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Chris Polman: quietly making multiple sclerosis research tick
In Context
Profile Chris Polman: quietly making multiple sclerosis research tick Consensus can be an elusive thing in science, but it is Chris Polman’s stock in trade. As chair of the International Panel on Diagnosis of Multiple Sclerosis, which is responsible for updating the ubiquitous and gold-standard McDonald criteria for diagnosing multiple sclerosis (MS), Polman is habitually called on to shepherd 15 leading international scientists towards an agreement on exactly which signs and symptoms constitute the disease. Not a job for the hot-headed, so it is just as well that in his adopted home of Amsterdam—a city renowned for its relaxed approach to life—Polman might be described as the most laid-back man in town. Alan Thompson is Director of the Institute of Neurology at University College London in the UK, and has worked with Polman on and off for the best part of 20 years—including as President to Polman’s Vice Presidency of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), which Polman later presided over in 2003. During their two decades of working together, Thompson says he “can never remember us having an argument”. This gift for diplomacy, Thompson says, “is one of the hallmarks of the man—his ability to reason and his abundance of common sense. Chris exudes a quiet sense of calm, and you always have the feeling that he is in control of events”. Control, oddly enough, was something that the young Polman seemed to be in short supply of when it came to his early career, preferring to go with the flow and see where it took him. “Why medicine and why neurology?”, he asks. “It just happened. Medicine because some of my family members were positive. And then neurology because while being trained to become a medical doctor I just liked neurology.” Was there anything in particular about neurology that he liked? Well, no, not really: “Sometimes you hear people say ‘I like neurology because it’s strategic thinking or biological thinking’. I’ve never, ever, ever felt that way about neurology.” As Thompson attests, Polman’s leadership in MS has been “much more about achieving the best for our patients than any personal motivation”. This low-maintenance approach to career progression took Polman from the small town of Zevenaar in the east of the Netherlands, where he was born in 1958, to the Free University Hospital and VU Medical Center Amsterdam in 1982 by way of Nijmegen University, where he studied for his MD in the mid-1970s. He was appointed Director of the MS Center at the VU Medical Center in Amsterdam in 1998, and it was during his first few years there that Polman got involved in MS, seizing the opportunity to contribute to the first trials of MS treatments alongside more basic work on experimental autoimmune encephalomyelitis models to study the causes of the disease. Although it was chance that 876
was ultimately responsible for his involvement in MS, that combination of clinical and fundamental research “didn’t develop by chance”, says Polman. “That’s really something I wanted to do.” He’s been doing it ever since. According to Fred Lublin (Mount Sinai School of Medicine, New York, USA), Polman “has played a pivotal role in designing clinical trials, assessing symptomatic therapies, and bridging the domains of clinical and basic science research” for the past 25 years. Polman’s influence on trial design in MS has been profound, and his association with clinical trials since the first for MS treatments started in the mid-1980s has given him a unique perspective on the health of MS research. Polman looks on the 1980s, when the first MS trials were still being designed, as a golden age for collaboration between academic neurologists and drug companies. “The companies really needed the neurologists because they couldn’t design the trial themselves—there was no example, there was no standard, so the standard had to be designed”, he recalls. Those years, Polman says, were characterised by a positive interaction from both sides. But times have changed. Now, says Polman, “because [the drug companies] know what they want, they’d rather talk to the FDA than to clinical neurologists. They design their own trials, and they’re not so much interested anymore in intellectual input and academic input”. The situation has now reached a point, Polman argues, where any interaction takes place almost exclusively between drug companies, regulatory bodies, and clinical research organisations, “who just want to produce something rather than think about something”. The academic analysis that helped to get to the bottom of how drugs did or did not work in the early trials is a thing of the past. Now, says Polman, “academic neurology, at least in the MS world, is losing its grip on clinical trials. And I don’t think that’s to the benefit of drug design in MS”. From as understated a man as Polman, it is a stark assessment. But Polman does still see some cause for optimism. A new role for academic researchers in MS clinical trials will probably rely on the development of new drug classes that hit new targets, he says—something that will hopefully be on the agenda at this year’s combined meeting of ECTRIMS and its American counterpart ACTRIMS in Amsterdam in October. Polman has been chairing the local organising committee, where no doubt his fellow committee members have found him to be just as Lublin describes him: “An exceedingly pleasant person to work with and one of the most collegial of colleagues; always thoughtful, never contentious”.
