Monthly Archives: April 1999

The quiet evangelist

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PROFESSOR Suzanne Cory hadn’t thought she would be a scientist. As a girl she dreamt of becoming a writer, until a hard-headed self-assessment put her right: “I decided I was too ordinary, too middle-class, and I would probably never have the kind of experiences that good literature is made from. And I wasn’t sure that I had the nerve to be exposed to those events anyway.”

Instead, she took that objectivity and turned it to pursuing the cause of cancer. Thirty years on, she has won international acclaim for her scientific discoveries and the directorship of the nation’s biggest and most prestigious medical research institute. She is also in the vanguard of those warning Australia that it must invest more in medical science now or find itself out of the race early next century.

Cory, the director of the Walter and Eliza Hall Institute, has called for the Federal Government to accept the recommendations of the Strategic Review of Health and Medical Research, to be considered by Parliament in the current sitting. The review, chaired by businessman Peter Wills, said federal funding for health and medical research should be doubled and capital gains tax reformed to internationally competitive levels to encourage private investment in science.

Cory is a quietly spoken woman with a gentle manner but an evangelistic zeal. For the first 30 minutes of our interview she talks almost without pause, hammering home the urgency of Australia’s situation and the need to drum up support for Health Minister Michael Wooldridge’s pitch to Cabinet on the issue. Central to her vision is the exploding biotechnology industry and the potential for Melbourne to become a “genome valley” – the biotech equivalent of the IT industry’s “silicon valley”.

Cory argues that Australia will only be able to cope with a projected doubling of health costs by 2015 if it invests in basic research now. She says Australia must explore gene technology and discover medicines and techniques that it can sell internationally if it is to afford future products such as pharmaceuticals that have been developed overseas.

Doubling research funding would create between 10,000 and 15,000 jobs and lure back talented Australians working overseas. Some of the profits from the emerging biotechnology industry could then be ploughed back into research and the wider community.

She believes Australia is well-placed to contribute to what has been called the biologists’ search for the Holy Grail – the Human Genome project – which involves scientists all over the world working to map the 100,000 human genes, as well as the genomes of other key organisms. Once a gene’s role in a disease is understood, scientists should be able to comprehend the molecular basis for the disease – the chemical blueprints – then design medicines accordingly.

The project’s benefits are expected to include improved crops and livestock, more precise diagnostic markers of disease and “smarter” and “more natural” medicines that are, she says, “based on an intelligent appreciation of the pathways inside cells, so you can design a drug that is much more selective for the pathway that’s gone awry in, say, neuro-degenerative disease or cancer.”

“Long-term, we’ll be able to tailor medicine to the individual. We will know a person’s DNA profile. For example, certain families inherit a predisposition to diabetes. It’s a very complex disease due to (the) inheritance of certain versions of probably five or six genes.

“We don’t know what those genes are at the moment, or how they interact, but in the future we probably will. We’ll be able to detect which child in a family has inherited that constellation of genes and so from very early on, the family will know that this child needs certain lifestyle changes in order to prevent the onset of diabetes. That may be (repeated) across a range of diseases.”

Cory has almost always worked with minute elements that can have significant effects on human health. The motto of her discipline, molecular biology, could be, “The devil is in the detail.” Cancer starts with a single cell that goes wrong and much of Cory’s work, with her husband and scientific partner Professor Jerry Adams, has been focused on discovering the cancer devil’s whereabouts at the level of the gene.

Last year Cory shared the Australia Prize for molecular genetics for the discovery that oncogenes – cancer-causing genes – could be activated by genetic accidents in the body’s production of antibodies.

Breakthroughs like that help make a lifetime of painstaking detective work worthwhile. Cory says: “When you have come to an understanding of something important and you are the only one in the world who knows it, for just a few minutes – because of course, you have to publish it – just that moment is wonderfully exciting.

“It’s punctuated by lots of things that don’t work, long hard days at the lab where things go wrong … But understanding how life works is such an exciting voyage of discovery that you can put up with a lot of shipwrecks along the way.”

Cory grew up the eldest of three in a Kew family. Her father was an accountant and her siblings went into music and business; she says she was lured into science “by good teachers, of course … One was a year 9 teacher at Camberwell Girls Secondary School. She just had such an enthusiasm for science that it spilled over and infected you.”
Cory became firmly hooked at university when she learnt about DNA and chromosomes and genes: “Every lecture we heard, this story was unfolding.” She resists the notion that women scientists were unusual back then, pointing out that they’ve always been well represented in the biological sciences.

