64- Dr Ahmed Iqbal- Challenging the status quo of understanding

Dr Ahmed Iqbal is a Senior Clinical Lecturer in Clinical Medicine, School of Medicine and Population Healthat The University of Sheffield and Honorary Consultant Physician in Diabetes for the NHS. His research interests emerged from challenging the status of understanding of the physiological impact of diseases and how this could be managed for better patients’ outcomes.

More info about Dr Ahmed Iqbal: https://www.sheffield.ac.uk/smph/people/clinical-medicine/ahmed-iqbal

Transcript

Sandrine: 0:00

Okay. So let's get cracking. Good morning. Good afternoon. Good evening. Dear listeners, you're on the podcast research lives and cultures. I'm Sandrine, your host, and today I'm interviewing Ahmed Iqbal. Welcome on the show, Ahmed.

Ahmed: 0:27

Thank you very much. It's a pleasure to be here, Sudhir, and thank you very much for having me.

Sandrine: 0:31

So you work as a clinical academic and your role is as a senior lecturer at the moment. You work at the University of Sheffield and in clinical medicine. I've done in the recent few weeks a series of interviews with, clinical academics. And I'm really intrigued in why people would want to have such a complicated life, because obviously being an academic is complicated enough, but being, a doctor and also being in a researcher to me sounds pretty crazy. So I'm really, really interested to have a sense of, you know, the early years that you had in your career, can you give us a potted history of, of your professional career so far?

Ahmed: 1:16

Absolutely. Well, thank you very much. It's an absolute pleasure to speak to you and convey my thoughts to your listeners. I must take you back to my formative years. I was born in Swansea in South Wales. Where my father, who was an immigrant from Pakistan, was working as a physician. And some of my early memories around medicine are looking at him work and, you know, looking after the local community. After that, we spent a period of time back in Pakistan where he started to work for, for a chest hospital. And in those formative years in the city of Lahore, Sanjay and I recognized that the world was not equal for all people. So, for example, have vivid memories. of seeing people who were very, very underprivileged and did not have access to healthcare coming to see my father in the clinic when we used to, you know, go visit him on the weekend and him going out to our village and lines of people would come and see him just to get a script. And that left a real indelible mark on my memory. And then growing up, I, my parents actually dissuaded me from pursuing medicine. They thought it was far too much of a stressful career. I was in love with chemistry at school and I wanted to pursue chemical engineering or the natural sciences. Having discussions with friends and colleagues and a particularly gifted chemistry future. And I've worked experience in a local hospital back in Wales, motivated me to pursue medicine. So I entered the clinical program in Newcastle Medical School in 2002. And I really enjoyed the basic physiology, the pharmacology, the biochemistry, and an opportunity came to apply for, for what's called an intercalated degree. And not many people were doing this in my year, but I looked through various programs and the one I found most interesting was a program down in London at the Imperial College in Medical Sciences with Haematology. And I thought I should do something broad so the Medical Sciences bit appealed to me and the Haematology bit because I'd enjoyed all the lectures on how the blood is formed and The different illnesses to deal with the blood so up to up to my medical career to date when I was an undergraduate. So I went down to London in 2005, very naive and wide eyed. I started working. In the lab towards the latter part with a very illustrious man who left again a strong impression on me, Professor Goldman, at the Hammersmith Research Laboratories in London, and I got my first taste of research. What I realized is that actually, it's difficult, you do a lot of experiments, you spend a lot of time in the lab, and there are many setbacks, but then the joy of getting it right and finding something really interesting and novel, was what, you know, gets you out of bed. So I went back to Newcastle and I decided to apply at the end of my medical training to what was then known as the Academic Foundation Program at the University of Bristol, where I, again, through serendipity mainly started to work with Professor Colin Dian in thyroid hormone research and a chance meeting then with my current mentor. When he came to give a talk on type one diabetes in Bristol, led me to apply to Sheffield. So I then applied to academic clinical fellowship. And then if you like, you know, one thing led to another, I started to work in a field. I started to, I was fortunate enough to get funding for a PhD in the field that led to more opportunities until I was appointed senior lecturer a couple of years ago. So it's a long journey. It started from those early years. The serendipitous critical point, I think, was doing the intercalated BSC, which then opened doors to, to the rest of my career.

