Questions and Answers February 2008
After the first performance on 7th February there was a post-show discussion with students of Biology, Performing Arts and Health and Social Care from local sixth forms and colleges. Here are a selection of questions submitted by the students, including some which there was no time to address during the session, with answers from Angela Priestman and Christine Watkins..
Q How did you come up with the idea of mixing biology with performing arts?
AP The original idea was Christine's, but the Wellcome Trust have also thought about Biomedical science and how it is both communicated and portrayed to different audiences and they fund a programme which supports good ideas like this one (well done Christine). The objective of the funding is quite simply to portray an aspect of Biomedical science in an interesting arts focused approach. So its focus is public engagement. There are some great projects funded through this scheme and if you go to the Wellcome Trust website you can see the work of some of them which are showcased.
CW My interest as a writer for performance lies in the combination of different modes of expression; I wanted to see what happens, for example, when information conveyed directly through a scientific lecture is combined with a choral song cycle. How do we enjoy, understand, experience what we see and hear when information from different realms is brought together in this way? I'm very pleased that Angela Priestman was willing to take part in this experiment!
Q. What will happen when all our malaria drugs are ineffective?
AP All drugs used against parasites will decrease in effectiveness with time. This is because we kill the susceptible parasites and those parasite populations which are more resistant survive - so in effect we are selecting fro resistance. Can we prevent this form happening? We can certainly manage the development of resistance - slow it down essentially, by ensuring that anti-malarial drugs are prescribed and not able to be bought over the counter. When a clinician prescribes a drug, it is given on the basis of assessed clinical need and the patient is provided with instructions on how to take the drug in order to minimise the chances of resistant parasite populations persisting. However, managing resistance is easier said than done - especially when you think of the global context of malaria control. It requires concerted international effort and clear governmental input.
Ok but has this answered your question? What would happen if all the drugs were ineffectual? Put simply we would have to rely on another method of disease control. When you control a disease - especially a vector borne disease like Malaria - it is always a good idea to use a variety of tactics, that is, to use a number of different control measures and in an integrated way.
This means that if one of your control measures fails, then you still have others to fall back on. So if we were ever in the situation of having no effective drugs against the malaria parasite - then we would have to rely on other methods of control which focus on the mosquito - preventing it from biting humans and reducing the numbers of mosquitoes. These latter methods can be very effective in reducing malaria - as was shown by the trials using insecticide-impregnated bed nets in Africa.
A good malaria control programme then, will have integrated control measures which work together to reduce the incidence of malaria and this helps us cope when (or if) one of those control measures becomes less effective.
Control measures against malaria include: early identification and treatment of people with malaria, management of malaria drugs which focuses on using some drugs only with the most serious cases (this is to slow down the development of drug resistance in the parasite), control of the mosquito vectors by using insecticides to kill adult flies and the removal of mosquito breeding sites, reducing the number of bites people get by providing bed nets, other types of house screens over doors and windows, use of repellents in travellers and educating people so that they know of the different ways they can help reduce malaria in their communities and this is not an exhaustive list! Just as malaria pervades all of human life in certain parts of the world, so too should the control against malaria pervade society - it should be evident at individual and community level and right up through to Governmental health strategies.
This article, click here , discusses the effectiveness of a combination of methods in malaria control as used in Eritrea.
The World Health Organisation (WHO) web site on malaria has lots of information about control programmes and methods.
Q Where did you get the inspiration from?
AP You need to ask Christine Watkins this question! She is the writer but it certainly got me thinking about the process of science and how it can be both gloriously rewarding and intensely frustrating almost at the same time!
CW I was looking through some old archive papers, researching something completely different, when I found a copy of speech delivered by the poet John Masefield in praise of Ross's work as a poet and a scientist. I was immediately interested by this way of seeing Ross's poetic work and scientific research as part of one process. This got me thinking about how this could be explored further.
Q If the vector is more difficult to control, apart from with nets, should we be concentrating on genetic methods of Plasmodium eradication?
AP Good disease control programmes are integrated - that is, they incorporate several methods of control which attack the disease from a number of different angles. This way if one control approach fails or becomes less effective, then we can simply rely more heavily on others within our armoury. We must continue to raise awareness of the role of the vector among affected communities and continue to supply bed nets as a very effective and low tech way of reducing the incidence of malaria.
