Professor Mark Nelson is chair of the Discipline of General Practice and senior research fellow at the Menzies Research Institute, both at the University of Tasmania. He is part of a team that recently secured US$50 million in research funding from the US National Institutes of Health. Professor Nelson is also an honorary associate at Monash University and a GP in Lindisfarne, Tasmania.
“I was always pretty undecided about what I was going to do when I left school. I come from a rural background where no member of my family had been to university. I started studying science but, after a month, I realised I didn’t like it, so took a year off and worked as a labourer. I was very glad to be accepted into undergrad medicine at Monash University the next year.
After a few years of postgrad clinical work, I travelled around the world for a year with my then girlfriend, who is now my wife. When I returned I worked in Australia’s first private emergency department, in Melbourne. I enjoyed working there for 6 or 7 years, but there were slow times in the emergency department and I became interested in further study. I enrolled in a graduate diploma in family medicine through Monash and that’s what got me interested in general practice.
I started working in general practice part-time while continuing my graduate diploma. I converted that into a masters, which I really enjoyed and completed in pretty much record time. I was approached by [Professor] Chris Reid, who was looking for a GP coordinator for the 2nd Australian National Blood Pressure Study. I joined that study, and decided to do a PhD within that program.
The national study included a run-in phase where people gradually came off their blood pressure medicine until their blood pressure returned to a high level and they could enter the study. But we found that the blood pressure of 17% of people who stopped their medication never returned to the high levels. For my PhD I tried to identify predictors for this group of people. I used to call it my John West study after those old tuna advertisements, because I was interested in the ones that got rejected. There’s a lot of work on choosing who we can medicate but very little on ‘unmedication’ — determining who might be able to stop their medication.
I am a principal investigator on ASPREE, the ASPirin in Reducing Events in the Elderly study. This is a huge randomised controlled trial, which looks at the risks and benefits of aspirin in people aged 70 years and over. The study expands beyond the usual associations with cardiovascular disease to look more broadly at the effect of aspirin on disease in general. We’re recruiting 19 000 people, including about 4500 from the US and 14 500 from Australia. I originally wrote the research protocol 10 years ago and the study should be finished by 2018. Our initial studies received funding from the Heart Foundation and the National Health and Medical Research Council. In 2009, we succeeded in getting US$50 million from the US National Institutes of Health to fund the full study. It shows that research in primary health care is an export industry, because we brought all that money into Australia.
I’m interested in research for a number of reasons. I’m a rationalist and believe in evidence-based medicine. Yet in clinical practice we often just continue doing what we’ve always done without thinking, ‘is there a better way of doing this?’ The objective evidence you find in medical research is not always popular because it often shows that what people thought was working actually doesn’t. You learn just as much from a negative study as you do from a positive one.
I’m a full-time tenured academic at the University of Tasmania and split my time 60:40 between the Menzies Research Institute and the school of medicine. Being a full-time academic usually includes two clinical sessions a week, but I choose to do a third in the evening to maintain continuity of care. Combining research and clinical work keeps me busy, but the quality of life in Tassie is fantastic. I go for a run every day, and I’ve started going for bushwalks to remote areas. Being in Tassie also reduces the travel times — in Melbourne I used to refuel my car once a week, but here it’s once a month.
Keeping connected to clinical work is very important. It means you can speak with more authority to fellow general practitioners as someone who’s working in the system and also understands the pragmatic aspects of getting research results into practice. We need more clinician researchers, because translational research is important. There are several ways GPs should be involved in research. Firstly, 100% of doctors should use the findings of research, but probably only around 60% do so. Secondly, I reckon about 40% of GPs have the altruism to participate in research in some way, such as becoming involved in a clinical trial or responding to surveys about what we do in general practice. Those people are very much appreciated. Finally, probably about 2% of GPs are interested in running research. That’s probably a bit of an indictment of our profession, because if you look at other specialties, research is taken for granted. For our profession to really prosper, we need more people to participate in research as investigators."
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