And. Welcome to the Centre of Personalised Medicine podcast hosted by John Lee, president of the Oxford Personalised Medicine Society, and me,
Dr. Monica Cooper, junior research fellow at the centre, the Centre for Personalised Medicine KPM is a partnership between University of Oxford.
Welcome Centre for Human Genetics and Suntans College, Oxford.
The KPM provides opportunities for students, academics, clinicians and the public to explore the benefits and challenges personalised medicine.
In the second episode of our Meet the Advisory Board series, we have the honour to talk today Mary,
after she started her career as a chemist with a focus on sustainable energy production and solar energy conversion,
and taught and research at both Oxford and Cambridge University when she left academia.
She had a number of appointments amongst them, chairing Cambridge University Hospitals,
NHS Foundation Trust and currently chairing the Science Museum Group.
In 2012, she was appointed Dame Commander of the British Empire for Services to the NHS.
We had the pleasure to talk to her about her experience of working in academia and industry,
her views on personalised medicine and clinical practise, and much more.
Thank you so much. Then Mary Hart joining us today. It is our honour to have you with us.
You've had a really interesting and exciting career path. What would you say is the most notable moment in your career?
I have had an interesting and diverse career, and I think one of the things I would say is that when I've changed course, I haven't always.
At once thought I've done the right thing, but I think the most.
Notable thing did do was to be offered and accept the chairmanship of Cambridge
University hospitals because that really set me off in a new direction of chairing,
being in charge in some ways of a large and complex organisation.
And I found that an enormously interesting thing to do.
I was very privileged position to be in a position of considerable influence to do good, and I really enjoyed that.
So I think probably that move, that career move was the most notable thing I've done.
I've switched to a bit of a different part of your career first.
You've done a lot of work as a chair of the Board of trustees of the Science Museum Group.
This is a hugely important part of public engagement in the historical aspects of science.
But as a scientist yourself, how do you think science can also increase public engagement with the modern scientific development?
It's a good question because, of course,
the very nature museum tells you that the Science Museum and other museums are going to be partly about the past.
And the one a wonderful collection of objects that we have in the five museums, in fact,
in the Science Museum Group are the world's most major collection of scientific technical engineering artefacts,
dating mostly back to the 18th century and beyond more recently.
But on the other hand, a strategic document and our mission statement is about inspiring futures,
by which we mean inspiring the futures of young people to be literate in and sympathetic to STEM subjects.
We can't all we shouldn't all be scientists, but we should all be sympathetic and literate in science,
just as we should all be literate in English and mathematics,
because the extent to which our culture is underpinned by STEM and digitally underpinned is ever increasing.
And it's a huge part of one's life, I think, to have these tools at one's disposal.
So in the museum, we aim to inspire people about the future and to build what we call science capital in individuals and society and in our visitors,
both our physical visitors and our virtual visitors, of which there are over 11 million.
By igniting curiosity about the wonderful inventions that we show, the wonderful bits of kit,
the wonderful people who have made these discoveries created these improved devices and machines and equipment to make people appreciative of science.
Now nobody is forced to go into a museum, not like you're forced to go to school when you're a youngster.
And so we have to do all this in an informal and engaging way.
And so going back to your question about engaging people, we put on a lot of events at the moment, virtual webinars about things.
We've had a very interesting series of blogs from the science director of the Science Museum, Roger Highfield, on covid.
As the pandemic has unfolded and museums have to, as it were,
refresh their appearance and not seem at all cobwebby because the first rule of running
a museum is you've got to get them in through the door or through the virtual door,
and then you can engage the museum, which still feels a bit like something as gate captive and way.
Yes. So we are the most family friendly of all the national museums in a normal year.
And let's hope we get back to one of those soon. In a normal year in book school groups with their school teachers ready for a learning experience,
we have through the doors of our five museums, over 600000 schoolchildren every year.