Sandrine: 5:05

What do you think has been the thread in, in terms of your interest? Because you talk about these encounters with academics where you're given an opportunity, to work in, somebody's lab and it sparks interest and you have a good relationship or you meet with somebody at a conference and one thing, leads to another, but in, in term of your own research interest, is there a thread or a narrative that, that goes through?

Ahmed: 5:31

Yes, it's a very good question. So it was never a path for me because it's, I started off with hematology and ended up becoming an endocrinologist and diabetologist to be specific and with a little bit of thyroid research in the middle. But I think that in the common thread, the principle theme, the narrative in my case is trying to understand human physiology under normal circumstances, how it's altered in diseases, but then critically, what can be done about it to help the patient in the clinic? So the current area of interest I have actually uses some of the basic concepts I learned all the way back in 2005 in London, which is how the immune system response to various conditions and how it can be altered in disease. So I vividly remember how I got into this particular area and if I can just give you a brief summary without getting too technical. When I was a more junior doctor, I, a postgraduate doctor, I was working in, in a peripheral hospital in Doncaster. And there was, I went to the library one afternoon and there was a medical journal, a leading medical journal debating one of the trials in diabetes that had been closed early because people in one of the trial arms were having cardiovascular deaths. And we'd known for many years that in diabetes you have high blood sugars and if you can control the sugars very tightly you prevent the complications in the eyes, the nerves. But it wasn't clear as if you can control blood sugars very tightly. If you can prevent heart attacks and strokes in people with type 2 diabetes. Now, this trial had sought out to test that and we were all expecting that very tight and normal control will prevent heart attacks and strokes, but actually what happened is that people in the trial arm who were randomized, if you like to the very tight control ended up dying more. And this led to a lot of intense debate and It piqued my interest because I was asking myself, well, why is this happening? And around about the time there was some correspondence in the medical literature that low blood sugars, which happen as a consequence of tight glucose control, might be causing these cardiovascular events. And one of the mechanisms that was proposed is that low sugars were causing inflammation in the body. And I had some interest in inflammation immunology. I was doing diabetes training and I put the two together that led to the research application. So it's really that theme of what happens under normal circumstances. How is that perturbed with disease and what can we do about it? What was the theme that led to my current niche, if you like?

Sandrine: 8:07

And it's funny because in a way this, paper that you describe almost like something very counterintuitive and sort of picking, picking the curiosity and say, hang on a minute, how is this even possible? And it's like, you know, challenging the status quo of thinking.

Ahmed: 8:24

Exactly right. And sometimes that's hard to do in science. I can tell you, even to this day, there is debate in the medical community. Some people do not believe that low sugars are causing these events. They argue that actually, People who are frail due to whatever condition are likely to also have low blood sugars and are also likely to therefore have heart attacks, and that there is no cause and effect, whilst my group and others have shown that low sugars can actually cause inflammation, which is Is a plausible mechanism for causing these events. So the debate continues on. I think, you know, when you go against the grain, if you like, throughout the history of science, you'll find that you'll get a little bit of pushback and challenge. And my message to early career academics and other colleagues who are going through this is if you see a problem, don't dive into it straight away. Look back, understand where the clinical problem is and approach it with your own mind. Don't be influenced by the narratives because. History has taught us that narratives around medicine and science may well be very wrong. Form your own opinion and try and come up with hypotheses to test them robustly.

Sandrine: 9:36

So what do you think was the defining moment in terms of deciding to go through this dual career? Because as a junior doctor, you may have been involved in research and all that, but then, you become a consultant and, at that stage, because it, it makes life much more complicated what is really the pool to carry on doing research?

