In Context

884 www.thelancet.com/neurology Vol 8 October 2009

Profi lePaul O’Connor: from manual labour to multiple sclerosis masteryScrap metal worker and grape picker are not the previous job titles you might expect for one of the world’s leading experts in multiple sclerosis (MS). But while Paul O’Connor, director of MS research at St Michael’s Hospital in Toronto, Canada, can probably now omit these early jobs from his CV, he remembers them, particularly the grape picking, with fondness.

O’Connor took the scrap metal job in a factory in Paris, France, and the second at a vineyard in Bordeaux to earn some much-needed francs during a year of travelling after high school. The vineyard job came with some additional perks. It was “pretty hard work”, he says, but at the end of each day “they would give us a sample of the wine that they were making on the premises. Or several samples! I certainly developed an appreciation of French wine.”

After his adventures in France, O’Connor returned to his homeland, Canada, enrolled at the University of Toronto, and studied medicine. “I always wanted to have a job where I felt like I was helping people in a direct way”, he says. “As a career, medicine seemed to off er that.”

O’Connor’s nurturing instincts led him to train initially as a family doctor. While interning for general practice, however, O’Connor realised he needed something more challenging. “I’ve always been absolutely fascinated by the brain—the mystery of how it works”, he says. A residency in neurology at the University of Toronto, Canada, was thus an obvious choice for him.

So, why the specialisation in MS? O’Connor explains that he wasn’t keen to work with neurological diseases of the elderly, such as Alzheimer’s disease, Parkinson’s disease, or stroke. He wanted to work on a disease whose victims were relatively young. “If one did something to help those people, you might have a lasting impact”, he reasoned. MS fi tted the remit.

MS was also a disease that, at the time, had very few treatment options. O’Connor could therefore see a role for himself: developing new treatments. “In order to facilitate that goal”, he says, “I took some time off and did a Masters degree in clinical epidemiology”.

The course, also at the University of Toronto, equipped O’Connor with the skills he needed to design clinical trials, and he has been heavily involved in trials ever since. Around the time O’Connor was starting out, the anti-infl ammatory drug interferon beta had been shown to be eff ective for MS. This fi nding led to the development of various other anti-infl ammatory drugs, and O’Connor was particularly instrumental in the development of one known as natalizumab.

All of these drugs have their problems, however. They have to be injected, and they also have unpleasant side-

eff ects such as headaches, nausea, and, in the case of interferon, fl u-like symptoms. “Patients in general hate needles”, says O’Connor. With the additional side-eff ects, he says it is no surprise that “I’m asked every single day in my offi ce when oral therapies will be available”.

O’Connor and his team at Toronto have stepped up to the challenge and have recently been working on several diff erent oral anti-infl ammatory drugs, many of which are in phase III development and show promising results.

Good news, surely? It is, says O’Connor, but only for people with relapsing-remitting MS—the form of MS in which patients have attacks of symptoms interspersed with periods of recovery. Unfortunately, for patients with progressive MS—characterised by a gradual worsening of symptoms, sometimes also accompanied by attacks—none of these treatments, old or new, is eff ective. O’Connor thinks this is because, in progressive MS, “the disease is too fi rmly rooted within the brain.” Most of the anti-infl ammatory drugs that they use, he explains, “don’t penetrate much into the brain itself”.

It is very diffi cult for patients with progressive MS, says O’Connor. “[They] feel abandoned, they feel disenfranchised, because there are far fewer trials going on for progressive MS, and to date nothing has worked.” Finding a treatment for progressive MS, he says, would be his “number one wish”.

Given O’Connor’s nuturing character, does he fi nd it hard to deal with patients with MS for whom he can only relieve their distress rather than cure the disease? “Yes, I think they are a diffi cult group of patients to deal with because they have a multiplicity of physical, psychological, and social symptoms.” But he adds, “One of the things about working in medicine is, if something is easily done, then the challenge isn’t there. If there’s no challenge for me, personally, there’s no reward.”

On top of O’Connor’s care for patients and his clinical research, he is also a scientifi c and clinical advisor for the Multiple Sclerosis Society of Canada, and has a hand in raising funds for the charity. O’Connor is a keen cyclist and enters numerous sponsored cycle rides in and around Toronto.

His cycling has also taken him further afi eld. Last November, for fun, he and his wife went on a cycling tour in California, USA. A cycling-cum-wine-tasting tour of the Napa Valley, to be precise. “I have recently become more enamoured with Californian wines … particularly the Merlots”, he says, clearly happy that his alternative early training still comes in handy.

Ruth Williamsruth.williams@absw.org.uk

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