John Knight: seeking answers to the biggest health challenges

Meet Professor John Knight, Professorial Fellow in our Renal and Metabolic Division and Medical Director of Ellen Medical Devices Pty Ltd.

How long have you been working at The George Institute?

Started in March 2014, so that’s three and a half years now.  

What attracted you to working here?

I was moving towards retirement when one fine day Professor Vlado Perkovic took me out to lunch and made an ‘offer I couldn’t refuse’.  Perhaps the attraction for the George was my odd mix of academic medicine and commercial nous.  For me the lure of the George was irresistible: a grand vision, a global reach, original thinking, ground-breaking publications in the best journals, and most importantly the understanding that in research, while asking the right question is critically important, finding the right answer and making it work out there is the toughest part of the assignment. 

How would you summarise the research you do and the difference it will make to healthcare?

The George has involved me in a bewildering variety of splendid projects over the past few years, in all sorts of realms.  Clinical trials, epidemiology, big data, China, DFAT.  But lately I've come full circle, back to the kidney.  Focusing on just two projects, both with the potential for measurable global impact (one of the things I love best about working here). 

The first is a prospective cohort study of dialysis outcomes in India, led by Professor Vivek Jha.  We are enrolling 1000 subjects in 10 states as they start dialysis, and tracking not only the clinical outcome but also the economic and social impact on the patient and their families.  The study could form the nucleus of a national dialysis registry for India so that outcomes can be benchmarked against those obtained in other parts of the world.  There has already been interest from other countries – Africa, Asia, South America – in adopting our low cost, on line data collection model.  Rigorous measurement of outcomes is a critical success factor for dialysis treatment, so the impact of this project on quality of care could extend well beyond India as kidney disease becomes increasingly common and dialysis treatment becomes increasingly available in low and middle income countries.

For the past few years you have been involved in developing the world’s first affordable dialysis system, first in a global competition and now helping to bring the winning design to market. How did this idea come about, and what could this device potentially mean for dialysis patients around the world?

This second kidney project had its origins in an epidemiological survey published in The Lancet in March 2015.  We asked two simple questions – first, how many people are on long term dialysis for kidney failure around the world?  (The answer is about 2.5 million, including those with successful kidney transplants).  And then, how many are missing out?  Turns out to be roughly 7 million people, who need dialysis or a transplant but can’t afford it, and so will die an unnecessary death each year, due to the sad fact that these safe and effective treatments are just not affordable where they live. 

In the Georgian spirit of seeking answers to the health challenges we identify, we went on to run an international competition (The Affordable Dialysis Prize) to seek a technological breakthrough which could provide low cost treatment to prevent those unnecessary deaths.  We got some really strong entries from around the world, but our international judging panel voted unanimously to give the prize to Vincent Garvey, an Irish engineer working in Shanghai, who invented a miniaturised still which can make peritoneal dialysis fluid at the point of care, using solar power and water drawn from any source. 

The affordable dialysis system is in the running for a 2017 Eureka Prize. What was your reaction to hearing this news?

Just before Christmas, the George joined forces with Vincent Garvey to establish Ellen Medical Devices Pty Ltd, an Australian company whose sole purpose is to build and test a prototype of Vincent’s prize winning invention, then undertake field trials (with George Clinical’s help), obtain global registration and bring the product to the marketplace.  We submitted our plans to the Eureka Prize - but they get thousands of entries, so we were absolutely amazed and delighted to be on a short list of just three for the Eureka Prize for Innovation in Medical Research, which oddly enough is sponsored by Johnson & Johnson, my old employer. 

How did your career in research get started?

My research career has been long and chequered.  After training in medicine (paediatrics and nephrology) I spent two years at the lab bench at Guy’s Hospital in London, as the molecular biology revolution was just getting started.  Worked as a clinical academic at the Children’s Hospital, the usual triple-treat of patient care, education and research - the research was mainly molecular immunology, with a sidebar in the then emerging Cochrane Collaboration.  Moved to the not-for-profit sector - the old Australian Kidney Foundation (now Kidney Health Australia) for some national policy work, particularly on clinical practice guidelines, renal epidemiology and Aboriginal health.  Headhunted from there by Johnson & Johnson to a role in therapeutic risk management in Europe, Asia and the US for nearly a decade, a position with a marked applied research component.  Then ran my own consulting company here in Sydney.  And now I’m full circle, back to the clinical academic world.

What motivates you most in your work?

The opportunity to sit and read and think, in depth, at length and in absolute peace - so precious and so rare, one of the great gifts the George gives to its people.  I watch so many of my aging medical contemporaries still rushing from dawn to dusk: that vital ‘triple-treat’ I walked out on 20 years ago.  These days at the George I have time and space to contemplate, ask questions, sift through things, try to identify opportunities and actions of lasting value.  The standard phrases are ‘impact’ and ‘make a difference’ – these concepts are in the end simple by-products of the quality of the thought processes which underlie them. 

To explain to people what I do I say…

I’m a physician, and I’m a medical researcher.  So each day I try to follow the advice of the late great Mohammed Ali: “float like a butterfly, sting like a bee”.  Maximise time with people and minimise time with screens.  And above all focus on the big picture tasks, the few that really matter.  The rest of the time protect your wicket when you need to, and be content to let the ball go through to the keeper without offering a shot.  Punish the odd loose delivery.  These are the fundamentals of crafting a huge innings.  Are cricketing metaphors still OK?

My biggest achievement so far is…

Ahead of me, I trust.  It’s nostalgic to look back on a long and colourful string of modest hits and spectacular misses, but much more fun to consider the adventures that lie ahead!