Given that Edinburgh is world-famous for its festivals (there are 12 in total), some might have considered it brave of the organisers of the Festschrift Conference in honour of Peter Sandercock to refer to the day as “a festival of epidemiology, clinical trials and evidence based medicine”. Their confidence was justified however, as over 170 people from around the world came together on the 15th April 2016 to celebrate Peter’s career, his achievements and his contribution to stroke research.
The day began with a look to the past, and a reminder that 30 years ago, when Peter began his research, knowledge of global stroke epidemiology was limited and there were no effective evidence-based treatments for stroke. Stefano Ricci spoke about Peter’s work with the Oxford Community Stroke Project (working as Charles Warlow’s first research fellow), and its influence on our understanding of the epidemiology of stroke as well as its role in introducing a practicable yet simple method of stroke classification. Bo Norrving discussed the changing global burden of stroke, and in particular how it is declining in high yet increasing in low income countries. Peter Langhorne colourfully likened the work of the Cochrane Stroke Group in looking through “long-dead clinical trials”, to haruspicy, the ancient practice of predicting the future by looking through the entrails of dead animals. On a more positive note, he went on to discuss the beneficial influence the group (for whom Peter served as coordinating editor for a decade), has had on stroke practice worldwide. Zhengming Chen completed the session by reflecting on IST-1 and CAST, the first mega-trials testing treatments for acute stroke, and how they revolutionised a field that was previously lacking in high quality evidence.
The next session was entitled ‘from past to present’ focusing on aspects of current large scale trials in stroke and trauma in which Peter is involved. Colin Baigent discussed Peter’s role as co-chief investigator of the IST-3 trial, which, with over 3000 patients, accounts for around half of the total avail- able randomised evidence on the effect of thrombolysis in acute stroke. Next Ian Roberts spoke about the three CRASH trials in trauma and head injury, in which Peter has played a supporting role. He made a nice point that while the ‘how to’ of designing trials is well understood, the ‘how to’ of actually running these large trials is a ‘craft’ which is passed from ‘master craftsman’ to ‘apprentice’. Martin Dennis spoke about the portfolio of trials he has run (Peter in a supporting role again) establishing the evidence behind interventions that may protect the rest of the body whilst the brain has time to recover after a stroke. Richard Lindley concluded the session with a talk on the nuances behind conducting stroke trials in low and middle income countries, and how interventions may need to be adapted to a given population based on affordability. Paradoxically, he also said, some low-cost interventions evaluated in low-in- come countries may well find application in the developed world too!
The session after lunch was centred on the future of stroke research, and Joanna Wardlaw began by discussing the process of translating an interesting clinical observation, through basic science and into clinical trials, using small vessel disease as an exemplar. Prof Wardlaw identified the ‘Sandercock tool box’ – a list of tips to advancing medical knowledge using Peter’s pragmatic approach to science. Next up was Rustam Al-Shahi Salman who used the example of haemorrhagic stroke to discuss how randomised controlled trials need to be big, simple, and easy to do in order to be successful. He also explained the importance of understanding the local population in conducting an international trial (even if that means camel riding in Mongolia). Gillian Mead discussed the potential role of fluoxetine in recovery after stroke, and how conducting several concurrent ‘sister’ trials can be a useful alternative to a single multi-national trial; in this case, the FOCUS (UK), EFFECTS (Scandinavia) and AFFINITY (Australia) trials. Will Whiteley completed the look into the future with a talk on the potential value of using ‘big data’ to improve stroke care, and the possibilities of incorporating machine-learning technology into medical research.
In the final session of the day Shaun Treweek spoke about Trial Forge (www.trial-forge.org), an initiative that intends to improve the evidence base behind the process of conducting trials and Jane Armitage discussed the need to train a new generation of experts in clinical trials, reinforcing the importance of apprenticeship in learning this trade.
Appropriately, Peter gave the last lecture of the day. He spoke about the highs and lows of his career, in what he referred to as “36 years of team science”. His top tip for success? “You need to be steely in a nice way”.
There were recurrent themes over the course of the conference when speakers expressed their opinions of Peter and his approach towards his work and his colleagues. “Calm” and “diplomatic” were the two most frequently used adjectives throughout the day. Many cited his diplomacy as the crucial factor in holding these mega-trials together. Several speakers regarded Peter as a “master craftsman” in clinical trials. However, Craig Anderson, from Sydney, in a typically robust antipodean fashion, characterised Peter (with a twinkle in his eye as he said it) as a “tenacious bastard”. Much laughter ensued. The most evident aspect of the day was how Peter’s approach to research has influenced many stroke physicians, trialists and epidemiologists. In all it was an enlightening, enjoyable day that covered the entire spectrum of stroke research whilst celebrating the role Peter has played during his illustrious 36-year career in the field.
Congratulations and happy retirement to Prof Sandercock. Edinburgh can proudly add a 13th festival to its events of 2016.
