I got a cab this yesterday, and I said good morning and asked how the driver was doing, as I always do when I grab a cab. They looked at me and said ‘you are a happy person, so many of my rides are not’. This really got me thinking about happiness and outlook. Life is challenging for a lot of us right now. The world is a scary place. A lot of the rules that we thought existed to manage how society works are being challenged, and for those of us who work in the NHS the job feels harder than it’s ever been. It is easy to fall into what Mr Girlymicro and I describe as the pit of despair. Some days, the only thing we can control is what that pit looks like. Can you line it with pillows, blankets and Darjeeling tea, to make it manageable until you find the ladder out? On days where I find myself within the pit I try to focus on what positives I can i.e. find my pillows, and use what comfort there is to ride the wave. Here are a few of my reflections from my recent pit time about my things to be grateful for, even on bad days in case anyone else is finding it hard right now.
Allows people to show you who they are
I like to think that I approach everyone with the same baseline attitude of trust and optimism. There have been a few times in my career where this may have been an approach that ended up costing me, either emotionally or professionally. I’ve made an active decision that this is how I want to continue however, as I don’t want to be someone who is forced into a cynical existence. I want to continue to think the best of everyone and their intentions.
If I then get caught out because of this ‘glass is half full’ approach I think there are still positives, even if it can come with a cost. It may not always feel like it but knowing who people are is a gift. Seeing the person behind the mask enables you to know what really motivates their behaviour, which only makes you more empowered to interact with them in the future. In this one, reality, no matter how painful, is better than existing in your previous delusion. That said, someone told me once ‘when someone shows us they are believe them the first time’. So I now try to face up to my new reality on first exposure rather than getting stuck in a loop of second chances.
Aids with learning more about who you are
When your back is against the wall, when resources are limited or you are in a place where every interaction feels like a battle, it’s tiring, it’s draining and boy is it depressing. Part of survival in these circumstances is choosing your battles, and often doing a lot of thinking about how to manage yourself within that space. If you’re like me, there will also be a lot of questioning about how you ended up in that difficult spot. All of this can feel a bit like self flagellation in the moment, but it actually fulfils an important purpose, and it’s not just about survival. All of this strategising and reflection is an essential part of learning.
The learning, for me, is always about which decisions did I make that led me to this place, and how can I make better choices and see red flags when I have previously missed them. When making decisions about which battles to go into, what do those choices say about my priorities and the things I value? How can I use this self knowledge better? The big one though, is also what was/is my role in where I’ve found myself. The ugly and oft unwanted truth is that I have always played a role, so where was I the protagonist is the piece? Where is my learning about how to be better? A better person? A better colleague? A better scientist? Learning is a gift and we should take it where we can find it.
Motivates you to channel creativity
You may not be able to control the external forces that feel like they are whipping your existence into a hurricane, but you can control some of your responses to them. Now, I’m an emotional person, and in my hurricane I often feel like Dorothy in her house as it’s flying to Oz. For me, I need to find a way to ground myself and my thinking. I need an outlet and something that I can focus on to stop my mind from running wild. During these times I have so many thoughts but also moments of inspiration.
If I were a more creative person I suspect I would paint or write poetry. It will surprise none of you though to find that instead I tend to list possible future blog titles based around what I’m processing. If a particular ideas seizes me I will just sit and write the whole thing but often it’s about capturing the moment in the form of titles. I know that 2024 and 2025 have been hard times by the fact that I have over 300 blogs in some level of draft. Some of those will get collated, some of them will go nowhere, and some of them will keep me busy writing for the next several years. Looking back on these titles shows me that positive things can come out of difficult times, and helps me process where I’ve been, where I am now, and where I’d like to get to.
Provides you with moments to practice responses
It’s not just practical skills where practice makes perfect, it’s also valid for our coping responses and communication skills. This can be anything from saying no or setting boundaries, to skills that help you manage emotional overwhelm or anxiety. No one wants to find themselves in difficult times or managing difficult relationships, but I don’t think I’ve ever met anyone who hasn’t gone through periods of challenge in their lives, so the sooner we get better at some of these responses the better we will manage when the bad times hit.
That said, you don’t want to be doing the self reflection or learning needed to identify what responses might help you when you are in the midst of things. It’s probably best to do your thinking in calmer times, and use the moments of trouble to practice applying them. I don’t want anyone to have enough of these moments to excel at the application piece, but the reality is you will hit difficult times and so having them as part of your toolbox can only help.
Helps you learn who your trusted friends are
I have a small number, and I mean below 10, of people in my life I trust with all of me. The people I trust to give me the difficult truth and help me through managing my response. The people I know who are always there to support and don’t have an agenda, or want anything from me for being in my life. When I was younger, like many of us, I thought it was nice to be popular, to have a long list of people I thought of as friends. It’s taken me time to realise that I have friends, and then I have the people I can call at the darkest and worst times in my life who would catch a flight to wherever I was and just give me a hug if that was what I needed. The people who would answer the phone if I needed them to at 3am and just listen to me cry it out. I am so grateful for these people, but you often only work out who’s who during the dark times.
Gives you an opportunity to review priorities
It is very easy to get into a vibe and just carry on down a pathway that you set your mind to without ever taking the time to review. This is especially true for healthcare careers, where you decide in your early 20’s the pathway of professional and educational development you will follow for the next 20 years. As you are going through difficult times and learning who you are however, it is also a good time to decide whether this is what you want any more? Is it worth the challenge? Is it worth the fight? Is it worth the energy you are putting in to keep going? Every time I’ve been through this exercise the answer has come back yes to the general sense of direction. I have come to a different conclusion about different components of the whole though. I’ve quit committees and other commitments, where the answer has come back as no. All to enable me to put more time and energy into the things have come back as yes. Not everything works at every phase, and so bad times give you an opportunity to drop those things that no longer serve your inner purpose.
Makes you focus on what is important
Dropping things leads me onto my next thought. Once you have reviewed yourself and your priorities the next question I ask myself is ‘what do I need to survive this?’. What are the important keystones of your life that you can focus on in order to ride out what is going on. Sometimes what you need are big things and big changes. Sometimes the thing you need is just something that will get you through the moment of struggle. For example, there are days where what I need more than anything in the world is to lie on my sofa with the lights out, the patios doors open, and to just listen and watch while the rain pours. It’s been something that calms my soul since childhood, where I would gather a duvet and sit on a swing wrapped up and warm while the rain fell all around me. It depends on the situation and the moment.
My responses to the hard moments have a tendency, in general, to be more insular. Some people, in these difficult circumstances, become extraverted and focus on spending time with people, be it for distraction or support. I tend to want to reduce my exposure to the outside world and outside stimulus, and retreat to my safe space, being at home in my castle with Mr Girlymicro. I want to pull up the drawbridge and immerse myself in things that will distract my mind, like movies and games, or calm my soul, until I’m forced to re-engage with the outside. There’s a lot to be said for understanding yourself enough to know what aids you when the world feels like it is crumbling around you. These moments can remind you of what you value, and the self care that you perhaps should have been doing more of.
Aids in future planning
I talked earlier about how being conscious of the decisions and things you prioritise during hard times in order to learn more about yourself, but I think it also goes beyond that. Bad times can provide moments where you can thoroughly review your life and start to refresh your thinking about who and where you want to be when you come out the other side. When the world is so shaken you lose your centre, it’s an opportunity to find a new balance that will enable you to strike out in a new direction when the clouds do eventually clear.
I often struggle to live in the moment. Even more so when I don’t like the moment that I am in. In order to escape the reality of where I’m at I will play with dreaming of different futures, like some people imagine outfits I imagine where I could be. If I find one that speaks to me I think ‘what do I need to find my route forward?’ ‘What could lead me there?’ Obviously a lot of this is just release via dreaming, but sometimes things stick and it can change how I plan my next steps. This is how I decided on writing a pathology murder mystery series when I retire, and how I’m even taking steps now to prepare for that aspiration as I pootle along in my everyday life. Using this method to review and map your ambitions can be a helpful use of your time, not just an escape.
Reminds you of what you are grateful for
As dear Taylor says ‘If you never bleed you’re never gonna grow.’ Growth is hard and sometimes unwelcome, but if we want to be better it is inevitably something that needs to happen. That said, we need something to get us through, and if I had to sum it up, that thing is gratitude. It’s remembering through the maelstrom who we are and what we value. Different people are grateful for different things but, for me, in terms of the big stuff, it always comes down to family. My family by blood, and my chosen family. Both of whom will be with me no matter what.
As for the smaller and everyday, during the pandemic friends of mine went out of their way to send me little gifts. A teacup to have my favourite tea in. A bottle of gin or champagne so I could enjoy what little down time I got. Many of those items sit on my dresser in the kitchen and remind me to be grateful. It’s often not the large gestures that stay with us, but the small things that remind us we are in peoples thoughts. The moments that remind us that we are seen by others, so we don’t succumb to feeling invisible in our gloom. Whatever you are grateful for though, make sure you pay it forward when you can, so your things can sit in someone else’s kitchen and remind them they matter.
Helps make you ready for what comes next
I wanted to finish with a reminder that getting through the hard times prepares us for the future. If you take on the learning, about yourself and others, you will walk out of that storm a better, more prepared person than when you entered it. There will be a future that will be brighter because of the darkness you’ve lived through it. That doesn’t make what you are experiencing right now better, it doesn’t make it fair, but sadly life is like that. What it enables you to end up being is a more defined version of yourself. A person who knows who you are and what you want. Hopefully a person who is able to go after those things. It can also help you to be a person who now knows what you don’t want, and what you are prepared to let go of carrying in order to improve your life. That too is a different kind of bonus.
When I’m deep in the darkness I tell myself if I can find my ‘second star to the right, and just keep on till morning’ I too will find my way out of the storm and end up where I want to be.
Today, I’m at the Advancing Healthcare Awards, as I’ve been shortlisted for an award from the Academy of Healthcare Science. It’s so lovely to be considered, especially as this nomination was linked to this blog, and it’s the first time I’ve ever been considered for something linked to Girlymicro. That obviously means an awful lot. In all honesty I’m highly unlikely to win, and that is nothing to do with modesty. If you don’t know the other people listed below, they are all pretty epic, and I think are much more aligned with the judging category.
The thing is for me, it’s not about the winning, it’s about sharing in the success of others, and that’s what I’m really looking forward to. Now, you may roll your eyes at me, and say that I am just saying that as everyone wants to win. I acknowledge that I won’t refuse the award if offered, but I can genuinely say that I’m OK to be the person that cheers loudly for others. I’m lucky enough to have won a number of awards in my time, and I’m even more fortunate to have been considered for many more.
At the start, I really did think it was about the winning, but over the years my appreciation of just being in the room has grown. Now, I consider the fact that someone has given their precious time to nominate me the real win. Time is the thing that no one has a lot of, and for someone to use it on something for me means the absolute world. This isn’t just true for awards, however, my point of view and how I celebrate has changed for most things, from grant writing and papers, to goals in my personal life. Doing my PhD, and writing my PhD thesis, really caused me to actively think about what works for me. So, I thought on a day like today I would share my thinking in case it helps others.
What success looks like feels different at different times
As I’ve said above, I haven’t always had the same attitude to marking progress and success as I have now. I think undertaking a PhD, and trying to make my way as a clinical academic, where so much of what happens results in failure, really caused me to actively think about how I maintained my motivation and marked progress. This is especially true for long terms goals, including those career milestones which occur over years rather than months, and where there are likely to be a lot of peaks and troughs along the way.
It’s important to also know that success feels different at different moments in life. There have certainly been times in recent years where the successes I’ve marked have not been about the big things. They haven’t been about winning large amounts of grant funding or awards. My successes have been about getting through the week, and to be honest, sometimes they have been about getting through the day. The pandemic hit me hard and I think I’m still in recovery mode. At these times, for me, it’s about finding and celebrating the small wins and setting myself small targets, in order to feel like I’m still moving forward.
If you only celebrate the successes you miss out
I wish I’d learn to change my attitude to success earlier. I feel like, in hindsight, I missed out on enjoying some of the journey of my career by being so target focused, and only appreciated the big mile stones. I’ve always been the same though. When I was at uni or doing my A-levels, I was so focused on getting through the exams, I never had the energy to go out and celebrate afterwards with everyone else. I would just go home and crash out. Making the shift to celebrating the steps along the way has made such a change to my perfectionism by making me appreciate the building blocks it takes to achieve. I also think it has made me a better mentor, supervisor and leader, as I now encourage others to do the same. Don’t just celebrate when you get a paper accepted. Celebrate when you have finished writing it and you are ready to submit. Celebrate getting a first draft of your thesis written, not just the day that you pass. Celebrate completing a section of your training portfolio, not just the day you get the completion certificate. Celebrate the fact that you have done the work, shown up and made the effort. Not just the outcome, about which you may have little control.
Acknowledge the work done
There are days when you will not achieve. That is just the reality. There will be days when you stare at the screen and manage to eek out 300 words, rather than finding your rhythm and getting down 2000 plus. To try to persuade yourself otherwise will just set you up for failure. It’s important to work out where the benchmark for celebration is, and also to match the reward to the benchmark. For me, some days that’s rewarding myself with a bubble bath if I finish a blog post early enough to make the time. Some days, it’s saying if I can make it through the next 30 minutes of meetings I’ll reward myself with a biscuit and a cup of tea. Other days, it will be that I can buy myself the dress I want if I can get back to running a continuous 5K. Not everything is worthy of a reward, in my world, I still have to set and meet a target. It’s just that target gets flexed these days based on the reality I find myself in. I still have to do the work, there is no free pass.
Marking progress in any form is worthwhile
The reason I now adjust my benchmarks is that I’ve learnt the value of movement, and not being paralysed by the size of the task ahead or the pressure I’ve placed upon myself. If you only celebrate the big moments, the end points, then in the times in-between it can be easy to feel like this movement doesn’t exist, as it’s harder to realise the progress you are making. This could just be me, but there is so much value to psychologically feeling like you have momentum. That even if the way up the hill is slow and painful, you are still getting closer to the summit. There’s a figure banded around that only 20% of grant submissions are successful. Most of the essays that get submitted will not get A’s, and for every successful interview candidate there will be multiple people that don’t get the job. If you don’t acknowledge and notice the progress it is easy to get overwhelmed by the failures. So mark progress where it happens so that you don’t just see the ‘no’s’.
There is always value in feeling seen
I’ve written before about all the reasons I think it is important to nominate others for awards. A lot of the reasons why you should nominate for awards also hold true for putting people forward for other opportunities, such as membership of committees, or inclusion on grants and papers. It can feel very lonely when you are carving out a path for yourself, especially if you are not following a well trodden path. Nominating and putting others forward can help them feel recognised, but the same is also true for you. Opening ourselves up to risk of failure, of not being chosen, or receiving feedback that may not be glowing can be hard. The thing is, this is how you build networks and get seen. This is how your name gets known. You may not get that opportunity, but it may be that the panel remember you for a future one where you may be more suited. This one comes back to celebrating the things that are in your power to control. You have control over the submission, over the putting yourself out there. You don’t have control over how your attempt lands (other than making sure you put in the work), or who you are competing against. So the success to celebrate here is the courage it took to take a chance, and step out of your comfort zone. Celebrate rolling the dice on yourself.
Feedback can be the greatest gift
I’ve received some pretty hard core feedback in my time, everything from ‘you contribute negligibly to infection prevention and control’ to ‘there does not appear to be anything that demonstrates this applicant has anything exceptional or above average for their future career trajectory’. I’ve had documents returned covered in red, comments about the fact that I can’t write, and grant rejections where I’m pretty sure they didn’t even open the form, despite the fact I’d sacrificed 6 months of my life to complete it. Needless to say, it is these comments I remember rather than any of the ones that said anything positive or nice about my submissions.
Now, I’m not saying that I celebrate the harsh ones right away, I permit myself a period of processing. This period of processing is easier and shorter if I’ve allowed myself to celebrate the work it took to get the submission in. After this period of processing/mourning, however, I make an active choice to go through and find the learning. I find the commentary that is based in fact, no matter how uncomfortable. The commentary that is actionable, and I reflect on how to make the change/improvement. I try to learn how to be better for next time. I then celebrate my engagement with the process. It may not be a party. It may be a ‘thank god that’s done’ drink, but I mark it. I mark the learning and I mark the fact that I had the courage to do the work that was hard/unpleasant. Celebration shouldn’t just be about joy. For me, it’s about acknowledgement of significant moments, and that includes failure as long as there’s learning.
Any journey worth taking is filled with moments of tantalising closeness
Traditionally, success is often seen as moving from point A to point B. In reality, in my experience, success is more like a series of concentric circles where improvement is cumulative, and often based on iterative improvement. Therefore any journey actually has a lot of near misses with success before success actually occurs. It’s actually important to notice when these near misses occur, rather than just discounting them as failures. These near misses represent huge steps of progress in themselves, and therefore deserve to be acknowledge as an important part of the journey. Not least because, by celebrating them, it can make it easier to take on and include the learning they provide, rather than discounting them as just another failure. The lens through which we see these moments can have a direct impact on how quickly we move from near miss to direct strike. Attitude is everything, and so make sure you embrace these as the opportunities they really are.
Sometimes the moments between successes can be protracted
There are things in life and professional practice that are the work of years, rather than weeks or months. Even if a project is over months, there can be moments when it is hard going. Writing a big report can feel soul destroying when you are on draft 54 and everyone has given conflicting feedback. Undertaking a professional portfolio can just be draining when you can’t get anyone to give you the time needed to sign off competencies or review sections. Then there are things like a PhD which run over years and are comprised of numerous stages, all of which are likely to rely on other people at various points, or to practice skills you are only just learning. All of this means the time from commencement to completion can be long, causing relying on internal motivation alone to be pretty hard going. By acknowledging that these bigger pieces of work are comprised of segments, and celebrating completion of these parts instead, can enable you to visualise progress made as well as to celebrate the learning gained along the way. It can also help you to regain momentum when you lose it.
The real learning occurs long before the end point
Talking about celebrating learning, this is an important point for me. It’s taken me a while to really stop and reflect on what ‘success’ really means. For a long time if you’d asked me I would have said it was the completion of something, but I’m not sure I would any more. The certificate at the end, or the gateway is symbolic of that completion, but for me now it’s more symbolic of the learning and change that occurred within me as part of the process. It’s the hard won changes, in either knowledge or outlook, that have been gained that are the real marker of change linked to the activity. This learning happens as you are involved in the process, and there is normally a fairly steep learning curve at the start. It therefore makes less and less sense to me to just celebrate at the end. Celebrating during the toughest moments, where the maximum learning is being gained, no matter where along the process that occurs, now makes the most sense. For me, success is getting to the point where I feel I do something better than I did before, be that decision making, leadership, or a practical skill, and so I celebrate when these breakthroughs occur, rather than relying entirely on an external evaluation of my progress.
Share the moments
This photo was taken at another Advancing Healthcare Awards lunch, many years ago. You can see all the smiling faces of people still involved in my life even now. The thing is, I didn’t win, but that is not what I remember about the day. I remember a glorious afternoon and evening with people that I admire and care about. I remember laughing so hard that one of us fell over. I know that we still talk about that day even now. I don’t even remember what I was nominated for, because it is the people I remember, not the lack of a win.
All of this is to say, it is the people in our lives that make life worth it. It is the people who pick us up and put us back together. It is the people that celebrate our successes and cheer us on. So why would I want to have less of that, and restrict my access to these moments. Share the joy, share the progress, and share the moments that matter in making us who we are. Life is short, so seize it.
Friday the 25th April, was World DNA Day. I’ve had a series of blogs that I’ve been playing around with for a while linked to what DNA is, how we look for and investigate it and how we are exploring DNA in our everyday lives. It felt like this was the time to put these blogs out there. Linked to this I’ve also had two books I’ve wanted to talk about that were set within worlds that have changed because of genetic testing and genetic manipulation. It was fun to share reviews of these in the context of talking about the current technology and scientific/ethical questions are to see what these fictional landscapes might add to the discussion. I hope you reading these as much as I enjoyed writing them.
This month I’ve been honouring of World DNA day 2025 by publishing a number of posts linked to what DNA is, how we look for it, and what it means to send it away.
Today I’m talking about Upgrade by Blake Crouch. In the story explored in this world, DNA based technology, although very obviously rooted in present day science, has evolved and so has the impact and access to this technology for both individuals and society. In this post I thought it might be interesting to explore ow much of this book is science, and how much of it is fiction? Before I get onto that however, here’s a reminder of the other posts that have been available in the DNA blog series:
One of the reasons I picked Upgrade for the final book review is that I thought it would be interesting, after discussing the current usage of DNA for testing and therapies in previous posts, to explore a book that covers a slightly further future, based in 2060, and what impact the use of DNA technologies could have on humanity in the future.
‘You are the next step in human evolution . . .’
What if you were capable of more?
Your concentration was better, you could multitask quicker, read faster, memorize more, sleep deeper.
For Logan Ramsay, it’s happening. He’s beginning to see the world around him, even those he loves the most, in whole new ways.
He knows that it’s not natural, that his genes have been hacked. He has been targeted for an upgrade.
Logan’s family legacy is one he has been trying to escape for decades and it has left him vulnerable to attack. But with a terrifying plan in place to replicate his upgrade throughout the world’s population, he may be the only person capable of stopping what has already been set in motion.
To win this war against humanity Logan will now have to become something other than himself . . .
In this world, DNA based technology, although very obviously rooted in present day science, has evolved and so has the impact and access to this technology for both individuals and society. It raises some interesting questions about what it means to be human. In this post I thought I would explore some of the science that is included, and what questions the use of this science brings into play.
Are visions of a world where DNA controls our lives unique?
Before I get into the science of the book however, I wanted to flag that visions of a world where the use of DNA testing, evaluation or modification, are not new. GATTACA (did you see what they did there……they are all DNA bases) have been around since the 90’s, when the technology we use clinically now was only in its infancy. Fear of how science could be used in the future is a pretty constant feature of this type of creative content, as it provides a safe way to explore these fears and ethical challenges. I suppose what I’m saying is that just because something is included in these kinds of visioning pieces does not make it bad, wrong or scary. It just means that we also need to think and reflect on what checks and balances are included as part of their introduction in order to make sure the world we create and influence based upon them is the one that we are aiming for, and we have taken steps that include the law of unexpected consequences rather than ignoring it. DNA editing is an amazing, technically complex and powerful tool that has the potential to be positively life changing, so please keep that in mind when you read the rest of this post.
The world of upgrade
In the world of Upgrade the impacts of climate change have really been felt. Entire cities have been flooded as the seas rise and access to food has become a real issue for vast portions of the worlds population. Logan, our protagonist is the son of a genius, a woman changing the face of science. Being the child of a world famous geneticist makes Logan feel the reality of being a normal person surrounding by an extraordinary vision.
I had extraordinary dreams but had been gifted only an ordinary mind
Sadly, as is often the case in these tales, his mothers (Miriam Ramsay) drive for change comes with a fair amount of hubris. In an attempt to address the food shortages Miriam, with Logan supporting as a junior scientist, develops a new gene editing tool called Scythe in an attempt to genetically enhance rice crops. The process goes wrong, and results in The Great Starvation that leads to the deaths of 200 million people.
As a result of the mass deaths, genetic manipulation using Scythe or related tools originating from CRISPR, are outlawed and their use results in a mandatory 30 year minimum jail term. Thus making the field of genetics either outlawed or suspect, and to the birth of the Gene Protection Agency, a police force which aims to track down those undertaking illegal manipulations or research.
Logan ends up going to prison for his work with his mother’s research, and his mother commits suicide. After serving his time Logan is released and joins the very agency that has been set up to prevent a repeat of the genetic manipulation that changed the world. At the start of the book Logan is investigating a scene where an explosion happens, his body is hit by shards of ice, and his life changes again…..forever.
My mother had tried to edit a few rice paddies and ended up killing two hundred million people. What havoc could she wreak—intentionally or through unintended consequences—by attempting to change something as fundamental as how Homo sapiens think?
So, what is gene editing?
I’ve already mentioned CRISPR but I’ve not described what it or gene editing actually are. Gene editing as defined by the World Health Organisation is:
A method for making specific changes to the DNA of a cell or organism. It can be used to add, remove or alter DNA in the genome. Human genome editing technologies can be used on somatic cells (non-heritable), germline cells (not for reproduction) and germline cells (for reproduction).
Before I go further I should probably talk about how CRISPR works and what it is used for. Tools like CRISPR/Cas9 are tools for gene editing, and are the present day origins behind the futuristic tools present in Upgrade. Emmanuelle Charpentier and Jennifer Doudna were awarded the Nobel Prize in Chemistry in 2020 for the development of CRISPR, commonly referred to as genetic scissors.
CRISPR allows you to design a targeted way of manipulating a gene section that you are interested in, and in some cases then replace it with an alternative gene section, which enables the gene to function in a different way. Being able to target and replace, or inactivate genes, in this way opens up a whole new world of possibilities, from health to industrial applications. There are three main approaches to gene manipulation:
Replacing a disease-causing gene with a healthy copy of the gene
Inactivating a disease-causing gene that is not functioning properly
Introducing a new or modified gene into the body to help treat a disease
Now, wearing my geek credentials on my sleeve, I wanted to share with you a music video that describes how CRISPR works. It’s set to the music of ‘Mr Sandman, bring me a dream’ and is retitled ‘CRISPR/Cas9 bring me a gene’. I love this as it I think it describes the history of the process really well. I will tell you now though, that when I made Mr Girlymicro watch this for the 5th time he could not get out the room fast enough, so this may just be a me thing.
Where is the science rooted in the present?
Having talked about the fact that gene editing isn’t the work of science fiction, I thought it would be useful to talk about how and where it is actually being used right now.
According to the Federal Drug Administration there are a variety of types of gene therapy products, i.e. products that manipulate genes, currently available:
Plasmid DNA: Circular DNA molecules can be genetically engineered to carry therapeutic genes into human cells.
Viral vectors: Viruses have a natural ability to deliver genetic material into cells, and therefore some gene therapy products are derived from viruses. Once viruses have been modified to remove their ability to cause infectious disease, these modified viruses can be used as vectors (vehicles) to carry therapeutic genes into human cells.
Bacterial vectors: Bacteria can be modified to prevent them from causing infectious disease and then used as vectors (vehicles) to carry therapeutic genes into human tissues.
Human gene editing technology: The goals of gene editing are to disrupt harmful genes or to repair mutated genes.
Patient-derived cellular gene therapy products: Cells are removed from the patient, genetically modified (often using a viral vector) and then returned to the patient.
There are a number of ways that gene therapy products are already being used for the clinical management of patients, including for patients with conditions such as HIV and sickle-cell disease. One big change that has occured during my clinical career is the use of CAR-T cell therapy for tackling some types of cancer. CAR-T cell therapy is a type of immunotherapy where a patients own T cells (type of white blood cell) are taken from a patient who has cancer, and the cells are then modified in order to better recognise and attack cancer cells within the patients body when they are then given back. So gene editing is already saving lives and in every day use, even if its roll out is currently limited.