Should we concentrate on genetic methods of Plasmodium eradication? I am presuming that you mean we should concentrate on learning as much as we can from the Plasmodium genome. The answer is yes! Since the genome of Plasmodium falciparum was sequenced and published (see Paper in Nature 2002) molecular scientists have been busy determining the function of its genes. Plasmodium falciparum has 14 chromosomes and about 5,300 genes - we know (broadly) the function of about 40% of those genes - and the remaining 60% appear to be unique to malaria. So, there is a lot of work to do. Functional genomics will tell us what the genes do, how their expression changes and things such as how these parasite evade the immune system and develop resistance to drugs used against them. One of the key areas for immediate study is the identification of parasite antigens that could be used in vaccines. All of this work is on-going and we will no doubt hear of advances in the not too distant future.
Of course, what we are doing with the Plasmodium genome is also being carried out with the Anopheles genome - what do those mosquito genes do? And how might we better understand the interaction between parasite and vector in order to control the disease.? Exciting times and we need more molecular scientists to help with this work - can I tempt you?
Q. What did you want us to get out of this production?
CW I wanted to create an inrigung and captivating performance which would offer you an experience of the connections between things; of ways of seeing the world, and becoming more aware of your own place within it. I believe that curiosity about that is at the root of both art and science, and performance originally took its impulse from that curiosity too. The dramatist Bertolt Brecht called it "Propaganda on behalf of Thinking'.
AP I wanted you to think about scientific discovery in a new way - by focusing on one person and particular moment in time. I could have referred you to the papers outlining Ross's discovery, but you wouldn't have a feel for the man, the moment and the importance of his discovery. Our approach brought Ronald Ross alive and hopefully made you imagine yourself in his shoes - it gave you a picture of hot sultry days in India and the frustration sometimes associated with searching for the evidence to support a theory. I suppose you need to ask yourself - what did I get out of it? What do you remember? What have you taken away from it? Hopefully it entertained you, educated you and enthused you to think of scientific discovery in a new light - something you can do.
Q How long do mosquitoes live for?
AP Well it will depend on the species and also the geographical location. If we are talking about tropical mosquitoes, the adults probably live for 2 - 4 weeks. If you collect wild adults and keep them in the lab, in cages, they can survive for a month or more. Also, if you culture mosquitoes in the lab - they do not have the stresses and dangers of predators, wind, rain etc and so they are generally longer lived. In the UK some mosquitoes only have a single generation in the summer - and they may overwinter as adults - so this means they are adults for 6 - 8 months. The life of a mosquito in tropical locations however, is probably fairly short and most end up as food for other organisms especially birds. Female mosquitoes transmitting malaria must live long enough to take a blood meal (containing malaria) and for the parasite to develop to the sporozoite stage and migrate to the salivary glands. The mosquito must then find another person to feed on - thus transmitting malaria in the process of feeding. Parasite development within the mosquito is temperature dependent but usually takes about 7- 9 days....so to be a vector of malaria, a female mosquito must live longer that about 10-11 days.
Q Why didn't you go into the point of malaria being responsible for sickle cell anaemia in this country?
AP Because it is NOT! You have your information muddled here. Sickle cell anaemia is a disease of the blood (a haemaglobinopathy) in which the haemoglobin - the principle protein in blood cells - changes shape and causes the red blood cells to become more sickle like in shape. It is a genetic disorder that people can inherit from their parents. People who are homozygous for the Haemoglobin S gene (that is they have one copy of S from their mother and one copy from their father) will have sickle cell disease - which is a serious and life threatening disease. Some people are heterozygous for the S gene - meaning they carry one copy of the S gene, whilst their other haemoglobin gene is normal. These people have sickle cell trait. This means they are carriers but do not usually suffer any of the serious effects of having two copies of the S gene.
It was noticed that the distribution for the Haemglobin S (the sickle gene) overlapped with the distribution of malaria and scientists started to think of why this might be.
It seems that someone with sickle cell trait has a survival advantage over people with normal haemoglobin in places where malaria is endemic. It should be noted though that people with Sickle cell disease and trait can get malaria - just that those with the trait are more likely to survive infection with Plasmodium falciparum. Data shows that they survive to adulthood and are able to have children and thereby pass on the gene to the next generation. Why might they have a survival advantage? well it seems that under certain conditions, people with sickle cell trait do have some red blood cells that sickle - and it is the sickling that prevents the malaria parasite from parasitizing red blood cells.
So, the key thing to remember is that it is sickle cell trait that may confer an advantage - but Not sickle cell disease which is a serious and life threatening condition. More information can be found at this web site. sickle cell trait and malaria
Q How is all this relevant to Health and Social care students?
