Professor Robert Winston on grief, guilt and the truth about fertility

January 20, 2023. Series 7. Episode 56

“You start wondering if your own life is worth continuing. It’s obvious that you think about that. But what do you learn? I don’t know. I think people learn different things and people react to grief very differently.”

Joining us for this episode is Professor Robert Winston – scientist, author, broadcaster and politician. Devoting much of his adult life to the crisis of infertility – IVF pioneer Lord Winston is that rare breed … a scientist who can speak fluent human.

With fertility and genomics never far from the headlines, Lord Winston continues to face down considerable controversy – periodic media storms that would send most scientists sprinting back to the safety of the lab. In this conversation Lord Winston lays bare the harsh statistical truth about IVF … facts, he says, you will not learn from the fertility industry.

A one-time Peer of the Year winner, Lord Winston also has an active political life beyond his career addressing the crisis of infertility. Sadly, it was in the Lord’s last year, that he revealed an altogether different, very personal crisis with the sad loss of his wife Lira, who died suddenly at their home. In this episode you’ll hear how, with Lira in his arms, he called 999, only to be met with an operator who wasted precious time in getting an ambulance. Lord Winston also tells us movingly how Lira’s death caused him to question whether he could live on without her.

Topics covered:

The truth about fertility success rates
Collaboration & resilience
How to cope with public scrutiny
Grief & guilt
The NHS Crisis
The dangers of genomics

Robert’s Crisis Cures:

Find mentors who you trust. Anne McLaren was a very good example – a brilliant female scientist.
Work in collaboration with a team you get on with.
Be persistent but recognise your failures. Because failure teaches you to do it better next time.

Links:

Twitter – https://twitter.com/ProfRWinston?s=20&t=VwMwUWMFtNTrBsbDXgHvzA

Website – https://www.robertwinston.org.uk/

Genesis Research Trust – https://genesisresearchtrust.com/

Inventors: Incredible stories of the world’s most ingenious inventions – https://amzn.to/3Xtp04q

Ask A Scientist: Professor Robert Winston Answers 100 Big Questions from Kids Around the World! – https://amzn.to/3GXY7ya

Stream/Buy ‘Allies’ by Some Velvet Morning: https://ampl.ink/qp6bm

Some Velvet Morning Website: www.somevelvetmorning.co.uk

Your Daily Practice: Sleep by Myndstream: https://open.spotify.com/track/5OX9XgJufFz9g63o2Dv2i5?si=b2f9397c92084682

Host – Andy Coulson

CWC production team: Louise Difford, Ed Isaacs and Jane Sankey

With special thanks to Global

Full episode transcript:

Full transcript:

Andy Coulson: [0:00:06] Hello, I’m Andy Coulson, and welcome back to Crisis What Crisis, the podcast that aims to guide you towards a more resilient approach to life and whatever it might throw at you.

My guest today is the brilliant Professor Robert Winston. Scientist, author, broadcaster and politician. A man who continues to devote himself to ending the crisis of infertility for so many parents with his pioneering treatments focused on IVF and the efficacy of embryo screening.

But Lord Winston is also that rare breed of scientist: a professor who can speak fluent human, and who, through his award-winning TV programmes including Child of Our Time and The Human Body has helped millions reach a greater understanding of who we are and why we are who we are.

As a member of the House of Lords since 1995, and a one-time Peer of the Year winner, Lord Winston has had an active political life. Earlier this year in the Lords he revealed a personal crisis with the sad loss of his beloved wife Lira, who died suddenly at their home. Lord Winston described how, with Lira in his arms, he called 999 only to be met with an operator who wasted precious time in getting an ambulance to the house. Lord Winston called for improved training for those emergency operators.

With fertility and genomics never far from the headlines, Lord Winston has also faced down controversy throughout his career, media storms that would have made most scientists disappear back into the safety of the lab. But not so our guest who, I am pleased to say, is a man unafraid to give his clear opinion at a time when it is becoming increasingly and rather worryingly unfashionable to do so.

Lord Winston, welcome to Crisis What Crisis.

Lord Winston: [0:01:52] Nice to speak to you. I have to say, I don’t find it terribly easy to talk about myself, but I’ll do my best.

Andy Coulson: [0:01:59] The question really that I’d like to start with if I may is that your working life, as I touched on in that introduction, your working life has been spent in large part in the environment of the most acute kind of personal crisis, with parents who are unable to have a child. And although you have been able to help so many with your work, of course the very nature of IVF means that for most of the people that you treat it doesn’t succeed.

How have you approached those highs but also the lows, where I suspect you, and I imagine the people that you work very closely with, are faced with elation and distress and I suspect not very much in between?

Lord Winston: [0:02:45] I think it’s a very good question. I think unfortunately when I started, I suppose when I was first offered the chance to run the infertility clinic, which was the first one actually in Europe, at that time infertility wasn’t really regarded as being that important. John MacLeod-Brown retired, he was my professor, and I was then appointed as running this infertility clinic at Hammersmith, at the Royal Postgraduate Medical School. I told the senior consultant in the unit what I was doing and he said to me, “What on earth do you want to do the futility clinic for?”

