In this episode of Doctors Getting Coffee, I had the great pleasure of catching up with an old teacher of mine - Professor David Morris. He is the Head of Liver Surgery and Peritonectomy at St George Hospital. We talked about his beginnings in England and the troubles he had with his family because of his love of medicine. We go on to talk about his arrival to Australia and his pioneering of the Peritonectomy Procedure in Australia. We talk about one of the drugs he developed called BromAc which is in phase 2 trials for COVID.
All in all, it was a wonderful talk that I wished could have gone for longer.
I hope you enjoyed it as much as I did.
Shout the next Coffee: buymeacoffee.com/DrSyl.AU
Become a Member: youtube.com/channel/UCiOBkubL46VQT9mPqrnJlrQ/join
Become a Patron: patreon.com/DrSyl
In this episode of Doctors Getting Coffee, I had the great pleasure of catching up with an old teacher of mine - Professor David Morris. He is the Head of Liver Surgery and Peritonectomy at St George Hospital. We talked about his beginnings in England and the troubles he had with his family because of his love of medicine. We go on to talk about his arrival to Australia and his pioneering of the Peritonectomy Procedure in Australia. We talk about one of the drugs he developed called BromAc which is in phase 2 trials for COVID.
All in all, it was a wonderful talk that I wished could have gone for longer.
I hope you enjoyed it as much as I did.
Shout the next Coffee: buymeacoffee.com/DrSyl.AU
Become a Member: youtube.com/channel/UCiOBkubL46VQT9mPqrnJlrQ/join
Become a Patron: patreon.com/DrSyl
[Music]
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[Music] hey guys dr still here junior doctor in sydney australia and uh on this episode
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of doctors getting coffee i have the absolute pleasure and honor of having a chat with professor david morris now
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professor david morris is the head of the peritonectomy and liver surgery unit at st george hospital he's also a
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clinical academic you have a professorship with the unsw which is my old university and i
0:40
remember fondly the early morning friday morning lectures that we did in his office thank you very much for those
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um and uh today did i still have a water pistol when when we did that i think it
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was the group before where the water pistol retired so if it was anyone's turn to speak
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you wanted to go with your anatomy prepared that's for sure that's right [Music]
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so today i want to talk a little bit about your life your journey in this incredible thing we call medicine
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but i thought i'd start with a bit of a different question and it's a question about fear and the operating theatre
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because you know medical students and me as well you know even holding a retractor can be a bit of a scary thing even scrubbing
1:30
for the first time making sure you don't touch certain things it can be it can be scary being in an operating theater it's a different world
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and you know someone with as much experience as you i was just curious do you ever get scared in the operating
1:42
theater anymore uh very very seldom um
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i i guess that it's a mixture of
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probably stupidity on my part for not being afraid
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but i it's not very often that i feel feel afraid of things
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in terms of traumas when you have people who have lost a great deal of blood and are actively bleeding i think those are
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you know you kind of feel in those cases well this isn't my fault i i didn't do
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this it's not like and all you're doing is fixing it up and so
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um yeah i don't feel fearful yeah you just you're just trying to make it better so
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yeah your responsibility is just to make it as good as possible there are some times where you can't do anything
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and uh that can i'm sure be challenging at times um and
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did you feel fear when you were younger like as a junior surgeon or in medical school or was it always
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not really i must say that i've really enjoyed um surgery an awful lot um and
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it's a it can be a tremendously positive thing now sure when something bad
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happens and you lose somebody because of that then it can also be a very um hard
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thing but um almost all of the time it's it's a very
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um rewarding thing to be doing yeah was was there a pivotal case in your life
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that kind of brought you to the direction of surgery or were you playing with surgical teams
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as a child when i was a well that's a good question when i was a child i made
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literally hundreds of ethics kits i think skits wasn't that they're
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airplanes and tanks and ships and so on i actually thought i had a bit of a problem really uh because i
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made hundreds of these kits and they had you paid them as well to be perfect yes and
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uh when i went to university i actually was quite bored the first few years of
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medical school was kind of anatomy and physiology and
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biochemistry and krebs cycle and ah you know it was dreadful
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and um and then i i kind of joined a clinical team a surgical team
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and i got to go to theater and to scrub that day and i stayed there all day and i stayed
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there all night and i stayed there the next day and i thought hmm this could be fun
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and really i've never ever doubted that that's what i wanted to do from then on
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i've often thought i'm not good enough to do this i'm never going to pass this next bloody exam or whatever
