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Sonia Buist: expanding our knowledge of COPD
Perspectives
Profile A Sonia Buist: expanding our knowledge of COPD Chronic obstructive pulmonary disease (COPD) doesn’t get much sympathy, or a lot of research funding, says A Sonia Buist, one of the world’s leading experts on this increasingly burdensome but still poorly understood condition. In the developed world, Buist points out, COPD is almost exclusively a smoker’s problem, and hence considered to be “self-inflicted”. Little research has been done on risk factors beyond smoking, and there is no drug to stop progression of the disease. “There are lots of important and unanswered questions”, says Buist, a professor of medicine, physiology, pharmacology, public health, and preventive medicine at Oregon Health and Science University in Portland, USA. Ever since she decided to go into pulmonary medicine during her residency, inspired by the “tremendous international respiratory group” at the University of Colorado in Denver, Buist has been seeking answers to these questions. Her investigation of the worldwide prevalence of COPD, the BOLD Initiative in this week’s Lancet, “may well end up being her most important scientific contribution”, says her long-time colleague Philip C Hopewell, a professor of medicine at the University of California, San Francisco. Hopewell also points to Buist’s determined efforts to launch the Methods in Epidemiological, Clinical and Operations Research (MECOR) programme. Since 1994, more than 300 scientists, chiefly in Latin America, have learned to do respiratory epidemiology through the course, with many publishing original research in top-tier journals. The first MECOR course in Africa begins this month, in Malawi, and courses are planned next year for Turkey and India. “The idea is that you are training people to do basic epidemiological and clinical research to quantify the burden of disease in their environment and to come up with interventions that are appropriate to their environment”, Buist explains. “The solutions to health problems in Africa or Latin America or elsewhere have to come from their own environment, and they have to come from their data.” Buist dates her interest in international work to her childhood in India, where her father served as a policeman during the days of the British Raj. The family returned to the UK in 1945, settling in the small Scottish town of Dollar, where Buist and her two brothers attended Dollar Academy. After graduating from medical school at St Andrews, Buist moved with her then-husband to the University of Colorado, where she completed her residency. She spent a year in Montreal studying COPD and airflow obstruction and went on to Oregon for two pulmonary fellowships, where she developed and evaluated tests of small-airway function. In 1973, Buist received her first research grant from the National Institutes of Health (NIH), and has been funded by the NIH ever since. www.thelancet.com Vol 370 September 1, 2007
Buist was on-hand for the eruption of Mount St Helens in nearby Washington State in 1980. As the only person in the region with expertise in epidemiology and pulmonary medicine, she took on the job of investigating the health effects of the eruption. “It was very exciting because at the time there was so much anxiety in the community about the health effects of the volcanic ash”, Buist recalls. “Businesses were not locating here, people were actually leaving here because of the anxiety.” But by comparing loggers who worked in volcanic ash-coated forests with those employed in areas free of volcanic debris, Buist and her colleagues were able to show that breathing the volcanic ash produced only transient health effects. “She was terrific”, says Thomas R Martin, who was a pulmonary fellow in training at the time and joined Buist’s research team. “She became one of my role models because she was so knowledgeable, thoughtful, and she was tremendous at organising groups and getting work done.” Martin, now a professor of medicine at the University of Washington in Seattle, adds “One of the unique things about Sonia Buist is her ability to lead any group she participates in. She has used those same characteristics in studying COPD.” Buist’s other interests include how asthma may affect COPD later in life, as well as how occupational exposures can contribute to the disease, especially in the developing world, where regulation of such exposures is lax or non-existent. She also recently investigated patient-guided decision making in asthma. So far, her 600-patient study has shown that, by engaging patients with poorly controlled asthma in making decisions about their care, outcomes and adherence are better than with usual care, or management by guidelines. “It makes physicians a little uncomfortable that they may be departing from the guidelines”, she explains, but “for that patient it may be the right thing.” Buist’s sense of humour and “whimsy” has been as inspiring as her scientific achievements, her colleagues say. “She’s been a tremendous role model for me in how to develop professionally and how to try to have a sense of balance and a sense of having fun at the same time”, says Martin. Buist has written two books on hiking in Oregon’s Mount Hood, launching her own company—Lolits (Little Old Ladies in Tennis Shoes) Press—to publish them. “For somebody with a background in clinical science she has a very wide vision”, says Peter M Calverley, a professor of respiratory medicine at the University of Liverpool in the UK, who has collaborated with Buist for many years. “It’s that breadth of vision that perhaps sets her apart from others.”