Ahmed: 9:58

That's a really important question. I think it's really only right that I, I, I divide it into two parts, but I also discussed the pros and the cons, if I may, just in the interest of candor so people can really understand what it involves. I think as I progressed through my research career, I had some setbacks, but also I had success and I realized that it was just about. Pursuing my aims with tenacity. To this day, what I really find appealing about it is, I'll give you a real life example. Tomorrow afternoon, I'll do a clinic for looking after young people with type 1 diabetes. These are people between the ages of 18 to 25. And every time I do this clinic, it reminds me of the burden type 1 diabetes, in particular, places on these young people. The things people without diabetes take for granted are decisions they have to make on a daily basis. They have to navigate a turbulent time of their life with the diabetes, relationships, work, driving, finances. And you talk to them, often they give you ideas. So, you know, many years ago a patient once said to me, You know, I just wish someone could take this away or outsource. I could outsource my diabetes to something else. And now we have this technology we use where we have this so called artificial pancreas where you have a pump and a sensor and the two talk to each other. And automatically deliver insulin in between meals and the person just uses a smartphone device to give insulin via the app on the telephone. And in a way, it does outsource your diabetes and people come in saying, Oh my God, I had the best night's sleep after going on the system. I can exercise. It's very discreet. I can travel throughout the world with the system working and I can sleep. I don't have to worry about time zones when I go from here to Japan or, you know, so those innovations, those technologies that come about by research people do. And as a consultant, as a clinician, of course you can read and apply them. But what motivates me is we play a part in developing them. And it gives me great satisfaction because one of the first trials of this technology, which I've given an example of, was done in three centers in King's, in College in London, University of Cambridge and Sheffield. And I was a junior research fellow. I remember having to go up to the clinical research facility, sleep overnight in the facility, in a room next to the patient when we were trialing this, checking up on them. And now to see it, you know, a few years later, come to the clinical arena, that's really you know, positive. So that's one of the, if you like, the motivations behind it, but then there are practical advantages and there are also some drawbacks. So for me, flexibility is very important. So then I have, my wife is also a clinical academic, albeit in a different field, and I need to be able to work flexibly. So for example, this morning, I'm working from home doing this podcast. After this, I'll be booking some travel to conference, then reviewing papers and have two meetings about further grant ideas. Tomorrow is my clinical day and I'll go to the hospital, and so is Thursday. Friday afternoons I typically also work remotely. And I think the ability to then pick up my children from school, take them for a walk in the park, you know, this is very appealing to me. It doesn't mean that I do less work. In fact, I probably end up doing more work because there's always a competing deadline, there's always something happening, but I like the flexibility of doing it on my own terms. The second point is I need a varied working week. You know, I love doing clinics, but I do find personally. Doing a lot of them every week could become a bit overwhelming and repetitive, and, and having the variety of having a steering committee meeting for a large trial on a Monday morning, followed by mentoring some students, giving a talk to colleagues about a new drug. Then doing a podcast with you this morning and doing some grant meetings with colleagues as diverse as a dental colleague versus a pediatric endocrinologist in the afternoon clinic tomorrow with a colleague who is a research fellow and mentoring and then, you know some admin time, a consultant meeting, there's a real variety. And then of course, there's an opportunity to travel. I think that again is an appealing bit. So I've been very fortunate to travel to many places. As part of my research and I think, you know, it's a real it's a real highlight. You go learn science. But as a as a perk, you get to enjoy these beautiful cities. There are cons. Of course, my time is split 50 50. But there's always a tension between the various aspects. Sometimes clinical practice takes precedence. So I do eight weeks a year of internal medicine. I'm slightly different from most clinical academics in that I still do the very intense medical, general medical on calls. And I spend time on the wards where I look after between 25 to 30 patients. That happens twice a year in four week blocks. They're very intense. And my academic work invariably has to take a back seat during that time. That can lead to a bit of stress as academic tasks can accumulate. And then I have to spend some time firefighting when I get off the wards. There's also, of course, the issue of pay, and I think that's a topical issue, and it's worth remembering that many of the academic jobs I've done over the years centering, haven't been what's called banded. In other words, they did not attract a higher pay supplement because I wasn't being on calls, and that meant that financially you are slightly worse off. One of the other things. to consider of course is I did my training very quickly actually for clinical academic, but whenever you take breaks in your training, for example, the intercalated degree I did in London and then the three year PhD I did four years I wasn't a consultant four years earlier, which meant I wasn't accruing a higher income four year earlier. And that, that was It becomes important towards the latter part of your career when it comes to pensions, et cetera. And I think it's worth bearing that in mind. I think these are things which are perhaps not mentioned. The clinical academic balance if even if it is struck, there's also the requirements of, appraisal, both in the NHS, but then also in the university. Now you can, to a certain extent, have a common ground you can use in both, but there is a, you know, additional burden. Of course, there is a requirement to publish, a requirement to generate grant income, a requirement to take on students. And, you know, some of these things are outside your control. Our job is to test hypotheses. using the scientific method in a rigorous and robust fashion. The results are not in our hand. So if the results are negative, in other words, they're not, for lack of a better word, attractive or sexy to the general community, they may not get a high impact publication, which then has knock on impact on grant income and so forth. So it can be a precarious path. Particularly for early career academics. And I'm, and I'm conscious of that, but in short, I think my motivation still comes from my patients. But I am also very privileged to have a flexible working lifestyle with a very varied week. I'm conscious of the demands and tensions between my clinical and academic work, particularly doing the own falls in internal medicine. But I think it can be achieved through very careful time management, having excellent colleagues and a supportive environment.