AP Biology is an important part of your Health and Social care course - where you study illnesses and disease. Therefore, this performance should have been interesting to you from the disease viewpoint. Another important part of your course is to study Ethics. There are many ethical issues relating to malaria treatment and control which you could pick up on and discuss. Finally, our world is getting smaller - we talk about the global village, but what it means is that health issues in other countries and other regions of the world are of importance to us - we should know about them and - in the interests of justice - seek ways of ensuring that treatment and facilities available to us here in the 'west' might also be available to those with less resources and money who are suffering from disease elsewhere.
CW Ronald Ross was one of the early advocates of an organized approach to sanitation as a method of disease control; we highlighted this aspect of his work in the section of the performance where the choir sing 'Hymn to Sanitation' . The words of this song are taken from a book 'Mosquito Brigades and how to organise them' published by Ross in 1902. He stressed the importance of 'Sanitarians' - people we would probably refer to as community health workers today, and commented on their vital role and their low pay. Mosquito Night reflected this, as well as the fact that sanitation methods (drainage etc) of mosquito control could not provide the whole answer to the problem. Nb The Hymn to Sanitation can be found on the Songs section of this website.
Q What made you interested in studying mosquitoes?
AP I am a parasitologist - that means I have studied parasites from my first degree (when I did my final year project on fish parasites) through my PhD (on tapeworms) and then to my work as a scientist working on vectors of disease such as the blood sucking flies (including mosquitoes).
Since working on mosquitoes, I have become interested in their mating behaviour and the pheromonal control of that behaviour and this is the focus of my current research work. Mosquitoes are fascinating creatures - in fact the evolution of the blood sucking habit itself is immensely interesting. More importantly, thinking about ways in which we can interfere with the process of blood feeding - and so control disease transmission is challenging.
I would recommend parasitology as a great subject to study - how can you not be fascinated by an organism that uses another organisms as its environment?
Parasites can still give students that wow! factor experience because of their sophisticated biology and parasitology allows you to cut across disciplines within biological science. You can focus on parasite ecology, or biochemistry, or immunology or indeed molecular biology of parasites. We have just begun to unravel the secrets of parasite genomes and so it is an exciting time to be a parasitologist. Parasites are highly evolved organisms and it will take all our wit and ingenuity to overcome them. So come on - join the battle.
CW I had very little interest in or understanding of mosquitoes before working on this project, but I now see them in a whole new light! This is one of the joys of being a writer; it's a constant process of discovery.
Q How did you come up with the idea of mixing biology with performing arts?
AP The original idea was Christine's, but the Wellcome Trust have also thought about Biomedical science and how it is both communicated and portrayed to different audiences and they fund a programme which supports good ideas like this one (well done Christine). The objective of the funding is quite simply to portray an aspect of Biomedical science in an interesting arts focused approach. So its focus is public engagement. There are some great projects funded through this scheme and if you go to the Wellcome Trust website you can see the work of some of them which are showcased.
CW My interest as a writer for performance lies in the combination of different modes of expression; I wanted to see what happens, for example, when information conveyed directly through a scientific lecture is combined with a choral song cycle. How do we enjoy, understand, experience what we see and hear when information from different realms is brought together in this way? I'm very pleased that Angela Priestman was willing to take part in this experiment!
Q. What will happen when all our malaria drugs are ineffective?
AP All drugs used against parasites will decrease in effectiveness with time. This is because we kill the susceptible parasites and those parasite populations which are more resistant survive - so in effect we are selecting fro resistance. Can we prevent this form happening? We can certainly manage the development of resistance - slow it down essentially, by ensuring that anti-malarial drugs are prescribed and not able to be bought over the counter. When a clinician prescribes a drug, it is given on the basis of assessed clinical need and the patient is provided with instructions on how to take the drug in order to minimise the chances of resistant parasite populations persisting. However, managing resistance is easier said than done - especially when you think of the global context of malaria control. It requires concerted international effort and clear governmental input.
Ok but has this answered your question? What would happen if all the drugs were ineffectual? Put simply we would have to rely on another method of disease control. When you control a disease - especially a vector borne disease like Malaria - it is always a good idea to use a variety of tactics, that is, to use a number of different control measures and in an integrated way.
This means that if one of your control measures fails, then you still have others to fall back on. So if we were ever in the situation of having no effective drugs against the malaria parasite - then we would have to rely on other methods of control which focus on the mosquito - preventing it from biting humans and reducing the numbers of mosquitoes. These latter methods can be very effective in reducing malaria - as was shown by the trials using insecticide-impregnated bed nets in Africa.
