Could variation in the architecture of men and women’s hearts explain why their risk of cardiomyopathy differs? Dr Paz Tayal, Clinical Senior Lecturer in Cardiology at the National Heart and Lung Institute is investigating this with the aim of improving outcomes for patients affected by this disease of the heart muscle. Dr Tayal also discusses the ‘juggle struggle’ of balancing work and family life, and the importance of truth telling in academic medicine.

As winter sets in, I start to pack away the summer dresses and bring out the woolly jumpers and sturdy boots. When I do this, I will not be going into my husband’s closet to find things that fit me, nor indeed will I be wearing his shoes.

That seems obvious right, because we are different sizes.

We don’t think twice about that, yet in medicine, we are only just beginning to realise that male and female patients might need to have tailored ways to diagnose and treat disease.

Even in health, male and female hearts are not the same. At birth, the hearts of male and female babies are about the same size. However, at puberty, male hearts have a faster period of growth compared to female hearts. Whilst this eventually settles down, throughout adult life the mismatch persists, and the female heart remains smaller.

Male vs. Female Hearts

You might say female hearts are smaller than male hearts because generally females are smaller than males. You’d be right, but that’s not the full explanation. The female heart is not just a scaled-down, smaller version of a male heart. It is completely unique, both at the big picture functional level and small picture cellular level. Female hearts have more heart muscle cells than male hearts, which we would not expect from the size difference. We are just beginning to understand what this might mean.

I am a cardiologist and a scientist. I study how and why the hearts of male and female patients differ in disease, and what impact this might have for how we diagnose or treat heart muscle diseases (cardiomyopathies). Heart muscle diseases affect up to 1 in 250 people, often at a young age. Whilst many patients can be treated with medications, a rare few experience very serious complications from their condition such as sudden death or needing a heart transplant. We urgently need ways to improve outcomes for all patients with these diseases.

These heart muscle diseases can occur due to abnormalities in the genes involved in the way the heart works. Sometimes having the genetic problem is enough to cause disease, but in some patients an additional trigger is needed to develop the disease. We have studied this with alcohol, certain viruses and chemotherapy. We call these additional triggers ‘environmental factors’.

Sex specific research

Female patients have a totally unique set of environmental factors that are generally not accounted for when treating patients or studying heart disease. Each female has a reproductive lifespan, spanning from menarche to menopause, and for some, there are pregnancies, multiple pregnancies, pregnancy complications, infertility, polycystic ovary disease, and early menarche or early menopause along the way. The impact of these reproductive factors on the risk of developing heart muscle disease, or of getting complications from heart muscle disease are currently not understood. This is what I hope to tackle in my research programme, which began this year with the award of an MRC Clinician Scientist Fellowship.

I will explore what the impact of reproductive risk factors are in the heart muscle diseases and I will look at whether we should have sex-specific criteria for diagnosis and treatment. I will also see if there are sex-specific signals in heart gene abnormalities.

Sex specific research, that is, research specifically designed to address the similarities and differences between male and female patients has been overlooked in medical research. We have been very good at studying the minutiae of an organ, or a fancy biomarker, but sometimes the bigger picture view gets missed.

As a result, many treatments have been trialled on study groups that are predominantly male, and then applied to female patients on the assumption that they will respond similarly. For example, many trials of life saving defibrillators in heart failure only had between 9-27% female patients.

Improving female academic leadership

We are also beginning to understand that the make up of the scientific team affects how research is done. Heart disease trials that have a senior female academic leading the team recruit more female participants. That is astonishing, and we are trying to understand why that should be the case.

It makes a strong argument for improving female senior academic leadership, however there are currently very few senior female academics in cardiology. We desperately need to make research careers more attractive to female clinicians and scientists and institutions and government must work harder to identify and then address barriers to progression.

