Latest / EHA Unplugged / Hematology Portraits: prof. Elizabeth Macintyre

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Hematology Portraits: prof. Elizabeth Macintyre · EHA Unplugged

• 0:03
  Greetings and welcome to EHA Unplug, the official podcast
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  channel of the European Hematology Association EHA.
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  Hello, I am Isabella Rivera, your host for EHA.
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  Today we have the privilege of interviewing Professor Elizabeth
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  McIntyre, a past president of EHA and the present president of
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  the Biomedical Alliance in Europe.
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  She's a full hematology professor at University
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  Parisite, where she headed the diagnostic hematology at Necher
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  Anfam Malad Hospital. In this episode, we'll explore
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  her career in hematology, her involvement with EHA and the
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  Biomedical Alliance, work she's been doing, and her vision for
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  the future of the hematology field.
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  Thank you very much for being with us today.
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  And thank you very much for inviting me.
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  It's a pleasure to be here. So, Professor McIntyre, can you
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  share first what initially motivated you to pursue a career
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  in hematology? When I went to medical school,
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  my family, who are farmers from the north of Scotland, thought I
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  was going to become a General practitioner in the north of
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  Scotland. So if anyone had said to me that
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  I was going to become a hematologist in Paris, I would
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  have fallen off my seat. So anyway, I went to medical
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  school in the north of England in, in Newcastle upon Tyne and
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  knew which specialties I didn't want to do.
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  So it then became, I think a process of exclusion and also of
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  the people that inspired me. And I think that point is
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  important, important because if we have hematology teachers and
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  mentors who inspire us, or we have medical teachers and
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  mentors that inspire us, we're more likely to choose that
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  specialty. So anyway, I obviously I did
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  internal medicine as everybody in British training.
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  That's the way to get into hematology.
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  And so after once I'd done my two years of internal medicine,
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  I, I chose hematology and then moved from from the northeast of
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  England to London to University College and University London.
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  I did both clinical and diagnostic hematology because
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  that's the way the British training program works.
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  And I thought I was going to spend the rest of my life
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  working as a practicing clinical hematologist in the United
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  Kingdom. But then I, I, I did a little
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  bit of research, translational research and I wanted to learn
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  to speak French. So I told my boss in London, I
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  was going to Paris for a year to, to learn to speak French.
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  And then I would come back in and start working again in, in
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  the United Kingdom. And as soon as I got to France,
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  I, I liked it there. So I stayed a bit longer and I
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  did a master's and, and also I met my now French husband who's
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  also a hematologist. And to cut a long and exciting
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  story short, I came back to London, finished my clinical
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  training, and then we both went to Harvard and in Boston in the
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  early 90s. And and then the stars were
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  aligned and somebody offered me a job in Paris.
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  I knew nothing about the French hematology system.
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  I sort of naively presumed it was state was the British 1.
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  And I was lucky enough to get a chance to to set up diagnostic
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  hematology in a new department at, at Nicaron from Malad
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  Hospital in, in what is now University Paris city.
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  Now, I thought I was coming to do clinical and laboratory
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  hematology because I didn't know that you could just do
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  laboratory hematology or diagnostic hematology.
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  Would I have applied for such a job if I'd known that that's
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  what I was going to be doing? I don't know.
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  But anyway, I soon discovered that there was a lot to do in
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  setting up a diagnostic hematological malignancy service
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  and that there's no way I could have developed it with the same
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  energy if I'd been in the clinic on the wards and been trying to
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  develop diagnostic hematology at 7:00 in the evening when I was
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  exhausted after all my clinical duties.
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  I, I've, I've worked in, in Nechehon from Malade ever since
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  I was lucky enough to work in a healthcare system, but has a
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  generous funding or it's maybe not always seem that seems that
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  way from the inside. But I think we've been very
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  lucky in France in that we have been able to do innovative
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  diagnostics for hematological malignancies.
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  And, and I became head of department for, for the
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  laboratory and worked closely with the the both the local
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  clinical teams in the hospital, but increasingly with the, the
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  clinical cooperative groups, which are very important actors
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  in French, in French he monk practice.
