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Photo of Dr Alasdair Coles

Posted: 23 December 2011, 23:14

Neurologist Dr Alasdair Coles of Addenbrooke’s Hospital, Cambridge, talks to Nigel Bovey about his work and his faith

Dr Coles, why did you get into science?

As a child, the first thing I wanted to be was a scuba-diver. As a teenager, I wanted to be a fighter pilot. That took me into science.

I’ve always enjoyed the excitement of discovering new things. I’m not content with what we already have. I want to be part of discovering things and making new and better things happen. Science is about discovering new things and changing our understanding of things to make life better.

How would you describe the science you do?

Part of the time I’m a doctor dealing with diseases of the brain – a neurologist. I am also a scientist working to understand how we can cure or treat brain disease – a neuroscientist. My particular area of research is multiple sclerosis.

What is multiple sclerosis?

Multiple sclerosis is a brain disease that affects young adults, mainly young women. If you see a young woman going down the street using a stick or in a wheelchair, she is most likely to have multiple sclerosis. In the UK it affects 100,000 people.

MS starts with an attack of imbalance or difficulty walking or problems with the bladder and bowels. That lasts for a few weeks and then disappears. It might be weeks or even months before another attack happens. To begin with, these attacks get better, and usually the people who get them don’t bother to seek medical attention.

But over time, the attacks leave some permanent damage, so people are never in quite as good condition as they were. Subsequent attacks leave further damage and that’s when day-to-day problems appear. So by the age of around 40 most people are struggling.

MS also affects the thinking processes. So people who have to be quick with words, such as journalists or sports commentators, find their thinking gets dulled and slows down.

To what extent is MS life-threatening?

It is mainly quality-of-life-threatening. People with MS have a slightly shorter life expectancy (five to ten years) – the equivalent of someone who smokes.

Most people with MS would say that is not the big issue. The big issue is that for the last 10 or 20 years of their life they will have day-to-day problems.

What causes this condition?

It is an autoimmune disease. The root of the problem is in an immune system which mistakenly identifies the brain as an invading bacterium or virus and starts to fight it off. To begin with, the attacks happen to little bits of the brain, which is why there are specific, occasional symptoms. As time goes on, the attacks are more widespread and affect wider parts of the brain.

So the cure lies in identifying and rectifying the trigger mechanism?

Yes. Ideally we want to be able to re-educate the immune system to teach it that the brain is a healthy part of the body and shouldn’t be attacked.

Over the past 20 years, we’ve gone quite a long way towards achieving this. If we are successful, we will be left with people who no longer have fresh attacks but whose brains will still be scarred and damaged from previous episodes.

A second challenge, therefore, is to be able to promote brain repair in people who have a lot of damage. At the moment, that is very difficult. But the experience of someone with MS today is very different from what it was 20 years ago.

Back then, doctors would tell a patient that the condition was untreatable. Today, we can offer three or four drugs. Over the next few years, there will be up to a dozen drugs that will make an impact on the disease. So it is very exciting and positive.

To what extent does gene research and gene therapy form part of your response to MS?

There is no doubt that the genes play a small role in determining how likely it is that a person will get MS. But, unlike Huntington’s disease, there isn’t one gene that is responsible for MS. There may be 100 genes that each slightly increases or decreases the risk of getting MS. Each one by itself has a trivial effect but if you have enough of the risky genes, then you are prone to get the disease. Even that is not all. You would have to encounter something in your early childhood or early adulthood which would trigger the disease.

Given the number of genes involved, realistically gene therapy is not an option. However, the more we understand about a person’s genetics, the more we can see which particular parts of the immune system are going wrong and we can target our drug therapies more effectively.

So you and your colleagues are not carrying out stem-cell research?

No, not in our work. But in other parts of the world people are using human embryonic stem cells in the laboratory to turn them into brain cells as a tool for seeing whether this or that drug in the laboratory helps.

How do you feel about the use of such genetic material?

