By bringing together students from differing fields of study and allowing them to share, compare and contrast their work and their experience, this series highlights the wide variety of important, interesting research and study taking place at Queen’s University. Here, Ann Harkin talks with David Burke. Their conversation has been edited for clarity.

Ann Harkin: Hello David. This is exciting – I haven't had a pen pal since 1984!

It’s been quite a journey for me to get to the PhD I am doing now. I hold three undergraduate Bachelor of Health Science degrees in Complementary and Alternative Medicine (CAM) and a postgraduate Masters in Public Health, and I have been in practice since 1999, enjoying a colourful and varied career. I have always had the ambition of doing a PhD, but it’s about more than just climbing the academic ladder for me; I feel compelled to be here. I’m a bit unique in the School of Biological Sciences, because I’m a herbalist learning to become a scientist in order to prove what I know to be true from my decades of experience prescribing herbal medicine to treat drug-resistant infections. I simply couldn’t let the scientists have all the fun! Truthfully, I feel that here at Queen’s I am in the right place at the right time and aim to make the most of this amazing opportunity. I am highly ambitious and have a few top jobs on my radar, but paramount in my mind is also my belief that as a mother I do things so that my children know that they can!

David Burke: Hi Ann, it’s great to hear from you and I look forward to discovering more about your work. My background is also in medicine, and during my undergraduate medical degree, I intercalated with an additional bachelor’s in medical science. I am now about 9 years into my post-degree medical training and work as a specialist trainee in medical oncology in Belfast on a path to becoming an oncology consultant. This work can be very hard at times but also very rewarding. During my medical training, I have been drawn to projects that aim to use supportive treatments alongside standard-of-care treatments. There is a wealth of help for people encountering cancer that can be improved upon. And I believe that with the right research and evidence, such interventions could be cost-effective for the health system too. This includes integrating physical activity, nutrition, peer support, and counselling interventions among other things. I am very grateful that I have had a year working with the early phase trials team in Belfast learning clinical research basics. I'm also delighted that the Belfast Trust has funded my PhD to explore nutrition and physical activity interventions for people with advanced bowel cancer. I'm in my first year of this PhD now, still doing out-of-hours shifts in the hospital as well. What is your PhD thesis title? Can you summarise your study in a couple of sentences for me (if such a thing is ever possible with a PhD!)?

Ann: My title is ‘Evaluation of natural plant-based botanicals as an alternative to therapeutic antibiotics, and in antibiotic potentiation.’ In a nutshell, my project aims to address antimicrobial resistance. I have chosen a number WHO priority pathogens, the multidrug-resistant (MDR) bacteria causing the greatest number of nosocomial infections; and I have 15 high potential plant-derived antimicrobials (PDAms) I have determined through empirical knowledge and my dissertation research. I will determine their antimicrobial effects against these PDAms against MDR bacteria and compare these antibiotics. I will apply combination studies to determine antibiotic potentiation, that is the ability of the PDAms to potentiate the efficacy of existing antibiotics whose spectrum of activity is limited. Then I will look to ascertain the mechanism of action in AMR.

David: Your research sounds fascinating, and definitely timely. I remember from my undergraduate degree I had the chance to work with the World Wide Antimalarial Resistance Network (WWARN) in Oxford. The stark reality of how close we are to global antimicrobial resistance is sobering, and I am fascinated by the integration of "traditional" medicine into the "western" medical model. I feel like this has long been the problem with any complex or bespoke interventions. It is relatively easy to assess a tablet prescription against a placebo, but much harder to assess bespoke herbalism, or lifestyle interventions etc. I think its brilliant that you are working to bridge that gap. How did you initially discover herbalism and set up a herbalist practice?

Ann: Thanks David, I’m always flabbergasted when people say they find my research fascinating, as I am so fascinated by everyone else’s research! It’s certainly a compliment coming from your good self. I hope to do my best, but regarding the integration of traditional medicine into mainstream healthcare, until people stop condemning complementary and alternative medicine (CAM) because of a (perceived) lack of clinical evidence, and money to underwrite the use of CAM by rigorous scientific investigation, I fear that nothing will change. It's an interesting question regarding herbalism. Melbourne is my hometown; far North Queensland is my spiritual home. I lived and worked on an organic flower farm in the early 90s and, with a baby, being exposed to tropical ulcers, ear infections, etc. you soon learn on your feet. Another mother on the farm had been studying naturopathy, so I followed suite once back in the city. I have been practicing it ever since then, in 1999. I first started out as an in-store naturopath. Australia is at the forefront of natural medicine training. Australian naturopaths study a 4-year degree here and we are trained in pharmacology and drug nutrient/herb interactions. Most chemists and health shops in Australia have an in-naturopath keeping the public safe. Can you tell me about your research and thesis?

