Tag Archives: medicine

A sack of tech cats

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Reading Long Shot by Kate Bingham and Tim Hames for the Telegraph, 15 October 2022

“Not only were we building the plane as we were flying it,” writes Kate Bingham, appointed by Boris Johnson in May 2020 to chair the UK Vaccine Task Force, “we were flying in the dark and simultaneously writing the instruction manual, and fielding endless petty questions from air traffic control asking about the strength of the orange juice we were serving to passengers.”

The tale of Britain’s vaccination effort against Covid-19 ends happily, of course: the task force arranges for clinical trials, secures 350 million doses of six vaccines, oversees any amount of novel infrastructure for their manufacture and distribution, and delivers Covid-19 as close to a knock-out blow as one could reasonably dream of.

At the time of Bingham’s first phone call, in January 2020, things looked rather different: it seemed to this British venture capitalist, who had no specialist knowledge of vaccine development, that she was being asked to take responsibility for a huge amount of government expenditure “that would, most likely, prove completely wasted.”

Vaccines normally take decades to develop, while viruses can mutate in a matter of weeks. There was, Bingham insists, very little chance of success.

Britain’s internationally celebrated vaccine development and production regime was set in motion, from something like a standing start, by a team, that included a bomb disposal expert, an Indian rowing star, an Italian consultant, a former ambassador, a football pundit, and the redoubtable Ruth Todd, whose day job was to see that submarines were delivered on time. This is a book about the skills and experiences necessary to build extraordinary ventures under pressure. Although the science is sketched ably enough here and there, this is not a science book.

Bingham’s background is in drug discovery — a notoriously unpredictable business where some of the brightest minds in biochemistry stake their future careers on one roll of the clinical-trial dice. VCs, if they’re wealthy enough, can spread their risks over a few dozen companies, but even they barely survived the dot-com crash of 2001. Bingham’s one of the new breed that emerged from the wreckage, an investor altogether more interested in managing the companies she helps create than in driving start-ups into premature IPOs. She still carries in her DNA an instinct for spreading risk, though: the VTF spent 4.6 billion on six vaccines in the hope that one might work, one day, maybe.

Coming up to speed with the science was no easy task, even for a major biotech player. There was no shortage of brilliant work to choose from, but little way of telling what innovations would pay off on time. Bingham salutes the work of Robin Shattock at Imperial College, London, graciously acknowledging that his “amplified mRNA” technology, which triggers large immune responses from very small amounts of vaccine, will surely be mature enough to help combat the next pandemic (and be in no doubt, there will be one). [Iona, “amplified mRNA” is a separate (though related) technology to the mRNA tech harnessed by Pfizer]

On the other hand, those teams who were fully ready were anxious to make an impact. Bingham only found out about Oxford University’s non-profit vaccine partnership with AstraZeneca over the radio, and Pfizer, partnering with BioNTech, much preferred to throw its own money at things than rely on any taskforce handholding.

Choreographing this sack of tech cats was not, says Bingham, her hardest task, and with the help of Tim Hames (a former chief leader writer for the Times) she patiently anatomises how she weathered the formless paranoia of politicians, the hampering good intentions of civil servants, and (most distressing of all, by some measure) the random mischief-making of government communications demons.

The ears of the National Audit Office may burn (she dubs their “help” a foolish and expensive joke); most everyone else emerges from this tale with due credit and generous thanks. Indeed, Bingham’s candid account will be uncomfortable reading for those who nurse a dogmatic hostility to “insiders”. Bingham’s husband is Jesse Norman MP, then the financial secretary to the Treasury. Bingham has no difficulty demonstrating that this has nothing to do with anything, but that didn’t stop the Guardian’s jibes, its “chumocracy” tables and the rest.