So we do operate at scale and have a duty and a responsibility to those youngsters to ignite their curiosity.
Perhaps one in 100 is influenced to become a scientist.
Moving on to our next question.
Having spent 10 years touring the campus, university hospitals, NHS trust and spending time directing the Addenbrooke's Charitable Trust,
how does your perception of health care in the UK changed both before and after this release?
Well, when I took up the chair of Cambridge University Hospitals, I had already been on the board for 10 years.
So I had been associated with Addenbrooke's Hospital and the Rosie,
which is the Associated Maternity Hospital since 1993, during which time the NHS itself changed a lot.
So when I first became involved, it was when the whole notion of NHS trusts were new.
That's to say organisations with boards that had a reasonable degree of self governance,
whereas before there were regional health authorities and the hospitals were run very
much as units within those bigger organisations by managers rather than boards.
And then came along the so-called Foundation Trust Movement, which again gave trusts who got foundation status,
more autonomy and the freedom to borrow money, for example, which is quite important if you want to develop your hospital.
So I think it would be fair to say that when I went on the board back in the early nineties,
I knew remarkably little about the structure of the NHS and I learnt as I went along and it evolved as I went along.
So fast forwarding to now there have been.
Well, a number of organisational changes over the years, the internal market,
so-called internal market between so-called purchasers and so-called providers was introduced.
The idea to introduce competition between different hospitals and organisations for the same patient, if you like.
So you'd have to offer better terms. That idea has fallen out of favour and it was organisationally complex.
And the idea of integrated care has come in, so I think what I would say of the NHS now,
apart from the fact that I think it has coped remarkably well with the covid epidemic.
Is that it would be good to have a period.
Of organisational stability, because these huge reorganisations are very time consuming and quite expensive,
and I think that has sometimes been a tendency when things don't seem right to
change the organisation rather than change the way that organisation does things.
But I am a big fan of the NHS.
It is a noble ideal that is largely realised in practise that people are treated without charge to them at the point of need,
not according to the ability to pay. That being said.
There's quite a lot of work to be done on public health in the United Kingdom.
We are the most obese nation, is it in Western Europe?
And we saw that, I think, in the very bad mortality statistics in the first couple of covid waves where being obese or having diabetes,
which often goes together, of course. And having hypertension is a big risk factor.
So I think there is a lot of work to be done on public health.
Maybe recovering from the pandemic will spur us on, but it's often been said that the NHS is not a national health service,
it's a national sickness service, which is, of course, true.
You don't go to hospital unless there's something wrong and preventative medicine and healthy lifestyles and so forth.
I don't know, it's something we don't. Do very well.
So if I was still involved with the NHS, which I am actually, but not in the way of,
you know, having to influence or seeking to influence the direction of travel.
In terms of what gets the money. It would be to.
Work on on public health and public health improvement.
What I hear is that your work has influenced you and things, and we noticed that you spent time in academia as well as the cross industry.
How do you think these experiences compare? And would you recommend that to people to spend time in both sectors?
Yes, I would. I think that most people nowadays, perhaps involuntarily, as much as voluntarily, will have several career changes of direction.
The days when you sort of joined up ISSI fresh out of your chemistry finals in my case,
and sort of stay there until they give you a gold watch on retirement that just gone.
And so people need to prepare for a more diverse career, which I have had more by a series of accidents than by grand design, if I'm honest.
But so I think that a grounding in academia, particularly in a scientific subject.
Is a good base to go out into business and industry with,
it doesn't equip you with the legal and accountancy skills that you will need to pick up a bit crazy legal skills,
but a grounding in academia and more particularly in science, gives you accuracy, numeracy, respect for evidence rather than opinion.
Less usefully, it makes you obsess about details until you've got everything right or at least right to own satisfaction.
And typically in business and in industry or indeed as head of a hospital or a museum,
a lot of things kind of float across your desk and you have to make a decision often based on what you would regard as a scientist,
as imperfect evidence. So you have to slightly loosen up.