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  So I, I was lucky enough also somewhat paradoxically to work
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  in, in adult hematology as an adult trained internist and
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  hematologist, but in a pediatric hospital and, and some
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  pediatricians not from our hospital because there was
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  little and progressively no he monk in our hospital, but one of
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  the other Paris hospitals, Torso Hospital and Guileverge's team
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  asked us to, to work with them on minimal residual disease
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  management of children with, with hematological malignancies.
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  And so we've worked at the both the adult and the pediatric
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  space progressively more and more specialized in lymphoid
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  malignancies. And I was also able and I chose
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  to separate the benign hematology diagnostic service
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  from the he monk service. Now that's not popular with
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  everybody. Some people think we should in
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  diagnostics, we should be running the whole gamut from
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  keeping a a hospital department running for the whole of
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  hemostasis thrombosis, the full blood counts, the 2424365365
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  hematological service that is necessary to keep operating
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  theaters and to keep emergency rooms and to keep a hematology
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  to keep the hospital running. And that that should be mixed in
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  with a specialized Hemonc service.
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  But I don't think that's the way that diagnostics should be
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  evolving in today's specialized world.
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  So I progressively set up and separated the two, the two
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  departments into non malignant and the he monk service and that
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  has been I think a huge success for both parties.
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  Hem Onc has gone from strength to strength, maintaining and
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  defending a cellular and a molecular approach and
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  progressively integrating molecular cytogenetics and
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  working closely with hematopathology to provide an
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  integrated Hem Onc service, which I think is a very
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  different service to patients. To the non malignant service
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  which I handed over to a hemostasis and thrombosis expert
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  who built up the non malignant hematology service, which I
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  don't think she would have been able to do if she'd been
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  overshadowed by a head of department whose priority was
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  malignant hematology. And that's contested.
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  But I think it's the right model and my successor thinks it's the
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  right model. And we we think that model
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  should be envisaged in other hospital departments in France.
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  It's very close to the the HMDS model, the hematological
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  malignancy diagnostic service that has been developed in the
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  United Kingdom. And I think it's something that
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  should be considered across across Europe.
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  There have been so many advances in this time in the diagnostic
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  procedures. The techniques have changed so
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  much in this time. You have been instrumental also
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  in implementing this in France and advancing this.
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  What are your thoughts on the recent advancements and the
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  prospects of diagnostics in hematology?
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  We're lucky we're in a discipline where diagnostic
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  innovation has been relatively easy because blood and bone
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  marrow and lymph nodes are relatively accessible.
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  So we're at the forefront of that development and it's up to
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  us to integrate those advances beyond publishing papers, but
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  actually in the implementation phases that mean that patients
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  benefit from it and that it's integrated into their healthcare
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  pathway. Now that has implications on
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  healthcare management, on funding healthcare, funding
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  diagnostics, and I think it also has implications for training.
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  I don't think you can now run a diagnostic service while still
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  doing clinical practice. I just don't think there's a
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  space for running that on a part time basis.
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  Now within Europe, hematology training tracks are slightly
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  varied and one of the commonest tracks for clinical
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  hematologists is to be trained in therapeutic hematology and to
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  do some lab work and to do some translational research.
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  I'm being over simplistic, but those clinical hematologists
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  learn some microscopy, but less and less microscopy and there's
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  little exposure to the flow cytometry, the the molecular
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  techniques, the molecular cytogenetics, the increasingly
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  the omics techniques. So either you think that you
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  consider that happens in a research lab.
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  So you do your clinical practice, somebody looks down
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  the microscope and you have biomedical scientists who
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  provide the data and you integrate them all.
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  Or you go further down that track.
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  And that's a less common pathway.
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  But your medically qualified hematologists will choose
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  diagnostic hematology. Now it's it's sometimes called
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  laboratory hematology, sometimes it's called pathology.
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  OK. In North America, it's it's
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  within the pathology department, but it has various different
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  labels and people don't really know where it sits.
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  So I think some people might just like to think that that all
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  stays within the clinical hematology track and that some
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  clinical hematologists will become the diagnostic
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  hematologists, but without the somewhat formalised training of
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  what it is to to do hospital diagnostics, to do regulatory
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  grade reimbursable healthcare. Because it's not the same thing
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  to take samples and publish a paper as to get it integrated
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  into clinical practice. In France we and I think it's
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  one of the rare European countries where you can become a
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  biological hematologist. But interestingly it at European
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  level that is recognised as being a general laboratory
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  hematologist or a laboratory biomedical Dr. So there are
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  issues about recognition. There are full time laboratory
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  specialists who do microbiology, clinical chemistry, what else?
