Arts Week 2017: Grin and Bear It: Peter Fifield on Virginia Woolf’s Teeth

This post was contributed by Professor Martin Paul Eve.

george_charles_beresford_-_virginia_woolf_in_1902_-_restorationOn Wednesday 17 May, as part of Birkbeck’s Arts Week, I attended a talk by Peter Fifield on Virginia Woolf’s teeth. As Peter made absolutely clear, this was not some metaphor for her fearsome book reviewing, nor was it any kind of Little Red Riding Hood-esque pun: “my, what big teeth you have, Mrs Woolf”. Instead, he really spoke about her teeth.

Indeed, Fifield traced the curious history of the extraction of a set of otherwise healthy teeth from Virigina Woolf in the early 1920s. The official reasoning given was that Woolf had a “high temperature” and she was told that the extraction of these teeth would help to alleviate this. Unsurprisingly, a few days later, Woolf wrote of how she still had the temperature.

Yet Fifield astutely notes that there was an undercurrent in medical thinking at this time that theorised a set of localised sepses – that is, bacteriological infections – as the potential sources of mental illness. And, indeed, the 1920s was a period of rapid change in this space. The shell-shock victims of World War I had opened the gateway to a new model of mental illness, rooted in the psyche and unlocked by psychoanalysis, rather than in the hereditary or the surgical domains. Certainly, it was a period of change for the authority to speak on mental conditions.

The thesis of local sepsis, as Fifield recounted it, was a way in which a medical, surgical approach attempted to reassert its authority over and ability to help with mental conditions. The list of body parts that could potentially be removed in order to alleviate the mental suffering of the patient – as hypothesised by at least one influential American, who was in touch with Woolf’s own doctors – was extensive, in Fifield’s account. To put it mildly, one could be subjected to a series of medical horrors in the apparent service of healing.

Fifield also examined the ways in which these ideas of mental illness, genetics, bacteriology, and surgery fed into Woolf’s writing, diaristic and novelistic. For instance, in Mrs Dalloway, Fifield notes, Septimus has not only a Latin root for seventh, but also a resonance with the Greek root of “septic”. Mrs Dalloway does not quite say she will “do the extraction herself”, but she is nonetheless also convalescing at the start of the text from a condition with which Woolf believed herself to be afflicted: a tachycardia (rapid heart rate) brought on by influenza.

For me, Fifield’s talk also had a contemporary medical resonance. In the field of auto-immune conditions, contemporary medicine observes correlations between incidences of gum disease and lupus, vasculitis, and rheumatoid arthritis, for instance. Furthermore, it is believed in at least one new but credible theory that stomach bacteria – a local sepsis – could be the triggering cause of a set of epigenetic regulations of gene expression that send the immune system itself into overload. There are also many studies on how patients with these conditions are especially prone to depression and other mental illnesses.

In other words, to this day, the holistic approach that integrates the dental, the stomach, sepsis, genetics, and mental illness, persists. Of course, it is easy for us to look back and laugh at medicine of the past, as we will no doubt one day be looked back upon and laughed at. Further, nobody today, one would hope, is advocating the removal of teeth to help with a serious auto-immune condition. There is, though, more to this old theory than simple ignorance. It simply couldn’t be properly seen or understood at that time.

Finally, Fifield’s talk was also fascinating for its examination of photographs of high modernists smiling, or otherwise. Woolf’s demeanour in many photographs is easy to read as one of the depressed woman; that figure of tragic sadness whose photographed life, we now know, will be lost to that struggle. Yet Fifield did find several of Woolf baring her teeth. The same cannot really be said of James Joyce, although Samuel Beckett was photographed cracking the odd smile (perhaps because, as he put it in Endgame, there is nothing funnier than unhappiness). Nonetheless, in providing metaphorical food for thought, giving the audience something to get their teeth into, Fifield’s story of Virginia Woolf’s teeth was a fascinating tale of how, in the medical culture of her day, there was little for Woolf to do except to grin and bear it.

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Science Week 2017: Resistance – film screening and panel discussion

Dr Clare Sansom, Senior Associate Lecturer in Biological Sciences, writes on the screening of Resistance: not all germs are created equal and panel discussion on antibiotic resistance, which took place as part of Science Week 2017

resistance_panel-disc-3Antibiotic resistance is one of the most crucial issues facing humanity in the early 21st century, with some commentators even suggesting that it poses as serious a threat to civilization as climate change. It was therefore timely that one of Birkbeck Department of Biological Sciences’ contributions to Science Week 2017, with its strapline ‘Microbes in the Real World’, should tackle the issue. This took the form of a screening of an award-winning feature film from 2014, Resistance (subtitle: Not all germs are created equal) followed by an extensive and lively panel discussion. The four panellists were scientists from the department whose research is geared to the development of antimicrobial drugs: Dr Sanjib Bhakta, a Reader in microbiology; Professor Nicholas Keep, Executive Dean of the School of Science and a structural biologist; and two promising students from Dr Bhakta’s lab: PhD student Arundhati Maitra and MRes student Alina Chrzastek.

