1 00:00:01,140 --> 00:00:12,480 Richard, this is an interview between Professor Richard Knox and Paediatrics Professor and Derek Hockaday, 21st of July for 60. 2 00:00:12,480 --> 00:00:18,300 Richard, just to plunge directly because we're dealing with your happenings with Oxford University. 3 00:00:18,300 --> 00:00:24,510 When did you first feel you were going to come to Oxford? What made you want to come to Oxford? 4 00:00:24,510 --> 00:00:27,060 It was a complete surprise. 5 00:00:27,060 --> 00:00:42,810 I was in the United States at the Johns Hopkins University, in the Department of Paediatrics, where I was the chief of paediatric infectious diseases. 6 00:00:42,810 --> 00:00:53,470 I had a very good research programme there and obviously an exciting job. 7 00:00:53,470 --> 00:01:06,050 So a letter arrived from the University of Oxford, which strangely said at a recent meeting of the electors of the university, 8 00:01:06,050 --> 00:01:11,620 your name came up as being interested in the chair of paediatrics. 9 00:01:11,620 --> 00:01:20,310 And David Weatherall was the person who. Suggested this. 10 00:01:20,310 --> 00:01:24,930 I was shocked. News to you is that's completely news to me. 11 00:01:24,930 --> 00:01:30,990 So I actually called David Weatherall and he's sort of in his typical way, said, oh, 12 00:01:30,990 --> 00:01:41,490 it's just this northern accent, which I would attempt to imitate, just typical Oxford politics. 13 00:01:41,490 --> 00:01:46,410 The fact of the matter is that Henry Harris, who's the richest professor, knows John Littlefield, 14 00:01:46,410 --> 00:01:58,110 who is your department chair, and John Littlefield, put your name forward as somebody who, um, might be interested. 15 00:01:58,110 --> 00:02:08,390 So I said, well, it's the first I've heard of it. And at the same time, I had a sort of media style reaction. 16 00:02:08,390 --> 00:02:17,580 And it's difficult for I've been in the States by that time, about 12 years. 17 00:02:17,580 --> 00:02:29,580 I didn't really have any intention of returning to the U.K. And in the States, we are doing mostly research work on mostly clinical admixture. 18 00:02:29,580 --> 00:02:42,870 It was a mixture of the two. Um, uh, I had probably at that time something in the order of 60 percent of my time was research, 19 00:02:42,870 --> 00:02:54,190 40 percent was clinical, largely infectious diseases being a very specialised, uh, department, um, head. 20 00:02:54,190 --> 00:03:04,830 I was head of the Division of Paediatric Infectious Diseases. So that involved me obviously also in a lot of training and teaching. 21 00:03:04,830 --> 00:03:18,810 Did you have your own IQ with somebody? Really you know something the infectious diseases team, uh, consulted on in patients. 22 00:03:18,810 --> 00:03:29,610 And also, of course, we had a, uh, extensive outpatient programme, but not a dedicated I.T. facility. 23 00:03:29,610 --> 00:03:34,470 And sorry, you were saying about teaching. I mean, what was that ward rounds or lectures? 24 00:03:34,470 --> 00:03:45,330 Yes. I mean, we had all the states medical school. We had a large number of extremely, by their own admission, extremely bright medical students. 25 00:03:45,330 --> 00:03:54,390 But we also I had a, um, a fellowship programme for training in infectious diseases. 26 00:03:54,390 --> 00:04:08,730 So we had a number of of what we call fellows who spent three years in the programme training in infectious and paediatric infectious diseases. 27 00:04:08,730 --> 00:04:18,030 This was supported by the National Institutes of Health grant that belonged to the department. 28 00:04:18,030 --> 00:04:23,100 Did you have to come to an interview in Oxford or had they killed off the other candidates? 29 00:04:23,100 --> 00:04:34,120 No, it was very odd. Again, Wetherall said, well, you better come along and visit us. 30 00:04:34,120 --> 00:04:49,590 Uh, so I did. Um, and I remember David met me in a pub in the evening that I arrived and he said, oh, by the way, 31 00:04:49,590 --> 00:05:01,350 they'll probably want to talk with you tomorrow for formal the Oxford Quadrille, he called it, which again, was completely unanticipated. 32 00:05:01,350 --> 00:05:07,560 I thought I was just coming to take a look and meet with people. 33 00:05:07,560 --> 00:05:12,420 So actually, this was the electoral board meeting. 34 00:05:12,420 --> 00:05:31,240 There were other candidates and, um, they as far as I know and recall. 35 00:05:31,240 --> 00:05:40,230 There had been other people who had been approached and for one reason or another. 36 00:05:40,230 --> 00:05:46,590 Discarded, I think, because they didn't fit. 37 00:05:46,590 --> 00:05:56,790 To be honest, the real reason was that Harris and Wetherall were dreaming up the Institute of Molecular Medicine, 38 00:05:56,790 --> 00:06:07,050 and it had become obvious that there was a big gap not only in Oxford but in the UK in infectious diseases research, 39 00:06:07,050 --> 00:06:16,680 and which obviously I had been involved in and which was very strong in the United States, but comparatively weak in the UK. 40 00:06:16,680 --> 00:06:19,680 And they wanted somebody for the Institute of Molecular. 41 00:06:19,680 --> 00:06:26,550 If if the Institute of Molecular Medicine, which is a pipe dream at this point, was going to take off, 42 00:06:26,550 --> 00:06:37,080 they've been given a pretty strong hint from Sydney Brenner and others at the MRC 43 00:06:37,080 --> 00:06:45,960 that they ought to have at least one post senior post the professorial level, 44 00:06:45,960 --> 00:07:02,100 obviously, in infection. And so I think that there was not much motivation to appoint people who did not have a molecular genetics background, 45 00:07:02,100 --> 00:07:09,000 which happened because I was in the United States to be a good fit for them. 46 00:07:09,000 --> 00:07:13,260 So when you came over, you got the job, came over. 47 00:07:13,260 --> 00:07:20,430 What did you feel, say, after a fortnight about the Oxford Hospital as compared to the Johns Hopkins? 48 00:07:20,430 --> 00:07:25,950 Do you think they were very different or. I was in a daze. It was so completely different. 49 00:07:25,950 --> 00:07:40,900 But I you know, I, I knew that it was going to be I mean, I come from an institution where the Department of Paediatrics had 119 faculty members. 50 00:07:40,900 --> 00:07:55,990 In the Department of Paediatrics and I had five faculty in infectious diseases, and they were all international figures. 51 00:07:55,990 --> 00:08:06,430 I was coming to the UK in a setting where I was the only card carrying infectious diseases paediatric specialist. 52 00:08:06,430 --> 00:08:20,500 And I was coming to, in a sense, a hospital that combined what one might call tertiary speciality, 53 00:08:20,500 --> 00:08:28,840 um, clinical and research and teaching with a district hospital. 54 00:08:28,840 --> 00:08:45,400 Um, so I was, in a sense, having to get used to the combination of the National Health Service and the university. 55 00:08:45,400 --> 00:08:51,190 But there was a very small cast of characters on the university side in paediatrics. 56 00:08:51,190 --> 00:09:00,230 I mean, we basically had a reader and a lecturer and both of those were destined to leave. 