A good malaria control programme then, will have integrated control measures which work together to reduce the incidence of malaria and this helps us cope when (or if) one of those control measures becomes less effective.
Control measures against malaria include: early identification and treatment of people with malaria, management of malaria drugs which focuses on using some drugs only with the most serious cases (this is to slow down the development of drug resistance in the parasite), control of the mosquito vectors by using insecticides to kill adult flies and the removal of mosquito breeding sites, reducing the number of bites people get by providing bed nets, other types of house screens over doors and windows, use of repellents in travellers and educating people so that they know of the different ways they can help reduce malaria in their communities and this is not an exhaustive list! Just as malaria pervades all of human life in certain parts of the world, so too should the control against malaria pervade society - it should be evident at individual and community level and right up through to Governmental health strategies.
This article, click here , discusses the effectiveness of a combination of methods in malaria control as used in Eritrea.
The World Health Organisation (WHO) web site on malaria has lots of information about control programmes and methods.
Q Where did you get the inspiration from?
AP You need to ask Christine Watkins this question! She is the writer but it certainly got me thinking about the process of science and how it can be both gloriously rewarding and intensely frustrating almost at the same time!
CW I was looking through some old archive papers, researching something completely different, when I found a copy of speech delivered by the poet John Masefield in praise of Ross's work as a poet and a scientist. I was immediately interested by this way of seeing Ross's poetic work and scientific research as part of one process. This got me thinking about how this could be explored further.
Q If the vector is more difficult to control, apart from with nets, should we be concentrating on genetic methods of Plasmodium eradication?
AP Good disease control programmes are integrated - that is, they incorporate several methods of control which attack the disease from a number of different angles. This way if one control approach fails or becomes less effective, then we can simply rely more heavily on others within our armoury. We must continue to raise awareness of the role of the vector among affected communities and continue to supply bed nets as a very effective and low tech way of reducing the incidence of malaria.
Should we concentrate on genetic methods of Plasmodium eradication? I am presuming that you mean we should concentrate on learning as much as we can from the Plasmodium genome. The answer is yes! Since the genome of Plasmodium falciparum was sequenced and published (see Paper in Nature 2002) molecular scientists have been busy determining the function of its genes. Plasmodium falciparum has 14 chromosomes and about 5,300 genes - we know (broadly) the function of about 40% of those genes - and the remaining 60% appear to be unique to malaria. So, there is a lot of work to do. Functional genomics will tell us what the genes do, how their expression changes and things such as how these parasite evade the immune system and develop resistance to drugs used against them. One of the key areas for immediate study is the identification of parasite antigens that could be used in vaccines. All of this work is on-going and we will no doubt hear of advances in the not too distant future.
Of course, what we are doing with the Plasmodium genome is also being carried out with the Anopheles genome - what do those mosquito genes do? And how might we better understand the interaction between parasite and vector in order to control the disease.? Exciting times and we need more molecular scientists to help with this work - can I tempt you?
Q. What did you want us to get out of this production?
CW I wanted to create an inrigung and captivating performance which would offer you an experience of the connections between things; of ways of seeing the world, and becoming more aware of your own place within it. I believe that curiosity about that is at the root of both art and science, and performance originally took its impulse from that curiosity too. The dramatist Bertolt Brecht called it "Propaganda on behalf of Thinking'.
AP I wanted you to think about scientific discovery in a new way - by focusing on one person and particular moment in time. I could have referred you to the papers outlining Ross's discovery, but you wouldn't have a feel for the man, the moment and the importance of his discovery. Our approach brought Ronald Ross alive and hopefully made you imagine yourself in his shoes - it gave you a picture of hot sultry days in India and the frustration sometimes associated with searching for the evidence to support a theory. I suppose you need to ask yourself - what did I get out of it? What do you remember? What have you taken away from it? Hopefully it entertained you, educated you and enthused you to think of scientific discovery in a new light - something you can do.
Q How long do mosquitoes live for?
AP Well it will depend on the species and also the geographical location. If we are talking about tropical mosquitoes, the adults probably live for 2 - 4 weeks. If you collect wild adults and keep them in the lab, in cages, they can survive for a month or more. Also, if you culture mosquitoes in the lab - they do not have the stresses and dangers of predators, wind, rain etc and so they are generally longer lived. In the UK some mosquitoes only have a single generation in the summer - and they may overwinter as adults - so this means they are adults for 6 - 8 months. The life of a mosquito in tropical locations however, is probably fairly short and most end up as food for other organisms especially birds. Female mosquitoes transmitting malaria must live long enough to take a blood meal (containing malaria) and for the parasite to develop to the sporozoite stage and migrate to the salivary glands. The mosquito must then find another person to feed on - thus transmitting malaria in the process of feeding. Parasite development within the mosquito is temperature dependent but usually takes about 7- 9 days....so to be a vector of malaria, a female mosquito must live longer that about 10-11 days.
