This week’s guest is a pioneer of IVF, award-winning broadcaster, and member of the House of Lords, Robert Winston.
In this episode
00:50 - Robert Winston: early life
Robert Winston: early life
Robert Winston was born in London on the 15th of July, 1940. He's a British professor, medical doctor, scientist, television presenter, and a Labour peer. He's also been heavily involved in IVF research and pioneered new techniques in screening human embryos. He joined Hammersmith Hospital as a registrar in 1970 and, as a Wellcome research fellow, he became an associate professor at the Catholic University in Leuven in 1975 and was scientific advisor to the WHO's programme in human reproduction from 1975 to 1977. He's written hundreds of books and articles and presented several BBC television series, including 'Superhuman: The Secret Life of Twins' and the award-winning 'The Human Body.' He's also a lifelong supporter of Arsenal Football Club, and a passionate musician. He also briefly embarked on a career in the theatre before he decided he was going to work on fertility.
Chris - Let's go right back to the beginning. Let's hear about the very young Robert Winston. What were the early years like for you?
Robert - It was a pretty happy childhood, I suppose, marred by the death of my father when I was eight. My mother and father were very involved with each other emotionally and they were both fairly political, but not party political. They didn't believe in party politics.
Chris - And this interest in theatre.
Robert - Well, my aunt was a theatre director and she took me to my first theatre, The Lyric, at about the age of six. And my grandmother on my father's side was an opera singer, and I think theatre was in the blood, actually. And in fact, quite a lot of my family looking back - they tell bad stories which aren't true, really - but they're very theatrical.
Chris - So at what point were you disabused of the notion that the theatre was the direction to go and you went down the medical line. Were you pushed into that or did you think, 'No, that's my calling.'
Robert - Well, I left school without any clear idea what I wanted to do. I had a place to do natural sciences and I suddenly thought, I don't want to look down a microscope for the rest of my life. Also, I unusually had a gap year because that wasn't very common. Normally, you went straight from school to university. So I had a gap year and I thought, I don't know what I'm going to do. So I rather idly wrote round at the end of the summer term to three different medical schools and got a couple of interviews. I was interviewed by the first one and they said, 'why aren't you wanting to go to Cambridge?' And I said, 'Well, I just think it would be quite interesting to do medicine here.' So I ended up doing medicine and I had no clear idea about it. And actually, if I'm honest, and this is something that's not easy to admit, but it just seemed quite glamorous to be a medical student.
Chris - I wondered if it was the operating theatre that was the attraction that pulled you into it, because you went to the London Hospital Medical College, which is actually where I went to medical school when it still existed. It merged with St. Bartholomew's and then into what's now Queen Mary, University of London. But what happened through medical school, then? Did you then get drawn towards fertility? Because that's what you are most known for.
Robert - No, it was nothing like that really. Of course, you're right about theatre and medicine because, of course, obviously that's what surgeons did and when people went to see Fabricius operating in Padua, you know, it was a theatre. It was a real theatre. You were never more than a hundred metres away from the body that they were dissecting. I took a whole term to dissect one body. The smell must have been awful. I think I knew I was interested in women's health. That was quite a big thing.
Chris - While at medical school? Even then?
Robert - I was. But I did look at other things and I wondered about psychiatry, I wondered about orthopaedics. I was interested in a whole range of different things and then when I got into doing clinical medicine, I suddenly realised there was a real need to look at women's health much more intensively. I felt that, actually, women hadn't really been getting a very good deal and it was very, very clear that there was a huge amount of research going on in reproduction which was worth doing, and also generally pregnancy. If you're not brilliant, it's quite sensible to go to an area where there isn't much competition. And actually, at that time, reproduction was wide open.
Chris - And you judge yourself to be not brilliant? Very self-effacing.
Robert - I think I'm quite ordinary. I think, really, I was very lucky. Also, I had some wonderful teachers. At school, there was a man called Sid Pask. I did my first in vitro fertilisation when I was 16 with a sea urchin's eggs. And Sid Pask took a group of us up to Scotland, to a marine biology station, and he gave us experiments to do which had been published in the literature. Lord Rothschild was one of the people he suggested I should try and look at. So we looked at what he was looking at, which was the block to polyspermy in eggs. And Rothschild chose to look at what was happening to that moment when fertilisation occurs, there's penetration of the egg, and immediately there's this membrane which forms around the air which prevents other sperm getting in. And it was very simple to reproduce that under the microscope because it's just seawater. But I never for a moment thought I'd be doing this in humans 20 years later.
