What attracted you to start work in medical science? Were there any particular obstacles you had to overcome?
Very early in my medical career I was fascinated by knowledge that sheds light on mechanisms of disease. As an undergraduate this was fostered by my teachers during my pre-clinical studies in Cambridge and clinical training at Guy’s Hospital and the Brompton Hospital. A link between physiological mechanisms and pathology provided an intellectual challenge which nicely complemented my major focus at the time, which was in acquiring clinical skins as a diagnostician.

At what point did you develop an interest in rheumatology and what attracted you to it?
Initially my interest in medical science was engaged by my junior posts in cardiology. This interest provided an opportunity to work with patients and at the same time spend time in a catheter and angiographic laboratory investigating vascular, congenital and coronary vascular disease. However, I soon realised that I was much more interested in the emerging subject of immunology than cardiac physiology. I was fortunate to receive excellent mentoring at this stage and for a while contemplated a fellowship in transplantation immunology. But because I did not wish to disengage from working in general medicine, a registrar post in rheumatology and general medicine provided an ideal opportunity for my next stop. The immunological focus of rheumatic disease was emerging as an exciting research field and a fellowship in 1968 in the Department of Immunology at the newly founded Kennedy Institute of Rheumatology, associated with Charing Cross Hospital Medical School, sealed my fate as an investigative clinical scientist.

Which areas of your work do you find most satisfying and which most frustrating and why?
The opportunity of working with basic scientists at the bench in a subject I am interested in whilst retaining my clinical expertise and building a clinical research programme has been the most satisfying aspect of my work. It led to a partnership with Professor Marc Feldmann in the early 80’s, which became seriously focussed on investigating the immunology of rheumatoid arthritis when he moved to the Charing Cross campus. We realised our bench to bedside goal by identifying the regulation of the cytokine network by tumour necrosis factor (TNF). This led to the development of anti-TNF therapy which has been an important option in the treatment of rheumatoid arthritis and other immune-inflammatory diseases such as Crohn’s disease, ankylosing spondylitis, psoriatic arthritis and psoriasis. It has spawned a billion dollar industry for anti-TNF biologicals. The frustration in our programme in the early 90’s was the unwillingness of the pharmaceutical industry to support our translational and drug development ideas. Happily this was circumvented via personal contacts with an antibody biotechnology company in the USA which supported our proof of concept and mechanism of action trials. This opened the way for clinical development eventually of three anti-TNF licensed drugs.

What problems are faced now by someone just starting their career in academic medicine and in your specialty and what are the new opportunities?
The major problem is the perception that commitment to research and academic training is a barrier to a satisfying career and a well rewarded, permanent post in academic medicine. Service commitments are seen as an intolerable burden that interferes with a happy and balanced life. The fantastic opportunities that are now available via fellowship schemes with mentoring, to work in an excellent environment are not always alluring enough. I feel that nurturing bright students has to be given serious support by seniors at an early stage. Unfortunately this is hampered by the intense undergraduate course and clinical training programmes which leave little time to build such relationships.

You have been quoted as saying that you hope your success will act as a stimulus to British Asians to make a contribution to the welfare of the nation. How do you think this cause can be best helped? What barriers do British Asians face in progressing in medical science and how can they be overcome?
By boosting self-confidence and by witnessing the success of non-white people in scientific achievements, I passionately believe that medical science has no racial or national barriers and that the health of people can be improved by knowledge and translation of scientific advances into clinical medicine. In the Asian cultural background, scholarship is highly regarded. It is likely that the new generation of British Asians will find their place in medical science in the UK as equals with their compatriots.

To what extent is a discovery a leap of conceptual understanding and to what extent is it constant trial, error and occasional luck?
In our case the concept emerged from observations in vitro on diseased tissue from joints. Access to molecular probes played a key part in this and subsequent experiments in an animal model. As, of course, did the clinical experiments with a specific monoclonal anti-TNF antibody and objective clinical and biological response end-points. These observations reinforced the hypothesis and spurred us on to a conclusion.

What are the main ingredients to successful collaborative work in medical science?
Trust, inter-personal chemistry, over-lapping but distinct strengths and team work. Working under one roof and a single management in a well funded and technologically well equipped environment helps- as does access to clinical facilities in the NHS. Of course, nothing succeeds as well as success itself.

What are the main drivers for excellence in medical science and how can these be promoted?
The most important are knowledge of pathogenesis of disease and technical advances which permit powerful tools for research to be applied to tackle difficult questions.

What are the prospects for patients with rheumatoid arthritis? Where are new advances needed?
The prospects of rheumatoid patients are enormously improved. Early and aggressive drug therapy has led to control of disease in most patients. This has not only improved the quality of life but also prevented disability and prolonged the life expectancy of patients. Standard disease modifying agents plus anti-TNF therapy in selected cases has contributed to this evolving scenario. But enduring disease remission can still only be achieved in 40% of patients and continuing therapy is needed. Advances require short-term interventions leading to a long-term benefit.

You have been knighted and won many prizes, what’s next for you?
To promote translational clinical science in any way I can. I am taking an interest in the ongoing research programme of the Kennedy Institute and am on the Board of a couple of university spin-offs which are developing new therapies. I am also finding more time for my family and leisure pursuits before I get too old to enjoy them.