Transcript - 9 September 2009
Gareth Mitchell: This is the podcast of Imperial College London. Hello again. I’m Gareth Mitchell, presenter of Digital Planet at the BBC and a lecturer here in Imperial’s Science Communication Group. If you work or study here then this podcast is your chance to catch up on what some of your colleagues are up to. And if you’re from the outside then welcome to our world. Today, a rethink about patients’ safety over at our Medical School. That’s in just a moment. And also Summer School CSI. High school students from around the world converge on our crime lab.
Voice: We do some blood typing where you teach the students how to tell the different types of blood and the chemistry or the science behind it. We do a DNA fingerprinting as well where we teach the students how to separate different fragments of the DNA. Some other activities as well involving us in fingerprinting and code breaking. All sorts of activities. It’s quite exciting.
GM: Yes, we’re at the Summer School where some of the world’s brightest young brains are getting into everything from share dealing to robotics. Perhaps some of them are destined for science in high office.
Sir Gordon Conway: The great challenge of working for a government department, and particularly a government international development department, is if you get things right you change the lives of millions of people. You can really help millions of people by getting things right.
GM: Stories from behind the scenes at the Department for International Development. Part two of our interview with Professor Sir Gordon Conway just back at Imperial after a stint in government and a career that that’s taken him around the world. Also this time, the true cost of dealing with climate change. Some of our experts have been doing the sums ahead of Copenhagen in December. That’s one of the stories in our news section and it’s all right here on this the September edition of the Imperial College podcast.
Well, first off this month we’re going to start by talking about medicine. And specifically a subject that’s of great concern to patients but is one that doctors don’t always really like talking about. I’m talking misdiagnosis. And that’s of particular concern to Professor Graham Neale here in the Clinical Safety Research Unit which is part of the Academic Department of Surgery at St Mary’s here at Imperial. So first of all Professor Neale just tell us a bit about this research. What aspects of misdiagnosis are you looking into?
Graham Neale: Well, this all stems from a study we did at the turn of the Century when we reviewed a thousand case records looking for adverse events. And in doing the study we found inevitably a number of patients whose treatment had been delayed or who had suffered as a result of a misdiagnosis.
GM: And to be clear about the kind of thing that we mean here. So this might be a hospital admission; a patient comes in; often there’s a lot of pressure; the patient is dealing with a medical team obviously confronted with many, many cases and it’s just at that crucial first encounter with the medical staff that mistakes are made in terms of the diagnosis then, is it?
GN: Yes, because of the pressure of work and because of human nature. We make most of our diagnoses by recognising patterns. We don’t do a detailed analysis. This is bronchial asthma because it looks bronchial asthma and sounds like bronchial asthma. But in fact it is possible that the patient is wheezing because they have early heart failure. And if they get incorrectly labelled then quite clearly the treatment is not going to be correct.
GM: So it’s you responding to this initial research that revealed something like up to two per cent of cases of patients going through hospitals have been misdiagnosed and that there have been adverse events related to those. But one would have thought that when you had that initial diagnosis, maybe it’s in the Emergency Room or upon admission, okay, maybe a few mistakes can sneak through that process but there are so many other processes that the patient goes through once they’re within the medical system. How come these mistakes don’t get picked up?
GN: Well, of course, the majority of them do. Within the first 24 hours early misdiagnoses are then corrected and the patient is put on the right track. Unfortunately, however, again it’s part of human nature, once one has written down this is a patient with a urinary tract infection, shall we say, we tend to stick with the diagnosis. It’s something that’s called diagnostic momentum. It goes on from into the nursing records and it goes on to the medical record written by the junior doctors on the ward and it will persist perhaps for days before someone realises that there is something behind the patient’s symptoms other than a simple urinary tract infection.
GM: So obviously you’re intent on studying how misdiagnosis comes about and how big a problem it is and you’ve already mentioned that initial study some years ago. So where are you taking it from here? How are you actually researching this?