Andy Coulson: [0:03:30] That’s how he described it?

Lord Winston: [0:03:32] That’s how he described it. And I think that was an extraordinarily common, probably male, response in the ‘70s when I started that clinic. And it made me more aware that actually there was a real job to be done.

But the reason why I did it, I think, well, it was for lots of different reasons. First of all I thought there was a huge amount we could do to improve infertility in the late ‘60s, and that had been quite important, and I was aware that a lot of people were pretty distressed by it.

But I think what you’re pointing out is quite important, and that is outside that very few people who admitted that they were infertile because they were ashamed about being infertile, nobody realised that this was a crisis for people. I think that’s the thing. And I think actually most men and women never talked about their relationship, never talked about they thought that they had failed, where they thought that they were so depressed that they had disappointed their partner, something which affected their sexual relationship most often, which actually affected their psychological health. And people who found that they often didn’t even want to go into work. And women who certainly would not want to go into a room where there were pregnant women. People who wouldn’t go to dinner parties, because of course at that certain age when you’re in your 30s, that’s what you talk about: your kids.

So all of that was something which became very revealing. And I think actually when IVF became a sudden cause célèbre it was-perhaps the best thing that IVF did was not actually getting more children, but actually getting more people to talk about why they couldn’t have children.

Andy Coulson: [0:05:16] Yes, yes.

Lord Winston: [0:05:16] And I think that’s not been really recognised, sometimes. Because of course what we’ve done, and what I’ve done, is to peddle in failure, because as you rightly point out, most cycles of treatment fail. And nobody admits, no private clinic admits, even the HFEA doesn’t admit this, but actually if you start on invitro fertilisation treatment, over all in Britain, or in France, or in Australia, or in America, your chances of having a live baby at the end of one single cycle, from the beginning cycle, is about 21%. So one in five, something like that.

Andy Coulson: [0:05:52] Yes.

Lord Winston: [0:05:53] And the market doesn’t mention that, and now of course worse still they are selling egg freezing, and if you look at that, about 0.2% of eggs that are frozen will actually result in a live baby.

Andy Coulson: [0:06:07] Robert, that’s fascinating. Having brought such an important, fundamental issue out from the dark and into the light, what has it shown you? What has it demonstrated to you about human resilience? Because when you’re having that conversation about the odds of success, when you’re very happily- I suspect the much easier conversation when there is that moment of success, but then the so much harder conversation when the process fails, what has that shown you? What has that taught you about human resilience, if you like?

Lord Winston: [0:06:46] Well, I think actually towards the end of my clinical career- I’m still working, by the way, I still do research on embryos. But at the end of my clinical career, I retired from active medicine at 65 because unless you’re doing it full-time, you’re probably not going to do it properly, and I had a lot of other things I really wanted to dabble in.

But I think what you do, what I found I was doing in my 60s particularly in a clinic, was listening far more than talking. I finally understood actually, and it took a long time for me to understand, I think really by listening what I was able perhaps to do, insofar as I could do anything, was to actually help people find that resilience that you’re talking about.

Because actually you are going to fail a lot of the time, you are going to see people who are really actually gambling on a 1%, 2%, 5% chance of this treatment working, and really, you’ve got to prepare them for the fact that there’s a whole life outside there which has nothing to do with children. And that’s difficult to do when you’ve been fertile.

I’ve got three kids and I remember my six-year-old, we were sitting around the breakfast table one morning and he said two things. Because at that time IVF was very much in the press. He said, “Tell me, are more people born by the test-tube or by the other method?” And then about two weeks later, looking around the breakfast table again he said, “Aren’t we lucky, you’ve done it three times and we’ve got three of us?”

We were living in that sort of curious, bizarre world. It was a very odd thing. And I think that trying to help people recognise that you don’t have to have children ultimately to be happy, even though it’s probably the most fulfilling thing that we all do, because ultimately as you know, it’s the one life-changing event that we can generally go through apart from the loss of our parents, actually.

Andy Coulson: [0:09:01] Robert, you touched on the controversies there, that have been many over the years because of course the subject of fertility and of embryo screening provokes such strong emotions. There have been times I think in your career when that has got pretty extreme. You’ve had death threats by people who disagree with your approach, disagree with the work that you do.

Lord Winston: [0:09:26] The way to confront that sometimes was to come out- for example, I was repeatedly told in the media that I was playing God, and that was really a common phrase that people used. It was headlines quite often, you know? And so I said, “Well of course I play God, because we’re given a God-given intelligence and we have to use that intelligence to improve the lot of people around us and our own lot.” So actually playing God is a good thing, not a bad thing. So it’s bandying the words, of course it is.

As a result, of course, that resulted in the headlines, “The man who thinks he’s God,” or, “Here he is playing God,” or whatever. But on the other hand it did bring out the silliness of that into the open.

