Stephen L. Hauser, MD, the Robert A. Fishman Distinguished Professor and Chair of the department of neurology at the University of California-San Francisco School of Medicine (UCSF), completed his two-year term as president of the American Neurological Association (ANA) at its annual meeting in October. Before he passed the gavel along to the new ANA president Timothy A. Pedley, MD, the Henry and Lucy Moses Professor of Neurology and chair of the neurology department at Columbia University's College of Physicians and Surgeons, he spoke to Neurology Today about his tenure at the ANA — and some of the organization's priorities.
Clearly, Dr. Hauser's years in academic medicine have given him an insider's view of the challenges and opportunities facing members of the ANA, an organization of 1,642 academic neurologists and neuroscientists. He trained in internal medicine at the New York Hospital-Cornell Medical Center, in neurology at the Massachusetts General Hospital (MGH) and in immunology at Harvard Medical School and the Institute Pasteur in Paris, France. He worked at MGH prior to joining the staff at UCSF in 1992.
As a neuroimmunologist, Dr. Hauser's research has focused on multiple sclerosis (MS). He demonstrated that autoimmune T cells, previously thought to be the sole trigger for MS, must synergize with disease-causing antibodies to produce typical MS lesions. This led to one of the first clinical trials showing the effectiveness of a therapy (immunosuppression) directed against antibody-producing lymphocytes in MS. Dr. Hauser has also studied the genetic susceptibility to MS and has led a multicenter effort to identify the DNA variants that influence the risk of MS development.
WHAT WOULD YOU PRIORITIZE AS THE KEY ISSUES AFFECTING ANA MEMBERS?
Our key priority is to help members overcome obstacles to developing and maintaining successful careers in academic neurology. Last year, we published a report from our Long Range Planning Committee in the Annals of Neurology, which was appropriately titled “Saving the Clinician-Scientist.” The report focused on developing practical strategies to enhance the attractiveness of careers as neurologist investigators and to ensure that aspiring clinician-scientists are retained.
WHAT ARE SOME OF THE CAREER OBSTACLES FOR ACADEMICS AND WHAT IS THE ANA DOING TO ADDRESS THESE CONCERNS?
First, we developed a plan to introduce flexibility during residency training in neurology. This will permit trainees who plan careers in academic medicine to have a substantial exposure to research during residency, shortening the subsequent transition to independent careers.
Second, the ANA is creating an annual course in clinical neuroscience research, to be held each summer for academically oriented residents. The course will be directed by John Griffin, and we plan to launch this annual event in August 2008 at the beautiful Stein Eriksen Lodge in Park City, UT.
Third, we want to improve opportunities for mentoring and career guidance. We have begun to address this in part through several new courses for trainees and mentors, some of which take place at our annual meeting.
Beyond these recommendations, we need to examine the entire continuum of training for physician-scientists, from the first days of college to the successful launch as independent investigators.
YOU'RE ALSO THE EDITOR OF THE ANNALS OF NEUROLOGY, THE OFFICIAL ANA PUBLICATION. TELL US HOW YOU ASSUMED THE ROLE.
When Dick Johnson retired as editor-in-chief of the journal, a search committee was organized by the ANA to select his successor. The ANA president by no means is expected to assume the role as the editor. In fact, my selection represented in some respects a paradigm shift for the journal, given my role as a president in the ANA and my other responsibilities as an active chair of a department of neurology.
I could assume this new role at the Annals because I was permitted to assemble a wonderful group of associate editors, each of whom plays a very active role in the day-to-day life of the journal. (Clay Johnston serves as vice editor-in-chief, and Donna Ferreiro, Dan Lowenstein, Jorge Oksenberg, and Bob Messing are associate editors.) Because we are all at UCSF, we are able to have weekly three-hour meetings where we debate, decide, and learn from each other.
I think that it is safe to say that for each of us, these meetings are the highlight of our week. Another advantage of this weekly academic round-table is that each of us has a different area of expertise. Finally, our team is anchored by a truly remarkable young man, Adam Stewart, who is our managing editor and resident informatics guru. Adam's enthusiasm, his ability to juggle the many tasks required for us to get to print each month, and his passion for our journal has made a huge difference as we have taken over the reins.
YOU INTRODUCED SEVERAL CHANGES TO THE JOURNAL'S FORMAT WHEN YOU TOOK THE HELM IN 2006. TELL US ABOUT HOW YOU ALTERED THE JOURNAL, INCLUDING THE NEWS SECTION, “NERVECENTER.”