Not surprisingly, given the timeliness of the issue and (it has to be admitted) the size of the venue – the tiny Birkbeck Cinema in Gordon Square – the session was over-subscribed. After a short introduction by Dr Bhakta, who used his own research field of tuberculosis to set out the ‘global threat’ of drug resistance, the packed audience were treated to 70 minutes of engaging and at times chilling documentary. The film, by US producers Ernie Park and Michael Graziano or, collectively, Uji Films, uses a combination of archive footage, animation, interviews and personal stories to explain how we have arrived at a point where antibiotics are failing and what we need to do to ‘save antibiotics in order to save ourselves’. Although the film was made in the US and focuses on US policies and case studies, the problem it describes is a global one and it would not have been difficult to find equivalent examples in the UK.

The producers weaved three case studies of patients who had suffered antibiotic-resistant infections engagingly through the footage. We were introduced to a teenage lad who had been exceptionally lucky to survive drug-resistant pneumonia with some disability; a fit, middle-aged man who picked up methicillin-resistant Staphylococcus aureus (MRSA) while surfing and is now seriously disabled; and, most harrowingly, a mother whose 18-month-old baby picked up a new strain of MRSA and died within 24 hours.

The film’s narrators explained that all antibiotics are ‘poisons that kill bacteria but not us’; if they don’t kill the bacteria they make them stronger. Using antibiotics in such a way as to promote this rapidly sets up a ‘Darwinian battleground’ in which weak bacteria are knocked out but strong ones survive. This can happen very quickly because bacteria grow and divide so fast. In the words of scientist and author Maryn McKenna, we had the only effective way of killing bacterial pathogens and squandered it. And we have done this in three main ways: by over-use in the environment, in agriculture and in medicine.

The first two of these are particularly prevalent in the US and some Asian countries and less of a problem in Europe, where regulation is stronger. In the US, antimicrobials are used in everyday household products, sprayed on everything from fruit trees to kitchen counters. And once farmers had realised that constant small doses of antibiotics made livestock grow faster and fatter, even in crowded, unsanitary conditions, they were determined to keep doing so even though it ‘makes as much sense as sprinkling antibiotics on your children’s cereal’. Most US-produced meat and poultry is now contaminated with resistant bacteria, and occasionally this is multi-drug resistant. A Danish hog farmer, Kaj Munck, explained the sensible approach taken in Denmark where antibiotic growth promoters in animal feed were banned in 1995 following an extensive public debate. The Danish pig industry is still profitable, producing 28 million a year: about the same as the state of Iowa.

The beginning of the antibiotic era in human medicine coincided with World War II, when it was seen as a ‘miracle drug’ for curing infected wounds. Over-use, however, started very soon: penicillin was given to overseas sex workers, not to protect them from infection but to prevent their US military clients from becoming infected. The danger of resistance was known as early as 1945, when Sir Alexander Fleming told the New York Times that “in such cases the thoughtless person playing with penicillin is morally responsible for the death of the man who finally succumbs to infection.” Doctors who prescribe antibiotics inappropriately are often not morally wrong, or even thoughtless, but over-anxious to avoid mistakes when the chance of an infection being bacterial is low but not vanishingly so. Readily available, rapid diagnostic tests would go a long way towards preventing this type pf misuse.

It would not matter as much if antibiotics became ineffective if there were other molecules ready to take their places. However, the current antibiotic pipeline is weak, with few drugs coming through. Pharma companies can spend at least a decade and a billion dollars on developing a single drug, so it makes more sense to work on drugs like statins that patients must take every day. We must begin to encourage and reward companies that bring forward antibiotic ‘drugs of last resort’ rather than best-sellers. In short, the film concluded, the problem of antibiotic misuse is a classic example of ‘the tragedy of the commons’; one individual’s over-use of antibiotics may be neutral or even beneficial, but if everyone does it there will be a huge problem. To win the arms race against bacteria we may need to redesign all the processes through which we discover, use and protect antibiotics, and to ‘use our wits to keep up with their genes’.

