David Levison - Transcript Summary

David LevisonProfessor of Pathology at Dundee University (retired 2009)

Interview location: Ninewells Hospital, Dundee.
Interview date: 5th September, 2007

Key Themes: Alder HeyLegislation and RegulationMentors and Influences, New Technologies

  

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Section 1

  • Describes how he chose to do medicine and how his interest in pathology developed.  As a junior doctor he felt wanting and thought If I...understood the pathological processes better, I’m sure I’d be better at [treating people].”
  • How an unusual postmortem case, where he discovered a link between pet birds and the cause of death, fired his imagination and convinced him to pursue pathology: “It taught me a lot about how exciting and interesting things could be.”
  • Talks about the thrills of diagnosis with reference to specific cases, and about some lessons learnt.  "It’s not being intellectually brilliant that will make you effective all of the time, but just doing the job properly.”
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Section 2

  • Original research in the 70s into the mechanics of menstruation, which proved a challenge to received wisdom.  Describes early use of electron microscopy and a very different research climate from today’s. “Nowadays to do such a project, I would need to fill in a 64-page ethics form.”
  • This research revealed the role of apoptosis, or ‘programmed cell death’, in menstruation.
  • Highlights the role of serendipity in research.  “All of my interests have been serendipitous.  But I think that’s the way you enjoy life – you have to make use of the opportunities as they come along.”  
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Section 3

  • Gets involved in renal pathology almost by default, and this subsequently became a major interest.
  • Gets involved in GI pathology – which became another major focus in his career -- at a time when new technology was transforming the field, to the extent that “one had to learn it from scratch”. 
  • Works with Basil Morson, the doyen of GI pathologists, in London.
  • The story of the Nobel Prize for ulcer researchers -- how new technology can challenge cherished assumptions and meet resistance:  “I -- along with virtually every other pathologist -- dismissed the little things that turned out to be Helicobacter pylori.”  
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Section 4

  • Discusses his attitude to diagnosis.  Although he rarely has direct contact with patients: “I am always very conscious there’s a patient at the end of [the diagnosis].”
  • Mentions briefly the value of multi-disciplinary teams in bringing pathology back into mainstream of clinical practice. 
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Section 5

  • Returns to early family life and formative influences.
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Section 6

  • Discusses some major advances in technology in his time – particularly immunohistochemistry, which has taken much of the guesswork out of cancer care: “this technology has made diagnosis much, much more specific.”
  • Talks about his work as chair of the Tissue Bank Committee in Dundee, his advisory role on legislation governing tissue research in Scotland, and his support of the ‘presumed consent’ position for the use of surplus tissue for research.
  • Expands on his concern that current legislation is putting a brake on medical progress:  “I know of studies that have not been done because it’s just not worth the effort of going through the ethical hoops.” Acknowledges that he feels very strongly about the fallout from Alder Hey and Bristol controversies.
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Section 7

  • Returns to his “professional heroes”, including Basil Morson, Alfred Stansfield and Jeremy Jass.
  • Interesting anecdote about groundbreaking research on gut lymphomas, and process of getting it recognised by the medical establishment.
  • The fun and challenge of diagnosis, illustrated by real cases – including the riddle of silicon stones in the bladder and the man who nibbled doormats. 
  • Further stories about the medical detective work needed to spot rare conditions, such as Zollinger-Ellison syndrome, and Whipple’s disease.

 

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Section 8

  • Returns to personal story and tells of the death of his young wife and the importance of the postmortem in coming to terms with the tragedy. “Postmortems can be very, very helpful to individuals – to the living.”
  • But postmortems don’t always yield results easily – intensive work with the microscope on the organs and tissues removed may be needed for a definitive diagnosis.  He tells the story of finding the rare angiotropic lymphoma, for which he became renowned.
  • Talks of his feelings about performing autopsies and the irony of the fact that he is squeamish: “You may think it's funny [but] I don't like blood!”
  • Discusses how he finds the balance between respect for the individual and the necessary professional detachment to do the job. “Until you've made the first cut you think of the body as a person.”

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