Chris - It must have planted a seed though, it sounds like it did.
Robert - I suppose I started to try to collect eggs and fertilise them in about 1976, which was about two years before the first IVF baby.
Chris - That's when Bob Edwards and Patrick Steptoe were beginning had been pursuing for a number of years the whole IVF idea, isn't it? Because Louise Brown came along in 1978 as the first IVF baby.
Robert - Bob's papers go back to the sixties, and I think it's very interesting to look back. There have been so many interesting things said about the beginnings of IVF and sometimes I think there's a lot of mythology about what really happened.
Chris - Did you meet them? Did you spend time with them?
Robert - Yes, I did spend some time with them, but I'm afraid we didn't really get on very well. I think Patrick felt sidelined because he very much wanted to be in a London teaching hospital, which I was of course.
Chris - This is at the Hammersmith Hospital by then?
Robert - The Royal Post Graduate Medical School, which was really a wonderful place to be at. And Patrick was out at Oldham. I don't know, we didn't get on. This isn't a criticism of them. I think that he'd worked really hard for a very long time and he'd been under huge scrutiny and massive criticism for what he was doing as being 'unethical.'
Chris - The Daily Mail ran a headline when Louise Brown was born saying, 'This was the devil's work.' This is the national press. The front page news would be: it's the devil's work, making life in a dish. Was it that they wanted to get there first before they shared this? Was this just scientific protectionism and then they were happy to let people have this? Or was there something else going on?
Robert - I can't really comment on their motives, but they didn't publish the details of what they'd done very quickly. If you look at the publication record, you can see there was a long delay. And certainly, they were invited to Australia to look at the other big group doing this with Alan Trounson who was, to me, a hero. Alan, I think, is one of the really great people in reproduction generally because Alan shared everything. There was one occasion when I went to Melbourne specifically because he'd left IVF and come back to it because the Melbourne unit wasn't working very well, the pregnancy rate had slumped and he'd obviously changed the lab. And I went down there, got dressed and went into the sterile environment which he had and there he was in the centre of the virology laboratory on his own.
Robert - I didn't see him at first because he just had a hat and mask and everything on, gown and over shoes. And he was looking down a microscope with his back to me and I walked in and, as I walked towards him, I could see this plume of smoke coming up from the petri dish. And it was only when I got really close to him I could see that actually he had a mask on and there was a cigarette under the corner of the mask. And Alan said, 'You know what? I think the ash is quite good for it.'
Chris - I was going to say, what was the conception rate? Maybe nicotine is a good stimulus for conception.
Robert - Alan's a genius.
09:02 - Robert Winston: pioneering IVF
Robert Winston: pioneering IVF
The second part of Chris' sit down with Robert Winston explores the early days of IVF treatment through to today, where 7 million people have been conceived this way...
Chris - I met Louise Brown when she was 40. She came back to Bourn Hall, which was the clinic that Patrick Steptoe and Bob Edwards founded and set up. They operated from there, didn't they, in Cambridge? And it's still a pioneering IVF clinic. She said there's always a lot of demand for her time when there's a zero or a five in her age, but she came back because she was 40 that year. One of the things she memorably said to me was, there are now millions of us - meaning millions of babies born by IVF. Has it surprised you how far or fast this has gone? Or did you expect that sort of trajectory because of the reason you outlined, which is women had had a raw deal in medicine?
Robert - I never thought it was going to be very valuable. I didn't see IVF as being a big area in public medicine.
Chris - Why not?
Robert - I thought it was going to be too complicated and I was quite a Luddite. I was doing it early, but I thought it was going to always be quite specialised. You would have to have a good laboratory, you had a whole lot of stuff that you weren't going to get through the NHS. But actually I had it much easier than he did up in Oldham. I had a hospital that was a research hospital that actually was prepared to take risks and didn't care what it really cost, providing we could help get some help and so on. And we found it very easy to pave our way. But I didn't really think it was going to be that. So when in fact we got to about 7 million babies, I was very surprised.
