https://doi.org/10.36866/pn.86.24

Kevin Fong is an anaesthetist and honorary lecturer in physiology at University College London (UCL). He holds degrees in medicine and astrophysics and is co-director of the Centre for Aviation Space and Extreme Environment Medicine at UCL. Appointed a Wellcome Trust Engagement Fellow in 2012, he has fronted several BBC Horizon documentaries on aspects of physiology and most recently BBC 2’s To Boldly Go…, a series exploring the body’s physiological adaptations and limitations for survival at the extremes.

Q&A: PN speaks to… Dr Kevin Fong

How healthy do you feel physiology is, as a discipline?

I get the impression that we are seeing the disappearance of physiology departments proper in the UK over recent years. They are becoming part of wider disciplines – which is strange really, given this country’s huge history in whole-body, integrated physiology. I think physiology is still alive and well but somewhat hidden – it is buried under other things; cardiac physiologists are subsumed within cardio-thoracic or cardiological research teams and pulmonologists are subsumed within respiratory teams. A lot of people don’t recognise it as a discipline in a way that perhaps they did 20 or 30 years ago. To say ‘I’m a physiologist’ in any public environment is to invite the question ‘What is physiology?’ so in that sense, I think its public profile is not what it could be.

Do you think that it is important that physiology is promoted as a discipline specifically, or do you think it is more important to create an
interest in science more generally?

I think it is important to ensure that there is a new generation of capable physiologists to continue investigations within physiology. There is this sense that the future of medicine is simply molecular in nature – of course, this is the exciting, leading edge of it – but at the end of the day, the genomes make proteomes, the proteomes make organ systems and they, as an integrated whole, make physiology. I remember going through medical school thinking, ‘They must have answered all of those questions because everyone seems to have moved on to this other game; we must understand everything about the macroscopic properties of the heart, or a pair of lungs or bone or muscle’, and actually far from it – there are many, fundamental unanswered questions that are of huge practical, medical, scientific importance. After decades and decades of understandable focus on the molecular side of things – which, in a sense is still physiology just on a different scale – eventually I think it will come full-circle and we will begin to appreciate again that our nuanced understanding of integrated physiology is essential to everything we do in science and medicine.

In your view, what part does physiology play in modern medicine?

As an anaesthetist it’s obviously central to my everyday clinical job; that’s what we do in anaesthesia and intensive care, we manipulate whole-body physiology in real-time and try to balance it against injury or illness, or the system as a whole from pharmacology. The core speciality of the anaesthetist is really being able to fly a person’s physiology in real-time against assembled threats – and that is what attracted me most to it. It’s not just a picture in a text book or an equation about gas exchange, it’s happening in front of you, levels are going up and down and the only thing preventing the situation heading too far in the wrong direction is you and a syringe full of drugs, or a machine. Physiology is central to anaesthetists, but every doctor has to have an intrinsic understanding and appreciation of the impact of what they are doing upon the patient’s physiology – not just on the organ in which they are specialising. Whether it is appreciated or not, a fundamental understanding of physiology is absolutely central to modern medicine.

How does physiology inform your job/research?

Medicine doesn’t work if you don’t treat the whole. Ultimately the more you work in medicine and with the human body, the more you realise that it is very hard to deal with any part of it in isolation. What happens in one area tends to have impacts throughout – it’s almost so obvious as to be not worth stating and yet, because the trend in medicine is towards super-specialisation, we can get a little bit siloed in our view. That’s one of the things that attracted me to anaesthesia – it is still a general speciality, you have to understand the human body as a whole and that is what I enjoy, the childhood wonder that I had about the way things worked is about the whole human body. No-one goes to a bookstand, opens up a book of the human body and says ‘that lung bit is fascinating’ – you look at the whole thing – all of it is amazing.

You work on space medicine. Can you tell us about your research on the effects of zero gravity on human physiology?

Before I studied medicine I studied astrophysics. With those two qualifications I was really, really lucky and got the chance to go and work at NASA’s Johnson Space Center – in their human adaptation and countermeasures office. It’s the home of astronaut training and I was asking the questions of how you protect astronauts’ physiology against microgravity and long-duration weightlessness. I got very interested in plans to send humans to Mars – not only because of the science that might lie there waiting to be discovered, but for physiologists it’s the boundary condition mission, it’s taking the effects of weightlessness and extrapolating them – these are missions that maybe last up to 1000 days so if you are thinking about what the ultimate effect of long-duration weightlessness is on the body, then you really have to think about a mission to Mars, because that is the longest one on our books at the moment.

It’s fascinating that when you look at the history of it, people readily predicted what would happen to the body. They predicted that bones and muscles would waste, they predicted that it would have some sort of effect on your sense of balance, but there was a whole bunch of other stuff that
came as a surprise – it has an effect on your immune system, it seems to affect haemopoiesis, you get space-based anaemia and really profound problems, not just with your balance, but with your hand–eye co-ordination, your ability to track moving objects. The more you look, the more you see – weightlessness has a multisystem impact. You need to understand the physiology of spaceflight before you can develop protection against it. The best thing about it was that I was there in the front row seats as these questions that were almost science fiction but on the borderline of becoming science fact, were being tackled.

You are becoming a regular on TV and have been appointed a Wellcome Trust Engagement Fellow. How important do you feel it is as a scientist to get ‘out there’ and communicate what you do to a general audience?

It is hugely important – it is difficult to overstate it – but it is worth overstating because it is so important for the public to have a much clearer understanding of what we do and why we do it. I think you have a duty to share the fascination that you have with science otherwise, if you don’t share it, it’s like being the curator of an amazing museum of rare and beautiful artefacts that you never bother to show anybody else. There is just no point. I think it is also important to bring the next generation through, because certainly I know what it was that brought me to science – it was hearing people communicate it when I was growing up. I still remember some of the seminal science documentaries I watched, I remember James Burke doing Connections on a beach somewhere and using a spiral shell to demonstrate the Fibonacci series. If those memories endure and have driven me to a career that I have really loved, then you feel like you should return that. It is lovely to have the opportunity to do that [communicate what I do]. I think it is fundamentally important.