GN: What I’m trying to do is to gather a reasonable number of cases where misdiagnoses has been clearly important and to analyse the nature of the misdiagnosis. Because if we understand the nature of the error we then have an opportunity of restructuring the way in which case records are put together to minimise that kind of error. Some studies done in Canada show that there are 30 or more failures in cognition which may lead to medical error. And these vary from what I’ve already mentioned; things such as recognising patterns but not recognising something that doesn’t quite fit. I want to know how often each of these possible failures of cognition may occur and what we could do about trying to limit the issues that arise from misdiagnosis.
GM: It sounds like you have to diagnose the misdiagnosis really. And I know we’re going ahead of ourselves a little bit here but once these insights come about, and I’m sure they will given enough time and effort, what then? Ultimately are you going to try and feed that back into the training that medical students receive when they come to university?
GN: The first step is to feed it into the diagnostic process, particularly the diagnostic process as occurs in the Accident and Emergency Department and also into some of the Out Patient clinics and ultimately into General Practice. So that’s step one. Step two is recognising when to move from pattern recognition to detailed analysis. That is so important. And then the final step will be to take it out to medical training. Now, I intend that all these things should be done at the same time. And here at Imperial we hope to be running out some thoughts and training in quality and safety as a vertical theme which will run through the whole of medical training from the day they come into medical school to ultimately the day they retire from the National Health Service. It’s not enough just to train them in the undergraduate world. It must go on into the foundation years and then on into specialist training.
GM: How is this being received by your fellow doctors? Because as I hinted in the introduction presumably this whole thorny issue of misdiagnosis, it can’t be their favourite subject necessarily.
GN: No, but I have some very good colleagues here at St Mary’s half a dozen or so who are really interested. They say, look, this is a tough call. It’s go ing to be difficult t o do. They agree that we’ve got to start at the bottom and gradually work away at this. It’s going to need a cultural change in the way in which medical practice occurs within the hospitals. I think General Practice is ahead of us here. They work together much more effectively then we do in hospital practice.
GM: Now, this is work that you’re embarking on here at Imperial but I guess you’re not alone in looking into this.
GN: No, indeed we’re not and we’re very pleased to be part of funding from the National Institute of Health Research. About two or three years ago they invited hospital trusts to apply for a very sizeable grant to support efforts to improve quality and safety in hospital care. And I’m pleased to say that Imperial NHS Trust and King’s College NHS Trust were the two winners and winners to the extent that they’re getting around a million pound a year for five years to fund the overall work in improving quality and safety.
GM: Professor Graham Neale. Well, still to come a low carbon future for China. Can it be done? Our Professor for International Development certainly reckons so and he’s one of the top people advising the Asian giant on just how. Stay with us for that. But right now let’s have a quick bit of headline news from around the College.
Headlines from around the College
Imperial researchers say that for the first time they’ve predicted the effectiveness of a drug in humans based on their metabolism. The way that our bodies process and absorb medicines varies widely especially when it comes to how we metabolise them. The team from our Department of Biomolecular Medicine working with colleagues at Pfizer Research and Development is interested in compounds in the urine related to bacteria in the gut. One in particular is an indicator for a bug that inhibits our uptake of certain drugs. The researchers tested 99 men taking the popular painkiller paracetamol. And sure enough they found that high levels of a substance called para-cresol sulphate in the urine indicated certain gut bacteria that disrupts the drug’s action. Being able to predict drug response by non-invasive means like this might help doctors to alter the composition of bacteria in the body to improve drug metabolism. And it’s also a step towards the more personalised medicine of the future. The work is published in the journal Proceedings of the National Academy of Sciences.
And there’s news this month from Imperial experts on the costs of dealing with climate change. Could it be somewhere between 40 and 170 billon US dollars? Well, that was the initial estimate from the UN Framework Convention on Climate Change. It’s the cost of about three Olympic Games per year. Well, say scientists at our Grantham Institute for Climate Change, even that giddy amount is a serious underestimate. The true cost is likely to be two to three times higher; that’s if you budget for the impact on energy, manufacturing, retailing, mining, tourism and ecosystems. Well, those sobering calculations a part of a report released ahead of the Copenhagen Climate Change Conference in December published jointly by Imperial and the International Institute for Environment and Development with contributions from a whole host of other universities and institutes.
