by Sasha Nimmo

‘Meet the Scientists’ is a series, interviewing researchers working on ME and chronic fatigue syndrome. We hear about current research directly from scientists and meet the people doing such important work to improve our health. The series will introduce early career researchers through to interviewing scientists and clinicians who have been working on the problems for decades.

Dr Michael Musker has 30 years’ experience in mental health nursing and published work in mental health and nursing. He then completed a PhD in Medicine with Adelaide University. He is currently working on his first study, which is looking at into leptin, interleukin 6 and clinical symptoms in ME/CFS (Canadian Consensus Criteria) as well as several other studies at Mind and Brain SAHMRI.

Mind and Brain SAHMRI is collaborating with one of South Australia’s patient organisations, ME/CFS Australia (South Australia), who helped recruit participants.  The research is led by two professors of psychiatry, Prof Julio Licinio and Prof Ma-Li Wong. The samples taken in the study will be used to develop a genetic database.

Tell us about your role.
I am employed as a Senior Research Fellow for the Mind & Brain Theme at the South Australian Health & Medical Research Institute (SAHMRI). However the research centre collaborates and partners with all of three of the Universities of South Australia. I am a Clinical Titleholder for Adelaide University, an Associate Lecturer for Flinders University and I have provided a Masterclass for the University of South Australia. My main role is clinical research and this includes interviewing people about their Chronic Fatigue Syndrome and gathering lots of information about their experience of the disease, as well as performing the clinical side of the investigation.

How does it differ from other research you’ve work on?
It is my first study as I am relatively new to research (now in my third year), but the Theme Leader Julio Licinio has experience in researching this disease. It is not the only research project I am working on as we are also looking at research into Depression; Chronic Myeloid Leukaemia (a type of cancer); Population Research; Bullying; Sexual Abuse and other areas. You can read about all of our other research projects and download the information sheets at http://mb.sahmri.com/

SAHMRI is essentially like a big brain of research, we have many Research Themes here such as Resilience and Well Being, Heart Health, Cancer Research, Aboriginal Health, Metabolism and Nutrition, and many others. We are essentially one big family of researchers with complex collaborations between Themes. You can read more about the different themes at SAHMRI.

Can you give us an update on how your study is progressing?
I also manage the clinical aspect of the research. We invite the participant in for a full day, starting at 8am. After providing breakfast and a cup of tea, we then perform a Dual X-Ray Absorptiometry Scan (DEXA), which is a very light X-Ray of the whole body and provides information about bone density and fat distribution across the body. We then go to our full day of blood sampling in our clinics at SAHMRI, which includes cannulating the participant and taking blood samples throughout the day. We have a system that has not yet been used before in Australia called the Edwards VAMP. This allows us to take a pure blood sample, and return any excess blood to the person’s system. It is very effective and allows us to take blood samples with ease, and without discomfort for the participant. We take a total of 69 samples, taking one every 7 minutes. This seems a lot, but when you calculate the amount it is only 276 mls in total, which is less than a small glass of water, and almost half the usual amount of blood given for a usual blood donation (usually about 500mls). We take care of the person, ensuring they are relaxed, providing meals and media to keep them entertained. It is a comfortable environment, and there is an extremely comfortable lazyboy recliner chair, similar to those you would see in the Gold Class Cinemas. It actually takes three people to provide the clinical care during the research as we have to store the blood on ice immediately, then spin the blood in a centrifuge every 35 minutes to separate the red cells and plasma. We then store the plasma in a -80 Freezer for analysis. We have a Clinical Research Officer and an Honours student supporting this aspect of the research.

What criteria are you using for this study to select patient cohorts and why did you choose it?
We are collaborating with the Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome CFS (South Australia) and I met with the President of ME/CFS (SA) to discuss our research. We are using the document ‘A Clinical Case Definition and Guidelines for Medical Practitioners’ (An overview of the Canadian Consensus Criteria) which lays out the assessment process and approach for the clinical assessment of ME/CFS. We also ask in our Participant Information Sheet that the person already has a diagnosis from their GP or a specialist in CFS. Most participants have expressed that they have had CFS for many years. We use a number of questionnaires to gather information about the individual’s health.

