cognate science disciplines, so you need some biochemistry, some anatomy, some physiology etc. in your first science degree, some core subjects and then you’d be selected, if you’re a strong student of course and with the right attributes, into a graduate medical degree four years. At this university, we will be defining that as an M.D., like they do in the Doctor of Medicine, like they do in the US and in other countries, but that means it’s being taught at the master level. It is not to be confused with a PhD, of course, it is a master’s level medical degree, first entry medical degree. Now we believe then that the students will be a) more mature when they enter medicine as a graduate but b) will have the foundation of a strong science degree to build into their clinical medicine. We believe that if they don’t have the wherewithal with basic science, they will struggle or, if you’d like, not apply the new science as it’s developed from a strong base and we need that, we believe, at Melbourne to fulfil the type of attribute and the young doctor we want to graduate, ready for their internship.
WB: The competition for healthcare workforce is global now and it’s going to become more global. How do you think we position ourselves, as a country, to compete effectively in that area? Are there things we should be doing that we’re not doing now?
JA: That’s a good set of questions there. It is the environment that is very attractive, in Australia, both for the living conditions, the quality of life we have, it is wonderful, but it doesn’t suit everybody. And, of course we’ve got a lot of our population outside the cities. When we think of the outer metro and rural and regional and remote you can’t expect every top line specialist to be available for an appointment next week. So, what can we do about that? We have to fill that need or make use of our resources in a way to meet that need. Now you can move people around by helicopter or light plane. That’s an issue you can bring the doctors to do into an area for a particular set of cataracts or whatever you might do. So, there’s lots of ways you can set this up.
Another way is to get our young doctors to spend some time before they, if you like, move into the private sector, in a rural or remote region. I think it would be very good for medicine to do so, so there’s lots of ways the government will need to continue to change the way our workforce is distributed. Depending upon their career path and time, you might need to use different incentives. If you’re in Malaysia, I understand, that if you’re trained in the public system as a hospital as a doctor you have to spend up to 10 years in the public sector before you can move into the private system. So, there’s other ways that countries use to distribute their workforce.
WB: What competencies do you think that the academic leaders of today need to be successful?
JA: Yes, the academic leaders is another workforce shortage. I mean as you know, if you read the papers, that the academics the average age is more than 50. Now well that is not what it used to be. So where is the career paths to attract academics and clinical academics/medical academics to run the medical schools is in really short supply as we’ve had to expand new medical schools one of the real gates to this barriers has been where do you find a competent academic workforce to actually populate these new medical schools. And so, it is even in the hospitals, who’s going to do the teaching and the training. I think you’ve got to give them A) reasonable remuneration, B) look at the quality of the workload. There’s nothing more satisfying than teaching, seeing those light bulbs turn on and actually feel as a teacher you’ve made a difference, and unless you’ve experienced it you can’t know how powerful that is, so there is that drawcard. But once you’ve done it, you know, it’s amazing how it gets in your blood. It’s like research once you’ve made a discovery in your blood. And so what we want to do at Melbourne is to ensure that every one of our medical graduates has been taught how to teach and then we would ask them when they move into the internship and being a registrar, they will have some protected time for research and teaching and it’s remunerated so they don’t, if you like, at the present time most of it’s done pro bono in their own time. That pressures on quality sometimes, it means that they do it as an afterthought, leaving the student stranded on occasions. we can’t have that. We must look at the quality and protect these academic teachers with appropriate remunerated time, not at the specialist level, but at a reasonable level so that they can actually have time to teach.
WB: And if you were mentoring an aspiring academic or clinician James, what would be your advice to them about how to chart their career?
JA: I think it’s all about the environment. Choosing your mentor and choosing the lab or the environment. It is critical. So do your homework, ask some questions, go and meet the current PhD students or students who have been through a particular branch and see how they got on, and then you’ll find out very quickly what works and what doesn’t work. It is a bit of a lottery, like choosing a research topic is a bit of a lottery but I’ve always found that if I have two or three projects on the go, they rise and fall and have their own momentum at different times as the science comes and goes. And keep going. Don’t you just, what I’ve always done is work hard and play hard, I think you’ve got to keep yourself very fit. If you’re going to really get into this high level 24/7 but it’s a wonderful tool. I mean being a scientist, teacher, leader now in the medical school I mean I couldn’t ask for anything better.
WB: That makes a great note to end the interview on. Thanks for your time.
JA: Thanks very much.