The juggle struggle

 I am a full time clinical academic and also a very proud mother to three young children. I’m incredibly passionate about my patients and the research I do for them, which motivates me. But the ‘juggle struggle’ as I call it is immensely challenging. This is the tricky act of balancing being a consultant cardiologist, scientist, grant writer, paper publisher, supervisor, teacher, journal reviewer, and national committee member (the Royal Society, British Cardiovascular Society) with being a mum, wife, daughter, friend, chef, taxi-driver, school rep, costume maker, cake baker, as well as official rememberer of all school events. Can we have everything and do it all? Yes, but just not on the same day!

I strongly believe affordable childcare should be a national infrastructure priority to enable parents to return to the workplace productively if they wish. Employers should continue to respect and value flexible working, for many reasons that extend beyond the benefits to working parents. I also believe we need to be more honest and open about how hard it is, and that that’s ok. The image of this being effortless is not doing anyone justice.

Still a work in progress

In academic medicine as a whole, I think we could do with more truth telling. We only ever really see everyone else’s successes in terms of grants or papers, we never see the inevitable failures behind closed doors. Talent in this game will only get you so far, it’s resilience that will take you to the top. However not all of us are born with steely resilience and it’s a skill to be learnt, just like driving a car.  I’m still a work in progress. But there are things that help. Figure out what empties your stress bucket instead of filling it up. For me, that’s playing with my kids, exercising and reality tv (I did just say we need more honesty, no judgements!). I have an incredible support network of family, friends, colleagues, and mentors. I was selected to be part of the AMS SUSTAIN mentoring programme and the dedicated programme of leadership, coaching, mentoring, presentation, and media training has been invaluable.  I’d encourage everyone at whatever career stage to get a mentor, there are great schemes at the Academy of Medical Sciences and Imperial. Find your tribe and uplift someone in theirs, it makes the world of difference.

Ubuntu (ooh-bun-too) is a concept, a philosophy, a way of living in Africa. It highlights the interconnectedness of all individuals and encourages people to recognise their shared humanity. Here, Dr Sungano Chigogora, Senior Teaching Fellow in Epidemiology in the School of Public Health, explores the spirit of Ubuntu and why it should be at the heart of teaching and learning.

In Central and Southern Africa, Bantu means ‘people’ or ‘humanity’ to hundreds of millions of individuals whose languages have common ethnolinguistic roots. To them, Ubuntu is a core characteristic of humanity that extends beyond the individual, and recognises not only their humanity, but how they belong to a deep community in which they can participate, share, and grow. As observed by the late Archbishop Desmond Tutu, “Ubuntu is very difficult to render into a Western language. It speaks to the very essence of being human. … to give high praise to someone we say … ‘he or she has Ubuntu’. This means that they are generous, hospitable, friendly, caring, and compassionate” (Tutu, 1999).

The proverb “umuntu ngumuntu ngabantu” (with language and dialectic variations), communicates how a person is a person through or because of other people. It conveys autonomy, character, accountability, egalitarianism, and an inextricable bond to others. In action, ubuntu calls for empathy, inclusion, the fostering of positive environments, building of bridges, resilience, action, courage, empowerment, and living well together (Ngomane, 2019). It exists in all spaces inhabited by people: home, work, school, the market. Referred to as ‘Africa’s gift to the world’, Ubuntu was linked more broadly by the Dalai Lama to ‘the oneness of seven billion people’ (Houshmand, 2019).

Ubuntu is evident through everyday activities from the mundane (such as in greetings that reflect recognition of the value and dignity of the other person) to the divine (religion, ethics, philosophy). Children are given names that convey what they mean to the community; my own name, Sungano, is a bond, a promise, a covenant, the glue that keeps us together. I suppose it should be no great spiritual mystery then, that I strive to create connections wherever I go.