But when she was working casually at the CSIRO she saw a woman scientist forced to resign because she had married. Cory admits she was lucky to win her scholarship to study at Cambridge: “When I was a student there were very few scholarships at all to go overseas, but almost all of them stipulated men only. And the one I got – I think they forgot to say men only!”

It was at Cambridge that she met her American-born husband. They returned to Australia, had two daughters and worked together until Cory was in effect made his boss when she became director in 1996.

She misses the hands-on science, and the day-to-day working partnership: “It was difficult, in the sense that we’ve always worked as a total pair before … But I think it’s worked out surprisingly well … You can’t have two people being a director.

“I think a lesser man might have had more trouble than Jerry, but he’s an incredible person.”

CORY is surrounded by colleagues who not only admire her, but like her. Her formidable predecessor at the institute, Sir Gustav Nossal, launches into a 10-minute dissertation on her strengths: as a scientist of world renown, as a mentor of the best and brightest students, as a visionary leader who picked the importance of the genome project as the coming wave of world biotechnology. And as a person who would talk as nicely to the tea-lady as she would to the Health Minister.

Says Professor Bob Williamson, director of the Murdoch Institute: “She’s universally respected within the science and medical community for being scrupulously open and honest … She’s not Machiavellian.” He adds drily: “I think it’s possible to overcome those disadvantages if you’re good enough, and Suzanne is good enough.”

At 57, Cory’s professional preoccupations now revolve around ensuring that others get the kind of opportunities that have meant so much to her. She emphasises the need for a strong education system: “I am very worried about the cutbacks to the universities because if the universities aren’t strong, then we’re not going to produce good researchers. I know that at some universities, science enrolments are way down (since the introduction of tertiary fees). Investment in education … is really absolutely fundamental.”

Australia is just holding its own in the brain-drain stakes, she says, with as many foreign scientists arriving as local ones are leaving.

But the situation could become critical if funding does not improve. “The US is doubling its (medical research) expenditure, the UK is committing huge amounts of resources; so are Japan and Korea … If they all start rolling before us, we’ll be playing catch-up.”

First published in The Age.

Helping doctors to help themselves

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WHEN applied to women, it’s called the madonna/whore syndrome. It’s an inability to see a group of people as they really are, with their mix of flaws and virtues; an over-idealisation whose flip side is an equally unrealistic denigration. And it underlies many people’s attitudes to doctors.

We all want them to be kind and clever, caring and capable. According to whether or not they live up to our expectations, we see them as saints or sinners. No wonder doctors feel so misunderstood.

But there is one consistent element of criticism of the profession: it is the perception that medicine is a club whose members sometimes have greater allegiance to each other than to the community they serve. Doctors are believed to close ranks to hide or minimise colleagues’ mistakes or misdeeds. It is a perception that the Medical Practitioners’ Board of Victoria must work harder to dispel, and the State Government’s review of the act that governs the board creates a chance to debate how best to do this.

The medical board stands between vulnerable patients and the doctor who is overservicing, unethical, misusing drugs or alcohol, incompetent, sexually abusive or impaired through mental or physical illness.

Nine of the 12 members of the board are doctors themselves. Their (admittedly narrow) brief is to set minimum standards and to protect the community, not to punish doctors for misdemeanors.

But sometimes the board seems to interpret even these basic notions of “minimum” and “protection” very narrowly. Take the case of a psychiatrist who developed a therapy that the board found to be unethical and destructive of some patients’ mental health. The board’s interpretation was that the community was safe if the doctor received a short suspension and promised to stop the therapy. Patients might wonder whether a therapist who could be so gravely misguided and oblivious of harm was equipped to influence the emotional lives of others for the better.

The board’s hearings are not always constituted in a way that preserves the perception of impartiality. Is it appropriate that a member of the board sit on a case involving a defendant with whom he has even a referring relationship? Is it appropriate that the board accept and rely on expert testimony (as opposed to character evidence) from doctors who have had close professional relationships with an accused doctor?

This kind of link between the parties would not be tolerated in most arenas in which allegations are adjudicated. It can only reinforce any suspicion that the rules of the “club” favor collegiality over impartiality, the doctor over the patient.