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or i'm not going to get the job but i've never had to doubt that i wanted to do it and
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that i enjoyed it i think that's a really good marker of if you've found your calling is that you're staying back
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you're not looking at the clock anymore you're in a flow state yeah and that's something i like i wish i would
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i love working with your hands and fixing problems with your hands is a beautiful thing and uh that's what i love about surgery
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is that it's tactile and you still have the connection with patients but um it's
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hard work that's for sure now the doubts that you get about getting a certain job or getting passing
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a certain exam how did you kind of um confront or like get past that i did
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this again and again and again and again and again yeah yeah that's right until
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you learned it [Music]
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and in terms of getting jobs um i was very lucky um in the sort of jobs
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that i got um and um i had some great people um who were
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um you know very um motivating and helpful in steering me um
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you know towards um research and yeah how early on did you get involved in
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research well i was a registrar and to be honest i did research because
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in england i knew that if i didn't um do research i wouldn't get on right
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and so i i did it because i knew i needed to do it but then i kind of got bitten
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and um i've never stopped doing research and i've written
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nearly a thousand manuscripts and i have a h index which is um
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quite good um about 70. um and
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i've written a few books and to be to be honest there are a few more books that i should write
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um but i i really enjoy the research and it's it's a kind of thing that um
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it's like bragging but it's it's kind of um it's real you know you actually
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have done something today i was talking to some colleagues about the fact that
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we got two u.s issued patents last week
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and again that's a a kind of uh you know it it's a real thing and it does mean
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that you've actually achieved something and yeah it's good right and that's with
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i feel like we need to take a step back and go because you so you're born in england is that right oh yes okay right so let's because i can just hear the
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accent but it's subtle uh so you were born whereabouts and and where did you grow up i grew up in
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herefordshire which is where the cows come from on a farm and my father was
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absolutely disgusted with me that i wish to do medicine and he was a businessman um and we had a
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with trucks and warehouses and mills and so on and he was very cross with me that
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i went to the medicine and when i decided i'd come to australia he was even more cross with me
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and we sort of seldom talked for a while but then when i got my first decent farm
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in australia he kind of softened a bit and um you know when i got a really good
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farm in australia he he kind of began to you know take an interest again i didn't know this was one of your interests oh
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yeah yeah so um was so you got the skills of because farming is no no i didn't get
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the skills it's a congenital disease [Music]
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um but the skills i had a farm of my own in england before i came here
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but even then i had a very steep learning curve in australia because
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sheep farming which is mainly what i've what i've done it is quite different in australia it's uh
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it it's very different from england in what way is it the the environment
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themselves are they more impressive no they're not aggressive um it's much drier here and so
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um it's not as intensive um and the sheep here
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we have two flocks now we have a merino flock and they produce fine wool and they
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produce crossbred lambs and then we have a crossbred flock which um you know are sort of good for meaty
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lambs and um in england um there are no merinos or at least there's no interest
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in merino wool it's just um you know meat production wow that's that's so interesting and um did
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you see like did that ignite any interest in anatomy when you saw sheep being you know butchered and
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things because surgeons were initially butchers on the battlefield that's right isn't it quite yeah no i don't think i really
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did much of that okay and so he did medical school um in england yeah and how did you you said it
9:52
was a bit boring was that because it was easy or because it wasn't uh you weren't connecting with it in an intellectual
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life oh so much of the first years was just kind of learning um it with no um sort of
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context of um usefulness or importance um and
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uh i'm not good at that i like to become arbitrary yeah yeah okay