And as ever you can stay up-to-date with news and events here at Imperial via our Press Office website. Just go to imperial.ac.uk/news.
Well, now then, is it just me or are the students around here getting ever younger these days? That was my quip to a colleague the other day as a procession of very excited and very keen looking school students from around the world was making its way across campus. The group was attending one of this year’s STEM World Summer Schools. STEM, by the way, stands for Science, Technology, Engineering and Maths. These residential schools and masterclasses are hosted jointly by Imperial College Outreach and Exscitec. There are all kinds of such courses for students across a wide spectrum of ages and backgrounds but this particular one was for high achieving 11 to 16 year olds. Well, we dispatched Science Media Production MSc student Elizabeth Hawk on a mission to meet some of the participants and their mentors, many of them students past and present from Imperial. Well, as you’ll hear, it’s an impressive group size and the students come from far and wide.
I’m from Hong Kong.
I’m from London.
I’m from China.
I’m from India.
I’m from Yorkshire.
I’m from France.
Elizabeth Hawk: I’ve just popped into the temporary robotics laboratory which has been setup in the great hall here in the Sherfield Building. I’m just grabbing a few words with Neil Monteiro and he’s one of the mentors here. So Neil, tell us a bit about what you’ve been doing here.
Neil Monteiro: We’re encouraging the kids to build and design their own robots. The idea is that they’re learning the engineering process and applying it to a real world problem rather than just learning in the classroom. So on the first day we explain what a robot is and then introduce the kit that we have to them. And then over the next days we successively design and test various parts until at the end they compete in a competition together.
EH: And what’s your background?
NM: I was a physics student here. I’ve actually now finished but I still return to mentor in my summer holidays. I work as a teacher. The job is brilliant for an undergraduate to do so a lot of us come back and there’s a few of us, people working in the City, that actually still come back and do this job.
EH: I’ve just come over to the other side of the robotics laboratory to grab a few words with Obe. Tell us where you’ve come from to be here.
O: I came from Nigeria.
EH: What do you enjoy about coming here?
O: The environment. It’s very nice. All the facilities they have here to work. The amount of experiments we get to do. They really explain every single thing so you get to understand it very well. It’s very good.
EH: Tell us a bit about the robot that you’re designing.
O: It’s meant to scoop up balls and take them out of the arena. It looks like a tank and has tank tracks to drive it.
EH: And tell us a bit about the competition at the end.
O: You get four minutes to take out as many balls from the arena as you can. And you work in teams of two each so two players competing against two other players to get as many balls out as possible.
EH: Is it very competitive?
O: Yeah, very competitive.
EH: Are you going to win?
EH: Now, Melanie Thody you’re from the Outreach Office. Tell us a bit about what you get up to.
Melanie Thody: Our main aim of the Outreach Office is to attract the most able students in science to Imperial College. And wrapped around that we want to inspire the next generation of scientists by raising aspirations in all the subject areas of science and medicine. And to help us do this we’ve developed a partnership over 10 years with Exscitec which has allowed us to expand and enrich what we do.
EH: Alan West is CEO of Exscitec. So tell us a little bit about the Summer School and the other projects that you’re involved in.
Alan West: This particular Summer School is for gifted and talented students and it builds on a legacy of work that we’ve developed over the last 10 years through Outreach. What’s clear is that students benefit tremendously from coming to the College, working with academics from the College, seeing the College facilities and then building their aspiration to be part of the community and to be part of science.
EH: I’m here now with Fiona Palfrey and she works for Exscitec as a project manager and she’s involved in the organisation of this Summer School. So can you tell me about the organisation. Because these students have come from far and wide all around the world and they all come here to Imperial so what happens when they get here?
Fiona Palfrey: Well, they come to get linked up with their academic mentor who they’ll be with during the day. So groups of 10 students work with their mentors and attend either a maths, chemistry, forensic science, business, robotics, or astrophysics stand. And then they share experiences and learn from our undergraduate mentors what careers might be open to them if they follow certain subjects after school.