The trouble is, given a problem as complex and fluid as democratic government, expertise is only authoritative in relation to some particular subject. Without insiders — those with firsthand knowledge in a particular affair or circumstance (like, yes, the PM’s adviser Dominic Cummings, who insisted the VTF should be handled as a business) — experts are merely preaching in the wilderness. On the other hand, without experts to inform them (people like Sir Patrick Vallance, the government’s chief scientific adviser) insiders have nothing to offer but windbaggery.

Knowledge and power must meet. Bingham and Hames’s accessible, edge-of-the-seat account of how British innovators vaccinated the UK and much of the rest of the world is also a quiet, compelling, non partisan argument for dialogue between business and politics.

The seeds of indisposition

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Reading Ageless by Andrew Steele for the Telegraph, 20 December 2020

The first successful blood transfusions were performed in 1650, by the English physician Richard Lower, on dogs. The idea, for some while, was not that transfusions would save lives, but that they might extend them.

Turns out they did. The Philosophical Transactions of the Royal Society mentions an experiment in which “an old mongrel curr, all over-run with the mainge” was transfused with about fifteen ounces of of blood from a young spaniel and was “perfectly cured.”

Aleksandr Bogdanov, who once vied with Vladimir Lenin for control of the Bolsheviks (before retiring to write science fiction novels) brought blood transfusion to Russia, and hoped to rejuvenate various exhausted colleagues (including Stalin) by the method. On 24 March 1928 he mutually transfused blood with a 21-year-old student, suffered a massive transfusion reaction, and died, two weeks later, at the age of fifty-four.

Bogdanov’s theory was stronger than his practice. His essay on ageing speaks a lot of sense. “Partial methods against it are only palliative,” he wrote, “they merely address individual symptoms, but do not help fight the underlying illness itself.” For Bogdanov, ageing is an illness — unavoidable, universal, but no more “normal” or “natural” than any other illness. By that logic, ageing should be no less invulnerable to human ingenuity and science. It should, in theory, be curable.

Andrew Steele agrees. Steele is an Oxford physicist who switched to computational biology, drawn by the field of biogerontology — or the search for a cure for ageing. “Treating ageing itself rather than individual diseases would be transformative,” he writes, and the data he brings to this argument is quite shocking. It turns out that curing cancer would add less than three years to a person’s typical life expectancy, and curing heart disease, barely two, as there are plenty of other diseases waiting in the wings.

Is ageing, then, simply a statistical inevitability — a case of there always being something out there that’s going to get us?

Well, no. In 1825 Benjamin Gompertz, a British mathematician, explained that there are two distinct drivers of human mortality. There are extrinsic events, such as injuries or diseases. But there’s also an internal deterioration — what he called “the seeds of indisposition”.

It’s Steele’s job here to explain why we should treat those “seeds” as a disease, rather than a divinely determined limit. In the course of that explanation Steele gives us, in effect, a tour of the whole of human biology. It’s an exhilarating journey, but by no means always a pretty one: a tale of senescent cells, misfolded proteins, intracellular waste and reactive metals. Readers of advanced years, wondering why their skin is turning yellow, will learn much more here than they bargained for.

Ageing isn’t evolutionarily useful; but because it comes after our breeding period, evolution just hasn’t got the power to do anything about it. Mutations whose negative effects occur late in our lives accumulate in the gene pool. Worse, if they had a positive effect on our lives early on, then they will be actively selected for. Ageing, in other words, is something we inherit.

It’s all very well conceptualising old age as one disease. But if your disease amounts to “what happens to a human body when 525 million years of evolution stop working”, then you’re reduced to curing everything that can possibly go wrong, with every system, at once. Ageing, it turns out, is just thousands upon thousands of “individual symptoms”, arriving all at once.

Steele believes the more we know about human biology, the more likely it is we’ll find systemic ways to treat these multiple symptoms. The challenge is huge, but the advances, as Steele describes them, are real and rapid. If, for example, we can persuade senescent cells to die, then we can shed the toxic biochemical garbage they accumulate, and enjoy once more all the benefits of (among other things) young blood. This no fond hope: human trials of senolytics started in 2018.

