From Diagnosis to Treatment
Chris Kennard reflects on an amazing career at the commanding heights of Neurology
By Richard Lofthouse, Editor of Oxford Today
It’s almost a set piece of medical comedy, being whacked lightly on the patella by a reflex hammer wielded by a doctor. If the femoral nerve doesn’t correctly activate a circuit of nerve cells in the spinal cord and cause a reflexive jerk of the knee, something might be amiss, neurologically, in the spinal cord or brain. There’s a deeper point here, concerning the history of clinical neurology, a field that Professor Chris Kennard has worked in at the highest level for forty years. ‘In the seventies when I started as a senior house officer here in Oxford, it was a widely accepted joke that neurologists were fantastic diagnosticians but therapeutic nihilists, - that is, we had nothing to offer the patient.’ ‘I had colleagues who left the field when they realized this.’ But, he reports, this predicament has at least radically changed during his career, rendering the joke obsolete.
The day we meet [Sept 29th 2016] at the John Radcliffe Hospital, the sun is streaming in and Kennard’s office, on the 6th floor of the West Wing, itself on Headington Hill, offers a fantastic and unexpected northerly view over what seems like uninterrupted countryside.
Previously at Imperial College London, he came to Oxford as Professor of Clinical Neurology in 2008 charged with building the Department of Clinical Neurology up and improving collaborations between the clinical neuroscience departments in Headington with the basic neuroscience departments in South Parks Road. He has done exactly that, constructing what can only be described as one of Oxford’s mega-departments. When he arrived, Clinical Neurology at Oxford was excellent, but not preeminent in the UK. He began by setting up a Neuroscience Strategic Oversight Committee, to make sure that disparate bits of the University were aware of each other and working together. That insight also reflected the devolved nature of Oxford, where individual departments fight for external funding from the likes of the Wellcome Trust, rather than a central University body. Acutely aware of needing to achieve the scale to win what Kennard calls ‘big money’, he led a strategic merger between Clinical Neurology, the Nuffield Laboratory of Ophthalmology and the Nuffield Department of Anaesthetics, to form the Nuffield Department of Clinical Neurosciences (NDCN), the resulting entity now comprising 450 highly effective researchers working right across old divisions. It also meant forging greater collaborations with Experimental Psychology, Psychiatry and ‘half-neuroscience’ departments such as Pharmacology and the Department of Physiology, Anatomy and Genetics (DPAG).
With the new structure in place the big money came, with a string of hard-fought, multi-million pound funding successes since 2010. That put gas in the tanks and allowed Kennard and his colleagues to strike out into fields where Oxford had formerly had less prominence, such as Parkinson’s disease (one of Kennard’s own area of specialism) and Alzheimer’s disease.
The net result of all this is threefold. First of all, ‘It’s gone from being a relatively small department to one of the largest clinical neuroscience departments in the UK’. Second, the department achieved the top position, along with Experimental Psychology and Psychiatry, in the 2015 Research Excellence Framework (REF). Finally, Kennard’s leadership has directly helped to ensure that the neurosciences have come to occupy a major position in the University’s Medical Sciences Division, considered the best in the UK for the past six years. No one wants to take rankings too seriously, yet Oxford’s prominence in medical science was mentioned by the Vice-Chancellor in her (October) 2016 Oration, as having helped the University rise to No. 1 in the 2016-17 Times Higher Education World University Rankings.
I ask whether technology, and specifically CT and later MRI brain scanning capacity has transformed Neuroscience since the 1970s, allowing it to furnish therapies where before there was just a diagnostic label. Initially, Kennard’s reply is cautious. ‘…we don’t have a full understanding of the mechanisms behind diseases such as Parkinson’s and Alzheimer’s.’ But, he continues, ‘What we do have is the infrastructure in place for developing therapies when we have sorted out mechanisms, and the sort of cross-discipline work that leads to translational neuroscience.’ (A quick check of the Medical Research Council website reveals that ‘translational’ means ‘the principle of turning fundamental discoveries into improvements in human health and economic benefit.’)
Specifically on Alzheimer’s, he notes that on the other side of 200 plus failed trials of new compounds and big pharma woe, the broader insight is that victims of the disease need to be diagnosed many years before they show overt symptoms. ‘One day I think there will be a blood test that would allow protective drugs to be administered much earlier in a patient’s life.’ But that could take a decade or more.
Yet for all this, great strides have been made. The right drugs can now grant a decade or more lease of life to a victim of Parkinson’s disease, ‘even though we can’t stop it.’ Even in less serious conditions such as migraine headaches, Kennard reports that therapeutic drugs are available that simply weren’t in the past – so too in many other areas such as multiple sclerosis.
‘The biggest strides have been made in brain networks – how different parts of the brain interact with each other.’ When asked why it is that neuroscience has suddenly become quite a ‘cool’ subject in the wider publishing and media world, Kennard notes that brain scanning, which Oxford has always been a leader of, has permitted ‘a sort of neuro-phrenology. Where once Gall felt for lumps and bumps, proclaiming particular personality types based on skull shape, now we have a brain scan that can show how areas of the brain light up under certain activities.’ Asked for a sliver of advice on how we can all minimize out risk of dementia, which can begin to develop years ahead of any symptoms, he laughs -
‘Health body, healthy mind’– it’s still true!
As the 2016-17 academic year began, Chris stepped down as Head of Department while remaining a Senior Kurti fellow of Brasenose College, only to be immediately recalled by the Vice-Chancellor to serve as interim head of the Medical Sciences Division. He began this role on January 20th. He has organized a termly series of seminars at the College, open to non-specialists and alumni alike. Called Brain, Mind and Society at Brasenose, the discussions sit at the intersection of neuroscience, ethics and society. Chris is also organizing Oxford’s first BrainFEST in March 2017, and is Chair of the Scientific Programme Committee of the World Congress of Neurology that will take place in Dubai in 2019. He continues to advise BNC graduate students while being the Medical Delegate for Oxford University Press.