Author: Vidhya Natarajan
Known to medical students worldwide as the author of Robbins Pathology and also as an authority in Natural Killer (NK) Cells, Dr. Vinay Kumar is presently the Alice Hogge & Arthur Baer Professor of Pathology at the University of Chicago, where he is the Chair of the Department of Pathology and Executive Vice Dean of the Division of Biological Sciences. Following is the transcript of the recorded interview and we sincerely hope you will learn from Dr. Kumar’s experiences.
JYI: We are honored and privileged to be talking to be talking to you today Dr. Kumar and today we will be asking you about your undergraduate experiences and career choices. The first thing our readers at JYI want to know is about your educational background- like where did you go to college and your journey in brief up to the position you are in right now.
Dr. Vinay Kumar: Okay, unlike most premedical students in India who joined college after their 12 years of schooling, I actually went to Fergusson College in Pune and completed my Bachelors in Science with honours and distinction in Botany. I joined medical college in Amritsar in 1962. After finishing my MBBS, I went to Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, where I did my internship as well as 6 months of surgery and medicine house jobs. Subsequent to that I came to All India Institute of Medical Sciences (AIIMS), Delhi, where I joined the MD program in Pathology. I completed that in 1972 and soon thereafter I left for the US and joined Boston University.
JYI: We notice that you were honoured with Best Medical student Award, Pfizer Award and Gold medal for Highest Achievement as a medical student at your graduation. How much role did this play in shaping your career?
VK: The various medals and all those things are nice to have when you get them and it makes you feel good. It makes you feel that your hard work has been recognized and rewarded. But, in the long run it is not the medals that make a difference or the position in your class that makes a difference. What really makes a difference is what you are actually able to do rather than what your certificate shows.
JYI: Retrospectively speaking, when you completed your MBBS, your undergraduate degree, where did you picture yourself?
VK: Actually let me go back a little bit. When I completed my B.Sc. in Fergusson College in Pune it became very clear to me that I am going to have a career in research. In fact I thought I will do a PhD in Botany and be a researcher in plant evolution. But, following the suggestion of my family members I joined MBBS. The day I entered MBBS I knew that research is going to be a very important part of my career. When I was in my second professional year and was exposed to Pathology, I decided that research in Pathology was going to be a part of my career. So, after that I went to AIIMS and got an MD in Pathology and did research there with Professor Ramalingaswamy, which basically launched my research career while in India. Once I came to Boston, I started doing research soon after joining Boston University.
JYI: We would like to know why and how did the transition from India to United States happened? Like did you feel the need to go to United States for your research career to progress?
VK: When I was finishing my MD in Pathology the opportunities for research in India were very limited. There was no infrastructure, it was very difficult to get reagents, it was very difficult to get journals which used to reach the library by snail mail after 6 months to 1 year of publication. The number of journals supplied to the library was also very limited. And very importantly there were very few role models who had made their careers as physician-scientists with some notable exceptions like Prof. Ramalingaswamy and M.G. Deo at AIIMS. Therefore at that time I really had no choice but to come to a place were research would be supported and the infrastructure will be there. That was in 1972. I don’t think that is really true anymore in India. I think it is possible to have a great research career in India because the money is there, the resources are there, the people are there and the scientists are there. So there is very big difference between 1972 and 2010.
JYI: What do you feel about the medical education system of India?
VK: I think that the medical education system in India is geared more towards learning most things theoretically. For Example, if you ask a medical student in India to give the causes of pulmonary hypertension he or she will probably give you an entire list of causes. Perhaps a student in US might be able to give two thirds of the list. The difference is that medical students in India have very little opportunity and training to put into practice what they have learnt before they graduate. In this example the student in India would be able to tell you all the causes (rare and common) of pulmonary hypertension but will find it very difficult to actually manage a patient who came in with pulmonary hypertension. Whereas, medical students in US in their fourth year would not only know the most common causes of pulmonary hypertension but also be able to treat the case. So that is a very important practical difference. I think what a senior fourth year medical student in US is able to do is typically what a junior house officer is able to do in India. So an intern in India cannot do what an intern in the US can do. When I say ‘cannot do’ I don’t mean that Indians are less intelligent or that Americans are more intelligent. I mean that the training in India during MBBS is much more geared to learning than being able to actually apply that knowledge in a real life situation. Learning to apply theoretical knowledge happens at a slower pace in India than in the US (UK is also more like India in this regard).
JYI: What will be your suggestion to improve the medical education system of India?
