Interviews
Name: Donald G Weir
Degree/Masters: M.B., B.Ch., B.A.O. (1958), M.D., F.T.C.D., F.R.C.P.I., F.R.C.P., F.A.C.P.
What are the memories of your student days in Trinity?
I was fortunate in being allowed to live in Trinity on campus for three years. This allowed me to get to know a large proportion of the students in Trinity at that time and also to develop whatever disciplines were available to me. Apart from academic pursuits, these included golf, hockey and singing. I had aspirations to play cricket but this was rejected by my fellow South African students who were a powerful group in Trinity Medicine at the time! I was a clinical student in the Adelaide Hospital as it was then. Again I was fortunate in being given responsibility for the management of Emergency Department patients while still a resident student, a situation that would not be allowed today! Nevertheless it afforded me a firsthand experience of clinical medicine which was irreplaceable. Some of the escapades we got up to I am embarrassed to recall at this stage, I only hope we didn't upset anyone.
Who were your fellow students? Did you maintain links with any of them?
My close friends were Thomas Wilson, Peter Dowse, Hubie O'Connor, Biddy Acheson and Jane Jackson. Thomas has done sterling work teaching Hubie and myself the rudiments of painting. Unfortunately Hubie passed away last year.
You have been a role model to generations of medical students and doctors. Which people, if any, made an impression on you while a student in Trinity?
I was greatly influenced by Blanche Weekes in anatomy, Michael Fry in physiology, and Joan Mullaney in pathology. As a clinical student in the Adelaide I was especially grateful to Peter Gatenby, David Mitchel and Brian Mayne who were brilliant teachers of clinical medicine at the bedside. Jack Henry was also a passionate teacher of surgery and I can still remember many of his didactic statements. Later as a consultant I learned a great deal from Graham Neale, David Lane and my registrars in Sir Patrick Dun's Hospital (SPDH) such as Peter Daly and Dermot Kelleher.
What did you like most about being a student and was there anything you disliked?
At that time the number of students in each class was relatively small so it meant that our teachers got to know us very well. This was a great help in our career decisions. With hindsight we were taught too much anatomy and too little biochemistry. I felt that the wonderful practice of allowing students to go to whatever clinician, in whatever hospital, took their fancy, not only allowed us to gain a wide range of opinions but also stimulated the clinicians to vie with one another to attract the largest class. The teaching of students at that stage was the major academic endeavour of most consultants. Since then the education of interns, senior house officers and registrars has unfortunately tended to reduce the time available for the training of undergraduate students. I think by the standards of medical practice today we, as resident students, were probably inadequately supervised when treating patients in the accident department.
How did you combine a busy life as a doctor with that of an academic and researcher?
As a student and junior hospital doctor I was embarrassed by the dearth of Irish clinical research being presented at international medical meetings, in Britain and elsewhere. I determined to do what I could to improve this situation. I was greatly influenced by John Scott who pointed out the potential of combining the basic study of biochemistry to unravel the problems of clinical medicine. Our first success in the early 1980s was the discovery of the pathogenesis of the vitamin B12 deficient neuropathy (sub acute combined degeneration of the spinal cord). This work along with a review paper on the biochemical pathways involved was published in The Lancet.
I was also fortunate to know Cliona O'Farrelly , Alex Whelan and Con Feighery who taught me the importance of immunology in our quest to understand the pathogenesis of coeliac disease. This was a clinical disease which often presented with deficiency of the vitamin folic acid. Since folate metabolism was the main subject of our research with John Scott, Ann Molloy and Joe McPartlin it seemed an appropriate subject to study in tandem. The result has been the publication of over 300 original articles, reviews and chapters in International journals. In particular we published an article each year in The Lancet throughout the 1990s and I personally presented our research on five occasions to the annual meeting of the Faculty of American College of Experimental Biologists (FACEB). This was at a time when the funding for Irish research was still miniscule.
