Berlin, Beijing, Brussels and Beyond

You know how Dr. Who always starts with something weird happening? Like unexpected plagues of spiders or people behaving strangely? I’m expecting Jodie Whittaker, the fab new doctor, to appear at any moment now because, in my life, time has been collapsing. For how else to explain that it is suddenly November, with jingle bells and sleighs appearing in every shop front? It was only May last time I looked.

Even by my standards, the last few months have been manic. I’ve been in Athens, Berlin, Paris, Beijing, Brussels and more.   So let me present some of the highlights, especially the super intriguing stories. To be a top story, it has to equal blue Haribos.  I was hosting a bioeconomy event in Brussels once and discovered that Haribo employs legions of blue-green algae to manufacture the blue colour they use in their sweets.  Who knew?  I can’t be the only person who avoided blue food like the plague, and now I discover that the blue is totally natural.  I tweeted this top factoid and it trended in Belgium for 9 hours. Nine hours.  Tells you a lot about Belgians huh? But I’m still not doing blue Slush Puppies.

Once again, the microbiome – that’s all the bugs that live and on you – has been a source of enormous fascination.  At the European Respiratory Society Congress in Paris, which was attended by 25,000 pulmonologists, one scientist was telling me about mice models of COPD (the distressing chronic respiratory disease).  The thing you need to know is that a mouse cannot come across the poo of another mouse without eating it.  If these sort of mice live in boxes exposed to cigarette smoke all develop COPD.  But if you transfer the dirty bedding (ie that contains poo) of the same sort of mice that have breathed nothing but clear air,  the ones exposed to smoke don’t develop COPD.  There is something about the bacteria in the clear air mouse that confers protection.  But why? There’s much still to learn.

We are increasingly understanding that there is cross-talk between the bacteria in the gut, with the brain, the lungs, and even the skin.  For example, people with gut disorders tend also to have a greater incidence of skin conditions like psoriasis.  And the hallmark of both conditions is not a thriving ecosystem of bugs, but a paucity of species.  And when I was hosting Live@EASD, the TV service for the major European diabetes congress in Berlin, the microbiome once again largely loomed.  This time in principally in association with obesity.

And I was very lucky to spend some time in Norway, interviewing, with my chum Dr. Adam Rutherford, the winners of this year’s Kavli Prize including Emmanuelle Charpentier of CRISPR fame.

Two people have impressed me enormously.  One was Lise Kingo, the Danish CEO of the UN Global Compact, which is responsible for facilitating the achievement of the UN’s Sustainable Development Goals,  I interviewed her in Toulouse at EFIB18, an event attended by an enormous range of companies involved in the bioeconomy.  Both of us were telling the audience that they need to get out and tell their stories to you all.  Biodegradable plastics, replacing fossil fuel derived products with bio-derived ones from waste streams – these folk have such a good and important tale to tell. But they don’t do it because the fuss over GMOs has made them nervous about the public.  Lise told them that they should get out there and tell everyone that what they are doing is contributing to the sustainable development goals.

The other person that was a joy to interview was Venki Ramakrishnan, President of the Royal Society and Nobel Prize laureate for his work on the structure of the ribosome, the extraordinary cellular factory that turns DNA’s instructions into proteins.  He held an audience of 300 enthralled at the Royal Institution and his book, the Gene Machine, is a cracking good read.

It’s Berlin again, then Boston and Slovenia and Brussels..and, and, and.  I wish you the best of travels.


Tasseled Hats and Fancy Gowns

What a great day!  I was very touched and honoured to receive a Doctor of Science honoris causa of St George’s Hospital Medical School – an honorary degree which, in case you were beginning to worry, doesn’t give me licence to do proper doctoring, dispense medicines etc.  Phew, said my sister, whom I subjected to much pretend doctoring as a child.  As you can see, dressing up acquired a whole new meaning as I got a very splendid gown plus a Harry Potter style sorting hat complete with stylish tassel.

