19 March 2012
ByAppeared in BioNews 649
By Abi Bown
Royal Albert Hall, Kensington Gore, London SW7 2AP, UK
Monday 12 March 2012
As their teacher marches them down the corridor to watch a science play about pharmacogenetics, you could forgive any teenager for thinking (probably out loud and repeatedly) that this is going to be 'boring'. But anyone fortunate enough to see 'Dayglo', the latest play by the Y Touring Theatre Company as part of National Science and Engineering Week, would be the first to admit they were completely wrong.
'Pharmacogenetics is not something most Year 10 pupils usually discuss or have an opinion on', says the introductory leaflet to Dayglo. I can believe it - before the play I wasn't totally sure what the word even meant.
Now I can tell you that it involves designing drugs that treat a disease at the genetic level, using information about an individual's genetic make-up to choose the type and amount of drug that is most likely to work and least likely to cause negative side effects.
This fascinating new era of personalised medicine is changing the way we think about treating disease but, as this play so skilfully and thoughtfully explores, it is an era that comes with its own challenges.
Before the start of the play, everyone is given a handset and, in the style of 'Who Wants To Be A Millionaire?', we answer multiple choice questions like 'If a test could tell you how your future health is going to change, would you want to know?' and 'Should we do everything in our power to treat a disease?' These are not easy questions and as the cumulative scores come up on screen there is much hushed whispering and calls of 'What did you put?' We have already been drawn in to the 'theatre of debate' and the performance hasn't even begun.
'Dayglo' follows the story of Evelyn, a one-time punk rocker who is diagnosed with breast cancer, and her feisty teenage daughter Stella. We discover during the play that Evelyn carries a mutated version of the BRCA gene, which predisposes her to breast and ovarian cancer.
This is where pharmacogenetics comes into action: finding out that she has the BRCA mutation allows her treatment to be tailored to her genetic profile. It also gives her access to clinical trials. But with only a 50:50 chance of being on the new drug, instead of placebo, and no guarantee that it will work any better, it is a tough call. But does she have a duty to take part in the trial anyway, to further research for the sake of all faulty BRCA gene carriers - particularly when this could include her own daughter?
Stella faces her own difficult choice: should she find out for sure if she carries the faulty BRCA gene, even though the surest way to prevent her developing cancer would then be to have both her breasts and ovaries removed?
With such difficult issues to deal with, I was impressed that 'Dayglo' turned out to be so much more than just a sad story about cancer - although I confess there was a little tear on my cheek during the final scene. Much of this diversionary drama comes from meeting Noel, a chicken shop worker and love interest for Stella, whose brother has sickle cell anaemia.
From a discussion of the economics of drug companies producing personalised medicines using his workplace, 'The Chicken Shack', as an excellently constructed analogy, to his begrudging comments on the 'cancer mafia' as he raises money for sickle cell anaemia in a sea of cancer charity runners; Noel's character opens up whole new areas of debate. At the same time he provides the comedy and romance that makes the play genuinely engaging. For me, he is by far the most divisive, entertaining and successful character.
But let's not forget Brian, the overwhelmingly camp Welsh male nurse. Often the favourite character for many of the teenagers, it is obvious that his inclusion is no accident and that Abi Bown, the play's author, really knows her audience.
However, my only real complaint stems from this character. For one, I didn't think Brian behaved much like a nurse - it is he that tells Stella of her family history of cancer, without her mother's consent. I was disappointed that something so ethically dubious was used so casually to drive the story forward. Similarly, Brian implies that being part of a clinical trial will afford you better care. Whether or not this insinuation is fair, its inclusion takes a step over the otherwise impartial line maintained throughout the rest of the play.
When the lights come up, we reach eagerly for our handsets again and return to the questions, and I can see from the scores that I'm not the only one who has changed my mind. Now I feel that 'yes' or 'no' is probably better replaced by an 'it depends'.
Careful rephrasing of questions to substitute 'would' with 'should' sparks particularly intense debate, since no one really likes being told what to do - particularly not teenagers. But with scientific experts to inform the argument, this is where the real engagement happens. It's also where 'Dayglo' will become so much more than just another educational video, as it initiates discussions likely to spill enthusiastically out of the classroom.
Dayglo works not because it makes pharmacogenetics interesting (it already is) but because it makes it accessible. The play and its interactive component work perfectly together to help young people realise that, even though there are no obvious right answers, people still have to make these decisions - and that one day, either through career choice or the misfortunes of their future health, those decisions could fall to them.
'Dayglo' is a Theatre of Debate resource for schools, aimed at Key Stage 4 pupils, was researched and developed by the Association of Medical Research Charities and the University of Ulster. It will also be screened at Picture House cinemas in the coming weeks.