A Clinical Pharmacologist of drugs and therapeutics, Professor Lexley Pinto Pereira is distinguished as the only clinical pharmacologist in Trinidad and Tobago. Among her achievements is the key role she played in establishing the country’s Poison Information Centre, now at the Sangre Grande Hospital and the initial National Drug Formulary used by all resident physicians. Her ground-breaking research on chronic respiratory and metabolic disease yielded significant information on conditions associated with asthma in children and adults, and contributed to the development of the Caribbean guidelines for asthma.

Professor Emerita of Pharmacology at The University of the West Indies, she is an inspiration to her students and has been described as a “tireless educator of pharmacology”. She has contributed greatly to the advancement of the Department of Paraclinical Sciences under the Faculty of Medical Sciences at The University of the West Indies. She is the primary architect of the curriculum in Pharmacology in the medical programme and introduced the relevance of clinical pharmacology applications in the programme. She was the first academic in the country to mentor postgraduate students in Pharmacology. Her contributions to medical education in the Caribbean led to her receipt of the UWI Vice Chancellor’s Award for Excellence in Teaching in 2002.

NIHERST interviews Lexley Pinto Pereira

Q: Trinidad has been your home for the past 25 years but you were born in India. What was it like growing up there?
A: I was born and brought up in Bombay. I am the youngest of six children, life was tough, hard and happy. My mother gave up her career as a headmistress to take care of the family so my father, a medical doctor, was the sole breadwinner. The cost of living in Bombay is extremely high so I think they did a good job ensuring all the children were educated to the postgraduate level. I spent a lot of time studying but I also spent a lot of time with my brothers. I was a bit of a tomboy and played a lot of hockey, cricket and football with my brothers.

Q: What was school like?
A: I disliked primary and early secondary school. I began to enjoy it at the O levels stage because it was more competitive and interactive. I also detested mathematics at first. It is strange but my love affair with mathematics only started at around O levels. I enjoyed science and history but loved English literature and language. I only went into the sciences because I was close to my brothers who pursued the sciences so I got to do experiments with them at home which nurtured my love for science. My father was also my role model at the time and it seemed like medicine was the profession I was expected to enter.

Q: How was your university experience?
A: That was the most glorious time of my life. I really loved medical school. Interacting with the patients was interesting. After class we would sit and try to diagnose them and decipher what treatment we would give and then realise we were completely wrong during class the next day. We learned to balance leisure and studying. When I see students today studying excessively I tell them “go and get a life”. If you stay with your books all the time you restrain your mind. Today’s generation is definitely more pressured. Medicine has advanced tremendously, biologicals are replacing synthetic agents, the information highway seems limitless, but I do think our students gear themselves to meet the challenge extremely well.

Q: What did you do after graduating?
A: I did my residency in medicine and then switched to pharmacology which I loved. I thought if I could marry pharmacology with medicine that would be perfect. Clinical pharmacology was an emerging discipline at the time and so I did my MD in pharmacology. I switched because India has a vibrant pharmaceutical industry with research and development, drug trials and the marketing of the drug so therein was the romance of being a clinical pharmacologist. I eventually joined a multinational pharmaceutical firm as a medical advisor and stayed there as deputy medical director until I came across to Trinidad around 1989.

Q: What brought you to Trinidad?
A: My late husband took up an assignment here so we migrated. The pharmaceutical industry in Trinidad was not at the level where they were doing innovative drug research so I started practising medicine. In 1991, I joined the UWI Faculty of Medical Sciences as a lecturer and I’ve stayed in the Faculty since. At UWI my primary job was teaching, then I got into curriculum development and postgraduate teaching. I learned a lot from my graduate students. In my academic research, I was prompted to look closely at asthma as my young son had developed the condition after we moved here. I began to examine the profile of the condition in our population, triggers that bring on the acute episodes, the drugs patients take and don’t take, all with particular relevance to our paediatric population.

Q: Can you tell us about that research?
A: Well we found that the common cold was the most significant and frequent cause for producing acute asthma in children who came to the hospital. So with my graduate student, we got samples from the nasal pharynx of each child and worked in collaboration with the University of Wisconsin, Madison to demonstrate which specific virus was the culprit that was associated with these severe exacerbations of the disease. We were also able to report that the average age for the first wheeze of the child in Trinidad is less than three years and that only about 32 per cent of repeat attendees at Accident and Emergency do their follow up visits at the clinic. That is concerning because a regular follow up could prevent a future attack. Our studies showed that just about 40 per cent of patients take their medication as prescribed, about 50 per cent do not know how to use their inhaler device and a paucity of knowledge on when and why to use their prescribed medication was one of the main causal factors that took them to the emergency room repeatedly. It was discouraging to note that the biggest offenders in these categories were the elderly and children.

Q: What causes asthma and why doesn’t everyone with the flu get asthma?
A: Asthma generally has two causes, genetic and environmental. The lungs of asthmatic patients are different from the non-asthmatic individual in that they are hyper reactive or “super sensitive” comparatively. The connection we made between acute asthma and the common cold is beneficial to the patient and caregiver because we can encourage parents to be alert when the child is developing the flu or the virus. Administering preventer or controller therapy aggressively at that time can avoid the occurrence of an acute attack. Asthma cannot be cured, but it can be controlled and that is what follow-up visits and preventer therapy aim to do.

