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Lords, Supermodel Ladies and Super-Rich Gentlemen:

I was thumbing through one of the glossy magazines this evening when I came across a question posed to one of the new relationship embarked upon by one of the supermodels – “could you let the readers known just what is was that attracted you to multi-millionaire Mr XXXXX ?”

I suppose we all think we know the answer to that one. But what if she answered that it was actually Mr XXXXX’s profound knowledge of the plays of Christopher Marlowe that was the basis of the attraction ? “Pull the other one” I can hear you say. People aren’t that gullible, are they !. Well, it is one of life’s truism that people are, or certainly can be.

So many irrational and odd things certainly seem to happen. The Terminator is now Gubernator of California. We pay vast bills for our mobile phones in order to talk a lot of twaddle and in doing so make the mobile phone network industry among the richest in the world. Unlike in the USA, where multi-millionaires tend to build a new wing for a hospital or a university, here they tend to buy football clubs and spend millions on paying top footballers wages in excess of £100,000 per week. The 2003 Conservative Conference cheers and applauds a speech commending a man who shot and killed a burglar. The UK MMR programme is wrecked as a result of focussing on some none too convincing research and exchanges protection against these rather nasty diseases for a mumps epidemic or two (with a few extra-ordinarily painful testicles and ovaries thrown in). We seem to think that public services can be paid for out of thin air. We smoke tobacco. We ignore the ever-present risk of emerging and re-emerging infections and only get upset when the media tells us to get upset, as was recently the case with SARS.

This last point indicates why the new House of Lord’s report “Fighting Infection” is so welcome.1 There might be a few multi-millionnairies in that exalted chamber, but this is splendid document that builds upon “Getting ahead of the curve” and the documents emanating from that equally splendid tome. To quote the report – “…recognition of the size and threat of infection to national and international populations, and of the number of new, as well as currently rare infectious diseases such as SARS which may spread rapidly, underlines the importance of establishing robust national and international structures”. It clearly tells anyone who will listen that we need to take infection seriously, that we need to have enough skilled people and adequate services in place, that we need to beef up our public health and surveillance services, and that we need to have effective clinical expertise in infection medicine in all parts of the country and not just in those areas fortunate enough to have enthusiasts living and working in their patch.

Should we believe what “Fighting Infection” has to say ? In my view at least one consequence of ignoring it could be Armageddon ! Despite the icebergs, it has taken a mere 22 years for HIV numbers to grow from perhaps 100,000 cases world-wide in 1981 to more than 42 million, and who knows where it will end ? Ask yourself this – was the plot of the film “28 Days Later” really so far-fetched ?

There certainly are gaps around the country. There has also been some movement towards filling those gaps. New consultant posts are being created: two new Microbiology Consultant posts are being advertised in Sheffield as I write, and a new Infectious Diseases service is being created in Brighton, one of the UK’s larger cities and site of a new medical school. Both NHS and academic ID trainee posts have been springing up in many parts of the UK such as London, Sheffield, Glasgow, Middlesborough and Cambridge. There is also a constant flow of microbiology trainee posts in many parts of the UK, although some have been hard to fill. Very encouragingly in my own opinion, joint ID/Microbiology and ID/Virology training posts are also sprouting up in various places, and the quality of applicant where they have appeared has been, encouragingly, very high indeed. However, looking to the future I personally find it a worry that some of the new medical schools – specifically East Anglia (Norwich), Peninsular (Exeter & Plymouth), Warwick (Coventry), Swansea and the York end of the Hull-York Medical School – currently have no NHS or university staff working in Infectious Diseases/Tropical Medicine.

So – where to from here ? Infection Medicine in all its forms needs to be promoted whenever and wherever we can promote it. Microbiologists, Virologists, ID Physicians, Tropical Physicians and CCDCs need to make common cause whenever and wherever they get the opportunity. When it comes to the eternal battle between the human organism and the billions of infective agents lurking out there, you cannot do things properly without the laboratory level, the bedside level and the societal level all being attended to. This will cost dosh, but can we really afford not to take things seriously ?

Anyhow, if we all slim down to supermodel proportions, we might be able to attract enough multi-millionaires to pay the bills!Reference: House of Lords. Science and Technology Fourth Report, July 2003. http://www.publications. parliament.uk/pa/ld200203/ldselect/ldsctech/138/13801.htm