Having established that gene editing is very much the next frontier for expansion in healthcare, it’s probably important to consider how stable these changes will be within the wider the gene pool. It’s worth noting that the human genome editing techniques that are being introduced in healthcare are linked to somatic cells, where changes would be non-heritable, rather than within germline cells, which are involved in reproduction, where any changes would be inherited by future generations. Most of the changes that are currently being targeted for gene therapy would not therefore cause the changes to be established within the gene pool. There is a question about whether the target genes, even for somatic changes, may become more established as some of those carrying them may not have previously survived to reproductive age, but to be honest this feels like the impact will be minimal and a price worth paying as a society for improving both quality and length of life in those impacted. Changing future generations of children is however a whole different ball game.
The technology discussed within Upgrade has moved on somewhat from CRISPR. It retains some features of current technology however, as the delivery of Scythe is via viral vector. The interesting thing about this form of delivery is that, in the world of Upgrade, the viruses have been modified and use their standard invasion routes to deliver the genetic material into cells, but, unlike the way that this is being undertaken as part of gene therapy in current healthcare, the viruses do not appear to have been fully modified to remove their ability to cause infectious disease. Some of the plot, therefore, is driven by the fact that it is possible to undertake wide spread indiscriminate gene editing within the human population. The modified viral cells retain their transmissibility alongside their gene editing functionality, and so a gene manipulation can spread in a similar way to any respiratory viral infection. The R0 within Upgrade is 8, which means that every person infected will infect, on average, 8 other people, which means the potential for spread within the population is massive. (If you want to know more about what an R0 is, I’ve covered it in a previous post here). It is not clear to me whether the gene targets within Upgrade are targeting just somatic changes, or a combination of somatic and germ line, but when you can spread so widely so quickly that is probably not the main consideration.
What questions does Upgrade raise?
Within the world of Upgrade, the gene editing doesn’t just target a single gene, but a whole suite of different genes for large scale changed. The problem with using gene manipulation that changes multiple gene targets, that are non-personalised to the condition/individual, and are highly transmissible, is that it is highly likely that the changes won’t work for everyone’s genome. There are going to be side effects or potentially significant impacts. Within Upgrade these are seen through errors that then occur in the brain due to protein mis-folding, very similar to how prion diseases work. The change in some people is catastrophic and there is no intervention available to reverse it. Using indiscriminate gene manipulation has the power to create mass disruption and change societies. It is this power for change that is the jeopardy that drives the novel. Is the cost worth the outcome, and who gets to decide? How much collateral damage would we be prepared to accept, even if the wider benefit to society is a positive one?
Prion diseases: A rare group of neurodegenerative disorders October 2022 In book: Viral, Parasitic, Bacterial, and Fungal Infections Antimicrobial, Host Defense, and Therapeutic Strategies (pp.651-662) Edition:1 Chapter: 53 Publisher: Elsevier: Academic Press
What does it mean to be human?
As part of this risk/benefit consideration, Upgrade asks a lot of questions of the reader, the main one of which, for me, is what does it actually mean to be human?
There is a genetic definition of what it means to be human, but the gene modifications within humans causes our protagonist Logan to ask some very valid questions about what it actually means to be human. Is it just about genetics? How much can we change not only our genes, but our outlook/perceptions, as people and still remain human?
The ‘upgrades’ received cause different characters in the book to judge humanity in general, and other human beings, in very different ways. Do genetic changes make you superior? Does being intellectually smarter permit you to make decisions for others for their benefit, as determined by the smarter individual? In many ways this brought to mind, for me, the old approach to clinical decision making, which was very paternalistic and the role of the person/people impacted was highly passive. I’d like to think we are now moving towards a much more patient focus decision making process, but this book made me think about what would happen if this model was used, not just for one to one interactions, but for the future of humanity.
The question about decision making is an interesting one however. There is plenty of data that demonstrates improved decision making in small groups, and if time is of the essence how would you engage with enough people for a decision to be valid? Especially a global decision? How many people would you need to interact with for a choice about changing the DNA of your species to be valid? How would you manage a lack of consensus? Would you let the world burn whilst the choice was being made, or would you accept that at some point someone would need to step in and lead the way forward? It’s the uncomfortable space between ethics and pragmatism, and definitely not something that is easy to answer, even conceptually.
Is intelligence the problem?
As discussed above, a lot of the plot driven by the counter to our protagonist in Upgrade, is based on the concept that if humans were smarter they would make better decisions. Therefore, by improving how people think and removing some of the emotional component the human race would be improved and therefore ‘saved’. This is especially important in the world of Upgrade, as because of the damage that is being done linked to climate change and other damage caused by humanity, the clock is ticking and Logan is very aware in his upgraded state that there is only 100 years left to save mankind.
The problem, as it plays out to me, is that it is very much not about intellect however, it’s about the ability of individual humans to care enough for others. For one person to make decisions that costs them rather than benefits them for the sake of someone that they do not know well if at all. This is especially true for problems that are going to impact future generations, like climate change, where the people most impacted have yet to be born. By the time we ‘meet’ those who will be most affected it will be too late to save them. Even for a present day context it raises questions, we all think of ourselves as having empathy and caring for others, so why does that not play out and allow us to care for the migrants that are dying trying to join us and share in our safety? Why is our compassion so limited?
One of the reasons for this has nothing to do with intellect, and would in no way be altered no matter how smart we become. It’s based on a theory known as the Dunbar number, which predicts that we can only empathise with a maximum number of 150 people, the number of people that would likely to have been the maximum size of our primate tribe. More than this, we can only truly care, to the point we may want to sacrifice, about a much smaller number of people. The book therefore postulates that we aren’t held back due to a lack of intelligence or innovation, we’re held back by a lack of compassion and the ability to truly care about people we don’t know and will never meet. If we are to change anything about ourselves in order to save mankind therefore, it’s not intellect we need more of, we need to find a way to increase our capacity for compassion and therefore change our Dunbar number, to adapt for the world we now find ourselves in. So maybe the answer to the problem is to become more ‘human’ rather than less.
Where do all of these questions leave today’s gene editing technology?
Gene editing technologies are making massive strides, saving lives, and positively helping people who have serious health conditions.
Somatic gene editing is well established, and has been developed over the last 20 years so that regulation is in place, and it being more and more routine rolled out in countries that have access to advanced scientific technologies. The problem is just that however, these interventions are technologically challenging and incredibly expensive, and therefore not universally available. This means that they also do not necessarily take into account the diversity of the human genetic population or the lived experience within different cultural communities. Regulation is also not present universally, with some people forced to access these therapies through the use of rogue clinics, or by undertaking medical tourism, which brings with it increased risk. There is also the potential for illegal, unregistered, unethical or unsafe research and other activities, including the offer of unproven so-called therapeutic interventions, as with any emergent technologies. Ensuring equity of access and appropriate regulation will be essential to ensure a safe global adoption of these therapies.
Germline gene editing is however in a very different place, as this would lead to the editing of DNA in a way that may be heritable across generations. There is an intense debate linked to its use as the the future generations that would be impacted would have no capacity to consent to the changes, and or risks, that are being made. There could be possible risks and consequences for offspring and for society in general, and once that genie is released it will not be possible to put it back in the bottle. Discussing what circumstances it would ever be appropriate to undertake these changes requires us all to be actively engaged in these discussions.
I hope you’ve enjoyed these series of blogs linked World DNA Day and taken some to celebrate the miraculous nature of just being you. I’ve really enjoying sharing some of the technical information, but also diving into some fictional worlds and discussing the thoughts that they provoke. With summer coming up I hope you may even pick up a copy of these great novels and dive into their worlds yourself. If you find any others in your reading adventures, return the favour and let me know. I may even include them in a future review. Happy reading.
This month I’ve been honouring World DNA day 2025 by publishing a number of posts linked to what DNA is, how we look for it, and what it means to send it away.
Having spent some time covering what is the current state of science in this area however, I thought I would follow up with a couple of book reviews whose fictional worlds focus on how the world of DNA, DNA editing and DNA interpretation could change the lives of everyone involved. The first of these is The One by John Marrs.
This book is set in the near future in a world very much like ours. It’s nice for me to review a book that is set in London, where I can also do a bit of location tourism and spot similarities between this fictional london and the London in which I live. The tech and the science in this book are very much just one step further open than some of the modern day science I covered, especially in part 2 of this blog collection. All this being said, this book is also a thriller and so not necessarily like life as we know it.
How far would you go to find The One?
A simple DNA test is all it takes. Just a quick mouth swab and soon you’ll be matched with your perfect partner–the one you’re genetically made for.
That’s the promise made by Match Your DNA. A decade ago, the company announced that they had found the gene that pairs each of us with our soul mate. Since then, millions of people around the world have been matched. But the discovery has its downsides: test results have led to the breakup of countless relationships and upended the traditional ideas of dating, romance and love.
Now five very different people have received the notification that they’ve been “Matched.” They’re each about to meet their one true love. But “happily ever after” isn’t guaranteed for everyone. Because even soul mates have secrets. And some are more shocking than others…
The One is set in a world where, instead of just sending off your DNA to find relatives or health characteristics, there has been a gene discovered that can be used to link you up to your one true biological match. The person you are supposed to fall in love with. This is because the discovered variant of this gene causes physiological changes and the production of a pheromone that is unique to you, and which is particularly attractive to (statistically) one other person, who has a complimentary version of this gene. Production of the pheromone means that when you encounter each other you immediately physiologically react, and experience a biological ‘love’ match. Within the setting of the novel, a company called Match You DNA, has been marketing a product where you send a swab and can be matched with the person you are genetically made for. Sending away for matching has become common, with over 1 million matches, but is neither universally undertaken or universally accepted as a good thing. The book starts with a number of characters taking their DNA tests, for various reasons, in the hopes of being matched with their soul mate. Five couples are then matched and the novel follows them through their matching journeys.
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What about the science?
The world of The One includes science and technical details that bring up a heap of both scientific and ethical questions that I think are really important for us to think about, whether we work in science or not. Science impacts all aspects of our everyday lives, and so the more we know and think about how it impacts us, the better prepared we will be, both as individuals and as a wider society. I really enjoyed exploring this world and so wanted to share what questions the setting triggered for me, and how it relates to the world in which we currently live. If you have already read/listened to the book, or if this blog prompts you to do so, I would love to hear what it triggered for you.
How much can anyone own a gene?
The founding premise of the world building in The One is that a single company would have sole access to this form of specific DNA matching technology, I posit via some form of patent for the gene, although this isn’t really discussed. A gene patent is the exclusive rights to a specific sequence of DNA (a gene) given by a government to the individual, organization, or corporation who claims to have first identified the gene.
So can someone own a gene? It may surprise you that the answer is both yes and no. A company can patent specific DNA sequences, such as DNA sequences that have been manipulated and altered in a lab, making them different from naturally occurring DNA. This wouldn’t help in the case of The One, as the company cannot patent naturally occurring genes, such as the genes they would need to target, as they exist already in the human body. However, patents can, and have been granted, for specific uses of genes, such as diagnostic tests or therapies, even if the gene itself is not patentable. This has happened for diagnostic tests including those for the BRCA1 and BRCA2 genes, which are linked to hereditary breast and ovarian cancer, and for the area of the Staphylococcus aureus genome where the SCCmec gene cassette inserts, leading to S. aureus displaying resistance to methicillin (MRSA). It is therefore possible that a single company would be able to corner the market, for a period of time, and be the sole provider of this kind of service, and therefore have the kind of societal influence demonstrated within the novel.
Can there really only be one true gene match?
This book is very much based on an advancement of the kind of DNA sequencing that people can currently use to check on their ancestry and relatedness, as discussed in parts one and two of this blog series. How realistic is it that there is only one copy of a gene variant in the world for each of us however?
While the human genome is highly similar across individuals (99.8-99.9%), small differences do exist, totaling 3 – 5 million variations, some of which can have profound impacts. Studies like the All of Us Study, funded by the National Institutes of Health, have discovered over 275 million previously unreported genetic variants, showcasing the immense diversity within human genomes. Whether this variation would be localised to a specific gene with each variant being present at just the right kind of frequency that there would only one person in the world for us is yet to be mathematically modelled 🙂
It is also unclear exactly how the translation of this gene variation into physical expression via pheromones, which are chemical messengers that can influence attraction, would work. The extent of their impact would need to be the topic of further research. Pheromones are known to play a crucial role in mate selection and social behavior in many animals, but the evidence for their direct influence on human attraction is less conclusive. So this bit of the world building that is inspired by science, but definitely science fiction at this point.
How does nature vs nurture work?
The nature vs. nurture debate explores how much of an individual’s characteristics are determined by genetics (nature) versus environmental factors and life experiences (nurture)
At it’s very core, much of The One is about whether nature always trumps nurture. Are we slaves to our genes? Is the development of a loving relationship with someone who is not your genetic match, developed over years, always going to be trumped by a brief encounter driven by genetics?
One of the big dilemmas that some of the couples face, and a central theme discussed in the book, links to this debate and examines how the revelation of being matched impacts on characters pre-existing, as well as their new relationships. What if those who were already married and in happy relationships from before the existence of matching, decide to swab themselves and are not in fact each others matches? What if you run into your match as part of your normal life but are already dating, is cheating then OK? Are those with relationships that have not been validated by Match Your DNA of less value, both to individuals and society, than those that are biologically prescribed? Does nature automatically trump nurture?
If you start to extrapolate even further than this, does it mean if you can’t find a match that you default into being considered a second class citizen? A short step on from that, could you be compelled to take part in matching even if you don’t want to? These are some of the future possibilities hinted at during The One. Although these conundrums are very much science fiction, they are definitely rooted in other types of discussions that are happening even now, such as whether we should sequence the genome of every baby at birth in order to provide better preventative healthcare? In fact, it is a threat that is developed in another novel within the same world, called The Marriage Act, which points a lens at the role of government in handling these issues and how once individual decisions can suddenly be adopted by society as embedded behaviours, resulting in the loss of individual freedom to decide.
One of the other interesting threads, for me, is the question of is it OK to breach other societal norms because of a DNA match? Should an 18 year old (minimum age for matching) suddenly feel like they need to date a 90 year old? Should you leave behind all of your connections and stability to fly across the globe to be with someone you don’t know on the basis of a single gene? If your match dies, does that mean you will never find another true love?
On a wider societal scale the book triggered a number of other considerations for me. Such as, what would be the consequence of people no longer going through the dating process and leaping straight to a formulated relationship? Would it impact social skill and other development? What opportunities would we take away from people to learn about others, but also to learn lessons about themselves? How can impacts that appear to be at the individual level completely change the way society as a whole begins to function?
What about giving up on self determination?
Building on the above, one of the very interesting themes for me is what happens if the person you are matched with is just not a very nice person? Does you biological compunction overwhelm your personal choice? In other words, if nature trumps nurture, what happens to self determination?
Self determination theory includes three key components. The first is that of competence, where people need to gain the skills to control their lives. Second is autonomy, where people need to feel they have control over their choices, and finally, relatedness, where people need to feel connection and belonging.
The One raises interesting questions about which of these drivers may be the strongest. Finding your DNA Match leads to intense feelings of belonging and enhances feelings of security, as you’ve found your One, and it is not supposed to be reversible. It removes doubt, but does it also remove effort? Relatedness is definitely enhanced by the concepts of gene matching. However, the concept of DNA matching also directly reduces any sense of autonomy, as you are seeding control of a key relationship to your genetics, which you have no control over at all. The sense in the book is that this causes an understandable level of conflict and cognitive dissonance* that runs within all of the characters present.
*the psychological discomfort experienced when we hold two or more conflicting beliefs, attitudes, or values simultaneously
Another question that struck me linked to this is….which biological compunctions are the strongest? The bond with a child or the instinct to reproduce are both strong biological imperatives, so if these are placed up against a link with a DNA match, which would win out? For instance, would you walk away from your child and never see them again for the love of your life? Having spent a while pondering it, my thoughts on this are that these discussions are not as binary as I have perhaps presented them and that everything is likely to be combination of nature and nurture, and it is how these unique combinations come together that drive us and make each of us even more unique than we are on a genetic level. Still, I am intrigued about whether there would be a hierarchical determinant to some of these drivers, that is if they were all real.
What about informed consent?
Not to spoil the story but there seems to be a strong temptation for people in the world of The One to not only send swabs from people other than themselves, but to also access the results of other people and therefore control access to information that doesn’t belong to them. Now, I’ve already covered in part two why taking the DNA from other people for testing could have legal consequences, but why else could it be considered wrong?
I thought it might be important here to talk about the importance of informed consent, and why some of the consent gained could perhaps not be considered to be truly informed.
Informed consent has a number of key components to it, but some of the big ones are linked to open disclosure of both the benefits and risks of any test/procedure, alongside discussion of whether there are any alternative options, so that the person deciding whether to go ahead is making that decision with access to all of the best information, i.e. the decision is informed.
Now, obviously how much informed consent is needed does vary widely depending on what is being undertaken. As I said in part two, most of the common DNA tests to send away are not considered medical tests and are not therefore subject to these kinds of gate keeping. If the world changed so that this form of testing had such impacts on lives, then should that be reconsidered so individuals truly knew what they were signing up to? Would just ticking a box on an Internet form really provide sufficient levels of understanding that the consent could be considered informed?
There are also interesting questions raised in the book about the consent linked to use of data. Is it acceptable to collect data for one thing and then use it to develop a test that wasn’t part of the acceptable use criteria for that data? Is it OK to gather a whole heap of human genomes and then utilise them for research purposes if that wasn’t part of the consent for which they were collected? Is it OK as long as it is all anonymised? All of these things depend upon the type of consent that is given.
In part two I talked about the data that is being collected for current DNA testing for non-medical testing and that the resulting sewuences are likely to be used for other purposes, and that use is probably included in the terms and conditions you sign when you send off for testing. How obvious this is will probably vary between companies. As these are non-medical devices though, the consent is unlikely to need to be informed. Most people think about the swab, but not the DNA sequence that results. If you are making an entire business based on those sequences, such as in this book however, you probably need to be certain that their use is legitimate, and covered within the purpose for which they were collected. #nospoilers
Is a single company having so much power dangerous?
In a previous book review I wrote about the Theranos scandal and the impact of a single company with massive influence who didn’t follow good scientific practice had on the lives of the people they tested. Obviously the Theranos scandal is real life, real people were hurt, and real people went to prison. The One on the other hand is a work of fiction, and a space where some of these more ethical concerns about the impacts of scientific developments on the the life of people can be somewhat more safely explored. It does call into focus whether one company should have so much capacity to influence the lives of so many. It made me think, if this were to happen right now what kind of oversight would be required? How could lobbying and other practices mean that some of the neutrality of that oversight could be impacted? Also, how much oversight would be appropriate? How do we ensure quality without negatively impacting innovation? How do we allow the good whilst minimising the bad? This is something science is constantly struggling with and there are no easy answers, but the capacity for harm if you get it wrong should be something that all scientists should live with and actively reflect on.
Hopefully this blog, and going on to read the book, will help us all to take some time to think about some of the ethical considerations that this fictional world raises, and encourage us all to think a bit more about our own and societies role in DNA testing moving forward.
One last note, if you prefer your content as visual media, The One has also been made into a TV series which is currently on Netflix. Full disclosure, I’ve only seen a couple of episodes. The feel of the series seems pretty similar to the book but the actual plot lines seem to have been changed quite a lot. Pro of this is that you can quite happily enjoy both as the series gives new aspects to new enjoy. However you decide to explore it I would definitely recommend a dive into this world and enjoying the surprises that it brings and the thoughts that it provokes.
Friday just gone, 25th April, was World DNA Day. I’ve had a series of blogs that I’ve been playing around with linked to both DNA in our everyday lives and two book reviews where the world changes because of genetic testing and genetic manipulation. I thought I would write these posts, because as much as artificial intelligence could change the way we live and is frequently discussed, we are all accessing DNA based testing more and more, with many of us not really thinking about how this too is changing the world in which we live. Depending on how you feel about science and needing to have a refresher on what DNA and how we look for it and interpret it, you may want to hit up part one of this blog series first.
In part one I also introduced the kind of testing that DNA and DNA sequencing can be utilised for, not just in a accredited healthcare laboratories, but also linked to private companies who offer information on things like ancestry. In today’s blog I wanted to go a bit more into what can be the less thought about results of sending away your DNA, and also what kinds of things you might want to think about, or have in place, before you do.
Thinking unexpected consequences?
In part one I used this quote from a recent article:
As stated in a recent Independent article:
As they’re based on estimates, I suggest treating home DNA tests as a fun investigation to get to know your family history a little better rather than a to-the-letter representation of everything that’s ever happened in your gene pool – Ella Duggan Friday 28 March 2025
It describes sending away of your DNA as a fun investigation, and recommends not taking the results too seriously. This is definitely the right attitude in many ways, as you wouldn’t take key health guidance from a magazine quiz, you’d want to speak to a healthcare professional who can put your results in context. The problem with not taking the tests themselves too seriously is that we don’t really think about the consequences of taking them or where the results might lead. My family have been given these for Christmas, for instance, and it was seen as a fun piece of science that could be done after lunch. Taking and sending away your DNA, the thing that makes you you, however, should always be done with a little more consideration that that. So I thought it might be useful to use just a couple of examples of why.
Health services
Sending away DNA for health reasons to private companies has been controversial ever since it was introduced into the UK and there are a few reasons why this is the case.
Firstly, if you have health concerns, then really you should be accessing medical care through healthcare professionals who you’ll be able questions, and who can put your results into a risk context for you based on your own medical history, rather than just getting a list of genes in isolation.
One of the other reasons you should manage this form of testing through health providers is that you can then be linked into any medication or further testing that is required. The presence of a gene alone can be pretty meaningless, you need to then look for whether that gene is being expressed (see part one) in order to really understand it’s impact, and so there are likely to be follow up requirements to any results received.
If you are going through genetic testing, especially if it has impacts on decision such as reproduction, you would normally be supported through the process ahead of the testing, and when the testing is returned, through professionals such as genetic councillors. If you get your results by sending your DNA away you may get completely shocked and surprised by the results that you can get back, and may make some decisions based on the findings that may not be correct for you and require better input from someone more used to interpreting the results. It could feel like a really lonely way to hear bad news.
Finally, these tests are being sent off to laboratories that don’t require accreditation. They are acting as medical tests, without going through the rigor that is required for the equivalent tests in healthcare, and yet are interpreted, by some, in the same way, and therefore effectively out of context. They may also not have the required levels of validation linked to the information and interpretive guidance that is issued with a result, so that you know what being present or absent for gene X or Y actually means for you. It also means that there may be less processes in place to ensure that you get the result that is actually meant for you and not for Professor X down the road. If you are processing hundreds of samples this kind of error, without safety checks, can be easier than you’d think. Knowing the quality of the result you are receiving may be less than obvious.
Ancestry services
OK, OK, I can hear you say. I wouldn’t send my DNA off for medical testing, but surely sending it off for ancestry services is ‘no harm, no foul’ and just a bit of fun. My first caveat here is that not all ancestry services are the same and not all of them look at the same sections of your genome. Some will look at your mitochondrial DNA (which will always come from your mother and your maternal line) in order to give a view of where your ancestral DNA comes from over generations. This is often referred to ancestral origins, and is much less likely to hit you with real time life dilemmas. Many kits are also paired with items that look at wider genomic matches, or DNA matches, and so you may get back more than you bargained for if you didn’t look closely at what was going to be provided.
I’ve included just a couple of, extreme, examples of how these kinds of unexpected consequences can play out in real life. The first is a BBC News story that came about because a woman was contacted by a stranger after sending off her DNA via an ancestry site. From the results it eventually became apparent that she had been accidentally swapped as a baby in a hospital in her 50’s with another child. Thus having dramatic and rather unexpected consequences for her and her family.
The other example I’ve included links to a couple of documentaries where the use of DNA matching platforms has uncovered serious misdemeanors or crimes, including IVF undertaken using the sperm of medical professionals without the knowledge or consent of the parents involved, and sperm donors being involved in the insemination of more couples than disclosed, thus increasing the risk of their children potentially interacting/dating/mating in later life without knowledge of their genetic linkage. This is obviously not the fault of the DNA matching service, and is something that is beneficial to uncover and stop, but has hugely dramatic impacts on those involved without any prior warning or support in place. It certainly wasn’t what they expected when they sent away their swab.
Is it just human DNA that counts?
Finally, to follow up on the takes of the unexpected, and because infections are fascinating, I wanted to share a link to a video that I think is really great about the first time DNA testing of HIV was actually used to convict someone of a crime. This one isn’t a word of warning, as I suspect that none of us are going to decide to deliberately inject someone with HIV contaminated blood, but I wanted to end this section with something where the use of DNA testing in the hands of people who really know what they are doing is a powerful tool for good. Also, because I wanted to give a non-human example of where I think some of this may go in the future.
What do we need to know before we start to send our DNA away?
Having laid out my warning stall, I wanted to go through some things I think you should actively think about before sending your DNA away.
What is the legal situation?
First and foremost, the sending of DNA away for processing is covered under something called the Human Tissue Act or HTA (in England). I’m flagging this as the first thing as, unlike what you see on TV, you should not be taking DNA from other people and sending it off to see what it says, and especially not for any form of DNA match testing. In the UK, if you do take anyone’s DNA sample without them being aware of it, it is considered a violation and you are liable to prosecution which can result in up to 3 years imprisonment. It is not OK to steal someone else’s DNA without their consent! There’s a lot to this one and I’m not a legal expert, but it seems to be something that many people are not aware of and now you know.
What level of information will be gathered?
All of the different tests offered will do things, and companies interpret the results slightly differently. It’s incredibly important to know what you are sending your DNA away to be tested for, how it will be tested and what kind of information you can expect back.
The main types of DNA tests and the areas they analyse are:
Autosomal DNA Tests = examine the 22 pairs of autosomes and the X chromosome. Commonly used for ancestry testing and can help determine ethnic origins, identify genetic predispositions, and find relatives. Utilise single nucleotide polymorphisms (SNPs), which are variations in a single DNA base pair
Y-DNA Tests = analyze the Y chromosome, which is passed down from father to son. Used for tracing paternal lineage and can be helpful in genealogical research
Mitochondrial DNA (mtDNA) Tests = use mitochondrial DNA, which is inherited maternally (from your mother) used for tracing maternal lineage and can be helpful in genealogical research
Paternity Tests = examines specific regions (loci) on the chromosomes to look at parental relationships
Health-Related Genetic Tests = looks for specific genes or regions of the genome that are associated with certain health conditions to try to identify genetic risks, diagnose genetic disorders, or assess treatment options
You may need to read the small print to really understand how the testing will be undertaken and to manage your expectations. If you can, make sure you look up examples of what the results you will receive will look like, and if there would be any follow up support given. Also, crucially see if there will be additional funding required to get access to the full data set you are expecting so you don’t get hit by any unexpected requirements.
How will data be used?
The next few sections are all linked to what happens to the results of your testing that you are sending away.