EH: I can hear that this room is filling up with people and it’s getting very busy all around us so I’ll let you get back to work now. Thank you very much. I’ve just come into the crime lab now to have a chat with some of the students here. So tell me what your name is.
NP: I’m Nana.
EH: And where do you go to school?
NP: In Somerset.
EH: What kind of things have you been doing in the forensic science classes here?
NP: Blood analysis, DNA analysis, looking at crime scene. We were making aspirin yesterday and all sorts of things.
EH: It sounds like really fascinating stuff. So it’s been really hands-on then?
NP: Yes. We’ve been doing a lot of stuff. Constantly doing stuff which keeps you busy and it’s good. I like it.
EH: Maybe in the future you actually want to be a crime scene investigator so do you think this is a really good way to put you on the right path?
NP: Yeah, definitely. It gives you a view of what it’s like. It’s much harder than I thought it was going to be but I like it.
EH: Just grabbing a few words with one of the mentors here in the crime scene lab, Samira Colley. So tell us a bit about being a mentor on this programme.
SC: It’s a very exciting programme. I love doing it. We get to do a lot of activities where you apply different chemistry concepts into some sort of scenario that’s different from the stuff that you do at university or at school. We do some blood typing where you teach the students how to tell the different types of blood and the chemistry or the science behind it. We do DNA fingerprinting as well where we teach the students how to separate different fragments of the DNA using gel electrophoresis and how we use DNA to tell different people apart. Some other activities as well using fingerprinting and code breaking. I really love telling new students about science subjects, especially chemistry. I really like to get them to engage in the activities and probably decide to pursue a career in chemistry in the future. Why not? It’s quite exciting.
EH: Fiona, if I could just come back to you for a moment. You mentioned that thi s is obviously a great opportunity for students who are gifted in sciences and love studying sciences but what about other groups of students?
FP: We provide Summer Schools for students who are gifted and talented and for students who perhaps have barriers to their progression in learning. And so there are groups of students who are talented, who are bright but who need to have their aspirations raised. And so coming on an experience which is fun and challenging at the same time and they get meet more people when they go back into school they can talk about their experiences and they can feel confident in themselves about what they might be able to achieve in the future. So there is a varied programme for students of all ages and for all abilities.
EH: I’m also joined by Richard Palfrey who is another of the project managers involved in the organisation. Can you tell me a bit about the ethos behind this. What’s the idea of getting all these students here to do extra science in their holidays?
Richard Palfrey: Well, the reasons are quite straightforward really. In the UK there are not enough students getting excited by STEM subjects – Science, Technology, Engineering and Maths – and with Asian economies being so strong at manufacturing we need to bring through our system more innovators. People who discover, find, invent, create new technologies. And for the international students so they see the value of Imperial College. Students coming to this world recognised institution and learning new technologies.
C: I’m from India.
EH: This week you’ve been doing maths so tell us a bit about what you’ve been getting up to here.
C: It’s a very different way of looking at maths because when I first got into maths I thought it would be all about problems and solving them. But for maths we visited Barclays Capital so now we know where we’re heading if we do maths. Then we learnt a lot about shares and investments. I’m usually a science kind of person but after learning about all of this you actually get to think in both directions. Do I actually want to do science? Look at the other career opportunities that are put forward. This is a good experience going to Barclays. Apart from just sitting at a table and solving sums you have a whole lot more to do.
EH: And any idea what you’re going to be doing at university?
C: I’m planning on doing either mechanical or chemical engineering.
EH: And what about after that?
C: After that is just a question.
GM: Well, we’ll leave that question hanging then. Participants and organisers of that STEM World Summer School there. And we’ve got loads of lovely stuff about other aspects of Imperial Outreach but we just had to cut it out for timing reasons. So if you’re interested in finding out more, like for instance the Associate Scheme where students spend 15 days working alongside teachers in a school or college or you want more information on courses like the one we’ve just been hearing about then do check out the Outreach Home Page. There’s plenty there and it’s at imperial.ac.uk/outreach. That report was by Elizabeth Hawk presenter of the Short Science podcast. Check it out at shortscience.co.uk.