57 00:09:00,230 --> 00:09:05,210 I went to Newcastle and David went to Bristol. 58 00:09:05,210 --> 00:09:17,950 Um, so it was it was radically different, um, from the point of view of what I would call a structure of things. 59 00:09:17,950 --> 00:09:25,840 And I was now obviously expected to be a consultant paediatrician on the NHS, 60 00:09:25,840 --> 00:09:34,510 as well as taking responsibility in my university capacity for research and teaching. 61 00:09:34,510 --> 00:09:48,340 Um, the lines between what a professor does and doesn't do with respect to the NHS has always been, shall we say, ambiguous. 62 00:09:48,340 --> 00:09:57,580 I saw my role very clearly as having, shall we say, leadership vision, um, 63 00:09:57,580 --> 00:10:06,100 rather than being hands on in the management and governance of my NHS position. 64 00:10:06,100 --> 00:10:14,730 But it became very clear. That, as a professor of paediatrics in Oxford, 65 00:10:14,730 --> 00:10:25,300 I had major responsibilities for child health at the national level and the European level, even the international level. 66 00:10:25,300 --> 00:10:31,210 And I think that did coincide with what one might call vision leadership, 67 00:10:31,210 --> 00:10:40,630 but in order to fulfil those, one had to be pretty involved in integrating one's, 68 00:10:40,630 --> 00:10:49,750 um, activities with with all of my colleagues in the NHS, both within the Department of Paediatrics and elsewhere. 69 00:10:49,750 --> 00:10:57,880 So it was a it was very challenging. You mentioned size and organisation, but what about actual clinical care? 70 00:10:57,880 --> 00:11:01,720 Did you feel that the two institutions were roughly similar? 71 00:11:01,720 --> 00:11:07,510 Did you think they were? You know, there was a very, very decisive difference. 72 00:11:07,510 --> 00:11:14,830 I was used to being in the United States for all that time to specialities. 73 00:11:14,830 --> 00:11:29,120 Paediatrics was no longer, you know, a general paediatrician with an interest in people, were oncologists or neurologists or nanotechnologies or. 74 00:11:29,120 --> 00:11:46,820 Infectious diseases specialists, cardiology, etc. I came to Oxford, and in essence, although people had interests in research in the clinical arena, 75 00:11:46,820 --> 00:11:54,200 there was a huge emphasis on being a general paediatrician, as I say, with an interest in. 76 00:11:54,200 --> 00:12:06,110 I found this completely anachronistic and it was my immediate sense that my job, 77 00:12:06,110 --> 00:12:18,680 my vision had to be to essentially put in place a firm basis for paediatrics, sub specialisation. 78 00:12:18,680 --> 00:12:25,010 We didn't even have a centre for cancer in Oxford. 79 00:12:25,010 --> 00:12:37,820 The only recognised subspecialty was neonatal medicine, which Professor Tizard, my paediatrician, my predecessor had built up. 80 00:12:37,820 --> 00:12:50,420 And there I think there were some strengths. But again, it was largely on the back of the NHS with very little in the way of academic appointments. 81 00:12:50,420 --> 00:13:08,520 So the whole structure of things was was extremely different, and I know that to begin with, I was viewed as. 82 00:13:08,520 --> 00:13:31,020 How can I put it an extreme and aggressive head, because I felt no sympathy at all towards those who were harmed, shall we say? 83 00:13:31,020 --> 00:13:38,100 I saw them as meddling around in areas where they didn't have any training, sort of amateurs. 84 00:13:38,100 --> 00:13:44,190 Well, I mean, you know, I give you a very concrete example. I mean, you know, oncology. 85 00:13:44,190 --> 00:13:54,270 Yeah. I mean, to me, it was unthinkable that people who would be looking after patients with solid as well as, 86 00:13:54,270 --> 00:14:03,060 you know, blood malignancies would not be trained. 87 00:14:03,060 --> 00:14:10,140 It was and it looked awful. And there wasn't really an adult centre for cancer. 88 00:14:10,140 --> 00:14:21,030 No. I mean, all of this was to come. Yeah. Things in 1984 were still in I say more traditional. 89 00:14:21,030 --> 00:14:27,090 Obviously, the Department of Medicine was much further ahead because it was so much bigger. 90 00:14:27,090 --> 00:14:37,950 But even there, you know, many areas of expertise were, in a sense, 91 00:14:37,950 --> 00:14:48,810 not covered by people who had been grounded, trained, immersed in their subspecialty. 92 00:14:48,810 --> 00:14:54,570 Do you think. I wouldn't say one compares the nursing or the physiotherapy with Johns Hopkins. 93 00:14:54,570 --> 00:15:03,300 Yeah, I mean, although there were differences in the the management. 94 00:15:03,300 --> 00:15:17,100 The structure of things, because, of course, we didn't have the NHS in the United States, we had a hospital in which everything was integrated. 95 00:15:17,100 --> 00:15:35,850 So in a sense, I did not in the UK, in the US, expect to, you know, attend the meetings of nurses, physiotherapists, whatever. 96 00:15:35,850 --> 00:15:51,450 Yeah, one was much, much more adjacent. Now, in the interface with the NHS meant that one had to be visible and credible to staff such as nurses. 97 00:15:51,450 --> 00:16:00,930 One of the first things that happened, I'd only been in post for a few weeks when suddenly the hospital management, 98 00:16:00,930 --> 00:16:05,700 for financial reasons, decided to close one of the paediatric wards. 99 00:16:05,700 --> 00:16:19,650 And I had to organise a petition signatures from Oxford citizens, but also involve the physiotherapists, people and pharmacy, the nurses, 100 00:16:19,650 --> 00:16:23,370 respiratory technicians and so on and so forth, 101 00:16:23,370 --> 00:16:34,710 so that they became aware that we had a role to play in championing child health because it was a district hospital. 102 00:16:34,710 --> 00:16:48,480 There was no identity as such to paediatrics. We had a ward or several wards and the neonatal unit which were embedded within the district hospital. 103 00:16:48,480 --> 00:16:56,880 But there was no sense of there being a children's hospital, as we now have in the West Wing. 104 00:16:56,880 --> 00:17:16,410 There was no centralisation. Indeed, the hospital was designed in the 60s by people and overseen by people who were not paediatricians. 105 00:17:16,410 --> 00:17:23,460 So none of the wards were ever designed to have children in them or to think about the fact that 106 00:17:23,460 --> 00:17:30,390 parents would need to speak with their children if they were very ill and there were no facilities. 107 00:17:30,390 --> 00:17:39,960 There wasn't even a place where you could take distressed parents and sit them down and talk to them in private. 108 00:17:39,960 --> 00:17:53,770 All of these things became suddenly of huge, a huge dimension of what I could see to be a need for the future. 109 00:17:53,770 --> 00:17:57,810 It was going to take many years. In fact, it took 20 years. 110 00:17:57,810 --> 00:18:07,290 But eventually we did manage to succeed in making the case for and getting the children's hospital. 111 00:18:07,290 --> 00:18:17,070 I'm getting the impression from your turn, really, that you felt that these deficiencies, shortcomings did impact on actual patient care. 112 00:18:17,070 --> 00:18:29,070 Yes, without a doubt. I mean, you know, we had sick children with neurological conditions who were in the Radcliffe Infirmary. 