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um and so did you do your junior doctor years there went when did you know i was like yeah i was a consultant surgeon
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there before i came here um but i i did all my junior years and registrar years and
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fellow years there and then i became a consultant surgeon in nottingham
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in an academic post and then i i came here
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after i've been a consultant for three or four years other than the mourinho what drew you to australia
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a personality defect of my own in that
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i really wanted to have my own department and
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you know decide what i was going to do and in the uk all although i'd get
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shortlisted for chairs of surgery that appoint guys that were 15 years older than me at the time
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and i just worked out that i wasn't really prepared to wait and then i i looked at a few jobs abroad
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in canada and then here but this was the first one that i then applied for and
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why canada are here because i thought they had reasonable health services
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whereas in the states i don't think i could ever have quite sort of settled into the
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system of medicine [Music]
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and prof what were some of the challenges with setting up your own department uh
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i guess that when i came here i thought that there would be so much politics oh
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that i would probably operate on a lot of rats and write quite a few papers and
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but i found that i really became
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clinically very busy because i concentrated on something that people weren't interested in the
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time which was metastatic disease in the liver and then the lung and then the peritoneum
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and it was certainly the case when i came that those patients were not
12:30
being offered very much at all and it was
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then quite um useful to
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develop this department to concentrate on that did you
12:48
get involved with peritonectomy proceed i mean you're one of the first to do it in australia is that right
12:54
oh yeah yeah yeah you kind of were at the forefront and you let it yeah um was it happening overseas did you learn
13:00
about it in england and bring it over or i was the origin of the peritonectomy
13:06
yeah i was the uh american college of surgeons traveling as scholars a scholar in the
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mid 80s i don't remember which year and i went to a number of places in the
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states that i was thought were doing interesting work and one of those places was paul sugarbaker
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and paul was doing extensive cytoreductive surgery and
13:30
intraperitoneal chemo not at the time and i thought he was mad and i think i
13:35
probably told him so and then his first decent paper came out
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in 95 and i realized that the results in that
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paper could not be achieved by other treatments in that he had
13:52
long-term survivors of patients with colon cancer with peritoneal disease and
13:57
appendicity cancer with peritoneal disease and i wrote to him
14:02
and said sorry i got that wrong will you you know will he show me how to do this and he's
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been very generous over the years in teaching me how to how to do it and we have an
14:15
organization in the world called soggy which is has also been
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very useful around the development of peritoneal
14:27
cancer treatment and um yeah we started off as a small band
14:34
of people and i think our first meeting we had about 10 or 15 people um in the
14:40
world at this meeting and these are proceduralists following the procedure right yeah and then the last meeting we
14:45
had there were over a thousand people at it and so it's kind of but that's sort of 20 years
14:52
so i mean i can assume what you find amazingly fulfilling about your role and
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you know what would be really nice about your job to be able to deliver this care and kind of extend people's lives by
15:05
such significance but what do you find like what what do you love about your job
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um well there's no doubt that there is a technical um
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sort of fascination in being able to do harder and harder and harder things safely
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and our mortality for peritonectomy is now of the order of one percent unless you
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have you know high risk features and we've done
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well over one and a half thousand of those procedures um here
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what's the the real buzz apart from that i think that the real buzz is
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seeing the patients years afterwards and knowing that you've actually changed what
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has happened to them and what is now sort of routinely available and i i've
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certainly had a few fights over the years with um the government and um
16:05
colleagues and so on about um you know the availability of these
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services um and yeah i guess it's it's uh
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ended well i think that people have a much better chance of being treated now than they
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did i guess when you're kind of pioneering a new procedure yeah um there's always going to be friction
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and uh how do you go about kind of dealing with that friction when you have
16:34
a new idea you know health care is very risk-averse it's hard to have a startup in healthcare because if you start uber
16:41
