Conversations with Evelien Gevers
Photo: Julie Newman
Ju: What is the focus of your research and medical practice?
Evelien: I am interested in the physiological process of growth, and particularly how growth hormone affects the epiphyseal plate (a cartilage plate in the long bones that is necessary for growth). My medical practice focusses on hormone disorders in children, particularly growth anomalies.
Ju: What does this involve? What are you working on at the moment?
Evelien: Currently, I am investigating which are the cells in the epiphyseal plate that growth hormone acts on. I do this by using animals that have deficient growth hormone production and looking at different cell types within the plate by visualizing the chemical signatures left by growth hormone's action.
Ju: What made you feel passionately enough about this area of research and practice to choose it?
Evelien: I was intrigued by the diseases caused by aberrant hormone secretion or action that I saw in children, ranging from therapy resistant rickets due to abnormal action of Vitamin D to a syndrome with aberrant skin pigmentation, bone cysts and precocious puberty due to abnormal hormone signalling. I decided to become a paediatric endocrinologist and to learn the techniques that would allow me to understand the molecular and physiological mechanisms involved in endocrine disease, and in growth problems in particular.
Ju: How did you train for it?
Evelien: I did a medical degree, and finding that I was interested in research, I then did laboratory work culminating in a PhD. I then continued to train as a paediatrician, which is a five-year clinical training, and continue to pursue both clinical and scientific work, specialising in paediatric endocrinology.
Ju: What do you ultimately hope to achieve from it?
Evelien: My aim is to be a paediatric endocrinologist as well as a scientific researcher, so that I can see children with complicated endocrine disorders, and through my research can contribute to the understanding of the cause and ultimately to the improvement of therapies for such disorders.
Ju: Before I started this project, I thought it was quite common to research as well as to practice medicine, but in fact it's very unusual. Why is this? How do career paths for doctors and researchers usually differ?
Evelien: It is not very unusual to be an academic clinician in a university clinical setting, but it is less common to pursue both basic laboratory research and clinical work. Many clinicians have chosen to do medicine because they were attracted by the clinical work. There used to be little emphasis on research during medical training, and therefore most of those doctors would choose a clinical job. Doctors who are interested in research can do an MD or PhD and then choose an academic career, but because of limited jobs and funding, not all of those doctors end up doing research.
Ju: Is it different for surgeons, who can only develop new techniques on patients? Or do most surgeons not carry out research either?
Evelien: Times are changing, and you will also find surgeons with an interest in research. For example, some orthopaedic surgeons interested in arthritis and joint replacements do research to develop biomaterials and tissue transplantation to improve surgical outcome.
Ju: You come from The Netherlands, and received your initial training and qualifications there. How have you found things to be different in the United Kingdom? Is it more common for people to practice both medicine and research there?
Evelien: The situation in The Netherlands is rather similar to that in the UK in this respect.
Ju: In order to finish your qualifications, you are currently doing general paediatrics at University College Hospital (UCH) in London. What does this involve? How does the work link up with Great Ormond Street children's hospital (GOSH), which is just down the road?
Evelien: I have just been a specialist registrar in General Paediatrics and this involves seeing patients on the wards, in A&E and in out-patient clinics. For most common problems, we do not need specialists from GOSH, but for unusual problems, we communicate with consultants at GOSH for specialist advice, if necessary on a daily basis. Sometimes, children are transferred for a day for specialist investigation, and occasionally, very ill children are transferred for a longer time.
GOSH is a tertiary hospital where only paediatricians can refer to, so they have a different population of patients.
Ju: One focus of my project is to explore the way in which we perceive and define normality. How do you think society's ideas about what is normal affect your work?
Evelien: Clinically we work with actual statistical averages or ‘norms’ (rather than society’s perceived ones that may be unrealistically narrow), since deviations from these measurements may be associated with disease. However, we always strive to treat patients as individuals who in most respects are no different to anyone else
Ju: Obviously children may be of short stature for very different reasons. For some it may be a side-effect of a serious illness, and some simply have a genetic condition that makes them short. Do their attitudes and their families' attitudes vary according to the cause of their short stature?
Evelien: There is a huge variation between the attitude of patients and their families towards short stature. Of course, there is a bias in the patients we see, since patients who suffer from their short stature are more likely to see a doctor. There does not seem to be a correlation between the height of the patient and the ‘suffering’. The vulnerability of the patient in other aspects of life may play a role.
When children are short due to another illness, they and their parents sometimes feel that the short stature makes them even more different. When patients are short due to genetic factors that make the family short, parents often feel that they want to do as much as they can to prevent the children ending up short like they did, even when they do not mind their adult height any more. There is also a confounding factor that short stature often goes together with delay of puberty, and that it actually is the delay in puberty that the patients feel uneasy about.
Ju: Do you find that children's attitudes to being short are very individual? Or are they similar? How much are they affected by their families' attitudes?
Evelien: Yes, the attitudes are very individual. Often the personality of the child affects the degree to which they perceive their height as problematic, and the family’s attitude also has an influence.
Ju: Have you got an opinion on how unusually short children and adults are treated in the media? Do you think we still have a 'freak show' approach to people who look unusual?
Evelien: Media seem to focus on particular problems over time, probably related to current affairs. It seems that short stature was extremely popular to write about a few years ago, and that the peak of media interest for short stature has passed. Fortunately, extremely short and tall people do not often work in the amusement industry any more, but at an individual level they are still often treated as being different, similar to other patients with chronic disease.
Because of the high costs of some growth-promoting treatment and the disagreement between specialists about whether this is a useful treatment for children who have idiopathic short stature (which means that there is no known cause for their short stature), this topic has been highlighted in the media. Sometimes children were portrayed as ‘just a little shorter’, and although that is true to an extent, the severity and impact of the short stature could be easily underestimated by the readers/viewers which will affect their opinion.
For many other causes of short stature, it is the underlying disorder that is being treated, and the disorder often has other consequences apart from short stature that need the same hormone treatment. Like for other treatments, society will have to weigh up the costs and the benefits of the treatment.
Ju: Another focus of my project is to develop a 'scientific' model of disability that is distinct from the 'medical model' of disability. How do you think scientists view disability? Do you think this has changed significantly over the past few decades?
Evelien: I think that view may be more individually determined rather than determined by the profession. I would hope that, in general, they would think about disability in a more social than medical context, incorporating people with differing abilities in all aspects of society, emphasizing their abilities rather than their disabilities. I think that because scientists do not necessarily regard their work as being related to disability, their view may not be very different from other professionals.
Ju: Do you think the stereotype of the research scientist has changed at all over the years? Or have views of scientists as god-like figures with power over life and death simply become more extreme?
Evelien: I think the attitude to scientists has always been mixed with both positive and negative aspects. The last decennia scientists may have been viewed more as having power over life and death, because some of the work they did was more closely related to the daily life of many people. On the other hand, society also realizes that scientific progress can be extremely slow and that many diseases still cannot be cured.
Ju: Do you think our exaggerated beliefs in the power of scientists affect scientists ability to work? For example, do you think our fears about the impact of science are exaggerated because we think that scientists are more powerful than they are?
Evelien: I think most scientists do not view themselves as extremely powerful, and realize that they are experts in a small area of medicine or science, and therefore the public opinion does not affect their work. On the other hand, political decisions are influenced by the public and decisions regarding cloning, embryonic stem cells etc do affect the ability of scientists to work.
© Ju Gosling aka ju90 & Evelien Gevers 2008
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