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Germinating virologists

A new generation of virus experts are not just good researchers but good communicators too

Green virus under microscope This is a "boom time" for virologists, according to one of the featured rising stars, and it is set to get busier. New and resurgent diseases, increasing resistance to treatment and long-haul tourism, which is spreading previously rare conditions, are all contributing to the changing landscape of infectious diseases. What's more, there is also an increase in the prevalence of existing diseases: HIV infection continues to rise and the major centres are seeing more and more hepatitis C.

Some observers feel that there are not enough clinical virologists, but the workload is unpredictable and against the baseline of normality, such as it is, there are spikes of activity due to unexpected infections.

In 2004, for example, there was an outbreak of mumps in some of our universities. The cause was low immunity in those too old to have received MMR (the MMR programme only started in 1988), but young enough to have not developed natural immunity through exposure. The virologists had to work out a strategy for dealing with this – how to test, treat those infected and provide prophylaxis for those at risk.

Since then, of course, we've had the bird flu outbreak and now the swine flu pandemic. Even where these turn out to be scares, planning and preventive measures have to be put in place. Swine flu, fortunately, doesn't look as though it is going to be as severe as feared, but nevertheless, at the time of writing this article, there are 52,160 laboratory-confirmed cases including 231 deaths in around 100 countries and territories.

Interestingly, 80 per cent of emerging conditions are zoonoses, ie a disease that normally infects other animals, but which – in certain circumstances – crosses species to infect humans.

As well as the clinical and public health issues, there is a shortage of new anti-viral drugs. As in other areas of medicine, molecular biology seems to be the area generating exciting developments and both the doctors featured are using this to investigate novel therapeutic approaches.

Perhaps more than in any other area of medicine, public education is a priority, but getting the balance right when discussing risk is tricky. The public needs to understand the dangers, but the reporting can be alarmist. Writing about swine flu in the Virology Journal earlier this year, deputy editor, William R Gallaher said, "This is time for calm, thoughtful action and not the panic we have seen spread around the globe inspired by media reports."

Those responsible for public education have my sympathy. Play down the dangers and be accused of not giving people the facts; talk them up and be accused of scare-mongering. Against this background, Cambridge University's consideration of a new type of consultancy post for Dr Chris Smith (featured opposite), whose remit would be as much about educating the public as clinical practice and University teaching, is innovative and exciting.

The Author
Neil Kendle is managing director of Kendle Healthcare

Dr Ravindra Gupta, Wellcome Trust Clinical Research Training Fellow University College London Division Of Infection And Immunity

The emergence of new viruses and increasing drug resistance is drawing attention to the importance of public health and virology research. One of the rising stars in this area is Dr Ravi Gupta. He read social and political science as part of his medical degree at Cambridge, which led to an interest in international development and to his research interest – HIV resistance in the developing world and how to limit emergence of resistance and optimise therapy in limited resource setting.

Extensive resistance
HIV resistance is obviously a potential problem everywhere, but in poor countries where, for cost reasons, often one drug is  given rather than three and where, due to lack of regular virological monitoring, most people will stay on a failing drug regimen for longer periods, extensive resistance has become a global health priority. Ravi Gupta is coming to prominence in this area due to a recent high-profile meta- analysis and a number of presentations at major conferences. In his short career, he has received a string of awards including a Fulbright and, in both 2008 and 2009, the Young Investigator Award from the Conference on Retroviruses and Opportunistic Infections. A forthcoming paper in The Lancet is expected to generate a fair amount of attention.

Fundamental biology
His interest in molecular virology has also led to him working on more fundamental biology, looking at new targets for anti-HIV drugs, concentrating on how HIV interacts with immune system. He has also been involved in pandemic flu.

Public health is a smallish area, according to Ravi. Sadly it is smaller than it should be, given its importance. There are few people with expertise in molecular virology and public health and it doesn't look set to change in the near future seeing there are few people of his age in the area.

Dr Chris Smith, clinical lecturer in Virology, University of Cambridge

Dr Chris Smith is one of a new breed of opinion leaders who are as much communicators and educators as researchers. He is the first 'rising star' I have interviewed who has his own page on Wikipedia.

His day job is a clinical lecturer's post in virology at Cambridge. During medical school he became interested in neuroscience and went on to UCL to do a degree in this, which "switched me on to research". From there he went to Cambridge to do a MB PhD, a unique programme that allowed him to do research leading to PhD and keep up clinical training. During this time he realised how important molecular biology is becoming and looked for a way to learn about it. As luck would have it, Dr Stacey Efstathiou, a virologist at Cambridge, was trying to modify viruses to turn them into therapeutic agents for the brain. Chris Smith's neuroscience knowledge was just what he was looking for. Their work involves adding therapeutic genes, which have key genes deleted so they can only infect once, to a Herpes simplex virus.

Despite this ground-breaking research, however, Chris Smith is better known for his work as a broadcaster and communicator on science. The hugely successful Naked Scientist, which Chris started when he was a house officer, is a radio show, website and series of podcasts. It has a Sunday-night radio slot for the BBC in the Eastern Region and is syndicated internationally including to Radio Europe, KWMD Alaska and Observer (Caribbean) networks. The show is released as a weekly podcast which gets 100,000 downloads each week. In addition, Chris broadcasts live every Friday morning on Radio National, Australia, and on BBC Radio Five Live; he also fronts the Royal Society of Chemistry's Chemistry World podcast, and he founded and presented the first 100 episodes of the Nature Podcast, for the journal Nature.

His media skills, along with the fact that he is a virologist, make him a natural choice of expert when stories about infections such as bird flu become newsworthy. During the week following the story breaking about swine flu, he talked to an audience of 935 million people through radio and TV.

Chris is finishing his training in clinical virology and is in discussion with Cambridge University about the setting up of a novel and adventurous consultant post that would combine clinical virology and teaching at Cambridge with a remit to educate the public on virology. The aim is to exploit the expertise he has built up in generating Naked Scientist to increase public knowledge in microbiology on issues such as C difficile, norovirus and MRSA.

Chris was involved in conducting the first postmortem on radio for National Pathology Week and quotes this as an example of the type of public education he would like to see more of. The broadcast showed a public grown wary by the Alder Hey body-parts scandal both the merits of a postmortem and how respectful the whole procedure is.

According to Chris, "The Alder Hey scandal did great harm and the number of postmortems being done is very low, putting the education of junior doctors at risk."

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6th August 2009


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