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Professor Fiona Stanley was interviewed in 2000 for the Interviews with Australian scientists series. By viewing the interviews in this series, or reading the transcripts and extracts, your students can begin to appreciate Australia's contribution to the growth of scientific knowledge.
The following summary of Stanley's career sets the context for the extract chosen for these teachers notes. The extract covers how she became interested in studying epidemiology. Use the focus questions that accompany the extract to promote discussion among your students.
Fiona Stanley was born in 1946 in Sydney, New South Wales and moved to Perth, Western Australia in 1956. In 1970 she received a Bachelor of Medicine and Surgery from the University of Western Australia (UWA).
In 1976 Stanley received an MSc in Social Medicine from the University of London and became a member of the Faculty of Public Health Medicine (MFPHM) of the Royal College of Physicians, UK. During her studies there she was introduced to epidemiology, biostatistics and public health, the areas that became her life's research focus. After her time in London, she was a visiting scientist for a year at the National Institute of Child Health and Human Development, National Institutes of Health, USA, where she researched the epidemiology of preterm birth.
In 1978-79 Stanley was the senior medical officer (child health) for the Western Australian state department of public health.
During 1980-1990 Stanley served as deputy director and principal research fellow of the National Health and Medical Research Council unit in epidemiology and preventive medicine at UWA. During this period she received the MD from the university (1986) and was elected a Fellow of the Faculty of Public Health Medicine (FFPHM) of the Royal College of Physicians, UK (1989).
In 1990 Stanley was appointed to her current position as director, TVW Telethon Institute for Child Health Research, and professor, Department of Paediatrics, UWA. Her work involves investigating causes and prevention of major childhood illnesses.
Stanley has been elected to the fellowship of numerous faculties and academies, including Foundation Fellow of the Australian Faculty of Public Health Medicine (1991), Fellow of the Faculty of Community Child Health (1991), Honorary Fellow of the Royal Australian College of Physicians (1994), Honorary Fellow of the Royal Australian College of Obstetricians and Gynaecologists (1995) and Fellow of the Academy of Social Sciences in Australia (1996).
During her career, Stanley has received many honours and awards. Among these are Companion of the Order of Australia (1996), an Honorary Doctor of Science from Murdoch University (1998) and the Howard Williams Medal in Child Health from the Division of Paediatrics of the Royal Australian College of Physicians (2000).
Since her interview in 2000, Stanley was elected to the Fellowship of the Australian Academy of Science in 2002 and named Australian of the Year for 2003.
Epidemiology and biostatistics: starting the little motor
After your medical studies at the University of Western Australia you went overseas. Why did you leave?
I was specialising in paediatrics, but I didn’t finish. I was running the Aboriginal clinic from the children’s hospital and we would bring kids into hospital. Working in Aboriginal health can make you very depressed, and I was extremely despondent about the Aboriginal situation. I didn’t think it was going to improve. Also – reinforcing that whole bit about trying to make a difference, and doing epidemiology and investigating causal pathways to disease – I realised that trying to deliver health care to these Aboriginal kids was not really going to change the situation. I felt I had to go and do something else, and probably it was wrong that I had done medicine, I wasn’t going to be a good doctor. I was going through all of these questions about what my role was going to be in life and I was very unhappy.
You might say that I ran away. I have heard Michael Marmott say that he turned down a registrar position at the top Sydney hospital. I turned down a registrar position at the Royal Melbourne Children’s and went off to England to try and find out what I wanted to do with my life. And there I discovered epidemiology and social medicine, biostatistics and public health.
Did you think about leaving Australia for good?
Yes, but a whole lot of things happened which changed my attitude totally. I met Geoff Shellam, who is my husband.
And who now holds the Chair that your father used to have.
Yes, in Western Australia. Geoff became an incredibly important mentor for me. When we got to London he encouraged me, for example, to take up an opportunity to join the social medicine unit at the London School of Hygiene and Tropical Medicine, and to follow the route of becoming a researcher, doing a PhD. And the luck bit was that I walked into the London School of Hygiene when it had all of the top people in England – in epidemiology, biostatistics, social medicine. That’s when all the lights turned on, when what Geoff calls my ‘little motor’ started. Once, when an interviewer asked me how I kept going, I said, ‘I just have this little motor inside me,’ so Geoff sometimes says to me, when I’m looking absolutely dreadful on Saturday morning, ‘How’s your little motor this morning, dear?’ But it was just as if the little motor switched on. I realised then that epidemiology was extraordinarily powerful.