I think one of the things that really did help me though in the really early days was that particularly when some of the churches were so opposed to what we were doing, and were doing everything to bring campaigns into Parliament, and Enoch Powell with his private members bill and various other things were going on, I think one of the things that was really helpful was to demonstrate that actually I equally came from a faith position where actually fertility was regarded as being quite important but actually it was designed- I mean, for example, if you take the biblical sources, one of the interesting things that people never thought about-

In the book Genesis, interestingly called Genesis of course, which there could be all sorts of issues about that, but in Genesis we see four matriarchs; Sarah who is Abraham’s wife, then we see Rebekah who is Isaac’s wife, and then we see Leah and Rachel who are the next generation, Jacob’s wives. And of course, all four of those women are infertile. It’s really interesting to consider that. Seriously infertile. Sarah actually laughs about being told that she’s going to have a child because she says that it’s impossible, but it’s the angels. Rebekah has great problems in her pregnancy when she finally gets pregnant, with her two twins struggling inside her womb, as it says in the bible.

And what Rachel says, as the pretty wife of Jacob, she says something really interesting to him. What she says in Hebrew is, “Give me children or else I’m as good as dead.” And the husband Jacob replies, “Am I in God’s stead that I can help you?” i.e. dismissing her. He’s got lots of wives.

The reason why I mention this is because actually it’s a fundamental position which is in biblical terms used by the Abrahamic faith who were being so critical of what I was trying to do with infertility. And of course, showing exactly that this is a time-related, longstanding problem which has gone right through human history, that actually fertility has been a very serious issue in many different areas, in many different faiths, in many different religions.

And of course I was well aware, for example, that if you’re an infertile woman in parts of Africa, once you’re infertile you are abandoned, you had to leave the house. You are no longer in fact even a person. And if you couldn’t pregnant again you might not even have any support. So you were completely isolated. And that of course has happened in many parts of the world, it’s not just in Africa, it certainly was true in the Middle East as well. I’ve seen it first hand with some of the people I’ve treated, particularly from the Gulf States.

Andy Coulson: [0:13:01] Of course more recently you’ve found yourself getting criticism for having the audacity to give your opinion as a scientist, as a fertility expert, on the gender debate. For some, that’s put you on the wrong side of what it is to be progressive, at least for them.

But I listened to a BBC interview you gave in 1996, Robert, and you were asked, on a very respectable programme by a very respectable broadcaster, in pretty sniffy tones it has to be said, to justify why you thought it was right to offer fertility treatment to widows and, heaven forbid, lesbians.

Things change don’t they, pretty quickly?

Lord Winston: [0:13:46] I think I’m rather proud of that actually.

Andy Coulson: [0:13:48] And so you should be.

Lord Winston: [0:13:51] I think in Britain I was certainly the first person to offer lesbians treatment, and interestingly it came about when a very famous editor of a very well-known tabloid newspaper which will remain nameless actually phoned me and said, “We want you to write an article, maybe we’ll give you 1,00 words whatever, about why lesbians justify treatment with IVF.” I said, “Well, I’m not going to write that for you because you’ll plaster my article with all sorts of objections and negatives.” He said, “No, we won’t edit it, we promise we’ll give you the complete page.”

I thought, you know, “What have I got to lose?”

Andy Coulson: [0:14:35] And that was very much running against the grain. I mean, you mention-

Lord Winston: [0:14:39] Completely, yes.

Andy Coulson: [0:14:40] You mention the media at the time. But it was something that ran right the way through the kind of national narrative. That interview that I mentioned was not an interview with a tabloid newspaper, that was an interview on one of the most respectable programmes on BBC Radio. You were absolutely pushing against the tide in an entirely challenging context. You’re right to be proud of that, I think is what I’m saying.

Lord Winston: [0:15:19] Andy, I think I have to say something at this point. This is not me, don’t forget that we- we have this sort of celebrity culture which is such a bad thing, and it’s one of the reasons why we’ve had the wrong Prime Minister sometimes. Celebrity culture basically takes over, and it produces all sorts of ridiculous-

The fact of course is that I was extremely lucky. I had assembled a team around me that were hugely supportive, and actually more important than me, because had I had that conversation with them I knew perfectly well they would say the same thing.

And you know, I was lucky when I appointed people to the unit to find- I didn’t actually go for the best scientists, because I’m not a great scientist myself. I went for the people who I thought I would get on with, and who I felt were somewhat like-minded. We would go out for a meal or something.

I think actually, talking about resilience, one of the biggest ways of dealing with problems actually is to build things around you with people who you respect, who you think are valuable and actually can work in collaboration. And I think that collaboration is really important in terms of resilience, so it’s another thing that I would just drop in here.

Andy Coulson: [0:16:38] I think that’s absolutely right. It’s interesting, that’s come up in a number of conversations that we had, the importance of a sort of esprit de corps.