The first thing to check before you send off your test is how long will your data be stored for once. This is important for you in terms of being able to access reports, but also about how long your legacy data will be available. Will you have access to wider information if you request it to be passed to your healthcare provider? Is there any information on the data analysis tools used? Are you even allowed to ask questions or is all patented and under intellectual property rules, which is reasonable but you should know what the boundaries are. Most healthcare reports should be kept for at least 10 years, but as these are covered under different guidance, will you only have access to download your data for a set period of time? Will it be possible to get your own local back up of your data? Once you know the answers to these questions you can then make active choices and comparisons about which aspects are important for you.
The article below is a little old, as it’s from 2018, but many of the questions still stand. How carefully will your data be ring fenced? You may not think about it much, as your DNA may hold little financial value to you, but DNA databases are one of the main assets that companies who process your DNA have, and why the testing is actually relatively cheap. Having access to thousands of DNA sequences, along with medical histories sometimes, means that data is incredibly value for scientific and commercial development. This is OK, we need sequences to develop new testing. Pharmacy companies also need access to sequences to develop and model new medicine. Therefore, it is likely that your data monetised and used for other purposes, which may or may not be OK with you. The big question to ask is whether it will be anonymised and how it will be used. Knowing this information before you commit allows you make informed choices, as not all companies are likely to be identical in how they handle things.
Another aspect that you might not think about is data security. If your data is of value to the company, and therefore is a potential asset, then it may be of interest to others. This can make data security to prevent things, such as hacking, important. This could be especially true if your DNA reveals linkages of significance, or things that you might not wish disclosed, such as cancer risk. Doing some research to ensure the security of any data that is held is important, but not often high on the list of questions that people ask.
Who can data be released to without my knowledge?
I’ve talked above about who will have access to your data, but mostly I talked about your anonymised data. It may not just be anonymised data that you are concerned about by however. If you are sending off for testing that relates to cardiac, cancer, diabetes or other risks, than this can have much wider impacts if shared. The legal landscape in relation to this is very much changing and catching up with the concept of genetic information as a protected asset is slow. Also, warning, I’m no expert in this. However, when sending away for this kind of testing it is important to know that it is often not covered by medical confidentiality, as it’s not considered a medical test when conducted via private companies. Being aware of how this impacts the rules around your data and what the company will or will not release is key. Why is it key? Well, it can impact all kinds of insurance schemes, from requirements to declare for holiday insurance if you are seen as ‘knowing’ a risk, to life insurance changes in cost or profile if released directly to the company. Knowing whether your personal, non-anonymised data can or will be released is essential before choosing whether or to whom you’re prepared to send you swab away to.
I suspect that this last point will probably impact those of you reading this blog less, but for to complete this list…….your DNA can also be released to law enforcement, depending on the country, so if you’ve secretly been a mass murderer then maybe don’t send your swab away and get your DNA added to a mass database.
What will happen if the company is sold?
As I said earlier, one of the biggest assets these companies hold is the databases of DNA sequences which we provide them. When something happens to the company therefore, it is this asset that many of those interested in the company might be after, and they may have nothing to do with the purpose you sent your testing for. Reading the small print before you send away your sample may not be able to prepare you for what happens when those rules change and you are no longer dealing with your original commercial provider. The one thing you can do in these circumstances in understand what access and rights you have to request that your data is deleted, or to delete it yourself, in the case that circumstances change.
I’m aware that the section above on what you might need to think about is pretty heavy and so I wanted to finish part 2 on something a little more population level and upbeat in relation to why having access to this testing is a good thing for science in general. For instance, we know that the ability to undertake ancestral testing was a reason that the bones of Richard III were identified and confirmed, which had big impacts for history buffs. It show that the use of wider availability of testing has all kinds of benefits, and not just to science. In terms of wider science, being able to look at bones using DNA testing has supported identification of Mycobacterium tuberculosis as present in Egyptian mummies which has helped us understand the evolution of this infection over centuries. More recently, looking at the development of Homo sapiens and how we became the human beings we are today has been forever changed by wider applications of these methods. Use of these technologies can therefore impact all aspects of our lives moving forward, and it really is up to us, both as individuals and as a society, about where they work for us.
Parts three and four of this blog series will be linked to book reviews that explore what those futures could looks like if the use of DNA testing and genetic manipulation change how we look at ourselves and others. So join me in continuing to explore the power of DNA.
Friday just gone, 25th April, was World DNA Day. I’ve had a series of blogs that I’ve been playing around with linked to what DNA is, how we look for and investigate it and how we are exploring DNA in our everyday lives. Linked to this I’ve also got two book reviews coming where the world changes because of genetic testing and genetic manipulation. So this is the first of four part DNA bonanza.
I thought I would write these posts, because as much as artificial intelligence could change the way we live and is frequently discussed, we are all accessing DNA based testing more and more, with many of us not really thinking about how this too is changing the world in which we live.
I remember really clearly the first time I actively came across the concept of DNA, DNA testing and DNA manipulation. It was in Jurassic Park, when Mr DNA pops up at the start of the film to talk you through how they used DNA and cloning in order to make the dinosaurs. This film came out in 1993, I was 13 and I just remember how all of my class were queuing up to get tickets. It was the first film I really remember there being hype about, well that and Aladdin which was a different kind of seminal moment. It was the first film I remember watching and thinking just how cool science and scientists were.
In fact I talk about Mr DNA so much that the wonderful Mr Girlymicro brought me a Mr DNA Funko pop which lives on my desk at work and reminds me that the impression we make on people stays with them.
What does all this have to do with how we use DNA now? Well, in 1990 when Jurassic Park came out, the routine use of DNA, even in research, was still pretty much science fiction. The structure of DNA had only been described in 1953. Polymerase Chain Reaction (PCR), which is the main way we investigate DNA, had only been developed in 1983, and was only starting to become more widely available in the 1990’s. When I started working within healthcare in 2004, we were only really just starting to move from PCR being something that was used in research to something that was common place in clinical diagnostics. The leap from there, to a world where thousands of us can swab ourselves at home and post samples off to be diagnosed with SARS CoV2 during the pandemic, or to get information on our genetic heritage, would have sounded like something that would only occur in a science fiction novel if you’d mentioned to me back theb.
Just a flag, this part one post has a lot of the technical stuff linked to what DNA is and how we investigate it. You may want to skip this post and head directly for part two if you don’t want to be reminded of secondary school science, but if you can bear with me I think it will help some of the context.
What is DNA?
DNA, or to give it its full name Deoxyribonucleic acid, is commonly referred to as the building block of life. The structure of DNA consists of a double-stranded helix held together by complementary base pairs. The nucleotides that form the base pairs are adenine, thymine, guanine or cytosine. These nucleotides act to link the two strands together via hydrogen bonds, with thymine always pairing with adenine (T-A) and guanine always pairing with cytosine (G-C).
Sections of DNA then combine together together to code for genes, which are sections of DNA that work together in order to code for proteins, that then permits the expression of our DNA in physical form.
Genes are organised into chromosomes or packages of DNA. Each chromosome is formed from a single, enormously long DNA molecule that contains a strand of many genes, with the human genome containing 3.2 × 109 DNA (3,200,000,000) nucleotide pairs, divided into 46 chromosomes formed from 23 pairs (22 pairs of different autosomes and a pair sex chromosomes).
So how do we get from DNA to proteins? The specific sequences of nucleotides that form our DNA are arranged in triplets (groups of three). To turn DNA into protein, it gets transcribed into RNA (ribonucleic acid) within cells, with each of these triplets coding (translating) into an amino acid, which then get combined together to form proteins. The amino acids combined dictate what form and function the resulting proteins takes. Proteins then serve as structural support, biochemical catalysts, hormones, enzymes, and building blocks for all the processes we need to survive as humans.
Long and short, everything comes from your DNA, it’s super important, and is unique to you, but it’s structure is complex and there’s a lot of it in each of us.
How do we investigate DNA?
Now that we know about what DNA is, and how important it is for life, not just for humans but for all living things, it makes sense why so much time and energy has been deployed into understanding more about what it means for us as a species, as well as for us as individuals.
I’ve mentioned that PCR was first developed in the 80’s but didn’t really come into routine clinical testing until the 2000’s. What is PCR though and how does it work?
I often describe PCR as a way to look for DNA that is similar to looking for a needle in a 25 story block of flats sized haystack. The human genome is 3.2 billion base pairs, and we are often looking for a fragment of DNA about 150 base pairs in length, 1/21 millionth of the genome. It’s quite the technical challenge and you can see why it took quite a while to be able to move from theoretically possible to every day use. What makes it even more complicated is that you need to know what that 150 nucleotide fragment is likely to contain or where it is likely to be positioned within those 3.2 billion base pairs to really do it well. The human genome was not fully sequenced, and therefore available to us to design against, until the year before I started my training at GOSH, 2003. The progress therefore in the last 20 years has been extraordinary, and I can only imagine what will happen in the next 20 years. Hence the book reviews that will be coming as parts 3 and 4 of this blog.
So, how does PCR work? Well the first thing to say is that there are actually a number of different types of PCR, although the basic principles are the same. For example, there are some types of PCR that target RNA. There are also types of PCR that are used more frequently within clinical settings for things like SARS CoV2 testing, that are called Real Time PCR, called that as results become available in real time rather than waiting for the end of the process. It is for Real Time PCR that the small ~150 nucleotide fragment length is an issue. So all of these processes have their own pros and cons. Like many things in science, you have to use the right process to answer the right question.
The basic principles shared between types of PCR are as follows:
Designing your primers:
Primers are the pieces of DNA that you design and make that will stick to your target piece of DNA you are interested in. The reason this works is because of the fact that the nucleotides that make up DNA are complimentary and so A binds to T, C binds to G. As DNA is double stranded you can design your primers (your equivalent to the magnets to find you needle in your haystack) so that they will bind to your specific target (the piece of DNA you are interest in). If you want to have your primer stick to a piece of DNA sequence that reads AAG CTC TTG, you would design a primer that ran TTC GAG AAC using the complementary bases, make sense?
You design one set of primers for one strand, this is called your forward primer (moving from 5′ to 3′), and then you design your reverse primer at the other end of your target for the opposite DNA strand (moving from 3′ to 5′). Doing it this way means that when you start your PCR process you end up with complete copies of your target. You will then successfully have pulled the needle from your haystack using you targeted magnets.
Undertaking the PCR:
Once you’ve got your primers (which you can just order in once designed) you can then get onto the process of the PCR itself. You combine your sample that you think might contain the DNA target you are looking for (be that human, bacterial, environmental etc) with the reagents (chemicals) that you need to make the process work all in a single small tube. This tends to be a delicate process that needs to be undertaken at controlled temperatures as the protein that runs the process (Taq polymerase) is delicate and expensive. To do this we combine:
DNA Template: This is the sample that contains the DNA target you want to amplify
DNA Polymerase: Almost always this is Taq polymerase which is used due to its heat-stability as it originates from a bacteria that lives it deep sea vents. This allows it to function at the high temperatures required for PCR and is used to make the new DNA copies
Primers: These are the short, synthetic DNA sequences that you design to attach to either end of your target DNA region. These then allow the DNA polymerase to add nucleotides to create the new DNA strands
Nucleotides (dNTPs): These are single nucleotides (bases) that are then used to build the new DNA strands (adenine, thymine, guanine, and cytosine)
Buffer Solution: This solution provides the optimal conditions (pH, salt concentration) for the enzyme to function properly
Once you have your reagents you then put them on a platform that heats and cools for different steps to allow the enzymes to work and for the new DNA strands to be created:
Denaturation: The double-stranded DNA template is heated (typically to 95°C) to separate it into two single strands. This step ensures that the primers can access the DNA sequence of interest
Annealing: The temperature is lowered (typically to 50-60°C) to allow primers to bind to their complementary sequences on the single-stranded DNA. This is the step where your magnets find their needle
Extension: The temperature is raised again (usually to somewhere around 72°C, the optimal temperature for Taq polymerase activity). Taq polymerase extends the primers by adding complementary nucleotides based on the DNA sequence to create new copies of the original DNA target
These three stages are repeated in cycles, typically 20-40 times, which results in thousands and thousands of copies of the original target to be created, so that eventually your 25 storey haystack is made up of more needles than it is hay, and therefore it is easy to find what you are looking for.
Interpreting your results:
At the end of your PCR step, if you are using traditional PCR, you run what is now called your PCR product or amplicon (the things you’ve made) through something called a gel. This is just a flat jelly made of agarose (or seaweed) which also contains a dye that binds to DNA and allows to separate your DNA based on size. This allows you pick out where you have samples that have the massive amplification you are looking for, as you can see it as a band within the gel. If a band is there and the right size (as you know how big your target was supposed to be) this is a PCR positive.
If you need to know more detail than whether something is present or absent, for instance if you need to know not just that a gene is there but which variant of a gene is present, you need to be able to tell what the nucleotides that were added between your two primers actually were. To do this, you will follow up PCR with a process called sequencing.
You take your target PCR’d section and then put it through a process to work out what the nucleotides added were. This involves doing the PCR process again, to make even more copies, but the nucleotides added into the reagent mix have fluorescence attached so you can tell which ones have been added during the PCR process. G’s often produce a black colour when hit by light, A’s green, T’s red and C’s blue.
For our original sequence we talked about, AAG CTC TTG, the sequence would read Green, Green, Black then Blue, Red, Blue followed by Red Red Black. Colours are then back interpreted into a DNA sequence (a series of letters) and there you have it, you know what the DNA is between your primers and you can then interpret your sequencing result. If you have large fragments of DNA you are interested in, you may have to do this in overlapping segments and put it back together, something like a jigsaw, before you can get your answer, but the basic process is the same.
What can DNA tell us?
As I’ve said, the search for DNA and specific genes has become an increasingly normal part of providing diagnostics in healthcare. Most of us will have sent off a swab for a PCR at least once during the COVID-19 pandemic. PCRs are frequently used in my world of infectious diseases to see if a bacteria is present or absent. They are also used so that I am able to see if a bacteria will respond to an antibiotic, by seeing if they carry antibiotic resistance genes, which can be crucial to getting patients on the right treatment at the right time.
Looking for specific variants of genes is also key to making sure that the treatments we give also don’t cause any unexpected consequences. A good example of this is when we use PCR and sequencing to look at genetic variants of a gene called MT-RNR1. A specific variant in this gene, m.1555A>G, is known to increase the risk of aminoglycoside-induced hearing loss. Aminoglycosides are a crucial antibiotic class that are used pretty widely, but especially in management of some conditions such as cystic fibrosis and certain types of cancers. A small number of people have a gene that makes them prone to something called ototoxicity as a result of taking these antibiotics, resulting in hearing loss. If we know a patient has this gene variant we can then choose to use different antibiotics, improving patient outcomes and avoiding a life long hearing impact.
Outside of screening linked to patients presenting with specific conditions, the use of DNA sequencing is being utilised more widely to look for genes or conditions before they even present with symptoms, in order to reduce time to diagnosis, and hopefully to be able to find patients and start management before they’re impacted or even present as unwell. A great example of this is the newborn screening programme that started last year. This screens newborns using the heel pricks of blood taken at birth so that rare diseases that could take months or years to diagnose by traditional means are picked up early in life, therefore allowing appropriate treatment to start earlier and hopefully saving lives.
DNA is fascinating and I love knowing about it. It’s not just me though. In recent years there has been an increasing trend for people to send off their DNA for other purposes than to hospitals for clinical testing. I’m not going to say too much about this in part one, but it was this that really inspired me to write these posts in the first place and is the main focus of part two of this blog series.
Just a quick google however provides a wide number of different companies offering a variety of DNA testing services outside of the NHS (NB I don’t advocate for any of them):
Crystal Health Group: Operates a network of DNA testing clinics, offering relationship testing and other services.
23andMe: Provides DNA testing for health, ancestry, and other personal insights.
Living DNA: Focuses on both ancestry and wellbeing-related DNA testing.
MyHeritage: Provides DNA testing, particularly for ancestry research.
AncestryDNA: Company specialising in DNA testing for ancestry discovery.
The complication with all of this type of provision of testing is that outside of the clinical world in the UK, where testing should be undertaken in accredited laboratories and reporting of the results must meet certain standards, sending off DNA to private companies is much less monitored.
I hope you can see by some of the technical descriptions just how complicated these DNA processes can be. How time consuming, and how expensive to get right. There is also a lot of nuance about the different types of PCR, sequencing, gene targets, and results analysis that can be offered under the umbrella of ‘DNA testing’. Without the right people involved to make sure that there is embedded quality assurance challenges could arise, depending on what kind of testing is undertaken.
As stated in a recent Independent article:
As they’re based on estimates, I suggest treating home DNA tests as a fun investigation to get to know your family history a little better rather than a to-the-letter representation of everything that’s ever happened in your gene pool – Ella Duggan Friday 28 March 2025
The devil for all of these things really is in the detail, and we’ll get into that detail much more in part two! For those of you interested in learning more about the history of DNA testing, I’ve included a talk below. Happy World DNA Day
Being present on social media or even listening to the news right now can be hard and take me into a pretty dark head space. It’s easy to write negative posts as a result of this head space and to give energy to the people or situations that make life challenging, or who make us feel badly about ourselves. Those people get to spend enough free time in my mind, however, without me giving them more air time or more of my energy than they already have. So, in the spirit of active rebellion, let’s turn the world around and talk about the people who do deserve the energy and recognition. The ones who give liberally, support unconditionally, and act as the cheer leaders that we all need in our daily lives to just get through the week. Let’s focus on the good rather than being drawn into the dark.
Thank you to the people who catch us when we spiral
We all know that I have a strong tendency to spiral, especially linked to event triggered anxiety. I’ve written about it before. I wanted to take a moment to thank those people out there who recognise and actually help flag to me when I’m spiralling, as sometimes it can take me some time to even notice the deterioration in my thinking. Just recognising that you have fallen into that head space can be challenging, but recognition is the first step in managing and exiting the spiral.
The second reason having ‘spiral friends’ is super helpful is that I have a very very small list of friends who I can call (and they can call me) and say ‘I’m in a spiral’. We then support each other by talking through the source of the anxiety, the validity of the anxiety, and if there are any actions that are valid/required. People who take time out to talk through and validate responses when needed and dispel irrational thinking as required, give the greatest gift in terms of time and support.
To the people who listen to the repetitive statements until we’ve worked through our process
I not only have a tendency to spiral, but to sometimes get stuck in my thinking. When I’m fixated on something, I can be one of the most annoying people in the world to be around. Becoming hyper focussed is one of my greatest gifts, as it means that I can just sit down and write 5000 words or focus for hours at a time. It’s also one of my greatest curses, as when that fixation falls onto something that I have no control over or is more of an emotional block, it can be really challenging to stop that focus becoming an unhelpful fixation.
When I fixate on something I just can’t let it go. I have to process my way through it. Sadly for those around me that processing tends to take the form of a very repetitive conversation cycle, whilst I try to talk my way through the weeds I have gotten caught up by. This means, for Mr and mummy Girlymicro, and my besties, they get stuck also having to have these conversations with me. On repeat. I do eventually get to the point where I come out the other end, but I know it would be easier for everyone around me if I could just put it in a box and move on without the thorough exploration this process requires. So thank you for your patience and generosity with your time, I know you all have other things to do and I owe you a lot of champagne in return.
To those who love us, not grudgingly, but because they truly accept our imperfections
Having just read the last two paragraphs it should come as no shock at all that I am far from perfect. I annoy myself sometimes, let alone anyone else. The thing is, I have some people in my world that truly love me. They don’t love me despite my flaws. They love me because of them. They love all I am, despite how challenging that person can be. Knowing that is the most empowering thing I can wish for someone. It makes me feel safe enough to express and face my fears. It empowers me to share my failures, challenges and learning, through things like this blog. It is my greatest hope for all of you that you also find your people who make you feel this way, whether they are your family by blood or by choice. These people enable us to be the best versions of ourselves, and I couldn’t be more grateful.
Shout out to those who truly embrace difference as a positive
Humanity is tribal. Most primates are. That means that we can have a tendency to like people who act like us and hold similar values. The thing is, our diversity and difference is what makes us stronger, and should be something that is embraced rather than suffered. As someone who holds a rather weird and wonderful mind, that may not process and see the world in the same way as others, I sometimes really feel how I am seen at ‘other’. I often just don’t fit in and, even more than that, I frequently want to walk a path that is not valued or trodden by others. There are people out there, who rather than being baffled or thrown by this approach, fully embrace it and what this difference offers. Instead of trying to make me fit into a box that doesn’t feel comfortable, they support and encourage the risk taking that is required to walk my own path. They do not find my difference a challenge or a threat, but an inspiration and a positive trait. They see value in me as me, and that is not so common. These people are the ones that have the ability to change the world by expanding acceptance and re-defining normal. We need to find them, honour them and celebrate their vision.
Thank you to those who remind of our strengths rather than focusing on our flaws
Part of learning and growing as an individual is having the self reflection to understand our flaws as well as our strengths. It’s easy to lose perspective, as our area of change is often linked to the things we want to fix, to the extent that out flaws loom large and we forget about the strength side of the equation. Many of us are perfectionists who struggle to come to terms with the fact that we are, and always will be, a work in progress. It is also easy, therefore, to lose sight of how far we’ve come and to just see how far we have yet to go. So, this one is a shout out to the people who help us re-focus, and bring back into perspective all that is positive about ourselves. The ones who help us bench mark that, actually, we’re doing OK.
To those people who will hold us while we cry it out
I wear my heart on my sleeve, I always have. I’ve lost count of the number of times I’ve felt judged for this and when I’ve received comments such as ‘you’re too emotional to be a leader’ or other judgements that indicate you cannot be emotionally expressive and be good at your job. Comments that indicate empathy or emotional intelligence may actually be a risk rather than something to be developed. For a long time this meant that I tried not to fully engage or bring that part of myself to my working life, to try to be more remote and not express how I was feeling. Now, I’m not saying we should scream and shout, but I do think that I am a rounded individual who is not a robot, and neither are the people I work with. Therefore, to be my authentic self I need to acknowledge that I come with feelings, beliefs and biases, which need to be noted and managed, but also make me a better human being if handled appropriately.
Outside of work especially, I’m such a crier. I weep at movies, I cry with both sadness and joy, and don’t get me started on my behaviour at weddings. I am so grateful to have friends and family who allow me to safely experience all the peaks and troughs of these emotions, and know that a box of tissues or three may be required if we are going to Les Misérables.
I am beyond grateful to those who give us courage to be the true versions of ourselves
Speaking of my emotional side brings me onto authenticity. When I started my job I wouldn’t talk about being a gamer. I wouldn’t talk about movies, or other things that interested me, as people would comment ‘geek’ and roll their eyes. Over the years since I’ve realised how important it is to fully show up, and to bring my whole self to spaces, especially when in a leadership role. If I don’t lead the way, how can I expect others to. It’s not always easy however. Sometimes the comments cut deeper when they are made at our authentic selves rather than at a protective shell. It can be easier for others to try and bring us down when we offer so much of ourselves as a target. There are definitely times when I just want to retreat into my shell and take the easy road.
Even when writing these blog posts, there are times when it would be easier to hide from some of the challenges, especially when there are comments made linked to my choices. I stand by those choices however, I stand by sharing the highs and the lows, and by showing my flaws as well as my strengths. It takes courage some days. Some days more than I have available. So I want to say how grateful I am to those of you who lend me courage on days when I lack it. I look back on the many of the positive comments on this blog when I start to doubt myself, and use them to give me clarity and strength to move forward when it might be easier not to.
No matter how hard it gets, if you can find these people in your life it’s worth fighting for
It took me a long time to feel (mostly) comfortable in my own skin, and so much of that progress has been due to me finding the people in my life who told me that it was OK to be me. I’m fortunate to have a great family by blood, but I also have key members who are my family by choice. No matter where you find them, treasure them. In these difficult times, when the world can feel like you could be swallowed by quick sand any second, use them to anchor you. Use them to reflect. Ask, will this matter in 6 days, 6 weeks, 6 months or 6 years? Use them to help gain the perspective you need to pull yourself up and get out there to fight the good fight and stand up for what’s right. Just don’t forget to also thank them for the amazing role they have in your world and pay it forward so you can be that same person for others. The world is always darkest before the dawn, so lets get through this time together.
I got an alert of my phone last week that I set up this blog on WordPress 10 years ago! That was a bit of a shock I can tell you. That said, as I posted about in 2020, although I set up the blog and made my first post as I finished my PhD in 2015, I didn’t start posting regularly of another 5 years. I started it as I was looking for my next passion project but I didn’t really know what I wanted to say for quite a while. Despite the gap between starting and regular posting however, 10 years still feels like a gateway and something worth marking. I thought therefore that I would write something that reflects how I, my practice, and in someways the world, feels like it has changed in the last 10 years to mark the event. On the back of that, it also seemed fun to embed a few of the blog posts that have been put together since Girlymicrobiologist began in order to show how this blog too has changed and grown.
Apologies, this turned into a bit of a long one.
Microbes have changed
In 2015 I had finished my PhD in January, as well as a PGCert in Teaching and Learning in Higher and Professional Education. I had just taken my final clinical exams (Fellowship of the Royal College of Pathologists) in September and found out I’d passed them in November. After a decade of focus linked to completing what felt like an unachievable list of academic steps I was done. The question therefore was………what’s next? So, in December 2015 I started my first ever blog post, although I had been sitting on the web page for 6 months not knowing how to begin. This is how that Girlymicro blog began:
So, this is my first ever blog post. Bear with me as I don’t really know what I’m doing.
I’m what is know as a Clinical Scientist and I work in Infection Control.
Most people don’t know what a Clinical Scientist is so I thought I should briefly explain.
Most scientists that work within hospitals are involved with imaging (X-rays, CTs etc) or processing patient samples. We all work to support diagnosing patients. Did you know that scientists are involved with >80% of all diagnoses within the NHS? Their work is crucial to improving patient care, but the scientists are often unsung heroes as they often never meet the patients they help.
I do not work in the lab all the time like many scientists. I’m a clinical scientist, so half my time is spent working in a patient facing role within infection control and the other half involves bringing science to infection control to make it more efficient/evidence based. I work within a hospital with a team comprised of nurses, doctors and scientists. I have a PhD in infection control. I am also working towards my final clinical qualification (Fellowship of the Royal College of Pathologists) which is the same as my medical colleagues. My job is to help the translation of the science into a form that healthcare professionals can work with. Sometimes this means working with language so we are all on the same page. Other times this means working with the latest science and technology and developing new tests that will help.
I’m passionate about my job, but I’m also aware that many people don’t know that it exists and I’m hoping that this blog will help to change that. I plan to share a bit about what my day to day life is like as well as the science which I hope will inspire others to become healthcare scientists. After all, I have the greatest job in the world. And that is worth shouting about.
