On October 9th, The Department of Psychiatry welcomed Professor Ed Bullmore as Head of Department, succeeding Professor Peter Jones. Professor Bullmore is the fourth person to take the role of head, and in addition to this new position, Professor Bullmore also will continue to serve as co-chair of the Cambridge Neuroscience network, chair of Cambridge Health Imaging, director of R+D CPFT, and vice president of Immunopsychiatry GSK (part time). Despite this busy schedule, Professor Bullmore took time to sit down with us to discuss his first month leading the department and to share his plans for the future.
So firstly, congratulations on your becoming Head of Department –
Well thank you
– and then, I wanted to start by asking about the letter you sent out to the Department when you first stepped into the position, where you mentioned that it will take a little bit of time to settle into “the new normal”. How is that’s going?
It’s going well I think…though it’ll take a couple of months to completely transition. For example, some of the medical school committees the Head of Department sits on only come around every term or so, and I think until I’ve had a chance to sit on each of those and understand what’s going on, I’m not really fully orientated to the role.
We asked Peter when he talked to us just before stepping down, and I’ll ask you as well, what attracted you to the position of Head of Department?
Well, I think the strongest driver for me was…Psychiatry is a strong department, but I think it could be even stronger if we were a bit more integrated within the department, and the department as a whole was a bit more integrated with other relevant research.
So is this referring to something along the lines of the Cambridge Neuroscience Network?
Yes, the Neuroscience Network is great, but it is a virtual network…I think Psychiatry, we’ve got to sort out our space, our physical space as well.
That was also one of the things that Peter said, that quite simply the physical building space was a potential area for growth and development.
It is, yes, because at the moment we’re scattered over four sites. And I think that is…not good. You know, there’s a lot of good work being done despite that accommodation, but it’s not ideally what we want. It means, for example, that students working for different parts of the department are quite isolated from each other. I think it hinders creating that kind of research community and culture that cuts across individual groups.
Going back to why I was interested in the role, Peter has done a fantastic job as Head of Department; compared to where we were when he took over and where we are now, you know there’s been huge development. But I also saw – and I think Peter would agree – there is a window of opportunity over the next three to four years to try and push for a more definitive reorganization of mental health research and neuroscience research generally. And in that context I’d like to see Psychiatry come together under one roof…those sorts of things are very difficult to push for unless you are Head of a Department (laughs).
What about education and student satisfaction – how do you see that developing under your leadership?
We’re very lucky with the students we have in the department, I think…that’s a huge strength of Cambridge generally, is that the University is very attractive around the world to some of the best and brightest, and, because of that we do have very good people coming into the Department. I think that in narrow academic terms, you know, like getting a thesis submitted on time, getting contact with a supervisor, being encouraged to make conference presentations and publications, we do fine, but in a broader sense we need to do more to support the students. I think they are among the principle “victims”, if you will, of our current space arrangement. The senior people – well, I, for example – move quite a lot between this site and others, and so the fact that we are on the different sites matters less. But the students typically get stuck, quite understandably, but they do tend to stay on one site more than the senior people, and I think therefore they get less of what is potentially a very important part of the Cambridge experience: the peer group. I mean, we’d like to say the faculty are good (laughs), but you know it’s really the exposure to peers, other students, people just a few years ahead of you on the career curve, that is an incredibly valuable part of the Cambridge experience. I don’t think we’re offering enough of that to our cohort in Psychiatry because we’re spatially and geographically distributed. We will need to do more to promote that kind of integration, crosstalk, or networking…those sort of things aren’t happening enough.
Can you also tell us a little bit about how you see the research in the department progressing?
Well…we are waiting with bated breath on the outcome of the REF exercise. Last time this happened, frankly, we rated top in the country for quality, and that’s really been our research brand, if you will: a small volume of high quality research, which we hope is going to be as well-regarded now as it was by the RAE last time.
This department obviously has leading research groups in several areas, but if there’s one word that crops up more and more as I think about things, it is integration. The traditional Cambridge model of a professor, a couple of postdocs, and three or four students in a self contained group has got a lot going for it – you don’t want to meddle with that as the building block of a research department – but I think there are also limits to what can be done if that is the only scale on which research is organized. Imaging, for example which I have worked on a lot – I mean, you can’t really do imaging as a self-contained group. You need computing support, you need access to the imaging infrastructure, you often need access to patients…there are many aspects of the work we do that would benefit from a more integrated organization.
We need to think about some of the big themes around which we could get a bit more strategically organized…I think development is key, for instance, and I also think translation is key…so those are some of the obvious areas where we might want to really focus our efforts. I’m not trying to stop anybody from doing anything they’re already successfully doing, you know, but those of us trying to do clinical research studies should consider the best way to proceed.
Is it the most efficient way to proceed for every PI to delegate to their PhD student the task of getting a clinical research study started when each PhD student will never have done that before and will therefore have to spend 9 months learning from the ground up what it is to get a study started? That to me is probably not very efficient, and I’d like to see the department do a bit more in terms of supporting that clinical research portfolio, particularly at an early stage, and particularly for early stage scientists.
You’ve talked a bit about restructuring and forming networks within the University; do you see that happening on a larger scale within the University’s academic system as a whole, as well as nationally and internationally?
Already we have some quite good national collaborations…Ian Goodyer’s got this big grant with UCL, for example, and many of us still have collaborations ongoing with the Institute of Psychiatry. There also seems to me an emerging cluster of research-intensive NHS trusts, which is another important thing. We hope to support and improve the interface between the University and the NHS. One of the things we’ve done over the last few years is try to improve the software available to support patient recruitment into clinical studies, and that’s been adopted by other trusts in the Southeast, which could emerge as a bit of a cluster…but to be honest I’m thinking a bit more locally than nationally or globally at this point (laughs).