113 00:18:29,070 --> 00:18:42,120 And if they became. Over and above that neurological condition, it was something that needed, you know, 114 00:18:42,120 --> 00:18:50,980 paediatric care, somebody had to go down there or they had to be whisked up to the job. 115 00:18:50,980 --> 00:18:57,850 And people in the Radcliffe Infirmary, with all due respect, did not know how to look after children. 116 00:18:57,850 --> 00:19:02,800 And that's the neurologists or the neurology department. 117 00:19:02,800 --> 00:19:11,680 Yes. And you'd have a house officer supervised by a consultant in adult neurology who may have been on 118 00:19:11,680 --> 00:19:19,720 the job for a few weeks looking after an extremely sick child and having to work out fluid balance. 119 00:19:19,720 --> 00:19:29,560 So we had a number of absolutely awful situations in which kids came up in an ambulance from the R.I to the jail, 120 00:19:29,560 --> 00:19:40,000 and we found that they got pulmonary oedema from being given too much fluid, especially since many of them had ADHD syndromes. 121 00:19:40,000 --> 00:19:47,470 Right. Just for the time that to the teaching had to do find the clinical students compared with. 122 00:19:47,470 --> 00:19:57,530 Wonderful. From the moment I came, one of the great joys was the terrific. 123 00:19:57,530 --> 00:20:09,640 Characters and intelligence and. Depth and breadth of the Oxford medical students, they were ajoy from the word go. 124 00:20:09,640 --> 00:20:21,260 Um, and I think they really liked paediatrics, um, and enjoyed their time on this six to eight weeks that they did. 125 00:20:21,260 --> 00:20:27,970 Of course, it occurred to me very immediately that we had, again, 126 00:20:27,970 --> 00:20:38,260 an incredible system in the UK where about 50 percent of our medical students would end up in general practise, 127 00:20:38,260 --> 00:20:44,770 not necessarily deciding at that time to do that at the time when they were students, 128 00:20:44,770 --> 00:20:49,060 but they would end up about 50 percent would end up in general practise. 129 00:20:49,060 --> 00:20:56,380 And about one third of your practise is paediatrics and child care. 130 00:20:56,380 --> 00:21:09,400 So how I asked myself, can you prepare people to go into general practise when they're going to do six to eight weeks of child health? 131 00:21:09,400 --> 00:21:15,870 Mm hmm. This is clearly not sufficient. 132 00:21:15,870 --> 00:21:20,110 Did you get to change it length and that still the same? Right. 133 00:21:20,110 --> 00:21:31,120 And I still feel that this is a major problem with general practise is that they are unsure and and why wouldn't they be? 134 00:21:31,120 --> 00:21:41,830 It's good that they're unsure about managing children, although the majority of children go to their GP are going to get better. 135 00:21:41,830 --> 00:21:49,870 We know that. But for those who have difficult problems, whether they're acute or chronic, 136 00:21:49,870 --> 00:21:58,840 it's asking an awful lot of general practitioners to have the knowledge to be able to make the right calls. 137 00:21:58,840 --> 00:22:04,330 And as a result, it's my belief that, of course, they need their hand held. 138 00:22:04,330 --> 00:22:12,370 They need to talk to somebody who's a paediatrician to be reassured that they're not doing the wrong thing. 139 00:22:12,370 --> 00:22:17,050 And much of the time they're doing the right thing, but they need to be reassured. 140 00:22:17,050 --> 00:22:25,540 And so, of course, they had to be referred to the hospital. They come to outpatients or they get sent up to the emergency room. 141 00:22:25,540 --> 00:22:35,020 And this is a very inefficient way to carry out primary care in child health. 142 00:22:35,020 --> 00:22:42,550 Did you redesign the courses of rotations of lectures etc for almost completely. 143 00:22:42,550 --> 00:22:54,400 But I would say that I, I was very, very, hugely supported by NHS paediatricians as well as obviously, 144 00:22:54,400 --> 00:23:00,010 um, my academic colleagues who had university appointments. 145 00:23:00,010 --> 00:23:14,260 And the reshaping of the teaching of this eight week course was an evolutionary process that started when I came, 146 00:23:14,260 --> 00:23:23,920 was enormously facilitated by the interest and input, as I say, at the NHS and and my colleagues. 147 00:23:23,920 --> 00:23:36,910 And I think it took roughly five to 10 years before we felt that we had got something that was excellent. 148 00:23:36,910 --> 00:23:45,370 And I believe that from about nineteen ninety four or five onwards, our evaluations, 149 00:23:45,370 --> 00:23:55,660 whether they were formal and external or internal, were uniformly, um, placing paediatric teaching on the top level. 150 00:23:55,660 --> 00:24:00,720 Yeah. Now in the States, have you been doing vaccine work. 151 00:24:00,720 --> 00:24:14,050 Well, yes and no. Yes. In the sense that I was deeply conscious of the work that was going on in the field of Vaccinology. 152 00:24:14,050 --> 00:24:24,820 Um, my own basic research was that not necessarily pragmatic. 153 00:24:24,820 --> 00:24:31,810 And when I came to Oxford and realised that I had a role as a clinician scientist, 154 00:24:31,810 --> 00:24:39,160 it was a no brainer that I needed to take the the interest that I had at the time. 155 00:24:39,160 --> 00:24:49,840 It was my office influenzae type B continue to have a lab that was doing basic research, but I had to develop a clinical programme. 156 00:24:49,840 --> 00:25:01,660 And actually this was a no brainer because the UK, believe it or not, had not caught up with the fact that there was fact. 157 00:25:01,660 --> 00:25:12,960 Seeing that was not just in research and development, it had been implemented in the United States and actually in Finland. 158 00:25:12,960 --> 00:25:21,840 But a curious thing happened, I was told by the head of clinical microbiology, Cellcom was his name. 159 00:25:21,840 --> 00:25:25,500 He said, Why have you come to the UK? We don't have a problem with him. 160 00:25:25,500 --> 00:25:35,490 Office influenzae type B? I said, Oh, that's interesting. Can you show me the the epidemiological data? 161 00:25:35,490 --> 00:25:41,490 And she said, Well, I'm not sure I can point to it exactly, but I'm part of the group of, 162 00:25:41,490 --> 00:25:46,620 you know, public health microbiology that have labs all over the country. 163 00:25:46,620 --> 00:25:51,540 We talk, we meet regularly and we know what's going on. 164 00:25:51,540 --> 00:25:55,470 So I said, so you don't actually have any figures? He said, well, no. 165 00:25:55,470 --> 00:26:01,380 But I mean, you know, all of these labs are processing islands' of him office influenzae. 166 00:26:01,380 --> 00:26:04,260 So we would know. 167 00:26:04,260 --> 00:26:24,450 So at that point, I set up with the help of the US a five year prospective study to actually find out what the incidence of invasive HIB disease was. 168 00:26:24,450 --> 00:26:29,430 And after five years, we found that the incidence was about the same as it had been in Baltimore, 169 00:26:29,430 --> 00:26:36,540 Maryland, in the USA, and it took it took Cellcom completely by surprise. 