During the 10 years between setting up the website, with a world of good intentions, and writing today, many things have changed. Not least of all are the organisms people care about and the way transmission is understood. My PhD thesis was on the role of the environment in transmission of healthcare acquired infection. In many ways, getting papers published out of it was a struggle as very few journals were interested in the built environment and Infection Prevention and Control (IPC). Now organisations such as the Healthcare Infection Society run entire events linked to it, and I run something called the Environmental IPC Network, as the topics impacts so many of us. On a national level I’m now involved in writing guidelines to help support environmental IPC, all of which was a pipe dream when my thesis was being written. It felt like a very lonely area to be working in, but over the last 10 years it feels like the built environment is finally being recognised as an important component to how we keep patients safe in the world of IPC. I’ve now even had my own PhD students continue the work.
The other thing that has changed are the organisms that are perceived as being important. Even more though, there are organisms that were not even thought about in 2015, or didn’t exist, that can or are impacting so many lives, for instance Candida auris is a new kid on the block, and Mpox was called something completely different. Few people cared about Gram negative bacteria when I started my PhD, let alone Adeno. This was true even to a certain extent when I finished. I’ve worked on Adenovirus for over 2 decades, so it feels especially vindicating to see it make it onto the UKHSA priority pathogen list for research. All of this is to say, you don’t need to follow the crowd, if you find a problem that you believe is important enough, stick at it. Gather the evidence and put it out there. Eventually you’ll find others that join you in seeing the significance of your direction of travel.
Speaking of organisms, in 2015 we testing for the odd Coronavirus, and of course the severe acute respiratory syndrome (SARS) outbreak had happened, and the Middle Eastern Coronavirus (MERS) outbreak was ongoing. Many of us had been concerned with the potential of Coronaviruses to cause a pandemic, but most of the planning was still linked to Influenza based risks, as that was what had been seen historically. Awareness sadly does not necessarily link to preparedness, and as lived experience shows, the SARS CoV2 pandemic was both fast and devastating. We were unprepared, but I don’t know that we ever could have been.
Outbreaks with a worldwide distribution are not unusual and the table below shows just how many have happened or have been ongoing from 2015 onward. It also shows that not all outbreaks with world wide spread are considered to be pandemics, and not all pandemics have death tolls in the millions. In fact a pandemic is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”. With this classical definition including nothing about population immunity, virology or disease severity. So, preparing for a pandemic is not as simple as it can initial appear.
NB for ease I grabbed this list from Wikipedia, please don’t judge me for it
The table also shows quite how hard life can be in the world of IPC as the organisms don’t stop because we are tired and need a break. In fact the world re-opening post pandemic, combined with some of the scientific distrust that the political handling of the pandemic created, and the fear people experienced, means that managing outbreaks since has been an ongoing struggle. Vaccine hesitancy is having a real impact on transmission and making a key line of defense less effective. Many experienced experts in this field and others related to infection and public health have now retired or moved away due to the ongoing personal impacts. This means it’s more important than ever to turn up, be seen and to have engaged conversations across boundaries and silo’s in order to develop trust and support patient safety. No matter how hard it feels, it is still worth it.
My clinical world has changed a lot, partly because of the changing organisms and the pandemic, but also because the patients and healthcare are changing. It can take quite a lot to keep up with all of these changes, and you have to be fully engaged with an approach that aligns with continuous learning to stay up to date. On top of this, when you start out as a trainee with over a decade of training ahead of you, you have also got a list of key education targets to prioritise. It can therefore feel very much like you are just working your way through a list of items that need to be ticked off so you can eventually get to the finish line. There is a lot of ‘onto the next thing’ as soon as you manage each key milestone because otherwise it can feel overwhelming. One of the key things I’ve realised since 2015 is the importance of cherishing the moment and recognising the importance of progress, rather than rushing from one thing to the next with my entire focus about keeping an eye on the prize.
Passing FRCPath first time is still one of the most challenging things I’ve done in over 2 decades in healthcare. To be honest, I’d rather do another PhD than take FRCPath again, any day of the week. I wish that I could have found a way forward where I didn’t let my ability to pass, or risk of failure of an exam define me, but for many years it did. I’m pretty sure that telling my younger self this would have achieved nothing, as it takes time and distance to be able to understand that the tick list isn’t everything, but just in case it helps anyone reading this……you are more than the sum of the exams you sit, the letters after your name or the achievements on your CV. You have value no matter where you are on the pathway, no matter how many diversions you have taken, and to be honest, it’s OK to also decide the end destination is no longer for you. Who you are matters more than any tick list.
Part of the way I’ve gained perspective on my own training is by supporting others now through theirs. Seeing PhD students go through their own trials and tribulations, and sharing in their eventual successes., has given me insight I couldn’t have gained any other way. Supporting Healthcare Science training, everywhere from writing curricula to mentoring individuals at all stages of their careers, has allowed me to see things from all kinds of different perspectives. It’s given me so much insight, as well as time to reflect on how I felt and what might have helped me along the way, in order to try to help others better.
I feel more seen as a Healthcare Scientist than I ever have. I feel that Healthcare Science as a discipline and a profession is more seen than it ever has been. There are so many more routes into Healthcare Science these days, with so many more options. This is a truly brilliant step forward from when I joined, when there really was only one route as a Clinical Scientist and having to really fight to show that you could do things differently if you wanted to go another way. As the same time however, all that choice can feel a bit overwhelming, and in some cases paralysing, as people just don’t know where to start. In order to reach more people and support them in navigating this changing landscape though does require a willingness to be visible, to bring ourselves and our stories, in order to show others what an amazing profession this is. To show the openness and diversity of the workforce, in order to make sure everyone knows this can be a profession that is welcoming and open to everyone. You can’t be what you can’t see, so let’s make sure we are seen!
I have been fortunate enough to have experienced opportunities that I never believed would be open to someone as normal as me. I don’t come from a privileged background. I didn’t go to private school or attend Oxbridge. I don’t have connections, or a rich family to bail me out and pay for my exams/conference fees/fancy memberships. So when I get invited or asked to do amazing things, I of course say yes, but I’d think to think I’m saying yes for more than just me. I’m going into spaces and having conversations with people so that I can represent. Represent my workforce. Represent my gender. Represent my background and represent my family. To do so is an immense honour and a privilege that I don’t ever lose sight of.
No one I knew, outside of work, had ever had a New Years Honour, so it never even occurred to me I would get one. Being able to undertake work in Africa which aims to reduce infant mortality by 20% in high mortality settings, is not work that I thought I would ever get involved with, it felt too big for someone like me. That’s just it though, ‘someone like me’. We put so many labels and restrictions on ourselves. We limit our own vision. If the last 10 years have taught me anything it’s that you probably can’t see where you will end up, there’s too much joyful chaos in life for that, but you can control saying yes. Saying yes to things that scare you. Saying yes to rooms that may intimidate. Saying yes to being open to opportunities and changes in direction, even when you have no idea where they might lead you. Half the joy is in the discovery, so put on that adventure outfit and head out the door.
I’ve talked about the tick list and why visibility matters, and not just for you as an individual. Now I want to talk a bit about glass ceilings and choosing to do things differently. I have, over the years, lost count of how many times I have been told that something wasn’t for me. Not for me because of my background, profession or gender, or maybe just because I didn’t fit in. I used to hear a lot of ‘no’ and I used to feel like others could define me. The thing I’ve learnt is, that the only person who can define you is you. You can give away your power to others and let them made those choices for you, or you can own your path, your career and your choices, in order to define yourself. I’m not saying any of this is easy. I’m not saying it is fast or straight forward. I am saying it is a choice.
I became the first non-medical Infection Control Doctor (that I know of), because I worked to create the path to get there, which hopefully others will now follow. I didn’t know that was possible when I started, and it came with a goodly number of fights along the way. There were days when I definitely believed the ‘no’s’ and didn’t think it would happen, but I kept trying, I kept showing up. It became clear that I would never make Professor at my original home within UCL, due to long standing bias for medical over scientific backgrounds. So I pivoted and found a new academic UCL home that welcomed me and supported me in my journey instead. Things that are worth fighting for take time and commitment, and nothing is guaranteed. Paths are often not well trodden, and so finding the right people to support you along the way is key. Don’t drift. Make your choices consciously. Know what you are willing to fight for. Know also what you are prepared to let go of. When things come together share the knowledge, share the path, and make it easier for others to follow. Drop that ladder down or prop the doorway open.
I had thought it was post pandemic blues but I think it’s just transitioning to another phase of life and career that got me thinking about this one. I’ve been working at GOSH for 21 years this year, pretty much my entire working life. During this time there have been two mentors that have pretty much introduced me to and gotten me through everything. In my clinical life it has been Dr John Hartley, and in my academic world it has been Professor Nigel Klein. Now, John retired part way through the pandemic, and he really is the reason I have my Consultant post, as I took his Infection Control Doctor role. Nigel sadly passed away last year, before he had the chance to retire. In my head, I’m still the new girl on the block, the new person in the department, the young upstart. It is a shock to look around and realise I am now one of the people who have been there longest and I have very large shoes to fill, knowing how unprepared I feel to fill them. The giants that have gone before have left, but I wasn’tt prepared for them to leave. I think the biggest shocker has been that there are some who now look at me in the same way that I looked at John and Nigel, when I don’t feel like I am even in the same league. I think they will always loom large in my mind, and I honour what they taught me by embedding it in my practice.
Your career can feel like such an open pathway ahead of you. Then you wake up one day and realise you, probably, have less than a decade left. It’s at moments like that you really need to think about what it is that you want to achieve, what you want to prioritise, in order to maximise the impact of the time you have left. Ten years feels like a long time, but its really just 2 cycles of PhD students, 2 large project grants and only 3 trainee Clinical Scientists. It’s no where near as long as it feels and so planning ahead takes on an all new perspective. If your a planner like me, now is the time to plan for this new phase of your career.
Learning that you can’t fix everyone or everything
Part of that planning for the future is also knowing what not take on. I am a simple soul, I like being liked. It’s taken me a long time to grow in my leadership to the point where I acknowledge that I not a god, and I don’t have a magic wand, therefore I can’t fix everything or everyone. Nor can I be liked by everyone. Part of being a leader is making tough decisions, part of being a leader is also about honesty and not saying the easy things, just to be liked. Sometimes, I have learned, putting off the difficult conversations and the difficult decisions does no one any favours and so it’s best to have them early. As a mentor, you are there to advise, but the decision are owned by the person making them. You are not people’s parents and they are not children, we should therefore be aiming for adult adult conversations. Acting like a White Knight can actually do more harm than good, as you are removing learning opportunities for those you swoop in and save. It is a difficult balance to know when to step in and when to maintain a pure supporting role. It is one that I will continue to get wrong. All I can do is learn, do my best, own the consequences, and aspire to be better.
The flip side of learning you can’t fix everything is being aware of your duty to try to make things that are in your remit of control or influence as good as they can be. As I’ve said, I have a decade left in all likelihood, and therefore my job is to ensure that I maximise the opportunities for others until the day I don’t have the ability to influence any more. My career is very much no longer about me, it’s about those who I will be leaving behind to carry on once I’m writing murder mysteries and drinking martinis at three in the afternoon. My job is to support as many people as possible to be in the best position possible when I walk out the door for the last time. I realise it’s now my job to keep the doors open and assist people through them. Whether it’s mentorship, nominations, or speaking peoples names in rooms they haven’t been invited into, I plan to do all I can to make sure that I pay it forward every opportunity I get.
I have the job I planned for and dreamt about for 2 decades. It is my dream job and I love it I wouldn’t change it or my decision to go for it for the world. There is no doubt however that post pandemic it has been hard. I don’t know if it’s because I’m getting older, because the job and the world right now feels pretty intense and hard core, or because my body still kind of hates me for what I put it through during the pandemic, but I definitely feel burnt out and recognise that even a dream job can be a lonely place to be.
The thing is, not every day is going to be a great day. Even in a dream job there will be bits that are harder or speak to you less. It’s also OK to not be OK. The world, and especially those of us in infection control, have been through a prolonged period of pretty significant stress and trauma. We are not going to be the same people we were going in. You don’t have to change the world every moment of every day, sometimes showing up and doing your best is enough, and what your best looks like will be different at different times. I have learnt the importance of asking myself, what would I say to a friend in this situation, and to show myself the kindness that I would show to others rather than acting as my own harshest critic. Try to take a step back and give yourself the prospective you need to find a route forward.
Just the act of writing this post has made me realise how far I’ve come. If you’d asked me in 2015, I would have said being a leader is about setting an example, about getting things right, about showing competence and keeping a cool head. I’m sure leadership is about some of those things, but what I have learnt, for me, is that leadership is about authenticity.
It’s about prioritising bringing my whole self to every encounter. It’s about saying sorry when I make mistakes, rather than pretending to always be right. It’s about sharing that I too am finding it hard, rather than pretending to be OK, but that success is about showing up anyway. It’s about the fact that some people will find this bringing of self about sharing of weakness and use it as a route to criticise, not everyone will like or even ‘get’ what you bring to the table. It is also about knowing that you don’t have to like or be liked to work with others, but that it is instead about developing shared goals, and that diversity of thought makes us stronger and not weaker. Finally, it’s about knowing that it can be scary to share who you truly are as the comments and the insults hit harder without having an armoured shell in the way. However, if you don’t show that you can bring your whole self to a space others will feel less able to do so. Creating safe spaces where people can truly be themselves is one of the greatest things we can do, and so we need to model the way forward so that others don’t have to take that risk instead of us.
Of all the posts I was most scared to share when I wrote it in April 2021 was the one where I talked about losing my sister and how it felt to know that I wouldn’t be able to have children on top of losing her. It was one of the first really personal and vulnerable posts that I put out and I was really scared of what the response might be, both from family and from strangers. Instead, it was shared more times than any other post, and people still come up and talk to me about it, my sister, and Morgan my niece, who we also lost. Something that terrified me, led me to being able to talk about something that impacts so many and is talked about so little. Sharing, was a bravery I don’t think I would have managed in any other way than on this blog, and having conversations with people who read it are so meaningful to me, even now.
More recently I shared a post about what it feels like now, over 10 years since losing my sister. I really wanted to post how something that feels so insurmountable, in terms of not having children when you wanted them, can actually turn into something where your life still has so much meaning and joy. A position I could not have even imagined in 2010 when I lost them. I truly, honestly, love my life. My life has meaning and I have achieved things that I’ve been forced to admit would not have been possible if my life had taken a different course. I hope that sharing this can help others who are not there yet to know that there is a future where they will smile, laugh and feel valued again, no matter how dark the moment feels.
I’ve always been a family girl, but I’ve not always prioritised them in the way that I should. I’ve missed funerals and weddings for work. I’ve cancelled dinners and missed trains home. The pandemic, and life in general, has made me decide that I need to put my family first, and thus myself. There needs to be balance to make it through the marathon of a healthcare career, and some of that balance requires that the job cannot always be the thing that defines who we are. Mummy and Mr Girlymicro are my world, and every moment spent with them makes me a better person and thus better at my job. Bringing my whole self to my job and my leadership requires me to nurture precisely that, my whole self. So credit where credit is due. My family support me in being able to do what I do. They make me martinis when I’ve had a bad day, give me water when I’ve forgotten to drink, and feed me when I’ve inevitably forgotten to eat. They love me for my flaws as well as my strengths, and put me back together when I break. They are my everything, and so they need to feel like my priority in life. I guess my learning is this, don’t become so focused that you forget to acknowledge the people that got you there, and don’t be so ‘eyes on the prize’ that you forget to enjoy the journey with those who care.
Last, but by no means least. I have learnt to embrace the unexpected. I’m a planner but when I started posting on this blog I didn’t really have a plan. I had no idea where I was going or what I was doing. I just knew that it felt like it was something that was needed and had been asked for as part of a challenging time when people were looking for information. It was something that was supposed to be a little hobby that unexpectedly became a central rhythm of my life. Something that is a focus of a little time every day. Something that feels mine when less and less of my working life feels that way. It’s a space where I really feel I can connect, in a way that is probably a little insane for something I throw onto a page and don’t see people read. None of this was planned, and yet it has changed my world. It has changed my plans for the future. It has given me a creative outlet, and some hope in pretty dark times. So, if I have a thought at all for you to take from this overly long blog post, it is this. Embrace the random moments that come your way. Embrace the actions that you roll a dice on and don’t think will lead you anywhere, because every once in a while, without you even being aware of the whys or the how, they may change your life for the better.
This weekend I’m off to Torquay for the Agatha Christie Spring Literary Festival. It will involve talks, a statue unveiling and even a ball! Some of you will know that I’m a massive Agatha Christie fan and love a good murder mystery. It’s part of the reason my ambition for when I retire is to finally have time to write some of the pathology murder mysteries that I have drafted out. I’m planning a three book series called The Murder Manuals. Anyway, that’s some way off but I still love to indulge in a bit of Agatha joy.
Whilst thinking about it this weekend, when I should have really been packing instead, it occurred to me that maybe one of the reasons that I love my job so much is because, in many ways, working in Infection Prevention and Control (IPC) is like working to solve real life mysteries and challenges on a daily basis. You come into work every day not really knowing what the future will hold and spend your days trying to uncover who the criminals (microorganisms) are and how to prevent future ‘crimes’, in the form of infections. This feels even more true having recently posted about how a forensic science lecture I went to looked at solving crimes. So, whilst my head is all linked to the detective process (I suspect I’m more Miss Marple than Hercule Poirot, although really I’d love Mr Girlymicro and I to be Tommy and Tuppence) I thought I would write about why I believe IPC professionals make the best healthcare detectives.
Beginning at the end
Like most good crime dramas, we in IPC, often make our entrance towards the end of a story when we things have already happened. We then have to work backwards to understand what’s happened as well as working forward to prevent any future risk (‘crimes’). Now, the point we get involved can range a bit. Just like in detective dramas, if the crime is obvious the police get involved early. Sometimes however, Miss Marple suspects a crime has occurred (think Sleeping Murder) but everyone else can be slow to get onboard.
In the world of IPC sometimes there are very clear events that need to be looked into. An outbreak for instance is traditionally described as 2 cases linked in person, place and time, or a single case of a significant infection, such as Ebola. This works pretty well most of the time but there are circumstances where using this definition can mean it takes you longer to identify an outbreak, or ‘crime’, has occurred. An example of this is when outbreaks are linked to an intermediate environmental source. This means that you may have low level numbers of cases which don’t appear to be linked in time, or even person, but are just linked to location. I’ve written about the importance of environmental IPC before, but this is one of the reasons it can be particularly tricky.
Need to understand the rules
In every detective story there are rules. If you’re in a Christie novel there will be a denouement, if you’re watching Columbo you will always see the murder at the start, and if the murderer is a female she will always be the person Morse tries to flirt with badly at least once. Infection Prevention and Control is no different. There are unwritten rules that you need to learn and which will help guide you on your way. Vancomycin Resistant Enterococci outbreaks will often have an environmental component. Norovirus outbreaks within staff often have a secret staff member who vomited in the toilet and told nobody. Pseudomonas aeruginosa outbreaks make people ask ‘have you checked your water?’ All of these things give you a way to start investigating and a set of questions to begin with.
Now, here comes the word of warning. Just like The Murder of Roger Ackroyd broke the rules, so do bacteria and other outbreak causes not always behave the way they are supposed to. Just like any good police drama with a rebellious detective, you need to know the rules but also know when to ignore them. Know when to switch tack and think that your MRSA outbreak may actually be linked to your ventilation system, not direct hand to patient transmission. Be neutral enough when looking at your data to not ignore the clues that are there. Red herrings will be present and distract you, so know when to call a fish a fish.
Start broad and narrow down
One of the best ways, with any investigation, is to start broad and narrow down. This enables you to avoid diving down rabbit holes and missing other pathways that should be investigated. Very rarely can you turn up to a country house murder and exclude most of those present, and as Hercule Poirot famously states “it is always wise to suspect everybody”, and the same is true with IPC investigations.
Ask yourself, why do I think that there’s something happening? How do I know that cases occurring at the same time are actually linked? How are my surveillance systems set up to support identification of low levels of cases over prolonged periods? How sure am I then that a ‘crime’ has actually been committed? Once the body as been found, in terms of looking for sources, where do I get my information from? Do I consider just other patients, or patients and families, or patients, families and the environment, or even patients, families, environment and staff. This, all before you even start to consider how different organisms behave in different types of patients. In a country house murder you need to consider those above stairs as well as those below, and in stories like the A.B.C. Murders, you even need to consider those who came and rang your doorbell.
There are so many moving parts within healthcare and we need to ensure that we are capturing as much of that landscape as possible when we start our investigations. Starting broad supports this, but you also then need to know the key moments to start excluding options so that you can eventually get to the depth needed to support interventions and change. Eventually you have to have the scene where you commit and name the murderer. Within IPC, events such as outbreak meetings can really help with this, as unlike our favourite detectives, we can’t keep all the information to ourselves right to the very end. These meetings bring people together to both help gathering information but also to decide on how to focus next steps.
A plethora of unreliable witnesses
In A Murder is AnnouncedMiss Marple states, ‘Please don’t be too prejudiced against the poor thing because she’s a liar. I do really believe that, like so many liars, there is a real substratum of truth behind her lies’. One of the things that is often quite difficult to pin down during IPC investigations is….what is the truth? Truth is often seen as definitive but in reality truth relates back to the lens through which the individual sees the world. For instance, if you asked me what I was doing at 7am last Wednesday I wouldn’t lie, but I would have to offer some form supposition as I can’t actually remember precisely. The other complication is that those directly involved may be even less able to recall their own roles. If I’m sick in hospital days can merge into one and I’m focussed on my physical reality rather than taking in my environment. This is all before we take into consideration the fact that we may be providing sedatives and other medications that could impact recall. Would I remember that one of my visitors mentioned my niece had diarrhoea……..probably not.
Within IPC investigations no one is likely to remember every physical action, which is why audit can be a helpful addition, in order to have an external person capture trends. In other scenarios the actual witnesses to the event can’t speak, for instance ventilation gauges that may have fluctuated or alarmed (is that a voice?) to an event that no one wrote down or reported. This is especially challenging when you are trying to get to the bottom of grumbling outbreaks that have been going for some time, but also is a particular challenge linked to infections with organisms that may not become apparent for months, such as some surgical site infections or infections with pathogens like Aspergillus. Memory can make individuals particularly poor witnesses in these scenarios and good record keeping and notes are essential to support look back investigations (investigations where you are looking back to capture risks and event detail).
Need to know which tools to use
If you only interview half of the witnesses in your case, you’ll be lucky to get even half of the story, as it will all depend on which people hold the information. On some occasions you will luck onto all the answers with the first witness, but is this a risk you want to take? The same can be true in IPC investigations if you don’t think about the tools or sampling methods you want to access from your toolkit. Is your main focus on using bacterial culture? Do you have a method that will work even if the patient is on antibiotics? If you are looking for a viral cause, what method is best? PCR is not PCR is not PCR. You can look for RNA, or DNA, you can extract from different volumes and different types of samples. The pros and cons of all of which need to be considered. Putting together a sampling strategy in response to an investigation is like choosing the pieces of a jigsaw puzzle whilst knowing that you are not going to have all of the bits. You want to choose pieces that give you the best chance of accurately guessing what the picture is.
In IPC there are various pieces of documentation that will help with thinking in this area. Documents like the UK Standards for Microbiology Investigations (UK SMIs) can help guide thinking linked to which samples might be useful to take. UKHSA also has various documentation linked to outbreak investigation with specific organisms and interpretation criteria, such as measles, C auris, and TB. At the end of the day however, just like your detective walking into a murder scene, you will need to work out how to apply that guidance to what you see in front of you.
It’s all about the clues
Once you have investigated and questioned your witnesses then you need to be able to work out from your clues which pieces are useful and which are your red herrings and may lead you astray. Like all investigations the most important thing is to be methodical but you then need to make time to be able to think and reflect. Poirot famously once solved a case without leaving his front room, just by being able to sit and question those involved. I’m not saying that this is something we should try in terms of IPC, but I do think it holds some lessons for us about the power of thinking time. Especially when you are in the midst of an outbreak there is often a real drive to be seen to be doing something, responding to everything, and constantly doing more. After 20 odd years in micro/IPC I think I’m beginning to think that Poirot may have been onto something.
If you are constantly changing or adding in responses it can be really difficult, even if you reach resolution, to know which thing you did made the difference. Early on in an outbreak it can be easy to rush into making recommendations prior to having gathered all the information you need. It sometimes feels good to call an exposure meeting the minute you get the information that an event has happened. For instance, you may have days to respond in the case of something like a chickenpox (incubation period 8 – 21 days), before those patients become a risk to anyone else. Therefore waiting to call a meeting until you have gathered all the clues, until you know everyone’s immune status, levels of exposure etc, can mean that your meeting is so much more effective in managing any risk. Waiting until you have a decent action plan for where you might search for clues, i.e. sample, may mean you find the answer so much more quickly then having to go in for multiple attempts. Taking a breath and putting thought before action may mean you get to the final result so much faster. So utilise those Little Grey Cells!
Not everyone takes kindly to be investigated
IPC should not be about blame, but just like the house guests in a country house murder may not take kindly to a visit from Inspector Japp, some occupants of your ward may be less than happy to see IPC walking up to the nurses station. Although I talk about the similarities between IPC and detectives, we should not be feared and act like police, or worse than that judiciary. Often the reason why Jessica Fletcher gets further faster in finding the murder than the police at the scene is because she is seen as just another friendly visitor rather than someone looking to find fault. Her focus is on building and utilising relationships in order to gather information. She is often seen by the other witnesses involved as being part of their team, and the outputs of her investigations are often linked to co-production of outcomes by sharing information, rather than going it alone.
In general, as in many areas of working life, relationship building is key. You see Jessica all the time in Cabot Cove, not just when there’s been a murder. That means that by the time she finds the body she already knows most of the players and has built up relationship capital with those involved. This enables her to sometimes ask the challenging questions. I believe the same needs to be true for IPC. If clinical teams only see us when things go wrong, they are automatically going to be somewhat defensive. If they see and work with us when times are going well, as well as less well, they are more likely to feel we’re in it together with shared ownership. All of which means we may also get to the source that much faster when we need to.
Sometimes there’s a twist in the tail
There are a number of famous Agatha Christie stories where the murder victim turns out to not actually be dead, I won’t spoil them here. The same can be true for IPC cases. There are certain organisms, of which Adenovirus is my personal favourite, that can both cause primary infection and then go latent and reactivate later. Often this reactivation is linked to immune status, and of course many patients in hospital have immune systems that are doing less well. These present challenges as you can look like you have a cluster of cases but, due to the type of patient, they can all be independent findings that happen to cluster together. So, without the right investigations you can call ‘murder’ when actually there is no corpse. Being happy to hold your hands up and step down when you have new information is an important trait, but knowing to get the testing done to enable you to do so is even more so.
The other scenario that can happen is, as Sherlock Holmes famously said, “When you have eliminated the impossible, whatever remains, however improbable, must be the truth“. There will be things that have been done, behaviour that has occured, that you would never imagine or predict. Over the years I’ve found a lizard in a bathtub, olive oil used as skin care by parents, and all kinds of things in fridges and freezers, just as the tip of this iceberg. Things that out in the real world would probably not be a risk, but in the healthcare world can lead to all kinds of issues, none of which would be on my primary list of questions when trying to identify a source. The world continues to surprise me, and therefore in the world of IPC keeping enough of an open mind to to respond to the unexpected is essential.