Cross-pollination by related professions would help. A psychiatrist sits on the psychologists’ registration board; a psychologist would bring to the medical board similar ethical concerns as doctors but a decreased likelihood of close links with defendants. The board also needs at least one member with a background in patient advocacy to ensure the consumer’s viewpoint is strongly represented.

The board has a problem with gender imbalance in some hearings. Women make up the majority of complainants overall and nearly all complainants in sexual misconduct cases. But one recent sexual misconduct case (in which the women’s complaints were dismissed) was heard by a panel of four male doctors and one woman.

The panel’s makeup was sharply criticised in private by mental health professionals not associated with the case, who believed it left the board open to charges of gender bias.

Other problems relate to the inadequacy of legislation governing both doctors and psychologists. Struck-off psychiatrists and psychologists have been able to set up shop again instantly by calling themselves “counsellors” or “therapists”.

Successive governments have been stymied because they didn’t want to accidentally ban others who use those descriptions, such as financial counsellors and beauty therapists. The New South Wales health complaints commissioner, Merrilyn Walton, has suggested that one possible solution would be to ban the use of those terms only by those who have been de-registered by a professional body.

There are also gaps in the protection the law offers doctors when they report colleagues. Doctors cannot be sued for defamation if they report another because he shows signs of having becoming mentally or physically ill. But if a doctor reports a colleague for sexual misconduct or potentially dangerous incompetence, the reporting doctor has no legal protection.

The law should be changed to cover all three categories. We can’t expect doctors to speak out to protect patients knowing that their own career, good name or financial wellbeing might then be sacrificed to the quirks of the legal system.

Most doctors are neither heroes nor villains. They’re like the rest of us, decent people who try to do the right thing in difficult situations, succeeding better some times than others. It’s their responsibility to struggle with implicit biases they might have in coming to ethical decisions about the public interest. It’s our responsibility to create a system that supports them in that task.

First published in The Age.

The ghosts of belonging

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SERIES: GOING HOME

Karen Kissane

`HOME” was a mysterious place, the stuff of myth and legend; my family’s dreamtime. It was never the corner shop where we lived and worked; not the cement backyard of Tarax bottles where we pedalled our trikes, or the storage shed of Sorbent rolls and tinned food where we played hidey among the cardboard cartons. I grew up knowing that “Home” was not the place with which I was most familiar, but somewhere altogether different.“Home” was where families went for a holiday as soon as ever they could save the money. “Home” was where other families went for good when they just couldn’t crack it here – because of the slog or the heat or the heartsickness. “Home” was the place grownups talked about at their parties, sang about over their beer and referred to (only half-jokingly) as “Holy Mother Ireland”. Home is where the heart is, and their hearts were thousands of miles away.

This psychic umbilical cord seemed the source of all their grief and all their joy, and the intensity of the attachment left me feeling that life in the country of my birth was somehow insubstantial. Grownups’ memories of the childhoods they had been forced to leave behind overshadowed the reality of the childhood I was trying to live. Perhaps it is like this for all children of migrants.

Everything significant seemed to come from the other side of the world: my unknown grandparents and aunts and uncles, my fairytale heroes and heroines, the music that made me want to dance, the picture-postcard scenery that looked like Tolkien-land.

In the 1960s, urban Australia had little to offer a child’s imagination. But the Irish had stories of forebears in the famine dying by the roadside with grass-stains round their mouths; of priests risking death to run illicit schools for Irish children; of the heroes of the Easter Rising in 1916. The Irish knew who they were and what had been suffered on the way to it.

Some were less forthcoming about their painful personal histories. They could be dogmatic and prickly, a quick-tempered pride shielding their vulnerability to shame (that scarring trifecta of poverty, oppression and religious rigidity being altogether ennobling only in romantic novels).

But beside them, easy-going Australia seemed unformed, passionless, bland. Aussie families never seemed to have heated rows about politics at the dinner table, and they didn’t laugh as much either. Their flame of life seemed turned down to simmer.

Anglos did ballet or swimming; I learnt Irish dancing and sweated in a woollen kilt in the March heat of the St Patrick’s Day procession. I went to crowded schools run by stern Irish nuns and took in the national neuroses like mothers’ milk. I left school adept at pontificating on mortal sin, but wholly unacquainted with Shakespeare (just another bloody Englishman, after all) or even Joyce (“that filthy man”).