I was also lucky that in OPCS (the Office of Population Censuses and Surveys) at that time in the UK was another incredibly powerful and wonderful group of people, with databases for the whole of Great Britain, with record linkage, and the Oxford record linkage survey. It was the place: registers of diseases, like birth defects registries being set up and linked into databases. So I learnt the usefulness of not only epidemiology but biostatistics, even though two of the great people with whom I was working – David Clayton, now Professor of Statistics at Cambridge, and Peter Armitage – said to me, ‘We tried, Fiona, to teach you statistics!!’ I always had to have some very good biostatisticians around me – which is a good message for being a role model. You don’t have to do everything really well; you can get those around you to help you.
Luck played a part again when we had a year in the United States at the National Institutes of Health, just after I had finished my thesis in London on low birth weight babies. When I lobbed into the National Institute of Child Health and Human Development they asked what I would like to do, and I said, ‘Well, what about running a workshop on the epidemiology of prematurity, preterm birth?’ I was extremely interested in the aetiologies of preterm birth and the outcomes of babies who were increasingly being treated in intensive-care units – and the very, very high rate (we didn’t know just how high then) of preterm birth in Aboriginal mothers. In those days NIH was very good to its foreign visiting scientists. Although I was very junior, I was told, ‘Here’s a cheque. You can invite anyone in the world you want to for a three-day symposium and we’ll publish the proceedings.’ Can you imagine? I invited the world of perinatal epidemiology to this workshop: they all came to NIH.
Innovative methodology and causal pathways
Since your return to Western Australia, you and people like Michael Hobbs have set up an immense database to link hospital records and keep track of what happens to people. That is unique in Australia and one of the few in the world. In your use of those sorts of disciplines and data, what are you proudest of?
I guess there are two answers to that question. One is actually setting up the innovative methodologies – doing the record linkage and exploiting it, setting up really good cohort studies – and using the methodologies to address really important hypotheses. My approach with my people is still, ‘What’s the most important research question we can answer now in this area?’ – be it neural tube defects, other birth defects, cerebral palsies, brain development, preterm births. I call ‘What’s the most important research question?’ going for the jugular, and it’s become a bit of a joke.
But also we went right in there and did it. Our first study for the birth defects registry was the folate hypothesis; our first study for preterm births was looking at whether social support in pregnancy was effective in reducing preterm births – a hugely difficult study to do; we looked at the issues of survival of the very low birth weight preterm neonate and what that has done in terms of cerebral palsy rates; and we looked at the whole area of birth asphyxia and cerebral palsy. Some of what we did in those four areas led straight into and furthered our interest in Aboriginal maternal and child health. The low birth weight, preterm birth story, and how that was important in Aboriginal health, is still a profoundly important aspect of our work.
So there have been two very important things. One was the methodologies and getting all of ‘the’ expertise, training people up in that area of epidemiology when there were very few epidemiologists in Australia. The other has been the specific areas we have worked in. I guess the two that we are best known for – whether I’m proudest of them I don’t know – are the cerebral palsy work and the folate and spina bifida work.
The cerebral palsy work is showing, essentially, that birth asphyxia, certainly at the time of delivery, is not the most important factor. And that there are unknown factors.
Yes. Also, antenatal pathways – things like neuronal migration and placental effects, and infections and inflammation, and early human brain development and how it goes wrong – is probably going to be profoundly important in cerebral palsy. They’re going to be more like birth defects than birth asphyxial causes.
But what I hope I’ll be remembered for 10 or 20 years down the track is a whole new thinking about causal pathways to brain damage, or brain anomaly. You start with the population, yes, but you don’t think of simple, single risk factors. I am excited that you can actually start to get into molecular epidemiology (cerebral palsy is a good example) and to look at the genetic/environmental interactions in terms of the ways brains might develop and develop badly, or go wrong, go off the track, off the program of normal development, and how that might happen – and social epidemiology, and how that all fits together.
We are becoming more rigorous in our epidemiological methodology and thinking, and causal pathways thinking means not just thinking of single risk factors. We are in a single risk factor epidemic: you must eat this or that. Yes, eating soy has been shown to be beneficial in breast cancer, but these are single risk factors. Look at the social, physical and environmental context in which risk factors arise, and then you might get a much better handle on true causal pathways – which are very complex and much more difficult to elucidate. If you analyse the causal pathways properly, not only will you get them right but you’ll have better chances of knowing when to intervene, to prevent. These are very exciting new developments (even if I do summarise it all so briefly).
An edited transcript of the full interview can be found at http://www.science.org.au/scientists/interviews/fs.
Focus questions
Select activities that are most appropriate for your lesson plan or add your own. You can also encourage students to identify key issues in the preceding extract and devise their own questions or topics for discussion.
biostatistics
epidemiology
paediatrics
causal pathways
single risk factors
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