Chris - Were you concerned when IVF first came along about what the consequences might be long term? I think it was Jim Watson behind that Daily Mail headline. Were you worried about what the genetic consequences could be of doing this sort of playing God in a dish?
Robert - Jim Watson was always prepared to say things. He still does.
Chris - He still does very much so.
Robert - You can't take him very seriously. I think we were concerned. I think I'm much more concerned now than I was then because I think now we have a lot of evidence to suggest there might be epigenetic effects.
Chris - Of IVF?
Robert - Yes, what you have in the culture media is still a bit of a black box. That five days in culture media is still the biggest failure rate. And so there needs to be much more research. And actually that's what I'm doing at the moment. So I've got a small team at Imperial where we're looking at culture media, we're doing very detailed analysis of what we're seeing and we're finding some very interesting molecules which are being produced by the embryo which are not in the original solution. So it's a rather exciting area.
Chris - So did we go down this road of waving through IVF because we saw there was a need, we saw there was a big demand, many people probably were motivated financially to do this, but because we were blithely ignorant of the role of this epigenetic component where there was an additional layer of control over how genes work, that we just didn't have any idea of at the time, is that why we were just prepared to let it go and we may be we may be cruising for a biological bruising later.
Robert - I think it's much more to that. I think one of the problems has been that actually, once you start to set up a clinic and do IVF, it's very easy to do. You don't need to think about what you're doing. It's regulated, there are certain things you can do and you can't do and so on. And it's a process which you go through.
Chris - But it's not so much the practitioners, I'm getting at the science and the concern about the biology.
Robert - Basically, for people who go to an IVF clinic, infertility is seen as a diagnosis. Like having pain in the chest and asking for, let's say, some form of heart surgery. It's complete nonsense. Of course we should be making a diagnosis, and what we're doing is treating people with the least successful treatment in the whole fertility spectrum. So nowadays the NHS is doing a pretty poor job at treating people with anovulatory infertility, with male infertility, with tubal infertility. The main causes of infertility are not being properly treated. People are just diverted into IVF which, internationally, and you can see what the world results are, run at about 21-23% per cycle at a huge expense with a failure of investment in proper medicine. A key to bad medicine is not to make a prognosis, but just to treat the symptoms. And that's actually what we're doing. We're treating the symptoms of infertility rather than trying to understand it.
Chris - But once you've created a life - you use the figure 7 million IVF people have been conceived - is there a risk that, because we didn't know at the time that there are additional genetic factors at play, these people may have skeletons in their genetic closet that we haven't discovered yet?
Robert - We can't say that for sure, but what we can say is that we know increasingly that when an embryo is in an environment which is not particularly favourable or too favourable, you end up with certain changes which result in their not being able to accommodate a different environment when they are adults. So, for example, that classic work that was done years ago in Sweden, where they looked at a birth cohort from the 1800s and 1790s showing that if you were subjected to a good harvest at the age of nine as a boy, your male grandchildren were more likely to have heart disease and so on almost certainly because of epigenetic effects. And we know increasingly that epigenetic effects are almost certainly transferrable. And that's now increasingly obvious with very recent research and probably not just through one generation. So I think we have to be aware that a lot of the diseases that we're most worried about, some of which will be psychological and psychogenic diseases, are possibly related to epigenetics. And that's a fascinating area. But of course it may be much more than that as well; maybe vascular disease and a whole range of other diseases. I don't think we're going to get lots of people with cancer. But you might want to ask yourself what is the effect of changing metabolic issues in culture? What will be the risk to sugar metabolism, for example, and so on. I think there are some real questions to ask and I think at the very least we should be documenting what we're culturing embryos in much more carefully and actually doing proper research to see how we can optimise what we're doing because we're not doing that properly. So talking to you now, I would say, look, if you're listening to this as a young person thinking about research, think about what opportunities there really are in human reproduction at the moment. It's wide open for somebody to really just have another look at. There's some ethical difficulties about doing some of that research, but much of it doesn't require huge difficulty and some of it can be mimicked in some animal work as well, which we always, regretfully, rather ignore.
