by Chloe H., Year 11
Fiona Marley is a Senior Health Executive at the NHS with over 30 years of experience in the field of Highly Specialised Services, known most notably for her role as Ex-Deputy Director, who took the time to join us in our second Rosewell Lecture of the year.
She focused on three key areas of her recent work: the control of the outbreak of Mpox in the UK; gene therapy in the treatment of Spinal Muscular Atrophy; and an innovative surgery for Spina Bifida. All three of these had their own distinct impact on me which I have summarised below.
Firstly her lecture gave me, an aspiring medic, further insight into the running of the NHS and all of the different roles within it. Through her explanation of Commissioning (the process of assessing the healthcare needs of individuals and consequently putting in place services to meet them), she highlighted how it takes a truly varied team of people to control the outbreak of diseases such as Mpox. This made her lecture appeal to a wider audience as she mentioned jobs that many people of my generation aspire to, such as lawyers, accountants and those in marketing. This surprised me and hopefully many others, as I did not realise the scope of the NHS and how it has a place for everyone’s unique skillset. She also focused on how Mpox spread so quickly, with it beginning in asymptomatic animals such as monkeys in two main areas – Central and Western Africa. Then, through the bursting of lesions, it is transferred to humans who experience symptoms such as a rash and a fever. She mentioned how this then spread to other areas such as the UK and the precautions that were put in place to stop an epidemic. This felt particularly poignant as she related it to the spread of COVID-19, helping us to understand the true importance of an early response to these kinds of diseases. This led me to question which factors held the most importance when making these early decisions without much evidence to guide them. Her response to this was that they look at patterns from past diseases as well as what is feasible in the individual cases. However, one of the main things that I learnt from this segment of her lecture was the reason why we now call it Mpox instead of its former name, Monkeypox. She explained that its previous name held racist implications as well as leading to misinformation (with people believing that Monkeypox could only come from monkeys), so was changed to Mpox instead.
Fiona then shifted her focus to a new treatment for Spinal Muscular Atrophy (SMA). SMA is the consequence of a genetic mutation that leads to SMN1 protein deficiency and although only around 2,000 people have this condition in the UK, around 1.7 million people are carriers of the altered gene. This condition primarily affects movement; however, a new form of gene therapy known as Zolgensma has been created. This delivers a replacement gene by intravenous methods so that the new SMN1 protein is produced. Fiona presented both the advantages and the disadvantages of this new treatment as well as mentioning briefly the discovery process of new drugs and how they come to be on the market. Despite Zolgensma having a much higher cost than its competitors, as well as causing potential liver harm, it is a one-time treatment and, if given before the age of two, can have a profound impact on the individual. This topic was what I found most moving about her talk as she really focused on the joy that this treatment can bring and how her work is genuinely changing lives, leaving me feeling very inspired and hopeful for the future in what can feel like an increasingly pessimistic world.
Finally, Fiona talked about a new surgery to treat Spina Bifida in the womb. This condition affects the renal tube and can lead to loss of movement in the legs as well as bone function. However, the new method of treatment that she described begins by, similarly to a C-section, a team of surgeons who will cut into the womb, then treat the Spina Bifida of the baby whilst inside of the mother, close with stitches and then allow the mother to carry the baby to term and deliver naturally. This surgery has only been performed a few times due to the high levels of expertise required from the surgeons. Moreover, Marley presented the link between healthcare and socioeconomic factors as she mentioned that many people would have to travel far distances whilst pregnant in order to access this surgery, making it hard to perform on a wide range of people. She did however say that she hopes that more people can be trained to perform this type of surgery in the future, making it more accessible across the continents. This topic also led me to wonder whether this type of surgery could be used to treat other conditions in the future and I would like to hear more about these types of treatments.
In conclusion, I am very thankful to have learnt from Fiona Marley’s expertise and I am excited to see what her future endeavours include.