Sandrine: 17:45

mean, that's one of the hottest topic, really, from, when I do sessions with researchers and academics, and this idea of the balance between different activities, and, You, you alluded to this idea of, the expectation within the sphere of, your clinical practice and also expectation for the university, they are different. So what's been, the discipline that you've had to had to create balance in terms of the time that you allocate to different tasks or what you say no to. Very often people feel that they can't say no, especially early on in their career. And then it's very easy for things to get out of balance very quickly. So what's been the, the approach that you've had yourself to keep grounded and and not feel totally overwhelmed.

Ahmed: 18:36

That's a great question. I still think I'm learning in entire honesty. I have started to become more disciplined, not ruthless, but more disciplined with the projects that I will take on. So the way I look at it now strategically, Sandrine, is I have a mind map. What is my core research focus? What is my core clinical focus? My core clinical focus is to provide the highest quality of clinical care to my patients when I'm on the wards and when I'm in clinic. And when I'm off, I'm very religious, really, of leaving the hospital and moving on to the academic environment. So this almost physical demarcation of academia, and clinic has helped me because often if you're in the hospital environment, invariably something can come up or a colleague may ask for a specialist opinion. And whilst it's a short period of time, a five minute conversation over the course of weeks, months, years, the aggregated time is lost. So I think that's very important. And my research focus Then I divide into CoreAIM, which is the research on hypoglycemia and cardiovascular risk, and then more ancillary studies, which are of interest, and lateral collaboration. So I always try and focus on the CoreAIM, keep that going, think about the next step, the next grant, the next paper. The ancillary studies, I, I have a system in my head of weighing them up. Is this novel? Is this going to change practice? Is this something I enjoy? And if the answer to this is yes, yes, yes, then I'll say yes. But if I think it's probably not that novel, I don't think I'll enjoy it. I don't think it's going to change practice, then I don't feel bad about politely declining and saying, thank you very much. I'm honored that you've invited me. I, with sincere apologies, cannot take part. And I think having a strategy helps because you're then internally consistent. Now, this will of course change with time. At times, your clinical focus may have become heavy or the research and your interest will change. But, but that's really how I've approached, approached it. Yes.

Sandrine: 20:48

It's almost like having a decision tree and it's funny because it's something that you have in medical practice, you know, decision tree in term of, the course of action for treatment. And often people don't apply that to their own professional life, but actually it's a way of almost like taking the, the emotional dimension that we have, when an offer is placed. present itself. And it's, it's hard, because they could be an something exciting about it. But actually, is this going to serve me? Or is it going to serve my interest? Am I going to enjoy that? Which often people don't really embed in their decision making process.

Ahmed: 21:27

I completely agree. And actually, I think the enjoyment is key because. What makes it doable is if you have fun, and if you get a bit of a kick out of it, or even through achievements. Not necessarily academic achievements, small wins, like getting, you know, for me, one, my first academic F2, now known as SFP Doctors, has got an abstract accepted at a meeting in the U. S. with me as the senior author. And that, to me, is a great win, because, yes, I've been privileged to present. But helping them present, you know, that it is a win that I like to celebrate. And those things, they build momentum and hopefully a positive mindset. That's not to say it's all rosy. I'm conscious to give you balance. There are many hard days. On Sunday I was playing tennis. I came off my doubles match and had an email from a journal saying the paper had been rejected. But you know, that's part of the course. We do get to learn is not over time to take it personally. And following Monday, we just found another journal and we submitted it. They're making some improvements. So

Sandrine: 22:36

What do you feel for, for you, has been or is still the most challenging in navigating that dual pass?