VK: Before I answer your question let me tell you another difference. In the last 10 – 15 years in the US the education system has shifted from passive learning to active learning. Passive learning is learning that occurs typically in a lecture hall. A brilliant lecturer gives a brilliant lecture and the students are passively listening to it, absorbing water like a sponge! Then the student goes back home makes his/her notes and reads it. Active learning requires the student to put an initial effort him or herself. So in active learning the student would be expected to read the material and understand the material and come prepared for discussion rather than be given a lecture. What that does is it trains the student to think about the subject him or herself and digest it as much as possible before being told by the lecturer. The active learning process leads to a much better retention and the knowledge gained becomes a part of you. Thus there are two things which I think need to change. One is the emphasis from passive learning which is mainly lectures to active learning which is mainly discussing cases and reading the lecture material from the textbooks by oneself. The second thing, as I said earlier is getting to practice what you learn before you finish the medical college. In 3rd and 4th year of medical college the students must be given graded responsibilities, not that they be allowed to give medication or prescribe medication but they should be required not only to take a complete history and do a complete physical examination (which they do very well) but also write up a coherent management plan. I think that is the kind of change that needs to occur so that when a student becomes an intern and he sees a patient with acute myocardial infarction he/she has a very good idea of what to do about it without having to get directions from the registrar. When I was an intern and I got a case of myocardial infarction, I was in PGIMER (in Chandigarh) at that time, I was frightened to death because I knew everything about the theory of myocardial infarction but I had no confidence to prescribe medications to the man who would die if I did not take care of the patient.
JYI: Talking about your research, The Natural Killer Cells (NK Cells), you are an authority on the cellular and molecular biology of the NK cells. We would like to know about the conception and the initial days of this ground breaking research?
VK: So, I arrived in Boston in July of 1972. At that time the Chairman of the department was Dr. Stanley Robbins (the Robbins of the Robbins Pathology). I made it very clear to him and that I came here to do research in cancer biology. He connected me to a senior professor (Dr. Michael Bennett) who was interested in tumour immunology. Two of us began to work together. Although, I already had a faculty position as an instructor, I behaved and acted like a trainee because I did not know much about the subject. So we started this research. He gave me, as often happens in the US, tremendous independence and responsibility. He used to say this is the problem and go figure out how to solve it. We discussed of course. He did not leave me completely on my own. We had intense discussions for a few months and then I began to learn how to formulate hypothesis and test them. I also learned how to work with mice. We were trying to understand why certain mice are genetically resistant to leukaemia and others are susceptible. These questions lead to a series of experiments. My first paper that cracked this problem was published in the May of 1974, roughly two years after I had been there. It was the very first paper published anywhere describing a new subset of lymphocytes which were responsible for resistance to a viral leukaemia in mice. That is how the discovery of natural killer cells occurred.
JYI: What played role in your specific attraction to Immunology?
VK: As I have mentioned, my interest was in cancer. Of course, you can study different aspects of cancer. You can study carcinogenesis, you can study the molecular biology of cancer and frankly when I left India my interest was to study the molecular changes that underlie cancer (in my memorabilia I still have a hand written draft of the plan I wanted to pursue to understand the molecular causation of cancer!). But when I arrived in Boston there was no senior investigator working in my department who was interested in this problem. So, I had to make a change in the plan and grasp at the opportunity that was available and I shifted my interest from trying to understand carcinogenesis to trying to understand how the immune system is involved in protecting from cancer or not protecting from cancer. So it was more a question of curiosity about cancer and then finding an opportunity to do cancer immunology. One has to be able to seize the available opportunity and that is what I did. You may say I was lucky and indeed I was.
JYI: What will be your advice to the undergraduates (specifically in India and in general) who want to take up research in biomedical sciences?
