Transcript Nov 2008
Gareth Mitchell: This is the official podcast of Imperial College London. And I’m Gareth Mitchell of the Science Communication Group here at Imperial and I present the BBC’s technology programme Digital Planet. Hello. And this month, a healthy appointment for Imperial as it welcomes onto the staff the man who co-discovered the Ebola virus.
Peter Piot: We discovered the Ebola virus which was ironic because when I was in my last year in medical school and I went around to my professors they all said there was no future in infectious diseases – that’s over.
GM: He’s the founding director of a new institute for global health here and he’ll be giving us his thoughts on the big health challenges that the world faces. That’s coming up in just a few moments. And one of the country’s leading vascular surgeons says that too many diabetes patients in the UK are losing their limbs unnecessarily.
Professor Roger Greenhalgh: There are approximately 100 major amputations from diabetes occur per week and 50 per cent of those could be prevented. The whole of Europe is suffering the same problem.
GM: And also a roundup of new from around the University including an insight into what gets bacteria feeling all stressed out. Hey, relax. It’s okay. It’s just this month’s edition of our Imperial College podcast.
Peter Piot on why tackling global health is the key to international development
So if your job description includes founding a specialist institute to tackle some of the world’s biggest health problems you’d better be the kind of person who likes a challenge. Thankfully that’s not a problem for Dr Peter Piot just appointed as the first Director of Imperial’s new Institute for Global Health. Currently Executive Director of UN8, the joint UN programme on HIV/AIDS he’s been one of the world’s leading figures in the fight against that disease. He has over 30 years of experience of the science and politics of infectious diseases all of which he’ll bring with him when he officially starts in post here at Imperial early next year.
In return for a hefty responsibility he’ll be given access to top experts from around the University from the Faculty of Medicine to the Business School and from the Biological Sciences to the Climate Change Institute. As the appointment was announced Peter Piot was on campus recently to meet some of his new colleagues and he took time out to talk to us on this podcast. Now, having read his CV I had to ask him about one of the achievements right at the top of it. How he co-discovered the Ebola virus in Zaire in 1976.
Peter Piot: When I was just a graduate from medical school and was in training in virology our team at the Institute of Tropical Medicine, we discovered the Ebola virus. Which was ironic because when I was in my last year in medical school and I went around to my professors they all said there’s no future in infectious diseases. That’s over. And in my short life I’ve seen so many coming up not the least AIDS but mad cow disease, just name it, legionnaires’ disease. And so what I bring in a sense is work in the field, some fairly basic research in the laboratory, on HIV particularly, and thirdly now my more recent experience in policy setting and making the money work also. It’s not enough to have money, it’s not enough to have the science, but you also have to make sure that it gets to the people who need it.
GM: And I suppose in your career you’ve seen how health has become an increasingly global issue and this must be down to globalisation and basically we’re travelling around the world so much more.
PP: We’re travelling around the world. Viruses travel with us. People come from everywhere. And also there are so many growing inequalities, social inequalities, and that brings with it also many health problems. Let’s forget about the fact that Britain is an island, yes, but any health problem even 10,000 miles from here can have an impact tomorrow in London. Plus global health has made it really to the top, top agendas. The G8, the UN General Assembly, the World Economic Forum, they’re all dealing with malaria, with AIDS, tuberculosis, health systems. Who would have thought that five years ago? And it’s just an indicator of how important health has become. Because people who are not healthy can’t develop their country. So it is part really of an overall movement of globalisation but also of economic and social development.
GM: I suppose it just goes to show what a gargantuan task you have in the Institute and the other institutes that you collaborate with. Maybe a daunting prospect or I’m sure a gleeful challenge. Depends how you see it.
PP: Well, Imperial has been doing a lot of work, and particularly research, on health problems for developing countries. It’s first class in that aspect. It’s building on that, that I want to do but also create synergies. Because I think that we could benefit more from what the Business School is offering, from collaborating, from the engineers and so on. So I think it’s one step at a time.
