Today, he is board certified in general internal medicine, endocrine diseases and diabetes, associate professor of general internal medicine and an expert on mechanisms behind insulin-resistance in pre-diabetes/type 2 diabetes, as well as an adjunct professor in clinical experimental diabetes research.

Beginning in 2012, he will share his time between a fifty percent research position at the Sahlgrenska Academy and a fifty percent position as medical adviser at Gothia Forum, Sahlgrenska University Hospital, region Västra Götaland. One part of his job is being principal investigator (PI) for different projects within his particular fields of expertise. At the moment, he is directing the first study ever where probiotics are being used to lower the blood sugar of type 2 diabetes patients. The study is run by Sahlgrenska Center for Cardiovascular

And Metabolic Research together with Bio-Gaia, a Swedish biotechnology company that has developed a food supplement with Lactobacillus reuteri, a bacterium that naturally inhabits the gastrointestinal tract. The study is based on research by Fredrik Bäckhed, Professor and an expert in microbiology and mouse physiology at Sahlgrenska University Hospital. For a long time he has been investigating how intestinal bacteria affects obesity and diabetes in animals. Previous research has shown positive results and now Per-Anders hopes that this will also happen in this study. For twelve weeks, they will test the bacteria against placebo on 45 patients with type 2 diabetes.

“On an experimental level it’s of course very interesting to see what happens to the blood sugar and how this can affect the pathophysiology. But this could of course have an enormous potential for the patient, therefore I have no doubts about putting my heart and soul into this project.”

Leading position

Principal investigators often have the function of being opinion leaders.A company that is initiating a clinical trial often wants someone who can take command and show that the research has legitimacy, and hopefully gives some positive results.
“The work is basically to coordinate and supervise the different steps, which can involve overview of x-rays, measurements, euglycemic hyperinsulinemic clamps, trying to get pilot projects carried out and looking at various methods. You make sure that all of the projects are under control and are well performed. Almost like a dad in a big family.”

Finding the right patent

There is not a universal job description for a principal investigator and the role of a PI can vary depending on the specific research field or establishment. But in general, the PI often takes on the organizational and leading role in a study or clinical trial. He or she also gives direct feedback on the protocol of a current study or gives his or her point of view on when the best time is for a company to take the next step. A PI also participates in giving valuable input on how to find patients, something that can often be a bit problematic.

“From time to time, I read clinical trial protocols with such specific details regarding the selection of participants and criteria that it becomes very difficult to find such patients. I’m sure there are good intentions in the theoretical planning and design of a study. The only problem is that you may be targeting patients that don’t exist. That’s why it is so important to always have contact with the healthcare units to see which patients are available.”

One thing Per-Anders would like to see is more studies and clinical trials within non-institutional care and primary healthcare, where there is a bigger possibility of finding suitable patients. However, many district doctors are running on a tight schedule and often have few resources. Therefore the focus is mainly on taking care of patients and consequently not much time is left for studies.

“This is something that we’re trying to change in the region of Västra Götaland. Through Gothia Forum, a new program is being established that will give support, for instance by initially sending out a nurse to help with the most time-consuming parts. I think this can be an important step towards more clinical trials within non-institutional care.”

Trusting your gut feeling

The job can be both quite challenging and at times a bit stressful, occasionally with urgent meetings and the difficulty of recruiting patients within the right timelines and constantly trying to find new patients. As the principal investigator, the job also comes with a level of responsibility. If there are unexpected side effects from a drug or a study that doesn’t work out as planned, the PI has to step forward and accept some of the consequences or critique.

“I only participate in a study as principal investigator if I really feel that it has some potential. It is an absolute condition. I’m sure that PI’s have different ways of reasoning, but for me integrity is very important. Sometimes my gut feeling has proved to be correct. 10 years ago, I was asked to be a coordinating doctor for a test of a substance that seemed very interesting. I accepted, and eventually this became a new scope for therapy within type 2 diabetes. On another occasion, I received a request that I couldn’t possibly believe in and therefore declined. The product never became further developed.”

Making a difference

The job of a principal investigator involves a lot of time and commitment that often goes beyond actual economic compensation. As Per-Anders puts it, “This isn’t something you take on in order to make a lot of money. The people who work as PI’s do it because they are driven by their interest in the patient and in moving a research area forward.” But even though the job includes a lot of hard work and challenges, he doesn’t have any second thoughts about his choice of work.

“It’s very exciting to be involved in developing new drugs or food supplements, especially if I have a hunch that something new is being introduced that can be of help to type 2 diabetes patients. That is the main reason that I’ve chosen to do this. I know that there are people out there who are unwell. Through this job, I can actually make a difference,” says Per-Anders.

“Of course there are a lot of challenges. But every time a new study is initiated, I always get an almost intoxicating sensation, a sort of childish expectation about what the outcome will be that never wears off.”