Robert Winston: a career in television
Robert Winston
Chris - Let's talk about your broadcasting career for a minute, because that sprung up alongside doing all this amazing fertility work as well. I know what my story is. It was right place, right time, opportunity meets potential. Was that true for you? What happened? How did you end up on the big screen?
Robert - First of all, I was working at the RPMS, the Royal Postgraduate Medical School at Hammersmith, which was run by a man who I think was massively misunderstood. Professor John Brown, who was very supportive of me. He was a very good reproductive clinician and he used to have visitors from all over the world and he would always tell visitors coming here 'you go and see the lab down the road and see what Robert Winston's doing.' And he was amazingly supportive. And you know, I didn't really justify that. But the fact of the matter is, I worked in the environment, which really was very, it was unprescriptive and what you did in your spare time was, you know, if it was interesting and it might support other things. And so getting involved with television, which I did initially in 1974, I did a program with John Mansfield called 'Predictions', which looked at what the health service might look like in 25 years time in the year 2000.
Chris - Were you right?
Robert - No <laugh>. Do you know what? The program won the Prix Europa Award in Berlin. It's a big prize. And it was celebrated by the BBC, it was complete rubbish <laugh> and I presented much of it. And looking back at it, that's too embarrassing to watch, you know, it was not great stuff.
Chris - But did they come to you or did you actively sort of solicit that?
Robert - John was running Horizon at the time and the early days of Horizon, or he was certainly running science. I think he was running Horizon already or certainly was involved with it. And John was one of these people who would constantly be reading the medical journals and he'd read something I'd published and he thought, let's go and have a chat. And he came and he, he walked into the laboratory and he said, 'of course the great thing about you is, busy people have always got time to see each other.' But of course, I was sitting there idly doing nothing at all, working with some rabbit of something, with my mind off it really. No, John was great. He was a very interesting director and he did two things for me. He'd stand me in front of a camera, we came to do 'Your Life in Their Hands.' And I was presenting it and he'd say, 'stop, Robert, you sound pompous.' Or 'Robert, I don't understand a word what you said.' And he kept on battering me until I suddenly thought, and I listened. He was great because he was quite brutal. So I started to think about trying to work out how you have quite complicated things to explain. And that I think really did stand me a good stead. And although I wasn't great at your life in their hands, it did encourage the BBC to consider, to re employ me in due course. But by that time I was really trying to develop my career. So I didn't do much research, the only thing I was really doing about was trying to defend reproductive medicine in the media because we were concerned about what you were talking about earlier, about the terrible comments being made about IVF, but then I got much later on to the human body, I suppose was, for me, quite a big breakthrough because that did sort of, by that time, I felt I probably did have something was worth saying about something quite simple and yet very complicated, the body. And actually I was very lucky there because I had another director who was like John Mansfield, utterly brilliant, Richard Dale. And there I was very lucky because the BBC had a big budget then and they assembled the most amazingly talented production team. And of course I owe so much to that. Really.
19:59 - Robert Winston: life in the House of Lords
Robert Winston: life in the House of Lords
Robert Winston
Chris - More recently, you've made politics much more a prominent part of your life. You joined the House of Lords 20 years ago about then, wasn't it? What sort of difference has that made? How have you got involved there?
Robert - Well, it's been really interesting because of course I've come in at a time when Tony Blair decided, well, it was before Tony, I came in at when John Major was prime minister. But, Tony Blair came in with his idea of reforming the House of Lords. And there was a lot of talk about that. But the House of Lords reform bill as it went through, was very different by the time it had gone through. And it became increasingly obvious that reforming the House of Lords was going to be much more complicated than anybody had expected. I was making speeches, which I was proud of, that was ridiculous really, saying, looking across the other side, to the hereditary peer saying, well, of course on the other side you have all these people who are taller than us, much more handsome, better looking, you know, these are the hereditary peers you see.
Chris - They always say politics is show business rugby people, but I'm not fitting you in that category.