170 00:26:36,540 --> 00:26:42,870 But he was absolutely delighted that actually it had gone on in Oxford. 171 00:26:42,870 --> 00:26:47,520 So he then gathered all the data, which was perfectly reasonable, 172 00:26:47,520 --> 00:27:01,280 put it under his arm and went off to the meetings and neglected actually to attribute the findings to to the to the pathology, 173 00:27:01,280 --> 00:27:09,960 which would have been such a surprise to the microbiologists who were, as, you know, quite a sort of regimented group. 174 00:27:09,960 --> 00:27:17,130 And the idea I mean, it took people a very long time to come to terms with the fact that as a paediatrician, 175 00:27:17,130 --> 00:27:24,960 I was also a microbiologist of a serious microbiologist. 176 00:27:24,960 --> 00:27:29,970 So that was that was to come to your question, really was yes. 177 00:27:29,970 --> 00:27:41,730 Yes. I needed to extend vaccines from the basic work I was doing in the lab to the epidemiology. 178 00:27:41,730 --> 00:27:49,620 And we then went on to set up clinical trials because having decided that there was a high incidence, 179 00:27:49,620 --> 00:28:00,600 the next step was to to actually do studies to show that the that the vaccine was well accepted and effective in children. 180 00:28:00,600 --> 00:28:06,240 And first of all, Oxfordshire and then Countrywide is the Haemophilus. 181 00:28:06,240 --> 00:28:10,980 This infection, virtually all respiratory tract to. No, no meningitis. 182 00:28:10,980 --> 00:28:19,170 Right. So the biggest problem with meningitis, but there was also a terrible condition called epiglottitis, 183 00:28:19,170 --> 00:28:25,230 which is an acute inflammation of the larynx and life threatening many. 184 00:28:25,230 --> 00:28:32,160 It's a septicaemia disease. So you have conditions like septic arthritis. 185 00:28:32,160 --> 00:28:38,340 You do get pneumonia. But the biggest issue with hip disease was meningitis. 186 00:28:38,340 --> 00:28:47,790 I mean, we would see one or two and sometimes more cases every month at the John Radcliffe and life threatening disease. 187 00:28:47,790 --> 00:28:55,050 So in your first year and then later, how many people did you have, as it were, a unit for? 188 00:28:55,050 --> 00:29:03,940 So I was able to hire immediately on the day that I started a lecturer, David Isaacs. 189 00:29:03,940 --> 00:29:17,400 Um, uh, and very quickly after that, I recruited Simon Kraul, who had been an Oxford student and who was very excited about doing research. 190 00:29:17,400 --> 00:29:26,850 Um, I then was able through the system was very different from what it is now. 191 00:29:26,850 --> 00:29:35,880 I was able to get a new blood investigator award, um, which brought me another, if you will, 192 00:29:35,880 --> 00:29:47,910 position that I had a reader who was I mean, David Beckham's position became vacant rather quickly and so did our Alan Stewart. 193 00:29:47,910 --> 00:29:53,640 Green left almost immediately, um, to go to Newcastle. 194 00:29:53,640 --> 00:30:06,360 So really sort of had to lecturers a new blood and to establish posts. 195 00:30:06,360 --> 00:30:12,420 But I had also asked for research assistance for my laboratory as part of my. 196 00:30:12,420 --> 00:30:17,500 Package, which Henry has supported for three years. 197 00:30:17,500 --> 00:30:29,970 Um, so it was a pretty small operation, but I was able to recruit registrars to doing research and then to generate funding. 198 00:30:29,970 --> 00:30:42,360 Um, so and so I was able to to, in a sense, generate opportunities for people to do a one or two year stint. 199 00:30:42,360 --> 00:30:47,520 When you have a registrar doing research, did he do some clinical. 200 00:30:47,520 --> 00:30:58,890 Yes, often on call as part of their required green stamps that they needed for their career progression. 201 00:30:58,890 --> 00:31:10,590 So they actually wanted to do it to keep their hand in. But in the end, they would do weekends and evenings. 202 00:31:10,590 --> 00:31:16,560 Um, during the day they were doing research. 203 00:31:16,560 --> 00:31:27,190 My guess is that the cut the colleges train of people who look after things, we're aiming to train general paediatricians at time. 204 00:31:27,190 --> 00:31:36,900 Yes. I mean, to be honest with you, I had very little involvement with the Royal College of Paediatrics and Child Health. 205 00:31:36,900 --> 00:31:44,970 Well before that it was actually the British Paediatric Association. 206 00:31:44,970 --> 00:31:53,710 It had none of the characteristics that. 207 00:31:53,710 --> 00:32:04,210 Suggested that I should use it as a I prioritise my time and I thought there are 208 00:32:04,210 --> 00:32:09,670 other people who will go to the PPA and Andrew Wilkinson was a stalwart at that. 209 00:32:09,670 --> 00:32:22,030 And I left nothing. They did look to me, it seemed to me, to be in line with the vision that I had for paediatrics, and I told them so. 210 00:32:22,030 --> 00:32:34,540 But it didn't change and it still hasn't. So when you came and got into the epidemiology and all the other interests, did you continue benchmark? 211 00:32:34,540 --> 00:32:45,070 Well, no, I think I did very well. Some some but more showing people techniques. 212 00:32:45,070 --> 00:32:51,370 But no, I was, you know, in terms of concentrated time at the bench, 213 00:32:51,370 --> 00:32:58,180 that was now impossible and in fact, was a very good reason why after seven years, 214 00:32:58,180 --> 00:33:07,870 I applied to take a sabbatical because I was worried that not having been actively involved in any lab work at the bench myself, 215 00:33:07,870 --> 00:33:13,840 I really had lost a lot of Know-How. 216 00:33:13,840 --> 00:33:18,430 And techniques were exploding in molecular genetics at the time. 217 00:33:18,430 --> 00:33:30,520 So I actually went off to Washington University in the States and Lewis for a year, which was restorative, um, absolutely fantastic. 218 00:33:30,520 --> 00:33:43,420 Um, but those first seven years were, um, well, it was all pretty low, but I think the first seven years were particularly challenging. 219 00:33:43,420 --> 00:33:48,760 You're never worked hard in your life. There's probably. 220 00:33:48,760 --> 00:34:00,910 Yeah, I think that's right. In retrospect, um, it didn't seem like I was working hard. 221 00:34:00,910 --> 00:34:05,260 It just seemed that there were so many things that needed to be done. 222 00:34:05,260 --> 00:34:13,900 I don't think I ever really felt that I was working hard. I mean, in that sort of sounds curious. 223 00:34:13,900 --> 00:34:27,640 I just had day in, day out, enormous sense of I think it was internal pressure that all these things needed, needed attention and needed to be done. 224 00:34:27,640 --> 00:34:35,440 And I was actually when I came to Oxford, very concerned that I would fail. 225 00:34:35,440 --> 00:34:37,870 The challenge seemed to me to be enormous. 226 00:34:37,870 --> 00:34:46,810 It seemed to be wonderful and the promise of the Institute of Molecular Medicine, which didn't actually happen until nineteen eighty eight. 