Lord Winston: [0:16:49] Yes. Of course you can still be misled and be wrong. I had that problem of course when I first treated somebody with HIV, which was hugely controversial. We filmed the conversation, it was filmed on television on a popular programme called Making Babies, and my whole team was opposed to me. I was horrified, because I had had three interviews with this woman in the clinic before deciding that really we ought to offer her IVF for various reasons.

When I told my team, and told them on camera because they were doing a fly-on-the-wall documentary, I got really negative responses and it took about six months before- I felt more and more confident that what I’d said to this woman I had to carry out. And eventually of course the whole team came round, but it took a while.

And I think that wasn’t brave, it was just basic real disappointment. And I think on camera, I remember giving an interview on the stairway somewhere which clearly showed my disappointment, because the cameraman had just chosen a remarkable backdrop which was this sort of curving staircase which was going downwards, and somehow it kind of was a visual metaphor I think for the fact that really we had to be much more open-minded.

Andy Coulson: [0:18:10] I’m really keen to talk to you more about the sort of transparency piece which you- you’ve been a pioneer on the scientific front, I think you’ve been a pioneer on the transparency piece, as we’ve already touched on, but I want to get into that in a little bit more detail later.

Before we do, Robert, crisis came pretty early in life for you. You lost your father Laurence when you were just nine years old.

Lord Winston: [0:18:31] I was eight, I wasn’t quite nine.

Andy Coulson: [0:18:32] You were eight years old. He was I think 42, an amazing man from what I’ve read, a true polymath. A diamond craftsman but also a very talented chess player and violinist.

It must have been an obviously terribly distressing time for you and your family when you lost him. When you look back now, do you think your early experience of grief armed you in some way for the profession you were to follow?

Lord Winston: [0:19:04] My father had been ill for about six months, and actually I think the grief wasn’t mine, it was my mother’s. And I think actually I hugely- I could see that my father and mother had a very vibrant relationship. It wasn’t an entirely normal relationship, easy relationship, they used to argue, they were quite volatile. But they were brilliant, because actually they were very happily married and I’m very sure they had a very strong sexual relationship too.

And basically I think I saw the grief of my mother as an eight- and nine-year-old as being how she dealt with it, and she was absolutely extraordinary. She wasn’t working, we didn’t have any money because my father didn’t expect to die and he was earning enough money, of course he was, but he didn’t leave anything that was very valuable. In fact she sold his possessions including his boat for next to nothing.

She was really, really short of cash and the family weren’t able to support her. She had to go out to work. She worked very long hours, she was coming home at sometimes 11, 12 o’clock at night later on, and I was by the age of 11 and 12 very much in loco parentis of two younger siblings. And I was very conscious that I had to protect her and try and see how I could be supportive.

I was then at a school which was a high-achieving school, St Pauls. I was entered there, but I was very conscious that they were paying fees for me and I knew that my sister had also got a place at the girls’ school. Fortunately we both got scholarships, so actually in fact that was a massive relief. But I was very conscious of the financial situation.

And I think truthfully the loss of my father was more important to me than I- I only now realise. It was basically, I really under-performed in the senior school, I didn’t really do anything very important at all. I learned to do things that I enjoyed doing like theatre and chess and stuff, but I didn’t get particularly good O-levels and certainly when it came to A-levels I don’t think they thought I would get anything like the sort of A-levels I got. I was told I wouldn’t be able to get to university.

So I was aware that I was not fulfilling expectations, and suddenly there was a crisis in the exams in the year before A-level when I suddenly realised that I really had to pull my finger out. I realised that I was not only letting my mother down, but actually letting myself down. And so I worked really for the first time, and focused.

And you know, that did at least give me decent A-levels.

Andy Coulson: [0:21:57] Decent A-levels, and you went on to university.

Lord Winston: [0:22:04] Not really what I wanted to do. I really wanted to read English because I loved English, but actually I ended up doing- I had a place to do Natural Sciences at Cambridge but it wasn’t for a year, and on the off-chance I thought I didn’t want a gap year because I really would need to earn some money.

And then I thought, “Well actually I could get a grant if I went-” because at that time people were still being called-up, so I was able to be called up- would still be, if call-up was necessary.

So doing medicine suddenly looked quite interesting and actually very glamorous. I didn’t do it because I wanted to be a doctor, really, I didn’t know what that really meant. But it just looked interesting. I was very lucky, various things happened and I ended up in a very junior post at Hammersmith but was fairly rapidly promoted and got a research project going and so on, so that was helpful.

Andy Coulson: [0:22:51] And you chose fertility despite those conversations about futility, because you saw- did you feel a- you’ve already explained why- it wasn’t just about the science, it was also this idea of bringing something that was in the shadows into the light.

Lord Winston: [0:23:14] That was a bit later on, because the first research I did was not related to fertility at all, it was related to various micro-organisms which cause problems mainly for women, and also some problems in pregnancy with blood clotting. So it was a little while before I got around to fertility, but then I realised that there was a wide-open field. And actually, quite truthfully this is not in anyway making myself grander or less grand, but I suddenly thought actually there was no research going on in this, there was a vast amount of research to be doing. And you know, if you’re not brilliant, why not go into an area where there is not much competition?