Steele is a superb guide to the wilder fringes of real medicine. He pretends to nothing else, and nothing more. So whether you find Ageless an incredibly focused account, or just an incredibly narrow one, will come down, in the end, to personal taste.

Steele shows us what happens to us biologically as we get older — which of course leaves a lot of blank canvas for the thoughtful reader to fill. Steele’s forebears in this (frankly, not too edifying) genre have all to often claimed that there are no other issues to tackle. In the 1930s the surgeon Alexis Carrel declared that “Scientific civilization has destroyed the world of the soul… Only the strength of youth gives the power to satisfy physiological appetites and to conquer the outer world”.

Charming.

And he wasn’t the only one. Books like Successful Aging (Rowe & Kahn, 1998) and How and Why We Age (Hayflick, 1996) aspire to a sort of overweaning authority, not by answering hard questions about mortality, long life and ageing, but merely by denying a gerontological role for anyone outside their narrow specialism: philosophers, historians, theologians, ethicists, poets — all are shown the door.

Steele is much more sensible. He simply sticks to his subject. To the extent that he expresses a view, I am confident that he understands that ageing is an experience to be lived meaningfully and fully, as well as a fascinating medical problem to be solved.

Steele’s vision is very tightly controlled: he wants us to achieve “negligible senescence”, in which, as we grow older, we suffer no obvious impairments. What he’s after is a risk of death that stays constant no matter how old we get. This sounds fanciful, but it does happen in nature. Giant tortoises succumb to statistical inevitability, not decrepitude.

I have a fairly entrenched problem with books that treat ageing as a merely medical phenomenon. But I heartily recommend this one. It’s modest in scope, and generous in detail. It’s an honest and optimistic contribution to a field that tips very easily indeed into Tony Stark-style boosterism.

Life expectancy in the developed world has doubled from 40 in the 1800s to over 80 today. But it is in our nature to be always craving for more. One colourful outfit called Ambrosia is offering anyone over 35 the opportunity to receive a litre of youthful blood plasma for $8000. Steele has some fun with this: “At the time of writing,” he tells us, “a promotional offer also allows you to get two for $12000 — buy one, get one half-price.”

“Fat with smell, dissonant and dirty”

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The revolt against scentlessness has been gathering for a while. Muchembled namechecks avant garde perfumes with names like Bat and Rhinoceros. A dear friend of mine favours Musc Kublai Khan for its faecal notes. Another spends a small fortune to smell like cat’s piss. Right now I’m wearing Andy Tauer’s Orange Star — don’t approach unless you like Quality Street orange cremes macerated in petrol…

Reading Robert Muchembled’s Smells: A Cultural History of Odours in Early Modern Times and Isabel Bannerman’s Scent Magic: Notes from a Gardener for the Telegraph, 18 April 2020

Hooked at the Science Gallery, London: From heroin to Playstation

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Happy Chat Beast tries to be good in Feed Me © 2013, Rachel Maclean

Popping along to the newly opened Science Gallery London and getting Hooked for New Scientist, 26 September 2018

IN THE spacious atrium of the new London Science Gallery, Lawrence Epps is tweaking the workings of a repurposed coin-pushing arcade game. It is part of the gallery’s first show, Hooked. He hands me one of 10,000 handmade terracotta tokens. Will I be lucky enough to win a gold-leafed token, or maybe one of the ceramic ones stamped with images of an exotic sunset? No.

Reluctantly (I’m hooked already), I leave Again and follow Hannah Redler-Hawes up the stairs. Hooked is Redler-Hawes’s responsibility. Fresh from co-curating [JOYCAT]LMAO at the Open Data Institute with data artist Julie Freeman, she took on the task of building London Science Gallery’s launch exhibition. She soon found herself in a room with six “young leaders” – selected from local schools in the London boroughs of Southwark and Lambeth – who, for the past year, have been shaping the direction of London’s newest public institution.