227 00:34:46,810 --> 00:34:54,340 So that was four, five years after I'd arrived with a wonderful vision and idea. 228 00:34:54,340 --> 00:34:58,960 And I embraced that with passion. 229 00:34:58,960 --> 00:35:04,770 But again, it was going to be a huge amount of work and time. 230 00:35:04,770 --> 00:35:12,900 Um so uh. My recollection is that most days I was up half, 231 00:35:12,900 --> 00:35:24,300 five or six trying to get some quiet time before going in and that I very rarely got into bed before 1:00 or 2:00 in the morning. 232 00:35:24,300 --> 00:35:29,460 Did you feel you got enough sleep? No, I was sleep deprived and I knew it. 233 00:35:29,460 --> 00:35:38,280 Yes, sure. Um, but I had somebody who who never seemed to share it, and in fact, I couldn't believe it. 234 00:35:38,280 --> 00:35:46,200 And, of course, you know, in my mind, David Weatherall was the with the model, um, 235 00:35:46,200 --> 00:35:53,310 he not only was very supportive, but I looked to him for how did he do things? 236 00:35:53,310 --> 00:35:59,700 And in fact, I realised that, you know, he was physiology was different. 237 00:35:59,700 --> 00:36:11,970 I never, never have met anybody who was able to do so much of such high quality despite being, you know, largely without sleep. 238 00:36:11,970 --> 00:36:17,220 I once stuck a note on his door and the old level seven, which said, Wetherall, 239 00:36:17,220 --> 00:36:24,700 Wetherall, how do you do it all now before the I am where was the laboratories? 240 00:36:24,700 --> 00:36:30,700 The military was on the fourth floor at a relatively small laboratory in that corridor. 241 00:36:30,700 --> 00:36:40,800 Yeah, that's where I housed myself. And then there was another one a bit further down, which eventually became the laboratory for the reader, 242 00:36:40,800 --> 00:36:46,980 Mark Gardner, who was working more on human genetics. 243 00:36:46,980 --> 00:36:50,880 And, uh, yeah. Now, I don't understand. 244 00:36:50,880 --> 00:36:54,720 In the States, you've been doing what you call basic work, as it were. 245 00:36:54,720 --> 00:37:00,480 And then over here you had to generate a vaccine. Well, the vaccines, yes. 246 00:37:00,480 --> 00:37:08,940 Yeah. The basic work was really that I was looking at the genetics of, um, capsule production, 247 00:37:08,940 --> 00:37:15,390 the B capsule of the organism, which is a complicated macro molecule. 248 00:37:15,390 --> 00:37:22,380 So there's obviously the synthesis, its transport, its assembly, its expression. 249 00:37:22,380 --> 00:37:34,680 And so there was a large amount of DNA within the genome of the organism devoted to making this antigen and expressing it. 250 00:37:34,680 --> 00:37:38,340 And this is the key virulence factor of the organism. 251 00:37:38,340 --> 00:37:44,220 But it was also the target for antibodies that would be protective. 252 00:37:44,220 --> 00:37:56,130 So the vaccine incorporated the antigen, the B antigen, the capsule polysaccharide with some modifications to make it more immunogenic. 253 00:37:56,130 --> 00:38:02,370 That work was not part of what I had done. 254 00:38:02,370 --> 00:38:10,470 I was doing so say the work on the genetics to try and find out much more and also to be 255 00:38:10,470 --> 00:38:20,020 able to make mutants that would allow us to dissect the role of the antigen in the disease. 256 00:38:20,020 --> 00:38:33,450 It was very unclear what role the type B antigen had in carige colonisation, transmission, invasion and so on and so forth. 257 00:38:33,450 --> 00:38:48,090 Um, but because a vaccine formulation had been developed in the United States. 258 00:38:48,090 --> 00:38:58,140 It was now a question of implementing that formulation, and that's why we needed the epidemiology of clinical trials, 259 00:38:58,140 --> 00:39:05,130 and this led eventually to the formation of what is now the Oxford vaccine group. 260 00:39:05,130 --> 00:39:08,970 Is there a genetic so human susceptibility? Yes, there is. 261 00:39:08,970 --> 00:39:17,940 And we didn't work on that. Now, later, you came to have to generate your own vaccine, not to be that road. 262 00:39:17,940 --> 00:39:29,940 You worked on another subject yet? Well, when the head was introduced in 1990, 92, we did a lot of work to see what happened. 263 00:39:29,940 --> 00:39:40,590 But I began to realise that I wanted to move on to meningococcus, another cause of meningitis and septicaemia. 264 00:39:40,590 --> 00:39:49,170 And the big problem there was that the model of conjugate vaccines which worked for him, 265 00:39:49,170 --> 00:40:00,150 worked for many of the strains of meningococcus, was not going to work for the B strain of the meningococcus. 266 00:40:00,150 --> 00:40:06,570 So a new approach was needed and in 1993, 267 00:40:06,570 --> 00:40:15,630 for an era began to emerge that was going to revolutionise the whole of infectious diseases, indeed of biology. 268 00:40:15,630 --> 00:40:25,380 And that was whole genome sequencing. I was deeply involved in that with my mentor from the United States and with Craig Venter. 269 00:40:25,380 --> 00:40:38,640 Right. And so the Home Office influenzae was first completely sequenced living organism in ever. 270 00:40:38,640 --> 00:40:47,070 So you setting and that set the phase for being able to do genome sequencing. 271 00:40:47,070 --> 00:41:01,440 And around 97, I began with Craig Venter to explore how we could not only sequenced the complete genome of the meningococcus B, 272 00:41:01,440 --> 00:41:13,920 but use that as a a directory of every antigen that might be included in the vaccine, of which there were about 600. 273 00:41:13,920 --> 00:41:26,280 But crucially, that time a colleague, Tripoli from Italy, who was the chief scientific officer for current vaccines, was going the same direction. 274 00:41:26,280 --> 00:41:30,600 And we formed a tree as a triad. 275 00:41:30,600 --> 00:41:40,430 Oxford Tyga, the Institute for Genome Research in USA and Kairouan and CNR that started in 97. 276 00:41:40,430 --> 00:41:50,190 The strain came from Stroud in the outbreak, the meningitis outbreak, which I sent to Craig Venter for sequencing. 277 00:41:50,190 --> 00:42:02,430 And by 2000 we had assembled and had the complete sequence of a strain, the Stroud strain of the meningococcus, 278 00:42:02,430 --> 00:42:10,740 which allowed us to interrogate the genome to find other potential antigens. 279 00:42:10,740 --> 00:42:19,770 As I say, there were over 600 possibilities that had to be narrowed down and was narrowed down over the years, 280 00:42:19,770 --> 00:42:31,650 the next few years, to the point where a vaccine formulation containing effectively four antigens was made. 281 00:42:31,650 --> 00:42:47,670 Kairouan by now become Novartis. And it took until 2013 before all the clinical trials and testing and rigmarole that goes into producing 282 00:42:47,670 --> 00:42:55,500 a vaccine satisfy the European Medicines Agency that we had a vaccine that they could licence. 283 00:42:55,500 --> 00:43:01,260 And do you think all the rigmarole as a due and proper process so extensive? 284 00:43:01,260 --> 00:43:21,500 It's a very, very good question. Safety of vaccines is so important that the public, I think, would say they want no stone, 285 00:43:21,500 --> 00:43:37,070 no stone left unturned in the bureaucracy and the communications and the inevitable fallout from commercial companies 286 00:43:37,070 --> 00:43:49,040 making vaccines and government supported institutions regulating them is a difficult is a very difficult recipe. 