It’s a team sport
Poirot has Hastings. Morse has Lewis. Sherlock has Watson. Tuppence has Tommy, and Jessica has most of the population of Cabot Cove. Solving crimes benefits from teamwork and IPC is no different. I’ve spoken about the importance of relationship building but doing IPC investigations well benefits from more than even that. One of the key ways these partnerships work is by creating the space where the discussion and reflection we’ve already talked about can happen. In healthcare, which is far from a contained setting with only a handful of key players, being part of a team can also provide vastly more eyes and insight into what happens in reality.
The Hawthorne effect is a type of human behaviour reactivity in which individuals modify an aspect of their behaviour in response to their awareness of being observed
One of the reasons that it’s important to undertake a team response within IPC is that if I turn up, a stranger or less frequent visitor on the ward, then those on the unit may behave differently because I’m there. If you see IPC hanging around a sink, for instance, then you may suddenly focus way more on your hand hygiene efficacy then you would otherwise. If I go to speak to a family, they may say different things to me than they would to the bed space nurse they see everyday. In order to get the full picture I may not always be the right person to ask the questions. Being fully integrated, being seen as part of the team, or having relationships with people that are, can make all the difference in terms of the success of your activity. Everyone benefits from having a Hastings to send in to ask questions from time to time.
No greater satisfaction than being part of the denouement
I don’t know about you but I just love the moment that everyone gathers at the end of a Christie novel and detective starts the process of walking everyone through all of the different clues, red herrings, and witness statements. The moment when you discover if you’ve picked up on everything that was on offer to you, and even more than that, the anticipating of waiting to hear if you’ve put it all together in a way that a) works and was b) actually correct.
I feel the same way when I finally have that moment when I crack the case, when I find the source, or even just get to the point where I understand a tricky result. The hallelujah moment when you look down at the jigsaw pieces you have and you can finally see the full picture. It’s the reason that some of our favourite investigative successes live on for years in teaching and case studies. I will talk about the case of the Norovirus and Biscuit Tin to anyone who will listen even now. The settings may be different but every detective, whether in a novel or in healthcare, loves to regale others with their exploits. We just can’t help ourselves. My excuse is that sharing the learning helps is all. That said I’m off to attend a talk called ‘How to kill people for profit’. I’m assuming it will give me all the tips I need to be the next cozy murder success and maybe even weave in the odd IPC detective drama moment into the mix.
There’s been a bit of a delay posting this one, as it was supposed to come out a couple of weeks ago, but I ended up needing to take a bit of a well-being break. Healthcare Science week was a brilliant blur but full on and, for once, when I went on leave I decided that all work, yes even this blog, needed to be put on hold so I could have a complete break. I hope absence has made the heart grow all the fonder……
Now, onto the science
At the start of Healthcare Science week, my family and I, because they love me, went for a night out to experience a different type of science…..forensic science. I wanted to go to see ‘Walking into a Murder Scene: an evening with Simon Fowler‘ by First Forensic Events for 3 reasons:
The first is that I think it is really helpful to engage with science beyond your discipline for inspiration and ideas. In this case, I’m not a big true crime fan or anything like that, but I was interested in how they deal with technical challenges we both share, such as low volume detection of targets by PCR amplification from human blood, as this could help with sepsis detection in clinical settings.
The second is that I have a long-term plan to write some pathology murder mysteries, by long term, I mean it’s my retirement plan, and so I also thought making some science notes could be helpful as success is mostly in the preparation.
Finally, I try to engage with science outreach wherever I can, no matter what the topic. I wrote a blog here last year about aviation outreach at a massive airshow known as RIAT and what learning that triggered for me. I really believe in seeking out and engaging with these opportunities, firstly because they do a lot to inspire me as to what more I can do. Secondly, because why reinvent the wheel? Learn from others about what works well and how I could switch up what I do. Last and by no means least, if we don’t support these people and these events, they may cease to happen. Finances are tight everywhere, and outreach is increasingly seen as a ‘nice to have’. Numbers talk, and so taking some time out of my day to be there to support others talking science is the least I can do.
The event was the first ones from a group known as First Forensic Events and was, in many ways, a trial run. The house was packed, though, and there was an obvious interest from those attending to just find out more about a world that most do not have access to. It got me thinking and as a result I thought I would focus this blog on what I took away in terms of how we, as scientists and Infection Prevention and Control professionals, could do more in terms of reaching out to a different audience and shedding some light on what we do to lift the veil in a similar way. I often think we don’t talk enough about the fascinating aspects of what it is we do for a living and this event made me realise that we are in position to share that with others and there are people out there who may want to learn more.
Location location location
The first thing I want to talk about is location. This event took place at the Royal Gunpowder Mills, which was objectively brilliant. One, it is not a place that is open that much to access, and so to be able to attend for an event already felt special. Two, it’s a place that’s interesting and quirky, and so even if people aren’t leaving and talking about how great your content is, they are likely to still be talking about what an interesting night they have had. I get pushed all the time to have events in cheaper and less interesting spaces because the costs need to be justified. The truth is, as much as we may dismiss them, locations can make or break events. Therefore, investing in them makes complete sense to me.
One of the reasons that location choice is so important is that it gives you the opportunity to really demonstrate that you have thought about the comfort and experience of your audience. Are there drinks available? What about food? How will people find their way to seats etc? Attendees will focus better on the content if they are not distracted by feeling hungry or thirsty or trying to understand where they need to be. They are also more likely to linger and talk to each other, which is key to both creating a buzz about the event and to permit natural network creation which will encourage future support.
A clear sense of identity
All things tend to be easier or work better if you have a clear sense of identity or what you want to achieve. This works for everything from advertising events and getting people into the room, to how people respond to the event itself. It is therefore worth investing a lot of time in both thought and planning in order to get this right, before diving deep into the practicalities and details.
When we spoke after the session it was clear that Simon’s focus was linked to training. His unique selling point (USP) for the session was to demonstrate not only some of the interesting cases he’d been involved in but also why and how he got into the work he did. He was also very clear that, in the same way we always want to focus on the patient, he wanted to make his sessions about the victims. Simon started off his session by talking about his core values and where he came from, in his case it was that he wanted a military career but that life turned out somewhat differently. He was diagnosed with Perthe’s disease which meant he was no longer eligible for military service, and so he then had to re-focus and choose a different life path. He built the start of his session up around his personal journey into science.
If we were to do something similar for health I think the need to be clear about our USP holds true, and for me, the things that seemed to engage the audience most were a focus on clear story telling with outcomes to show your role and it impacts i.e. what did you do and how did it change things? The other thing that seemed to really fascinate those present was discussion about prioritisation, outcomes and decision making. How do you decide what to do, in what order? How do you make decisions and how did those choices impact the end result? I suppose I’m talking about making thought processes an object of active discussion and raising awareness, rather than maintaining mystery or focusing purely on events. The stuff someone can’t find out by reading up about something on the internet and can only be got from a more intimate discussion based setting.
Back to the fundamentals
Keeping to the basics and planning, lets talk set up. Location is important but so is the staging. Everything from what you are planning to wear, to props and the tech that you will use. Is your outfit comfortable and accessible? Are you going super smart/business, that could be seen as hierarchical? Will you go branded or display your geek like tendencies with, for instance, a CSI T-shirt? All options are fine but they need to fit with your USP. Who are you selling up on that stage? Choose an outfit that fits with deliberation rather than as an accident.
Making the staging visually interesting is useful, especially if people are sitting for a while before everything kicks off. Offering an intriguing set up means that people will engage before you even start, as well as allowing people to speculate what might happen later. Having props that you will use draws your audience in.
It is important at the planning stage to also be considering accessibility. Too many people believe they have a loud enough voice that they don’t need mics etc. That works for some people but there will be people in the audience who you don’t reach and who will find it a barrier to engagement. Mics also allow nuance in terms of being able to go both loud and quiet as needed, rather than focusing constantly on projection. The same with slides if you are using them. Will they be accessible to people who are colour blind? What level of text is appropriate? What fonts may permit engagement? Should you be image heavy? In the case of something linked to criminal cases or health, how much do you show? Gore, surgery, infection etc can be triggering, so consider what level may be needed/appropriate. If you are recording (pictures, video etc) think how this might impact your staging and movement and if it will change your lighting requirements.
During the show itself, when we attended, there were some technical issues as the laptop running the slides stopped working. I think this is everyones worst nightmare, but has also happened to us all at some point. It reinforced for me that if you are relying on tech as part of your staging, you always need to have a plan B about how you will handle things if something happens to that tech. How you will you pivot? Having a plan means that you will be less flustered and therefore impact the experience less for those attending.
Selling credibility
Credibility is everything, whether we realise it or not. Setting up and selling your credentials is an important thing to do both before the event and early on during the establishment phase. Why should we listen? What do you know? What’s your experience….really? There are multiple ways that you can both do this and embed it. Thinking about how you are going to both establish and sell your credibility is something we don’t often consider and may take for granted, but if you are trying to speak to new people, especially outside of your field, it is something to really think about.
One of the great ways that it was done at the First Forensic Event was that someone else whom people may be familiar with, in this case Donal Macintyre, introduced Simon linked to both the event and by covering his skills and expertise. We all use testimonials in every day life and this setting was no different. I’d heard of Macintyre Investigates but as someone who doesn’t engage with a lot of true crime work the name didn’t mean much. It did however mean something to most others there, and he also talked about the TV work and others things Simon had been involved with in order to try to establish wider credentials. This is no different really to someone reading out your bio at a conference, but re-pitched to make it useful to a different crowd, and still well worth doing.
The other thing that Simon did was to acknowledge the other members of his crew. This was important for two reasons. One, because we should acknowledge that we are not single person armies and the work and support provided by others. It makes you not only more approachable but also acknowledges the work undertaken by other people to get us to where we are. In this particular case however there was another important purpose in acknowledging the other people who were involved, and that was to enhance the credibility of the event itself. The other people involved in First Forensic Events are other forensic scientists and police detectives, which aid to further establish credibility by inclusion in networks and experience. If others are willing to add their names to your events then it also demonstrates their backing and investment in your undertaking.
A story in three acts
We’ve reached the nitty gritty. How will you actually structure your event to achieve your outcomes? What are you trying to achieve? Simon was clear that it wasn’t just about factual presentation, but about him and his journey as a scientist. I think that was a really good decision and something that many of us as scientists should consider when working up our presentations. We are not science in isolation from ourselves, and so bringing your full self to these events is bound to be more impactful, and also helps to engage your audience more. For this purpose the session was structured around stories, stories about self, stories about action, and stories about impact. This kind of story based structure enabled the audience to really engage as the human ability to engage with oral tradition goes back to us sitting around campfires and learning through listening to tales.
The first third was based around learning who Simon was, what drove him and how he got into his work as a scientist. Fundamentally this section is about building of rapport as well credential building. It also enables the audience to settle in and for an expectation setting phase to be undertaken. The second third was a practical session. This is where Simon demonstrated some practical aspects of what a bludgeoning event could cause in terms of blood splatter, and scene investigation. This enabled a change in pace and energy, which breaks things up for people as they will have been sitting for some time at this point and changes it from being a didactic slide presentation. It also means people go into the break with a level of introduction of what may be discussed in more detail post break and therefore your audience can choose how much information they are comfortable with, and gives an exit opportunity if needed. This gives detail without inclusion of people or actual harm, and therefore allows engagement without emotional risk. The final section, post interval, was based on actual cases, still rooted in technical discussion, which supports focus on facts rather than emotion. This type of structure supports engagement and gradual submersion rather than attempting to shock.
Speaking to the room
This brings us onto the audience. How do we speak in a way that allows the audience to truly engage. I’ve talked about structure but there are other things that can help. The first thing we can do is do some scene setting. Making sure at the start of the session that everyone know how the event is going to work and what the rules are. This includes some basic things like telling people that there will be an interval, what time it will be and how long it will run for, so everyone can make sure they know how long they’ll need to engage. In the case of this particular event it also included scene setting around what might be shown and discussed, making clear the level of imagery etc in order to reassure and expectation manage. It also included being very clear that it was completely OK for people to leave and return at any point, as people may be triggered by different things, different memories, in order to reduce distraction by discomfort or concern about whether removing yourself would be acceptable. It also included the fact that there would be a Q and A, and that Simon and his team would be available for questions both within the event and during the breaks.
As with any science event it is worth doing what you can to avoid exclusion of your audience by thinking about how you will use technical terms and being weary of abbreviations. Many of us use abbreviations without even thinking about it as part of our engagement (I used the term PCR earlier) as it is part of our language. Those in the audience are less likely to have the same shared language however, especially if you are reaching out to a new audience. Making sure you allow time to explain any technical terms you are going to utilise is a key thing to practice. When you think you have explained enough you are likely to need to explain even further. As someone who doesn’t work in law enforcement some of the terms and abbreviations used in this event didn’t mean anything to me. That didn’t really impact my understanding or get in the way of the outcomes however, but made me remember how healthcare is filled with exactly the same barriers to full understanding, and that I need to be more careful about how I talk about my job also.
One way to make sure that you get feedback on how to improve and make tweaks on things like language is by making sure that the first time you do anything you add plenty of cheer leaders/critical friends into your audience. These people can flag and help you improve for future events, as well as providing some reassurance and friendly faces in the room to help alleviate your anxiety.
Maintaining accessibility
I’ve talked about accessibility already in terms of supporting your audience to logistically engage, but now I’m talking about connection. How do we make sure that we allow participants to connect with us, feel engaged with us, and fully share in the event. There are some key ways that I think this can be done, although sometimes it can be scary. I think the key one for me is allowing yourself to show vulnerability. Sharing enough of yourself that others can start to see you as a person. This includes sharing things such as values and drivers, but also sharing failure and things that did not go so well. Allowing people to see you as a person and not just a role.
The other part of this is being open and able to laugh at yourself, and allowing others to join you in that moment. All of this can be really shown in less structured moments. Moments where you make yourself available to engage 1:1 in breaks etc. Also, in a more open way by including moments where audience members can fully participate in things like Q and A’s. I always find it helpful to set parameters for these. Being open about the fact that there is nothing off limits, especially with kids. So they can ask what my favourite colour, is or how much I earn, or what I find the hardest, without restricting them to the science. Setting boundaries and expectations in general means that everyone knows what the rules are. Can you use your phone? Can people take pictures? Can people leave? All of which enables people to focus on engagement rather than attempting to predict what’s in or out of scope.
Pitching your future
How does it end? You’ve made it through, you’ve shown your full self. Hopefully you’ve felt that the audience engaged. You’ve made it through the Q and A. What do you do now? You need to make sure that you provide another opportunity to engage in the future whilst everyone is still paying attention. This is the moment to link to other opportunities, but this means you need to have those other opportunities set up and ready to share. What I’m saying is, as much as it’s crucial to focus on the right now, to make a real success out of events like these you need to be able to provide the next thing. So making sure you’ve planned ahead and have something else to sign post to is a key stepping stone to success.
Even if you don’t have another event planned you need to make sure you are thinking about marketing. What is your social media? Do you have a web page? Where can people go to find out more, either about you or about your future planning? Making sure that you have these things set up so that people can continue the engagement that they’ve started means that this is less likely to be a one off and more something that will be a stepping stone to future engagement. Having shown who you are and having brought people into your world, the logical thing is to make sure you have a plan for showing people what’s next.
So much that links us
So after all that, what did I think of forensic science. When I go to any of these things, what always strikes me is that we have so much that links us. Whether we are acting as detectives in finding an infection or a criminal linked to a crime scene, we are actually following very similar thinking and processes. We even use some similar techniques. I walked away thinking that I had been involved in a super cool event, but also struck by how brilliant it would be to do something similar for healthcare, and whether there would be anyone out there interested in setting something up. I left, as I almost always do, with my mind on fire with ideas and inspiration, and I wish to do so much more than I currently do. It reminded me how much we need to put ourselves out there and be brave. More than that even, it reminded me of how much the work we do is fascinating, and how interesting it would probably be to those that have never traveled in our footsteps. Perhaps even more so after the pandemic. So step up and step out, your audience awaits you!
It’s the 8th March, and we all know what that means…..It’s International Women’s Day!
This year, International Women’s Day is timed pretty wonderfully for me, as it happen to also be just as Healthcare Science Week is about to kick off. As both a woman and a Healthcare Scientist, I thought this was a great opportunity to combine the topics and talk about how these two things have impacted how my science career came about, and why I think a lack of recognition of both has incredibly important impacts on society as a whole. That said, this is also a post about how far we’ve come and the role that female scientific representation in the media has, and can have, on how we feel seen as women in science.
In what feels like a different life, where I was younger and had better hair, I was selected by the Royal Society of Biology to do some filming linked to raising the awareness of women in science. The session is short but was really interesting for me to do as it centered on who inspired me to become a scientist and how it happened. Now, many of you who read this blog will know all about that tale, but for context, I’ve linked to the video below:
The thing is, I suspect that there are still many people out there who might love to do science, and yet they’ve never had the chance to meet a scientist or really learn about the brilliant variability of a career in STEM (science, technology, engineering and maths). So what’s my point? Getting to actually meet and chat with a real scientist still feels like it’s a thing for the privileged few, not something that is available for mass consumption. You know what is available for mass consumption? TV and movies. This blog reaches 20 odd thousand people a year, a single episode of a TV programme, like Holby City, makes those numbers look so small they are not even worth considering. So it matters that the roles of female scientists within movies and on TV have not always been the most representative of either the careers available or the type of people that choose to engage with scientific careers. The reach and expectation setting that the media can have dwarfs any of the best efforts I can make across my entire career. Therefore, in order to celebrate International Women’s Day this year, I thought I would take the opportunity to talk through where we started with some of this representation in TV and the movies, and then celebrate quite how far we have come.
Why is it important to have women in science?
I kind of don’t believe I’m writing this section. This one should be a no brainer and yet I think it’s probably important to take a paragraph, especially with all the current commentary about equality, diversity and inclusion (EDI), to talk about why EDI matters.
The data supports the fact that we are far from a scenario where female representation in the workforce mirrors the distribution of women in the population. Worse than that even, is the fact that even if women make it into STEM careers they are doing less well than their male counterparts, including lack of representation in senior roles and general reduced access to research funding. There will be another post at some point about the source of some of these discrepancies but hint – it’s not because the women are worse at their jobs, that blog is still a little way away however.
One of the reasons for the lack of of women in STEM careers is that, according to work undertaken by Steinke et al in 2007, children are exposed to gender stereotypes and images of scientists through movies, TV shows and books where there is a lack of good representation of female scientists. They undertook work with primary school children where they asked them to draw a scientist, very few children drew female scientists and most listed media as the source of their inspiration. A similar study in Korea, in secondary school children, showed that only 16% of them drew female depictions of scientists. This kind of data backs up why media representation is so important, as you really can’t be what you can’t see. So many children do not realise that a scientific career is even a pathway that is open to them, if they are not fortunate enough to know one. If children can’t access what that career might look like through the information sources they access all the time then they don’t even consider it as an option for them when making their life choices.
But why should we care that we have less women working in science? What kind of difference do they make that we should try to move the dial on this?
Women make up just over 50% of many populations but much of the data produced by scientists, including clinical trial data, is biased towards male datasets. This leads to the outcome data for females often being less good. Some of this is likely due to a lack of female voice in the room when studies were being planned
There is often a research bias, where issues that purely impact women tend be under researched compared to issues that purely impact men
Inclusion of women in tech pipelines has been demonstrated to improved productivity and boost economic outputs
Science should be for everyone and therefore needs to include everyone. Science is best when it is seen through different lenses and priorities which different individuals bring to the table. Variable opinions drive improved change and innovation, so being inclusive is a win win
By increasing female representation in STEM we can switch up our focus from working to increase diversity and spending energy on being visible and role modelling, jobs that are overwhelmingly undertaken by women in STEM fields in addition to their day jobs, and allow women to compete better with their male colleagues by freeing up their time to focus on their science
What kind of representation did I see in the media when I younger?
Having talked about how important exposure to role models in the media are to encouraging women in STEM, I wanted to kick off by talking about the kind of representation I was aware of when younger and making decisions about my career choices. Now, a key disclaimer here, it appears that my teenage years were some horrific length of time ago, even though I’m blatantly still young, spry and filled with youth. Women, especially those in technical roles, often weren’t featured or were there to act as passive objects for men to respond to or act around. They were all too frequently there to be a foil for the men who were the focus of the storytelling. There wasn’t an abundance of female science representation in any of the media that I do remember, but what was present used to focus on 6 key stereotypes:
The Old Maid – the female scientist who is only interested in her work (and therefore not showing that you can be both a scientist and a person) who, as the film/show proceeds, has her female and emotional side brought out by the main male protagonist
The Male Woman – a female scientist who works in an all male environment. She is not as sexual a character as other women in the setting may be, but she is also not on the same level as the men she works with. She is often presented as having unhealthy habits, such as drinking issues, in order to show (it feels to me) that it’s unhealthy to try to be a woman in a mans world
The Naïve Expert – often a character in a film that is critical but does not contribute to any of the science solutions or really advance the story in any way. These often feel like box ticking roles or to aid the exposition of other characters
The Evil Plotter – usually a young and beautiful character who is there to trick the men within the film. They are set up to be hated by the both the other characters and the audience as they use their scientific knowledge and looks for evil. This one again strikes me as a way of demonising women who bring anything other than their knowledge of science and dare to be people with other needs as well
The Daughter/Assistant – this one is the typical smart and capable woman who is there as a subservient to a smarter, more well known, or more significant male character who will be the one to advance and resolve the plot whilst the female is there as a foil to show how smart and capable the male protagonist is
The Lonely Heroine – a woman who is depicted as intelligent and independent, and allowed to also be sexual, but somehow is not able to compete with her male colleagues. Usually, during the course of the story, she is gradually able to be seen and have an impact but only when she develops a relationship with a man who allows her to be acknowledged by others
Now, don’t get me wrong, all media and story telling is based on stereotypes and tropes, almost everything can be fit into a silo. That said, if the stereotype is only there to serve the male protagonists of the tale, that is a problem and it very much felt that way in films and programmes I watched growing up.
Scully effect
So what changed? I remember so clearly my first encounter with the The X-Files. It came out in 1993 (1994 in the UK) and I kind of missed it, but my sister and brother would not shut up about how great it was, so it took a while for this geeky 15 year old to discover Dana Scully and all of the science joy she would bring to me.
For those of you who don’t know anything about The X-Files (and you really should) according to Wikipedia ‘The series revolves around Federal Bureau of Investigation (FBI) Special AgentsFox Mulder (David Duchovny) and Dana Scully (Gillian Anderson), who investigate the eponymous “X-Files“: marginalized, unsolved cases involving paranormal phenomena. Mulder is a skilled criminal profiler, an ardent supernaturalist, and a conspiracy theorist who believes in the existence of the paranormal, whereas Scully is a medical doctor and skeptic who has been assigned to scientifically analyze Mulder’s case files.’ The reason that this series made such a difference for me, was because it was the first time that I saw a fully rounded female STEM character who was a person, with interests outside of her job, who was also an equal player in the story and able to challenge and lead within the series framework. She was more than just a foil, or a tool for exposition, and the number of times she was the one that did the saving became somewhat of a running joke.
It wasn’t just me that the character of Dana Scully had an impact on, her character led to what has been described as the Scully Effect. The Scully Effect refers to the phenomenon where women were inspired to pursue careers in STEM after watching The X-Files. This was the first time I think I really became aware of the power of the media to impact in more than a superficial way. The impression of this effect has been upheld by a recent study to try and capture some of the way that the Scully Effect impacted on those who watched the show, so you don’t just have to take my word for it.
There is no doubt that the role of Scully in The X-Files felt like a watershed moment for featuring women in STEM careers. Having just talked about the difference that Special Agent (Dr) Dana Scully made in terms of female representation in science I’m now going to excluding medics from the rest of this discussion as a) they are featured much more frequently in all forms of media and b) the lack of female scientific representation is one of the reasons that students see medicine as the only route open to them, rather than seeing the world of opportunities available within the world of science careers. (I still love you Dana, you’re still my girl)
So where did the change in TV go from there? Now, there are a few honorable mentions I’d like to give a shout out to, these are obviously based on my person taste, but I do think they are examples where things have continued to change for the better:
Bones is a police procedural linked to investigations of human remains undertaken by Professor Temperance “Bones” Brennan (Emily Deschanel), who is a forensic anthropologist, supported by FBI Special Agent Seeley Booth (David Boreanaz). Now, in many ways Bones fulfills many of the Old Maid stereotypes, but there are many key differences. For one, her intelligence is always held up as a positive and with high regard, and she is considered to be so valuable that her challenges with more emotional interactions are considered to be over whelmed by the value her intellect brings, which is quite a different take. Secondly, her emotional journey is mostly chaperoned by another female character in the show, Angela Montenegro, rather than relying on a male character for their character development (yes, yes, I know her and Booth get together but I’ll die on the hill that it’s secondary to Angela). Finally, and maybe most importantly, the character of Bones is very clearly signposted as being based on a real person, Kathy Reichs, who was also involved in making the show. As I said, representation is important and the fact that this clearly shows that you can be a successful scientist, and perhaps even close the circle and be inspiring enough to have a TV series based on you to inspire more young people, is a massive step forward.
Kathy Reichs
Two other TV science representations I love come from other police procedural or fantasy series, both are lab guys, all of which probably tells you a lot about who I am. These guys both speak to my heart as they are fully formed characters, not just single dimension caricatures of female scientists. They have flaws, they have passions, they are authentic, and most of all they love the science that is their calling. (this isn’t to say that science has to be your calling for it to be your job, I just love that there are representations of scientists on TV who love science the way I love science)
First, I’m kicking off with Abby Sciuto from NCIS. She’s a forensic scientist, who in that TV way has a world of completely different science skills rolled into one, but I still love that about her as she exhibits so much scientific curiosity. As an ex goth myself, one of the other things I love about her is her sense of self expression and not being limited or making herself smaller on the basis of what others think about her. She the opposite of those female scientific characters who rely on others to enable them to be people rather than lab coats. I fully respect and am so happy to see this kind of female science representation.
Second, is Ella Lopez from the TV series Lucifer, a TV series based on a comic where Lucifer, as the devil, abandons Hell to run a nightclub in Los Angeles. He then (for plot reasons) becomes a consultant to the LAPD and hi-jinks ensue. She’s also a forensic scientist who works for the LAPD, are you sensing a theme? I don’t know whether this is because of the kind of series I like, or whether the writers of these kind of series just feel like they have more time and scope to devout to full character representation. The reason I love Ella is that she is the complete opposite of the Old Maid/Male Woman stereotype. She is the emotional heart of most scenes, and is accepted for bring her full emotional quirky self to the table. As someone who often feels judged for wearing her heart on her sleeve, I love this is represented as a strength in this characterisation of a female scientist.
