I decided to study medicine because of my interest in natural science, along with the wish to work with people. Cancer knocked on my own family's door, so when the time came to choose a topic for my doctoral thesis, I chose oncology. This subject is still at the heart of my research. For the past 4 years I have been working to develop new anticancer treatments that combine novel laboratory research results with the innovative application of conventional cancer treatments in patients.
After my internship in the department of hematology and oncology at the University Hospital in Heidelberg, I changed to a research position at the department of molecular immunology at the German Cancer Research Center. Although I really enjoyed some aspects of my clinical work, such as dealing with patients, research offered me other important possibilities. For example, in a research environment you have a lot of autonomy, in contrast to the more routine and hierarchal working life in hospitals. The opportunity to work in my present research area came about because I had already worked on a collaborative project with scientists from the DKFZ as an intern.
The main focus of our work group is radioimmunotherapy. Currently most cancer treatments use chemotherapeutic drugs (cytostatic agents) that kill all cells, whether they are cancerous or not. The treatment harms healthy tissue and the side effects for the patients are not trivial. Our treatment strategy takes advantage of two powerful scientific principles, one coming from the world of immunology and the other from nuclear medicine. Borrowing from immunology, we have developed a strategy to generate tumour-specific antibodies, exploiting their exquisite selectivity. Nuclear medicine gives us radionuclides that have the intrinsic property of being able to kill cells in their vicinity. The result of attaching them to the tumour-specific antibodies is that these radionuclide antibodies travel to the tumour cells, destroying them but leaving the healthy tissue relatively unharmed. We believe such an approach will lead to the development of more selective, effective, and individualised therapies for cancer patients which, very importantly, will have reduced side effects relative to current chemotherapeutic agents.
This research requires the close interdisciplinary cooperation of scientists in different basic areas such as immunology, molecular genetics, pharmacology, pathology, physics, and radiochemistry, with application-oriented clinicians at university hospitals. I find this multidisciplinary research environment really interesting. I learn a lot about the priorities of my colleagues in various disciplines. These may be quite different from my own, and compromises must be made. Exchanging knowledge with these researchers is always stimulating, and the interaction is enjoyable, but it isn't always plain sailing! To get a consensus and to really get things done can be a challenge.
In addition to the disciplinary diversity of this research group, there is also a great deal of national diversity. This is something that really appeals to me: I meet and discuss science with people from a host of nations, even in my own lab and institute, in addition to the exposure to so many different people at international conferences and workshops.
Daily work is varied, and certainly could be described as spanning "from bench to bedside." I have gained experience in many of the "a-to-z" steps along the therapy-development path between the laboratory and the patient. My work has varied from cell experiments to preclinical animal testing and even to the advanced stage of clinical trials.
This brings me to a sensitive issue--animal experimentation. As the final step before embarking on the therapy in patients, preclinical animal testing is critical and indispensable. Animal studies (in our case mostly in mice) have to be faithfully planned to keep the numbers of animals involved low, and to reduce their suffering to a minimum. However, if the results will later lead to a benefit for a large number of cancer patients this puts it in perspective. It is a necessity.
Working in research also means keeping yourself informed. In an area where information is short-lived, reading the relevant literature and discussing it with colleagues represents a very significant part of my professional life. But this is also fascinating and exciting, especially if you use the opportunities presented by a research institute to acquire a much wider knowledge than that of your own specific area. At the DKFZ, for example, you may attend lectures covering a variety of aspects of the field of cancer, ranging from epidemiology to molecular biology to cancer therapy.
Besides the scientific work in the lab, a remarkable amount of time has to be spent in front of the computer. The major means of measuring your output within the "research community" is the number and quality of articles that you publish in appropriate journals. Fund-raising ability is another attribute you will have to develop. To those working outside research, it might be surprising to hear that you may personally have to write grants applications for funding to support your research project and personnel costs, even within the life span of one project. This is because the internal funding in your research institute or university is frequently limited, and grants from other organisations are required. Writing grants mainly comprises detailing research aims and plans and submitting them to a national authority or to sponsors from the pharmaceutical industry. Grant writing consumes a huge amount of time and energy, and not always with a successful outcome.
The link between research institutes and hospital departments is often a major bottleneck in the investigation of novel therapeutic strategies. Beside the time that must be spent on the required paperwork in order to get approval for early clinical studies (phase I/II trials), long-term cooperation has to be established and maintained to make these clinical trials feasible in the first place. Due to the high turnover of personnel (most of the hospital staff members involved have temporary contracts), such collaborations are fragile and must be carefully fostered. For example, you may succeed in setting up a clinical trial, having waded through all the paperwork to get the necessary approval, only to have the clinician in charge leave the hospital because his or her contract is over.
When working in applied research, my advice to medical doctors is to ensure they maintain their clinical skills. They should also be aware that jobs in this area are relatively rare--in my opinion, too rare--so the option of returning to a job in the hospital should always be kept open.
Working in a research institute is a real career alternative for only a small number of medical doctors. But if you choose this kind of work, the skills that you will acquire make you interesting to both university hospitals and the pharmaceutical industry. From a financial standpoint, the latter can be more attractive. But keep in mind that the economic pressures in industry will sometimes be of higher priority than the potential benefits to patients. Furthermore, intellectual autonomy in research will usually be more pronounced in research institutes or universities.
Career moves between clinical medicine and research, in academia or industry, are indeed quite possible, and a move in either direction is, thankfully, not a one-way ticket! Although I also enjoy this potential career flexibility, presently I am very satisfied working in therapeutic research that takes me all the way from mice to men.