I dedicated my doctorate to my father.  He was an extraordinary man.  He could charm birds from trees, living what we would today call a ‘colourful life’ which was a scant half step ahead of the law.  He had a tattoo parlour outside the Dockyard Gates in Portsmouth, a disreputable caff with a busy set of women employed (not by him I hasten to add) entertaining naval personnel above it and a huge business in slot machines.  He sent me to a posh girl’s school and paid the fees in coins.  From an early age, I wanted desperately to be a doctor and had five places to read medicine, but my father became ill during my A level year and died of cancer shortly after my exams.  So, he died assuming that his daughter was going to be a doctor. In fact, I narrowly missed the grades I needed but was still determined to go to University (the first in my family) and to do science, which was always my first love.  It’s taken 40 years to become a doctor, but I suspect my father would have been inordinately proud – although would have no doubt yelled something incredibly inappropriate just as I received the scroll. He terrorised my headmistress and once managed to get her to demonstrate a pogo stick in front of a large crowd of incredulous parents by dint of waving a huge wodge of cash at her and saying, ‘This for the swimming pool fund (and it was a vast sum in its day which he’d won on the horses that morning) if you get on this pogo stick’. Embarrassed?  I could have died.

I did also mention to the assembled graduates – congratulations to you all by the way – that I felt that at any moment, my Form 1 maths teacher, the hated Mrs Glass, would appear and demand that I stopped being so silly. Would I just come down from that stage?  I was ashamedly bad at maths and thought that if you were clever, you could do maths and I couldn’t, so I couldn’t be clever.  So, I’ve lived my life – which hasn’t been without success – thinking almost daily that I’m about to be revealed as a complete fraud and found out.  As I’ve got older, I have realised that imposter syndrome is much more widespread, not just confined to women although I think more prevalent amongst them and certainly not simply to those challenged by sums.  Perhaps we all spend our days thinking ‘how did I get away with that’?  It certainly doesn’t diminish that much with age, but I advised the St George’s graduates that they needed to keep a herogram file.  Every time – and there will be many occasions be sure – that someone says, ‘Great job’, stick the details into your secret herogram file on your phone.  Then, when you are feeling really wimpy, just click on the file and there will be an extraordinary number of people telling you how great you are.  They can’t all be wrong.

I ended my address by saying that you must be careful how you use that Dr in front of your name.  I was on a plane recently when the flight attendant came up to the man next to me and said ‘Sir, I see from the passenger list that you’re a doctor, there’s a lady with a problem back there, can you help?’  ‘Only if she’s rusting, I’m a doctor of metallurgy’ said my new best friend.

I felt deeply honoured and thank you to Jenny Higham, the Principal and to my great chum Dr. Deborah Bowman, who introduced me, and indeed to everyone at St George’s Medical School.


Fish, Brains and Dancing

Sometimes I have weeks which are memorable on several counts.  Well, here’s a corker. I found myself making a film about Alzheimer’s with some extraordinary scientists, had a day of fishy surprises in Stirling’s Institute of Aquaculture, and finally found myself dancing with Darcey –  yes, her Strictly Dameship herself – on stage, in front of a couple of hundred people.

But let’s start with the fish.  The University of Stirling’s Institute of Aquaculture, which is the largest of its kind in the world, hold an annual Ph.D. conference which I found myself hosting on a wet day in April.  There were some very impressive presentations. Did you know that farmed fish, especially when they are hungry, behave like a load of grumpy toddlers? Apparently, they barge about, causing trouble, in particular, biting the fins of other fish which is painful if you are on the receiving end, as well as a big welfare and health issue.  But provide them – and this is a top fish fact – with the equivalent of fish toys (the proper term is environmental enrichment) and there is a significant reduction in fin damage. Who knew?