Addiction, she argues, is a normal part of life. Every tribe has its social lubricants, and, as she points out, “we are creatures who like to explore, who like pleasure, who like extending our boundaries intellectually, emotionally and physically, and we are also creatures who aren’t that fond of pain, so when we encounter it we look for an escape route”.

A visit to Hooked becomes increasingly unnerving, as one by one you identify all the apparently innocuous corners of your own life that contain at least an element of addictiveness, from caffeine to Facebook. That journey begins with the show’s iconic image, a lolly-turned-pincushion from the series Another Day on Earth by Olivia Locher, whose work explores the moment when getting what you want becomes taking what you can’t help but take.

The Science Gallery ethos is to leave its visitors with more questions than answers. It is there to pique curiosity, rather than address ignorance. The success of this approach, pioneered by Science Gallery Dublin in 2008, can be measured by the project’s rapid expansion. There are Science Galleries planned for Bangalore this year, Venice in 2019 and Melbourne in 2020, not to mention pop-ups everywhere from Detroit to Davos.

Science Galleries do not amass private collections. Each show is curated by someone new, displaying work from art, science, engineering and territories that, frankly, defy classification. Shows already announced for London include explorations of dark matter and prosthetics. That latter show, explains the gallery’s departing director Daniel Glaser, is going to be very hands-on. A different proposition to Hooked, then, which is about international art and curatorial rigour.

Glaser joins our exploration of the wet paint and bubble wrap of the half-assembled exhibition. Among the more venerable pieces here are Richard Billingham’s films from the late 1990s, capturing the gestures and habits of life on benefits in the deprived corner of West Bromwich, UK, where he grew up. Smoking, snorting, hammering away at a PlayStation might be addictive behaviours, or might become addictive, but the films remind us they are also ways of dealing with boredom. They kill time. They are ordinary activities, and of obvious utility.

“We’re all users, which means we’re all at risk of tipping into harm,” says Redler-Hawes. “Addiction is a natural part of being human. It’s a problem when it’s harming you, but when that happens, it’s not just you that’s the problem.”

This point was brought sharply into focus for her when she discussed addiction with the gallery’s young leaders group. “My idea of addiction was a forty-something in a room unable to work, but these young people were absolutely engaged and a bit afraid that so much of the environment they had grown up in was very obviously vying for their attention, and quite literally trying to get them hooked.”

Naturally enough, then, online experiences feature heavily in the exhibition. Artist Rachel Maclean‘s celebrated and extremely uncanny film Feed Me (2015) is a twisted fairy tale where ghastly characters communicate in emojis and textspeak, as each pursues a lonely path in search of the unattainable.

More immediate, and more poignant from my point of view, is a new video installation by Yole Quintero, Me. You. Limbo, which very quickly convinces you that your phone is much more a part of you than you ever realised. Anyone who has had a relationship decay into a series of increasingly bland WhatsApp messages will get it. “A lot of these pieces are about love,” Redler-Hawes comments, quietly.

Although the emphasis here is on established artists, there are pieces that point to just how mischievous and hands-on this institution is likely to become in the years ahead. Katriona Beales‘s Entering the Machine Zone II is a new commission, developed with the assistance of Henrietta Bowden-Jones, founder of the first NHS gambling clinic. It is the world’s most pointless video game – though I defy you to stop playing once you have started. It propels you with frightening rapidity towards the dissociative state that, for gamblers in particular, is the real attraction of their vice – far more addictive than the promise of money.

It is also the state one achieves when climbing a demanding learning curve. Addiction in the guise of flow isn’t bad. Though then, of course, we call it passion. Not everyone will be comfortable with this show’s broad definition of addiction. But there’s nothing lazy about it. If the show doesn’t change your mind, it will certainly have sharpened your opinions.