287 00:43:49,040 --> 00:44:08,390 I am absolutely clear that the process is too long and it's not always efficient and it is very, very difficult to know how one can improve it. 288 00:44:08,390 --> 00:44:15,020 Mm hmm. You hinted that quite a lot of data was derived, been obtained in the States. 289 00:44:15,020 --> 00:44:23,130 How much data was obtained in Oxford? Well, you said, well, what was happening was we were getting just the sequence data from the United States. 290 00:44:23,130 --> 00:44:27,830 All of the analysis was going on in Oxford and in Siena. 291 00:44:27,830 --> 00:44:33,410 Right. And was Craig Venter doing an American strain when they doing this trial? 292 00:44:33,410 --> 00:44:35,480 Oh, no. That was that was our strain. 293 00:44:35,480 --> 00:44:44,240 And he was really just supervising the project, along with many other bacterial genomes, which they were sequencing. 294 00:44:44,240 --> 00:44:51,800 And again, I don't think he knew at the time whether or not it would ever get to being a vaccine. 295 00:44:51,800 --> 00:45:01,160 But it was obviously very delighted when it did. Now, you had your sabbatical and at the end of that, did you come back with a reformed structure? 296 00:45:01,160 --> 00:45:07,250 I mean, were are you going to do things different? No, there was. I mean, the sabbatical was absolutely pivotal. 297 00:45:07,250 --> 00:45:18,150 My lab changed dramatically at that point into. 298 00:45:18,150 --> 00:45:27,240 We had stumbled across a genetic trick that a bacterium has for invading host immune responses, 299 00:45:27,240 --> 00:45:39,780 and the technical details are not perhaps of interest, but we discovered repetitive DNA in bacterial genomes, which is a complete surprise. 300 00:45:39,780 --> 00:45:48,030 And that was a really exciting discovery because the repetitive DNA actually 301 00:45:48,030 --> 00:45:54,510 showed us how amorphous influenza and meningococcus and many other organisms, 302 00:45:54,510 --> 00:46:06,150 it turned out, are able to shuffle their genes and create a variation on the surface of the bacterium to confuse the immune defences. 303 00:46:06,150 --> 00:46:15,030 We call them contingency genes because bugs never know what environment they're going to be in and the host. 304 00:46:15,030 --> 00:46:21,540 So as you go from one person to another, you go into a completely different ecological niche. 305 00:46:21,540 --> 00:46:24,000 How do you adapt quickly? 306 00:46:24,000 --> 00:46:35,760 And the repetitive DNA turned out to be one of the keys to understanding the behaviour of the organism and its successful encounters with the host. 307 00:46:35,760 --> 00:46:45,750 And we spent many years working on that with a huge grant from both the MLSE and from the Wellcome Trust. 308 00:46:45,750 --> 00:46:55,670 But I returned from the sabbatical. Had you decided to change your interactions with the NHS? 309 00:46:55,670 --> 00:47:02,360 I suppose very gradually, 310 00:47:02,360 --> 00:47:15,170 circumstances were making it easier for me to be less involved with the NHS because the structure of paediatrics and child 311 00:47:15,170 --> 00:47:24,140 health had now become much more streamlined and huge numbers of appointments at the consultant level were made in paediatrics. 312 00:47:24,140 --> 00:47:30,590 We went from, I think, about six or seven consultants in 84. 313 00:47:30,590 --> 00:47:42,680 By the time I finished, there were more than 70 consultancies. And so what started off and I mean, that wasn't driven by me. 314 00:47:42,680 --> 00:47:50,870 That was circumstances. I mean, people began to realise that child health paediatrics was so important and one thing led to another. 315 00:47:50,870 --> 00:47:57,380 There was the money coming from the government for that, for the expansion of the consultants. 316 00:47:57,380 --> 00:48:04,340 Know that was coming, you know, first of all, from the regional health authority and then the government on it. 317 00:48:04,340 --> 00:48:11,330 Yes, it is. Yes, it's government money. But but obviously also going through the. 318 00:48:11,330 --> 00:48:21,260 Yeah. So who was the regional chief medical officer paying and could well actually started off being. 319 00:48:21,260 --> 00:48:24,740 What was her name. Oh Rosemary. Rosemary Roux. Yes. 320 00:48:24,740 --> 00:48:28,580 Who's wonderful taste. Yeah. She was absolutely so supportive. 321 00:48:28,580 --> 00:48:34,540 And um then Chris Paine was the sort of district officer and Alex Gatherer. 322 00:48:34,540 --> 00:48:40,480 It was very important. I worked very closely with Alex and Chris, but not Chris Paine. 323 00:48:40,480 --> 00:48:45,050 What pain I think it was they may have been. 324 00:48:45,050 --> 00:48:48,780 Chris, thank you. Yes. I worked very closely with Alex Gather. 325 00:48:48,780 --> 00:48:58,010 In fact, the other day I found my Talk Green College on the future of child health, which was in nineteen eighty eight. 326 00:48:58,010 --> 00:49:03,500 Right, in which I laid out the dream of the Children's Hospital. 327 00:49:03,500 --> 00:49:07,640 And um, it's quite interesting to read it now. 328 00:49:07,640 --> 00:49:14,450 Yeah I know, but yes, I mean I had to work very closely, obviously, 329 00:49:14,450 --> 00:49:29,330 not only with them but also with the succession of people who were the chief execs of the of the trust of which Nigel Crispen was the most fantastic. 330 00:49:29,330 --> 00:49:39,140 He stood out like a sore thumb against a background of very droll and inefficient characters. 331 00:49:39,140 --> 00:49:50,570 And I was very involved in trying to get the money through the regional health authority and the McGray for for a proper vaccine centre, 332 00:49:50,570 --> 00:49:55,370 which is now, of course, the Centre for Clinical Vaccinology and Tropical Medicine. 333 00:49:55,370 --> 00:50:06,250 We thought we had that money from R&D, but they removed all R&D funding in December of 2006. 334 00:50:06,250 --> 00:50:13,010 And did you manage to close it? Yes, no. Well, I put in an application to Geoff, the Joint Infrastructure Fund, 335 00:50:13,010 --> 00:50:19,460 and that's how we got the money for the Centre for Clinical Pathology, and that would be an NHS fund known. 336 00:50:19,460 --> 00:50:24,950 And that was combined because the John Warren Ward was on that site. 337 00:50:24,950 --> 00:50:39,430 We combined really a university based project with the NHS. 338 00:50:39,430 --> 00:50:47,620 Now, when you say that side, that was the church, yes, it was that the first time you'd spread the church? 339 00:50:47,620 --> 00:50:54,550 Yes, except that, of course, we did interface a lot with orthopaedics, for example. 340 00:50:54,550 --> 00:51:00,320 And but, yes, that was the first time that I had to have an office on the church side. 341 00:51:00,320 --> 00:51:04,000 Yeah. And now you must have been travelling quite a bit. 342 00:51:04,000 --> 00:51:05,680 Yes. Huge amount. Yes. 343 00:51:05,680 --> 00:51:22,510 I felt that we had to the part of my job was to be a PR agent for showing that we were a research department of international stature. 