From a distance it is easy to hold a clear view. The more you look into it, the more complicated it becomes.

I completely agree that a human embryo has the potential for life as a full human and dignity before God and that we should value them as a person in the making. It seems to be straightforward that by using those cells, you are using and destroying potential people, and that is a terrible thing to do. However, the diseases we deal with are terrible too. They do terrible things to human beings.

If it were the case that the only solution for a disease such as MS was to use human embryonic stem cells, I would have conflicting feelings but I would probably use them, and I would defend their use in terms of warfare. There is a war taking place between us and a terrible disease, and in a war soldiers lay down their lives for the greater good.

The key point, however, is that there is very little that is unique now about a human embryonic stem cell that means it has to be used in the treatment of MS.

The discovery of inducible pluripotent stem cells – cells from the skin of an adult that can be made into stem cells and then turned into other types of cells, including nerve cells – is a very exciting prospect and undermines the argument that only embryonic stem cells must be used.

As a doctor, you regularly meet people – and their families – with a debilitating disease. While you rule out using embryonic stem cells in the case of MS, you say that if that were the only option you would use them on the basis of a ‘just war’ principle. Would you also apply that greater good principle to the creating of a child to save a very sick brother or sister?

No one should be quick to come up with a response to this situation. If you have ever dealt with a family who are in that situation, you know it is horrible, difficult and tragic. It is where people are trying to do the best in desperate circumstances.

The logic of what I am saying is that sometimes a ‘saviour sibling’ would be acceptable. It is a very unsavoury and unhappy solution, but we are already in an awful situation with such families.

When and how did you become a Christian?

Throughout my schooling I was a great attender of church or chapel and a member of the Christian Union. I think that experience was authentic. But when I went to university I became an outspoken atheist. I think that was authentic too – it was me becoming independent and challenging everything I’d been taught about God.

That lasted for a few years and then in my early twenties a much more stable faith emerged. I became a Christian, but in some ways I am still becoming a Christian.

Was there a point or an incident in those student days that turned you towards God?

My girlfriend (who is now my wife) was a huge influence, mainly because she is the opposite of me in having faith without intellectual worries. I had all sorts of intellectual questions which I felt had to be answered before I could make a faith commitment. Yet she had a faith commitment without needing all the answers. That was quite a jolt.
 She also gave me a copy of CS Lewis’s Mere Christianity. (Lewis himself had journeyed from atheism to faith.)

I then went to work for three months in a small hospital in Chile. While I was there I had a series of very powerful experiences that gave me a sense of what it was to have a faith.

One weekend I went walking in a national park the size of Wales. The ranger told me there were only two other people in the park. Having camped overnight surrounded by old volcanoes, I set off for a trek round the lake. After a while the track turned into rubble and I had to pick my way through every step. I turned a sudden bend and discovered that this lake was bigger than I thought. I’d never get back to my tent before nightfall.

The trail was blocked by a cliff so I tried to climb it. I fell into the lake. I was very cold and my hands were bleeding but I scrambled out and battled on. I was in a sorry state. How would I ever get back to camp before dark? I started to panic.

Just then two people appeared in a canoe. I tried to call them over but they didn’t move. I struggled on and kept falling in the lake, getting colder and more and more sorry for myself all the time. The couple, meanwhile, stayed about 100 yards away, keeping an eye on me.

When I finally got round the lake, I met them at their camp, where they had a fire ready and cooked me some food. As we talked, I told them that I could have done with their help. They said that they came to this lake once a year to give thanks ever since the husband had been cured of cancer. The chemotherapy meant that they couldn’t have children but that for today I was their child.

That stuck with me for months. All these years later, I’m convinced that God gave me those people – and that picture – as an insight into how he cares for me. It is not a doting care that solves every problem but a care of someone who is willing to watch and to be there in my struggles.

Photo: Nigel Bovey

This article first appeared in The War Cry and is reprinted with permission

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