Ahmed: 22:42

Honestly, to be honest with For me, it's the time really it's the time think because research It requires you to reflect and think. You cannot have your brain at 7, 000 RPM to give you an analogy. It needs to be serene. You need to have time to reflect on what the gaps are in the field, to read the literature, to synthesize information. and to arrive at areas that need to be explored. Now, I do have protected time, of course, but often I'll get an email from my secretary with a patient with an urgent problem because insulin is running out, I need to write a script, or I might have you know, an urgent deadline for a submission. So that time, it, it gets, you know, eaten away. Now the way of one of the things which I think is a false economy, one of the areas which is a false economy is emails. So I think emails can eat up into time, lulling you into the false sense of security that you're working, but you're not progressing a central aim for the day. So what I do now is if I'm writing, if I'm thinking about an idea, if I'm reviewing a paper, I will take off my Apple watch. I will put away my phone and let my wife know I'm working for an hour or so, and I will just turn off the notifications on, on my emails. That really helps. The other thing which really helps with academic tasks is I put in my diary things I must achieve today, and I tick them off, and that gives me a sense of satisfaction and progress. The final thing which has helped me is in my office, I've got a white board where I write physically different priorities for the year. In terms of the students, my own outputs, the conferences, the papers, but then I have a section on personal development, things which I want to learn, you know, and things which will allow me to kind of progress. So time is an issue. I'm still learning about it. You know, having very clear boundaries does seem to help. Then the other challenge I should tell you, and this may be relevant to some people as well, of course. is the rigors and demands of both clinical and academic medicine are but one part of your life. There's also family, hobbies, spirituality, and all of these things need time. And actually, there can be a tension between, between things at times. So when a big grant is due, I remember last year in March for eight weeks I was almost absent, but I said to my wife, well, look we're gonna have to negotiate this and I will pay back this time with interest. You know, and you do feel guilty about that, to be honest with you, especially if you have small children. I think that is, again, a thing which can be difficult. But again having a supportive family, understanding that these are temporary periods of pain, then you can enjoy yourself a little bit later. Does help.

Sandrine: 25:42

And I think that's something they are periods that are. more crazy than others, but actually having conversation with, our family members is really key because they're part of the journey. And, if your wife is also on that, journey as well, it's like, how do we create, a family context where we support each other. And at the same time, we address how challenging it is on both sides. When you have these intense pair that the balance is not, there isn't a flow of balance. all the time. So there are periods that are, you know, well balanced while others are a bit crazy. There is always a flux, but actually talking about the flux with, family members really matters.

Ahmed: 26:23

I think you're absolutely right. I think that's absolutely key. And as you said, a flux pairs of Change and it's fluid. It's not rigid. And I think one of the things you have to learn to be successful pinnacle academic is to appreciate this flux and respond and be agile. You cannot be too hard in your thinking. You need to have agility to be able to ramp up your work in certain areas of your sphere at sometimes and then push back at others. You know, the other thing I should say is Having other than the other dynamic is, of course, you have the university and your family, but your clinical colleagues, it's really important to be a very good clinician because that buys you credibility, right? So remember, you're doing two jobs. You're a scientist and you're a clinician and human nature is such that when you're in the clinic, you're seen as a scientist, perhaps traveling the world and doing this and that. But are you really there for your patients? And when you're in the lab, you're seen as a clinician, you know, and some people can you know, feel like a bit of an imposter really in both. scenarios. So I think the way of doing that well is to be an excellent clinician so that you have respect and credibility of your craft, of your practice, and that you add value actually by opening up trials, in my case, to patients that are not otherwise available locally, bringing new innovations, and also involving clinical colleagues in research endeavors. Because that can also give them a bit of variety in their field. It's a win win and actually letting them know that when you're there in the clinic, you pull your weight and you do a good job. And as for the science bit, of course you need to, again, add value. So my main selling point, if you like, when I'm working with pure fundamental scientists is that I'm able to bring the clinical perspective. When we're writing grant applications, fashion clinical trials or human studies alongside animal and more fundamental cell data from the lab. And this then allows those applications to be strengthened, but also. allows therefore potential for translation of those innovations into man in the end. So it's really finding a niche where you add value to both sides and are credible. That is also skill one has to learn with time. Good way of learning it is to emulate those who do it well. And certainly I think that's quite a key part of it.

Sandrine: 29:04

I'll be interested to hear what's been the journey in terms of building a research team, because I'm a biologist and, when you're a straight biologist, the path is pretty straightforward in terms of PhD, one, postdoc two, maybe fellowship. And then, maybe, starting to build your team as a fellow and then moving on to a lectureship and so on. What has it been like to you in terms of actually having people working on, on your projects that you design accessing your own independent funding or collaborating on projects that were your own ideas?