344 00:51:22,510 --> 00:51:30,340 Plus, I enjoyed obviously the the contact and giving lectures and and. 345 00:51:30,340 --> 00:51:39,220 Yeah. And you were writing articles on show, um, only 500 about seven years. 346 00:51:39,220 --> 00:51:53,030 Well I suppose when I came to Oxford I had. Twenty eighteen, so more than 400 articles call because when did you start? 347 00:51:53,030 --> 00:51:57,230 I'm still waiting. Oh, yeah, I don't remember from the 2008. 348 00:51:57,230 --> 00:52:05,330 Yes. Yeah, that's when the university decided that my contract was null and void. 349 00:52:05,330 --> 00:52:08,900 And when you did retire, what did you miss anything particular? 350 00:52:08,900 --> 00:52:19,700 Well, yes, closing my lab was had me extremely, I would say, sad and depressed for several months. 351 00:52:19,700 --> 00:52:27,530 But you I'm working in it. Well, you know, I faced a decision which I took with Marianne. 352 00:52:27,530 --> 00:52:31,760 If I was going to continue my lab, 353 00:52:31,760 --> 00:52:40,580 then I would have had to obviously have applied for funding and then I would have had to have gone to a different department. 354 00:52:40,580 --> 00:52:47,660 I was adamant that it was the wrong thing to do to stay in my own department, especially when it's a relatively small one. 355 00:52:47,660 --> 00:52:56,240 Yeah, but the imam would allow you to. Well, the imam is a hotel and that requires that you pay your dues. 356 00:52:56,240 --> 00:53:03,110 So you've got to be part of a department to be in the imam. You've got to be affiliated to somebody. 357 00:53:03,110 --> 00:53:09,170 It's a bit different now because there is a provision for various units within the imam. 358 00:53:09,170 --> 00:53:17,050 But from my point of view, it was it was I would have to go to the Nuffield Department medicine or somewhere and say, what do you have me? 359 00:53:17,050 --> 00:53:22,040 Hmm. And I thought to myself, you know, you're sixty seven. 360 00:53:22,040 --> 00:53:32,540 Why would a head of department want to take you on in preference to somebody who's thirty eight and Brighton years ahead? 361 00:53:32,540 --> 00:53:43,880 And how do you know you will get funded because you can't put in an application for funding without the backing of your head of department. 362 00:53:43,880 --> 00:53:54,830 And I thought, do I really want to go this route, you know, down on my hands and knees to Peter Radcliffe to please take me on you a figure of speech? 363 00:53:54,830 --> 00:53:57,500 And I thought, hang on a second. 364 00:53:57,500 --> 00:54:08,750 What about, you know, you're so young at 67, why don't you reformulate you can do research with other people in other labs. 365 00:54:08,750 --> 00:54:13,220 And then Reno came up and you said, well, for God's sake, you said it's a no brainer. 366 00:54:13,220 --> 00:54:19,680 I'd like you to spend 50 days of the year in Siena. 367 00:54:19,680 --> 00:54:31,220 Who wouldn't? And what you will do there is work with all the scientists who are on the early research programmes. 368 00:54:31,220 --> 00:54:39,090 It'll be with the PhD students. You'll be holding lab meetings one on ones, providing advice, whatever. 369 00:54:39,090 --> 00:54:46,470 And I thought, well, that's two months of the year. And I thought, well, your own counsel for Institut Pasteur, 370 00:54:46,470 --> 00:54:57,780 that is four meetings a year and that takes up at least six weeks of time while then you're on the Advtech and I, 371 00:54:57,780 --> 00:55:06,890 it is up and suddenly six months of the year were completely and utterly taken care of. 372 00:55:06,890 --> 00:55:12,650 I would be working full time on those days, if not more. 373 00:55:12,650 --> 00:55:16,910 And at that point I thought, right, I will give this a go. 374 00:55:16,910 --> 00:55:21,740 If it doesn't work, I'll find another way. 375 00:55:21,740 --> 00:55:41,760 But I don't have to have my own lab and go through this machination which and then I felt after 30, what would have been ative 74 was my first. 376 00:55:41,760 --> 00:55:50,460 Seventy four, twenty six plus eight, thirty four years of getting funding, fighting, 377 00:55:50,460 --> 00:55:59,400 fighting for it and being responsible for 10 to 15 people just in my lab, 70 people in the Oxford Vaccine Group. 378 00:55:59,400 --> 00:56:04,410 And I certainly thought that's what keeps you awake at nights. 379 00:56:04,410 --> 00:56:10,680 Wouldn't it be nice just to do that? So that's that's the answer. 380 00:56:10,680 --> 00:56:14,280 But you asked me the question was yes. 381 00:56:14,280 --> 00:56:23,370 I mean, not having my own lab was was very painful, but I soon rationalised and got used to it. 382 00:56:23,370 --> 00:56:30,390 Let's go back to a particular question. You were saying how difficult oncology was when you arrived? 383 00:56:30,390 --> 00:56:32,790 Well, it's just an example. Yeah, I know. 384 00:56:32,790 --> 00:56:43,560 But when you left, um, say there was a sick child with a cousin, would they be in the church or would they be in the job market? 385 00:56:43,560 --> 00:56:51,790 Well, the situation was that, uh. 386 00:56:51,790 --> 00:57:02,560 The consultant oncologist's of which there were three by the time I finished, were really working hand in glove with adult colleagues, 387 00:57:02,560 --> 00:57:09,580 using facilities on all of the sites, but also recognising where their limitations were, 388 00:57:09,580 --> 00:57:14,950 which is one of them very important roles that oncology specialists must do. 389 00:57:14,950 --> 00:57:19,540 You know, have we got what it takes here? Do I need to refer? 390 00:57:19,540 --> 00:57:37,600 And if so, to who? So, um, the there was no oncology centre for children as such, but we did have the expertise now in being head of a department. 391 00:57:37,600 --> 00:57:45,220 I've got the feeling that you're in the zone, as it were, modern school like David Wetherall, where you would take a topic. 392 00:57:45,220 --> 00:57:48,280 And by and large that was where the research went. 393 00:57:48,280 --> 00:57:55,870 Well, say Pickering, way back he believed in let a thousand flowers bloom, you know, here, there and everywhere. 394 00:57:55,870 --> 00:57:57,460 And what are your thoughts about? 395 00:57:57,460 --> 00:58:09,710 Well, I mean, you know, times change to compete successfully on the international scene for MRC, Wellcome Trust, European funding, whatever. 396 00:58:09,710 --> 00:58:17,200 There's no way that you can say, well, I'll do a little bit of haematology and a little bit of oncology and the mandates here. 397 00:58:17,200 --> 00:58:27,300 And, oh, yeah, infection could be interesting. So the eclectic approach of Pickering, I mean, I admire it, but it's it's absolutely it was impossible. 398 00:58:27,300 --> 00:58:35,830 And we had to build a reputation for basic and applied research and infections. 399 00:58:35,830 --> 00:58:45,070 And I chose to focus on the lab stuff on bacteria, meningitis, pathogens, the neonatal unit, 400 00:58:45,070 --> 00:58:53,380 which was a very important area for clinical research, managing infections in the newborn nursery. 