Robert - I mean, some of the best debaters in the House of Commons and certainly in the House of Lords have a strong theatrical process because actually what has happened now in Parliament, which is very sad, people read their speeches. So you see people with their head down over a piece of paper, they come determined to give the speech they've written, not recognizing the speech has already been read by two other people, from different benches. And actually what they need to do is be listening and responding in a different way. I think the people who are successful to some extent in actually changing legislation and making the government rethink are those who may make mistakes while they're speaking, but speak extemporary. And we have some fantastic speakers in the House of Lords, and I look at them as wonderful models. I wish I could emulate them. I mean, Igor Judge, who's on the cross benches as the leader of the Cross Benches, I mean, he gave a speech on the British Constitution at the time when the Prime Minister was creating havoc last autumn. And he spoke for three minutes. And you thought, wow. I sat there open mouthed thinking, what a privilege to be in that chamber listening to this speech.
Chris - What about science though? Is that well represented there? And are you very much a lone voice or are you in good company?
Robert - It was better. You know, when I chaired the Select Committee for Science and Technology, which was a long time ago, that first time there were a couple of Nobel Prize winners on the table, everybody around the table was a fellow of at least one of the academies, of which there were three. There were one or two lay people, very few. And the lay people had been in business doing big industrial things. So I remember very well first chairing the report on nuclear waste. And I was terrified because I knew that this was going to be a big issue. Half of us wanted to bury nuclear waste and I was suddenly taking this committee over because I was the new chairman. And I, the more I thought about it, the more I was concerned that they were gonna vote. And that's fatal. You don't vote on these sorts of issues if you're gonna have any influence.
Chris - Why not? Is that because you're voting on something you don't know enough about
Robert - On a committee, you just don't divide the committee. You want to present a unanimous report. And if you can't get complete agreement, ignore that part of the report completely. Just find other ways of fudging the issue slightly to make sure that you get the right impact for the key issues. You all agree you must go through. And it was clear that we weren't certain as a committee. The guy who'd produced this report who was the chairman of the subcommittee, was Lord Tombs. And as we got into, and I thought, this is a taut situation, so I said 'what we have to talk about this morning, I think really my lords, is what we do about burying nuclear waste. And it's very fortunate we have Lord Tombs of course, who's going to be leading on this, and I wonder if I could just pass over to him.' And of course, you know, there's a roar of laughter. And so in fact, we got a report out which in fact went through. And there are problems of course with nuclear waste and we still have issues, but it certainly left us with some kind of nuclear industry <laugh>.
Chris - When we met this morning, you showed us the vellum where Oliver Cromwell had signed the death warrant for King Charles I, and you said he craftily put himself well down the list so that he <laugh> he didn't have the spotlight shone on him as the main signatory. It sounds like you were taking a leaf out of his book, or vellum even.
Robert - Well, I was really pretty intimidated by that committee. When I sort of took over as chairman and I thought, well, I'm probably the least qualified, certainly the youngest member. I'm really, what am I doing here? You know, that all these guys, you know, have done so much. And it's wise to remember in the House of Lords particularly that whenever you are speaking, whoever you are, there's always somebody in the chamber who knows more than you do. And, you know, we had some really good people in the government, you know, we had people like Bob May who'd been president of the Royal Society and people of that kind. And of course we still have Lord Rees, but we don't have many people of that calibre in the House of Lords now.
Chris - And do you think that's making a difference?
Robert - Well, of course the appointments are made politically and they're made for all sorts of reasons. I mean one of the big problems at the House of Lords is actually, if you're going to have an unelected chamber, you've got to make certain, you are appointing people who are going to do what is needed. And if you are expecting an expert chamber to give expert advice, you need to have experts, whether you like experts giving you stuff you want to hear or not.
Chris - Are you saying this, I mean, are you making a noise about this? Because it strikes me that we've just come off the back of a pandemic. We've got really important things going on on the international stage, ai, other sorts of intelligence and machine learning. We've got things like advanced genetics and embryo manipulation. We've touched on that, but also three parent embryos and so on, which is now going into clinical practice. There are really very important lifelong impacting decisions being made at the moment. It strikes me as quite frankly, daft that we don't have a stronger scientific representation in the decision makers.
