One of Karim’s most important achievements is his work with the investigation into the optimization of steroid replacement, from a scientific, a clinical and a financial standpoint. This involved not only becoming an active member of the All Party Parliamentary Group (APPG) on access to medicines (and giving evidence in parliament), but also obtaining NIHR support for scientifically investigating the most appropriate steroid replacement therapy.
Engagement with the Addison’s Disease Self Help Group (ADSHG) and the London Area Pituitary Patients (LAPPS) to determine a patient friendly protocol to investigate the different steroids available for glucocorticoid replacement. Other evidence of his patient engagement is the fact that he has not only has he set up a direct access patient information website, but he also sits on expert panels for AMEND (as a Trustee) and Parathyroid UK. He has also worked with the SFE in writing guidelines for patients with adrenal or pituitary disease who want to fast in Ramadan.
In addition, this work has created evidence for the correct use of different steroids, and the NIHR has funded a double blind randomized controlled trial to answer the question (regardless of cost) as to which really is the best steroid replacement. This has caused a widespread review of the practice of replacement, a number of publications in the area, and a fall in the price of hydrocortisone in the UK from over £100 per month to £3 per month. Nationally this has resulted in a fall to the NHS drug budget of £2 million per year.
Professor Meeran is Head of Speciality for Endocrinology at Imperial College Healthcare NHS Trust one of the highest scoring Trust in the recent GIRFT in Endocrinology. He has been responsible for not just local but regional MDTs, being an enthusiastic user of technology. He runs MDTs for pituitary, NETs, adrenal and parathyroid disease that are widely accessible using an encrypted version of zoom.
He has set up a service in Abu Dhabi that now houses the highest concentration of Endocrinologist in the world, having over 70 consultant Endocrinologists working at The Imperial College London Diabetes Centre in Abu Dhabi (www.icldc.ae). He runs the CPD for the centre, and has set up a trainees exchange programme with the country. In addition the project comparing different steroids for adrenal insufficiency has been expanded to include steroids that are available in resource poor areas of the world. He is working with industry to enable different doses of different glucocorticoids to be available at low cost.
He has written a number of undergraduate and postgraduate textbooks in Endocrinology, including “Integrated Endocrinology” (Laycock and Meeran), and “Lecture Notes in Endocrinology and Diabetes (Sam and Meeran) and the “Endocrinologists Specialist Handbook” (Robinson and Meeran).
Following the COVID pandemic, almost all conferences and meetings were cancelled, so Karim decided to have the planned Annual Imperial Masterclass by ZOOM on April 27th 2020. There have since been six such very positively received sessions, which are still available online on including the excellent calcium and bone sessions (Alex’s osteoblast).
He has set up a multidisciplinary service including radiology, ophthalmology, endocrinology and radiotherapy to optimally manage patients who have difficult to manage Graves eye disease in the Trust. The excellent attached patient review is just one of many.
Karim has now embarked on a further project on the use and price of Liothyronine. Together with the CCGs in London, he has set up a Liothyronine withdrawal clinic, which has resulted over the last few years in a significant fall in the expenditure on liothyronine, with very positive feedback from the patients (letter from patient also attached). The positivity with which these patients have taken to this clinic is remarkable, which is certainly due to his excellent ability to engage with patients on their terms.
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