How do you describe your job when you meet people at a party?
I have two answers – a polite one and a truthful one. If I’m at a sherry party, I’ll say I’m in medical research. If people ask for more detail then I’ll gradually reveal the unsavory details. People usually have two responses, either they burst out laughing, or they have a serious reaction and say “that must be terrible!”.
What is ‘cutting-edge’ about your work?
The first thing I would say is that people imagine that surely the technology [for incontinence] must have been sorted out years ago. They assume that since disposable baby diapers are very good compared to 20-30 years ago, surely the same benefits will apply to adults. But unfortunately that’s not the case. In academia it’s common for someone to have a set of expertise and apply those tools to multiple problems. What’s unusual is we do things the other way around: we have one problem (incontinence) and we focus all our expertise solely on that. We simply see what we can do for people who are incontinent. We round up a range of expertise to apply to that one particular area. For example, we’ll discover and be made aware of a particular problem – one we’re tackling at the moment is that many people wearing pads suffer from skin problems. So we look at the prevalence and exact nature of that problem, the parts of body affected etc. We develop methods for measuring friction between skin and pad materials which then leads us to build mathematical models to understand those interactions. We’re then able to talk with a major company we’ve been working with to develop fabrics that are kinder to the skin. Controlled clinical testing causes us to come up with methodologies and mathematical modeling. It’s quite unusual to do that all within one team. There is a lot of work being done trying to cure incontinence, which is not so much a disease, but a symptom of lots of things. Incontinence is a lot to do with the degenerative aspect of getting older. A lot of the available treatments or cures are inappropriate to apply to older people, or not successful – i.e. an operation or drugs when they’re already taking a lot of other drugs. What we are focused on is what can we do for people who can’t be fully cured. In nursing homes something like between two-thirds and three quarters of people are incontinent. Incontinence is second only to dementia in terms of being the deciding factor to move people into a home. But there are many people who are younger and suffer from incontinence. In the UK, somewhere around 5-6% of the population has a degree of incontinence. Two-thirds of that are women under 60. Incontinence is not just a problem of the elderly. That said, most of the people with a severe problem are elderly. They consume a bigger share of the NHS expenditure for an increasingly older population. The elderly is the subgroup of the population which is increasing the fastest. For the younger incontinence sufferers, the problem falls into two categories: 1. Stress incontinence – this is not psychological, but mechanical stress (i.e. caused by coughing, aerobics, lifting heavy weight…) 2. Urgency incontinence – the bladder announces that it wants to empty but gives you less notice than you’re used to. This afflicts the older end of the young spectrum, but it’s common to have a mix of two types.
What are the biggest implications your work will/could have in the future?
There are a number of ways of looking at that question. There will be piecemeal nibbling away at the same problems. The existing technology still has limitations: adult pads leak far more than baby diapers do. Disposable baby diapers don’t leak. We’re still aways from that with adult products. There is still a need for chipping away at these problems. Another important thing we’re trying to do is develop a quality of life tool for developers. It’s become quite common for people to measure the impact of disease on quality of life (i.e. heart disease, etc.) One of the drivers for this is economic. If the government has a certain amount of public money in the pot and they can choose to buy either 100 artificial legs for amputees or 1000 hearing aids for people….which do they choose? How do you work out where the priorities are? There are a variety of people and pressure groups who will try to influence the spending, but how do you decide whether an artificial leg or hearing aid will improve someone’s quality of life more? One of the things that’s happened is a tendency is to think in terms of symptom reduction or removal. But if you wear an effective pad you still leak as before. How well is that symptom managed for quality of life? We want to develop a way of measuring – if you buy this pad and it costs 15% more – what is the quality of life it delivers? This kind of tool gives us an incentive to come up with products that work better and deliver a better quality of life. One of the problems you have with incontinence is it doesn’t kill people. But incontinence robs millions of people of quality of life. Endless numbers of people are reclusive because the last time they visited their friend they left a damp patch on the sofa and they don’t want to risk that again. If we can see ways of highlighting that and showing how more expensive technology delivers a better quality of life then we’re on the right track – the alternative is that an incontinence pad becomes just a commodity and people opt for the cheapest one. Supposing I’m incontinent and if it’s not managed well, I’m 10-20% less productive in my work. Or as an elderly lady the joy of my life is attending the mother’s union but now I can’t. We’re trying to find ways to raise these kind of quality of life profiles and we need to develop measuring tools to do that.
Describe some of the highlights of your average day.
I’m very much a teacher. I enjoy actually enabling people to understand something. I get a tremendous kick when the penny drops for students and they engage with something. The whole process of how you communicate and teach – get people to see how things work and are drawn in – the moment of light is really rewarding. This is true in routine teaching, lecturing, writing… if you can take a quantity of material and make it accessible and relevant. I get a tremendous thrill out of making a difference. I frankly don’t get nearly so much as fun seeing a paper published in an erudite journal as making a difference to people. A more specific highlight: the national purchasing policy for the NHS (for incontinence pads) is based on our work. That equates to a lot of people around the country wearing what they’re wearing because of our work. Something else that’s a thrill is there’s a successful well-known product for incontinence on the market that we designed called Kylie pants.
Describe briefly how your career has progressed to date.
