Dr Baker was awarded a PhD at Newcastle University, and has continued to work in a clinical and research capacity, closely aligned with the NIHR Newcastle BRC’s Musculoskeletal Disease Theme. He tells us about his career development, his current research focus, and what value he has found being part of a broad network of healthcare and research infrastructure in the North East and North Cumbria.
I started as a full-time clinical trainee and got involved in the academic pathway via a more indirect route. At the time I had no experience of clinical research, so when a BRC-funded program for clinical researchers came up, I used this to link up with the academic career pathway. The Newcastle BRC supported part of my salary but has also provided me with funding to carry out research and clinical trials too. On a practical level, the Newcastle BRC also supports the infrastructure that enables clinical research to take place, which helped me to carry out my work overall.
I have also benefited from wider training support. For example, the NIHR Academy is a national collective of NIHR-funded trainees and they provide a lot of guidance and support. I attended two of their annual training camps which helped me develop many new and positive transferrable skills. Opportunities like this have helped progress my career.
Patient input is essential. I need to understand patient’s healthcare needs, but also their thoughts on the design of the research. For example, when I was first designing my PhD study, there was the general impression amongst clinicians that patients would not be interested in stopping drugs for a research trial. Before I even started my PhD, I did a qualitative study with patients who had rheumatoid arthritis to find out their thoughts on this. We discovered that it was something they would be very interested in. This information was helpful in terms of designing the study, particularly when it came to ethical approval. It is really very powerful to be able to say that we have spoken to patients as part of our research. The patients I speak to also give useful insights into study design. This improves the likelihood that they will take part. We have changed aspects of our trials based on patient feedback, and this has made a huge difference to recruitment.
Lastly, it is very valuable to be involved in dedicated groups. For example, I am involved in the PIMS Group (Patient and public Involvement and engagement in Musculoskeletal reSearch). This group welcomes researchers to present to patients and get direct feedback, as well as engaging patients and the public in our exciting new discoveries.
Overall, I have found that patient and public involvement is very fun to do. It is something that I will continue to do more and more in the future.
I have had some great industry collaboration. My research involves studying samples before and after an arthritis flare. We measure inflammatory proteins in the bloodstream using highly sensitive technologies. Our collaboration with a major pharmaceutical company facilitates this.
In the future, there is also potential to collaborate with industry partners specialising in diagnostics.
I am trying to validate the biological markers gathered as part of my PhD work. Once this has been validated, we can move forward to create a clinical assay which can be tested in a clinical trial. This will hopefully provide a test to determine which patients can stop drugs while in remission. To do this, we’re looking at cellular markers and the types of white blood cells in the bloodstream. We’re examining whether profiling those and then identifying certain types of white blood cell could help us to predict who could safely stop drugs. From here we could develop a test, to see whether this could reduce the rate of flare in people stopping drugs within a clinical trial.
That would be quite exciting, as it would be the first clinical trial of a biomarker-driven approach to stopping drugs in patients with rheumatoid arthritis. You could envisage this being rolled out to other autoimmune diseases if it was effective.
I think we can do a lot more in personalised therapy. Currently, it is one size fits all, which is trial and error. All patients are all given the same treatment after diagnosis. If it doesn’t work, clinicians will offer another drug. This might be by preference, rather than knowledge of the specific mechanisms of that patient’s disease. Ideally, a test could tell us which patients would respond to which drug before they start. This would be done at an individual patient level, in a similar way to how certain modern cancer drugs are used today. Once patients have responded to their drug and achieved remission, tests to identify who can safely reduce or stop treatment would reduce side-effects, improve quality of life, and improve healthcare efficiency. It’s all about giving the right drug to the right patient, at the right time.
Research has really changed the way I practice medicine. It is quite easy to fall into a pattern when you're doing clinical medicine. Often you don't stop to think about new improved ways of working. Research has helped me to be more innovative and willing to explore new ways of treating patients. For example, one of my projects will examine remote monitoring for patients living with rheumatoid arthritis. Traditionally, hospitals invite all patients to have their disease activity measured in person. This flags up if they have active arthritis, and what to do with their treatment. However, some patients who are doing quite well may be eligible for remote assessment instead. This would involve patient self-reported measures which can feed into a system whereby we can remotely monitor disease activity. The system could flag up patients who might need an earlier hospital review, versus those who are doing well and could avoid unnecessary trips to clinic.
Innovative new models of care such as this will greatly help us to improve patient experience. They can also help to use limited hospital resources more efficiently. This is especially important as we recover from the COVID-19 pandemic.
I have recruited patients from across the region for my PhD study. This has given me first-hand experience of how valuable the North East and North Cumbria network is. Additionally, I have worked with colleagues from a range of areas within Newcastle University to support my study. This has involved many of the excellent core facilities we have here in Newcastle. I know I could not have achieved as much as I have without their expertise and support. Going forward it will be great to link with organisations like the NIHR Newcastle In Vitro Diagnostics Cooperative (MIC).
I am just about to start a new role as Senior Clinical Fellow at Newcastle University, and Honorary Consultant at Newcastle Hospitals. This is supported by Newcastle Health Innovation Partners and is a fantastic opportunity to further develop my clinical academic career. This is a great example of how local organisations come together to support clinical research in the North East.
I think it is easy to forget how much is happening in the region, particularly in Newcastle. Everything happening in the region aligns so well to translational research.