It’s also about programme delivery. How to best do that. It’s the policy and the politics, communication and the leadership. These are all very important aspects. Good politics saves lives. Bad politics kill people. Think of AIDS. We’ve seen governments that refuse to endorse access to clean needles and needle exchange. That kills people. Like we still have in the former Soviet Republics, particularly in Russia. And then how to handle risk, anticipate risk? I mean we have a major epidemic now of contaminated milk in China. As a result of it there are thousands of neonates and very young children in hospitals with kidney stones. These are things that have to be managed in a way that is proper medically but also making sure it doesn’t happen again. And we could have prevented that. I can give you examples from many other countries.
GM: Dr Peter Piot, and there will be more from him later in this podcast including his views on the new health risks we all face from climate change. Before that though let’s have some of the stories that have put Imperial in the headlines over the last month or so.
Headlines from around the College
How to solve some of the world’s energy problems? Plenty of people say that we should move away from fossil fuels, and they’re quite right. But despite all that talk the trouble is that not everyone has a solution. Though when a bit of commonsense does break out backed up with some solid research about how to shift from today’s carbon economy to a more sustainable future perhaps it’s not surprising that it attracts some attention. A paper co-authored at Imperial in 2006 has just been named as one of the most influential studies in the field in the last decade. Titled The Path Forward for Biofuels and Biomaterials, the study appeared in the journal Science and has be en c ited in over a 150 subsequent academic studies.
It’s effectively a manifesto and it’s pretty detailed stuff with much to say about how to manufacture fuels from plant materials in an efficient and environmentally beneficial way. One of the paper’s authors is Professor Richard Templar, Director of the Porter Institute for Bioenergy and Biomaterials research, and he told our Imperial news team that as much as we’d like to we just can’t move away from carbon based fuels overnight. We need to embrace transitional technologies like battery power, for instance, though this, he says, is not without its problems.
Richard Templar: Maybe batteries are another option but currently they don’t take you very far. And in fact I could say even more powerfully that for the developing world there is no infrastructure that’s reliable for them to charge batteries up, for example. So they are actually going to need these fuels I think for a significant amount of time.
GM: And in other news researchers in the Department of Earth Science and Engineering are celebrating a bit of rock detective work. Because they figured out how ancient and very rare fragments of magma were formed. The little rocks are called komatites and they’re tiny and only fractions of a millimetre in size. But analysing such small samples actually needs a really big tool. In this case the Chicago Synchrotron, a kilometre sized circular particle accelerator that blasts the rocks with x-rays. By interacting with the molecular structure of the fragments the x-rays have given the most accurate picture yet of their chemical composition.
And would you believe it, the work jointly carried out with partners in the US and Australia has revealed that these tiny samples were actually formed in the mantle. Now, this is the bit between the Earth’s crust and core and it all happened at temperatures of around 1700 degrees Celsius nearly three billion years ago. And they were formed at much higher temperatures than we previously thought. The phrase, “earth shattering” certainly springs to mind here. The Synchrotron gives scientists a new and important tool for unlocking the mysteries of some previously very secretive rocks and ultimately giving new insight into how the Earth itself was formed.
Meanwhile another synchrotron, this time the Diamond Light Source Synchrotron in Harwell in Oxfordshire, has been helping reveal what makes bacteria stressed. If you thought that stress was just the preserve of City bankers then think again. Microbes are susceptible too. But it turns out that they have onboard crisis command centres that instruct them to mount emergency responses to changes in their environment like, say, the temperature or the level of saltiness. The command centres have been dubbed “stressor zones”. And seeing how they work needs a bit of kit that can capture events unfolding incredibly rapidly and on a very small scale. And that’s where the synchrotron comes in. And the Imperial team from the College’s Division of Molecular Biosciences say that the work will give important clues about the survival mechanisms of some of the most hardy and resilient organisms on Earth.
And there’s more Imperial news where that came from on our Press Office website. You can find that at imperial.ac.uk/news. And in fact you can get all the breaking stories before they even end up in the wider media. The website now comes complete with audio clips, slideshows and embedded media like video including some exclusive coverage of the Prime Minister’s visit in October.
