A well rounded career - Professor Alastair MacLennan reflects on his career in obstetrics and gynaecology

Interview by Sophie
Med J Aust
Published online: 3 September 2012

Professor Alastair MacLennan has spent the past 45 years working in obstetrics and gynaecology including 35 years at the University of Adelaide, where he was head of the discipline from 2006 until early 2012. He has published more than 350 peer-reviewed papers and five books, with particular research interests in cerebral palsy and menopause management. In 2011, he was made an Officer in the Order of Australia (AO). Now semi-retired, he continues as head of the internationally renowned Australian Collaborative Cerebral Palsy Research Group.

I had wanted to be a doctor since the age of 4. I began studying at the Glasgow University Medical School when I was 16 and then went to Oxford University. I had some great mentors. In Glasgow, my first mentor was Ian Donald, the inventor of obstetric ultrasound. In 1977, Professor Lloyd Cox, Australia’s first reproductive endocrinologist and foundation professor of obstetrics and gynaecology in Adelaide, asked me to come to Adelaide for 3 years. I’m still here 35 years later.

I was attracted to obstetrics and gynaecology because of its diversity. It allows you to be both a physician and a surgeon and there are many subspecialties such as oncology, maternal–fetal medicine, reproductive endocrinology and urogynaecology. I liked that variety, and I enjoyed maintaining that throughout my career. I’m one of few clinical academics who kept up both “O” and “G”.

Those two research themes are different, but a common thread has been evidence-based medicine. I’m a founder and vice-president of Friends of Science in Medicine — a voice against the commercial up-swell of nonsense alternative therapies. This association started at the beginning of the year and now has more than 700 supporters. We believe therapists should be honest about the treatments they give and not sell the public potentially dangerous and ineffective rubbish. We’re concerned that some universities are teaching and encouraging non-evidence-based alternative therapies.

Clinical academia gave me five jobs. The first was as a clinician in the public sector, where I delivered babies, did gynaecological surgery and counselled on reproductive endocrinology, especially menopause.
I also ran a small private practice.

The third job was research. My menopause research was mainly about trying to get effective postmenopausal therapies into the community. There has been some resistance to that. Women often want to do things naturally and they’re targeted by the alternative medicines market, but hormone replacement therapy (HRT) is much more effective. A lot of my work has focused on educating women and conducting efficacy and safety trials, including the Australian arm of the WISDOM (Women’s International Study of Long-Duration Oestrogen after Menopause) — the world’s second-biggest trial of HRT.

My wife, Dr Alice MacLennan, and I write a free booklet, Presenting a positive outlook on the menopause. We first published it 20 years ago and 2 million copies have been distributed. We write that booklet as a service to the public. It’s available free online.

My other main research interest is cerebral palsy. The profession has a fear of being blamed for cerebral palsy outcomes because of the lay and medicolegal belief that it is caused by asphyxiation at birth. However, although caesarean section rates have increased sixfold over the past 40 years, there has been no change in cerebral palsy rates, making it unlikely that labour or vaginal birth have any major influence. Gradually, research by the Australian Collaborative Cerebral Palsy Research Group has shown that less than 2% of cerebral palsy cases are due to severe acute hypoxia around near birth. Some appear to be caused by genetic susceptibility, triggered by environmental factors during pregnancy, such as an infection. We're the only group in the world doing this research.

My fourth job was in administration. When I was head of department at Adelaide, the number of employed staff increased from 120 to 320. We had wonderful senior clinicians and scientists who allowed us to build up a great team.

The fifth job was teaching. I’ve been lucky to have some great mentors in my career, and now I enjoy mentoring others. It has always been a joy to influence and educate the younger generation and to see them mature. Everyone on my research team began working with me as honours and PhD students, and it’s rewarding to see them develop.

In my spare time, I was also editor-in-chief of two menopause journals. I was also president of both the Australian and New Zealand Perinatal Society and the Australasian Menopause Society. It sounds like a lot, but I enjoyed the diversity of mental challenges, the camaraderie of clinical academia, the interaction with patients and students, and the feeling that occasionally our research made a difference and advanced clinical and scientific knowledge. Now that I am partly retired, I’m hoping my main income will come from golf.

  • Interview by Sophie



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