Well, finally, he’s doing his bit to advise China when it comes to a low carbon future. He assisted President Bill Clinton in his efforts to create more social housing for less well-off Americans and he’s even doing his bit to alleviate social inequality in communities near his home in Southern England. He is Sir Gordon Conway, Professor of International Development here at Imperial. And leading a new grant from the Bill and Melinda Gates Foundation devoted to European support for agriculture in Africa. Professor Conway has been President of the Rockefeller Foundation in the United States and Britain’s Royal Geographical Society. He joined Imperial for the first time back in the 1970s and went on to found the Centre for Environmental Technology. Well, in part two of my interview with him I was keen to hear first about the more recent line on his CV: his high profile role in government as Chief Scientist at DFID, the Department for International Development.
Gordon Conway: The great challenge of working for a government department, and particularly a government international development department, is if you get things right you change the lives of millions of people. You can really help millions of people by getting things right. And that was, for me, the big challenge. And so I worked there for four and a half years. It was tough. It was tough because most of the staff were economists or social scientists. There were very few natural scientists or technologists. I think I had an influence. I kept pushing on the idea that you had to have evidence for policies, which you would think was logical but isn’t necessarily so. And most important, I managed to increase the research budget. I was responsible for getting the research budget up from £35m a year to £220m a year. And in fact DFID is now the largest spender on research after the Department for Defence. So that was a big achievement. A lot of struggles and battles and internal Civil Service procedures before we got there but we did get there and so I’m pleased with that.
GM: What areas of science would we be talking about? I mean, clearly agriculture plays a role. I’d imagine information technology, ICT, is incredibly important in development. Health issues. What kinds of scientific disciplines are at the heart really of development?
GC: Well, I think they’re the ones we’ve got now. Quite a lot on agriculture. A lot on health. Now growing numbers of staff and growing budget for climate change. We still need more support on some of the crises that come up. Understanding things like earthquakes and tsunamis. Understanding Avian flu, for example, and other epidemic outbreaks. I’m still quite worried that the world is getting, I’m afraid, a lot more hazardous and many of these outbreaks or disasters we need better understanding of what’s going to happen.
GM: I get the impression that a large part of DFID’s role is going into the aftermath of disaster zones or war zones. And in fact myself, about a year after the conflict in Kosovo, went there to make a radio programme about how they were effectively redeveloping and rebuilding that region after the conflict there. And DFID had an enormous presence. Loads of their people were going around there rebuilding the hospitals, bridges, working with the Army, the United Nations and so on. It seems to be a large part of DFID’s role.
GC: Yes, that’s true. I think it’s something like 40 per cent of our overseas funding goes to those kinds of places. Iraq, Afghanistan, Nepal, Sierra Leone, Democratic Republic of Congo just to name some of them. And a lot of that work does go into governance and macroeconomic policies. Some of it goes into building infrastructure. What I have not yet been successful in doing is persuading them to put money into developing science and technology. There’s been a kind of rule that that can wait. I don’t think so. And I think my successor is very keen to push the notion that you need to build up science, technology and innovation very early on. A good example is Vietnam. I mean, Vietnam came out of the war very damaged by the war but really invested heavily in science and technology. And, of course, that’s what China has been doing too.
GM: And that brings us very neatly on to China actually. Because I know that alongside your role here at Imperial College you’re very involved in China and China’s carbon, or hopefully lack of, future. Just tell us a bit about that.
GC: I was asked to by the chair of a taskforce to produce a low carbon economy for China. What we’re doing is helping the Chinese think about how they want to eventually create a low carbon economy in China by 2030 or 2040 or 2050 or whatever it is. And they are very positive about this. We tend to read about the fact that the Chinese have got a lot of polluting industry. And it’s true, they do. They have a lot of polluting industry and a lot of pollution. But they’re closing down a lot of the old polluting factories and building new ones that are more efficient. Now, what the Chinese are good at doing is developing new technologies. They’re already the largest exporter of photovoltaic cells for solar panels in the world. They’re the largest manufacturer of electric vehicles in the world. And so for them it’s not a big challenge. It is a challenge but they see it as an opportunity. The Chinese believe that if they can get this right they’re going to be the world leader in clean technologies. One of the great features about the Chinese is if they commit themselves to doing something they more or less do it. There’s lots of criticism of China and there are many things about China that I don’t like but their ability to apply science and technology; their ability to be innovative and their ability to actually construct things and get them done and make them work is phenomenal.
