John Camm talks about his many career achievements including his highlights, research activities and involvement in patient groups.
When did you decide you wanted a career in medicine?
I decided I wanted to go into medicine when I was 14, at school. I had to make a choice between history and biology; I thought what the consequences would be and I decided against being a lawyer. I developed a fascination with the electrocardiogram as a medical student and later as a houseman and registrar and that led me toward a career in cardiology.
Who were your mentors?
A man called Denis Deuchar at Guy’s Hospital was a very eminent cardiologist in London in the late 1960s and early 1970s. There are obviously a large number of people who influence you at different times and points in your career but I think he was the biggest influence on me in terms of doing cardiology. Moving into arrhythmology, I was strongly influenced by Edgar Sowton at Guy’s and Roworth Spurrell at St Bartholomew’s. Roworth and I began to set up electrophysiology from scratch in the UK.
What areas of research are you most interested in?
I am currently working on the assessment of risk of sudden cardiac death in certain groups of patients varying from post myocardial infarction to heart failure patients and patients with ion channelopathies like long-QT syndrome. It’s a very fertile area and new data are coming out all the time. We’re making contributions to that, we’re doing a pharmaco-epidemiological study in long-QT interval syndrome induced by drugs.
I think the most interesting research work that I’ve done relates to trying to identify patients at risk of sudden death following acute myocardial infarction. Initially we only had beta-blockers and antiarrhythmic agents to treat them with but now have implantable cardioverter defibrillators, and this has become a really important topic. However, we can’t put devices that cost over £10,000 in everybody who might possibly need them. Much of my current research is concentrating on identifying patients at risk much more accurately.
Where do you think the future of electrophysiology lies?
I think we will be trying to simplify many of the interventional electrophysiological approaches particularly those associated with the management of atrial fibrillation, that is pulmonary vein isolation. I think there are clear ideas on how that can be done and achieved and that should lead to a much more efficient and shorter and less resource-demanding approach to the management of atrial fibrillation.
Secondly, there will be new antithrombotic agents to replace warfarin, for the prevention of stroke and atrial fibrillation.
The third important area would be the use of medical therapy to try and prevent the remodelling of atrial tissues, so that atrial fibrillation does not become entrenched and remains treatable by antiarrhythmic therapies.
Ventricular arrhythmias will become a much more important focus of research. They have been largely ignored for some years because of the excellent efficacy of the implantable cardioverter defibrillator.
Another issue will be the development of monitoring devices that will be implanted beneath the skin and will be able to measure multiple physiological parameters. This will definitely be one of the big developments in the next decade.
The development of stem cells to replace infarcted myocardium or cardiomyopathic tissue, and the development of biological pacemakers are other very important developments whcih will make a huge difference to the success of therapy. The EP arena isI an extraordinarily fertile area for research.
Why is it important to you to be involved in the electrophysiology community?
Because it’s a relatively new community; it only started, in the most primitive sense, in the early 1970s and in Europe it’s still an emerging speciality. That’s true in the UK and in most parts of Europe, as opposed to the US where it’s a much more mature specialty with a very much larger group of people who are involved with electrophysiology. So one of the main things that I am trying to do is help establish the specialty at the European level.
From the regulatory point of view, my involvement has largely been on two fronts. One, the need for the antiarrhythmic drugs, which have had a very chequered history – we don’t have many and therefore I’m very anxious that some of the unique compounds that are coming through the system are made available as soon as possible.
The second main reason for my regulatory interest has been that many drugs unfortunately have cardiovascular side effects which are potentially life threatening.
The cost of therapy is generally rising in all sectors of the health service worldwide and it is important that we try to spend the money available as wisely as possible. Therefore, I’m very keen not to simply establish widespread reimbursement but to establish reimbursement for appropriate use of expensive EP therapies.
You’ve been awarded several prizes and medals. Which are you most proud of?
The Mackenzie medal from the British Cardiovascular Society for outstanding contribution to British cardiology is the most important. Medals and diplomas are only important to me because they emphasise to me that I’ve been doing worthwhile things.
You’re involved in several patient groups. How important do you think they are?
I think it’s fundamental because unless we have a patient group which is capable of lobbying, demanding and popularising the various forms of arrhythmia management, we will not get anywhere because if it’s only doctors who are lobbying for funds we tend to be thought of as self-interested. We need to show that it’s not our interests that are paramount but the interest of the patients.
What do you like to do in your leisure time?
I’m a collector of British watercolours from 1750-1850 and I have a large collection and recently I have started to lecture about watercolours all over the world.
1965 – Exhibition, Guy’s Hospital Medical School, London
1971 – Qualified in medicine, Guy’s Hospital
1976 – Research registrar, Junior Research Fellow; Wellcome Senior Lecturer; Sir Ronald Bodley Scott British Heart Foundation Professor of Cardiovascular Medicine, St Bartholomew’s Hospital, London
1986 – British Heart Foundation Professor of Clinical Cardiology, St George’s Hospital Medical School, London
1990 – Chairman of Medicine; Chairman, Department of Cardiological Sciences; Chairman of Cardiac and Vascular Sciences, St George’s
Boards and Committees
Subject Board of London University
Trustee of the Royal College of Physicians
British Cardiac Society
British Heart Foundation
North American Society of Pacing and Electrophysiology
Fellowships and memberships
Royal College of Physicians of London
Academy of Medical Sciences
American College of Cardiology
American Heart Association
Council of Geriatric Cardiology
European Society of Cardiology
Heart Rhythm (UK)
Heart Rhythm Society (USA and Canada)
British Cardiac Society
Berzelius Medal, Swedish Cardiac Society
Mackenzie Medal, British Cardiac Society.
Gold Medal, European Society of Cardiology
1000 peer review papers
250 detailed reviews
Authored three, and edited 12 books