Fostering a sense of community in the School of Public Health

Growing up in Southern Africa, I lived Ubuntu, and view the world through its lens. My role as Course Organiser and Senior Teaching Fellow in Epidemiology in the School of Public Health (SPH) complements my temperament and views and allows me to practise Ubuntuevery day. While my world view is dominated by Ubuntu, my sense of belonging in education was initially formed by the experience of being excluded through racial segregation (as a Black child in a previously Whites-only school) and then later by the ‘otherness’ of being a Black woman in academia. The diminished humanity therein invokes in me an Ubuntu that wants to protect my own students from similar experiences, and demands spaces for them that instil ownership, belonging and confidence.

Sense of belonging impacts the performance of both students and staff in Higher Education, as it stems from a fundamental human desire to belong. Until recently, recognition of this fell behind research outputs, innovation, and academic achievement, almost as though we who inhabit academia were above human needs. Teaching activities that explicitly encouraged community-building through individual expression, openness, camaraderie, socialising, and trust were either not intentionally championed, or just simply did not receive the attention (and funding) they required.

However, teaching and learning literature demonstrates how, through participation, students can become part of the academic (and public health) communities of practice (Lave and Wenger, 1999), where they can share learning, resources, and ideas, solve problems, and develop identities.  Importantly, a sense of identity nurtured throughUbunturecognises the autonomy of the individual first, followed by formation of a unique academic and professional profile within this community. Thus, as a custodian of students on taught programmes in SPH, I take pride in making them feel unique and welcome, and having a personalised approach to their support and wellbeing. I also use my voice on the Postgraduate Taught Committee to elevate initiatives that encourage student belonging and inclusion, and am fortunate to share this platform with like-minded colleagues who are working tirelessly towards the same goals.

Ubuntu in a changing world

I recently completed the Master of Education in University Learning and Teaching, where the topic for my final research project was, “Maximising inclusivity, belonging and self-efficacy in blended online and in-person teaching and learning: An exploration of master’s teacher and learner perspectives in the Imperial School of Public Health”. This topic not only belies my interest in student sense of belonging, but highlights the fact that students are now learning in an ever-changing arena of global upheavals and developments in technology and artificial intelligence. Findings from this research led to several exciting recommendations for improved community-building in SPH, including consideration of how module and session planning can be approached with this in mind. My findings also highlighted how attributes such as attentiveness to others, ability to participate, resilience, and hope – which we can cultivate and embody through the spirit of Ubuntu – may transcend any challenges or changes. When we recognise that we are human beings and citizens first, and respect our social contract in Higher Education and beyond, we can continue to grow and thrive as learners, instructors, and researchers.

When it comes to tackling the world’s biggest health challenges, teamwork makes the dream work for Professor Wiebke Arlt, Director of the MRC Laboratory of Medical Sciences (LMS). Here, she discusses why it’s time that contemporary science shifted from a hero science to a team science approach – one based on productive collaboration rather than wasteful competition.

Going it alone is often glorified as the breakthrough way of achieving major milestones. However, if you look closely, most of these are achieved in a team effort and not by single individuals. Our perception of heroes rather than teams is often driven by the narrative and not the facts: when I was a child, I learnt that Edmund Hillary was the first to climb the highest mountain in the world, Mount Everest. Now I know that Hillary achieved this feat together with the Nepalese mountaineer Tenzing Norgay. Reading up on it, I discovered that they didn’t walk up the mountain on their own, but they were part of a large expedition team that worked together to achieve the goal. Hillary and Norgay were the second pair to be deployed as part of a systematic team approach to conquering the mountain.

This is very similar to the first human step on the moon taken by Neil Armstrong – seeing him take this step on a grainy black and white TV was a defining memory from my early childhood. Neil Armstrong is a hero to many but in fact he was only one of hundreds of astronauts and thousands of scientists and engineers who worked together for many years to achieve the moon landing, contributing original ideas and complementary expertise along the way. Only a few years ago I learnt about the key roles of women in the US space programme, including three African American mathematicians, Katherine Johnson, Dorothy Vaughan and Mary Jackson.

