Eric Espiner with present and former Christchurch Heart Institute (CHI) colleagues at a morning tea on campus to celebrate his book launch. From left: Lynley Lewis, Tim Yandle, Vicky Cameron, Eric , Chris Charles, Jo Whitlow and Miriam Rademaker.
“I was blessed by chance and good fortune. So often those sliding doors opened at just the right moment.”
When Emeritus Professor Eric Espiner arrived at Christchurch Hospital as a fresh-faced University of Otago medical graduate back in 1958, little did he suspect the outstanding clinical research career which lay ahead of him – with its numerous twists, turns and discoveries.
Now, with the wisdom and insights gleaned from more than 90 years of life and almost 70 years in medicine and research, Eric has written a memoir. Titled A Physician’s Journey, it’s an extraordinary and engaging account of scientific enquiry, doggedness and teamwork, contributing to a field of medicine then still in its genesis – cardiac endocrinology.
The book is an important historical document, accurately depicting the scientific endeavours of a dedicated team of multi-disciplinary medical researchers, clinicians and scientists working in Christchurch throughout the 1970s, 80s, 90s and beyond, in an environment where the culture of enquiry was firmly entrenched. It depicts a series of important discoveries which elevated the work of Eric and his colleagues onto the scientific world stage and into the pages of leading medical journals.
Their findings – that the human heart is itself an endocrine gland and that hormones can be used or manipulated to benefit the health of a patient – have changed the established view of how cardiovascular health is maintained.
The discovery that one of these same heart hormones is integral to maintaining health in the likes of skeletal development, foetal maternal disorders and neurological diseases, has extended the landscape of endocrinology, and opened up new ways of evaluating organ function using biomarkers of these newly identified hormones acting within specific tissues.
Although primarily focussing on the research itself, Eric does provide the reader with insight to the enormous influence of chance, serendipity and the vagaries of funding support which may determine research outcomes. Lost opportunities for patenting inventions – later shown to be worth many millions of dollars – add to the narrative.
Eric relates that his journey to medicine commenced in childhood, absorbing his mother’s tales of her nursing days, and listening to the likes of Dr Kildare on the wireless in the 1930’s. A love of biology at Christ’s College, and a desire to emulate older brother Harry and ace the necessary four ‘A’ marks required for acceptance at Otago Medical School spurred young Eric on to achieve the much-needed university bursary and marks to enable him to head south to Dunedin.
Some years later, now with his MBChB, he realised that although his social life had been well-served in Dunedin and his book knowledge of medicine robust, hands-on clinical skills were lacking.
“We found ourselves distributed to one of the four main regional hospitals in the country. After all the years in Dunedin, becoming an established and paid member of the medical workforce, with all its responsibilities and unpredictable challenges was a daunting experience,” Eric recalls.
Having qualified MBChB, a house surgeon internship at Christchurch hospital ensued, followed by a coveted post as a medical registrar two years later. Assigned to “the country outpost” at the newly commissioned Princess Margaret Hospital in Cashmere, Eric was to work in The Medical Unit – established by the University of Otago to train final year medical students and undertake research.
The unit was supervised by “debonair and brilliant” consultant physician Donald (later Sir Donald) Beaven. With his interest in diabetes, and other disorders of hormone function, Donald needed to recruit scientists to aide clinicians in detecting abnormal hormone function, by developing new methods for the detection and precise measurement of the hormone concentration in the circulation.
At his first interview, Don proposed research studies for Eric to undertake, measuring levels of a hormone secreted by the pituitary gland from patients with adrenal gland disorders. This entailed collaborations with Lincoln College scientists and hospital surgeons, transplanting the adrenal gland from its position above the kidney to relocate in the neck of the merino sheep. While a distant prospect, remote from his hope of obtaining credentials as a qualified physician, Eric subsequently took up the challenge, successfully completing his Doctorate on the role of the pituitary in regulating adrenal function.
Eric, having now passed the Royal Australasian College of Physicians entrance exam, took up a two-year travelling scholarship opportunity, first to the Royal Postgraduate Medical School in Hammersmith, London, then to the Peter Bent Brigham Hospital in Boston, where an adrenal hormone called aldosterone was the focus of endocrinological research.