and you know it's a startup the worst thing that can happen is someone misses an uber yeah if you screw up a startup
16:47
in in healthcare it can cost people's lives it's a different risk threshold yeah so when you're because you have
16:53
your own company but also you develop your own procedure you're very innovative as an individual how did you
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kind of overcome the barriers and friction from your colleagues or the departments
17:04
[Music] i think that the end of the day data is
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kind of one of the important things and one of the reasons that i follow up all
17:16
my patients sort of forever is a so that i know what the results are so we've
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actually got our own database with outcomes and the other reason is to cheer me up
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in that seeing patients that you've helped um you know as opposed to
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seeing 20 or so patients in the ward that we've just done huge operations on um is a good way of staying sane
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and how is your team at the moment it's just the clinical team i i should specify which team than torture is that
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yeah we've got about 10 guys on the team and we have we have fellows from um other parts of the world that come to be
17:54
trained which is good i find that when you get to that number it's um there's a lot of different uh you know
17:59
personalities and the dynamics on the ward can be challenging how do you uh kind of orchestrate that well as a
18:05
leader you're leading this team in there yeah how do you manage uh such a big uh team of clinicians
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hmm um i i i guess i'm sort of fairly strict about you know um
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about what's going to be done and how it's going to be done and um so on um but i think i've also i also
18:30
put a lot of effort into this myself and perhaps i don't get a lot of um
18:37
pushback from people because they can see that i'm committed this yeah yeah i
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work hard at this you do but so when you aren't working yeah uh what what do you do to kind of
18:49
uh switch off or is that not like this idea of work-life balance is that not something you um kind of buy into
18:55
because it is a bit of a marketing tool from i think i don't know the 80s or something i don't play golf yeah well
19:00
you're right okay i don't watch much telly um and uh i but i really do enjoy
19:10
reading and there's so much and as you know we've developed a few
19:16
drugs over the years and and actually in retrospect one of the most useful things i've done with my
19:22
life was that i was involved in developing albendazole for um hydatid long time ago
19:30
and that was quite silly why i could have done that and i think that was kind of
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um why i've always been trying to then develop other
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other drugs and one of the drugs we're working on at the moment has now
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um got really quite wide application outside of the mucinous cancers that i
19:57
developed it for and so i found that i had to read so much about respiratory
20:03
disease and um and it's really been quite interesting and the science of
20:08
respiratory disease and now we've got a lab working on that um two right two labs yeah that's right
20:15
there's multiple labs in the hospital that that you're running yeah um and they're working on on this
20:21
medicine um what's okay yeah what's the rundown bro mac so bromac is a combination of
20:30
bromelain which is an enzyme or a series of enzymes from the stem of the pineapple plant
20:36
together with n-acetyl cysteine and um
20:41
we were screening for a drug to dissolve a highly amused tumor called
20:47
pseudomyxoma and we went through heaps of drugs and nothing worked and then i said well okay
20:52
just start combining things and see what works and one day
20:58
a combination worked very well and we then worked out the science of
21:03
why that was wow so you actually you you made the observation and then worked out
21:08
the science rather than trying to predict it it wasn't the other way around that's right it was just chance
21:13
that we found something and then we worked out why and then that has
21:19
um broader applications than just the mucinous tumors yeah well it might cleave the spike protein
21:26
so it does cleave the proteins on yeah different creativity species
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yes in in kovid we um started off on the spike protein but i think that
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there are other um effects we we did some work in brazil just recently
21:44
where we um which has just been published where we took sputum from
21:49
intubated covet patients and then we
21:55
used our drug on on that and showed that we could um fluidize their really sticky
22:02
sputum within about 10 minutes so maybe an aerosolized kind of treatment could be really effective
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we're doing that yeah and that is applicable to i think other causes of ards apart from um apart
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from covid and the other interesting things in kovit is that the cytokines and chemokines that are in their airway
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which drives the inflammatory problems
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our drug cleaves those and so i think it will have quite good anti-inflammatory
22:37
action in the respiratory tree as well i mean acetylcysteine is something we learn
22:42
about to give for an overdose of panadol yes and then to hear that it's you you found a use for it that is so different
22:49
to a hepatic metabolism of that innovations did you always have this innovative kind of mind while you were
22:56
going through your training were you seeing procedures and thinking there was opportunities to improve the whole way
23:01
along or was it something more once you were established you started looking for problems i've got a pretty straight a
23:07
number of pretty strange things along the way you know what was one of the first early ones what's one of the first
23:13
things that well one of my changes one of my favorite ones was um cryo which is
23:20
um freezing tumors and um again when i was in the states in
23:27
mid-80s i i met up with a guy there who was interested in cryo as well
23:33
and we then both developed cryo for treating cancer but i basically made a
23:38
machine in the in the garage and um we we treated people um with that and
23:46
then it got better and we got an engineer and the engineer made a lot of improvements and so on and so on but
23:53
developing things is is good fun and
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[Music] the [Music] the kind of