And the other thing, of course, that's hugely important in business and public life is the ability to be a good team player.
That's not something you necessarily learn in academia. It's not what they're about, academia is primarily about scholarship scholars.
I mean, they're not necessarily natural team players.
They can be quite loners sometimes. But I've never I've always found my scientific background an advantage.
Or maybe it's fair to say that whatever your background is, if you halfway smart, you turn to your advantage.
But for example, when I was chair of Cambridge University Hospitals that has a medical school, it is a university hospital.
It has a huge clinical and biomedical research penumbra around it.
And I was equipped to understand what was going on and was sympathetic towards it.
And of course, in the science museum.
Well, the that the alarming thing about that is people somehow expect you to know all the sciences and you come from one specialist background.
I do remember when I was made chair of the Science Museum Group, my eldest son said to me, said,
well, mom, he said, I know you know a bit about chemistry, but what do you know about Railway's?
And I had to admit I didn't know a whole lot.
But as the National Railway Museum and Locomotion in County Durham in our group, I've learnt a good deal about railways now and very fond.
I am of our great steam locomotives that we have. So now we'd like to ask you about your experience of Oxford.
You've been closely involved with Oxford from your studies at Sundance and now current students at the college by the Busari.
What do you think some of the biggest changes Fox-Pitt students have been since a time here when I suppose
the most obvious and biggest change in terms of social impact was the college and the university going mixed.
So when I was up at St Ann's, which was 1962 to 1966, all the colleges were still single sex.
And it wasn't until the next decade that the first of the men's colleges went mixed.
So the university had a different flavour, the colleges had a different flavour and there were fewer women about it.
Striking actually that when the move to go mixed was mooted, the women's colleges were against it, largely because they feared.
That with men's colleges taking women, they wouldn't get the kind of cream of the cream that they were able to get when there were so few places,
relatively speaking, for women at Oxford and Cambridge. But anyway, that was a great social revolution that I didn't live through at Oxford.
But then when I came to Cambridge in 76 to teach,
that was just the beginning of what you might call an almost a stampede of the former men's colleges to admit women.
And I was I think I was the second woman on the high table of Trinity College, Cambridge, which rather characteristically, when mixed in a very.
Prudent way by, first of all, getting people like me as joint appointees,
so I was a lecturer in chemistry at Trinity and a fellow at Newnham before they went completely mixed.
So that was one change. Another, and it's not specific to the university, but I think it is hugely altered,
the experience of being a university student is the ubiquity of electronic devices.
So computers, smart phones, social media, none of that was around.
I remember the first little computer I used in my work.
It was in the early 1980s and it was an apple with about sort of 2k of RAM, I can't remember.
But it was I just did the most simple little calculation. So I suppose, again,
I'm talking from my own perspective as a scientist that has to actually change the
experience of being a student and what you need to learn and be proficient at.
And then the job market has changed. In my day, it was very easy.
The major employers did what was called a milk round. They came and milked the universities of their graduates.
It was very much a buyer's market for graduates.
And now it's so different. Much harder, much harder.
Obviously, some disciplines, engineering, computer science and so forth, as it were, produced more easily employable students.
And the other thing was many things that have changed student fees in my day, you know, a grateful nation largely financed you through.
I had a state scholarship and the college gave me a scholarship, too.
So I didn't cost myself or my parents, you know, much money.
And student debt is something I was never saddled with. So life has changed.
But on the other hand, many more young people now have the opportunity to go to university, and that's good.
We would like to move now to some questions around personalised medicine as we are the Centre for Medicine.
What kind of projects are happening in personalised medicine right now that you're personally excited about?
Well, so personalised medicine has been quite a long time coming, so I'm old enough to remember, though not very clearly.
Watson and Crick and their great discovery and then the early hopes that the basis of disease would be unlocked by knowledge of genetics.