Another bit of fishy fascination concerned cleaner fish – the fish which feed on other fishes’ parasites. Aquaculturists talk about ‘deploying’ them as if they were a load of tanks in a battle.  Wrasse is a champion fish louse muncher but grow slowly. Thomas Cavrois, a French scientist, explained how manipulating temperature and food during their development can reduce the time taken to get them to their optimum ‘deployment’ size by a quarter.  He also let slip that whereas almost no-one in the UK will eat wrasse, an ugly thick skinned blighter with flesh that has a curious green tint, the French will kill for a wrasse fillet which they think is delicious. I was not surprised. I once met a Frenchman on a beach in Brittany enthusiastically eating a chiton, a rock dwelling mollusk that looks a bit like a scaly squashed woodlouse. Briny tasting toenail is being over generous.

Finally, African catfish.  They are the principal farmed fish in Africa and Isa Suleiman, a Nigerian with a wonderful knack for storytelling, had the entire audience hooked as he explained current hatchery practices in Nigeria.  ‘Shooters’ are preferred as broodstock. These are much bigger than the other fish and local farmers believe them to be genetically superior and pay premium prices for them. Sadly, Isa concluded, having checked out their genetic profile, that they had got big by eating their friends instead of tedious old fish food.  He’s now working to provide better broodstock to make this important industry sustainable. It was a top day and thank you to Giuseppe Paladini, a Scottish Crucibliste, for inviting me.

Goldfish are notorious for having short memories – although this is in fact, a myth.  Memory problems in humans, however, are often the first symptom of something we all fear – Alzheimer’s – and over 10 million people already live with this disease across Europe.  Although there is some evidence that the incidence of Alzheimer’s is falling, its prevalence will increase in line with the increasing number of us who now reach advanced ages. We all want a cure but the understanding of the brain is way behind that of say, cancer.

This year’s Lundbeck Brain Prize has been awarded to four scientists who have each contributed enormously to the understanding of the basic science underlying Alzheimer’s.  It’s a disease of plaques and tangles in the brain. I was privileged to interview the winners for a film. John Hardy, the geneticist, who advanced the idea that the build-up of amyloid plaques was a key process, Michel Goedart whose work focuses on the tau tangles found inside brain cells, Christian Haas who managed to devise a model for testing theories and Bart de Strooper, who heads the UK Dementia Research Institute at UCL and whose work on the enzymes that chop up amyloid has been so important.  Back in the 80s, only a few hundred scientists were interested in Alzheimer’s, including these four. Now it is tens of thousands. I’m looking forward to interviewing them all again in Copenhagen in May. And if you are wondering why, with so much work, we still haven’t got a way to prevent or treat this terrible disease effectively, I suspect we have a number – but we just need to give them far earlier in the disease process which may begin 20 years before any symptoms appear.

Finally dancing with Darcey.  I am including the least incriminating of the pictures, ie the one where I look slightly less like a twitching sack of potatoes.  The Dame of Dance and Strictly Belle had come to the Aesop Showcase and Conference at the Guildhall School’s magnificent Milton Court venue.  Aesop, which develops evidence-based arts interventions for health, was founded by my husband Tim Joss. It was an inspiring occasion and I love hosting it although obviously, I had to sleep with my husband to get the gig.  You can read more about it here.  Darcey has developed a dance programme called DDMix for schools and showcased it at the event.  She talked about it with huge passion and then decided to demonstrate some of the moves. Unfortunately, I happened to be the only person with her on the stage at the time and got roped in.  Dear reader, I failed for how anyone can look elegant beside the ever elegant Darcey. I did confess to her that I had been thrown out of my ballet class at the age of 4 for being a danger to the rest of the class (an unfortunate incident with a chair) and offered to show her a few of my steps but luckily for the audience, she declined the femtosecond experience which would have ensued.  Roll on the next season of Strictly.

September: my manic month

Milan was the first stop in a manic month of travel.  I was hosting Live@ERS, a daily TV feed at the European Respiratory Society international congress.