VK: First of all I would say those medical students who want to take up research should try to get research opportunities before they finish their medical school. During their summer vacations and free time (nights and weekends) they should look around for people in their institution who are involved in research; if not in their institution then in some institution in the same city. For example, if you live in Hyderabad you might want to go to Centre for Cellular and Molecular Biology (CCMB). If you lived in Mumbai you could go to Indian Institute of Technology (IIT), Mumbai, where they have a very good biology department. You could go to IIT Kanpur. If you live in Bangalore you could go to National Centre for Biological Sciences (NCBS). There are plenty of excellent research institutes in India which are not attached to medical institutions. An aspiring student should go and express interest, find out researchers and knock at their doors. If the first door you knock at does not open you knock at the second door, if it does not open you keep knocking at doors and eventually some door will open. Somebody will discuss research with you. I think there is nothing better than having a hands on research experience while you are still in training because that way you could find whether this is something that you really enjoy or you thought you would enjoy but you did not enjoy. I think it is very important for those who want to go into research to be sure that they actually enjoy research because research is hard. Research is not like MBBS where you can work hard and memorise and pass the exam. In research you have to try and solve unsolved problems. There are no clear rules and no routines to follow. There are a lot of trials and errors and a lot of frustration. It involves learning new things which were never taught to you. Research is for the brave at heart. I don’t think everyone has the aptitude, the patience and the frame of mind to do be a successful researcher. Even though research is not for everyone I think everyone should try. After finishing MBBS and after some experience if you come to the conclusion that this is something you really like, then there are several possibilities. One can go and enrol in a program in biotechnology which is available in many institutions in India now. If one is even more serious than that one can enrol in a PhD program which is available in many research institutions in India like the National Institute of Immunology in Delhi, the NCBS Bangalore, the CCMB, Tata institute of Fundamental Research, and various IITs where they have a biomedical division. The decision to do a PhD is not an easy or a trivial one because it may take anywhere from 4 to 6 years to complete it. So one has to be prepared and motivated enough and one has want to do it and want to spend an extra 4 to 5 years in training. Of course, there are possibilities outside India in the US, Australia and many other countries. But, I don’t think today medical students in India have to leave India to do research. Cutting edge research can be done in India. I admit though that research facilities in India are not as numerous as in US. Therefore, some who are really interested will not find a place. I know people who are really motivated and have tried for 2- 3 years but since the number of facilities is limited and the applicant pool is large, some people may have to leave the country. So those are choices and avenues one has to note. The best universities in the US when they receive an application from a medical student who has done MBBS are not quite sure whether he or she really wants to do it or it is some fantasy in their mind that they would like to pursue. So if one has done something in India like working with someone in a research lab for a year or two then the universities in US have the confidence that this person really wants to do research. For someone who is just an MBBS graduate the likelihood of admission into an outstanding PhD program in US is extremely small. It has nothing to with intelligence. It is because the universities in US, who can’t see you, can’t reach you because you are not there and cannot talk to your professors because your professors were not involved in research have no way of judging how serious you are or how motivated you are. The best universities want students who are highly motivated and who have shown independence. I think it is something very difficult to judge in those who have only a MBBS degree.
JYI: Medical world knows and adores you as the author of Robbins Pathology. We would like to know that when around 30 years back you were offered to be a co-author, how did you receive it and how did you maintain balance between your research and authorship of a major text?
VK: I think that is a very good question and I will answer that. Well, the offer was given to me in 1979. I had been in Dr. Robbins department for 7 years then. Even when I was doing MD in AIIMS, Delhi I was very interested in teaching; I was a demonstrator and tutor in lab sessions and I began to feel that I enjoy teaching. Although my main goal in coming to Boston was research, Dr. Robbins asked me whether I would like to teach and I said, ‘Yes! I would like to teach’. He allowed me to take a few lectures. The lectures were extremely popular and students went and told Dr. Robbins that I was a very good lecturer. Then he gave me more lectures and made me in charge of all the practical laboratory teaching of Pathology in Boston University. I think over a period of 5-6 years he heard from other people and observed first hand that I was a very good teacher, that I had the ability to bring basic science into teaching and that I enjoyed it. I think that was the reason he asked me as opposed to 100s of other people he could have asked. Frankly, when he asked me to be a co-author it came as a shock to me and I had no idea about it. I did not even have a secret desire in my mind because I thought that was just not possible. So when he asked me I was taken aback. I was very concerned, just like you asked, whether I will be able to maintain the kind of devotion and hard work that is required to succeed in science and also be able to write a major textbook of pathology. I was very encouraged by my senior colleagues there who said that they had faith in me and encouraged me to take the opportunity. So, I did it and I must say I was very lucky I was able to do it. Maintaining this balance was very difficult. I worked for 14-15 hours a day, 80-90 hours a week. I believe that in life if you have to do something you have to be the best at it or at least try to be the best. I cannot imagine being a second grade researcher and a first grade teacher or a fist grade researcher and a second grade researcher. I had to be excellent in both or (I said to myself that) I should drop one of those things. So, a lot of good luck was involved in this, a lot of things happened by being at the right place at the right time with a lot of supportive people around. My wife, who is also a physician, and my children were very supportive, so that I could literally work seven days a week. Keeping the balance and keeping the family life at the same time was very challenging and very difficult and it took a lot of understanding by my family. I am very lucky.