Let’s talk movies?
So what about the movies? In some ways female scientific representation is always slightly more challenging in films. Slightly due to the nature of the medium, there is often less opportunity for character development (as you have a few hours vs multiple episodes) and so they still tend to fall very much into some of the stereotypes already discussed. There is still a strong tendency for strong female characters, when present, to still fulfill the Evil Plotter stereotype, and the film industry in general struggles to have female roles that are not reliant on male roles for context. That doesn’t mean there are not plenty of films despite this that have female characters I enjoy (Jurassic Park and Contact being just 2 on the left of the image below).
In terms of movies I want to discuss though, let’s start with the one on the right, Dr Elizabeth Shaw from Prometheus (2012). Those of you who read my Halloween blog on how the Alien movies reflect the world of Infection Prevention and Control, will already know how much I like this film series. One of the reasons the series appeals to me in general is that it doesn’t shy away from strong female lead characters, it started with Ripley after all. The female lone survivor trope is strong with this series, but I also like it when characters like Elizabeth are the ones that survive because they don’t shy away from their intellect and aren’t scared to be the smartest person in the room. Too often we hide away from owning our space as women, and I love a film where the characters are given license to own their space.
Talking about films where women are given permission to own their space, this next one is based on historical figures. My favourite female scientist movie of all time is hands down Hidden Figures, which came out in 2016. This film is loosely based on the non-fiction book by Margot Lee Shetterly and is about three female African-American mathematicians: Katherine Goble Johnson (Taraji P. Henson), Dorothy Vaughan (Octavia Spencer), and Mary Jackson (Janelle Monáe), who worked at NASA during the Space Race. If you haven’t seen this film I cannot recommend it enough. When I have bad weeks this film reminds me of the fights that others have fought just so I can occupy the space that I’m in, and the continued need to be that fight for the generation that will follow me. It’s about so much more than female representation, some of the challenges that these women faced due to the colour of their skin is mind blowing to someone growing up in the UK, not to say that there are not ongoing diversity and inclusion issues here. This film to me is everything that science representation on the big screen should be, and it’s just a pity that there aren’t as many examples as can be found on the small screen.
All hail Marvel
All this brings me to the one place that I feel consistently hits it out the park for me in terms of both female character representation and in showing scientists as real three dimensional people, Marvel (both Marvel Cinematic Universe and Marvel Studios). Personal opinion, but I feel like Marvel have done more for showing women who are scientists and characters in their own right than most other genre series, an irony I am aware of for a series based on comic book characters. This is probably made possible because they can draw on character development from so many decades of story lines in order to make it work.
My all time favourite is Dr Jemma Simmons from the Agents of SHIELD series, but that could be because you are able to get to know the character over 7 seasons. Film wise, I really love Dr Jane Foster from the Thor series. Previously my all time favourite film science character was Shuri from the first Black Panther series, I’m pretty conflicted about this now however due to some of the anti science opinions held by the actress.
There are frequently great scientific characters embedded across all parts of the Marvel universe ,however, and so I encourage you to find your own favourites. To help I’ve listed some of the big hitters, in terms of main characters, below.
Thor film series with Dr Jane Foster
Agents of S.H.I.E.L.D. TV series with Dr Jane Simmons
Ant-Man (and the Wasp) film series Dr Hope van Dyne (and Janet van Dyne)
Doctor Strange film series Ms Christine Palmer
Spider-Man film series (not actual scientists as too young to have careers but….) Mary Jane Watson
Black Panther film series Shuri
Captain Marvel film Dr Wendy Lawson
Eternals film, possibly all of the film characters as they are after all eternal
Another thing that I appreciate about the Marvel films is that even when a character is not present, due to them being part of another story stream, they often reference the absent character, and not just in a way that talks about their positioning linked just to a romantic other. One of my favourite examples of this is below, from Age of Ultron, and is part of a conversation about why Pepper Potts and Jane Foster are not at a party. The dialogue goes like this:
Avengers: Age of Ultron (2015)
If you are looking for something you can watch with your family, that will hopefully inspire the next generation of scientists, and help ensure that the next time a child is asked to draw a picture of one they may choose to draw a woman instead, this is a great place to start.
I feel we’ve come such a long way in terms of female scientific representation in the media, but there is so much more that needs to happen. We can all work to drive this by being aware of the films we choose to watch and where we decide to spend our money. Those of us working in science can also do a lot to make sure that we take opportunities presented to us that mean we will be seen, and hopefully inspire those who will follow us. Let’s embrace the moment, step out from the shadows, and truly show why having women in the scientific space is crucial for the best science to occur.
Thank you for taking some time out of your day to share International Women’s Day with me!
I’ve been finding myself in a bit of a hole recently where my first response to anything, and the first words out of my mouth, are always an instinctive ‘I’m sorry’. Whether I have done something wrong or not, whether someone is accusing me of something or not, I just can’t get the words ‘I’m sorry’ not to be the first ones that immediately leap to my lips. Now, owning when you need to apologise is a really important thing. The thing is, that there are a lot of consequences to unnecessary and anxious apologising that I don’t think we necessarily recognise. After all, what does it matter if we say sorry too much? No one is hurt by the words ‘I’m sorry’. Is that true though? After a particularly anxious weekend last week I spent some time thinking about how apologising too much can actually be a leadership issue, and what steps you can take to reduce the downsides if this is something you are impacted by, like me.
It can make you come across as weak
Leadership can be challenging at the best of times, but in a resource limited setting with competing pressures, it can feel more challenging than ever. Those you are leading need to feel secure in your direction of travel and protected in your leadership.
Despite authenticity being important, being an anxious apologiser can come over as weakness and something that can be exploited by others. It can come over as not owning your time, boundaries, responsibilities, or actions. Worse than that, it can also make those you lead feel more uncertain, depending on the context of the apology. Owning up to mistakes and proportionate apologies are great, inappropriate ones, very much less so.
Makes setting boundaries more challenging
One of the things that I am super aware of is that my anxious apologies make boundary setting less easy. I am allowed to take time off sick or to be on holiday, I should not feel the need to apologise for it. Doing so makes others feel less able to also take the time they are owed. I am an emotional person. I wear my heart on my sleeve. In many ways, I believe that makes me a better leader. I, therefore, need to stop apologising for trying to be myself rather than attempting to fit some predetermined mould. If I don’t feel I can be authentic, it makes me a lesser leader and means others will also feel like they need to hide who they are.
You may accept culpability even when you don’t
Another thing about anxious apologise is that your immediate response can end up making it look like you are taking responsibility for something which you actually aren’t. A recurrent example of this one, for me, is when someone takes action and ignores advice/guidance, and I end up apologising for not providing sufficient clarity. In reality, it was up to the individual to seek additional clarity if required, not for me to be psychic and try to predict their actions. Just one example of an easy trap to fall into.
It can make genuine apologies feel less authentic
This is a big one for me. If you apologise all the time, as an auto response, it can make those moments when you choose to do so consciously feel like it has less impact for the person receiving it. Making sure those moments where you need to own your actions and learning are undertaken with sufficient thoroughness helps, but avoiding using apologies as punctuation is a longer-term change.
You may end being annoying to be around
Speaking as someone who does this a lot, I hear from many of my friends just how annoying it is. A favourite quote of Mr Girlymicro to me when I get in a particular space where I constantly need to be told it’s OK is ‘stop apologising, it’s a sign of weakness’ from the film Little Miss Sunshine. It makes me laugh every time and reminds me of how much the required back and forth is an energy drain on everyone involved. Take a deep breath and step away from the spiral, and acknowledge the costs you are placing in others.
May make your leadership confusing
Another way that anxious apologies can make your leadership confusing it that they can work to actively derail trains of thought. They can end up de-railing conversations, so they become all about a single thing rather than the original focus of the discussion. They can make your communication less clear and end up meaning that key points are obscured, or worst of all, forgotten by all involved. As clear communication is a key foundation of good leadership, this is good for no one.
Conversations that are not about you can pivot
I had a moment last week when I got hit from out of the blue with an emotional response to a conversation. This meant that a conversation that should have been about me offering support, guidance, and clarity, became all about the people involved comforting me. This is a disastrous thing to have happen. My immediate response is then to apologise more for letting it occur, but this then drives the cycle. Stepping away from it. Knowing you should do better and reflecting with yourself why it occurred is the only real remedy you can offer.
So, how can we do things differently?
Acknowledging that this is not a healthy habit or coping strategy is a start, but what we actually do about it in order to do it less or limit the impacts on our leadership?
Listen to your frequency
One of the primary actions is to be aware of the frequency of your anxious apologies. For me, at least, this isn’t an always-on/always-off thing. It comes in waves depending on other things that are happening and my general levels of anxiety or confidence dips. Knowing when you are going through a bad patch enables you to focus some resource on reduction, especially in risky or high stakes moments. Doing the constant apologising at home may be annoying. Doing it in the wrong situation at work could have much bigger consequences.
Be aware, especially during high stakes moments
There are moments, for both you and your leadership, where being perceived as weak or accepting ownership when you don’t, can have significant impacts. In these moments it’s crucial to be aware of where your head is at and your tendency to undertake this behaviour. These high stakes moments tend to also be high risk moments, so if you apologise as a stress response, you are even more likely to fall into an apology during these encounters.
In order to help with this, one of the main things I try to do is just take a beat before I open my mouth. Those of you who know me probably know this isn’t my strongest skill. Mouth open, should be shut. At times like these, though, it is so important. That breath allows me to sense check my response and remove the work ‘sorry’ from my automatic vocabulary. It allows me a moment to try and re-phrase my immediate thoughts or dialogue to make it more in line with my core meaning. It helps me avoid throwing myself and others into an unnecessary bear pit.
Don’t let others take advantage
It is also worth remembering that it is not just you that notices this behaviour. In the past I had a colleague, who was perhaps not my biggest fan, who I realise in hind sight would almost set me up in scenarios to take advantage of my tendency to accept responsibility readily. If your apologies do come across as a sign of weakness, and you work in a high competition environment, then this is a risk. Taking time to understand how others respond to your anxiety trait (irritated, sympathetic, exploitative, etc) is an important part of learning how to manage your own behaviour. Know when to bite your tongue and stay silent despite all of your instincts telling you otherwise.
Try to embed change
One of the easiest ways (although still far from easy) to manage this tendency is to try to find other ways to respond. Ways that still allow you to feel you have responded but that are less likely to be interpreted as you taking ownership all the time. Embedding these changes consistently, even if you are going through a particularly bad spell, can make it easier. Language is a learnt response, and much of it is based on habit. Getting into a space where you only apologise consciously for things that actually require it is a habit worth gaining.
I’m still not good at this. I think it’s an area of constant improvement. I have found it is easier to try and embed this shift in written communication first, and then it comes a little easier with verbal reinforcement later. Just take it one conversation at a time and see what works best for you.
Find trusted friends
For me, one of the best ways I have to manage this is to find my people, my trusted friends. There are two main reasons for this. One, Mr Girlymicro loves me enough to cope with me apologising, me talking about apologising, and me agonising about whether I need to apologise, for the hours it sometimes takes to get me to work through what is going on, and to then move past it. I also have some key people in my life who I know I can text and be ‘this happened, do I need to worry’, and who I 100% trust in their response to guide my actions. The second area where I find these people really useful in my life is that they will flag to me, when I lack the self awareness to notice, when I’m starting to increase my anxious apologising, so that I can be more aware of my own emotional state and the impact it is having. Knowing that others have your back, and can support you, even when you are not aware that you need support, is a real gift in this life and if you have access to those people make sure you hear what they have to say.
Be OK with not always getting it right
You are not going to get this right all the time. There are times in my life when I don’t manage to get it right even most of the time. Treat yourself with the grace that you would give to others. Anxious apologising is driven by, guess what, anxiety. Don’t drive your anxiety further by diving deeper into the rabbit hole and stressing about things you can’t control. It happened. You may be able to fix it, you may not. Nothing is to be gained by stressing about it, and the best cure for some of that anxiety is to take action if you calmly decide there is an action to be taken. The irony of me writing these words is in no way lost on me, as I can never stop the resulting panic, that doesn’t mean that the logical part of my brain does not acknowledge that it is the right move however. Try choosing grace over guilt whenever possible, as you will be a better person as a result.
Invest your energy based on circumstance
Having acknowledged that you won’t get it right all the time, a key thing is to know when you MUST get it right, or when to invest energy in order to bring your best self. We’ve talked about being aware of your high risk moments, and if you only have a certain level of energy resource to invest, then this is where to choose to spend what you have. When I’m working through a significant anxious period I can’t keep it together at all times, I just don’t have that level of cognitive resource. I have to have my safe people who I can spend time with, so I have periods where I can just let myself be and work through how I’m feeling. I also tend to stay away from people or situations who I don’t need to interact with at that time and tend to make me feel less safe/triggered, in order to not fuel the situation I find myself in. No matter what is going on, trying to be self aware enough that you make good decisions to help yourself through is definitely worth the resource requirement.
Don’t forget to deal with the underlying drivers
At the end of the day, however, it’s important to remember that anxious apologising is a symptom and not the cause. It’s really easy to focus on the symptom that is taking up you energy and cognitive space, when really we need to be stepping back and seeing what is driving the current situation. In my case, it’s often when I’ve not recognised that my health is not great and anxiety is often secondary to flares, lack of sleep and generalised discomfort. That said, I am also of an age where being peri-menopausal is definitely a thing, and my hormones are definitely writing their own story right now, with little input from me. Whatever the reason, making sure that you try to understand what is driving you means that you can start to focus on the root cause of the problem, not just react to the moment, giving you both actionable intel and hopefully a way out of the way you are feeling. None of this stuff is easy, but know that you are not alone in managing it or finding a way forward. If you need one, I’m always happy to be your safe space.
With the news of the Oscar nominations for Wicked Part 1 coming out, I thought it was finally time to dust off this post that has been languishing in draft for over a year. I guess it will surprise none of you dear readers, that I am something of a musicals fan and Wicked is one of my favourites. I saw it for the first time on honeymoon in New York with Mr Girlymicro and knew very little about it going in. Whilst watching it, the song Popular rapidly became one of mine and Mr Girlymicro’s favourite tunes (alongside What Is This Feeling?).
The words have always triggered something in me in terms of thinking about leadership, especially the line ‘It’s not about aptitude, it’s the way you’re viewed’. With everything going on in the world right now, it feels like a really important concept to explore. Is leadership all just really all about being popular? And what does that actually mean?
When I see depressing creatures With unprepossessing features I remind them on their own behalf To think of Celebrated heads of state Or specially great communicators! Did they have brains or knowledge? Don’t make me laugh! They were popular! Please! It’s all about popular It’s not about aptitude It’s the way you’re viewed So it’s very shrewd to be Very very popular Like me!
What’s makes someone popular?
I’d like to start this by saying that I don’t really think I would know what makes someone popular from first principles. If I was in a 90s school based movie, like Mean Girls or Clueless, I would definitely be the girl who hides out in the library rather than being an IT girl or one of the popular kids. So, I’m probably not coming from a position of expertise on this one. I have however put those library skills to use and come up with this from those with greater expertise:
This popularity doesn’t just impact how we interact with others, it also impacts how we are treated, opportunities that we are offered, and helps reduce negative emotions linked to social rejection. This may seem self evident but it is also backed up by research with one study defining popularity as ‘generally accepted by one’s peers’.
How we are perceived by others can, therefore, definitely impact on our working lives and likability, or popularity. Whilst how we are liked one on one is referred to as inter-personality, popularity is determined at the group, rather than the individual level, and is related to a person’s ability to make others feel valued, included, and happy on a more general level. The question is………is all popularity therefore about making others happy, and is leadership therefore all about attempting to make the most people happy in the widest possible way? Does getting ahead professionally mean that you need to be part of the ‘in crowd’ in order to succeed.
Is it all about people pleasing?
If you’ve seen Wicked, there is a great scene where The Wizard talks about how he wants to be seen. A lot of the plot across the entire musical is about superficial appearances rather than the ‘truth’. A lot of sub-par decision making within the plot is hidden behind the mask of popularity, and poor leadership is permitted because of the wide spread popularity of those making the choices.
I’ve written previously about the challenges of being a people pleaser and how it is impossible to please everyone. One of the challenges, in terms of leadership, is that if popularity is considered to be the way forward, in terms of being a good leader, you will be forced to chase good opinion rather than focusing on strategic or other vision. It also inevitably leads to your leadership being less and less authentic as you try to follow, not your central ethos, but a diluted version based on the perceived views of others.
What are the advantages of being civil?
So am I saying that it is not necessary to be nice? Just being ‘nice’ is often considered to actually be a disadvantage within work place settings, it is often good for making friends in a 1:1 setting, but as I’ve said popularity is determined on the group rather than the individual level. Within this context being nice or perceived as ‘warm’ can actually have a negative impact on careers, as warmth is often considered to be inversely associated with competence i.e. you can’t be nice and good at your job. According to Porath (2015), being seen as considerate may actually be hazardous to your self-esteem, goal achievement, influence, career, and income. So being nice alone is not enough. What does allow the switch from nice to being popular?
According to the same paper by Porath, it is about not being considered nice, but is actually linked to respect, and in this context civility, which comprises of both warmth and perceived competence:
“Civility is unique–—it leads people to evaluate you as both warm and competent. Typically, people tend to infer that a strength in one implies a weakness of the other. Many people are seen as competent but cold: He’s really smart . . . but employees will hate working for him. Or as warm but incompetent: She’s friendly . . . but probably is not smart. Being respectful ushers in admiration–—you make another person feel valued and cared for (warm), but also signal that you are capable (competent) to assist them in the future.”
Civility, in this professional context, demonstrates benefits that being nice alone does not, especially in the context of leadership, where those who reported feeling respected by their leader reported 89% greater enjoyment in their work and 92% more focus. So maybe less about pop…u…lar and more about civ…..ili….ty? Or maybe they are one and the same thing?
I do have quite a significant word of warning linked to this linking however and that is, is the ability to be civil linked to privilege? If being considered civil, and gaining the associated advantages, linked to not having to fight or voice unpopular opinions? Anything that requires warmth as part of the algorithm risks benefiting those who are in a position where they can court popular support, rather than feeling like they need to make a stand. Having the energy and resources to be able to invest in being seen as civil is in-itself linked to privilege. If you are working part time or under resourced, you are unlikely to have the time resource to invest in some of the relationship building needed to be identified as both warm and competent. There are also people who believe that they cannot invest because of the risks to their careers in coming off as warm without the associated benefits of being seen as competent. The costs in terms of income or self esteem are not ones that everyone can risk in case it goes wrong.
Is civility just another way of benefiting those already in positions of seniority?
Is it therefore that civility, and it’s associated popularity, are just another route that benefits those that are already in a position of privilege. Is popularity linked to status? Traditionally status is based on attention, power, influence, and visibility, rather than acceptance from peers, and so popularity may be more significant in informal vs formal leadership settings. This isn’t saying that senior leaders shouldn’t be civil, and that they shouldn’t come across as warm. It does mean that they are probably at lesser risk from the disadvantages and risks once they are in a formal leadership position, where they are able to draw upon different markers of power and visibility to gain influence. This can give the false impression that you need to be popular in order to be a senior leader, whereas the reality may be that you can afford to be popular as a senior leader as you are less at risk of any of the negative consequences of you only being viewed as part of the equation.
What is the difference between being nice and being kind?
So, I’ve talked about being nice as not always a risk free move in terms of career progression, but what about kindness? I’m a massive advocate of kindness, but sometimes I wonder if people have the same understanding of the term as I do or whether they use it as a proxy marker for other things. For instance, we often talk about kindness and niceness as if they are interchangeable, but I’ve been wondering if the difference between the 2 is where the perception of warmth vs civility (combined warmth plus competence) actually sits.
I have certainly met people who believe that being kind and supportive means always being in agreement or always saying yes, whereas I believe that this is more acting from a position of people pleasing and being nice. In contrast I believe that sometimes the kindest thing that you can do is to say no, either because you’re not in a position to deliver what they want or that saying yes would put the other person in a challenging position. Nice can often feel right in the moment, whereas kind considers the wider, and sometimes longer term, implications.
How do we manage kindness in a way that is authentic?
Being kind can be challenging as it is not always about taking the easy route, sometimes it’s about making hard choices in order to help yourself, others or the organisation, to be the best version of itself. It can challenge some of the behaviours linked to people pleasing in order to move towards authenticity in terms of interactions and leadership. For me, kindness is very much about doing the right thing instead of the easy thing, but to really deliver on your values, you need to invest the time to understand what those values are first. What do we stand for? What three words would we assign to our core descriptors of self? Knowing what your core values are enables you to have a self check benchmark to help identify when we are being nice over kind.
Where does social capital fit in here?
Obviously, civility and kindness are not the only factors that come into play in the ‘popular’ discussion. There are all kinds of other forms of social capital that can impact on how successful we are at network building, influencing and leadership. Especially in the world of science and healthcare, expertise comes into play quite significantly, and access to funding can never be under estimated, in terms of providing leverage and empowerment.
It is always worth being aware of, and investing in, all of these different strands for long term success. Having said that, all of these also require you to have the capacity to invest. As someone who can’t have children, and therefore have greater freedom to balance my work and home life, I’m aware that I probably wouldn’t have been able to build a clinical academic career if my life had been different. If I’d had to leave on time for school pick up or had to be lead carer on the weekends, I wouldn’t have been able to publish the papers or apply for the grants required. There is inbuilt privilege in my being able to prioritise my career at times. This blog requires hours every week. Hours that I enjoy investing and which I reap the benefits of in terms of networks and connections. These are things that I wouldn’t be able to do if I needed to pick up a second job or was caring for a parent. When we ask people to have these additional pieces of capital to progress, we need to be aware that we are putting barriers in place so that not everyone can make the most opportunities. We need to make the most of the tools we have available to us, but as leaders, we also need to understand how to support people to access opportunities in a way that doesn’t disadvantage them in relation to others.
Let’s not forget that leadership is hard
I think that one of the things that it is often easy to forget is that leadership is hard, in some ways, if it’s easy you probably aren’t doing it right or stretching yourself enough. Part of leadership is making the unpopular and challenging decisions, and sometimes there are no win wins. Being popular, being considered empathetic is always a nice thing but it is not the only thing that makes your leadership successful. So is it, in the end, actually all about popular? If you were to ask me it is instead all about authenticity. The key thing, from my perspective, is to let people know who you are, connect with people as much as possible and share/co-create the vision. Then they can make informed decisions about whether to get on board the Girlymicro train or not! On this one, I may be with Elphaba.
It’s been a tricky few weeks health wise, hence the lack of posts. I managed to come down with Norovirus, after writing a blog post about how much of it was out there. Post infection it sparked a whole world of inflammatory cascade symptoms that definitely did not bring me joy. I then followed it up by passing it onto Mr Girlymicro, who really wishes I’d stop bringing my work interests home with me.
All of this meant that I ended up having to take 3 days off work sick. During this time and for the week after, whilst feeling still pretty wiped out, every single little word in any messages from work, or even a lack of any, led me into a spin. Were people angry because I was off? Had I messed anything up that people were now having to fix? Was I being judged for not being on full form? The levels of anxiety that being away induced were so high, but let’s face it, in reality no one was really thinking about me.
Now I’m feeling better I am so aware of the fact that everyone was just focused on getting through their own days, dealing with their own challenges. My ability to rationalise and manage my perceptions were just highly impacted in those moments, and I lost the ability to remember that the Spotlight Effect is a thing. In light of this, and having just ridden the roller coaster of forgetting how this can impact, I thought it was worth taking some time to talk about the Spotlight Effect and its possible real world impacts on our leadership and decision making.
What is the Spotlight Effect?
We are the lead in our own dramas. By definition we should have ‘main character energy’. Being focused on self is therefore understandable. We are programmed to be the center of our own universe. It does need to be acknowledged, however, that this very positioning can bring with it a biased world view and set of perceptions.
Due to this natural tendency to be self centered we tend to interpret our worlds through the lens of ‘self’. We interpret communication and interactions with other people in a way that up playing up our importance in their worlds and down playing their own real life demands on how they interact with us. This is known at the Spotlight Effect.
This happens in positive situations, where we believe that colleagues may be more impressed by things that mean a lot to us, or over estimating relationships and the amount of influence we may have. The inverse is also true in terms of negative situations, where we believe that our failures or mess ups are noticed by others way more than they really are.
What does it mean for how you see the world?
This tendency to over estimate how much others notice or are impacted by us can really impact how we see the world. It means that we can end up agonising over an off hand comment, believing that we have offended or pitched something incorrectly, when the other person has not even noticed that the moment happened. I’ve written previously about how much I can spiral, and there is no doubt that the Spotlight Effect can mean that I spiral, wasting time and energy on something that is objectively not real. Wasting energy and focus on things that aren’t real means we can miss the real opportunities for change and learning in our lives, as well as meaning we are less able to live in the moment and really appreciate the good things we have going on. Plus, let’s be honest, the stuff is exhausting and I don’t know about you, but I don’t have energy to waste right now.
What does it mean for our interactions with others?
It isn’t just spiraling and anxiety that can result as a consequence of mis-interpretation of social cues linked to the Spotlight Effect. It can actively impact how we engage with our daily lives and relationships. It may mean that we avoid others unnecessarily, as we are keen to not have to deal with the imagined slight we caused. It may also mean that we hinder relationships by talking too much about our lives and our successes, and therefore fail to demonstrate enough interest in the lives of other people. Being unaware of how this ego centric approach can impact not just ourselves but others can mean that connections are driven towards the superficial, and that our ability to lead and influence is negatively impacted.
How does it impact bad days?
There are some really concrete ways that the Spotlight Effect impacts me. For instance, I should probably have taken the whole week off work as I was in a really bad state. Instead, due to the fear of phantom errors and fictional judgement I made myself go back early, thus continuing to drive the issue. There are definitely other ways that this phenomenon impacts me in general life, if sense checking doesn’t occur. I have a tendency to hide and withdraw from interactions, as I fear judgement. It’s easy for me to assume that someone being quiet or not interacting with me is because I’ve offended them or done something, when in reality they are just busy with their own lives, and if I reached out everything would just be as it always was.
It can also impact on how I handle conflict, partly because I will usually have played out all of the different conversations in my head beforehand, and yet somehow expect the other person to have been part of those imaginary conversations. This can, if unchecked, mean that my actions can cause conflict resolution to not go the way I’d hoped because I’m listening to social cues in my head instead of the ones that are present in front of me.
How does it impact good days?
You would have thought that the Spotlight Effect would have it’s biggest impact on bad days and when you were already feeling anxious. I think the truth may be that actually the most damage can be done, if not aware, when things are going well. It can mean that just because life is going well for us, we assume that a) everyone else recognises and is similarly pleased for us and b) that life is the same for those around us, with everyone experiencing contentment.