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  Immunology, genetics, constitutional genetics.
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  And then there are pathologists who look down the microscope and
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  then there are clinical hematologists.
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  Now I'm UK trained and I'm a member of the College of
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  Internal Physicians because I passed the exam.
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  But as a hematologist, you become a member of the College
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  of Pathologists. So we're somewhere between
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  internal medicine and pathology and you need dual skills and we
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  should have a sort of spectrum of training between the two of
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  them, but we need some kind of European recognition of those
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  training tracks. But that's part of the problem
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  of hematology being recognized as a speciality in in.
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  Itself is absolutely. Yeah, sometimes it's with
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  oncology also a bit. And yeah, absolutely.
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  With internal medicine, it's it's difficult to situate
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  hematology because it's so broad.
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  Yeah, the. It's a very important point, and
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  we need to be recognized as a medical specialty in its own
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  right within the greater family of internal medicine.
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  That shouldn't be too complicated, and we're on track
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  to to make that work. But for the diagnostic
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  hematologists we have to find the right space not just for
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  hematology, but I think if we find the right space for he
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  monk, then I think that model may well be followed by other
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  specialties. Because if it's become difficult
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  to do non malignant and malignant hematology from a
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  diagnostic point of view, that's also true for other, for other
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  organs. And probably the closest
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  specialty would be neuro oncology, neuropathology and
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  management of, of, of CNS tumors.
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  But you could argue, do you not need nephrobiologists who would
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  manage renal disorders? And I, I think these kind of
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  issues need to be addressed. They need to be addressed as
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  we're moving slowly towards, to call them European boards is
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  perhaps a bit of an acceleration, but European
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  recognition of we have our European curriculum in
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  hematology, we have our exam, one day we will have boards.
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  I think at the moment we're on how do each, how does each
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  member state want to recognize these training tracks.
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  So it's an interesting space and I think we're a bit of a proof
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  of principle for how we manage an increasingly specialised
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  diagnostic process in, in, in cancer.
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  They imagine then you don't see patients.
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  So don't see patients, I see their samples.
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  You missed that. Personally, no, I I would miss
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  it if I didn't have the contact with the clinical cooperative
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  groups. And I, I think you need to feel
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  that what you're doing is useful, but there are different
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  ways of improving survival curves.
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  And I think we have contributed to improving survival curves.
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  I've avoided the issue that we can see in clinicians who've
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  been giving chemotherapy for 2530 years.
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  It can get a little tough. And I think on the other hand,
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  my job is as if I were a medical scientist, but I get paid as a
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  doctor and I do some teaching and I think I, I have a very
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  nice life as a, as it happens, as a woman.
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  I've been able to bring up my children.
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  I've been able to contribute to, to, to managing range of not
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  very pleasant diseases and I've been able to generate
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  understanding and to publish at an age when it was terribly
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  exciting to publish. And once you've got your h-index
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  up to being reasonable, then you say, well, what's the next step?
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  And where I am in my career now, I'd like to see young people
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  choosing our discipline because there's a, there are many ways
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  of doing hematology and there's probably a right way of doing
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  hematology for everybody who wants to to work in a discipline
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  that is right at the interface of understanding pathophysiology
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  and exploiting it for therapeutic intent.
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  How did you get into the HA and what has it meant to you in
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  during your career? I can't remember how good the
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  EAGI think I was probably asked to review abstracts.
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  And then I joined the the SPC quite a long time ago now.
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  Then I got into the Fellowship and Grants Committee, and then I
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  applied for the board. I didn't get elected.
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  David Grimwede did, and I applied again and I joined the
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  board in 2015. I'm a trans European.
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  I get the codes in European medical politics because I'm a
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  native English speaker and because I understand British
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  culture and I've learned to understand and love French
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  culture and I just love the European Space.
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  And if you love something, you'll always do it better.
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  And I've, I loved being EHA president.