JYI: As you climbed up the ladder in your career you were granted many administrative responsibilities. How was that transition?
VK: You are right! When I went from Boston to University of Texas, I was made responsible for the entire teaching program in pathology which was very easy for me because I actually liked it. The 100 cases that you see with Robbins pathology now were developed for teaching our medical students. The cases were not written for the book at all. They became part of the book many years later. So, I took a challenge which required leadership, which required the ability to persuade other people to change teaching from passive to active. So, I sort of learned leadership skills, nobody taught me but I learned that you have to make compelling arguments to your colleagues, you have to convince them to work and inspire them, and you have to respect differing view points. Trying to completely change from passive learning to active learning took about two years of work. I learned a lot about myself during that process and I enjoyed working with other people. I found it challenging to convince people to change their ways. I also found that the satisfaction that came from students’ coming and saying that Pathology is the best course in the whole medical school was huge. The teamwork was very satisfying because it required 30-50 people to work together to change the course. So that gave me confidence that I could do things which were difficult and things which did not depend only on me. In research you don’t depend on anybody except your own self and your students. You don’t have to convince other people. But doing something like this requires collective effort and convincing other people and you need leadership qualities to do that. After having done that I felt a sense of confidence that I could take on other challenges. So in 2000 when the University of Chicago invited me to become the Chairman of the department I accepted that challenge although I did not have any experience running a department in any form. I am a basic researcher but the Department has basic research and clinical responsibilities. I am in charge of the labs, surgical pathology, blood banking, histopathology, clinical chemistry, molecular diagnostics and things that I have never done myself. I took it as a challenge and with vision, with persuasion and having people share the vision, encouraging people; respecting their talents and giving them the credit for their work as a team I was able to do it. I took all this administrative work and I must say I have been very satisfied and the Department of Pathology at Chicago is now among the very best departments in the US. As I began to do more and more administrative work I had less and less time for research. My research output became less. If you look carefully over my CV after 2000 the number of paper published in a year has declined steadily. My department has 45 faculty members and 250 employees, so it was very time consuming. I made the decision that I would not step back from writing the books. I reached a point where I had to decide what I will do less. I decided then that I will reduce research but not do less well research. I decided that I would keep writing books and take all the administrative responsibilities. In 2006 the Dean asked me to become the executive vice dean which basically gave me the responsibility of research in the entire medical school in all the departments. I was offered that position because of the success we had in the Department of Pathology both clinical and basic. So, that is how I took more and more administrative work and frankly I have been offered other higher administrative positions at the level of the dean, at the level of the director of institutions but I refused because I realised that if I accepted those I would have to give up writing textbooks. I have written books for 30 years and gained enormous satisfaction from having done that,.
JYI: Lastly we would like to know, what keeps you motivated?
VK: As far as textbooks are concerned, what keeps me motivated is the responses that I get from students all over the world- that they enjoy, that they are thankful and grateful, that these books made a difference in their education and that the books were very important in their medical education. It is really the world wide impact and the feedback that I get when I travel which motivates me. As you know I had come to Mangalore last year. In fact Monday (1st February 2010) I will be going to India again and I will be talking at an undergraduate symposium in Indore and then I will be going to Pune and speaking there. I will be talking about education and research. I was in Australia last year after I left Mangalore and met medical students there. I got a lot of positive feedback. I think, being able to help such a large number of people in the world keeps me motivated as far as book writing is concerned.
As far as research is concerned, it is driven by the joy of solving difficult biological problems. I am hoping that my research will be useful for patients someday but I am also aware that the result of research and its translation into better health care takes a very long time. Research is something which is very personal. Some people like to solve crossword puzzles. They solve a puzzle and they feel happy about it (I cannot stand crossword puzzles). I solve an important problem in immunology and I get the same pleasure that some other people might get by solving crossword puzzle.
As far as administrative work is concerned, I think that it is the results that keep one motivated. The results of research that goes on in the Department, the results of excellent clinical care that we are able to give our patients is what keeps me motivated.
In the final analysis, being able to do some good gives me satisfaction and keeps me motivated.
JYI: Thank you Dr. Kumar, we appreciate your time and it was a pleasure talking to you!
VK: My pleasure!