The tour done, Glaser takes me around the building itself – a £30 million development that has transformed a car park and an underused wing of the original 18th-century Guy’s Hospital into a major piece of what the papers like to call “the public realm”. What this boils down to is that people come and eat their lunches here and find themselves talking to lively, well-briefed young people about curious objects that turn out to be about topics that don’t often come up in ordinary conversation.

Accessibility here is about more than wheelchairs, it is about ensuring that the people who used to visit the McDonald’s that formerly occupied the cafe area can still find affordable food here. This is important: there is a hospital next door, and streets full of people desperate for a steadying cup of tea. It is about building a terrace around the gallery’s 150-seat theatre, so you can come in and see what’s going on without finding yourself intruding or getting trapped in something you’re not interested in. It is about getting into conversations with the staff, rather than being approached only when you are doing something wrong.

Glaser, who has spent the past five years directing this project, is a neurologist by trade, and is keenly aware what a difference this space will make to researchers at King’s College London, the university associated with Guy’s. These days, knowing how to communicate with the public is a key component to securing funding. With this Science Gallery, Glaser tells me, “a major world university is turning to face the public. It’s becoming an asset to London. We’re a part of the city at last.”

Art that brings meaning to medicine

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Visiting Zhang Yanzi’s A Quest for Healing at Surgeons’ Hall Museums, Edinburgh, for New Scientist, 31 May 2018.

Scar is mounted on the wall of a small, brand-new gallery space in Edinburgh’s Surgeons’ Museums. Because of the way the room is laid out, this is probably the last piece you will come to. And that’s good, as Scar offers the perfect coda to Zhang Yanzi’s solo show A Quest for Healing.

Scar is modelled on a surgical bed Zhang spotted at the Hong Kong Museum of Medical Sciences. (The building itself was where treatments were developed for the bubonic plague, which raged in Hong Kong even into the 20th century.) It’s a violent and terrible cruciform structure, wrapped in bloody bandages – or at least, that’s my first impression. I step closer: the “blood” is ink made of cinnabar, a vermilion-red pigment traditionally used in Chinese painting. Zhang, one of China’s foremost contemporary artists, is no stranger to traditional techniques; much of her work has its roots in the artistic and poetic depictions of landscape known as Shan shui

And those “bloody” smears and stains turn out to be exquisitely detailed miniature scenes of flowing water, framed by “hillsides” of calligraphy, combining poetry with Zhang’s private thoughts. What at a distance seemed to be a work about violent medical intervention, becomes, closer in, to be something deeply personal, calming – even kind.

The stereotypical view of contemporary art is that it’s too clever for its own good and heartless with it, constantly tripping the unwary viewer into moments of horrified realisation (ever looked closely at a Grayson Perry pot?) Zhang’s work pushes in the opposite direction. In the centre of the gallery, an outsize felt-covered “broken heart”  is pierced with thousands of acupuncture needles. This is shocking enough, but only until the eye adjusts and you realise that those pins – so fine, and so many – are more likely cushioning the heart from further assault.

A Quest for Healing is not a sentimental show. Several pieces convey a powerful sense of human fragility. The most colourful piece here is also the most daunting: a wall-mounted pyramid of medical blister packs, their pills removed and replaced by strips of paper on which schoolchildren – thousands of them – have inscribed their prayers and wishes for the future. The weight of expectation borne by Wishing Capsules (pictured above) feels positively oppressive.

Then there are the linked drawings of Limitless, filling one wall with exquisitely drawn ants – half living things, half calligraphy, massing like clouds of stars. You can’t separate these tiny figures from each other, but then again,  you can’t write the whole lot off as a mere texture, either.

There’s a clever perspectival game being played in this show: our cosmic insignificance is a given, but our complexity demands that we press ourselves against each other, in an effort to understand.