See Review page 765
Anne Harding [email protected]
733
Profile A Sonia Buist: expanding our knowledge of COPD Chronic obstructive pulmonary disease (COPD) doesn’t get much sympathy, or a lot of research funding, says A Sonia Buist, one of the world’s leading experts on this increasingly burdensome but still poorly understood condition. In the developed world, Buist points out, COPD is almost exclusively a smoker’s problem, and hence considered to be “self-inflicted”. Little research has been done on risk factors beyond smoking, and there is no drug to stop progression of the disease. “There are lots of important and unanswered questions”, says Buist, a professor of medicine, physiology, pharmacology, public health, and preventive medicine at Oregon Health and Science University in Portland, USA. Ever since she decided to go into pulmonary medicine during her residency, inspired by the “tremendous international respiratory group” at the University of Colorado in Denver, Buist has been seeking answers to these questions. Her investigation of the worldwide prevalence of COPD, the BOLD Initiative in this week’s Lancet, “may well end up being her most important scientific contribution”, says her long-time colleague Philip C Hopewell, a professor of medicine at the University of California, San Francisco. Hopewell also points to Buist’s determined efforts to launch the Methods in Epidemiological, Clinical and Operations Research (MECOR) programme. Since 1994, more than 300 scientists, chiefly in Latin America, have learned to do respiratory epidemiology through the course, with many publishing original research in top-tier journals. The first MECOR course in Africa begins this month, in Malawi, and courses are planned next year for Turkey and India. “The idea is that you are training people to do basic epidemiological and clinical research to quantify the burden of disease in their environment and to come up with interventions that are appropriate to their environment”, Buist explains. “The solutions to health problems in Africa or Latin America or elsewhere have to come from their own environment, and they have to come from their data.” Buist dates her interest in international work to her childhood in India, where her father served as a policeman during the days of the British Raj. The family returned to the UK in 1945, settling in the small Scottish town of Dollar, where Buist and her two brothers attended Dollar Academy. After graduating from medical school at St Andrews, Buist moved with her then-husband to the University of Colorado, where she completed her residency. She spent a year in Montreal studying COPD and airflow obstruction and went on to Oregon for two pulmonary fellowships, where she developed and evaluated tests of small-airway function. In 1973, Buist received her first research grant from the National Institutes of Health (NIH), and has been funded by the NIH ever since. www.thelancet.com Vol 370 September 1, 2007
Buist was on-hand for the eruption of Mount St Helens in nearby Washington State in 1980. As the only person in the region with expertise in epidemiology and pulmonary medicine, she took on the job of investigating the health effects of the eruption. “It was very exciting because at the time there was so much anxiety in the community about the health effects of the volcanic ash”, Buist recalls. “Businesses were not locating here, people were actually leaving here because of the anxiety.” But by comparing loggers who worked in volcanic ash-coated forests with those employed in areas free of volcanic debris, Buist and her colleagues were able to show that breathing the volcanic ash produced only transient health effects. “She was terrific”, says Thomas R Martin, who was a pulmonary fellow in training at the time and joined Buist’s research team. “She became one of my role models because she was so knowledgeable, thoughtful, and she was tremendous at organising groups and getting work done.” Martin, now a professor of medicine at the University of Washington in Seattle, adds “One of the unique things about Sonia Buist is her ability to lead any group she participates in. She has used those same characteristics in studying COPD.” Buist’s other interests include how asthma may affect COPD later in life, as well as how occupational exposures can contribute to the disease, especially in the developing world, where regulation of such exposures is lax or non-existent. She also recently investigated patient-guided decision making in asthma. So far, her 600-patient study has shown that, by engaging patients with poorly controlled asthma in making decisions about their care, outcomes and adherence are better than with usual care, or management by guidelines. “It makes physicians a little uncomfortable that they may be departing from the guidelines”, she explains, but “for that patient it may be the right thing.” Buist’s sense of humour and “whimsy” has been as inspiring as her scientific achievements, her colleagues say. “She’s been a tremendous role model for me in how to develop professionally and how to try to have a sense of balance and a sense of having fun at the same time”, says Martin. Buist has written two books on hiking in Oregon’s Mount Hood, launching her own company—Lolits (Little Old Ladies in Tennis Shoes) Press—to publish them. “For somebody with a background in clinical science she has a very wide vision”, says Peter M Calverley, a professor of respiratory medicine at the University of Liverpool in the UK, who has collaborated with Buist for many years. “It’s that breadth of vision that perhaps sets her apart from others.”
See Review page 765
Anne Harding [email protected]
733