Roger Greenhalgh on why too many limb amputations are taking place
To prove that Imperial is more than happy to combine traditional communication technology with all this flashy new media stuff this (sound of a bell ringing) is Imperial’s answer to the parliamentary division bell and it’s the trademark of one of the university’s most eminent vascular surgeons, Professor Roger Greenhalgh. He’s a Meritorious Professor of Surgery at Charing Cross Hospital and when he rings that bell it’s the signal for delegates at a meeting he’s hosting to finish their teas and coffees and reconvene in the conference hall.
This was the first ever meeting of a new conference called Eyelegs. Running over a weekend it was a interdisciplinary summit devoted to the increasingly important area of preventing, diagnosing and treating tissue loss in the leg and foot. It’s a topic that Professor Greenhalgh feels particularly strongly about because, as he told me at the meeting, there are far too many unnecessary limb amputations, especially amongst those with diabetes.
Roger Greenhalgh: As I have spent 30 years or so being concerned with the management of vascular disease in various parts of the body it’s become clear that the results in terms of population studies of amputations is quite unacceptably high. I thought that might be a British problem but then found out that the whole of Europe is suffering the same problem. And take United Kingdom figures that approximately 100 major amputations from diabetes occur per week and 50 per cent of those could be prevented. So at this stage of my long career I feel somewhat appalled that we haven’t done better. This initiative is to try to bring together the disciplines to see if we can do something about the rising major amputation rate through improved diagnosis and management. And it will be a Pan-European initiative.
GM: And so for people listening to this who have diabetes or whose loved ones may do what can they take from this? Hopefully what encouragement can they take from the fact that you are all gathering here and talking very seriously about this issue?
RG: Well, if a person has an ulcer on the foot or the leg they mustn’t think that that is a normal part of ageing. The key is to go and seek medical advice very urgently. Because it could easily be caused by diabetes or some correctable problem. And if it’s neglected it may be too late to save the matter. And so early referral to a doctor is appropriate. The patient would be well advised to demand attention. Because it’s their leg and we know that doctors are taking this whole matter far too casually. It may be that that’s an unfair comment. It could be that the reason for the rising amputation rate is simply because patients are not aware that they need to go to a doctor or the first doctor they see is not aware that it’s a serious problem. But whatever is happening in the whole population at large the outcome is unacceptably poor.
GM: You were talking earlier on, in fact you began proceedings here by discussing various means of detecting and monitoring blood flow into the lower limb so you can you just talk us through some of those.
RG: Well, it’s relatively easy once a patient arrives with a specialist who can work out what’s wrong. Because Imperial College and Charing Cross Hospital, St Mary’s Hospital, Hammersmith, the Brompton, there are sophisticated facilities to determine the history, examination findings, investigative methods with the latest techniques: Duplex scanning, CT, angiography, magnetic resonance imaging. We have wonderful facilities for that and can service patients brilliantly, and do. The problem however is not those patients that we manage quite well. It’s the patients we don’t see. And if I wanted one thing from the ILegx initiative it is that there’s a spin off from this which informs the public that we shouldn’t be complacent. That it isn’t just a question of the doctors pulling their socks up. It’s a question of the whole system being looked at and an improved referral system. That the algorithms of referral are loo ked at so that patients come out of the woodwork earlier so they can get the appropriate treatment.
GM: And that’s the thing because we just can’t understate what an important problem this is. Especially given that diabetes is on the increase and not just here in London, in the UK, but worldwide as more and more countries become more affluent and these kinds of diseases traditionally thought of as being Western of developed world diseases are now spreading worldwide aren’t they?
RG: Well, diabetes is not the only factor. Renal disease is one. Smoking is a major factor. And, as you know, there’s been a massive decision to make smoking very much less acceptable and not in restaurants and public places to the same extent. And that is catching on right across certainly the Western world. Some people are pushing against it. But as soon as we realise, for example, that inhaled smoke of another, so called secondary cigarette smoking, would make arterial disease worse so that if a child or a youngster were inhaling secondary the cigarette smoke of a parent for years and years and years that child would be likely to have arterial disease at an earlier age through having inhaled tobacco. We can’t prove it for sure but that’s the direction the research is suggesting. Therefore cigarette smoking has been banished. But we haven’t yet had quite the same success with obesity and the diabetic process. But that’s got to come. There’s an increasing sense that we need to inform patients and the public how better to keep fit.
