My inspiration to go into Immunology dates from the first heart transplant in South Africa. I attended the Massachusetts General Hospital as a final year medical student to see for myself and then watched renal transplants in theatre in London. I was not convinced that this was an ethical, life-saving procedure – how wrong I was!
Once medically qualified, I was lucky to work with really top-class bosses. I completed my doctorate in a Medical Research Unit (on SRBC rosettes as a marker of human T cells) with Richard Batchelor, concentrating on the immune defect in burned patients. I then worked in Philip Gell’s department in Birmingham and learned about immunology beyond T cells, transplantation and HLA. Life as a scientist (albeit a medically qualified one) was easy in Birmingham. I concentrated on the new human lymphocyte markers (few monoclonal antibodies as yet) in leukaemias and without clinical commitment, I had not intended to return to patient care; that is until I arrived in Oxford as a consultant.
Once there, I found that not only was there was no one interested in immune disorders, but I was only the fourth woman consultant in a staff of >350! I found a few male general physicians willing to help me to see patients with SLE, ITP and other immune conditions in the clinics and I set up hard-copy databases for these conditions (this was 1978, before HIV). Once the new Immunology laboratory was set up to diagnose primary immune deficiencies (PIDs), it was important to be able to treat the patients. So immunology assessment and treatment clinics were established, for adults in 1983 and children in 1986; these are now run by Smita Patel.
I was very fortunate to be trained by Ron Thompson in Birmingham, and to share a lab with Mansel Haeney. Once in Oxford, Mansel and I realised there was a need for a clinically based immunology textbook for both medical undergraduates and out-of-date doctors, so in 1984 we wrote Essentials of Clinical Immunology, now in the 6th edition. The clinics grew exponentially, and we had to set up immunoglobulin therapy at home by self-infusion. Long-standing friendships with many colleagues worldwide began when I was invited by Ralph Wedgwood to the WHO-PID meetings in the US. Being introduced to ESID by Roland Levinsky and David Webster to run the 1990 EGID meeting in Oxford began my involvement with EGID and subsequently ESID.
One of my proudest accomplishments was starting the ESID summer schools, which culminated in PID schools around the world. Also in helping Bob Lebien start IPOPI at the 1990 EGID meeting and watching it grow and flourish, including convincing the WHO in Geneva to include immunoglobulin therapy on the Essential Medicines Lists for Adults and Children.
My advice for others embarking on Clinical Immunology, and PIDs in particular, is to fight the battles that you can win for patients and therapies and don’t take “no” for an answer – just avoid a question that will not go down well and find another way.