After my PhD I switched my focus to medicine and moved to Sussex University to conduct a project for EPSRC to determine research funding priorities in Biomedical Engineering and identify an area for my own future work. During this project, data became available from the first ever substantial epidemiological study on urinary incontinence which revealed that it affected some 3.5 million UK adults. This area just grabbed me. My attention was a drawn to the subject by the crudeness of the incontinence products then available, as well as great encouragement from two leading urologists and the fact that there wasn’t a single entry in the “incontinence technology” section of the directory of current UK research I compiled. Initially I worked at Sussex but I moved to UCL in 1984 to work with Professor James Malone-Lee (geriatrician) and Dr. Many Fader (nurse), people with whom I continue to collaborate today. Together we have conducted a sustained multi-disciplinary research programme aimed at improving the quality of life of people with intractable incontinence.
How is your job cross-disciplinary?
I spend quite a bit of time being multi-lingual, speaking with people of different tribes. The primary people that deal with incontinence are nurses not doctors, so I need to spend a lot of time understanding them. My scientific jargon doesn’t make sense to them. There’s a lot of interpretation that goes on. I do a lot of speaking at conferences that are not peopled by my peers, where there’s a room full of nurses and industry executives. You come across somebody who you suspect may have a solution to your problem, but you have to couch the problem to them so that they realize they have the solution to the problem. Probing each other’s worlds can cause many fruitful collaborations. But in my experience, collaboration is more often talked about than practiced. Unless you adopt the philosophy that you take your piece of work and throw it over the wall for someone else to look at and throw back…but it’s much better if you actually work together.
How do you see your field developing over the next 5-10 years?
There are a number of ways of looking at that question. There will be piecemeal nibbling away at the same problems. The existing technology still has limitations: adult pads leak far more than baby diapers do. Disposable baby diapers don’t leak. We’re still aways from that with adult products. There is still a need for chipping away at these problems. Another important thing we’re trying to do is develop a quality of life tool for developers. It’s become quite common for people to measure the impact of disease on quality of life (i.e. heart disease, etc.) One of the drivers for this is economic. If the government has a certain amount of public money in the pot and they can choose to buy either 100 artificial legs for amputees or 1000 hearing aids for people….which do they choose? How do you work out where the priorities are? There are a variety of people and pressure groups who will try to influence the spending, but how do you decide whether an artificial leg or hearing aid will improve someone’s quality of life more? One of the things that’s happened is a tendency is to think in terms of symptom reduction or removal. But if you wear an effective pad you still leak as before. How well is that symptom managed for quality of life? We want to develop a way of measuring – if you buy this pad and it costs 15% more – what is the quality of life it delivers? This kind of tool gives us an incentive to come up with products that work better and deliver a better quality of life. One of the problems you have with incontinence is it doesn’t kill people. But incontinence robs millions of people of quality of life. Endless numbers of people are reclusive because the last time they visited their friend they left a damp patch on the sofa and they don’t want to risk that again. If we can see ways of highlighting that and showing how more expensive technology delivers a better quality of life then we’re on the right track – the alternative is that an incontinence pad becomes just a commodity and people opt for the cheapest one. Supposing I’m incontinent and if it’s not managed well, I’m 10-20% less productive in my work. Or as an elderly lady the joy of my life is attending the mother’s union but now I can’t. We’re trying to find ways to raise these kind of quality of life profiles and we need to develop measuring tools to do that.
What’s the most unexpected thing about your job?
Something that surprised me was that there was nothing being done when I first got into the field. I naively imagined that there would be this body of data and established standards etc. When you’re trained in engineering this is the norm, but no, nothing like that existed. It’s been a mixed blessing. Because they’re so few people doing this you can have quite an impact. If you’re in a field with tens of thousands of professionals, it’s harder to make a mark. But making progress is harder because we have to start from scratch.
What’s the biggest achievement of your career so far?
There are a couple of conferences that I chair that I also developed myself. I was on the Institute for Mechanical Engineers committee when the then-chairman said, “Why don’t you run a conference on the latest technologies in incontinence?” When I told him it would be a very short conference, he said, “Why don’t you do something to produce fresh interest?” I came up with a crazy scheme for a conference (called Incontinence – the Engineering Challenge) which runs every two years in London – we just held our 7th one. Until two to three years ago it was the only conference on incontinence. I now do a similar conference in the U.S. The point about these conferences is they create a context for people in the field to come and talk about what they’re doing. We also invite people who are incontinent to come and talk about their story as well as speakers who don’t have any knowledge of incontinence but we suspect their expertise may have implications for our research. One example is we had someone come along who works for NASA and another who works for ESA. We asked them questions like, “How do people on spaceships go to the loo?” They have problems with fluid handling just like we do. We got another guy to come along and talk whose job was handling dental materials. We said to him, “You’re used to designing things for difficult environments (i.e. the mouth, which is wet, has a tricky pH balance, has to contend with coffee etc.) How can you help us with what you know?”. We give the mornings of our two-day conference over to this kind of fresh thinking. We have incontinent people on panels and we have along experienced caregivers to talk about their perspective. Then the afternoons are the more conventional conference fare. Industry turns up in droves (45% of our attendees are in industry). We always have speakers from industry but I ask them ahead of time not to give us a sales pitch. I send detailed instructions to speakers basically saying “you’ve got to make what you have to say accessible to diverse audience.” We’re trying to get all protagonists and stakeholders in one room together and give it a good shake – out of that comes collaboration.