It was a good decision actually, and I think it’s advice that I would give to young people still today. IVF was not thought about as being serious as a possibility. I had fertilised embryos in the past as a schoolboy, because I’d done that with sea urchins when I was 16, so I’d seen embryos developing under the microscope, which turned me on to biology, but I never thought we could do it in humans because everybody said it was impossible.

But it’s odd that 20 years later or so IVF came up on the books and suddenly there was that revolution. But before that of course I was doing a lot of work on the Fallopian tube, which was a key part of fertility because that’s where we all actually are conceived, actually in the Fallopian tube, not IVF. So I did a lot of work on physiology and that was published in quite good journals, and that really sort of gave me a minor reputation. And then of course trying to change the surgery made a big difference as well.

Andy Coulson: [0:25:01] You weren’t certain about IVF as a process, were you, when it started?

Lord Winston: [0:25:04] No, I wasn’t at all. Even after we had the first babies in the unit. You know, when we started, in the first three or four years very few babies were born after Louise Brown, only a handful. Everybody was trying to do it, but it was unsuccessful. I was hugely lucky because I met up with a man called Stephen Hillier who was absolutely just amazing. He read an advertisement that I put in Nature that I wanted somebody to help me as a scientist, and the reason why- he came along, and the first thing he said at interview was, “Of course, I know nothing about IVF.” But of course what he had done was to do extensive work on hormones, and that was the secret. The big secret that really got it going was how you controlled the hormones to make a viable egg possible, and regular fertilisation.

That, plus the help of Anne McLaren, who was a fantastic scientist, one of the great female scientists of her generation, who had done this in mice, that was really significant. And so that really was encouraging.

You know, everything depended on other people. And Steve Hillier who just basically realised we had to change the entire environment in which we were working, and so on, and that made a big difference.

Andy Coulson: [0:26:21] It’s quite a thing, though. You were having success, getting recognition for your approach which was focused on the Fallopian tubes as you mentioned. You’re seeing things happening from the IVF perspective, you’re doubting that, but then presumably there’s a moment when you say, “Actually I’m wrong about this, and I’m not afraid to say so, and I’m going to change direction here.”

That’s quite a- particularly in the scientific field, to do that was quite a big decision for you, presumably.

Lord Winston: [0:26:57] It’s interesting, because actually looking back, by that time I’d done the world’s first Fallopian tube transplant, which I didn’t ever talk about. But of course in real terms, surgically it was quite a demanding thing to do. And the tube was open after the surgery too, and the woman didn’t get pregnant for various reasons but she might have done.

So I was still trying to ride on two horses, really.

Andy Coulson: [0:27:30] To make that decision, is that another piece of advice really, that we should be giving here? That even when you are progressing, and to an extent being lauded for the approach that you’re taking, to keep an open mind that it might not be the one where you should focus your time, effort and career in the future.

Lord Winston: [0:27:49] Yes, I think I irritated the hell out of the people who were trying to do IVF, though. I think that I made a lot of enemies because I was saying that IVF is never going to work sufficiently to work in the NHS, because it’s never going to be successful enough. You know, it’s going to be too specialised.

I didn’t have the vision that actually this is what the NHS actually could do quite well, which was actually to find the time and the space to do specialised medicine. I now think that clinical academics actually really advance specialised medicine by doing exactly this.

And of course perhaps in that sense I was lucky because I was at the Postgraduate Medical School where the chance of being a successful clinical academic was really, really helpful. Because people there didn’t really care very much about how much you were doing clinically: if you had an interesting idea that you wanted to follow, they were very supportive. And I was given space, I was given a certain amount of ability to raise funds and so on, and I was just very lucky with that department.

Professor MacLeod-Brown, again, he was one of the great people. He was very retiring, a very modest man. I remember once I wrote a paper where I’d done most of the work but he had been very much the brains behind what I’d been doing, and I brought the paper into his office to say- at the top it said Winston and MacLeod-Brown, that’s what I’d labelled it, and he said, “This is a great piece of work, there’s one thing seriously wrong. You’ve got my name on it: take it off.” And I said, “But you’ve been really important in this, I couldn’t have done this without you,” and he said, “No, it’s not my work.” I actually argued with him, and finally he said something really amazing. He said, “Well, I’ll allow you to submit it to a journal. Where are you going to submit it, Nature?” which is one of the top journals. “But if you do that, I have to write a letter to the Editor to say that I had nothing to do with the work.” And he bloody well did that, too.

Andy Coulson: [0:29:59] Yes, yes. An important moment for you.

Lord Winston: [0:30:02] But it was published immediately. I mean, it was extraordinary. It went through peer review in a matter of three weeks and was for me a very big paper, actually. Nothing to do with IVF, but important.

Andy Coulson: [0:30:16] Yes. Your work, as we’ve already touched on, came under serious political attack in the early ‘80s. At one stage you were described as ‘evil’ by the Catholic Church. Your work on embryo research I think was the focus.