Our Live@ERS set

This is a huge meeting attended by some 22,000 respiratory professionals. The thing I love about attending big medical congresses is the vibe you pick up about what’s hot in the science.  It’s partly seeing the queues outside particular sessions but it’s also hearing the chatter over the coffee.  The lung microbiome was definitely hot.  Not that long ago, medical students were taught that the inner reaches of the lung were sterile.  We now know that they team with bacteria, which strongly influence the onset of disease.  For instance, studies of the microbiome in children with and without lower respiratory infection show that infection is the outcome of an ongoing turf war in the lung.  Resident non-harmful bacteria normally keep potentially harmful bugs in check, but some children either don’t have those peacekeepers or their efforts are overwhelmed.  There was a host of other presentations showing the role of the microbiome in COPD (chronic progressive lung diseases), cystic fibrosis, asthma and many others.  All of these illustrated the complex interplay between your environment, your bugs and you.  What does this work mean?  I think in the future you will see less emphasis on antibiotics and more on manipulating the lung environment to favour ‘good’ bacteria.  I think you will see testing of the microbiome in the initial workup as the microbiome of the lung may be a way of phenotyping (essentially a way to sort people with the same symptoms into different treatment baskets) which in itself may mean more effective treatment. Before you ask, live ‘good’ bugs pumped into your lung?  Unlikely I think.


The other thing that was hot was a big study from China on early-stage COPD.  If you’re a smoker, listen up. Normally, treatment is offered to those with symptoms, which means that their disease is already well on the march.  Those in the earliest stages, when lung function is about 80% of what it should be, typically don’t think there is anything wrong with them beyond a bit of a cough – “which is normal right if you smoke?” Yet their lung function is already declining.  There is no screening for early-stage COPD because there’s no evidence that treating it at this stage makes any difference.  Now we have the first indications that this might not be the case. Giving a broncho dilating drug called tiotropium reduced the expected annual decline in lung function in the treatment group compared to placebo. It’s a highly significant finding in China which is facing a vast problem caused not just by smoking but also by pollution and biomass burning.  It’s a study that potentially also opens the way to mass screening, say a lung function test for everyone, starting with smokers.  Some might say why not just ban smoking – well, both and of course –  but don’t forget that there are a significant number of people who get COPD despite being never smokers.

Finally, an observation from me about the newly published Mirror study, which compared patient’s and doctor’s views of their relationship Patients admitted fibbing, being far less than honest than even their docs had imagined.  Doctors also vastly underestimated the impact of severe lung disease on their patient’s daily lives and were much more concerned by their lung measurements than with what patients could or couldn’t do.  It’s a bit like us and the US, isn’t it.  Divided by a common language.  My advice to patients is to tell your doctors what’s important to you. And my advice to doctors is to ask ..and take what you’re told with a pinch of salt or three.

Future Energy Forum, Astana

I’ve spent some time last month in Kazakhstan hosting two conferences in the Future Energy Forum series, one on the role of cities and the other on the role of policy.  A standout speaker was Professor Mohan Munasinghe, joint winner of the Nobel Prize for Peace with Al Gore.  The conferences took place in the Kazakh capital, Astana which is hosting the World Energy Expo. Of course, I enjoyed the British Pavilion, designed by superstar architect British architect Asif Khan but the Kazakh pavilion (which is in the globe) was incredibly impressive.  You walked from the top down and around different levels, each representing separate renewable energies: wind, solar, biomass, hydro and space.  What struck me was the number of kids there, completely starry eyed, mouths open, gulping all this future down.  I suspect they will remember it all their lives and that it will prompt them to do two things; the first to dream of becoming an astronaut (the biggest queues were on the space level) and the second, cement in their minds that renewables are their future.

For older Kazakhs this is difficult to imagine – after all, their whole economy is based on the country’s production of abundant fossils fuels and their power is, by our standards, astonishingly cheap. Climate change doesn’t have the traction with them that it does elsewhere for they already live in the harshest of climates  – it can reach -60c in winter and +40c in summer.  So how do you persuade?  At a political level, one of the most persuasive arguments is economic. As other countries leave fossil fuels behind, the price will fall and the Kazakhs will begin to see their economy and influence in central Asia diminish. This is driving government.  As for ordinary Kazakhs, starting where they are and focusing on reducing energy use by increasing energy efficiency is the first step – that and inspiring a whole new generation with Expo.  It’s a strategy that I think will work – as it must.

