10 December 2012
ByAppeared in BioNews 685
BBC Radio 4, Tuesday 2 October 2012
Presented by Professor Jim Al-Khalili
What do mountaineering up Mount Everest and treating critically ill patients in an intensive care ward have in common? Quite a lot, as it turns out, according to Professor Hugh Montgomery on a recent interview for Radio 4's Life Scientific. Hosted by fellow scientist Jim Al-Khalili, the two settle down to discuss how pushing the human body to extremes in high altitudes indirectly informs clinicians how best to stabilise critically ill patients in intensive care wards.
Polite, articulate, and self-effacing, Montgomery is undoubtedly a polymath. Alongside being an intensive care specialist, he also conducts research into cardiovascular genetics and was the first to identify a gene for fitness, called ACE. Befittingly, Montgomery is also an avid long-distance runner and mountaineer. As if this wasn't enough, he also has a parallel career as a children's author and recently wrote a crime thriller novel that has now been adapted into a Hollywood produced film. Just to top it off, he also holds the world record for underwater piano playing.
By recounting tales from his expeditions in the Himalayas, Montgomery describes when he first realised that the conventional understanding of how the body copes with low oxygen was insufficient. Until recently, scientists thought it was all about oxygen delivery – you breathe harder, your heart rate increases, pumping more oxygen to where it is needed – simple. But interestingly, this explanation was at odds with Montgomery's own personal experiences of trekking at high altitudes. He suspected something more fundamental, at the genetic level, was going on.
These astute observations lead Montgomery to identify ACE, the first gene linked to human fitness, in 1998. He goes on to explain how different variants of this gene can influence whether or not a person will be good at things like sprinting, compared with more endurance-based activities like mountain climbing. The underlying message, explains Montgomery, is that the way the body uses oxygen is more important than how it is distributed.
Whilst Montgomery admits that many genes are now known to play a role in fitness, the discussion starts to become slightly misleading due to the way in which Al-Khalili poses his questions on the importance of ACE. Scientists have long grown out of the gene-centric view of life – that is, any single gene being responsible for a particular biological function – in this case fitness.
Indeed, we are told that Montgomery himself doesn't in fact possess the right kind of ACE gene for mountain climbing, yet this is something he excels at regardless. Non-scientists will easily be confused by this, and Al-Khalili's subsequent probing over whether or not we can 'streamline' children into certain sports based on the genes they carry seems to inappropriately emphasise the importance of one gene.
Montgomery does well to reign in these unethical (and bordering on eugenic) connotations about his research. He emphasises that ultimately these findings are changing paradigms in the way doctors in intensive care think about oxygen delivery and consumption in their patients. Interestingly, it suggests that giving less oxygen, and thereby allowing the body time to 'reprogram' itself to tolerate this, may in fact increase a person's chances of survival.
The interview then shifts to a broader discussion about life working on an intensive care ward. Montgomery poignantly remarks on how such an environment truly brings home the randomness and unpredictability of death. This leads him on to talk about DNR (do not resuscitate) orders, and all the pathos that it brings forth, including that of his own experience when his mother requested it.
Although this part of the talk reveals the more human side to Montgomery's career, I personally found it quite mundane. It was a disappointing contrast to the adventurous and intriguing scientific discoveries discussed earlier, which preceeded a more in-depth analysis of this exciting new area of research. Perhaps Al-Khalili didn't want to veer too far into the territory of academic jargon, but Montgomery is clearly an excellent science communicator, and the topic needn't have been brought to a close only half way through.
On the whole, this was an enjoyable insight into the life of a talented man with indefatigable energy and a multitude of achievements. Nevertheless, in my opinion the most interesting parts flagged too early, and Al-Khalili's mild-mannered style of questioning was not to my taste. All in all, it certainly wasn't a bad effort, but I think the BBC could have given us a better glimpse into this irrefutably fascinating personality.