But reading genome's was much too expensive and much too slow, I think, to make an impact for many years, but as that became cheaper.
And as molecular biology made the amazing advances it has in understanding the molecular basis of disease.
So these two things have come together to produce a real era of personalised medicine and I suppose right now.
A major part of the excitement of that field.
Is, as it has been for a few years in understanding the genetic basis of cancer and
tumour development and the certainly more targeted treatments that are now offered,
for example, to breast cancer patients, where I think there are, broadly speaking,
sort of 10 main tumour types to be looked at and lung cancer, another one.
But of course, it's not just cancer where genomic medicine is is coming.
Good so-called rare diseases in children so often have genetic causation.
And that's beginning to be uncovered, I think, by the power of big data allied with whole genome association studies.
So I was absolutely delighted going back five or six years now, time flies.
When Tim Gardam, who was then the principal of St. John's,
asked if I would become involved creating the Centre for Personalised Medicine by chairing its external advisory board.
And I've been very pleased to do that ever since and thrilled to see how it has
developed with a whole range of carefully thought through and impactful events.
Moving on, during your time as chairman of the Cambridge University Hospital's NHS Foundation Trust
and now you've done lots of work in creating Patient Decision AIDS for cancer patients,
how do you think personalised medicine will affect the way patients make decisions?
It's a very interesting question.
So, yes, I did do a lot of work on Patient Decision AIDS, which I got into an accident of history really years and years ago.
I took part in a squash tournament and failed to drink the requisite litre of
water afterwards and found myself in Addenbrooke's in agony with a kidney stone,
which I had grown always as well. But anyway, that qualified me to be a urology patient.
And years later, the head of urology at Addenbrooke's asked if I would become involved in helping make so-called
decision AIDS for patients with prostate cancer or benign hypertrophy of the prostate.
So male patients, which I did and became very interested in the role of patient empowerment.
So a decision aid is simply an aid to help patients exercise responsible choice over their treatment options.
So prostate cancer is a good example because depending a bit on the stage and grade, there could be three reasonable ways to go.
One is active monitoring, sometimes called watchful waiting. One is radiotherapy, whether internal brachytherapy or external beam radiation.
And one is, of course, radical prostatectomy surgery.
And depending on the patient and as I say, the stage and the greater the cancer, the clinical evidence may not be clear cut.
That one path is overwhelmingly better than the other. And typically patients don't really like to be told.
There are several things we could do for you patients.
I think on the whole like to be told this is what we're going to do for you and this will be the best for you.
And here's the evidence.
But where the evidence is not clear, then it does empower patients to understand the choices and exercise a personal preference.
I mean, they can always do that. No patient, of course, can have treatment forced upon them.
So how will personalised medicine change that?
Well, I think it will add another dimension, because the clinician will be able to say to the patient,
yes, you have prostate cancer and your tumour is of this nature.
And I can tell you that with those particular genetic signatures, you're likely to have an aggressive cancer,
you're likely to have an indolent cancer, and therefore there should be much more targeted therapies and alternative paths of action offered.
So I think that personalised medicine will add very powerfully to patient decision making.
I think there's a challenge for the clinician to be able to set this out, Cambridge and Oxford,
and notable for the enquiring minds of their sick, but not everybody wants a mini thesis on personalised medicine before they make a decision.
And it has to be OK to say it's up to you. Also, so personalised medicine is here to stay.
It is a force for good, increasingly powerful,
and it should be part of the clinicians and the patients armoury in all appropriate cases
to weigh that information and evidence and the balance of what is the best way forward.
For that individual patient. Have you recognised any barriers to implementation of personalised medicine, such as clinical translate ability?
I don't know that I know enough about that really to comment. But my perception is there is a challenge, actually, in terms of time.
Consultation time is at a premium. And what I have seen actually going back to Decision AIDS is that it can be very
helpful for the clinician to explain whatever it is and then to be able to hand over.