We've created a number of new regular sections that appear in each issue of the Annals. Each month, Clay and I wrote a “Message from the Editor” to explore varied topics relevant to clinical and academic neurology and medicine, as well as to explain or reassess the journal's editorial policies and practices.
“NerveCenter” is a news section that strives to bring timely and important issues of interest to the clinical neuroscience community to the spotlight. We were one of the first news organizations to discuss the problems with acute rehabilitation services for wounded soldiers in the Iraq conflict, and the neurologic burden of the Iraq war. Other recent stories have dealt with neuroscience in China, the NIH budget, concussions in sports, and ownership of DNA and tissue samples. Another new section, “Discoveries in Neuroscience,” highlights each month those new publications in general neuroscience that have, in the opinion of the editors, important implications for neurology.
When I first assumed the editorship of the Annals of Neurology, I thought that this would be a professionally interesting position, but I did not realize that it would be so much fun, or would become such a labor of love.
WHAT IS THE ANA DOING TO RAISE STANDARDS IN NEUROLOGY TRAINING?
The ANA has begun to develop better ways to prepare future academic neurologists for successful careers. To this end, we've taken a major leadership role in creating flexible residency options, permitting formal research training experience within the traditional neurology residency. We've also redesigned many aspects of our annual meeting to focus on the needs of young people. For example, satellite courses are offered for mentoring of junior faculty, in partnership with the NINDS, and a one-day course for K recipients is also offered. [The NIH K Awards are designed for postdoctoral researchers and early career scientists who may be new to the grant writing process, granting them funding while transitioning from mentorship to independence.] There is also a very successful and quite well attended breakfast for women members of the ANA.
In addition, the AUPN [Association of University Professors of Neurology] meeting, also held at this time, has developed symposia organized around key issues facing academic neurology.
WHAT DOES THE ANA DO TO ATTRACT PEOPLE INTO THE ACADEMIC NEUROLOGY FIELD?
Guided by the report of the ANA Long Range Planning Committee, the organization is preparing to launch a new course in clinical research. Geared for academically-oriented residents, fellows, and junior faculty, the course will be held on August 4 to 15, 2008, at the Stein Eriksen Lodge in the cool mountains of Park City, Utah. We don't have a final name yet, but it is tentatively entitled the ANA's Summer Course in Clinical Neuroscience Research. Although details will follow in the coming months, it is already clear that the Planning Committee has created an outstanding curriculum that will be fun, stimulating, and, I'm confident, most successful.
WE HEAR THAT CLINICIAN-SCIENTISTS ARE INCREASINGLY PRESSURED TO GENERATE REVENUE FOR THEIR ACADEMIC MEDICAL CENTERS. HOW DOES THE ANA ADVOCATE FOR PROTECTING RESEARCH TIME WHEN CLINICIAN-SCIENTISTS ARE PRESSURED TO SEE MORE PATIENTS?
It is an absolute responsibility of departments and institutions to provide adequate protected time for young clinician scientists. The days are long past when successful research careers can be built on evenings and weekends, after long days of clinical care.
For K recipients, as for recipients of many other junior faculty awards administered through private foundations, 75 percent protected time for research should be a key component of the recipient institution's obligation to the candidate.
I believe that everyone in academic medicine understands the need to nurture young investigators, especially in the current climate of historically low pay lines at the NIH. Obviously, our problems develop where the rubber meets the road and when our best intentions are met with the harsh financial realities that we all face. There is no simple solution, although I believe that all of our parent organizations — the ANA, AUPN, and the AAN — recognize the need to protect the time of our young clinician-scientists. My own personal view is that it is very difficult to ensure protected time unless 50 percent of a young investigator's salary is guaranteed through a junior faculty award or other institutional sources.
WHAT DISTINGUISHES THE ANA MEETING FROM OTHER ANNUAL NEUROLOGY CONFERENCES?
Judging by the feedback, both formal and informal, recent meetings have been remarkably successful, primarily for two reasons. First, the symposia are truly outstanding. Second, the meeting is absolutely geared to the needs of career-minded young investigators.
I think that no venue in neurology offers a better opportunity for young people to meet and interact with senior leaders in the field in an unhurried, intimate atmosphere. The meeting is intentionally small so that it can be located in a single hotel rather than a convention center. Our third annual junior faculty development course, chaired by Eva Feldman, provided practical information on how to negotiate for a faculty position; how to mentor and be mentored; and how to manage time, obtain funding, and set up collaborations.
For more information on the ANA and the sessions from this year's ANA annual meeting, visit www.aneuroa.org.