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safety side of it is clearly something that we're as doctors we're used to and we're used
24:12
to also working out whether something is really
24:18
ethical or not and if you've got unfortunately most of the patients that i have
24:25
worked on developing treatments for do not have other good options
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and even now with the with the covid stuff and the respiratory stuff we are only treating
24:36
people that don't have good options if you've been on a ventilator for 24 hours and you're not improving we don't have
24:43
an awful lot left for you so um you know and and that makes innovation and the
24:50
ethics of innovation a lot easier makes it a bit more simple yeah um one of the questions from one of the subscribers um
24:57
by the way massive thanks to your administrative staff who set this up in such a
25:02
quick time but i just sent out a message to some of the subscribers to see if they had any questions to ask but one of
25:08
them was how um can you get involved in drug development as a doctor but not let it bias you in in your
25:14
therapist that's a constant concern but on the other hand
25:20
um you're you have to move beyond what you do
25:26
yourself in that for example in the in the first work we did with bromack we did that here
25:33
it's now uh in phase two studies in um europe phase two yeah i didn't know that
25:40
the u.s that's very exciting and so uh and that's something that i i kind of
25:45
you know i'm not involved in and so and when you clearly when you write your results of stuff that you've done
25:50
yourself you declare what your um involvement is um so
25:56
yeah i i i get it um and but kidding yourself is not a very smart
26:04
thing because um you know it's gonna get repeated one of the happiest um
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days i had about two years ago was when an american scientist actually
26:15
repeated our work um and extended an independent body
26:20
independently hadn't even talked to us just just did it and that was that was really good because um i always tell the
26:28
guys in the lab it's really good when you give me crap results because it means at least i know you're being honest you know what i mean and you have
26:34
to be honest with yourself about stuff i mean that's one of the like core
26:40
beautiful things about research is that it's an approximation of reality yeah it's a complex thing and so
26:46
if you just you know yeah as you say you can't lie to yourself because you're trying to approximate reality and other people will use your tools to do that in
26:52
their labs and if that's different then you've got a big problem on your hands yeah um and that's and that's how i feel
26:58
as well if you're getting involved in drug development i mean what's the alternative you don't yeah and then there's no there's no doctors involved
27:04
in drug development that's a pretty bad recipe we do need to be because you can be the smartest scientist in the world
27:10
but if you actually don't know what the problem is and what would be suitable for that and what would make it not um a
27:17
sort of a useful thing then you're lost and so you do need a bit of both that is
27:24
iconic that and there's a quote from elon musk that's that kind of summarizes this in terms of engineering but it's so
27:29
true in medicine as well that like um the most common thing he sees is engineers optimizing things that
27:36
shouldn't exist yeah that's right like you've got to know what like why are we making this medicine why are we developing this this tool is do you need
27:42
this this tool yeah um but it sounds like a lot of your innovation has been in in terms of uh
27:49
kind of pharmacology yeah um from as a surgeon what about the tools that you
27:54
use intraoperatively are you involved in kind of you made the cryo machine yeah did you do
27:59
yeah is that another ablation devices right i i did bipolar rf that was um
28:08
i worked a lot on that and uh for the medical students who don't know what that is
28:14
rf is really a frequency ablation and um it's a way of basically um cooking
28:20
tumors oh okay and what we did with the probe and what we did was make bipolar probes
28:26
which made the cooking better and faster and bigger
28:33
anyway so um how then can a clinician get involved in in being more innovative
28:40
do you have any advice or how would i go about you know becoming a more innovative doctor
28:47
look at the problems do you believe in uh asking for forgiveness rather than permission
28:55
uh oh look i think that the um you know the system of regulation of what we do
29:04
has to um exist and has to work and um i don't
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um i don't think that that's uh one thing i've done this year
29:15
which is a bit naughty is that when we developed bromac for respiratory
29:21
use um i used it myself and i wouldn't um you know even think of
29:30
doing clinical trials until i've used it myself wow
29:35
and at much higher doses than you know and you know was that
29:41
had the ethics committee approved that no no they hadn't i just did that um
29:46
but on the other hand you know i'd love someone to try and tell me that that what something that i shouldn't have
29:51
done because it for me it meant that i was then pretty happy that the safety
29:57
side of it was okay and i certainly wouldn't want to have done it to other people before i was happy
30:03
my first cannula was in a stroke code and i completely missed and it was i
30:09
just told the registrar it was an uh a term with a neurology team weights a which hospital and i i had never done
30:16
one before just done it on a dummy months earlier forgotten how to do it and then they're like can you do one i
30:21
was like i've practiced that it'll be good to do it first like sure it's an emergency it's a recess this person's hemiplegic yeah and and after that
30:28
horrible experience of missing and hurting this poor patient yeah should have done on the hemiplegic side really anyway
30:33
um i i i i did it on myself to get it i said i'm not doing this on a patient
30:39
until i can do it on myself one-handed and ten attempts it took me but then you got it i got it
30:44
and uh it's a great feeling and then uh i have a pretty good success rate ever since so thank you so much for sharing
30:51
your time a final question um really for the medical students uh and junior doctors like me like um
30:58
by a lot of estimations i'd say you've had a very successful what looks like a very fulfilling career and i was wondering if you had any kind of advice
31:05
for anyone uh wanting to to follow similar footsteps in in their
31:10
in their career um well if you find something that you really enjoy
31:15
then it's pretty good idea to do it thank you that's it
31:21
professor academic pharma professor david moss thank you so much
31:26
for your time it's been an absolute pleasure my pleasure all the best guys i'll see you all in the next video bye
31:31
for now that was great good thank you very much
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[Music]