Ahmed: 29:40

I think one of the key things is I, when I finished my PhD, I had an idea of the research I wanted to pursue. I joined a European consortium alongside my mentor and that allowed me to work under his guidance and understand how these large trials work. I started to gradually take more responsibility. I started to lead one of the work packages within that project in Sheffield and then use that opportunity to build collaboration with colleagues in other centers in the UK, but also in Europe. And then an opportunity came just before I was appointed consultant to write a large grant around the mass control trial in my field with my mentor as co principal investigator. And I took that opportunity. I worked very hard with him, and we were successful in getting that grant. And now as part of that grant, I had an opportunity to hire a research fellow. And so we did that. So, and then I attracted one of the specialist foundation program doctors. And actually they then told their friends to have another one for next year. I advertised this project I won the grant for in the local medical school intercalation fair. We had a couple of students express interest. I've now recruited an intercalated B MEDSci student to work on it. And part of, alongside this, I work with a cardiologist within our unit and from my with my other area of interest and we got some money. We were jointly able to hire an MD, a research fellow as well. So, slowly, in that period after my PhD, learning how grant funding works, having an opportunity to apply. for a large grant as a co PI, which otherwise I would have struggled with because as an independent, purely independent investigator, open doors for me to then hire staff and start to come up with a research team, if you like. And now I'm using those connections I've acquired to write further grants and using the trial we have to build more collaborations across the North of England. And hopefully this will carry on. It's almost. You know, in a way you attract success. If you get something, you deliver on it and you exploit the opportunity. And then more colleagues want to work collaboratively with you and kind of starts a bit of a reaction. Not everyone. Some people of course will not want to, but it is the approach I'm taking. I'm still, I would not say I'm fully, completely independent. I have my research fellow, my primary supervisor and co supervisor, but I still work very closely with my mentor. And I think. That's by design. I want to do that at this stage of my career.

Sandrine: 32:34

And what has it been like in terms of, once you recruit people, there is an expectation that you, as the lead, you know it all. And obviously it's a misplaced expectation, what have you been doing in term of really building, a positive research culture in your team, getting people to take opportunities?

Ahmed: 32:53

So what I've done this means I've looked at all the research experiences and colleagues I've had over the years and try to cherry pick their best practices. So, Professor Goldman, first person I worked with, an excellent consultant. inspire. He's a charismatic person who would always take it back to the patient. So I'm trying, you know, when we are a little bit low and recruitment is going slow and try and remind my colleagues as to the potential this could have on patients and how it will change people's lives. One of my other mentors was an excellent administrator and they did that by ensuring that they met every single person in the team on a regular basis. And when they were with you, you felt like you were the only person in the world that mattered. So I try and set up regular meetings. I think particularly junior colleagues may not always feel comfortable sharing everything, but if you spend time with them, you can tell even from nonverbal communication that things may be tough and that support can be very, very helpful. It helps the person, but also helps you because If the crisis builds up and snowballs, it's much harder to contain down the line. So regular meetings with all, all, all the fellows. The third thing is one of my mentors, very, very accessible. So we had a great communication line and, you know, anything I wanted to ask, I could clear up and just send them an email. And, and I try and do that as well, you know, sort of having very clear lines of communication. There are some things I've learned, which I, Which are not so good, which I've seen happen and try and avoid them. Putting pressure on people. I don't think that works. I think we set clear expectations within reasonable timeframes of goals that need to be achieved. But you know, if you overload people, I don't think they deliver. I think how you give advice and constructive feedback is very important. If someone is in a negative state of mind, if you're in a negative state of mind, I don't think that's likely to work. So finding the right time to do it and dealing with rejection, I think is really important because when junior colleagues in particular get rejection, you know, these are bright people who may have been top of their class in school and at university and they've done their exams and all of a sudden they're really tasting rejection for the first time. It's a bitter taste. If you're a high achiever and supporting people, making them understand that this is part of the course, this happens, we have to work around this and build strategies to it. I think that also creates a positive culture. In short, I think it's about being there. honest, truthful, being a role model, saying things doesn't really matter and it's what you do. So, you know, for example, when we put out data, sometimes we will not put out an abstract if I, I don't think that the data is ready. Even if we think there's a high chance they could get an oral presentation because What matters is that we present the full picture and the absolute truth. And I think that has to be a common theme. And it then comes back to research integrity and, you know, making sure that you're on the straight path, so to speak, is having a culture of, we're here to test the hypotheses and tell the truth about the science that comes out of it. I think that's, One of the key talks, if you like, I have when people start in the group.