Peter Piot interview - part 2
GM: Professor Roger Greenhalgh speaking to me at the inaugural ILegx meeting at Imperial. And as we were discussing, vascular medicine is increasingly important, especially with diabetes and obesity on the rise around the world. And non-infectious diseases like those are also high on the agenda for Dr Peter Piot, who we spoke to at the top of this podcast, as he gears up to run our Institute for Global Health when it opens early in the New Year. To wrap up this edition of the podcast here is the second part of my interview with Peter Piot where we discuss the global rise of the so called lifestyle diseases.
Peter Piot: When you go to Asia, Latin America it’s the chronic diseases, non-infectious diseases. Mexico has about 30 million diabetics out of a population of maybe 110 million. And soon we can predict that India will have probably the largest number of obese people and the largest number of malnourished people in one country. So these are the new problems and we need to work on that as well. Traditionally global health has focused on infectious diseases. We now have to make sure that we work far more on lifestyle associated chronic diseases.
GM: So why an Institute for Global Health here at Imperial?
PP: Imperial has a lot to offer. I’m impressed by what’s going on in terms of research from the AIDS field to schistosomiasis to neglected tropical diseases, tuberculosis, malaria, just name it. But also chronic diseases which are becoming one of the big issues in many of the developing countries.
GM: And issues that are studied very prominently here at Imperial?
PP: Yes. Today health has become such a complex issue that you can’t tackle it with only one discipline with only, let’s say, microbiology or medicine. We need also people who know how to deliver programmes. And where do you find these? In the Business School. We need people who are developing new devices, new vaccines. You find them in the medical school but also with engineers. And we’ve got a major impact of environmental climate change of the environment so we work with the Institute for Climate Change. It will really be a multidisciplinary group tackling the major problems of health in the developing countries but also in underprivileged populations anywhere in the world.
GM: What’s the ultimate objective? Would I be putting it far too simply if I said the bottom line really is just making the world a healthier place? It would be a very grand claim to make, wouldn’t it? But in terms of nurturing and encouraging study and research in health that must be the ultimate endpoint?
PP: Definitely. Our ambition is really as Imperial College as a whole with this Institute as the catalyst. To do that we come up with new solutions, innovative solutions, for health problems for underprivileged populations and make sure that discoveries are being translated into something real, into policies, and that they reach the people. And also making sure that we can train a new generation of leaders and then researchers in global health. But also on alleviating the impact of environmental change, of climate change. Arsenic poisoning in Bangladesh, salination of the water. So it’s going to be a daunting task but on the other hand if we make sure that we can apply what we know already in the developing countries I think we will go a long way. But there’s still an enormous need for good research to find easier, cheaper solutions for the problems of tomorrow and of today.
GM: And just finishing off then, you mentioned climate change there. Obviously a huge health issue especially in terms of diseases that are now migrating to regions where they hadn’t been before and I’m thinking of maybe even like a malaria risk in North Western Europe for instance.
PP: Yes, as a result of climate change and global warming we’re finding now mosquitoes carrying viruses like dengue or malaria parasites in places where it was far too cold for these mosquitoes the year before. And that’s going to create problems. We also may see major population movements. And as a result of climate change extreme weather conditions are far more frequent. So more typhoons, more hurricanes, and that is going to have an impact on health as well. There may be desertification, access to water. Imperial has done strong research work on water and sanitation inside the Faculty of Engineering. So these are all as important as providing new antibiotics and other drugs.
GM: Dr Peter Piot ending this edition of the Imperial College podcast. Well, there’s plenty more for you in December including the latest from the Cassini mission to Saturn so don’t miss that. This podcast, as ever, will turn up on the first working day of the month. Oscar Buldum is the composer of this theme tune. He very kindly lets us use it for free. And be grateful. Without it you’d have me strumming some horrible kind of tune on my guitar. The official podcast of Imperial College London is jointly produced by our Science Communication Group and the Imperial Press Office. A reminder that you can find out more about this and other Imperial podcasts as well as all the latest College news by going to imperial.ac.uk/news. As for this edition, thanks very much for listening and I’ll see you next time. Bye for now.