He recalls “exciting times”, working with patients with high blood pressure, examining how change in aldosterone secretion affected salt retention by the kidney, and developing tests for Conns Syndrome (a small benign adrenal tumour overproducing aldosterone).
He met his wife Mary at a gathering of Boston city’s “Down Under Club”. Mary had migrated from County Durham to work as a dental hygienist for a Kiwi dentist based in Boston. The pair married a few months later at a registry office, and, with his visa due to expire, they moved back to Eric’s hometown Christchurch in 1967, where he took up a post as assistant director back in the Medical Unit, which was by then “in full swing” with several new physicians in training under Don Beaven’s direction.
On returning to the Medical Unit in 1967, Eric helped establish a strict but vital set of patient protocols, allowing interpretation of the changes in blood levels of the adrenal’s secretion of aldosterone as salt intake – essential in deciding whether further testing or surgical removal of an adrenal tumour was needed. This allowed study of the hormone changes in patients with heart failure both before and during diuretic treatment – critical to understanding the factors contributing to cardiovascular health.
The team began to study the first of several generations of ACE inhibitor drugs, to gauge its effectiveness in lowering blood pressure. Trialled on patients with heart failure, it delivered dramatic results, reducing breathlessness in many. The results were published – along with several other novel study results to follow – in esteemed British medical journal The Lancet.
More talent joined the Unit in late 80’s – scientists (later Professors) Vicky Cameron, Tim Yandle and cardiology registrar Mark Richards – who went on to establish the renowned Christchurch Heart Institute (CHI) within the University of Otago’s Department of Medicine.
“By the mid to late 80s it was clear that the heart was an endocrine organ – not just a muscle pumping blood but an organ secreting a new class of unique hormones into the circulatory system every second,” Eric says.
“Many ground-breaking studies emerged in the 1990s from this new “’cardio-endocrinology”’, clarifying the role of hormonal factors in heart failure and other cardiovascular disorders.”
Trials began on the first of these new circulating hormones, called ANF (later renamed ANP). The results (again published in The Lancet) clearly showed, for the first time, that the hormone played an important role in maintaining a healthy circulation by reducing blood pressure and enhancing salt excretion in healthy participants.
Another peptide soon emerged internationally called BNP – similar to ANP but the product of a different gene and expressed in the heart’s ventricular muscle cells. Since the plasma concentration of both ANP and BNP was increased when the heart was stressed, the Christchurch group reasoned that levels of these hormones in a blood sample might clarify the cause of severe shortness of breath.
Following up on this hypothesis, the Christchurch group showed that measuring levels of heart hormones could distinguish the cause of severe breathlessness – levels were much higher in those where heart failure was the cause, compared to levels in subjects breathless due to pulmonary diseases such as emphysema or pneumonia.
In the first report of the possible use of heart hormones as diagnostic markers in this setting, the group showed that a single measurement of BNP in plasma at the time of hospital admission was significantly higher in patients with heart failure compared to those without.
“The capacity of a simple blood test to distinguish cardiac impairment within hours of a patient arriving at a hospital ED was, and still is, a major breakthrough,” Eric says proudly.
Looking back over his 65 years pursuing clinical research, Eric considers himself privileged to have gained a commanding view of what he considers three key advances which have changed the course of endocrine practice; the development of immunoassay techniques to provide reliable measurements of hormone levels; developments in imaging such as ultrasound, echocardiography and MRI; and genetic engineering, which has allowed the scientific basis of many endocrine disorders to be studied in experimental animals.
“My journey could not have commenced, let alone been ‘completed’, without a like-minded group of colleagues working across diverse disciplines and national borders.
“To be part of the Christchurch team’s important contributions to these advances, to travel with them along the highways and byways through twists and turns, has been an extraordinary experience,” Eric writes.
A Physician’s Journey by Emeritus Professor Eric Espiner is available in most bookstores, or can be ordered online through Quentin Wilson Publishing at a cost of $34.99.
– Kōrero by Lorelei Mason