Interview with Dr Sue Brook
Posted on: Tuesday 1 November 2022
Author: Konrad Obiora
The year 2022 is pharmaceutical medicine’s twentieth year as a recognised UK medical specialty.
To mark this occassion, I caught up with Dr Sue Brook in the first of a short series of interviews with some of our FPM members about what inspired them to join the specialty.
The views and opinions expressed in this article are those of the people involved and do not represent the views of any company, nor, necessarily, represent those of FPM.
Dr Sue Brook has worked in pharmaceutical medicine for 10 years, starting with her first role in the specialty as a medical advisor for Servier Laboratories. Sue was a member of FPM’s Trainees Committee, and she completed the Pharmaceutical Medicine Specialty Training (PMST) programme in 2017 gaining entry on to the GMC’s specialist register the same year.
KO: Why did you decide to leave clinical practice to work in pharmaceutical medicine?
SB: I’ve always been interested in drug design and drug development. I did a chemistry degree before I started medical school, and during my final year of the degree I specialised in pharmaceutical chemistry and drug discovery. And although I was prescribing medicines to patients, I wanted to understand the biology, science, and pharmacology of what I was prescribing, how the medicines were discovered and to help influence the development of new medicines. After a few years working in the NHS, I started to explore other roles available to doctors in drug development.
How did you prepare for your first role in pharmaceutical medicine?
Nothing specific for the role, but I did a lot of preparation to make sure I was making the right decision. I spent a year researching alternative roles outside of the NHS; I spoke to consultants whose spouses already worked for pharmaceutical companies; I approached contacts on LinkedIn and their friends. I also spoke to people who worked in pharmacovigilance, for the Medicines Healthcare and products Regulatory Agency, and in public health to explore what options were out there. Everyone was kind to me and were generous with their time. After I decided I wanted to work in medical affairs, I started to look for companies. I knew I wanted to stay in West London and commute up to 30 miles or 30 minutes away, so I was specific about the companies I wanted to work for. At that time, working from home was less common than it is now and I had a child at nursery so couldn’t travel too far.
I also focussed on companies with portfolios that included the areas I was interested in like osteoporosis and metabolic medicine. I wrote to a few companies, sent them my CV, and applied for roles and got the job at Servier.
Did you encounter any challenges when you joined the specialty that you did not anticipate?
I had to adapt to working with a much wider range of people with different priorities. In healthcare, you’re working mainly with other healthcare professionals such as healthcare associates, nurses and radiologists, but in pharmaceutical medicine you work with people from many different areas – you do work with clinicians in clinical development – but you’ve got the sales force, the medical representatives, medical information teams, legal teams, medical liaison specialists; sometimes you might have to talk to other pharmaceutical companies. You might have to liaise with different offices around the UK, and work with sales and marketing who have different priorities. I also had to adapt to a new way of working such as meeting company goals, understanding budgets, annual financial milestones, business plans and future strategies.
Was balancing commercial priorities with your role as a doctor a challenge?
The topic came up in a few practice interview questions I did and also from someone I spoke to for advice; they said that a doctor has to be completely comfortable walking into the pharmaceutical industry knowing that you are working for a profiting making company and if the company doesn’t make a profit you don’t have a job, so you can’t have any qualms about stepping away from the NHS, which is about free healthcare, to a company whose key driver is profit. But that is how drugs are developed and if it wasn’t for them there wouldn’t be progress in drug development. I had to be mindful of that when I joined the industry.
Pharmaceutical medicine needs doctors. We adhere to the General Medical Council’s standards in ‘Good Medical Practice’ and we will always put the interests of patients first. And pharmaceutical companies must follow the ABPI’s [Association of the British Pharmaceutical Industry’s] Code of Conduct.
You still work part time as a clinician. Why did you choose to do that?
I missed the patient contact, so I split my time between pharmaceutical medicine and clinical practice. My clinical practise informs the work I do in pharmaceutical medicine. I work in clinical development and my clinical work really helps me when I read adverse reports or design protocols where I process a large amount of clinical data for serious adverse event reports. The experience is also useful when I am looking at exclusion and inclusion criteria for a clinical trial such as remembering the levels of renal and liver functions and abnormality that are tolerable. You also have knowledge what the patient is going through, and you can then plan trial appointments on dates that suit them because they could be unwell or need assistance to travel to trial venue.
Why did you decide to join Cancer Research UK (CRUK)?