In reality, this may lead us to not hear clearly enough what others have to say or think. We may miss clues that would have enabled us to understand challenges and anxiety in others. Thus losing the opportunity to address issues early. It can also mean that we feel over looked, as our accomplishments feel like they should be obvious to others, when in reality we just have assumed that everyone is paying as much attention to our careers as we do, which is obviously not the truth.
When does it mean for your leadership?
How we communicate as leaders and decision makers is always important. Understanding how that communication is going to be received and processed, not just based on our intent, is a crucial factor that we often forget to evaluate as we focus so much on the message itself. The Spotlight Effect means that we need to think about how others receive the message, both when things are going well and when the individual may be in a more anxious state. In order to do this effectively, timing, word choice and content are all key. Choosing words that are unambiguous and judgement free is important. Taking time to explain decision making, so that individuals don’t feel like they are over looked, unrecognised, or punished, can avoid mis-understandings. Reading your audience, so you are having the communication at a time when people are able to engage with it, can also be crucial.
When individuals are interacting and responding to us, we should be cognisant of how their current thought processes are influencing how they react. It is critical to not fall into spotlight behaviours ourselves, and therefore focus on really listening to responses and actively checking on our perception of what it is that we are being told. Sub-text is key, especially if others feel like they aren’t in a position where they can be heard.
What can it mean for your well-being?
Like many moments in life, self awareness is key. Understanding and questioning how your perception of situations and your sense of self is driving your behaviour is critical to trying to make the best decisions for yourself, both personally and professionally. I think I’ve covered in this post that I am far from perfect in this regard. I can often recognise that my perceptions are skewed but cannot always enable the next step of putting that to one side and so still feel the resulting anxiety and other effects. The thing that I can usually manage, is to be aware enough that I don’t make decisions or actions on the basis of what I know is inefficient thought processes.
As well as being aware of your thought processes it is also worth being aware of your areas of focus. Are you spending a lot of time placing resource into any one thing? Is this use of resource appropriate or is it due to obsessive or faulty thinking? It’s easy to get drawn into something without realising how much energy it’s taking or quite how far down the rabbit hole you’ve travelled. A level of self-check in terms of being conscious about where you’re investing your focus and energy can save you from wasting what resources you have on a problem that may not be as you perceive.
None of us get this right all the time. When you find yourself realising you’re staring into the glare of the spotlight and all that comes with it, the most important thing is to give yourself a break by being kind to yourself. We all have moments where we’ve mis-read situations, been deaf to the commentary of others, or reacted based on an ego centric focus. It happens. The key things are the actions we take as a result of the realisation of the bias we’ve engaged with and how we develop the self awareness to do better next time. Accepting that the lessons learnt are the most constructive way forward, rather than wasting more energy on self recrimination.
How do we sense check?
Knowing that we are unreliable witnesses to our own lives can offer a major step forward in being able to improve our insight into the reality of our situations, rather than interpreting it so strongly through our own glasses, be they rose or darkly tainted. I find there are three key moments when active engagement with self reflection is key in order to try to reduce ego centric bias from my thinking:
Checking expectations
Checking perception
Checking responses
Having clear stop and reflect moments at these key points can help reduce the Spotlight Effect, but also enable me to realise when I’ve already veered into spotlight territory to support me in trying to step out of the glare. I would also flag here, not to under estimate how much other people can help with these moments of reflection. I drive Mr and Mummy Girlymicro crazy with my constant need to talk through my thought processes, especially when I’m struggling to gain clarity or re-frame my thinking from a less ‘me’ focus. Having those trusted companions who can assist, and if needed call you out on your ego centrism, for me, is just an important thing in all aspects of my life.
How can understanding lead to better conversations?
One of the major interventions we can build into our interactions in order to prevent the Spotlight Effect impacting our leadership and decision making is trying to ensure that we have better conversations, in order to understand the drivers of others and embed their life experience in our relationship building and social interactions. So how do we have better conversations? How do we ask better questions that enable us to engage better in order to truly be interested rather than trying to be interesting. The main switch is to the use of open ended questions so our conversations can be driven by curiosity, not by the need to re-enforce concepts we already hold.
Focus on the use of questions that start with:
How?
What?
Why?
You can even frame questions by saying ‘tell me about’ or ‘describe’. By actively listening to the responses and following up with appropriate further open questions based on the answers, you can build both a deeper understanding and trust.
Embedding curiosity at the heart of our leadership leads to unexpected insights and outcomes that you couldn’t achieve alone. So, whenever you find yourself too focused on how you believe the path should be walked, phone a friend and ensure that you step out of the spotlight in order to see what different routes may be available in order to move forward in ways that benefit everyone involved. Only then can we demonstrate leadership which aspires to help everyone, rather than choosing pathways that benefit us alone.
Buckle up, this is a long one, but I hope you’ll enjoy reading it as much as I enjoyed writing it.
Many moons ago, I did an A-level in psychology. I enjoyed it so much that I even took some modules during my degree. During my A-levels, I still remember how much I enjoyed the section on group decision making and the different roles that both exist and can influence. During my degree, some of my favourite parts were linked to evolutionary psychology but also game theory and how mathematics and behaviour combine to impact how we should make decisions.
Now, many of you will know that I am a gamer and love all things from board and computer games through to tabletop role playing and free forming.
N.B. Some of you might not know what free forming is, so a quick description is that it is like the murder mystery games you can play, unscripted, but generally much more in depth. I like to think writing them is like writing a novel, but each character only gets their bit
Over the years I’ve had plenty of time to both write and play around within the free forming space using influencing/manipulations linked to group decision making but low and behold watching The Traitors is like all my experiments rolled into one and I LOVE IT!
What is The Traitors anyway?
For those who have managed to avoid getting hooked, first of all, congratulations, as I watch not just the British but also the overseas versions and just can’t help but get sucked in. But what is it? Launched in 2022 and is presented by Claudia Winkleman, it is a TV series where the aim of the game is to find the murderous Traitors in your group before they kill you all. Have any of you played the game Werewolf, either old school or the newer card game? At its very core, The Traitors is like werewolf with the option of extra wolves and the addition of afternoon tea.
There have now been three UK seasons, and for context, I’ve included the trailer for season one below:
The structure goes something like this. Between 20 and 25 people arrive at a pretty glorious castle in the Highlands. On arrival they spend a day getting to know each other. That evening, they meet for a gathering around a ’round table’. Whilst blind folded, at that meeting, the Traitors (usually three) are chosen, and the game then begins. The rest of the players become what is known as Faithfuls. During the days, the group then as a whole compete to add money to the prize fund which will be won at the end of the game, and at night, the Faithfuls try to find the traitors by banishing a person they believe is part of the Traitors group. If there are any traitors left after the banishment phase, the traitors choose one person to murder. Everyone meets for breakfast the next day and finds out who is left, and the cycle begins again.
Over the next few weeks, the numbers are whittled down until there are a handful (5 ish) left. The game ends at the point the group banishes all the people they believe are traitors until there are only those perceived as Faithfuls left. They can choose to end the game at any point once down to these last few, but if, when they choose to end the game, there are any traitors left in the group, the Faithfuls leave with nothing and any Traitors split the remaining money between them.
There are only two ways to leave the show
Banishment
Murder
Both are based on some form of group decision making. Over the course of the game, banishment starts with a large group of poorly linked individuals and progresses to a small group of highly linked individuals in a competitive space. Whilst decisions about murder are made in a small group based on trust and risk based decision making. The dynamics of both can, therefore, change over time. To understand the challenges behind these decisions, it is key to understand that group decision making can be more nuanced and complex than it may initially appears.
Let’s talk group decision making
Two heads are better than one…..right? The basic principle of why we should use groups to make decisions is that a group will make better decisions over time than an individual alone, especially during complex decision making.
There are a number of steps that can be used to support sharing and evaluating of ideas, to support improvement in the decision making process over that available to single individuals. There are also a number of possible ways that the ‘decision’ part can be undertaken, consensus, majority, unanimity, etc. The thinking behind using these processes is that each person comprising part of the group then becomes additive, and therefore, more is better.
These aspects to group decision making can, if used consciously, really help bring about the most positive aspects of any decision making process. However, they all require certain things to be in place for them to actually work in the way that permits the best possible outcome, and so group decision making is predicated on how individuals work within the group to actually support its success.
What are the particular challenges of group decision making?
We all like to think that we are smart, independent thinkers who can bring something unique to the table. Partly because, as individuals, we tend to believe that we will accept and weigh all of the different perspectives that will be brought to the table equally and therefore act inclusively and positively contribute. Is this true however?
In 1981 Meredith Belbin came up with a view of how team roles. the roles that we may default into in a team, can impact how teams work and relate to each other. People generally have a preferred role that they will fall into, but roles may change based on the needs of the group and the relationships that exist, especially as these can be dictated by how the group is working.
The truth is, as demonstrated within The Traitors, we don’t necessarily value all of these roles equally. Within The Traitors, often the people centred roles are valued more highly, especially early on, and so people who are ‘different’ such as plants or ‘challenging’ such as shapers may be prone to banishment early in the process rather than being valued due to the different perspective they bring. Other roles, such as the implementer or monitor evaluator, may become isolated as too focused on task and therefore ignore the social niceties required to build social capital, which is important to be able to call on when you inevitably come under suspicion.
We see those not like us as being a source of risk or difference that can lead to distrust, which makes those that could be highly valuable, linked to their differences in perspective or approach, actually to be seen as individuals to remove from the group early. Thus making the whole task of finding the Traitors to actually become more inefficient early in the process. These challenges aren’t just present in The Traitors decision making though, and so Belbin encourages self reflection to understand the roles we take and what benefits and disadvantages they hold.
How does voting impact and a lack of facilitation impact?
We often like to think that we are useful and can actively contribute. In the case of The Traitors, participants like to believe that they know, or can spot things that others cannot, and therefore can make themselves valuable members of the group. For the Traitors, all scenarios will feel like a risk as we like to believe that others are as obsessed with us as much as we are focused on ourselves, something called the Spotlight Effect. In recent seasons, there has also been a focus from the Faithfuls on obsessing about why they have been kept in and not murdered, hence placing increased focus on themselves and the importance they play within the group. All of this plays out around the round table linked to the fact that a single round of majority voting is utilised in order to enable the group to make a decision.
Other types of voting would have different impacts on the group and how they made decisions, but may not be as dramatic, and in most cases would take longer. The issue with many of these other types of voting is how dissent and intransigence is managed in order to move discussions forward and ensure that the beneficial aspects of group decision making are actually realised.
One of the reasons that these alternate methods would be challenging, even if included, is that they really rely on facilitation in order to work. In The Traitors, there is no external group facilitation, all roles are held by people in group who are driven by both group and individual needs and have an embedded interest in the selected outcome. The host acts merely as a neutral observer to the process. If setting up your own group, evaluating the success of groups you are part of, or thinking about processes, it is worth being aware of how decision making tools influence both group behaviour and group effectiveness, and ensure that the right structures are put in place to support both.
Why can the voting shift so rapidly?
As the Faithfuls become more developed as a group, or at any point where they feels like there is a dominant voice/person demonstrating confidence in their opinion, it can be surprising how quickly the conversations and prior decisions made before going into the round table can change. There is usually plenty of hanging around and talking during the day, where people get to know each other, voice suspicions, and try to capture evidence, which is usually in limited supply. The number of times this happens, and someone sounds like they are doomed to be banished, then everyone sits around the round table and suddenly everyone is voting for someone else entirely may appear surprising, but how often is group decision making truly group decision making? How often does it become the echoing of a dominant voice?
What is group think?
Groupthink was first coined as a term in 1952 but the first real published book investigating it was published by Janis in 1972.
Groupthink is a phenomenon that occurs when a group of well-intentioned people makes irrational or non-optimal decisions spurred by the urge to conform or the belief that dissent is impossible
The need to be part of the majority when voting, the need to be seen to be part of the consensus, makes the voting process and group decision making in The Traitors particularly at risk of Groupthink. This is where the desire for group consensus and harmony leads to poor decision-making. Within the round table at the traitors, especially at the start, no one wants to draw attention to themselves. You want to be middle of the road initially, as you neither want to draw the attention of the Faithfuls, thus standing out and being at risk of banishment, or of the Traitors, putting yourself at risk of murder. No one wants to be an outlier.
As time goes on, and the numbers decrease, individuals need to be seen to have a voice as not having an opinion increasingly raises suspicious. At the same time, there always seems to be a couple of players who become dominant, often due to the random luck of having found a Traitor previously, and are seen as being somehow more competent to find Traitors than others. Groupthink therefore definitely starts to play a more significant role in the middle stages of the game due to the changes group dynamics. How this Groupthink plays out can happen in a number of ways from collective rationalisation during discussions that one person is definitely a Traitor, normally based on fairly flimsy evidence, to some people being almost immune to accusations as they have come to be seen as such good Faithfuls, for equivalent light levels of data. It is often only when players reveal whether they are actually Faithful or Traitor, when banishment decisions have been made, that some members will then voice the fact that they didn’t support the wider decision or that they wish they had had the capacity to speak up.
The other interesting thing that comes into play during round table discussions, is that there are obviously traitors who are deliberately muddying the waters or throwing in dissent in order to disrupt the group decision making process. These members act like ‘mindguards’ who are group members that limit information and control dissent to influence the decision-making process. It is interestingly not only the Traitors who do this however, in varying seasons there have also been cliques that develop who have also acted in a similar way, but claim it is to protect themselves and improve the ability to identify those they perceive as untrustworthy. This tends to benefit the individuals but does not necessarily act to benefit the group as a whole, in terms of decision making quality.
Let’s talk treachery
The show wears its truth on its sleeve, it is called The Traitors after all. Trust plays a fundamental role in both individual relationships and on group dynamics. Therefore the role of trust and how this level of trust varies across the period of the show is an essential part of the entertainment factor and impacts on how successfully the group complete the given task of trying to find the Traitors in their midst. In a normal setting, trust is built over time as the group establishes itself. In the case of The Traitors, this process deliberately erodes trust, as the more the group establishes the smaller it becomes, and it becomes more likely that the person you are left talking to is actually a traitor whose considering your death. All of this leads to an ever building sense of paranoia.
The other reason that paranoia can be rife is that the role of Faithful is not static. You could therefore be sure that you had a relationships with someone based on the fact that they were ‘clearly’ Faithful, but it is possible that something could happen which means that they changed from being a Faithful to a Traitor during the course of the game. There are also moments when new group members are added later on, which means that members, and the group as a whole, lose their equilibrium and then need to re-establish. This also means that those players who are introduced later can also struggle to ever be seen as part of the group in the same way as the original players.
The reasons that players can change to become Traitors are three fold:
Original selection as a Traitor on day 1 (change from unassigned to Traitor)
Seduction – if a Traitor is banished, the Traitors can choose to recruit from the remaining Faithfuls. The Faithful can choose to join or refuse, but often even admitting that someone has tried to recruit you can lead to an increased risk of banishment
Ultimatum – if at any time there is only one Traitor left in the game, the remaining Traitor selects on member of the Faithful and they are given an ultimatum. They can either join the Traitor or they will be murdered. Needless to say, under these circumstances players almost always choose to join rather than die. This can impact dynamics later however and mean that the ‘forced’ Traitor may be more likely to turn on their fellow Traitors
The Traitors therefore have their own group dynamics that are playing out in secret amongst all of the dynamics of the wider group. All of which can impact how wider decision making processes occur, as some individuals may choose to sacrifice a Traitor to the wider group in order to establish themselves as more trusted or to change group dynamics.
So what is game theory and how does it apply here?
All of this brings us to game theory, and more specifically to the Prisoner’s Dilemma
Game theory is the branch of mathematics concerned with the analysis of strategies for dealing with competitive situations where the outcome of a participant’s choice of action depends critically on the actions of other participants.
When The Traitors is described as a game, it very much is, both as a whole and with every single decision made. The Traitors within the group are playing something called the Prisoner’s Dilemma, pretty much throughout as they decide every round table whether to support each other or sell each other out. At the end game, however, everyone ends up playing this particular example of game theory, whether they are a Traitor or a Faithful, as banishment’s continue until everyone believes there are only Faithfuls left.
Two bank robbers, Elizabeth and Henry, have been arrested and are being interrogated in separate rooms.
The authorities have no other witnesses, and can only prove the case against them if they can convince at least one of the robbers to betray their accomplice and testify to the crime.
Each bank robber is faced with the choice to cooperate with their accomplice and remain silent or to defect from the gang and testify for the prosecution.
If they both co-operate and remain silent, then the authorities will only be able to convict them on a lesser charge resulting in one year in jail for each (1 year for Elizabeth + 1 year for Henry = 2 years total jail time).
If one testifies and the other does not, then the one who testifies will go free and the other will get five years (0 years for the one who defects + 5 for the one convicted = 5 years total).
However, if both testify against the other, each will get three years in jail for being partly responsible for the robbery (3 years for Elizabeth + 3 years for Henry = 6 years total jail time).
Therefore the best move, for either Elizabeth or Henry is to defect, as this is the move with highest payoff, either because they both defect, in which case they only serve a year in jail, or because the other person doesn’t, in which case they walk away completely free and the other person pays the entire cost. This is what is known as the Nash equilibrium, where both parties should defect in order to maximise their individual benefit.
Within the context of The Traitors, this means that at some point, when the heat is on your fellow Traitors too much, you should join the rest of the group in order to banish them as a Traitor in order to validate yourself as a Faithful. It also means that during the end game phase, when players can continue to banish down until they reach the final 2, as long as you are sure that you are not one of the ones at risk of banishment, you should always continue to decrease the group to the smallest numbers possible in order to try to ensure that no Traitors are left. It is the balancing that with your individual banishment risk that is the biggest challenge however. When there is money at stake, when there is an actual individual cost to decision making, then the maths is clear about what you should do next.
What does all of this teach us, and how can we apply some of what we’ve learnt?
Apart from being a cracking piece of entertainment, I hope that this post about The Traitors has made us think that group decision making may not be as simple and issue free as we sometimes like to believe. There are a number of actions required of us as individuals in order to make it an group decision making the improved option, and a lot of individual responsibility that must not be forgotten as part of becoming a collective. When undertaking your role as a decision maker within a group setting it is worth being aware of the need to:
Self reflect on the roles you take when in groups, especially how these change depending on stress levels and how comfortable you are with other members
Actively evaluate how well your group decision making processes are supporting or impeding the effectiveness of the decisions
Not just default to majority voting because it is a) what you are most familiar with or b) quickest and perceived as easiest
Think about when to use facilitation to improve the quality of any group actions
Be aware of groupthink and attempt to have measures in place in order to reduce its impact
Know that, if the individual costs and consequences are high enough, the best mathematical choice is to defect (I say this tongue in cheek in terms of the maths, please also remember the human cost in any decision making)
Anyway, season 3 of the US version of The Traitors is just dropping now on BBC iPlayer, and so I’m off to see whether my thinking holds even if there are cultural differences. Just to finish though, I’d also like to end with flagging one of the best film examples of group decision making and how group dynamics can be utilised to impact outcomes. If you’ve never seen 12 Angry Men, it’s a masterclass, and I’d highly recommend you take some time out of your life to check it out and to think how you might respond if placed in a similar situation.
Norovirus is estimated to cause more than 21 million cases every year worldwide and to cost the NHS over £100 million every year. Because of its impacts, there’s been a fair amount in the news related to Norovirus recently as the numbers have been up this year. I thought the timing might be good, therefore, to talk about this clever and tricky virus, and why we should care about it even if it is not likely to result in significant harm to most people.
In their recent blog post the UK Health Security Agency (UKHSA) have listed a number of reasons why levels might be higher at the end of 2024 than in recent years:
Post-pandemic changes in population immunity
Changes in diagnostic testing capabilities
Changes in reporting to national surveillance
A true rise in norovirus transmission due to the emergence of GII.17
I’ve written a post before about food poisoning and food borne outbreaks, but as Noro (Norovirus) is the queen of this particular court, I thought it was high time I gave her the recognition she deserves and explain some of the reasons they’ve listed in more detail so that the reasons might become clearer.
What is Norovirus?
So, let’s start by talking some virology. Feel free to skip this section if the technical stuff doesn’t really appeal to you, I’ll try to include plenty of context in the other sections so they still make sense.
Norovirus is a single-stranded positive sense non-enveloped RNA virus, but what is that, and what does it mean?
RNA (ribonucleic acid) – We talk about DNA being the building blocks of life but viruses act a little different as they are able to take over the mechanics of the cell/host they invade. This means they dont have to have DNA to function. Their genomes (the code for what they are) can be made from RNA alone.
RNA molecules range widely in length and are often less stable than DNA. RNA carries information that can then be used to help cells build proteins using the machinery in the host, which are essential for replication and other steps
Single stranded – RNA is frequently single stranded, versus DNA, which is normally double stranded (there are however examples of single stranded DNA viruses, such as Parvovirus)
Positive sense – Noroviruses use their own genome as messenger RNA (mRNA). This means the virus can be directly translated (tell the cell what to do) into viral proteins by the host cell’s ribosomes (cell machinery) without an intermediate step
Non-enveloped – This refers to a virus that lacks the lipid bilayer that surrounds enveloped viruses, meaning that they are sometimes called ‘naked’. These viruses are more resistant to heat, dryness, extreme pH, harsh treatment conditions, detergents, and simple disinfectants than enveloped viruses.
Noro is part of the family Caliciviridae, and human Norovirus used to be commonly referred to as Norwalk virus. As genetic information has become more available, it is now known that there are 7 common genogroups or G types of norovirus (GI – GVII), only some of which can infect humans (GI, GII and GIV).
Representative virus strains and their known carbohydrate ligands are shown in orange. Data are adapted from PLoS ONE 2009, 4, e5058.
Within these main genogroups, GI and GII contain a number of different genotypes, which will circulate at different amounts across different years and cause most of the infection we see in the population. You can also probably see that, although we use numbers to talk circulating strains, they also commonly have names, often based on the city or area where they were found. This can make everything a bit confusing, so I’ll mainly just use numbers here. This year, as talked about by UKHSA, the primary culprit is a rise in GII.17.
Symptoms/presentation
Noro is interesting as it frequently presents as something known as ‘Gastric flu’. This means that initial symptoms are often linked to a headache and feeling generally unwell, potentially with a fever. So, not just the diarrhoea and vomiting that people often think of associated with this virus.
That said, you also get the perfectly well to sudden projectile vomiting type of presentation, which is what people think of. Norovirus is the reason I once sat at a train station and vomited on my own shoes, as it just came out of nowhere. There is often a very short, intense spike in temperature, and then it is upon you. This form of intense and sudden presentation is just one of the reasons for the transmissibility of this particular virus. The lack of warning means that it is almost impossible to get away from others, and you won’t have ‘taken to your bed’ before the acute symptoms start.
It is worth noting that as well as these differences in adult presentations, presentations in young children are often also different, with more diarrhoea rather than vomiting. This means that Noro in young children can slide under the radar until adults caring for them then start to feel unwell.
The incubation period is pretty short (a couple of days), and so transmission windows in close quarters can be pretty intense. The duration of illness in most people is also pretty short, although symptoms tend to come in waves, and so it can be difficult for individuals to predict in some cases when it will finally be over. All of this is true for your standard healthy immunocompetent adult, but it is worth remembering that in both children and immunosuppressed adults, presentations, severity of illness, and length of infectivity can be very different.
Diagnosis
Most diagnoses of Norovirus within the community are going to be based on symptoms and presentation, as in most cases, any management is going to be symptom relief by maintaining fluid balance, etc. More specific diagnostics therefore only tend to be undertaken within healthcare environments, where it is important to know viral details to help inform risk assessment linked to transmission, as well as to monitor recover and inform epidemiology (what strains are spreading and if any of them are cause more severe disease).
There are many possible ways to diagnose Norovirus in the lab, from routine diagnostics using molecular methods and immunoassays, to how people are looking to diagnose using Norovirus in areas like care homes in the future using smart phones and other novel methods.
Maja A. Zaczek-Moczydlowska, Azadeh Beizaei, Michael Dillon, Katrina Campbell. Current state-of-the-art diagnostics for Norovirus detection: Model approaches for point-of-care analysis. Trends in Food Science & Technology, Volume 114, 2021, Pages 684-695
In terms of immunoassays, there are a couple of commonly used tests. The first are lateral flow assays (LFA), which most of us will be familiar with in terms of the lateral flow assays used for SARS CoV2, and the principles are similar. Enzyme immunoassays (EIAs) follow similar principles but are usually undertaken in the lab with many samples being processed at the same time, allowing much more widespread testing to be undertaken.
Which diagnostic test is most appropriate depends on how frequent cases are. In outbreak or high prevalence settings, then EIA has sufficient sensitivity to detect most cases. If circulating levels are not very high, i.e. outside of the standard season or outbreaks, or in high risk settings where missing cases could have severe patient impacts, such as some healthcare settings, then most publications suggest molecular methods are the most appropriate way to test.
The molecular methods listed include isothermal amplification, with Loop-mediated isothermal amplification (LAMP) being a common method that was recognised during the pandemic for detecting SARS CoV2, and can be used outside of the traditional lab environment. I, in fact, validated a LAMP test for Noro when I was a trainee, so it’s been around for a while. The other listed is high throughput sequencing (HTS), which is a much more demanding technique requiring specialist skills and equipment, but also gains you all kinds of info, including that linked to strain and transmission data.
The most common molecular diagnostic test for Norovirus in high-risk settings is actually via polymerase chain reaction (PCR). This will usually target roughly a 130 base pair section of the Norovirus RNA genome out of the (on average) total 7500 base pairs of the virus, roughly 1.7% of the genome. This target area will usually enable differentiation between the common GI and GII species, which helps with monitoring and is chosen based on being present in all of those types in order to maximise sensitivity. Further differentiation into genogroups requires HTS but is often not needed outside of outbreaks and public health level epidemiology.
Norovirus is traditionally thought to be spread via what is known as the ‘faecal-oral’ route. That means that bits of poo and diarrhoea end up being swallowed by the person who then gets infected. This is because if someone has diarrhoea and goes to the bathroom, they will have up to 100,000,000 copies of the virus. This can then land in the area of the toilet, especially if the toilet seat isn’t closed on flushing, contaminating the surrounding area for anyone who goes into the bathroom and uses it afterwards. If someone then enters that bathroom and is susceptible to the virus, it is thought you then only need to swallow 10 – 100 copies of those 100,000,000 to become infected, and so only a very little is needed to spread the virus onward.
This isn’t the only route however. One of the issues with the acute vomiting phase of Noro is that someone vomiting can also vomit 30,000,000 copies of Noro. As the vomiting can be projectile, and come with a lot of force, this is ejected at high speed and can form what is known as an aerosol. This means the invisible vomit ‘cloud’ can hang around in the air for some time after the original vomit, meaning that anyone walking into the room where the vomit occurred for some time afterwards, or is present when it happens, can breath in the virus, and thus get infected that way.
