Leading Czech endocrinologist follows his dream in the United States

Doctor Karel Pacák is an internationally recognized endocrinologist and the current head of the Medical Neuroendocrinology section at the National Institute of Child Health in Bethesda. After resolving to help find a cure for cancer as a small boy, he devoted his life to scientific and clinical research in the field of endocrine oncology. He is also the winner of the 2016 Most Respected Czech Abroad competition organized by Czech Radio, which included finalists such as Miloš Forman, Eva Jiřičná or Daria Klimentová. Ahead of the award ceremony, I invited Karel Pacák to Radio Prague’s studio and began by asking whether his popularity had come as a big surprise.

Karel Pacák, photo: archive of Karel Pacák

“It was a big surprise. I was not expecting it at all. Moreover I did not know anything about it at first, my wife received some information from her friend and then one day she came and said “I think that it looks good, maybe there is a chance ”. I said to her “I don’t think I will be the one because we have so many exceptional scientists, exceptional artists, exceptional people abroad”. But she said “don’t give up, don’t give up, just go with it and everything will be fine”. So asked her to tell me the names of the 15 finalists and when I saw them I said “Absolutely no chance. These people are so good, and I know some of them, that I cannot make it. So forget it, I’ll go to work and that’s fine.” And then it happened. So it was a big surprise, definitely.”

If we can go back to the beginning, I understand that you made up your mind to be a doctor at a very early age –around six I believe….how did that come about?

“Yes, I did. My mother’s friend, who was very young at the time with two kids, was dying of metastatic cancer. I thought about it a lot. My inclination has always been to help those who are suffering and in need of help, so I went to my mom and told her “I know what is happening (though of course at six I did not realize all the consequences) Don’t worry. One day I will be a doctor and I will work to discover a drug that will help people who suffer from cancer. That’s how it all started. At the end of my high school years I was already working on some scientific projects and at the Faculty of Medicine at Charles University I started focussing on the field of oncology.”

Can you explain in simple terms what it is that you do?

“I work in the field of endocrine cancer. As you know there are endocrine glands, you will have heard of the thyroid, parathyroid and adrenal glands. Those glands can develop tumours and some of these tumours can be metastatic. Those glands are endocrine organs which means that they are releasing hormones and if they develop cancer these tumours can be problematic and in some patients very difficult to treat. And the field relating to endocrine glands and oncology is called endocrine oncology. So that’s what I do.”

Do you work in research more or do you work with patients as well?

“I went to my mom and told her “Don’t worry. One day I will be a doctor and I will work to discover a drug that will help people who suffer from cancer.”

“I work a lot with patients. Put it this way – I am a physician-scientist. I am definitely hybrid. I do the basic science with my group of fellows focussing on basic science and I have a group of fellows focussing on clinical work. So we do both, which is very complicated, very difficult and I would say that practice is almost disappearing. I would say we are one of the few groups doing both and I like that, because this is how you can help patients. You see the patients, you observe what the patients have and you transfer it to the lab and from the lab you transfer it back to the patient. We call it from bedside to bench and from bench to bedside. And that is what I like.”

We should say that you are not an émigré. You graduated from Charles University in 1984 and let the country in 1990. How do you come to be working in the United States?

“That’s right, I went to the US in 1990. My goal was to learn something from the scientific field, not to do clinical work at the beginning, because I did mainly basic research and to stay there approximately one or two years before returning home. And after two years I was thinking it is time to go home, because I really love the Czech Republic, you see. But my wife really loved living in the US, and she said why don’t we extend our stay for another two years. And my mentor liked me very much – of course he liked me, I was there 16 hours a day, maybe more including weekends –and he said he would do everything to help. So I agreed to extend our stay by another two years. During the first two years there I took examinations that allow me to enter the field of clinical medicine, because even if you have passed examinations here and I had passed an exam for clinical medicine, it was not considered valid in the US, so I had to take the exam again in the States as well as exams in my specialization. But the good thing was that those exams –at least in my field i.e. internal medicine, endocrinology, diabetes and metabolism– generally take six years in the United States and I managed to complete them in four – so that was good -I saved two years.”

So it was your wife…I thought what kept you there was the conditions for a doctor in the United States, the possibilities for research and so on.