New solutions need different perspectives

Teamwork makes the dream work – this is what I experience every day, as a biomedical scientist and similarly as a doctor in the NHS. The complexity of the biomedical problems we need to address requires an integrated team approach, with team members who bring different perspectives and expertise to solving the problems. In my workplace, the MRC Laboratory of Medical Sciences (LMS), we are interested in the mechanisms underpinning human health and disease. We study how these mechanisms involve genes, cells and metabolism, and how they are influenced by ageing, sex differences and the environment. We want to understand how these mechanisms contribute to the burden associated with ageing and multi-morbidity, including chronic cardiometabolic disease and rare and complex disease.

To achieve this, we bring together many different people at the LMS: biologists, biochemists and clinician scientists, as well as physicists, chemists, computer scientists and engineers. Working in a rich interdisciplinary environment, enhanced by our host Imperial College London, is exciting and provides different perspectives on the same problem. This creates opportunities to find new solutions, including new ways to test, stratify and treat disease. Importantly, we want to go one step further and promote transdisciplinary science at the LMS. This means we do not only aim to integrate different scientific disciplines but also to listen to many other perspectives from the outset, including those from public, patients, entrepreneurs and industry.

Transdisciplinary mission

Bringing together fundamental discovery scientists and clinician scientists to work as a team is a key part of our transdisciplinary mission at the LMS. Our clinician scientists in training are the Chain-Florey Fellows. This name draws from an early example of such a collaboration. Ernst Chain was a refugee biochemist from Germany and Howard Florey a migrant clinician scientist from Australia. They worked together in the late 1930s to develop penicillin for fighting infections. Chain and Florey worked in a large team of scientists with complementary skills including Edward Abraham, Norman Heatley and Margaret Jennings. Penicillin had been serendipitously discovered by Alexander Fleming in 1928, but the work of the team around Chain and Florey enabled its use in patients, saving millions of lives.

The Nobel Prize, the most prestigious accolade in science, was awarded in 1945 to Fleming, Chain and Florey. However, particularly Florey always insisted that the development and successful translation of penicillin into clinical practice was a team effort. He felt that he got more individual credit than he deserved through the recognition by the Nobel prize. Maybe it is time to consider changing the statutes of the Nobel Prize, which at present can only be awarded to up to three individuals rather than teams. The experimental discovery of the Higgs particle by the teams working at the Large Hadron Collider was transformative for physics, but due to the Nobel rules the prize could not be awarded to the successful team involving thousands of scientists from more than 40 countries.

In science, recognition of individual achievement rather than contribution to team science is sadly still the major basis of career progression. This belies the fact that major scientific breakthroughs today can only be achieved by team networking rather than lone hero scientists. We need to call for and create change in how science and scientists are assessed, to promote a culture of productive collaboration rather than wasteful competition. The future of scientific research is team science, but hero science still looms large – we need to work together as scientific community to change this. As called for in the UK Academy of Medical Science’s 2016 report on team science, a collaborative approach also requires training and reflection beyond mere science: “Key skills such as networking, leadership, management, assertiveness, and resolving conflict are critical for ensuring that team science projects are successful and beneficial to those participating.”

Embracing equity, diversity and inclusion

Working in teams also provides unique opportunities to embrace equity, diversity and inclusion. Prismatic perspectives from many different angles are crucial for solving major challenges. We need novel, original and unique perspectives from women scientists, first generation scholars, scientists from low-resource backgrounds and immigrant scientists. To achieve this, we need to work on dismantling the obstacles that currently prevent them from contributing to science in large numbers.

Lastly, science is global and has no borders. I am excited every day by the diversity of our international community at the LMS including PhD students, postdoctoral fellows, technical specialists, group leaders and operational staff – LMS potluck parties are legendary!

It is the most fabulous Christmas present that next month UK science is officially regaining access to one of the greatest team science incubators on earth, the European Horizon Programme.