Robert - Well I think you're right, but I think that also of course to, in my, just in my own defence, I would say at least the legislation we've got on embryo research and, and, and the and all that stuff, we've had really good debates and I think actually we got together very good legislation. I wasn't the only person involved in doing that. I mean, one of the people who I worked with very much in tandem from different parts of the house is Naren Patel. And so Lord Patel and I certainly, you know, were giving, we didn't rehearse our speeches together, but we knew really where we were coming from
Chris - The theatre coming in again?
Robert - You could say that, but actually I think it was very persuasive and you know, you're dealing with fairly intelligent people who can understand an ethical issue. And I think that actually works. But you do need to have a few people who had ethical judgement by that time. Of course, Baroness Warnock was really already quite elderly and really probably not really any longer as active in those sorts of debates as she might have been. And we needed new people. But of course, we've not been replacing those people. And I think that's a problem. So if you look around the Chamber now, there aren't many fellows of the Royal Academy of Engineering or the Royal Society or the Academy of Medical Sciences. And of course, for all the disadvantages of having people who are obviously no doubt with certain blinkered aspects to their career, those are really important voices. And that's only just one example. There are so many people I could think of who would be better in the House of Lords than I am. And I think, it's very easy to forget that there are all sorts of people who could be appointed and it's a lottery and to be fair, to be of any use there, you have to give up quite a lot of time. You can't just walk in, give a speech and walk out again, if you're going to really influence the chamber, you've got to be present a lot of the time and get the feeling of how the house is likely to react. And that means, it might be sitting in the bar or you know, wherever, but you get the feeling about actually how this is best presented. And unfortunately, in the Commons we're never going to get that because it's, it's divided by a ridiculous thing called politics. And we've seen how destructive politics are this year, the last two years, three years. I mean, where we've had crazy political decisions which have been simply a way of somebody promoting a particular pet subject or some interest that they've had.
Chris - Would for instance not be able to decide what sex fits into that? People seem to struggle to define what a man or a woman is and what you can do to yourself to have a sex change. And whether or not that means you have a different sex or not.
Robert - It's a daft debate, isn't it? I mean, the problem of course, and I know I'm gonna antagonise a lot of people, but it's biologically obvious that you can't actually change your sex. You can change your gender, but you can't change your sex. So I don't have a problem with that. I don't mind people being transgender. Of course there are some wonderful people who are promoting transgender issues, but there's a risk, of course, of doing it in a way which might be damaging. And of course in my own clinic, I found very early on that I saw a lot of people who'd had transgender reassignment and who felt deeply damaged by the process that they had exceeded at the time, thinking that this is what they wanted to be. And now realizing that they actually were bereft and actually really depressed. Now of course they might have been in any way, there's no controlled trials, but what I think we need to be thinking about is what is the scientific basis behind that desire? What is the scientific basis behind the request not to be in any way pejorative or trying to be prejudiced. It's to try and find out actually why this is happening, what we can do to make the best use of what is needed and to help people and to encourage them to carry on or not. But I mean, to offer, things which are going to damage their puberty hormones, which, we were using IVF before they were, we know how dangerous hormones are to block puberty. When somebody hasn't really got that degree of competence really, or they may have the wonderful energy to want to change, but the competence to really understand what really might be going on and not to have proper advice. And I think what we've seen recently, which has been quite controversial, of course it's been whipped up because it's a bit like that Daily Mail thing, isn't it? The fact is that the newspapers make a profit and they may only make a profit just, and they only make a profit just because they are actually controversial. And as soon as you don't have controversial articles and you see it right through our daily news now, in fact the news is changing increasingly, unfortunately, we're becoming less ready to read.
Chris - Very deep and intense conversation. What do you do to unwind at the end of a tough day, though?
Robert - I'm doing a huge amount of music at the moment, so the Wigmore Hall is a great place to be and the more I go to the Wigmore Hall, again, I stopped doing it for a long time, the more impressed I'm with the sort of quality of music we have in London. So I put music very high on my order and it seems to me it's a shocking thing in this country that we have not supported music in primary school in the way we should because we're not sufficiently educated in a whole range of things. Music is one very good example, which I think is a hugely civilising influence. And so just being able to see these great people on stage and thank them by applauding them afterwards is very special.
Comments
Add a comment