Newsletter has interviewed Professor José Ferro, a Full Professor in Neurology at the Faculty of Medicine of Lisbon, and Head of the Neurology Unit and of the Department of Neurosciences of CHLN.

«When it comes to neurosciences, we are almost in the pre-history of knowledge. The future depends a lot on technological advancements. Currently, much of what we know about the nervous system, about the areas that are important for things such as love, or will, has depended on advances in functional magnetic resonance, which is a technology. However, we have a lot of difficulty predicting what the new technologies will be like in five years time. For instance, what the role reserved for nanotechnologies in the knowledge of the nervous system will be, etc. There are technological advancements which can make us progress enormously, and which we did not anticipate. There is always an interaction between biology and other techniques. Hence the importance of degrees such as biomedical engineering, since they will lead to advances that do not pertain to the sphere of medicine alone».

Newsletter: What can you tell us about the origin of this Structural Unit, the Neurology University Clinic, its setting up, its founders, and which moments were more important, in your opinion, in its creation and history? 
Professor José Ferro: the chair in Neurology is quite old, going back to the time of Professor Egas Moniz, who was the first holder of a chair in Neurology in Lisbon. We then had various other renowned people, such as Professor Almeida Lima, Professor Lobo Antunes, and Professor Castro Caldas. This makes it a core subject in medical education, which this clinic is connected to, having been transferred from Santa Marta Hospital to Santa Maria Hospital when the latter was founded.

Newsletter: Regarding the activities undertaken at this clinic, in its three main strands of activity, namely teaching, research and relations with the community, what can you tell us about it?
Professor José Ferro: We teach in the medical degree, and also in the Master and Doctoral degrees in Neurosciences. We occasionally participate in other teaching activities, and carry out research with the Institute of Molecular Medicine (IMM), working with two IMM Units, one in the neuromuscular area and another in clinical research. We offer a few services to the community, such as carrying out complementary exams in the field of neurophysiology and neuropsychological evaluations. We have the Egas Moniz Museum, which receives quite a lot of visits from schools. Just now we have had a school visiting the various laboratories, the museum, and a reference library in the field of clinical neuroscience.

Newsletter: With regard to what you have just said, the school visits you have also have something to do with the figure of Professor Egas Moniz…Professor José Ferro: Some of the visits are indeed related with the figure of professor Egas Moniz, but others I associate with the huge interest that mostly young people have about how the brain works and the diseases that affect it, which nowadays are very much talked about. Somehow, the nervous system is the last frontier of biological knowledge, for which reason it is only natural that people feel very curious about it. The brain is still quite unknown, and it is natural that children and adolescents feel attracted to that area.

Newsletter: That may be one of the reasons for the huge interest and success, even at an editorial level, of, for instance, someone like Professor António Damásio, who was here for a while. However, it is not only him, other neurologists have published books that go beyond the specific context of neurology to become, sometimes, bestsellers…
Professor José Ferro: Precisely! Somehow, we are what our brain is, in cognitive, relational, and emotional terms. Accordingly, it is natural that people want to know a bit more about how it works, and about the biological bases of its functioning.

Newsletter: With regard to your pedagogical mission and the training of those who will be our future doctors, what are the targets you have set for their education? 
Professor José Ferro: we have a type of teaching that is very much based on everyday activity at the wards and the unit, and our goal is to teach medical students the essential steps in the neurological evaluation of patients, put them in contact with the most frequent pathologies of the nervous system, which they will find in their daily activity, independently of the speciality or activity they will pursue. This is the reason why we put a lot of emphasis on outpatient teaching. Contrary to tradition, most of the teaching is not done inside the wards, because nowadays patients in medical wards are very complex, in the sense they are rare or unusual patients. For this reason, most of the practical teaching is carried out resorting to outpatient clinics. Another aspect to which we pay a lot of importance is to instill a scientific approach in everything we teach, and stimulate students to practice and undertake research projects. For instance, we have had many students wishing to write final dissertations as part of the Integrated Master degree. It is a very gratifying experience, because the standard of the works is high, some even ending up in international publications, and this is all been a very interesting experience.

Newsletter: are students thus subject to a type of learning that includes a strong practical component? 
Professor José Ferro: There must be a corpus of theoretical knowledge, because the way of thinking, from a clinical stance, in subjects related to the nervous system is different from the rest of the human body. This is because when it comes to the brain, there is always the issue of location, that is, whereas in the case of the liver, location is not very important, when it comes to the brain it is completely different, a millimeter on the side can make all the difference, inasmuch the structure of the nervous system is very complex and, besides, it is distributed in space in a particular way, which implies that students need to think not only about pathologies but about where they are located. Accordingly, they must have that anatomical perception, and that makes them study. Sometimes they need to study the entire content in order to be able to follow up patients. However, it is good they feel quite ignorant in the first classes, because that motivates them to attain a maximum performance and study contents rapidly.

Newsletter: at the level of partnerships and of the relationships this Unit has with other entities that form the Medical Academic Centre, and about your specific contribution, what can you tell us on it?
Professor José Ferro: some of the partnerships we have are integrated in the actual teaching, like, for example, ophthalmology, given they form part of the same block. Then we have natural partnerships related to the hospital itself, such as the Department of Neurosciences, which also includes Neurosurgery and Psychiatry. Neurosurgery and Psychiatry have been a single service for a long time and for historical reasons. Then they were split up, but we still share many areas. We are almost one single unit. Then we have links, inside and outside the hospital, as well as international ones, set up by each individual researcher. Most of quality research these days is undertaken through quite broad networks, and all researchers working at this clinic are involved in these networks.

Newsletter: In terms of international institutional cooperation, what are your personal and professional expectations?
Professor José Ferro: what I would really like was that the Academic Centre became a reality, not merely a reality from an organizational perspective, but equally from an administrative viewpoint. In other words, I would like to see a single entity managing the entire academic centre. This will take some time, but there will be huge advantages when we have an integrated management. For instance, when hiring staff, clinical interest should not be the only rationale, academic interest should be considered too. All strands of people’s careers should always be taken into consideration.

Newsletter: You mentioned earlier how little we know about the brain and everything that comes from it, with regard to knowledge of the mind, the question of conscience … Without asking you to peer into the future, what do you think we can legitimately expect from this area? 
Professor José Ferro: do not like to predict the future at all … I believe that when it comes to neurosciences, we are almost in the pre-history of knowledge. The future depends a lot on technological advancements. Currently, much of what we know about the nervous system, about the areas that are important for things such as love, or will, has depended on advances in functional magnetic resonance, which is a technology. However, we have a lot of difficulty predicting what the new technologies will be like in five years time. For instance, what the role reserved for nanotechnologies in the knowledge of the nervous system will be, etc. There are technological advancements which can make us progress enormously, and which we did not anticipate. There is always an interaction between biology and other techniques. Hence the importance of degrees such as biomedical engineering, since they will lead to advances that do not pertain to the sphere of medicine alone.