Q Why didn't you go into the point of malaria being responsible for sickle cell anaemia in this country?
AP Because it is NOT! You have your information muddled here. Sickle cell anaemia is a disease of the blood (a haemaglobinopathy) in which the haemoglobin - the principle protein in blood cells - changes shape and causes the red blood cells to become more sickle like in shape. It is a genetic disorder that people can inherit from their parents. People who are homozygous for the Haemoglobin S gene (that is they have one copy of S from their mother and one copy from their father) will have sickle cell disease - which is a serious and life threatening disease. Some people are heterozygous for the S gene - meaning they carry one copy of the S gene, whilst their other haemoglobin gene is normal. These people have sickle cell trait. This means they are carriers but do not usually suffer any of the serious effects of having two copies of the S gene.
It was noticed that the distribution for the Haemglobin S (the sickle gene) overlapped with the distribution of malaria and scientists started to think of why this might be.
It seems that someone with sickle cell trait has a survival advantage over people with normal haemoglobin in places where malaria is endemic. It should be noted though that people with Sickle cell disease and trait can get malaria - just that those with the trait are more likely to survive infection with Plasmodium falciparum. Data shows that they survive to adulthood and are able to have children and thereby pass on the gene to the next generation. Why might they have a survival advantage? well it seems that under certain conditions, people with sickle cell trait do have some red blood cells that sickle - and it is the sickling that prevents the malaria parasite from parasitizing red blood cells.
So, the key thing to remember is that it is sickle cell trait that may confer an advantage - but Not sickle cell disease which is a serious and life threatening condition. More information can be found at this web site. sickle cell trait and malaria
Q How is all this relevant to Health and Social care students?
AP Biology is an important part of your Health and Social care course - where you study illnesses and disease. Therefore, this performance should have been interesting to you from the disease viewpoint. Another important part of your course is to study Ethics. There are many ethical issues relating to malaria treatment and control which you could pick up on and discuss. Finally, our world is getting smaller - we talk about the global village, but what it means is that health issues in other countries and other regions of the world are of importance to us - we should know about them and - in the interests of justice - seek ways of ensuring that treatment and facilities available to us here in the 'west' might also be available to those with less resources and money who are suffering from disease elsewhere.
CW Ronald Ross was one of the early advocates of an organized approach to sanitation as a method of disease control; we highlighted this aspect of his work in the section of the performance where the choir sing 'Hymn to Sanitation' . The words of this song are taken from a book 'Mosquito Brigades and how to organise them' published by Ross in 1902. He stressed the importance of 'Sanitarians' - people we would probably refer to as community health workers today, and commented on their vital role and their low pay. Mosquito Night reflected this, as well as the fact that sanitation methods (drainage etc) of mosquito control could not provide the whole answer to the problem. Nb The Hymn to Sanitation can be found on the Songs section of this website.
Q What made you interested in studying mosquitoes?
AP I am a parasitologist - that means I have studied parasites from my first degree (when I did my final year project on fish parasites) through my PhD (on tapeworms) and then to my work as a scientist working on vectors of disease such as the blood sucking flies (including mosquitoes).
Since working on mosquitoes, I have become interested in their mating behaviour and the pheromonal control of that behaviour and this is the focus of my current research work. Mosquitoes are fascinating creatures - in fact the evolution of the blood sucking habit itself is immensely interesting. More importantly, thinking about ways in which we can interfere with the process of blood feeding - and so control disease transmission is challenging.
I would recommend parasitology as a great subject to study - how can you not be fascinated by an organism that uses another organisms as its environment?
Parasites can still give students that wow! factor experience because of their sophisticated biology and parasitology allows you to cut across disciplines within biological science. You can focus on parasite ecology, or biochemistry, or immunology or indeed molecular biology of parasites. We have just begun to unravel the secrets of parasite genomes and so it is an exciting time to be a parasitologist. Parasites are highly evolved organisms and it will take all our wit and ingenuity to overcome them. So come on - join the battle.
CW I had very little interest in or understanding of mosquitoes before working on this project, but I now see them in a whole new light! This is one of the joys of being a writer; it's a constant process of discovery.