Sandrine: 36:22

You refer during a discussion about, the significant role that your mentor had, but when we are, progressing, there are things that are in the way. what do you think have been things that have really helped you, whether it's a mentor or other things? And, and other things that have been really an injurance in terms of stopping you in, in progressing in the way that you would have liked.

Ahmed: 36:45

So I think mentorship has been a key force multiplier. And if I can give you some specific examples. My mentor was able to, you know, at one point I was thinking of not applying for an academic lectureship, which was the next transition point in my journey because my wife was working in Birmingham. I was commuting from Sheffield to Birmingham every day. I was doing a clinical job. I was writing my thesis in that time as well. I was father to two young girls. It was a very challenging time. time in my life. And I just thought, I'm just probably going to stop this journey at this point. I will finish my training and I will just become a consultant in the NHS and kind of call it a day. And my mentor said, look, I respect your decisions. I'll support you, whatever you want to do. My view is that you do have the skills and attributes to pursue this successfully. I think what you need to do practically, is understand what you've already written in your thesis, which is a key barrier. How can you maybe produce a paper from that and then put those papers in the thesis as opposed to writing a long document? And that's what I did in the end. I had a hybrid thesis with some papers and the written format, which allowed me to finish it in six weeks. And then progress and submit and progress on to the lectureship and then of course that's what led to this European opportunity that spoke to you about and then the senior lectureship. So that practical point of that knowledge and insight of knowing that, you know, the alternative formats of submission that you should persevere and the confidence in me helped me. There are challenges, of course, there are and one of the challenges can be the hospital environment because. In, in the UK in particular, there's an enormous burden on hospital services and the healthcare organizations, understandably, to a certain extent, will see patient care as their top priority. In this kind of an environment, research can be seen as an added extra, a luxury. An interest for times when things are more calmer, but you see, that is, in my view, a short sighted approach for the simple reason that we've had a massive event in history from the corn COVID 19 pandemic that has taught us that research really is key. And it's through research that you generate new technologies and interventions that allow the best possible care of your patients. So the two really must go hand in hand. And sometimes, you know, you find that there can be a little bit of a pressure and pushback from organizations asking for compromise. I think the way around that is to engage colleagues, to speak to them, to highlight the value of research. to patients in the organization and how it uplifts the performance of the organization itself. So that at, at my current level, that's a, that can be a hindrance. But the, the other point really to, to note more junior, you know, faculty or junior colleagues coming through a hindrance is grant funding. If you are unfortunate and you try multiple times and you don't get it, that can be very, very disappointing indeed. So that, you know, that's a challenge sometimes. Yes, for sure.

Sandrine: 40:12

The comment that you have in terms of the perception of the role of research, for clinician is a really interesting one. And it's sort of linked to the next question that I have, In order to progress, as a lecturer, you have obviously to, get funding, you have to publish, but there, is also all these other bits to do with, citizenship and leadership and contribution to the institution. And in the context of being a clinical academic and having all these other responsibilities within your clinical practice, what does it look like to have a role beyond just the boundaries of, your research team. How are you contributing now or how do you want to contribute sort of more broadly?

Ahmed: 40:57

Yeah. I think that's very true. So when you, at my kind of career stage, you start thinking about that. So one of the ways I've started to do that is recently Diabetes UK was offered 50 million pounds by a philanthropist to come up with new ways of advancing type one diabetes care. It's known as a grand challenge and colleagues doing work in the UK will be familiar with this. And as part of that I saw an opportunity to apply to a diabetes research steering group in Diabetes UK, which will focus on this, but also other challenges. So, I was successful in, in being appointed to that, and it's through there that I hope to be able to shape the future UK. And Another initiative is I helped Diabetes UK alongside the National Institute for Health Research, the NIHR, set funding priorities for different career stages in the UK. We did a, an analysis of where the gaps were and we found that there was funding in early career stages, in doctoral students funding, in doctoral medical doctors getting doctoral funding, but not so much in other healthcare professionals, like pharmacists or dietitians, nursing colleagues and others. And similarly, that there was a big gap where people were able to do their PhD, even become lecturers, but there was a massive gap, a transitional gap between becoming a lecturer and a senior lecturer. And intermediate level funding was particularly Poorly supported. So that was another area, you know, where you'd be able, where you're able to influence policy going forward and being on an editorial board for a journal, if you like, if you're almost a gatekeeper for the quality of research coming into the field, and Working more broadly within the European Association for the Study of Diabetes. These are some of the roles that I've taken on at a national and international level. We're moving beyond the sphere of your immediate research team and trying to influence change more globally.