I’m sure you’ve heard mothers say their son had asthma but “grew out of it”. That’s absolutely correct. It can happen. Interestingly, boys tend to get asthma earlier than girls because their respiratory system tubes are much finer and narrower and their immune system is not as developed as their female counterparts. This, however, levels off as they get older. However, even if their asthma seems to have “disappeared”, it’s important that they are still careful as their lungs may still be hyper reactive.

Q: Are there natural medicines that effectively control asthma or do people have to use the prescribed drugs?
A: Drugs when taken correctly are not toxins. I cannot decry natural remedies but as of now there is no hard evidence that tells us that natural or plant remedies are the solution to relieve an acute attack or control future attacks. It is okay if patients feel comfortable using natural medicine, but if they do so and neglect to take their prescribed medication then they’re looking for trouble.

Q: You were instrumental in the development of the Trinidad and Tobago National Drug Formulary and the Poison Information Centre. Why were these not established earlier?
A: Trinidad and Tobago is a relatively small and young country and developing a formulary is something that would be done by clinical pharmacologists who are not commonly found here. I got involved because I saw the formulary as an important country-specific instrument. It gives one everything that a resident physician might want to know about a drug: its name, availability, strength, indications for use and so on. I spent time in Wales on a Rhodes Trust Award and learned about the formulary and the importance of a Poisons Information Centre so that was the basis of me starting these in Trinidad.

Q: Tell us some more about the importance of these developments.
A: The formulary gives medical doctors access to a wide array of suitable drugs to use when administering treatment.
Physicians may not always have time to keep abreast of new drugs on the market or all prescribing information on candidate drugs. And then drug representatives could be biased when selling their drugs. A formulary pockets all that information in a single document for all prescribed drugs. I advised and hoped that the formulary be updated biennially by a team of qualified representatives to ensure a continuous readily available topical formulary but this has not been done.

As for the Poison Centre- in Wales I saw how a centre worked, the advantages it offered and the number of lives that were saved. It was a ready reference centre for any medical professional if they had a patient who overdosed or ingested anything toxic. It saved resources and prevented morbidity and mortality, so I felt it important to have one in Trinidad. I collaborated with the World Health Organization in 2001 to start the centre at the UWI. It was later moved to Sangre Grande Hospital and is still there today under the direction of a toxicologist.

Q: What work are you doing now and are there any issues in your fields of interest that you wish to address in the
future?
A: I would like to investigate why some patients in Trinidad are poor responders to drug treatment even when it is taken as prescribed. It could well be due to noncompliance but I want to examine whether there is a genetic basis to this. Every drug has a receptor in our bodies with which it interacts to produce a particular response. The main class of drugs that relieve asthma work on receptors in our body called beta receptors. I want to investigate whether the beta receptors in these non-responder patients have been susceptible to a genetic differentiation. I’m also interested in investigating asthma control in our population. I am currently working with colleagues to examine the prevalence of pre-diabetes in schoolchildren, evaluate lung function and monitor the cohort till at least secondary school level.

Q: You have been credited with improving the pharmacology curriculum at UWI. What new element did you introduce?
A: Over the years we have introduced more clinical pharmacology into the programme which was predominantly basic pharmacology without exposure to patients or application of knowledge to the clinical scenario. With this approach, students can apply principles of pharmacology when they see patients in clinics, anticipate or look out for unwanted effects and be cautious in prescribing too many drugs which may have the potential to interact. I often bring consenting patients into the class. We discuss their condition and which drugs should be administered. This encourages students to think and extrapolate their knowledge of pharmacology to its clinical application. I do try to ensure my classes are interactive, that my students learn for life and their career, and not for an exam. I don’t want them to learn by rote. I want them to appreciate, analyse, rationalise and apply the material. That, I believe, is where I have made the difference with teaching pharmacology. The rewarding proof is when students come back from their senior clinical years thankful for having learnt so much in Pharmacology.

Q: Who are some of the people in your field that you admire?
A: Professor Martin Partridge from Imperial College London was a tremendous reference source and encouraged me
with my asthma research and Professor James Gern from Wisconsin Madison with whom we collaborated for the asthma research. Professor Christopher Triggle from McGill University has been a fabulous sounding board and Professor Philip Routledge from Cardiff University prodded me into looking at initiating a Poisons centre in Trinidad. The current UWI Principal, PVC Professor Sankat encouraged me in my early years at The UWI and Professors Seemungal and Teelucksingh have been excellent academic colleagues.

Q: As the only clinical pharmacologist in this country what do you think could be done to encourage more students into clinical pharmacology?
A: The fact that Trinidad and Tobago does not have an active pharmaceutical industry limits someone who wants to pursue this career locally. In time, postgraduate courses in Clinical Pharmacology will be shaped and become part of the training in the Department of Medicine.

Q: Do you think enough students are going into science? If not, what can be done?
A: I think today’s brilliant young minds are going more into technology and applied science. However, the global need for scientists will never be satiated. Locally, we need to build our capacity to handle national issues through exchange programmes with developed nations, workshops and regional training sessions. We also need to change our curricula to harness scientific capacity in students from an early age. I must say in this regard NIHERST has done a great job, your programmes have had great impact on many, including my children. The government must come on board and expand programmes like the Caribbean Youth Science Forum to encourage our young thinkers into science.

Q: What are you involved in outside of academics?
A: A lot of my interests were nurtured by my family. My late husband taught me to appreciate classical music; my
younger son at this age of my life persuaded me to learn to swim which I now love; my elder son encouraged me to be electronically savvy and my daughter introduced me to the new generation of young writers. So there is a lot of family support in my life. I think my story has been one of observation, listening and learning from experience.