The diabetes scientist

Shivani Misra

Shivani delivering a presentation

Dr Shivani Misra is Consultant Physician in Diabetes & Metabolic Medicine at Imperial College Healthcare NHS Trust, and an Honorary Senior Clinical Lecturer within Imperial College London.

For Shivani, science comes in many forms. This is something she knows well, as her career straddles two very different – though interconnected – paths. 

Listen to Shivani in this full audio interview, or read the highlights below.

What does a day in your life look like?

The way that I see it is I am a clinician, so I see patients – and in my case I see people with diabetes. As well as that, I'm doing clinical research. I'm interested in the way people with diabetes present when they're first diagnosed and what type of diabetes they have. I have a number of projects under that heading. My working week is literally an amalgamation of the two. I have clinics one day, and then I'm doing research the other day – which might be recruiting someone to one of my studies or doing some database work – and then I’m back to the clinic again on another day. So it's a real mishmash with plenty of variety which is frankly what attracted me to it because I get bored doing the same thing again and again! 

I think clinical work is equally a scientific endeavour, just perhaps in a slightly different way to when you're doing card carrying research.

When was the first moment that you felt truly like a scientist?

I think the moment I really felt like a scientist was when I was invited to talk at one of the major diabetes conferences in the UK. It was an auditorium filled with thousands of people and I remember looking out and thinking ‘okay, it looks like they've all come to hear me talk about my research’.

It was really humbling and very rewarding to actually be able to present my research findings and to have really informative questions from the audience members, and to be congratulated afterwards. I think that's when I thought ‘oh right, okay!’, because yeah, I could do experiments in the lab or number crunch my data in my office, but if you're not getting your message out and sharing your findings and learnings with other people, then you haven't really closed the circle. I think that's the moment where I really felt like other people viewed me as a scientist. I got validation for that, if that makes sense.

Do you feel that you’re part scientist, part clinician?

Science is applied across the board, just in different ways. When I've got my research hat on, I'm trying to make new discoveries, so I'm using various scientific methods, interrogating data, doing patient studies, and we're trying to derive new knowledge and new discoveries. And then, the hope is down the line that's going to improve things for people that I see with diabetes.

When I've got my clinical hat on, that's actually also scientific, because I'm doing things in a really evidence-based way, whether I'm picking the right treatment or the right intervention, all of that is guided by scientific evidence that's been generated.

In diabetes, we're really lucky sometimes that things have been published a few years ago and they've already made it into clinical practice. Also, there is an element of discovery. So for example, one of my funded projects came from an observation and a finding in one of the patients in my clinic. I realised ‘gosh! This is atypical, what does it mean?’ and we set up a study to recruit this individual so that we could study their type of diabetes in more deep detail and made some amazing discoveries which were then published.

So I think clinical work is equally a scientific endeavour, just perhaps in a slightly different way to when you're doing card carrying research.

Shivani in a lab

It’s so interesting hearing about the scientific method being something that is applied at all points. 

If you think about what most people consider to be research, if you go out to the general public they're going to think of a white laboratory with coloured test tubes with different chemicals. And yes, that is research. And it's potentially hard to see how a patient visiting a clinic could participate in that kind of research, but research is so much more than that.

And the example that I alluded to where in routine care I found a very interesting mutation in one of my patients led me to do a six months of my PhD elsewhere in Oxford to really interrogate in cells what this mutation was doing and then we were able to use that information to come back to the patient and change treatment for the patient.

So, research is diverse and research could mean making new discoveries in a patient, it could mean asking the patient how they feel about what's just happened to them. There's all sorts of qualitative, patient-based research, database research. There's a huge variety.

Was there ever a time that you definitely didn't feel like a scientist?

If you talk to anyone that works in research, they have dark days where they just can't see the wood for the trees. One of the things I set up during my PhD was a really big study which recruited over forty sites in the country, and recruited about eighteen hundred people. When I first started that project, it seemed like a behemoth, to be honest, and I just could not see how I could ever finish it. I think I was resigned to the fact that it was going to fail and my name would forever be attached to this failed product, and I just couldn't see a way out.

Whereas actually, we have finished the project and we're analysing the data now and it's super exciting. So I think sometimes for me, and with my personality, when I can't see the endpoint and it feels like all of this energy is going in and you don't know even if it's going to be something that's really exciting and impactful, it takes a lot of positive thinking to navigate yourself out of that. For me, what really helped was having the right mentors, because everyone that does research goes through this. You will have the best days of your life and you'll also have some of the most miserable and grumpy days when things are not going well. But that's the nature of it and those highs are really important to get through the lows.

Shivani speaking to a group

Why do you think someone should study science?

Often when you're trying to decide what to do, you don't have strong feelings about where to go. I think there are three reasons. Firstly, it's interesting, right? I mean, you have to have an interest. I remember doing biology A-level. I remember exactly what the teacher was telling me about and my mind was blown, I thought ‘wow, that's so intricate and amazing, I can't believe that's the biology of the human body!’ So, you have to have some sort of interest in science, the way things work.

The second thing is learning new skills. Science is intrinsically about learning a skill and applying it to answer a new question, addressing knowledge gaps or developing a new tool that will enable you to answer a question. You have to have that drive and desire to take on new things and that doesn't only mean conducting experiments in a lab, it could mean coding. I'm learning how to code at the moment because I need to analyse this massive data set of hundreds of thousands of people. 

The third thing is to basically join the two up and be really enthused by the concept of discovering something new and sharing that information. People have this traditional view of scientists being hidden away in the lab and being a bit socially awkward, and not wanting to talk to people. This has gone out the window! We're on social media, we're talking, we're interacting, we're advertising what we do and showcasing to the world what our discoveries are, and interacting with people that are going to benefit from those discoveries. It's so exciting and I absolutely love that third bit. When I'm thinking about part one and part two, always thinking about part three because for me that's the really fun bit.

Science is intrinsically about learning a skill and applying it to answer a new question, addressing knowledge gaps or developing a new tool that will enable you to answer a question.

If you were to get into a time machine and visit yourself at an age when you are making some of these decisions about study and career paths, what advice would you have for yourself?

I would go back to the time when I was trying to decide what to do my PhD in. I knew I wanted to do a PhD, I knew I was hooked on research, but I couldn't decide. I had two options: I had my own idea which was really interesting to me, it had come from doing diabetes clinics and seeing patients and not knowing the answer to a particular question. But some of the listeners or readers will know that it's really hard to come up with your own idea and then get funding for it.

I also had this other option, which was working in a very prestigious lab doing a project that essentially someone else had come up with, and being slotted into that machinery. I spent about six months trying to decide what to do. I was agonizing over it because I wasn't sure if I wanted to take on that risk. I made a list of pros and cons. 

I would go back to the Shivani of that year and tell her to definitely take the risk, because that is what I did in the end. It just took me a long time to arrive at that decision. I'm not going to say that it was easy, I got four rejections before I got my PhD funded, and even after that I mentioned that my project took a long time to complete and has been a real labour of love. But where I am right now, I've just got a massive Wellcome Trust fellowship which is going to fund me for the next five years, and I don't think I would have got that if I hadn't been able to prove my track record of taking an idea and delivering on it.

It's worked out really well, but I can't forget those six months when I was agonizing over this decision. So, I would definitely go back and tell her to pull her socks up and just get on with the high risk thing. 

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