As people can be infectious for some time after they’ve had acute infection (at least 48 hours) or when they have initial gastric virus symptoms before becoming acutely unwell, spread can commonly occur due to contamination of food products prepared by those infected. The common example is self catered events, such as weddings and birthday parties, where someone made a load of food on the morning and didn’t start to feel unwell until later in the day. 24 – 48 hours later a lot of the guests then suddenly start to feel unwell. This is a route via which lots of people can get sick from a single event and is known as a point source. Hand hygiene is always key, especially so when dealing with food, but the viral loading of people who are unwell with Norovirus means that avoiding being involved with food may be the only option, as there may just be too much virus present on hands etc to remove all of it easily.
The final route to consider is indirect spread. All of the circulating virus that’s in the air or in water droplets from the toilet flush, then will eventually come down and land on surfaces. Therefore those surfaces end up having a lot of virus upon them, and the virus, as non-enveloped, can survive on surfaces for some days. This means that then interacting with those surfaces can be a transmission risk, and so cleaning, and again hand hygiene, is really key to stopping ongoin spread.
Outbreaks
As those infected can be become unwell suddenly and spread lots of virus in a short period of time, Norovirus can be difficult to contain. Once an event occurs, all of the various transmission routes mean that Norovirus outbreaks can be difficult to control, and management is based upon rapid identification of cases and, if in hospital or even on a cruise ship, restricting contact to other people in order to reduce risk of spread.
The biggest issues occur in the kind of areas where lots of people get together, high densities of people in physically confined areas. Everywhere from military training camps to schools and nurseries can be affected. As mentioned before, centres where people may present in atypical ways due to age or underlying condition can also make it more complex to contain infections and prevent spread. Hospitals have high population densities with restricted space for movement, combined with patients that are high risk as they already have conditions that impact immune function or make them more vulnerable.
Outside of traditional health and residential areas, such as care homes, cruise ships are at high risk as passengers can feel fine when they get on board and then experience symptoms in a confined space, with little room to spread out.
Even once recovered from symptoms, some of the passengers are also likely to continue to shed the virus (one adult study suggested for 182 days) and therefore some of those who get sick early on and recover may continue to be a silent source and risk for other passengers if they don’t have good general hygiene practices.
It can also be a challenge to decontaminate some of the surfaces, as they are often predominated by soft furnishing where it can be difficult to use cleaning agents with sufficient activity as Noro can be resistant to disinfection and present in such high loads it can be hard to remove. This has led to the surfaces in cruise ships being a continued risk even when all of the original passengers have departed and a completed fresh set has boarded.
Seasonality
Norovirus outbreaks are seasonal, with the peak occurring in the winter months. This is partly because, as humans, we tend to spend more time indoors in close quarters with each other during the colder months. We get together for the festive season, and because the nights draw in earlier. This means that we tend to spend more time in higher density interactions than in the summer, where we might be out eating alfresco or going for evening walks, or in my case, cocktails. We also tend to travel to other households and cook for each other as part of the seasonal festivities, which means the food borne route definitely comes into play. Finally, as temperature and humidity impact on the indirect surface route, environmental conditions mean that the viruses survival on surfaces at this time of year is probably more prolonged. Norovirus never really goes away, but the number of cases definitely spikes during the winter.
Strain variance/immunity
The UKHSA mentioned that one of the reasons that there may be more Norovirus cases around now is because one of the current predominant strains is GII.17. The chart below is linked to circulating Norovirus in China, so not the UK, but you can see, even over a few years, how the levels of different circulating strains changes, and that within years there are normally a few strains that co-circulate with a predominate strain type.
Cao, R., Ma, X. & Pan, M. Molecular characteristics of norovirus in sporadic and outbreak cases of acute gastroenteritis and in sewage in Sichuan, China. Virol J 19, 180 (2022)
GII.17 is a less common strain and so many people will not have experienced it recently, if at all. If you haven’t had GII.17 before you won’t have immunity and therefore are susceptible to infection. Even if you have had GII.17 before, one of the reasons control of Norovirus is hard is that immunity is short lived. Even if you have experiences GII.17 before, therefore, the data shows that immunity lasts for anywhere from 6 months to 4 years, and therefore only relatively recent infection is protective. Finally, there is no cross strain immunity, so if there are three circulating strains of Norovirus in a season, unless you have experienced each of them in the relatively recent timeframe, it is possible to get multiple episodes, 1 from each strain, in a short period of time.
Prevention/Actions
Norovirus particles retain infectivity on surfaces and are resistant to a variety of disinfectants. This means that not only direct transmission routes (such as person to person) but indirect transmission via surfaces can be important. Interventions therefore need to take into account all of these different routes. Some common recommendations include:
Hand hygiene with soap and water (alcohol gel is less effective as Noro is a non-enveloped virus)
Staying away from other people until 48 hours after symptoms have ceased (as you often get a second wave of symptoms which increases risk of spread)
Avoid cooking or preparing meals for other people until at least 48 hours after symptoms have ceased, and ensure good hand hygiene when you re-commence
Cleaning with disinfectants (bleach etc at home) may be required, and multiple cleans may be needed due to the amount of virus present
Time cleaning so there is enough time for any virus in the air to settle on the surface, so a re-cleaning after 2 hours will probably be needed
Avoid going into a space where someone has vomited for 2 hours if possible to reduce the risk of inhaling virus
Ensure you are aware that Noro can present with gastric flu type symptoms, headache and temperature, before gastric symptoms start, and so be weary of seeing high risk individuals if you have any symptoms present (especially those in hospitals or immunocompromised)
Due to the challenges with short lived immunity and high viral loading, you won’t be able to avoid getting Norovirus into confined areas and high risk settings, so rapidly identifying when you have cases and making sure that your interventions enable you to stop secondary spread is key. If you get sick, stay home, ensure you keep hydrated, and don’t let the virus fool you into thinking it’s done when you are feeling that little bit better on day 2, it’s Noro’s way of tricking you into going back out into the world an spreading it further. The queen of the gastric viruses is super clever and so we need to be even smarter to prevent her spread.
This post was supposed to be something quite different. It was supposed to be about One Heath and a great podcast created by Beckman Coulter I was involved with in 2024, alongside some really inspiring people. In some ways it still is that, but because of the cruel reality of life it is actually also something quite different.
”Going Macro on Micro” is a podcast that Dr Simon Doherty and I were involved with that explores emerging themes and pressing issues in the world of microbiology. As the host, Dr Lough, says the podcast covers everything from investigating the global challenges of infection control to unveiling the future of diagnostic technologies.
The week the final episode of the podcast dropped, before Christmas, I got some pretty devastating news. Sadly Simon has passed away. Now, I didn’t know Simon well. We’d emailed since doing the podcase together and I kept an eye on the awards he received and his really interesting posts. In this limited contact though, he still managed to inspire. Recording the series with him was such a privilege. He was kind, open and funny. More than that he was so knowledgeable and I came away feeling like I’d learnt so much. I am so sad that I won’t be able to build on the foundation we laid to continue to learn from him and talk about the challenges/opportunities that face us in the fascinating world we both inhabited. I thought about not sharing these episodes when I heard the news, but then decided that I don’t want you to lose out on the honour I had of learning from him direct. I hope that you will hear both his wisdom and his challenge, and also aspire to do better, as I do, as a result. Thank you Simon.
I’ve decided to keep the focus on Simon and just put some graphics and links here that might supporting learning more about antimicrobial resistance and One Health. At some point when the loss of Simon has had a little more time to be processed I will think about writing something in a little more depth reflecting on his comments and the overlap between human health and veterinary medicine. Until then, the links to the episodes are below:
Ahmad Nayeem , Joji Ronni Mol , Shahid Mohammad. (2023). Evolution and implementation of One Health to control the dissemination of antibiotic-resistant bacteria and resistance genes: A review. Frontiers in Cellular and Infection Microbiology
Episode One
Rhouma, M., Soufi, L., Cenatus, S., Archambault, M., & Butaye, P. (2022). Current Insights Regarding the Role of Farm Animals in the Spread of Antimicrobial Resistance from a One Health Perspective. Veterinary Sciences, 9(9), 480. https://doi.org/10.3390/vetsci9090480
Episode Two
Sanseverino, Isabella & Navarro, Anna & Loos, Robert & Marinov, Dimitar & Lettieri, Teresa. (2018). State of the Art on the Contribution of Water to Antimicrobial Resistance. 10.2760/771124
Episode Three
Sanseverino, Isabella & Navarro, Anna & Loos, Robert & Marinov, Dimitar & Lettieri, Teresa. (2018). State of the Art on the Contribution of Water to Antimicrobial Resistance. 10.2760/771124
Episode Four
Sanseverino, Isabella & Navarro, Anna & Loos, Robert & Marinov, Dimitar & Lettieri, Teresa. (2018). State of the Art on the Contribution of Water to Antimicrobial Resistance. 10.2760/771124
Episode Five
Sanseverino, Isabella & Navarro, Anna & Loos, Robert & Marinov, Dimitar & Lettieri, Teresa. (2018). State of the Art on the Contribution of Water to Antimicrobial Resistance. 10.2760/771124
Episode Six
Sanseverino, Isabella & Navarro, Anna & Loos, Robert & Marinov, Dimitar & Lettieri, Teresa. (2018). State of the Art on the Contribution of Water to Antimicrobial Resistance. 10.2760/771124
It’s that time of year. The time when New Years resolutions get shared and we all try to persuade ourselves that overnight, if we just put in a bit more effort, we can change big facets of our lives. I’m becoming increasingly aware that the big gesture and external stuff is not really the space I want to be in, however. I’m fortunate to have ticked a lot of the external boxes at this point in my career, and so, in 2025, I want to focus on me and my development as a person rather than ticking another box linked to how people see me.
One of the reasons for this shift is the nature of the job, as it feels, in a post pandemic world, like I spend a lot of time in responsive mode. This becomes a habit and a way of being. Instead of running to keep up and fire fighting, however, I want to have time to experience the joy I feel when I’m learning and developing. This is especially important as I think many of us who went through the pandemic as healthcare workers are still very much in recovery mode, and there’s a lot to still be worked through and resolved with little time to actually do so. So, rather than create a list of tasks to be measured against, my list this year is about aspirations linked to becoming. Becoming a better version of me, becoming more joyful, and re-finding some of that pre-pandemic me.
I want to have time to catch my breath
As I sit here on a Sunday afternoon, I realise how much I need time to chill and unwind at the moment. 2024 was full on, and there wasn’t a lot of respite. It feels, therefore, that I’m hitting 2025 already pretty wound up and in need of prioritising some time off the treadmill. Even at work, having just managed to get down from just under 18,000 emails to ~200 over the Christmas break, I realise I need to stop being in responsive mode and guard my time more efficiently. I need to carve out planning time, and in a more basic way, time to make tea, have lunch, or god forbid – leave on time. I’m aware of how much better I will be at my job if I can catch my breath, see through the fog and take time to develop a plan or creative approach to the problem, rather than jumping in or going for the most obvious approach. All in all, a different strategy will have all-around benefits, so I need to work better at finding a new way to manage my time.
I want to live in a positive space
I have a tendency to swing from optimism to ostriching, and whilst most of the time I’m a ‘glass is half full’ kind of girl, it sometimes takes more energy than I have at present to live in that positive space. In 2025, however, I want to have enough energy to expend to make it happen. I want to listen to the noise, criticism, and the negative inner voices less. I want to focus less on what I lack and more on what I have. It’s easy to constantly focus on our areas of required improvements instead of celebrating how far we’ve come and where our strengths lie. There is always a space to focus on improvement, but it shouldn’t come at the cost of recognising the work we’ve already done. This year, I don’t want to benchmark myself and my progress. I want to live in a space where I accept and celebrate the place I am at. For once in my professional life, I want to be satisfied with the boxes I have already ticked and live in the moment.
I want to see my ride or dies
One of the reasons I am keen to find additional spare time and not take on more is that I want to carve out more time for me. Selfishly, this is nothing to do with work, but for me as a person outside of my professional life. The main driver for this is that I spent most of 2024 in work mode, and I didn’t spend enough of it in life mode. I’ve written about how fortunate I am with some of my friends, but in 2024, I just didn’t carve out the time to spend with them. They are super cool, and would never hold it against me, but for the sake of my soul I want to spend time with the people who see me, flaws and all, and love me any way. The people who are my ‘stick by you no matter what’ friends inspire me and drive me to do better, and I will be better for prioritising spending time with them.
I want to re-find my confidence
To be honest, I don’t know if it’s being peri-menopausal, post pandemic burn out, or just work over load in general, but my confidence has definitely taken a hit. Don’t get my wrong. I’m still the same bolshie girl, but the tendency to spiral after the moment is hitting me hard. The creeping self doubt is present in a much more apparent way than it was before the pandemic. Part of me thinks it’s because I’ve been living in ‘Professor Cloutman-Green’ mode for so long rather than having enough time in my own skin as Elaine/Dream. Whatever the reason, I want to find that confident girl again. The girl who had plenty of self doubt but didn’t let that doubt overwhelm her or take over who she was. She’s still in there, but I suspect a break and a significant amount of napping will be required to persuade her to put in a more consistent appearance.
I want to create and be inspired
Some of the things I want to make time for are pretty straight forward. I want to have time to cook when I get home and enjoy doing so with Mr Girlymicro. Cooking is something we love to do together, but time restrictions in recent years have made everything a functional task rather than an enjoyable endeavour. I want to spend the weekend drinking pots of the many different types of tea we have and languidly enjoying each others company, rather than having anxiety about the list of tasks I should be undertaking just to keep up distracting me from the moment.
A very specific thing I want to do with Mr and mummy Girlymicro in 2025 is to spend time visiting museums. Great museums, weird museums, museums that no one else visits. In 2023, we visited the Met in New York, and the joy and inspiration that filled my soul has stayed with me. In 2024, we managed a few stolen moments at the V&A, British Museum, and Natural History Museum, but I have to say I want more. London is filled with niche places to visit, and I want to wander with an open mind and just take in what speaks to me in the moment. This kind of activity is food for my soul, and I’m greedy for more. Also, if you have any recommendations, hit me up in the comments or DM/email me.
I want to invest in this blog
Being inspired helps me in many aspects of my life, but one of the biggest ones is the number of ideas I get for this blog when I’m just out and about experiencing life, and not just in scientific contexts. Focusing that inspiration into a creative endeavour like this blog then leads to even more fulfilment and joy. I know I’ve been talking for a couple of years now about developing a book out of this blog, and I’m not promising it will happen in 2025, but I want to take some serious steps in moving it forward if I can. At its most basic, I want to feel like I have time to enjoy sitting down and writing rather than squeezing in stolen moments on the tube when already exhausted.
2024 delivered more reads than I could have dreamt possible, finishing the year with over 21,000 reads from over 120 countries. I can’t believe that something I thought would be seen by a handful of people is now read by so many. I want to build on that momentum. I know professional blog writers get those numbers in a month, but I’m returning here to my pledge to not bench marking against others and just to focus on measuring myself against myself to capture growth. So here is to improving year on year and to doing more of what brings us joy!
I just want more
I know it sounds greedy, but I’m not embarrassed to say it, I want more. I want to sleep, and drink tea. I want cocktails and time spent with friends. I want more cozy rainy afternoons under a blanket and getting back to reading real books, rather than only having the focus to listen to audio books. I want Sunday afternoon walks with Mr Girlymicro, talking about nothing and feeding the ducks. I want to laugh so much my chest hurts and smile so much my face aches. I want to make time for the parts of myself that aren’t linked to work and outputs and re-train my brain to not measure myself against the ‘busyness scale’. I am not the sum of what I produce and I must learn not to measure myself as such. I am so much more, and in 2025, I am OK for it to be the year of greedily wanting more and giving myself permission to need.
I need to catastrophise less
At times of high stress, and let’s be honest I feel like it’s been high stress since 2020, my brain manages that stress by running scenarios. In many ways, it is not a bad way of managing my existence. Good, bad, disaster outcomes, all run wild in my brain. The main challenge over the last few years is that that scenario running has tended more and more to the disaster scenarios taking up my bandwidth. This can make the world feel darker and more challenging than it probably is, especially if it is compared with a more objective mindset. In 2025, it’s time to put on my positive pants and try to utilise the tools I have in a more balanced way in order to not create stress and drama where no such situation exists.
I need to step off the carousel
Catastrophising means that, by it’s very nature, I’m not living in the positive space I’d like to habit. Worse than that though, it can lead to spiralling, leading to negative rabbit holes that aren’t even linked to the original trigger. I’ve posted before on what this can look like for me. This isn’t good in the moment, but it also tends to result in a lack of sleep, as this is a frequent 3am affair, and thus impact on my general well-being. Everything becomes a self-fulfilling prophecy, as the tireder I get, the less perspective I have, the more likely I am to spiral, and therefore, get less sleep. In 2025, I want to step off both the carousel that leaves me so tired that the spirals happen in the first place, and also to step off the spirals earlier when they hit. For me, it’s focusing on using what serves me rather than being a passenger in the moment.
I need to take better physical care of myself
All of this brings me onto the fact that I just need to take better care of myself physically, as well as mentally. So much of my underlying health has suffered since the pandemic, and I have not allowed myself the recovery time that is required to really fix that. In 2025, I need more of option three in the pic below and way less of 4. I need to be more than intellectually active. I also need to find time to eat and drink in my work day. I often fail to help myself by forgetting or getting too busy to do the simple things, like taking meds. The reality is, I don’t have anyone to blame but myself, and I need to look after myself in the way that I would expect of others. It’s a simple thing, and I need to stop making life so complicated that it doesn’t happen.
I need to not make New Years Resolutions
Finally, and this is a big one for me. None of these things are New Years Resolutions. At best, I am saying that these are aspirations. I refuse to make a list that just adds yet more pressure to my every day life. I am a work in progress, and it is more than naive of me to think that I will wake up in a New Year and change who I am. I feel my habits make me more like the Titanic than a super yacht, and so any change in direction to avoid the icebergs takes time. 2025 is about self-love based on acceptance post self reflection and understanding that changing the dial is a choice that will need to be made daily. Starting the year by ignoring the noise of everyone elses’ proclamations and purely staying in my lane, whilst focused on what serves me, I think is a great way to kick off the year. I know some people find the resolution bit helpful, but I, for one, feel like celebrating the freedom I give myself by deciding not to comply with this particular tradition. Which ever way you decide works for you, I hope that 2025 brings you all of the joy and that you get what you need out of the next 12 months, and find the time to celebrate all that makes you you!
2024 was always going to be tough. Wonderful colleagues were facing challenges on all fronts. Close family members were going through significant change. Things that were going to impact not just my ability to balance life and work but also how that life was lived were very obviously coming down the line. I don’t know about you, but as a planner, I sometimes find the anticipation of the bad ‘stuff’ almost worse than its arrival, and 2024 kicked off with plenty of anticipation.
Now the end of 2024 is so close I can almost taste it, and much of the ‘stuff’ has both come and gone, I find myself still standing and grateful for all of you that have supported in enabling this to be the reality.
As a result of this year, I have spent a lot of time thinking about what keeps me going, what I need, and what I’m grateful for. None of the answers to these questions were linked to productivity or achievement. The answers, as it turned out, were all linked to people and relationships. These people, connections, and relationships were the answer to all my questions and remain the foundation of my everything. So, for my last post in 2024, I wanted to put something in writing that says thank you and talks about all the reasons why you are my team and my cheerleaders. You guys are the best!
I don’t need to see you to know that you are there
When times are hard, or adversity strikes, it is easy to end up feeling isolated and alone. It can be tempting to disconnect and enter protective mode, where you share less of who you are in order to limit your exposure. One of the things this year has shown me is how fortunate I am to never really feel that way. I know that whatever the world throws at me I am not alone. I am so lucky to have Mr and Mummy Girlymicro in my life, but it’s not just them. I posted this time last year about the amazing close friendships I have with some of my girls. These people, who I may not have even managed to see in person this year, are still there supporting me, even if I haven’t had a lot of time to connect. I still know that they are there and are backing me. I know if I reached out and I needed them, they would be there in a heartbeat. I’m aware of the privilege of this, and I am thankful for it every day.
We don’t need to always agree
One of the greatest signs of trust in any relationship is feeling safe enough to disagree, whether it be in work, romantic, family or friend based relationships. In travelling uncharted territory, there is no rule book and often no guide for how to make decisions or choices. This uncertainty can therefore inevitably lead to differences of opinion about what is the right approach in any given moment. Being able to disagree and yet still feel supported whilst working through the disagreement, in an attempt to reach consensus or just accept difference, is a real blessing. Even more so if it can happen without triggering preexisting insecurities or feeling exposed to judgement. I am trying to make conscious decisions to value moments where I learn more about myself and others by going through these disagreements, whilst also knowing how fortunate I am to have people in my life who are a safe space for these moments to occur with.
You forgive me for making mistakes
The process of learning and growing is not an easy one, and sometimes we have to face difficulty truths about ourselves and our flaws. I am flawed. I make mistakes, like ALL the time. I’d like to think that I grow each time and try not to make the same mistake twice, but even that is not 100%. One of the benefits of learning from disagreements is that it helps to garner enough understanding from any negative outcome that results to help make better choices in the future. I am grateful to my wonderful colleagues, friends, family and readers of this blog, for not only forgiving me for making those mistakes but also supporting me in sharing my journey in learning from them, not only face to face but also in this blog. My hope is always, that by being open, I support others in making more informed choices as we are all learning together.
You lift me when I am low
This year has had some significant lows. It has has included the deaths of some significant figures in my life, such as Professor Nigel Klein, who had been a key part of my working life for almost 20 years. He was the person who supported me in my first steps in academia, who supported and supervised me during my PhD, and has continued to be a key figure in my clinical academic career ever since. Significant health challenges have been present for colleagues and family and this has hit me hard at times, even if I am not the person unwell. I’ve been feeling pretty mortal, and also powerless to help in any meaningful way. So many of you have been so kind and lifted my spirits, from sending memes or commenting on the blog, to unexpected treats from friends and family that have made me feel seen and loved. Having a safety net of people who are prepared to pick up the slack when I’ve struggled or to remind me that everything will be OK has been an invaluable asset in 2024.
You drive me to be the best version of myself
When the world is overwhelming, when everything feels too much, it can be so tempting to want to throw in the towel and just ride the wave. Having to try (and sometimes fail) to get this blog out every week and to continue to show up has been crucial to just keeping me going whatever my mood. There have been weeks when this blog hasn’t happened. There have been days when I haven’t delivered in the way that I would wish. I have certainly been too tired to step up and see people or do things on the weekends or in my free time. Knowing that there is an expectation of levels of engagement, be it from my PhD students, colleagues, readers of this blog, or family, has kept me going and kept me present. You support me in trying to be the best version of myself and to keep showing up in the best way I can in the moment. You support me in not just accepting but seeking out things that challenge me and keep me on my learning pathway. Hopefully, I then get to feed that back via this blog, and therefore the loop continues.
I know you would always straighten my crown without telling me it was crooked
We’ve all been there, we’ve sent an email or written a slide, and it’s not quite right. There are people who reply to you and give you a heads up so you can issue a no drama correction, and there are people who reply all or stand up at the end of the talk to point out your error. I count myself so fortunate to have so many people who sit in the former rather than the latter bracket in my life. This is a pretty basic example, but I’m hoping you see what I’m trying to say. I have so many people in my corner who will steer me back on course when I’m beginning to drift, or who will gently escort me from a conversation that I’m not in the right head space to have. People who know when I need saving from myself, from reminding me that having that dairy filled cake is not wise, to pointing out that I can’t physically manage to book myself into speaking at three conferences in different cities in a week. I know my well-being is at the centre of their actions, and having that safety net is of incalculable value to me.
We are in this journey together
When I made my first blog post in 2015 I didn’t even know what this blog was going to be. When I started posting regularly in 2020, I knew my why but I didn’t really know my how. Now, looking back on the last 200+ posts I feel like I’m more comfortable with some of the how. My next challenge is the where. I feel very much like I want to continue to grow and that this blog is a medium through which I can do that. I’ve learnt so much from the journey so far, but I am certain there is so much further I want to go. This year the blog broke 20,000 reads for the first time, and that makes me feel like we are in this journey together, wherever it might lead. I love seeing the interactions when I post. I love hearing your thoughts and feedback. I love feeling like this is something we are doing together and that I learn from you as much as you, hopefully, learn from my experiences. I don’t know where this road ends, but I know that I am determined to keep following it.
You understand that performance is not consistent
This post has been really hard to write for some reason. It’s taken me hours of staring at the screen, and I don’t know how well it will be received. Some posts spring to life, almost fully formed, and take no time at all to write. Some just make themselves harder work. I am pretty sure, therefore, that not all of them knock it out of the park. There are certainly ones that speak to some people more than others. Having spent some time thinking about it, I’ve decided that this is OK. As long as my intention is to communicate something, and I never post for the sake of posting, then how it lands is out of my control. The main thing is that I always try to do my best.
The same is true with posting frequency. I will always try to post weekly, but this year has shown me that sometimes I just can’t manage that. I used to obsess and spiral about it, and now I’ve decided that if I am not in the head space to write something worthwhile, I am better waiting until that resolves. I’ve been so grateful with the patience shown to me on this front in 2024 and that you have stuck with both me and this blog through all the random trains of thought and erratic posting frequencies.
You don’t judge me when I bear my soul
I try to always be honest in this blog. I try to share both the good and the bad, in a balanced but honest way. The concept of authentic leadership is important to me, and to fulfill it I think I need to show all sides of myself. I can only do this because I feel that I have built up a trust and feeling of safety in writing this blog over the years.
I remember when I first started to post things that were more personal, I used to brace myself for the comeback. I almost expected my confessions of inadequacy or failures to be weaponised against me. In all the 200+ posts that have been written, I’ve only had a single comment that could be considered to be less than supportive of my sharing, and even this was written (I believe) from a place that the author thought it would be helpful. As a result of this building of trust, I write from a space where I am comfortable sharing my lived experience without revision or overlay. I genuinely believe that this means that the sharing has much more value because of it. So, thank you for supporting me in getting to this place of confidence and comfort and always encouraging me to bring my full self to our interactions.
I hear you when you tell me this is valued
In my darker moments this year, when I was questioning a lot of the things that required focus or time, I reflected on whether writing this blog was something that was valued by anyone but me. Whether it was a good use of several hours of my time every week, when I didn’t have time for a bubble bath or other self care. Then every time I went to a conference I would have lovely conversations with people about the blog, and all of them were so positive, and inspired me so much.
Over the last year, I’ve even had people spontaneously mention it in meetings or 1:1 interactions. It’s hard to communicate how much this means. When I sit on my sofa and need to choose between pulling out the laptop to write or watching some trashy TV to unwind, it is these interactions that keep me reaching for my laptop. When I’m on the tube and I need to choose between closing my eyes and escaping into an audio book or doing some blog writing on my phone. It is the memory of these moments that keep me plugging away. Knowing that others value reading this blog, hearing stories in response to putting my experiences out there, make every minute spent worthwhile. So thank you, thank you for giving this blog meaning, thank you for showing the time invested has value, and thank you for taking time out of your lives to join me in this endeavour that means so much to me.
Girlymicro 