As I touched on in the intro, that might have caused you to say, “Well, you know, I’m going to go back in the lab and do my work, and I shall just concentrate on what I do, and we’ll make the argument from a sort of scientific perspective only,” but you didn’t do that. As you’ve already mentioned, you invited the TV cameras into your lab at Hammersmith Hospital, you opened up. That was a very, very high-risk approach.

Give me a sense of what your thinking was at that moment, because as you’ve already mentioned, even your team were reticent, concerned about you taking that approach. What was the sort of driving thought in your mind, there?

Lord Winston: [0:31:16] Oh gosh, I think irritation, anger. There was Enoch Powell who was presenting this private members bill to Parliament, which I thought would destroy IVF working anywhere in Britain and leave us way behind, if not world-wide eventually, because it was so- it was doing everything to prevent embryo research which of course was how IVF was developed.

Andy Coulson: [0:31:42] Robert, you joined the House of Lords as a Labour peer in 1995. You said that you hated the first six months there. It sounds, from what I’ve read, that those first six months felt like another one of those mini work crises, essentially that you had a form of imposter syndrome. Is that right?

Lord Winston: [0:32:03] It’s very interesting, because I was asked- I didn’t know that my name was in Downing Street at the time, and I was asked by the leader of the Labour Party, “We’ve been reading your stuff, you seem to be quite favourable of the Labour Party, would you-?” he asked me if I would support the Labour Party in its debates or perhaps even speak with them. I said, “Yes, quite probably,” and he actually said, “Why?” I said, “Well, I’m a member of the Labour Party,” and he said, “Are you sure?” That was the conversation.

So I didn’t go in as a cross-bencher. And I found out that Tony Blair was very supportive of my nomination, but I didn’t really ever speak to him before that so I had no idea that was, you know.

Actually my wife was very opposed to my going into the House of Lords at all, and said, “I’ll never see you again.” She said, “Look, I don’t want to be a Lady.” She was a very modest individual, was Lira, she wanted family life. We were married for almost 50 years, just a year short, and she was pretty amazing because she put with me actually choosing that decision, and never complained about it.

Andy Coulson: [0:33:25] Robert, your wife Lira very sadly died a year ago. In a very moving speech earlier this year in the Lords you explained how, as she was dying in your arms, you were shocked by the response of the 999 operator. Can you tell us what happened?

Lord Winston: [0:33:50] Yes. It’s something I don’t want to go over too much because frankly, you know, obviously would it have made any difference? I don’t know. But the operator at the other end started to quiz me about my wife, and I was trying to say, “Look, she’s critically ill,” but of course I had her in my arms and I knew very well that the last thing you lose as you’re dying or going under anaesthesia is words and the voice, and you understand what’s being said to you. So I was very conscious, I didn’t want to say, “Look, she’s dying.” I didn’t want to say, “This is a catastrophic emergency,” or anything like that, but I knew that she was about to have a cardiac arrest because her breathing changed.

I tried to say, “Look, her breathing has changed, she has Cheynes-Stokes breathing,” I said. I didn’t say I was a doctor. The guy on the other said, “Count the number of breaths she’s having.” I said, “There isn’t time for me to do that. I need the ambulance emergency.” He said, “What’s the interval of seconds between each breath?” I said, “Look, this is not important. She is breathing irregularly. It is needed now.” This conversation went on and it seemed to go on for hours. It probably didn’t at all, it was probably seconds, they’ve probably got a recording of it somewhere I don’t know, because I think they do record these conversations.

Anyway, when the ambulance arrived of course it was too late, but it probably would have been anyway. There was a lot of COVID going around and it took I think about 18 minutes which was just a bit too long, really. So when the paramedics came, they were over-anxious and they actually kept going for far too long. They were really not prepared to give up, they didn’t want to give up. Eventually I had to tell them, “Look, you’ve done all you could possibly do. You’ve put up a drip, you’ve cardioverted her, it’s not working, and I totally accept that she’s dead.”

And you know, I think at that time, there are so many emotions you go through. You think it’s your fault, and I thought afterwards that I could have called a private ambulance. Bizarrely a few weeks earlier she had actually stuck a notice up of a private ambulance phone number, which she thought if we ever have an emergency that might be something that we should consider. I didn’t remember it, even stuck up on the kitchen door behind me.

But you know, you start thinking stupid things. I remember I had an argument about something totally trivial two days beforehand. Basically it was something she had said to me at a dinner party with other people present that I’d rather she hadn’t said, and I thought she said it in the wrong way, and when we got home I argued with her and she didn’t respond. And actually when she did respond I didn’t say anything, and then after she died I realised I never got around to apologising to her. Which is stupid really, because of course it didn’t matter, it wasn’t important. But you know, it was those sorts of things.

So one’s grief is not obviously very obvious, and actually I don’t think- I think my grief wasn’t very obvious at all at the time, and to some extent probably still isn’t. But it’s a massive gap, it is for anybody, and it sort of teaches you how people respond to loss in very different ways.

