Nicholas Wright - Transcript Summary

Warden of Barts and the London School of Medicine and Dentistry, and group leader at the London Research Institute, running the histopathology laboratory

Interview location: The London Hospital
Interview date: 8th October 2007

Key Themes: Alder Hey, History of Pathology, International Perspective, Legislation and Regulation

Starts with a brief history of pathology as a profession and how they moved from being generalists to specialists. Mentions the pivotal role of Rudolf Virchow in the 1840s: “He analysed the cellular basis of pathology and really introduced the microscope into diagnosis.”
Talks about the decline of the autopsy rate and the detrimental effect on research and teaching.
Explain, with a graphic example, that the core role of the histopathologist is diagnosing disease in the living, which carries huge responsibility: “Once that diagnosis has been made the die is cast. There is no way back."

Talks of his childhood in Bristol; his father – a sheet-metal worker -- was invalided during the war and money was tight.
As a teenager he read a book about the early bacteriologists, which fired his imagination: “I entered medicine with the express wish to become a pathologist, which is very unusual.”
Talks about some of the people who have been important in his medical career.
An early ambition was to attain a chair in order to teach and “to build a sort of family, or school of pathology”.
Describes progression of his career from Newcastle, via Oxford, to London.

Early research focussed on tissue repair mechanisms in the body, which has remained his core interest.
Describes the state of knowledge about stem cells at the time, which was minimal, and the evolution of understanding. His group was instrumental in discovering the extraordinary plasticity of adult stem cells: “The idea that adult stem cells were fixed forever, giving rise to the same sort of cells always…This turned out to be wrong.”
Discusses this discovery with graphic examples. His group’s original work in the field “started an avalanche of thought”.
Describes animal experiments involving bone marrow transplantation and subsequent infection with Helicobacter pylori, which eventually led to the development of cancer in the recipient: “It's a very bizarre thing.” This shed light on similar phenomena observed in human transplant patients.
Describes further investigation of mechanisms behind the phenomenon: “[The concept] is pretty controversial, not everybody accepts this. But there's a growing body of evidence...”
Discusses his role as a pathologist in this largely molecular research – as a medical person he is able to see a bigger picture than the pure scientists.
On the other hand, patient care is not his primary interest: “It's really disease processes which turn me on, rather than cases.”

New technology is constantly expanding research possibilities. “The thing that has really made these advances possible is molecular biology. DNA technology -- recombinant DNA technology -- enables you to actually dissect out pieces of tissue using what's called a micro-dissection apparatus.”
Describes in some detail his use of molecular biology techniques in his stem cell research, which is pure rather than applied. “One of the pleasures of working where I do is that no one is looking over my shoulder... If my lab was in the medical school, or being funded by different people, they may say, ‘How's this going to be translated into treatments?' It won't be [immediately]... That's a long way off, because we don't know the mechanism of the process which drives this yet. But we will do.”

Discusses Alder Hey controversy and the implications of the Human Tissue Act that followed: “It's far more intrusive than [we] thought it would be... We have to get this Act changed.”
Regrets decline in autopsy rates: “The way in which autopsies have really contributed to medical advance is the recognition of new diseases.”
Reiterates his passion for this work: “I can't imagine life without research.”
Mentors and influences in his early career and the standards he set himself: “I was determined to succeed... Failure was not an option!”
Conversely, how medicine has influenced his outlook on life: “You see a lot of people die from a lot of diseases, and it doesn't actually encourage belief in a benevolent being...”
Muses on the intrinsic fascination of pathology for him: “Every time [you] sit down in front of the microscope... there is a problem to be solved.”