I think the investigators are the best people to lead collaborations in the area that they want to be excellent in. What I need to do as Head of Department is really just focus on the local environment and make sure it is supportive and ready to empower people to do those sort of things. Have we got quite enough good project management support around clinical research, for example? But you know, one only has a certain amount of time and energy…I think one has to focus on a few things, and I think if we can make some definite progress in that direction that would be a good outcome.
Are there any other challenges that you’re looking forward to addressing as Head of Department aside from what we’ve talked about?
Well those are the big challenges…but generally I want to make more opportunity for the younger people in the department – the students, and also there’s a very important cohort of about twenty younger investigators who haven’t yet gotten the professorial badge but they’re on track to some kind of tenured faculty position – these are very key groups. We don’t do anything very much in the Department to bring those people together, and I think that’s something that we could probably move on quite quickly.
That’d be very appreciated, I think.
I think so. And you know, it would be a very enjoyable thing for me and for the other senior people in the department.
Also, we’ve got a good relation with the NHS, and I think if we can make that even better that would be beneficial to both sides – for instance, dementia is an area where the government wants to see more work done, and we are potentially in a good position to do that research, although we haven’t yet been terribly active in that area. If we had better partnerships with the trust, we could do more in that space.
Peter said in his interview with us that “psychiatric research hasn’t yet changed the world,” and compared to a lot of other biomedical research, our field has had limited impact. Do you have any comment on that statement as Head of the Department?
I think, unfortunately, that’s true. We definitely haven’t changed the world in terms of treatment. The experience of being a patient in mental health services in the UK now isn’t really very much different than how it was when I was training 25 years ago. The drugs that would be administered are essentially the same drugs, the diagnostic procedures are pretty much the same…there might be some changes around the edge in terms of how services are actually delivered, but most of those have been driven by cost efficiency savings. There isn’t a single “breakthrough” new treatment that’s emerged in the time I’ve been doing research.
The research itself I would say has been very successful – and I’m not just talking about Cambridge or any particular individual in Cambridge – but if you look at where we are now, the biological and genetic understanding of psychiatric disorder and the fundamental awareness that psychiatric disorders largely originate from disordered brain function, that has moved; that knowledge base is different to what it was 25 years ago. But, the translation of that knowledge base to new treatments and change in practice is what hasn’t happened, and that is a really important thing for us to fix. I don’t think the job is done in any area of medical research until you’ve actually made a difference to medical practice.
When you were asking about research strategy earlier and I was talking about translation, really that’s what I mean: driving towards new therapeutics. Peter’s very interested in the immunology of psychiatry, and so am I. I think there are a number of other people in Cambridge and elsewhere that are interested in that. One of the reasons that that is an interesting area and why we’re willing to take a chance in developing that area is because the therapeutic opportunities look so strong.
I’m very interested in the link between peripheral inflammation and depression, which is now emerging as a very strong basic result. Now if that’s true and a subset of patients with depression are depressed because they’re inflamed, then you can do a blood test for inflammation. You can identify this subset of patients with depression by a biomarker measured in the blood that indicates they’re inflamed and predicts that they might respond well to anti-inflammatory drug. And secondly, there are a lot of anti-inflammatory drugs around that are already in practice – almost every other branch of medicine uses anti-inflammatory drugs quite a lot, so they’re well trialled and they’re also still in active development by pretty much every drug company on the planet. These could potentially be repurposed for treatment of psychiatric disorders if we were confident that we could predict which patients were most likely to respond, and that goes back to the biomarker business. So the immunology of psychiatry is very interesting from that point of view. If you ask me how I could imagine psychiatric research changing the world, to go back to Peter’s point, it would be by changing treatment. You know it’s not going to be a paper…a paper or a grant is not going to change the world.
I saw that there was a sort of informal discussion or journal club that was starting up to do with immunology and the brain.
There is, there is. I mean that journal club, that’s a classic bottom up thing…so that’s a group of younger people in the department who have spontaneously pulled themselves together to share awareness and share experience, which is brilliant. I think we ought to as a department try to reciprocate a little bit by asking what can we do top-down to help people. Psychiatry’s quite complex, the brain is very complex, and the immune system is at least as complex as the brain, as far as I can see. So to understand how the immune system interacts with the brain to cause psychiatric disorders is very challenging. And I think it does need people to come together. It’s an example of an area, another area where we’re not really going to deliver as much as we could by working in the traditional small group model. We need more networks. We need to think about where people are located and how people are supported.
And if, for example, the Department wants to push more into the direction of immunology, which I think would be a very good idea, do we need to create more lab facilities? We just started doing that but it’s still a very tiny resource – do we need to seek more strategic partnerships with the considerable strengths that we have in immunology and other departments in the medical school. We are a small department, and I think we will do better if we could just concentrate a bit more on a few big things where we’re already strong but we could be even stronger. If we concentrate on those, and then figure out what can we do in terms of organization to really deliver as much as we can in those areas…basically what I’m about, I think, is just trying to identify a few big things and make sure that we are optimally organized to deliver on them.
And I think it’s got to work for the younger people and not just look good from the perspective of somebody like me. The young investigators and students are the lifeblood, they are the engine of this department, and actually of Cambridge of a whole, you know. Cambridge would not be ranked where it is as a world university if it weren’t for the quality of the young people who are attracted to the place, so I feel very strongly…(laughs) It’s true! There are many, many examples of that…let’s just say Watson and Crick and leave it at that, right? I mean that’s the classic Cambridge example of a postdoc and a PhD student making a big breakthrough more or less in defiance of what they were supposed to be doing (laughs).
Many thanks and congratulations to Professor Bullmore; we wish him the best of luck in his new position and look forward to the leadership he proposes.