I did my time working in medical affairs and regulatory and I had almost finished PMST, and I knew I wanted to find a role in clinical development. I looked at other companies, but I don’t think a lot of clinical development is done in the UK. What I liked about CRUK was it was oncology, so I would be dealing with more than one disease and studying genetic causes.
CRUK has several doctors, and we work on a handful of projects each. The projects can be at various stages of development. We conduct due diligence on the molecules right through to writing the clinical trial protocols with medical writers and study managers, and as the doctor you have input on the trial design and the inclusion/exclusion criteria. Once the trial is up and running, we and the pharmacovigilance team look at safety data and we assess the data with the investigators every time we accelerate the dose – the projects are primarily safety-driven studies. At the end we assist with writing up the study report and reviewing all data for efficacy.
My working day can include preparing slides for a presentation to one our external committees. The CRUK is a charity and governed externally, so at various stages of a trial an external committee recommends or ratifies our decisions on trials. I review scans of patients and decide whether we should continue a trial with the patient – the scans are also reviewed independently to make sure a doctor’s decision was made correctly. I am also on a safety rotation with the other doctors to review serious adverse events and whether they are related to a trialled drug or not.
Did the COVID-19 pandemic have an impact on CRUK’s work?
We did see a decrease in the number of patients who were attending appointments for our trials because they decided to stay at home. At the height of the pandemic, we had to pause some of the trials because our patients couldn’t attend the visits and we couldn’t start new trials because the priority was to divert resources to support the NHS. CRUK’s team at the Centre for Drug Development [CDC] designed and ran a trial of a drug that was developed to reduce COVID-19 symptoms and admission rates. The CDC team’s experience may have been in oncology, but the principles of conducting an early phase study are broadly similar whatever the disease area. That was quite an achievement because we switched from oncology to infectious/respiratory diseases.
What advice would you give a doctor who is thinking about moving to pharmaceutical medicine?
At the time you leave the NHS it can be scary and isolating because most people have no idea what a pharmaceutical medicine job involves. I compare leaving the NHS to leaving the army – you go from a very structured life where everyone knows exactly what they’re doing, and you’re very comfortable because everyone’s there to effectively do the same job – which is healthcare – into the unknown for which you aren’t really prepared. But I’d say nothing is forever, so if in a few years you think you’ve made a mistake, there are so many options both within pharmaceutical medicine and in the NHS to go to. If you have a royal college membership qualification, that is your ticket to go back to the NHS full time or part time, or switch between clinical practice and pharmaceutical medicine. But talk to a lot of people before making the decision to move to pharmaceutical medicine.
Why did you decide to undertake PMST?
I knew at the beginning of my career in pharmaceutical medicine that I wanted to undertake PMST. After leaving quite a structured training programme in the NHS, I wanted to go into another structured training programme which would give me a CCT [Certificate of Completion of Training] at the end of it. I enrolled on to the PMST programme straight away. I also knew that doing PMST requires you to learn and gain knowledge and experience in every area of drug development which you cannot do in one or even two jobs, so undertaking PMST requires you to learn about clinical pharmacology, clinical development, drug safety, statistics and marketing, and I think you need all that if you are going to have a good overview of drug development so that when you talk to manufacturing or preclinical scientists you can understand their points of views or their concerns. I’m glad I did it and learnt a lot, and I feel that I am on a par with a doctor who has completed four years of clinical training and got a qualification to show for it.
Pharmaceutical medicine has been a recognised medical specialty in the UK for 20 years. Where do you see pharmaceutical medicine in another 20 years’ time?
I would like to see more partnership and collaboration between the academic centres, the NHS and pharmaceutical medicine. This might be achieved by having office buildings physically close together or have a pharmaceutical medicine centre in a hospital. I also think with the enormous amount of data that is generated in the UK and globally it would good if there was a way of freely transferring and sharing data and harnessing machine learning to make sense of it.
Before we end the interview, what did you do to maintain your wellbeing during the COVID lockdowns, and did you do anything special to mark the end of the last lockdown?
Keeping fit was important, so I did a lot of exercise such as running.
I organised a disco with a friend for colleagues who are mums in a church hall to celebrate the end of the COVID lockdowns. The profits from the disco went a charity. We bought disco lights from eBay some wigs danced and Prosecco and jumped around for three hours to 70s and 80s music. We had a lot of fun.