I’m listening here to the Chief Engineer of the Kazakh state railway. A brief welcome was supposed to be his brief but bless him, the opportunity to tell a captive audience about the engines of his trains was an opportunity too irresistible to pass up. Engineers. They’re enthusiasts in every language.

The thing that most impressed me whilst I was in the country was its celebration of women warriors.  This is a Muslim country but Kazakh women enjoy high status and traditionally fought alongside men, typically as lethal horseback archers.  We celebrate Jane Austen, a writer of sharp social observation who dueled with her pen, on our bank notes.  The Kazakhs celebrate Queen Tomyris who personally killed Cyrus the Great of Persia in a 5th Century battle on their notes.  Gosh.

August: A month of rest for most, but not me!

We are only 10 days into the month of August and so far I have been very busy. Here are three completely contrasting things I have been doing so far:

Here’s a commentary from me, just published in Nature .

Everyone is getting in a froth about gene edited embryos and talking about the need for ‘conversations’.  I am making the point that the really urgent conversations that need to be had are about genomics which is now entering mainstream NHS care, rather than about a technology which is many years ahead and likely to be for the very few.  I say this particularly in the context of the UK Chief Medical Officer’s report ‘Genome Generation’ which calls for a social contract between patients and the NHS, especially about the use of data.

Here’s a piece that I wrote for the Mail on Sunday about the Princess of Wales and the furore over a documentary revealing tapes recorded by her voice coach. 

Astonishingly, it is 20 years since the death of the Princess of Wales.  I worked with Diana for 12 years while she was Patron of Birthright, the mother and baby research charity that was then part of the Royal College of Obstetricians and Gynaecologists.  I was its National Organiser, running the research programme but also all its fundraising events

I was a rookie charity organiser aged 26 and Diana was a rookie princess when we first met in 1982 at an event, ‘The Brilliant and Beautiful Evening of Fashion’ at London’s Guildhall.  We got on famously.  I called her ‘Miss’ and she mocked me for my short skirts and my ever constant clipboard.  I watched her grow from anxious ingenue to confident world superstar and she was a very important part of my life for over a decade. After her death, I became a Trustee of the Diana Memorial Fund.   Although it is now two decades ago, the week between her death and her funeral was one of the most extraordinary in British history and remains sharp in my memory.

And here’s a pic of the World Energy Expo.  I recently visited Astana in Kazakhstan for the World Energy Expo where I facilitated two conferences for the Future Energy Forum.

Astana is the capital of Kazakhstan and the Kazakh Expo pavilion (which was inside a huge ball) was outstanding, incredibly well presented and thought out.  After going up in a lift to the top, you made your way down through different levels, with each one representing a different sort of renewable energy – solar, wind, biomass, space and so on.  It was fascinating.  I watched a lot of very excited Kazakh children in the space section and wondered if a decade or so hence, they will be the astronauts and engineers of the future, having been inspired by their visit to Expo as children. In the UK I am sure that we will have a Tim Peake generation of engineers in the same way that there is a generation (who constantly tell me this) that were inspired to take up engineering and science by watching Tomorrow’s World.

I also visited the Great Britain pavilion which has a fascinating installation of a yurt made of perspex struts which lit up when you touched them, completely surrounded by a landscape panorama.  As the yurt lights came on, so the representation of light in the corresponding piece of the panorama changed, going from day to night or from sunny to cloudy. Sounds weird on paper but it was mesmerising to watch.

I was in Astana to facilitate two conferences of the 12 conference series, ‘Future Energy Forum’.  Kazakhstan has vast reserves of oil and gas and a booming economy based on oil but seem committed to a future in which renewables become more and more important.  They are especially interested in energy efficiency, as well they might be with a temperature range of over 80 degrees, running from +40 in the summer to -40 in the winter (Oh, and add a windchill factor of another 20 degrees).  I really enjoyed talking to young Kazakhs in particular at the conferences.