Maybe it's a link to a website that runs over everything again.
Certainly we did. One was funny thing. Yes.
After I did the prostate cancer and the BPH decision AIDS, I became a urology patient much more seriously because I contracted bladder cancer,
which was very successfully treated surgically at Addenbrooke's when I was chairman, which was interesting.
And thereafter I helped the urology department make a decision aid for bladder cancer patients, because, again, there's several courses of action.
So I think the challenges are, yes, finding the time for the clinician to explain, for the patient to absorb and consider the options.
And so there, again, decision AIDS links to good websites.
The bodying system is good, but raises difficulties about patient confidentiality sometimes.
Could you quickly explain what the buddy system means in this case?
Yes. So, well, again, taking the example of myself as a former bladder cancer patient,
before my operation, I had what's called an illegal or subtopic bladder substitution operation,
which in layman's terms is they take about half a metre of your small intestine, snip it down the tube so it makes a ribbon.
So the ribbon up into a nice pouch, as they call it, and plummet in between your urethra and your reaches.
And you've got a kind of new bladder. It's not a bladder because it isn't muscular, but anyway, it works really well.
So before I had that operation, which is a big operation, takes some time to recover from.
I was offered a buddy who'd been through it and was willing to talk about experience.
And that was really hugely helpful as a woman of about my own age, had an active lifestyle as I do.
And she continued to be a body, you know, during my period of recovery.
And when I said, oh, you know, this and that happening, she said, yeah, that happened to me, too.
So that's the buddy system. And it's great. But as I say, it can raise issues about patient confidentiality.
So it has to be very carefully organised, as it were, a pair at a time.
You see what I mean? That's that's definitely helpful.
I think not exactly a barrier to the uptake of personalised medicine, but a risk that needs to be considered is that it may be the case.
I think that some patients have rather unrealistic expectations of what personalised medicine may do for them.
There's a lot of excitement about finding drugs that although they're not very good for a generalised population with a particular disease,
may be brilliant for a small subset, for genetic reasons. And of course, that's a real phenomenon.
But it may be harder. It's always hard for people to accept that they have a condition that is probably terminal.
That doesn't mean to say it can't be treated, but it can't be cured.
I think as medical knowledge advances and personalised medicine does offer more cures,
it may be even more difficult for people who aren't able to be helped to accept that.
So I think there's a bit of a risk, if you like, about personalised medicine being oversold, at least in the minds of some patients.
It's been really interesting to hear that personalised medicine empowers the patient's autonomy as well as conscious decisions for treatments.
And we are also interested in the interdisciplinary aspect of personalised medicine, so moving on to the next question we like to ask you,
how do you think your background in the physical sciences and your work in
sustainability have influenced your outlook towards personalised medicine research?
Well, I think profoundly, having been trained as a chemist and then worked as an academic for 10 years with a small research group,
I was never going to be a really big time researcher.
But it has given me enormous respect for the advances that brilliant researchers with good equipment and good support can make.
And this is really quite a golden age of discovery in terms of the molecular basis of disease.
Hugely exciting. Going back to what I said rather earlier in the early years of, well,
when the when the human genome was first read, people, I think, expected quicker advances than were made,
partly because of the expense and the time involved in sequencing genomes and partly for the lack of a database,
the correlated genetic abnormalities with disease and pathology.
And now, of course, all that is tumbling out terabytes at a time from the information that is being clinically amassed.
So I think it's probably never been a better time to be a scientist.
And you mentioned interdisciplinarity. You know, you don't have to be a molecular biologist.
You could be a device engineer needing to produce some new piece of kit to do some new thing more cheaply or more quickly.
Look at actually at Oxford, of course, the great work of reading genomes is still the sort of Illumina technique.
But look at minion. Very different technology came out of Oxford.
We know a whole lot more about the basis of life and disease than we did, and that's exciting.
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Thank you for listening and we look forward to having you here in the next episode.