The genetic database sounds very interesting, how will it be used?
The technology for examining the Human Genome is advancing at a rate of knots, and at SAHMRI we also have expertise in Pharmacogenomics (Pharmacogenomics is the study of how genes affect a person’s response to drugs). We are collecting a genetic database of CFS sufferers and Controls (those that have no physical ailments – or are healthy participants), so that we examine common alleles and Single Nucleotide Polymorphisms for this disease. That is looking at the molecular map addresses for specific gene codes (Adenine, Guanine, Cytosine and Thymine) and see if there are any differences between both sufferers and control subjects. As our knowledge of CFS advances, alongside our ability to translate the human genome, we will be ready to examine this database without having to recall participants for a sample. We will also be able to use anonymised samples with other Universities who are specifically researching this area and seek to collaborate with us in the common cause of the unravelling of this disease.

You have a lot of experience in mental health, depression and PTSD, what led to you to study hormones and chronic fatigue syndrome symptoms?
I have actually changed roles since achieving my PhD. I was a qualified nurse for 30 years and went on to University to complete a Master’s Degree in Health Promotion, Research and Policy Change for which I obtained a distinction. I then completed my PhD in Medicine with Adelaide University, which provided me the avenue to enter research with the Mind & Brain Theme here at SAHMRI.

I work for two world leading professors in Psychiatry, and more specifically Molecular Psychiatry and Pharmacogenomics. Professor Julio Licinio, and Professor Mali Wong. They are dedicated in their interest of the biological aspects that affect many different health disorders, both physical and those that have effects on mental health. For example, we are also looking at the mental health effects of Chemotherapy on cancer patients. Professor Licinio is recognised as a world expert in the study of Leptin and other molecular aspects of disease and is in fact the editor of a number of Nature Journals. Professor Mali Wong is an expert in Pharmacogenomics, and together their expertise provides for a new approach to the examination of CFS. Professor Licinio is the Theme Leader of the Mind and Brain Theme and has a strong interest in the effects of Chronic Fatigue Syndrome on the human system. Julio has provided the inspiration and motivation for my current research into ME/CFS and Fibromyalgia.

Why is this work important?
Chronic Fatigue Syndrome continues to provide challenges to many individuals. A number of people I have spoken to have been affected in many aspects of their lives including interpersonal, social, and economical. For example, some participants have lost many of their friends, their partners, and even their jobs because of this disease. Although this is not the case for everyone, many are just hanging in there and suffering silently. Others have expressed that they have suffered for many years, and have found no answers when seeking help from professionals.

I have spoken to many genuinely distressed individuals who are seeking answers, having seen numerous specialists, and trying a variety of solutions, yet they still continue to suffer and are none the wiser about their disease. The human body is a miraculous machine, and we are far from understanding it from an holistic perspective. The cytokines and hormones we are examining, Interleukin 6 and Leptin, have many interactions with the rest of the bodily systems. They act as messengers on cellular based systems and even the brain, this then has concomitant effects for the way we feel, behave and respond to our environment.

Do you personally know anyone with ME or chronic fatigue syndrome?
I had a relative who suffered from ME/CFS and Fibromyalgia, but they have since died. I became very aware of both the physical, social and psychological effects of this disease. The most painful part for people is having to explain over and over how their fatigue disables them from doing everyday activities. My current research is certainly opening my eyes to the extent CFS effects people. When I spend the whole day sitting next to someone whilst taking their blood, I have had many conversations about the ways CFS can affect their lives.

Can you tell us about your experience of working at SAHMRI?
My main role at SAHMRI is about interviewing people, and most interviews last between 3 and 4 hours. I do a Structured Clinical Interview as well as use many internationally based research questionnaires and clinical outcome measures. On some days, I have interviewed someone for 4 hours in the morning, had a very quick break for lunch, and then perform another interview in the afternoon. It can be quite exhausting. In addition to interviewing, I usually take the person’s blood and then have to centrifuge the blood, separating samples into aliquots, and then putting them in storage. My role also involves all the logistics of the research from the ethics application, writing the participant information and consent forms, collecting the data, transferring data into the database, storing records, ordering clinical devices and equipment, storing and labelling samples, analysis, presenting the results, and making the tea for participants.

As a researcher you have to able to perform all aspects of the research, as well as keeping up to date with the latest research. We have a journal club within our theme where each researcher presents the latest literature on their topic area. SAHMRI also has weekly presentations in our huge auditorium from world experts, placing us at the forefront of research. I am also a member of a number of committees such as the consumer engagement committee, and the gender equity committee. I am the facilitator of our theme’s Consumer / Carer (Lived Experience) group, where I meet with consumers and carers when we talk about the current and future direction of our research. SAHMRI also has a mentorship programme, and I have a personal mentor who is the Deputy Cancer Theme Leader & Director of Cancer Research. I am working in an amazing research and learning environment where I have collaborated with the Wellbeing & Resilience Centre, CSIRO, Cancer Research, Population Health and many others.