David Holmes www.thelancet.com/neurology Vol 10 October 2011
Profile Chris Polman: quietly making multiple sclerosis research tick Consensus can be an elusive thing in science, but it is Chris Polman’s stock in trade. As chair of the International Panel on Diagnosis of Multiple Sclerosis, which is responsible for updating the ubiquitous and gold-standard McDonald criteria for diagnosing multiple sclerosis (MS), Polman is habitually called on to shepherd 15 leading international scientists towards an agreement on exactly which signs and symptoms constitute the disease. Not a job for the hot-headed, so it is just as well that in his adopted home of Amsterdam—a city renowned for its relaxed approach to life—Polman might be described as the most laid-back man in town. Alan Thompson is Director of the Institute of Neurology at University College London in the UK, and has worked with Polman on and off for the best part of 20 years—including as President to Polman’s Vice Presidency of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), which Polman later presided over in 2003. During their two decades of working together, Thompson says he “can never remember us having an argument”. This gift for diplomacy, Thompson says, “is one of the hallmarks of the man—his ability to reason and his abundance of common sense. Chris exudes a quiet sense of calm, and you always have the feeling that he is in control of events”. Control, oddly enough, was something that the young Polman seemed to be in short supply of when it came to his early career, preferring to go with the flow and see where it took him. “Why medicine and why neurology?”, he asks. “It just happened. Medicine because some of my family members were positive. And then neurology because while being trained to become a medical doctor I just liked neurology.” Was there anything in particular about neurology that he liked? Well, no, not really: “Sometimes you hear people say ‘I like neurology because it’s strategic thinking or biological thinking’. I’ve never, ever, ever felt that way about neurology.” As Thompson attests, Polman’s leadership in MS has been “much more about achieving the best for our patients than any personal motivation”. This low-maintenance approach to career progression took Polman from the small town of Zevenaar in the east of the Netherlands, where he was born in 1958, to the Free University Hospital and VU Medical Center Amsterdam in 1982 by way of Nijmegen University, where he studied for his MD in the mid-1970s. He was appointed Director of the MS Center at the VU Medical Center in Amsterdam in 1998, and it was during his first few years there that Polman got involved in MS, seizing the opportunity to contribute to the first trials of MS treatments alongside more basic work on experimental autoimmune encephalomyelitis models to study the causes of the disease. Although it was chance that 876
was ultimately responsible for his involvement in MS, that combination of clinical and fundamental research “didn’t develop by chance”, says Polman. “That’s really something I wanted to do.” He’s been doing it ever since. According to Fred Lublin (Mount Sinai School of Medicine, New York, USA), Polman “has played a pivotal role in designing clinical trials, assessing symptomatic therapies, and bridging the domains of clinical and basic science research” for the past 25 years. Polman’s influence on trial design in MS has been profound, and his association with clinical trials since the first for MS treatments started in the mid-1980s has given him a unique perspective on the health of MS research. Polman looks on the 1980s, when the first MS trials were still being designed, as a golden age for collaboration between academic neurologists and drug companies. “The companies really needed the neurologists because they couldn’t design the trial themselves—there was no example, there was no standard, so the standard had to be designed”, he recalls. Those years, Polman says, were characterised by a positive interaction from both sides. But times have changed. Now, says Polman, “because [the drug companies] know what they want, they’d rather talk to the FDA than to clinical neurologists. They design their own trials, and they’re not so much interested anymore in intellectual input and academic input”. The situation has now reached a point, Polman argues, where any interaction takes place almost exclusively between drug companies, regulatory bodies, and clinical research organisations, “who just want to produce something rather than think about something”. The academic analysis that helped to get to the bottom of how drugs did or did not work in the early trials is a thing of the past. Now, says Polman, “academic neurology, at least in the MS world, is losing its grip on clinical trials. And I don’t think that’s to the benefit of drug design in MS”. From as understated a man as Polman, it is a stark assessment. But Polman does still see some cause for optimism. A new role for academic researchers in MS clinical trials will probably rely on the development of new drug classes that hit new targets, he says—something that will hopefully be on the agenda at this year’s combined meeting of ECTRIMS and its American counterpart ACTRIMS in Amsterdam in October. Polman has been chairing the local organising committee, where no doubt his fellow committee members have found him to be just as Lublin describes him: “An exceedingly pleasant person to work with and one of the most collegial of colleagues; always thoughtful, never contentious”.
David Holmes www.thelancet.com/neurology Vol 10 October 2011