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Dr G. Strippoli NHMRC Centre for Clinical Research Excellence in Renal Medicine Cochrane Renal Group, School of Public Health University of Sydney Sidney, Australia |
Prof. Zoccali: Your father is a well known nephrologist in Italy. Which role did he have, if any, in your decision of choosing nephrology?
Dr. Strippoli: My father made me type hundreds of abstracts and his CV several times when I was a child and he was a young nephrologist progressing in his career! That may have had an ‘imprinting’ role in my decisions… I admire him profoundly as a person, and have a natural tendency to imitate and follow worthy example. He has given sustainability to my choice by supporting my studies and enjoying my achievements with pride. It is always a source of great joy to see him at the corner of the room taking pictures of me when I am invited to give a talk!
Prof. Zoccali: Young doctors are much attracted by basic research and pathophysiology. What led you to be interested in research methodology and meta-analysis?
Dr. Strippoli: At the University of Bari, Italy, my mentor told me I was a disaster at basic science! That was a good start.
I also understood that “most” young people are more attracted to basic science because this is the most straightforward way to obtain a PhD. Clinical research was going to be more difficult and time consuming. But I like difficult things and don’t like to go the way “everybody suggests I should go”, unless they are very convincing.
Meeting the right people was very important. I recognize this was a lucky draw, because there are fewer knowledgeable people in my current area of interest than in basic science.
Knowing about research methodology also gave me a sense of independence: all I needed was my brain, a computer, a knowledge basis, lots of time and hard work.
Finally, it is important to go fishing in the right pond. We are far away from getting the big picture of many aspects of therapeutics, prognosis and diagnosis. My current area of interest is one where research contribution is absolutely needed, and this became obvious to me since the beginning of my career. And “fishing in the right pond” is always rewarding.
Prof. Zoccali: I understand that you work both in Italy and Australia. What do you miss most when in Australia and viceversa?
Dr. Strippoli: When in Australia, I miss my family and the ability to be “a bit undisciplined” (like driving fast or parking in “slightly” illegal spots…these sort of “mistakes” have costed me lots of money in Australia…). I also generally miss my “Italian summers”, my “Italian Christmas” and my “Italian Easter”…. (because that is when I go to Australia).
When in Italy, I miss my Australian working environment. I have and have had in Australia opportunities which I could never expect at my young age: becoming an academic, teaching at University, interacting with high level and highly professional colleagues, the respect of these people. That capacity building environment I always look forward to returning to.
Prof. Zoccali: You are a quite prolific author. Could you tell us how you partition your time between research and clinical practice? (e.g. 50%-50%)
Dr. Strippoli: 75% research, 25% clinical work. In general, in the beginning of my career I took the “all or nothing approach” (as is typical of young people). I generally spend an entire month in the clinic, seeing patients only, and after that, it is time for research, at least 3 months, full time. This approach has been instrumental in publishing several “scientific” papers, many of which required lots of very hard work and acquiring substantial knowledgeability (based upon the principle that this is science, not papers and a “sausage factory”!).
Prof. Zoccali: What future do you foresee for nephrology as a specialty? Some envisage that progress in other areas will eventually make it a niche specialty.
Dr. Strippoli: I never thought of nephrology as a “kidney only” specialty. I think there is substantial space for broadening the scope of nephrology research and clinical care. Cardiologists, endocrinologists, internal medicine physicians have been happy to take lead where we should have claimed: hypertension, diabetes, “populations disorders” which we disregarded in favour of glomerulonephritis.
I see nephrologists have a tendency to develop theories but lower interest in “the next step forward”. By the time we realize many theories developed in a lab will need to move forward from the bench to the bedside, with development of large randomized trials and having to follow-up larger spectra of the population, then certainly “there will be life and food for future years” in nephrology.
Prof. Zoccali: Do you feel that clinical epidemiology deserves more emphasis in medical training?
Dr. Strippoli: Absolutely. Many underestimate the importance of simple things which will affect a multitude, because nobody taught them. The nephrologists have a tendency to see subcategories rather than populations. We are prone to think of “our own” diseases and populations. Training in epidemiology will teach people to broaden their horizons, then get more specific. Want an example? Nephrologists say water is good for the kidney. How many of us have actually studied this though observational or randomized designs? We all say it, but maybe if were taught how to prove it…somebody would do it!
Prof. Zoccali: Do you think that young doctors in academic centers should be given more time to devote to research?
Dr. Strippoli: Certainly. I would partition their time with my preferred 75/25% approach, and they could choose either clinical or research as a priority, but then it would have to be full dedicated time. Young people are often started to many things all at once, but you may not be capable of handling many things when you don’t know the big picture.
Prof. Zoccali: Do you have any hobby?
Dr. Strippoli: You introduced me as a “breeding” Italian nephrologist. This is a proper definition, since I breed and collect rare and exotic parrots. I own more than 300 parrots, including species of rare macaws, African greys, Indian ringnecks among others. I have fun matching them hoping the Mendelian segregation will work the way I expect based on my “opinions”! You will be pleased to know that aviaries are the only place where I’ll rely on personal opinion rather than evidence…
My interest in birds includes the fact that I am currently obtaining a private pilot license and have been recently flying all over Australian and Italian skies. That is an extraordinary hobby!
Prof. Zoccali: Frankly speaking, which advice would you give to a young colleague wishing to enter a career in nephrology?
Dr. Strippoli: Three suggestions: 1. Find a good mentor; 2. take your career very seriously, proactively and demandingly, do not just “wait and see”; 3. don’t be intimidated by others: they don’t necessarily know more than you!
A good mentor is somebody who is not INTERESTED in your work to the advantage of an Institution or his/her own career only; he/she is somebody who likes to help, who expects you to grow into a good man, a good doctor, a good scientist.
Taking the business very seriously requires formal training and proactivity. You want to become scientist and/or a nephrologists not by publication record and “time spent in the clinic” but by knowledgeability. Formal training, good values, hard work but also expectation from your work environment are the key to that. There have to be no shortcuts on your side nor on the side of those you work with, in which case I would suggest you leave immediately!
Trying hard and not letting people stop you or slow you from learning is also very important. This may happen, it has happened to me several times. The best papers I published are those that some colleague of mine told me were absolutely meaningless! You need to think you are putting your life into this. Australians have thought me if you intend to just “wait and see” or “follow the flow of other people ideas” rather than be a protagonist, you should just let go and enjoy life! Why being in a hospital if you are not learning? Why being in an environment which is not stimulating your intellectual growth? Also, importantly, your future relies on you. And as Luis Sepulveda says in his book of “The story of a seagull and the cat who taught it to fly”, you “will never fly if you do not dare to do so”.
Prof. Zoccali: Which of the following will make you happier? (please rank):
Having a “leading investigator” paper accepted in the NEJM
Tasting a valuable bottle of exceptional Pinot Noir
Italy winning the world cup
Falling in love with Penelope Cruz
Dr. Strippoli: You gave several options which are not all applicable to my tastes; so however:
1. A NEJM paper would be first in order (there is one on the way, I think…), although I have experienced that these joys last for only a short time.
2. A good second would Penelope Cruz but most of all it would have to be her falling in love with me, since generally things go the opposite way around… I would rather a blond girl, though!
3. A very, very, distant third would be Italy winning the world cup. I am not much of a soccer fan, but if they won (as they did) this would give me a stronger position to debate with the Australians about some Italian superiority!
4. Wine is fourth; unfortunately I do not drink wine. If I could change this option with smoking a very fine cigar, say a Cohiba, that would certainly go first in the ranking of importance.