One thing is, you start wondering if your own life is worth continuing. It’s obvious that you think about that. But what do you learn? I don’t know. I think people learn different things and people react to grief very differently. Some people bottle it up and that may be a good or bad thing, and sometimes they’re very open and that may be a good or bad thing.

I think maybe now it might help me a bit dealing with other people’s grief. Probably not much actually, because I think I’ve seen grief in the fertility clinic in a way that I do understand, and realise that actually we have to recognise that sometimes grief means termination of something and moving on.

And I think with invitro fertilisation some of the most important things you can do, I really believe this very strongly, is actually to refuse to treat somebody when they really want treatment. It’s high-handed and it’s very, very opportunistic, but if you think they’ve got a fraction of 1% or whatever it might be, and really this is just going to go continuing damaging- they’ve tried seven times, it’s really time to try and say, “Why don’t we shut the gate? Why don’t we look at some of the other things?”

I think some patients benefit from that conversation and some don’t. Because if they don’t benefit they’ll ignore your advice and go somewhere else.

But we’ve unfortunately sold invitro fertilisation, which has really, really become now the only treatment for infertility, and it really isn’t. And I think that has not been helpful. And I think sometimes people go into invitro fertilisation not getting properly investigated, and half of them fail and half of those people get pregnant spontaneously anyway, eventually.

Andy Coulson: [0:39:05] Robert, first of all I’m so sorry for your loss. That’s the first and most important thing I would like to say, on my behalf and on behalf of everyone who is listening to this I’m sure.

The second thing I would like to say, in answer to that question how does one find purpose after such a loss, your work is so fundamentally important to so many people, that is presumably- your family of course first and foremost, but presumably the answer that comes pretty quickly to you. You are still working hard on trying to solve that crisis of infertility still for so many people.

Lord Winston: [0:39:51] Well yes, I’ve interrupted you, sorry. But I was going to say that with the wonderful Sheba Jarvis who is my closest colleague, we’re working on a project which might really improve invitro fertilisation, but I’ll tell you what I have found, which is something I was doing while Lira was very much alive, and I was doing it increasingly. I was doing a lot of schools outreach.

I get huge pleasure from talking to schoolchildren of all ages from 6 up to 18, about ambition, about fulfilment, about getting out of the environment that they may have found themselves in, and so on. And talking about success and failure as well as talking about science.

I’m doing this a lot, I’m doing this several times a week. Part of the thing that I do is go into schools all over England, the North of England, North East, North West, and I go wherever schools invite me. So if a school invites me I try and go, because actually I find- obviously I don’t like long train journeys, and sometimes you think, “What the hell are you doing?” But when you get there, I just find that contact with young people rewarding to me, and sometimes I think it actually really does make an impact for them.

So that’s something which I’ve really been quite energised by. And it turns out that actually- of course, my wife was heavily involved with education anyway, professionally, and so actually it’s sort of in a different kind of way continuing this notion about education and opportunity.

I do wish the government would stop talking about levelling up, and recognise that levelling up of course is needed simply by improving education. If we just improved primary school education we would do so much to level up in a way that we don’t do other ways. But tinkering at the outside, that’s how you change people’s futures, because they then change their own environment. Unfortunately governments can’t do that very much because it’s so costly, but actually we could do much more by focusing it on the education particularly of the youngest, from primary school particularly, early on in primary school.

At the moment we don’t value primary school teachers nearly enough, because they have an immeasurably hard job, particularly in the deprived parts of the country where most children are going home to a house without a single book.

Andy Coulson: [0:42:31] Yes. We don’t respect teachers enough, full stop.

Can we go back to the science? Are we heading towards, or perhaps we’re already in a crisis with regard to genomics? Are you concerned about the direction of travel and the speed of travel with genetic engineering in particular?

Lord Winston: [0:42:54] It’s a very topical question, because at the moment we’ve got this bill going through Parliament which is the Genetic Technology Precision Breeding Animals Bill, which is being promoted by DEFRA. But essentially of course it’s a science bill because actually it depends on the science working. And the problem of course is that DEFRA sees it as a way of releasing organisms into the environment.

Unfortunately very few of us are really fighting this, because the science is very far from certain and the idea that you can have precision breeding is a nonsense. The word ‘precision’ is complete nonsense. You talk about precision medicine. You can’t have precision biologically because the very nature of biology is that what you do is unpredictable, and sometimes it will work and sometimes it won’t.

So to my mind the government are at risk of running into something at the moment, of course the bill is still going through the House of Lords, which actually is open to all sorts of imprecise things that we can’t predict. But unfortunately the government of course are not scientists, they don’t have a scientist who is speaking.

There’s a perfectly nice Minister who is a good person in the House of Lords who has no scientific background, and he is I think one of our intelligent Ministers. He’s a good person, he is listening, but of course the science that he’s being fed doesn’t seem to me to be accurate from the literature of the science that I read or from my own personal experience in the laboratory.