David: My current research title is: "Investigating the feasibility of a co-designed lifestyle intervention intended to improve lean muscle mass in people with advanced colorectal cancer undergoing anticancer therapy." It is known that muscle loss (sarcopenia) is associated with lower functioning, quality of life, and length of life in people with advanced cancer. There is also evidence that muscle loss in those with bowel cancer is linked to poorer response to chemotherapy. What's more, advanced cancer and chemotherapy worsen sarcopenia in a negative cycle. In healthy volunteers and people with early stage cancer, sarcopenia can be ameliorated by increased resistance-based physical activity, increased protein intake, and goal-setting counselling support. It is unknown whether similar interventions in people with advanced bowel cancer would be of benefit. Not least because of specific challenges in this group, such as undergoing chemotherapy, a high level of frailty and other medical conditions, psychological distress at diagnosis, side effects of treatment, and prior surgeries. However, I feel this is a group of people were there is unmet need. Could a lifestyle intervention in this setting help improve muscle mass, physical functioning, and other outcomes meaningful to people in this important stage of their life and cancer journey? And is such an intervention feasible? Through my research, this PhD will: explore the current best evidence for physical activity and nutrition interventions to improve muscle mass in this group; co-design an intervention alongside stakeholders; and develop and deliver a feasibility study of this intervention. So, a fair amount of work for me to do over the next three years! With that in mind, what does a typical work week look like for you? What challenges typically arise?

Ann: Very interesting David. Cancer is a wasting disease and severe sarcopenia is associated with an increased risk of death. As we say, a Multi/Inter/Trans: an disciplinary approach is needed. The impact of nutrition and environmental epigenetics on human health and disease is well documented, but undoubtedly, you have found an important gap in the knowledge you are looking to fill. It’s a fascinating subject. I’m sure one of your challenges is the state of the public health system and demonstrating how this can help save it money. As a natural medicine practitioner and as a mother who has raised my family without antibiotics, I know that natural medicine has a paramount role to play in addressing the threats to global health. This role is currently downplayed and often denigrated. The fact remains that 80% of the world’s population use traditional medicine, and 40% of pharmaceutical drugs are derived from natural sources. Whilst the body of empirical evidence among herbalism’s history is large, many people still condemn traditional medicine because of a lack of clinical evidence. Any criticism of natural medicine only hardens my resolve. To integrate traditional medicine into mainstream healthcare an urgent need exists for traditional medicine to be underwritten by rigorous scientific investigation. I want my voice to be part of this conversation, but more so I want to help shape policy.

David: I love that so much of your passion comes from being a mother and I can certainly relate to personal experience as a driving force as I have my own personal history with cancer. I had cancer myself in 2015. I was diagnosed and treated for stage 2C testicular cancer. Thankfully this treatment was curative and I am doing very well, but it left a profound impact. I am very aware of the toxicities of treatment, the long term physical and psychological effects, and the social and family component of a cancer journey. I am also so grateful to the researchers that came before. If it hadn't been for the work developing BEP chemotherapy I would not be alive. Also my interactions with many people with cancer and their loved ones during my job. Developing evidence that could lead to developing and funding support for people going through cancer - particularly those with advanced disease - is my drive. I love clinical research that works directly with people and hopefully benefits participants along the way. I enjoy collaborating with patient groups. And I love the challenge of complex intervention research - even though this is a very knew area to me.

Ann: I appreciate you sharing your difficult medical journey. As you say, you are aware of the toxicities of treatment, the long-term physical and psychological effects, and the social and family component of a cancer journey and your journey will help others. Being as you are aware of toxicities of treatment, the long term physical and psychological effects, and the social and family component of a cancer journey makes you a perfect PhD candidate. I think it’s brilliant that you genuinely want to help others now. This passion will fuel your journey. It is overwhelming, but we have 3 years. I am a baby scientist learning to walk before I can run (a marathon not a sprint), but soon I hope to fly.  We must take rest, however and yes, we are guilty of not practicing what we teach. I say there are two types of people; people who are driven and people who have drive. The latter drive our own ship. Just keep true to yourself. I hope your research can make a difference.

David: "I am a baby scientist learning to walk before I can run…we must take rest, however and yes, we are guilty of not practicing what we teach." I love this line! I feel exactly the same. It can be very overwhelming at times entering into a new discipline requiring a new set of skills. In the clinical environment, I can now feel like I know what I'm doing (some of the time), but in the academic environment, it can be easy to feel imposter syndrome again. I need to remember to keep at it, one step at a time!

Read Part Two of Ann and David's conversation here.