I did try to draw a line, deflecting my Dad’s attempts to fire me up about Irish politics. But Dad died when I was 10 and, after that, holding on to Irishness became a way of holding on to him. Holy Father Ireland.

So at 20 – as soon as ever I could save the money – I went home for a holiday.

At first I was conscious only of my foreignness. My mother, who was travelling with us, derided me for a tourist whenever my girlfriend and I exclaimed over the remnants of mediaeval castles that litter her patch, the west of Ireland. “Those ould ruins!” she’d sniff in disgust. “They’re all falling down!”

We’d insist on clambering over the ancient stones, heady with the glory of our find, while she sat in the car, arms folded and foot tapping. She hadn’t been home in nearly 20 years and she longed for time with her family, not with the crumbling homes of people long gone. I didn’t understand that this time, my preoccupation with the past was robbing her of the present.

Her mother – my grandmother – and I failed to connect for the first two days we were under the same roof. She was in her eighties and had more spirit than strength – her sight was failing and she moved stiffly with the aid of a walker, but her thin hair was defiantly hennaed and her cheeks determinedly rouged.

Her brogue was so thick that I thought she was talking Gaelic and waited for others to translate for me. She had impatiently written me off as a tad sub-normal, given that I couldn’t answer a simple question. When we finally twigged to each other, at least we discovered that we laughed at the same things.

My mother was a village girl. At 18, she had left Ballinrobe, where “marrying out” meant wedding someone from the next parish, to search for work in London and then half-way across the globe in Australia. My grandmother had never been further from home than Galway. She had never even made the three-hour trip to Dublin.

What had we to say to each other? We shared only a warm goodwill and a love of the woman who linked us. So I sat and listened as Grandma and her three emigrant daughters rewove the threads of their old life together as if it were a tapestry frayed by time. They came alive chatting of births and deaths and marriages, of the way the local convent school’s uniform had changed. They used preoccupations with the everyday to draw a veil over their emotional lives and their years of separation; too painful, perhaps, or maybe just too hard to bridge. It was affectionate. It was revealing. But it was not home. Not for me.

My father had been a Kerry man. Hard men, they say. But the landscape of his heartland is soft; lush green hills and lakes of a brilliant blue. When I got to his hometown of Killarney it was easy to give over entirely to the role of tourist, roaming for the sheer pleasure of it.

That, in itself, might have been un-Kerrylike. I went to see the farmhouse in which my father had grown up. It stood whitewashed and stolid near the edge of a road, blind-siding a glorious view of the Killarney lakes. Did any of the rooms overlook the scenery? I asked a local. Mmm, the bathroom maybe, he said, himself puzzled by the question. To him, the scenery was no more matter for comment than a fencepost – and a darned sight less useful.

Then came the thunderbolt. I was wandering along the main street of the town when a strange woman charged at me from across the road. I’ve never seen her before or since. I couldn’t tell you what she looked like and was too floored by what she said to remember what she told me about who she was.

She said with delight, “Sure, you must be Gerald Kissane’s daughter. You’re the image of him.”

He’d been dead for 10 years and out of the country for 40. I struggled so hard to remember what he looked like, and she’d known him well enough to recognise him in a daughter she didn’t know he’d had. Because they had grown up in a village. Together. They knew what it was to belong, and for their families to have belonged for so many generations that their presence was as natural and right as the rising of the sun.

FOR one deeply etched moment, it seemed that I must belong too. Nowhere else in the world would a stranger recognise me for my clan. For the first time, I felt what my parents must have felt; a sense that my roots go back for generations, that I was part of a long family history and enfolded by a familiar community. And then the full force of what my parents had lost hit me. I grieved for them and for me, for the aloneness, the dislocation, the never-quite-fitting-in-anywhere that is the fruit of immigration, unto the next generation.

The stranger disappeared after our brief encounter, like the mysterious wise women in Celtic fairy stories who vanish once they have revealed what the protagonist needs to know. Her appearance had made me understand my links with that place; her cheerful, unthinking farewell was a reminder of their limits. Ultimately, I was an outsider. My connections with this town lay in the past. Its ghosts had been a large part of my life, but I had never been part of its small world.

Some time later I was in San Francisco. Unexpectedly, it had gum trees, tall, scraggy, tangy-scented eucalypts that triggered a wave of homesickness as fierce as a blow.

It was near the end of the journey. Time to go home.

First published in The Sunday Age.