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  I thought it was a real treat. I, I can't think of any more
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  constructive element in, in building European confidence
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  than to be able to share some common ground from, from Turkey
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  to Portugal, because because we share the same diseases, we've
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  got something in common. And if we've couldn't, you know,
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  and that's something in common goes across many linguistic
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  boundaries. And it's just, I've just found
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  it such a constructive space at a time when there's rising
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  nationalism. And I think the potential for
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  European medical societies and European societies in general to
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  build confidence across borders is just priceless.
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  Yeah. And demonstrate the value of
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  cooperation and of being together.
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  Yeah, yeah. So now you're the president of
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  the Biomedical Alliance. What are your main goals there?
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  What? What are you doing?
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  Well, it's an extension of the same thing.
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  It was, it was the HA that asked me to, to, to represent the HA
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  at BioMed Alliance. And I, for various reasons, I
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  quickly joined the board and and then became president at the
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  beginning of 2024. And BioMed Alliance is a really
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  smart association of now 35 medical specialties, European
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  medical specialties. We don't have individual
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  members, which was created by four really smart specialties
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  that there was cardiology, one of the cancers, diabetes and
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  respiratory who realized that we we need to speak with a common
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  voice if we want to be heard by lawmakers and decision makers
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  and policy makers at the European Parliament and the
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  European Commission. And those 4 societies created
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  the. Medical Alliance recently, it
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  was in 2010 and little by little, more and more societies
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  realized that obviously we're only going to deal with
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  transversal issues. We will never deal with
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  something that is just cancer or just vaccines or just infectious
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  diseases. But there are so many
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  transversal issues. And one thing that I think it's
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  important to realize that in a, in a functioning democracy, the
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  government and the lawmakers listen to advocates.
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  And there are broadly 3 categories of advocates in the,
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  in the medical world. There there's industry who have
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  very, very professional advocates who are very, very
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  closely linked to the parliament and the Commission.
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  There are patient advocates who are becoming exceedingly
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  professional and and they're very good advocates and
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  understandably politicians listen to them.
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  And then there are the medical specialists and we are not
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  trained to be advocates and we're trained to be specialists.
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  So we talk about very specialised things and often
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  policy officers and lawmakers and politicians don't understand
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  us and sometimes we neutralize each other out because we're all
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  talking about such specialised topics.
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  So we have to have people who know how to how to advocate, how
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  to do advocacy for the role of healthcare professionals and,
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  and we represent doctors and biomedical scientists.
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  We're not a, we're not a union. We're not there to defend
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  doctors rights. We're there to make sure that
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  the the voice of biomedical research and medical practice is
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  heard when the laws are being written or when they're in
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  they're implementing phases. And for that, you need to learn
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  to talk clearly, to talk to give clear messages and to be
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  constructive in a multi stakeholder format.
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  And nobody teaches you that at medical school and nobody
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  teaches you that when you're when you're going through your
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  specialty training. And most eminent professors are
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  not advocates. So what do we do?
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  Do we either depend on public health doctors to be our
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  advocates? And, and, and it's very
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  important that there are public health specialists,
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  epidemiologists, statisticians, but they can't understand the
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  whole of medical practice. So at BioMed Alliance, we
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  believe that we need a small number of, you could call us
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  implementation scientists or regulatory scientists who have
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  enough background and experience to represent our specialty and
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  who've had enough experience to then go on and say, how can we
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  make sure that the that the laws that are coming out in the the
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  European health space are fit for purpose?
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  And it's better to be at the table while we're designing them
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  rather than complaining about them because we were absent when
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  we were designing them. So we like to think we're we're
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  constructive health pros to the European Commission, the
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  European Parliament and its policy officers and lawmakers.
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  So you are a bit out of your comfort zone because you're in a
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  space that is not natural. Again, to a medical doctor.
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  I think I'd say it's a new space.
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  I couldn't have done it when I was 35, but it's it's, it's a
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  good space for me now. I'm almost at the end of my my
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  career. I'll return a few years and it's
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  a space I like. And if you like being in a
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  space, then you're better at it. But I see that you have enjoyed
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  each one of those spaces where you have been or where you are
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  or still. And it is fascinating to hear
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  how you have advanced during your career and where you are
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  at. And very, yeah, good luck with
• 24:30
  this step. Thank you very much, Professor
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  McIntyre, for sharing your unique experience with us.
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  Thank you to all of you for tuning in and see you next time.