I was always very involved with undergraduate teaching which I greatly enjoyed as the students were always so intelligent and enthusiastic. Once, when I was asked to give the Kramer Lecture in Boston, I was asked why it was that Irish medical graduates were so much more effective on the hospital wards than their American doctors. On enquiry I was told that the final examination for their students consisted of multiple choice questions. I explained that in Ireland great emphasis was placed on the student's ability to examine patients and to come to a coherent plan of management. They argued that they had dropped this type of exam since all the patients were different. I explained that since they were being examined by trained clinicians, they could make suitable allowances for the variation in patient response. I emphasised that unless students realised that they would be examined in this way and that this would make up a significant portion of their marks, they would not adequately practice their abilities at this art. I was informed that a few years later the final medical exam in America reverted to the clinical form!
Together with Professor John Scott you determined the importance of folic acid with regard to spina bifida. Could you please explain the significance of the discovery in layman’s terms and how it affected people’s lives?
Folic Acid and B12 are the two vitamins concerned with the synthesis of DNA. We found that the maternal deficiency of folate was strongly associated with the presentation of the spina bifida deformity at birth which is associated with paralysis of the lower limbs, an appalling birth present. We also showed that the correction of the maternal folate deficiency was associated with a dramatic reduction in the incidence of the spina bifida deformity (In Ireland the incidence dropped from 10 to less than two per 1000 births). In particular we showed that it was imperative that women should take a folate supplement before they become pregnant as the spina bifida deformity in the spinal cord occurs very early on in the pregnancy and before the mother is aware that she is even pregnant! Subsequently we demonstrated that the spina bifida defect was associated with a specific defect in the DNA of one of the enzymes responsible for folate metabolism. These findings have been duplicated and confirmed elsewhere. Folate supplementation of certain foods such as cereals went a long way to eradicate maternal folate deficiency in our society.
As Regius Professor of Medicine in the 70s, 80s and 90s you put a strong emphasis on research. Why is it so important to have research as an important element of an academic institution?
Research is essential if we are to improve the standards of our disciplines. If we don`t continually ask "why something occurs?" we stagnate and tend to move backwards. This is especially true of clinical medicine where research is closely associated with standards of clinical practice. One of my proudest achievements was the use of the funds derived from the sale of the Nurses Home of SPDH to build the Sir Patrick Dun's Research Laboratories in St James`s Hospital (SJH),the first such laboratory to be constructed in this country. This allowed me to hold weekly research meetings in SJH which were instrumental in producing a rake of academic papers and started the evolution of SJH to become the premier academic hospital in Ireland.
This has been greatly enhanced by my successor Professor Dermot Kelleher who raised large grants to finance the building of further academic buildings and research wards to house subjects involved in clinical trials. Subsequently the funds derived from the sale of SPDH were used to construct the Medical School Building in SJH and I was happy to be a party to directing the use of these funds. In particular I was instrumental in insisting, against opposition from Front Square, on the building of the Bucket Lecture Theatre which has been an enormous benefit to house both the weekly hospital grand rounds and initially the monthly death conferences. This greatly enhanced the merger of the academic ethos of both the hospital and the medical school.
You have been very generous to Trinity and its teaching hospitals and have given regularly since the mid-60s, totalling close to €1.5 million. You have also been an active volunteer, serving on a number of boards. Why do you feel so strongly about giving back financially?
As part of my ambition as stated above to improve the reputation of Irish Medicine, I and others such as Graham Neale and Dermot Hourihane, realised that if we were to create the correct environment for academic medicine it was imperative that we needed to merge the small hospitals of the Federated Dublin Voluntary Hospitals (FDVH) into a major regional hospital. This would allow the development of a full range of modern specialties on a single campus. To this end I was a member of the central council of FDVH for 10 years before moving to SJH, and subsequently I was a member of the board of SJH for 16 years, to help the hospitals evolution to where it stands today. To this end I would like to pay tribute to Ian Howie who was chairman of both the central council and the board of SJH for all of this time. He did much more than could ever have been expected of him to obtain the correct result. I also served for two five-year terms, firstly on the Medical Research Council and subsequently as Trinity's representative on the Health Research Board. Once again I did this to help distribute what finances were available to further academic medicine in Ireland.
I was fortunate in having available to me a charitable fund within our family, and quite frankly I could not imagine a better way to spend it than in the promotion of academic medicine in Trinity, SJH and Ireland.