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Writing Antibiotics and Chemotherapy with Paul Garrod and Francis O'Grady

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Interests in infection and medicine and transferable drug resistance
Harold Lambert Physician
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Coming back to the interest in infection and medicine partly was this business of an intense interest versus the generality of medicine and partly the actual interest in how infections work, both epidemiologically and in the patient and the other reason I found that quite intensely interesting is that it's a wonderful teaching tool that- you know, host and parasite, the host is that patient there and the parasite- what's it doing, how do they relate, what happens, both at the individual level- how do you treat meningitis- and what is this bug doing? And that, ag- again, is communication with patients. The patient says, which is an only too reasonable question- Why did my child get meningitis. That's an extraordinarily difficult question and we do have answers but rather kind of high-tech, fancy answers. It's very hard to bring those to come to terms with the patient's or the relatives' biological understanding. Do you see what I mean? It's trying to- Yes, yes, yes, yes. And when we talk about communication that's exactly the kind of point which crops up. But, I mean, it's also a wonderful tool because I think medical students, they're very nice but they can be pretty boring, aren't they, with textbooks and stuff and you, you- when you see, sometimes it directly impacts on what you see. Now, take gastroenteritis, we saw shigella- that's dysentery- and salmonella and all these bugs, and unknown ones, epidemics, individual cases, lots of them, and then we started seeing ones with multiple resistance to antibiotics and I found this intensely difficult to understand that the actual mechanism, the biochemical mechanism by which- the gene coding for the protein which makes you resistant to streptomycin is a completely different product from the one giving you resistance to tetracycline or to penicillin. How is it they could all be jumbled together? I mean, that's really peculiar thing, isn't it, really? And, some Japanese workers found a fascinating thing, which of course none of us read Japanese so we didn't know, but the year after one called Naomi Datta at the Hammersmith published this book on transferable drug resistance and in those days I used to read "The Journal of Hygiene", as it was then called, and it's one of those eureka moments- not that I found it but I thought, read the paper and think- Ha! That's it! Which is a terrific thrill, isn't it, when you see a science thing linking up with what you're looking at. Yes. And the basis of it is, as you well know, it's horizontal gene transfer; in this case by plasmins bits of DNA floating round free of the chromosome, which as we now know have incredibly ingenious mechanisms to gather different genes together and it's a, a major- it's not the only mechanism- it's the major mechanism of drug resistance and this absolutely precise and exactly was what you were seeing and it also explained why antibiotic resistance- well one of the reasons why antibiotic resistance was a huge problem. So, it was one of the, I mean, mostly you don't know that, you just don't know what's going on but this was a case where the science and the medicine and the epidemiology, bingo, they came linking up completely really.

British doctor Harold Lambert (1926-2017) spent his career tackling infectious diseases, helping in the development of pyrazinamide as an effective treatment for tuberculosis. He also published work on the rational use of antibiotics and was a trustee and medical advisor for the Meningitis Research Foundation.

Listeners: Roger Higgs

Roger Higgs was an inner city GP for 30 years in south London, UK, and is Emeritus Professor of General Practice at Kings College London, where he set up the department.

He gained scholarships in classics at Cambridge but changed to medicine after a period of voluntary work in Kenya in 1962. He was Harold Lambert's registrar for 18 months in the early 1970s, the most influential and exciting episode in his hospital training. He set up his own practice in 1975. He helped to establish medical ethics as a practical and academic subject through teaching, writing and broadcasting, and jointly set up the 'Journal of Medical Ethics' in 1975.

His other work included studies in whole person assessment and narrative in general practice and development work in primary medical care: innovations here included intermediate care centres, primary care assessment in accident and emergency departments, teaching internal medicine in general practice and establishing counselling services in medicine.

He was made MBE in 1987 for this development work and now combines bioethics governance, teaching and writing with an arts based retirement.

Tags: infection, medicine, epidemiology, physiology, parasite, host, streptomycin, transferable drug resistance, horizontal gene transfer

Duration: 3 minutes, 17 seconds

Date story recorded: October 2004

Date story went live: 24 January 2008