Karel Pacák receives Most Respected Czech Abroad prize, photo: Andrea Filičková

“Of course, it was both. I had a lot of publications at the beginning and during the first four or five years I published forty to fifty papers. I lectured at Harvard, I lectured at Rockefeller University, at other very prestigious universities during the first four or five years. We developed a new approach in patient care, considering the stress and what is going on in the brain –so it was a very successful and enriching time. So it was not just my wife, it was also the success at work. You have to have both. If you are not happy at work, of course you will leave, if your loved ones say they want to go back or to change something, you will most likely change it as well, so it needs symbiosis, mutual agreement and we had that mutual agreement.”

How far have you taken that old resolve to help? With experience and hindsight - is that six-year-old boy’s dream out of reach, do you sometimes feel powerless in the face of the force of this disease or you feel that every step on the way is a step forward, this is how much you can do and you are happy doing it?

“I think that at least in the sphere I am working in –that is pheochromocytoma and paraganglioma or endocrine tumours – we did some very good things and made some excellent discoveries. We established a new biochemical diagnosis of these tumours and practically the whole world is using it. We gave it away for free and all universities – including Czech universities – are using it. We established new imaging on the localization of these tumours and the newest localization is absolutely phenomenal, allowing us to localize 99 percent of metastatic tumours –so that is very good. And we also discovered some genes that are very important and play a role in the pathogenesis of this disease as well as in the pathogenesis of metastatic diseases as such. What we are missing right now is the treatment. We are not missing it because we do not want to focus on it but you cannot do everything. We had to start somewhere, so we started with biochemical diagnosis, went on to imaging, then localization and management and the final step is –when you have a therapeutic plan you have to think about how to put the treatment together. So right now our logo is Marching for a Cure, we are really marching for a cure of endocrine tumours, we have in the pipeline two interesting studies and maybe another two are coming sometime soon in collaboration with my colleagues. So I think that the dream is coming through, step by step. My dream was to put something together in terms of treatment and the treatment is the last part of what I am doing. It may take three, five, six years. It depends, if we are lucky it will be a little bit earlier, if we are less lucky it will be later on, but I firmly believe that we will come up with some interesting treatment and we have some good ideas –so it may work.”

“We are marching for a cure and I firmly believe that we will come up with some interesting treatment.”

It can’t all have been plain sailing. Was there any point in your career where you thought –I wish I had chosen a simpler road to tread?

“That’s an interesting question – yes and no. Of course there is a lot of satisfaction in what we have done for our patients. On the other hand if you want to do something on a very high level – top level – it takes a lot of energy and it also takes up a lot of time. A lot has been discovered, and people working in the field are smart people so you have to compete with them and you cannot compete with them only in what you know but how much time you spend, in your dedication to the field, because these days you cannot succeed working six, seven, eight hours a day. I saw many brilliant people but they were lazy, and brilliant people if they are lazy will not make it, unless they have good luck, but that does not happen very often. So you must not only be good and have the knowledge required you have to have a passion for what you are doing and you have to devote plenty of time to it. And if you devote plenty of time to it, you will not have time for other things. So if you ask me would I choose something else, the answer is I would not, but my family definitely suffered from my choice.”

I do not know how often you are able to come home –if I may still call it home – to the Czech Republic – what do you miss most?

“The atmosphere. The atmosphere is something I very much enjoy, the interaction among people. Whenever I land here at the airport I feel like I am at home here, I know everything, I switch the TV on and in 30 minutes I know practically everything that is going on in the Czech Republic….I like the attitude of people, their readiness to discuss things, their friendly approach. Look, I was born in this country, I was about 30 years old when I left, my childhood, my university studies, my beginnings at the department of internal medicine, my specialization…everything happened here in this country, so I have very close ties to people in this country as well as to my professional colleagues. And also, I love the food. I love the food and I love to go sit in a small pub and just spend time observing people, just to watch what they are doing, how they are enjoying life, talking, it is wonderful to walk around Prague, look at the buildings, how everything is changing, how it is much more cheerful than it was 20 years ago…it really makes me feel very happy and very satisfied.”

Will you come back one day?

“Yes, I think I will.”