Sandrine: 43:03

When you think about this childhood years where you were seeing your dad, you know working, overseas, what sort of motivation does it give you in term of the role that you have in shaping, this field that you're working that is impactful how do you feel that you want to contribute in that space?

Ahmed: 43:22

A great question. I often reflect on that because I recognize I'm very privileged. I have origins inherited in Pakistan, country of 250 million people with enormous potential, but a victim of multiple crises, climate crisis, geopolitical, economic, and others. And in this vein, I reached out to colleagues in the Pakistan Inter Korean Society and they're very, very helpful. I, to them initiative around diabetes education. I recognize that the technologies I'm talking to you about the artificial pancreas and senses. These are not realistic prospect for the vast majority of people in that nation or even in that region. So one of the ways we can help people is through education. In other words, we equip them with the. knowledge and beliefs around how to manage their type 1 diabetes themselves. And this has been shown and proven, in fact, to improve diabetes care in Europe. We have these structured education programs we deliver routinely in the UK. where people who are newly diagnosed or even those who haven't been diagnosed recently undertake training on how to use insulin, the relationship between insulin and food, relationship between insulin and exercise, how to detect and treat hypos, all these things. Now, this doesn't cost too much to implement, but it could have a significant impact. So I'm trying to launch this with colleagues in Pakistan. The other aspect is teaching and training of doctors and other colleagues, professionals. I do that through virtual classes and zoom. We, you know, held some training sessions on, on various newer treatments and diabetes for colleagues that have traveled out and given lectures. To Pakistan, I try and get other people or colleagues of mine to come out. And, and, you know, I use the carrot of the lovely food is a. Mountaineers,

Sandrine: 45:19

good way.

Ahmed: 45:21

as good as French food, I guess, but it's certainly a cuisine, which is very, very old, rich. And then, you know, there's so many things you can do in the north of the country in particular. So it is a way of reaching out and building connections. But yes, looking back, you know, I remember those years in Pakistan and I still Recall, health care should be a fundamental human right, but for many people in this world, sadly to this day, being poor is sometimes a death sentence. And the motivation is to provide the best possible care for our patients in nations we reside in and we're fortunate and wealthy enough to look after them and to preserve this and to advance this, but also take other people who are less privileged, less fortunate on a journey with us and help them along the way.

Sandrine: 46:13

So one of my final question is about, if you were going to go on this journey again, what would you tell your younger self to ease the journey or in the way that you made choices?

Ahmed: 46:26

I would tell him to not worry or stress about outcomes, about grants that he put in or the outcomes of interviews. or the setbacks and I'd ask him to enjoy every single bit of it and to not take any criticism to heart and also not to take praise or platitudes too seriously either, to remain grounded and to just go with the flow, not take too much stress. I think that invariably does happen sometimes, and particularly with me. Over the years where, you know, you get some criticisms and setbacks and that can put you down or, on the other hand, success can lift you up transiently, is to treat, if you like, success and failure equally and remain grounded. It's hard to do but that's the way I'd say is, is the way forward.

Sandrine: 47:23

That would be very nice advice to your younger self. And so my last question is about joy. If you were to distill, what joy is for you in, in your professional life, in your research context, what's the nugget of it?

Ahmed: 47:40

Well, that to me is easy, is to go into my adolescent clinic. And to say to my patients, I have great news for you. There's this new thing, drug technology device. That's going to change your life and you're going to love it. Can I show it to you please? And that is the best part of it for me.

Sandrine: 47:57

That's wonderful. Thank you ever so much, Ahmed, for this really wonderful conversation. You, you've shared a huge amount of wisdom, which I'm sure will, will really help, others, who are on a similar career path as you. Thank you very much.

Ahmed: 48:12

Pleasure speaking Thank you very much indeed for having me.