So you know, we’ve been fighting until quite late in the evening on the committee stage, it’s had no publicity to speak of, but actually I think it’s time perhaps that people realise that this does need very careful thought and very careful legislation so that actually there isn’t a risk of either releasing plants that might be dangerous, or animals that might be dangerous in different ways to the environment or to other animals, and of course to human health.

And of course, I’m not convinced entirely that the government have got that right, and I think therefore- when people are talking about abolishing the House of Lords, suddenly I find that I’m a lone voice, because I’m almost the only scientist talking in these terms in a government bill. And you suddenly think, “Well, there’s a real point in having some experts in Parliament.”

So it’s given me a kind of lease of life really in the last couple of days. It’s ridiculous to say that because I’m doing other stuff, but it’s just an example of where I think we need to be a bit more cautious about things which- scientists are very ready to be quite certain. They don’t like uncertainty. Of course, we had to face it during COVID but we’ve already forgotten that.

I’s important that we do remember that actually what we do often has completely unpredictable consequences, and the classic example is the one that we’re most facing at the moment, which is climate change. And the reason why we’re facing climate change of course is because of our science and the technology which has developed from the science back in the 18^th, 19^th Century.

The Industrial Revolution is really the prime reason why we’re now fighting like mad to try and work out how we deal with the issues which science and technology have raised. And I think we have to be really cautious in that respect, because you know, we could certainly make animals that might be resistant to climate change, we might be able to make plants particularly that are resistant to drought and disease-free. But in doing so we might breed other diseases that we aren’t predicting.

So you might make a herd of cattle completely resistant to a common disease like foot and mouth, but then suddenly that herd might be wiped out because you’ve found another virus which is more prevalent.

And we should be learning from the Coronavirus because that actually of course probably came through animals like the pangolin and the bat, we don’t know. And therefore I think we have to recognise that whilst- I’m not certain about what I’m saying but I think there’s a need to be cautious. Of course I want to see animals being bred in the best possible way, of course I’d like to see plants which are really helping the developing world to gain nutrition. But actually for the moment, the farming that we’ve got is pretty reliable and can be profitable. Of course actually the government wants to make a lot more money with the industrialisation of these new technologies, understandably, but one has to accept that every time we do that there are risks with technology that we need to be very, very conscious of.

Andy Coulson: [0:47:52] And your view in that context absolutely carries across, I suspect even more so when we look at the human genome. Your view is, you mess with that at your peril.

Lord Winston: [0:48:03] I agree absolutely. I think it’s really something we shouldn’t do, because the real problem is we’d be messing with the human embryo and there’s a human embryo potentially there and that embryo can’t give informed consent for what you’re doing. And to my mind that’s critical, because our ethics depend on one of those key principles: the understanding of the technology, the informed consent, and the real concern that you might be damaging rather than improving life.

Andy Coulson: [0:48:35] Does your sense of- is ‘crisis’ the right word to use on this topic? Do you feel a sense of crisis from where the science is heading on this?

Lord Winston: [0:48:44] No, when my colleagues- some of them at the Crick Institute talk about precision and precision medicine, I think they have to understand that in biology, and certainly human biology particularly, there’s no such thing as precision. We can improve things with DNA technology and gene technology and so on, but we improve them, it’s not perfect.

There are very few genetic diseases, more than 20 years on from the Secrets of the Human Genome, which we greatly talked about, which have actually really been improved massively by this technology and resulted actually in huge numbers of cures. Yes we’ve made great strides, certainly we have improved some cancers and many other examples as well, but there’s a hell of a long way to go.

At the moment I’ve got really bad eyesight and in fact I’m going to have- because I can’t read, my next stage in my treatment is to have an injection of some modified cells into my eye to try and repopulate my cornea in both sides. Of course, I realise that that might be a gamble, it’s not precision. I’m told it’s likely to work but it doesn’t work every time and it might make things worse.

So I think, you know, we have to be much more aware that we’re likely to seem arrogant, and I think arrogance in any expertise is very dangerous. It’s particularly dangerous in science because science depends on uncertainty. We do science because we’re uncertain, that’s why we do it.

Andy Coulson: [0:50:29] Yes. Robert, thank you so much for your time today. We end every podcast by asking our guest for their three crisis cures. I hesitate to use the word ‘cure’ in the presence of an eminent scientist, but these are three things, can’t be another person, that you lean on or have leant on through the tough times.

What comes to mind when I ask for your cures?

Lord Winston: [0:50:56] I think find mentors who you trust. Anne McLaren was a very good example, I think, a brilliant female scientist, there should be more of them. I think work in collaboration with a team of people who get on. And I think a mixture of being persistent but also recognising failure is really valuable, because failure teaches you to do it better next time.

Andy Coulson: [0:51:25] Reacting to the failure. Accepting the failure and being prepared to change course.

Lord Winston: [0:51:31] Mm.

Andy Coulson: [0:51:31] Super. Robert, Lord Winston, thank you again for joining us on Crisis What Crisis, we really appreciate it.

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