401 00:58:53,380 --> 00:59:00,580 And then obviously the outreach, the clinical trials and all that goes with clinical trials, 402 00:59:00,580 --> 00:59:05,880 including epidemiology, which was the Oxford Vaccine Group. 403 00:59:05,880 --> 00:59:21,090 So that's the that was my decision as to how we would remain viable and that and unrealistic now really bright like David Dunga, 404 00:59:21,090 --> 00:59:28,530 we are sorry to see him go. Yes, he was very bright, eccentric individual. 405 00:59:28,530 --> 00:59:34,530 I had a great deal of time for David. He was very difficult to communicate with. 406 00:59:34,530 --> 00:59:45,450 And he only came to see me when he wanted something and when I would talk to him out of genuine interest about what he was up to. 407 00:59:45,450 --> 00:59:53,430 I always got the feeling that he thought I was asking him so that I could criticise. 408 00:59:53,430 --> 01:00:02,370 He was quite defensive, defensive, but also had a very strange, um. 409 01:00:02,370 --> 01:00:07,860 I don't think he understood me as a scientist. 410 01:00:07,860 --> 01:00:10,890 I think he saw me as hierarchical. 411 01:00:10,890 --> 01:00:20,790 And that makes sense because David Dunga was brought up and he was a survivor where the quality of what he did was never going 412 01:00:20,790 --> 01:00:31,350 to be at the time that he was a senior registrar and a young consultant was never going to be the way you would get on. 413 01:00:31,350 --> 01:00:38,520 Mm hmm. I think he was a very bright, creative individual. 414 01:00:38,520 --> 01:00:45,000 And had he been in different circumstances, he was already pretty well known. 415 01:00:45,000 --> 01:00:53,040 I mean, don't get me wrong, but had he been brought up in the kind of environment that I was lucky enough to be brought up and, 416 01:00:53,040 --> 01:01:01,290 you know, at Johns Hopkins and Boston and so on, I think he would have been a completely different kind of individual. 417 01:01:01,290 --> 01:01:06,200 Do you think he found that in Cambridge? I'm not sure. 418 01:01:06,200 --> 01:01:13,050 I I sort of get the feeling that it was more of the same. 419 01:01:13,050 --> 01:01:22,590 And by this time, David's personality and the way he did things and I don't know the difficulties he seemed to get himself into, 420 01:01:22,590 --> 01:01:24,300 hung around him again. 421 01:01:24,300 --> 01:01:33,540 I don't think he was any more successful in building bridges with colleagues, despite the fact that they were very warm in wanting to receive him. 422 01:01:33,540 --> 01:01:40,210 I think he continued to have a sort of paranoid defensive close to his chest. 423 01:01:40,210 --> 01:01:45,630 Don't let anybody know what you're up to. That's just my impression. 424 01:01:45,630 --> 01:01:50,040 But I want to say that I thought very highly of him. Now, have I? 425 01:01:50,040 --> 01:02:01,250 Is there something I should be asking you about or do you want to tell me? 426 01:02:01,250 --> 01:02:14,750 Well, I would I would like to say that if I had some doubts when I came to Oxford initially and I did, I'm so glad I made that decision. 427 01:02:14,750 --> 01:02:18,230 Of course, I've got no control as to what would have no control. 428 01:02:18,230 --> 01:02:23,630 Experience would have happened if I had stayed in the States. I think I was incredibly fortunate. 429 01:02:23,630 --> 01:02:35,760 I came at a time when it was all waiting to be done and all I needed to do was to apply oneself more than someone. 430 01:02:35,760 --> 01:02:39,830 Yeah, OK. But that was easy for me. 431 01:02:39,830 --> 01:02:50,600 What I couldn't have dealt with and there were only a very few such instances were insoluble problems. 432 01:02:50,600 --> 01:02:55,130 I mean, if it can be done and but there are some that are insoluble. 433 01:02:55,130 --> 01:03:02,000 You can have people problems, structural problems, work problems. 434 01:03:02,000 --> 01:03:05,780 You know, I have incredibly good fortune. 435 01:03:05,780 --> 01:03:20,780 I had only one person in the entire time and I was chairman with whom I could not get on and where it got to three wise men and all of that. 436 01:03:20,780 --> 01:03:26,130 And it hurt me. I still. 437 01:03:26,130 --> 01:03:32,230 Still worries me, you know, I mean, I hated the confrontation. 438 01:03:32,230 --> 01:03:39,450 It was unavoidable and it was a nightmare. 439 01:03:39,450 --> 01:03:44,820 But rest, I had such fantastic people around me, the students, the colleagues. 440 01:03:44,820 --> 01:03:50,170 Why would I stay in Oxford? Very simple reason. People. 441 01:03:50,170 --> 01:03:57,340 Oxford is just fantastic because of the people, maybe the university doesn't do everything, 442 01:03:57,340 --> 01:04:09,470 but people are wonderful and that's the the abiding thing that I've had the fortune to have been a clinician scientist. 443 01:04:09,470 --> 01:04:19,010 In a setting where it's been a joy to work with so many fantastic people and that without a doubt made it so, 444 01:04:19,010 --> 01:04:31,680 so much easier to be able to get things done. I don't want to go into the particular details, but what did you think of the three wise men set up? 445 01:04:31,680 --> 01:04:50,980 It provided a way to solve a problem that had become impossible, it was bureaucratic, it was. 446 01:04:50,980 --> 01:05:06,250 Clumsily handled, but it did at least get to the point where the boil burst, right, and lines were drawn, 447 01:05:06,250 --> 01:05:58,950 decisions were made by the individual in question very quickly left or look to leave and did leave. 448 01:05:58,950 --> 01:06:09,690 One last thought, I want to just add one thing, and that is I have been so fortunate to because my home life has been wonderful, 449 01:06:09,690 --> 01:06:17,100 wonderful kids and fantastically supportive wife, very happy marriage and good health. 450 01:06:17,100 --> 01:06:22,710 And, you know, yeah, all of those things are easy to take for granted. 451 01:06:22,710 --> 01:06:28,090 One, I thought you were saying that your chief in America, Johns Hopkins, had, as it were, 452 01:06:28,090 --> 01:06:33,030 recommended you to Oxford, but now you'd known David Weatherall and Johns Hopkins. 453 01:06:33,030 --> 01:06:36,960 There was really. No, never. Oh, I thought we did not overlap. 454 01:06:36,960 --> 01:06:42,120 Well, they both had. Yeah, yeah. But at different times I had never heard of him. 455 01:06:42,120 --> 01:06:47,670 Right. Right. And where did you get that stunning picture, Stella? 456 01:06:47,670 --> 01:06:57,480 Because when I was doing a lecture for I was asked to give the Hattie Alexander Memorial Lecture at New York. 457 01:06:57,480 --> 01:07:04,290 I wanted to trace the I knew by this time that Stella had been the technician for one of the 458 01:07:04,290 --> 01:07:10,290 faculty members in the Department of Biochemistry in the School of Public Health at Johns Hopkins. 459 01:07:10,290 --> 01:07:19,140 And so I asked her if she had any pictures of of, uh, of Harriet, Roger, Harriet and herself. 460 01:07:19,140 --> 01:07:24,930 And she did not have anything else. But and what's been a marvellous interview. 461 01:07:24,930 --> 01:07:27,804 Thank you very much, Richard. I hope it's been helpful. Yeah.