Bhakta introduced the panel discussion with a short explanation of the molecular mechanisms through which bacteria acquire resistance to antibiotics. Bacteria evolve quickly, and almost all have acquired some resistance either intrinsically, through mutations, or by acquiring resistance genes directly from other species. This is an inevitable process but we have some control over how quickly it occurs: good antibiotic stewardship is as important as innovative science for winning the ‘arms race’ described in the film.

Bhakta’s group at Birkbeck is interested in tackling the problem of resistance through discovering new compounds with novel modes of action and by aiming to ‘re-purpose’ some over-the-counter medicines that are already in use for other indications. Drugs in this category will have already been shown to be safe and are therefore quicker and cheaper to develop. Keep summarised the role of structural biology in antibiotic discovery as one of determining the structure of bacterial proteins that might be vulnerable to attack by drugs and identifying compounds that can bind to and inhibit them. We are now often able to see directly how these structures are changed by mutations that increase (or decrease) resistance.

Bhakta chaired the discussion that followed, which was extensive and wide-ranging, taking in politics and economics as well as science and medicine. Several questions touched on the role and responsibilities of the pharmaceutical industry, which is reluctant to invest in drugs that will only be used for short periods. More drug discovery than ever before is taking place in academic labs and small companies, often working together; Maitra, whose Birkbeck Anniversary PhD studentship is part-funded by Wellcome, highlighted the role of the Trust in promoting links with industry. Re-purposing drugs that have already been used clinically is much cheaper than developing a molecule from scratch. MRes students in Bhakta’s lab, including Chrzastek, are testing common anti-inflammatory drugs against Mycobacterium tuberculosis and have found some potentially useful activity although the mechanism of action is still to be explored.

Other questions focused on the need for strict antibiotic control measures. In many European countries, including the UK, antibiotics are only available on prescription and cannot be used as growth promoters in animal feed. This ‘best practice’ needs to be replicated worldwide, but it will be an uphill struggle. Bhakta told the audience that he often visits countries in south and east Asia where resistance is prevalent and has seen antibiotics available over the counter there. In countries without strong, publicly-funded healthcare systems there are often incentives for doctors to over-prescribe drugs including antibiotics. And even where this is not an issue, patients need to be educated to think of antibiotics as drugs of last resort rather than demanding them for every upper respiratory tract infection.

It was perhaps inevitable that someone would ask the ‘Brexit question’: in this case, is there a danger that we would reverse some of our ‘best practices’ when we are no longer bound by EU regulations? Encouragingly, Bhakta doubted that anyone would want to get rid of rules with such clear benefits. He felt that the now inevitable move of the European Medicines Agency, which regulates all medicines marketed in the European Economic Area, from London – and the confusion about how the UK drug market will be regulated – does present a danger, to our strong research base. And however the politics develops the international collaborations that UK-based doctors, scientists and entrepreneurs have built up over decades must be maintained.

Other Science Week 2017 events:

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Academia’s gender inequality problem

This post was contributed by Professor Helen Lawton-Smith of Birkbeck’s Department of Management. Professor Lawton-Smith is organising Improving gender equality in work – what can we learn from London’s business and policy organisations? on Wednesday 18 March, 2pm-5pm.

laboratoryWomen are under-represented in senior positions in science, engineering, maths and medicine disciplines at UK universities. Initiatives including Athena SWAN and the Aurora Women’s leadership programme have been set up to address this problem, yet such initiatives by themselves are not enough to tackle the problem of the current gender bias. What is needed is institutional embedding, so that gender and other diversity issues are integrated into an equality framework of decision-making processes and structures within organisations, which cannot be side-stepped by those in positions of power.

The four-year Transforming Institutions by Gendering contents and Gaining Equality in Research (TRIGGER) project at Birkbeck is championing the role of female academics in scientific subjects as part of a five-country European project. This initiative is testing a blueprint designed to raise the status of women in scientific and technological organisations such as universities. The nine action areas are designed to identify barriers to equality in the workplace, including the impact of research. The project builds on Birkbeck’s existing commitment to promoting female academics. Results and reactions have been very interesting.

Equality issues have been tackled in a variety of ways by companies and by policy making bodies such as local authorities and government agencies. According to the New York Times in October 2014, Silicon Valley also has a diversity problem – one which is being tackled head on by companies such as Google and Facebook.

Academia has a lot to learn from how other kinds of large organisation have identified the nature and causes of gender inequality. On Wednesday 18 March the TRIGGER project and the BEI School are hosting a networking event designed to explore which institutional changes work best in supporting gender equality in large organisations. The panel’s speakers will reflect on why changes were necessary, what changes have been introduced, the outcome of those changes, and what still needs to happen to improve gender equality. The diversity of speakers will ensure there are opportunities for learning for all.

Interested? Find out more

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