SAHMRI provides with me with a lifelong learning environment that allows me to research diverse topics. An example of this is our Theme’s research into Bullying and Sexual Abuse. I am presenting the outcomes of this research at the “The Alannah & Madeline Foundation” National Centre Against Bullying Conference this week in Melbourne and reporting the results of our study.

Is Adelaide, and Australia, a good place to be a researcher?
Adelaide is a great place to live, and having an amazing centre like SAHMRI, provides for an excellent work life balance. It provides a supportive and educational environment and is based in the new health precinct, nestled between the new Royal Adelaide Hospital and Medical & Nursing School of Adelaide University. I moved to Adelaide from the UK 15 years ago as a Lecturer for Adelaide University, and I have fallen in love with the place. I live in the Adelaide Hills, have a few sheep and a goat. I am able to live a rural lifestyle, whilst working in the city centre. SAHMRI looks after its staff, where we have a social club for special events, and even a gym and cycling parking in the building. We are based next to the River Torrens so I am able to go for a run during my lunch time. I have also been supported to go to conferences, enter the Tour Down Under cycling, and the Corporate Cup Running Programme. It’s a great lifestyle, combining physical and mental wellbeing in a modern workplace that has won many architectural awards.

Are you getting enough financial support for research? I ask because NHMRC hasn’t funded a study into ME or CFS since 2005.
You can never have enough funding for research. The more money you get, the more research you can do. Our research funding comes from a variety of sources, and you can read more about the opportunities to donate on our website.

What is your opinion on research using graded exercise therapy and cognitive behaviour therapy in chronic fatigue syndrome patients?
Any avenue of research is helpful. We have to acknowledge that the above approach won’t suit everyone, but for some people it will. ME/CFS has many negative effects on the person’s life, so anything that tackles some of the negative thinking and behaviour that might develop over time, would be helpful. For example our research into CFS excludes those that are currently suffering from depression, but people have argued that many people with CFS become depressed because of the constant pain, exhaustion and the other consequences I mentioned earlier. It makes sense to me therefore that Cognitive based therapies are essential to assist with motivation and positivity. We have the Resilience and Well Being Centre here at SAHMRI and their focus is on Positive Health and they use the acronym PERMA + (Positive Emotion, Engagement, Relationships, Meaning and Accomplishment) PLUS, Physical Activity, Nutrition, Sleep and Optimism, to measure and build wellbeing. It is my view that we must use an holistic approach to CFS tackling it from the perspective of the mind, body and the spirit.

Many scientists around the world have weighed in on the conduct of the PACE trial, what is your view of the scientific veracity?
I am going to steer away from adding to the controversy about this research, but will provide my view on recovery. Everyone has a different health journey, and in mental health we view recovery from the individual’s perspective and allow them to decide what recovery is for them. We do not talk about cure in mental health, but instead look at what the person considers what is ‘wellness’ for them. For some this will be engaging in a fulltime job, but for another it may just be the point at which they can actually go outside of the house to the shops. Ironically I see myself as a humanist and even though I am in scientific research, the overwhelming value of the individual outweighs any scientific dogma, or research evidence.

What are you most proud of in your career?
I was fortunate to receive the Nursing Excellence Award for South Australia in 2013, being presented this from the Health Minister SA. There are however many moments I can look back on and anyone who has done a PhD will know the feeling of finally printing that 80’000 word thesis into the form of a hardback bound book and holding the finished product in your hands. I have done a number of presentations at SAHMRI in the grand Auditorium which whilst scary, makes you feel just a little bit proud. I was also recently awarded the poster prize at The Australian Society for Medical Research (ASMR) conference here in Adelaide.

What would you like to achieve in your career?
I would like to be able to build a team of researchers that can focus on the health and wellbeing of participants. It is my ambition to lead the clinical development of Mind & Brain research that has a real effect on practice, translating our research into pragmatic results. It is my hope that I can do justice to those people who have offered their time and energy toward our research.

What do you enjoy outside work?
I have a small block of 9acres that I have to look after, so I do some gardening and grow my own fruit & vegetables, as well as cutting up logs with the chainsaw or digging lots of holes for fencing. I enjoy cooking and socialising with friends around the beautiful city of Adelaide. I spend time cycling through the Adelaide Hills, or running along the river Torrens and other picturesque spaces such as Mount Lofty.

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