Artists who dabble in medicine are a dime a dozen. Zhang is different. She’s steeped in this imagery, growing up in Jiangsu Province in the 1970s, playing with her doctor father’s stethoscope. While by no means rejecting Western medicine, Zhang makes us aware how much more effectively the Chinese tradition gets us to think about mortality, and time, and the nature of being a material body: yearning, growing, dying. And the work that results from all this? A Quest for Healing is, simply, the most humane art about medicine I have seen in years.

Bloody marvellous

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Visiting the exhibition Blood: Life Uncut at Copeland Gallery, London, for New Scientist, 20 October 2017

It caused a storm on social media when it was first shown in 2013, but Dan Glaser, director of Science Gallery London, has a deep and obvious affection for Casting Off My Womb, a scarf knitted over the course of a month by Australian artist Casey Jenkins using spools of yarn stored daily in her vagina. The scarf hangs across the gallery hosting Blood: Life uncut as a visceral and compellingly complex record of one woman’s menstrual cycle. “How else could you ever present that much data?” Glaser enthuses.

“Data” is one of Glaser’s watchwords. So is “visualisation”. He claims not to know much about art. It’s a pose, of course, but a useful one. After 15 years as a research neurologist, Glaser has reinvented himself as an impresario of science communication. His approach is bold: to wrest the gallery space off the art world and apply it to his own, very different ends.

This is the latest in a series of small, off-site exhibitions, and it’s in an out-of-the-way former industrial space in Peckham, south London, because the actual Science Gallery London building won’t be ready until next year.

Everything on show is meant to illustrate medical and scientific ideas. This is why they are here: they are only coincidentally works of performance art, or conceptual art, or what have you.

Normally, this approach encourages dull, derivative work. And if Glaser and his colleagues were as naive as they like to make out, that’s no doubt what we would have got. But the works here, including many new commissions, are often beautiful, and always visually arresting.

Inspired by research into sickle cell anaemia conducted at King’s College London (the gallery’s owner), Glaser and the show’s curator, Andy Franzkowiak, have assembled an exhibition that can be read both for its beauty and for its scientific pertinence.

Given the show quite literally drips with the red stuff, it is still capable of surprising subtlety. Turn from the mechanical behemoth perfusing a bucket’s worth of pigs’ blood in Peta Clancy and Helen Pynor’s installation The Body is a Big Place, and you confront a video filmed in the waters of a municipal swimming pool.

Those people clinging to the sides are organ donors, potential recipients and their families. They are each of them out of their depth in an alien environment, seen through a medium and at an angle that makes identities impossible to establish. If you want an image of what it is like to be caught at the end of your tether in the toils of a necessarily complex and bureaucratic system – well, this video is surely it.

Some of the best pieces here are the most direct. In a riposte to the usual cock-and-balls graffiti found in public toilets, the Hotham Street Ladies have decorated the walls of the gallery’s gents with menstruating uteruses made of icing sugar and sweets.

And then there’s Tough Blood by film-maker Stephen Rudder and choreographer Skylitz, a dance conveying, with brutal beauty, the excruciatingly painful episodes suffered by people with sickle cell anaemia.

The show ends with Jordan Eagles’ installation Blood Equality: a room full of overhead projectors displaying acetates smothered in the dried blood of sexually active gay, bisexual and transgender people.

It’s a campaigning piece, made to highlight the UK and US blood services’ refusal to accept donations from this cohort on the same basis as other groups. The eye is drawn first to the acetate sheets themselves, and naturally enough – given the associations between spilt blood and violence and pain – it’s not a pretty sight. It might not be until you turn to leave the room that it dawns on you that this blood is being projected. The walls and ceiling and floor are covered with it: rich, crackled, stained and impossibly beautiful.

In a strong show, it’s hard to think of a work that better expresses the intent of this queasy, seductive exploration of “the essential, expressive and visceral nature of blood”.

Dream on, George

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I am even tempted to have my own head cut off so that I can continue to dictate plays and books without being bothered by illness, without having to dress and undress, without having to eat, without having anything else to do other than to produce masterpieces of dramatic art and literature.

    —George Bernard Shaw