Which do you enjoy more, research or clinical work?
Dr. Neil W. Schluger's main area of academic interest has been in tuberculosis, including clinical trials, molecular epidemiology, development and evaluation of diagnostics, and human host immune responses. He is the principal investigator at Columbia University for the Tuberculosis Trials Consortium, a CDC-funded collaboration in clinical trials in which patients are enrolled in trials of treatment of latent tuberculosis infection and active tuberculosis disease. In addition, Dr. Schluger has led studies examining the transmission dynamics of tuberculosis in New York City, using tools of molecular epidemiology. He has a long standing interest in the development and evaluation of new tools for the diagnosis of tuberculosis.
More recently, in addition to his studies in tuberculosis, he has led clinical trials for the use of retinoids in the treatment of emphysema and for the use of interferon gamma in the treatment of idiopathic pulmonary fibrosis.
Question: Which do you enjoy more, research or clinical work?
Neil Schluger: Well for me I think that the heart and soul of medicine ultimately is a doctor sitting down with a patient, in a very individual kind of relationship and trying to make that person better but there are many things about medicine that I enjoy and I think from a relatively early stage in my career I realized that I enjoyed the intellectual challenges as much as the interpersonal relationship with patients and the intellectual challenges of science, of medicine, which is sort of the art of applied science in a way of public health. And so I knew from a relatively early stage in my medical training that I would like to spend a fair amount of my time in research. I do direct patient care, it’s about 15% of what I do but the most stimulating, intellectually stimulating parts of my career are the research parts. I think the most personally rewarding are probably still the patient care things that I do but the most intellectually stimulating parts are the research parts and I said I think I realized that at a very early stage in my career. I never had the intention for example of going into private practices, the activity where I’d spent 80% of my time. I fell into my current line of interest and work almost by accident, I would I spend 95% of my efforts working on tuberculosis which is a little bit unusual for people in the United States because TB’s not a common disease here but my first job as a faculty member after my training was finished was at New York University and really at Bellevue. Bellevue is one of the great public hospitals in America, the oldest public hospital in America and in many ways the most important and I was working there and it was the height of the tuberculosis resurgence in New York City and it seemed a good place to sort of marry these interests of research and patient care to address a disease that was really coming back in the United States but around the world never went away. So that’s sort of how the beginning of my career evolved.
Topic: A memorable research moment.
Neil Schluger: When I was a fellow, still in my training, I worked on an infection that’s a very rare infection generally but a relatively common one in patients with HIV and we developed a tool to sort of-- we developed a tool using molecular techniques that would help us diagnose this infection and understand its biology a little better and then when I finished my training and went to Bellevue, we were sort of up to our necks in TB as it were and tuberculosis is a-- although it’s an incredibly common disease around the world. It’s a disease that’s really stuck in time about a hundred years ago the major tests that we still use to diagnose tuberculosis are the tests we developed a hundred years ago. It’s embarrassing in a way I think for the world to be in that situation. So I and many other people working in the field began to think about the use of these molecular tools as a way to develop new diagnostic tests for TB and so we went up in the lab and played with this a little bit and developed what we thought would be a test that could work to diagnose tuberculosis and then we started to collect some patient samples, just sputum samples and tried this new molecular technique on it and it worked a couple of times. And that was one of those sort of fun and kind of satisfying moments where, you know, we’ve taken a brand new technology and applied it to a very old disease that hadn’t had any new technology for a long time and it was very exciting and, you know, we published that and we’re excited about it and I think that’s really what drew me in, you know, these sort of early results. Research is very frustrating, I always tell our young trainees in the lab, our young fellows, the hardest thing about getting into a career in research is that most of the time it doesn’t work. I always say “Look if research worked, we would have cured cancer a long time ago.” So it works but it works very slowly, but it was gratifying to have a result that you could see that seemed promising.
Topic: A memorable patient.
Neil Schluger: Yeah in fact I remember when I was a resident once we took care of a young woman who had come into the hospital for a relatively routine surgical procedure on the surgery service. I was training in internal medicine and we got called one night in the middle of the night, maybe one in the morning, she had come out of the operating room and was doing terribly, really dying, it appeared as though she was dying. For reasons that were not really clear, something had happened during surgery that had triggered some response in her system that inhibited her blood from clotting and she was just oozing blood all over the place internally and her surgical wounds. Her blood pressure was very low and it really looked as though she might die and so we brought her to the medical intensive care unit and worked all night that night and for many days after and at one point relatively early in her hospitalization her brother who seemed to be her only relative came to visit her in the hospital and at this point she was still very, very sick and it wasn’t clear if she was gonna survive and she was in a medically induced coma, I mean we’d sedated her because she was on a respirator and was having kidney dialysis and all the rest and her brother came up to us and said “Look I just wanna thank you for the efforts that you’re making and how hard you’re working to try and save my sister” and I just remember that moment because it was this very intimate moment in a way where someone was just expressing appreciation for what we were doing. In my line of work that doesn’t come up all that often, I don’t think, I mean there are people, my wife for example who is a liver transplant doctor, I always sort of joke she saves people’s lives for a living. But those moments for most of us don’t come too much. Many, many years later there was a similar thing where a patient, a private patient of mine came to the hospital, very sick, he actually had been at another hospital out somewhere else in the New York area, was doing badly and we transferred him in and we pulled him through out of the Intensive Care Unit and then I went on vacation just as he was recovering and I came back and he was one of the first appointments I had in my office after returning from vacation and he walked in and he said “Look I wanna thank you for saving my life.” And I didn’t save his life as an individual, you know, all these tens of people, physicians and nurses in a way saved his life but it was very gratifying and just one of those things every 15 years or so keeps you going.
Recorded on: 04/25/2008
Interpersonal relationships are just as important as the intellectual challenges of research, says Schluger.
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