GM: In last month’s podcast we talked about how optimistic you are. You have this, I think as you put it, genetic predisposition to be optimistic. And surely you need, and I’m not disagreeing with anything you’re saying, and I haven’t been to China, but if you go there and you see just the scale of construction in this massive, massive country. With just the amount of concrete they’re producing. It was something like half of the world’s concrete is produced in China. Concrete is incredibly carbon intensive to produce. Just things like that I think you’d have to be an enormous optimist to walk around China or travel around China and think that there’s any hope that they can be leading a much more environmentally aware planet.
GC: I understand that. But there are ways of producing concrete that are more environmentally friendly. There are all kinds of new technologies that produce building materials that are very low in their carbon production. And, again, the Chinese are optimistic about it. The Chinese are very interested in the Japanese model of building cities. In the West, particularly in the United States of course, our cities are sprawls. They’re saying if you actually build cities upwards, on the Japanese model, you may save a great deal of greenhouse gases. So there are ways of getting at this that may by different from the way we would think about it that will be positive.
GM: That talk of cities there and urban developments brings me on to another thing that I’ve read about you and when you were in the United States. You’re very interested in social housing. This says a lot about the breadth of interest that you have. So on one level addressing the really pressing issues of development in Africa, for instance, but also ensuring that people in what we would like to think of as the developed world have decent places to live. That’s important to you too as well then?
GC: I think it is. There’s various issues there. What I was involved in, in the United States was a consortium of the big foundations. People like ourselves at Rockefeller, the MacArthur Foundation and so on. And we formed a consortium to provide social housing throughout the United States. Travelled all round the United States. I’ve been to nearly all the poorest neighbourhoods in the USA. South Side of Chicago, West Sacramento, south of Boston, Los Angeles, New Orleans and so on. One of the most delightful of the people was the Head of the Housing and Urban Development Department we worked with who was a Jesuit priest. This was under Bill Clinton. And Bill Clinton was quite happy to appoint a Jesuit priest as Head of his housing programme. And I had wonderful days bargaining with this Jesuit over how much money we were going to get out of government. There’s an enormous amount of poverty in the United States. A lot of that poverty is related to healthcare. Unless you get a decent healthcare system in the United States that poverty is going to continue. That’s what President Obama is trying desperately to fix. But what is also interesting is that in rural areas you’ve got a great deal of poverty. Not just in the United States but you’ve got it here in Britain and you’ve got it in the countries of Europe. I live in East Sussex. There’s a lot of rural poverty in East Sussex. You wouldn’t believe it when you drive around and look. There’s a huge amount of poverty. There are situations where children in East Sussex have lunch at school on Friday and they don’t eat again until they have lunch again on Monday. I was in France last week staying in Languedoc and the French there were saying to me there’s a huge amount of rural poverty here in Languedoc despite the Common Agricultural Policy. So we’ve got these structures – Common Agricultural Policy for example, but it’s still not working. We still have poverty. And so you need to look at that poverty here and you need to look at poverty in the developing countries, for example poverty in Africa, and try and see if there aren’t ways of tackling both of those at the same time. Not just simply thinking of Africa as being a poor place and us being a rich place and we don’t have to care. We have to care here too.
GM: Professor Sir Gordon Conway bringing the September edition of the Imperial College podcast to an end. And indeed, the academic year 2008/2009. A new term with a new year begins next month which means we’ll have lots for you in our October edition. Do join me for that. I’m Gareth Mitchell. The composer of our theme music is Oscar Buldum and this podcast is jointly produced by the Science Communication Group and the Imperial College Press Office. Thanks, as ever, for listening and I’ll see you next time. Bye bye.