Articles

Radiology, Art & Science: A Conversation with Consultant Radiologist and Author
Dr. Michael Robert Jackson

 

14th Dec 2020

 

In this conversation with Michael Robert Jackson, MBBS, BSc (Hons), FRCR, we discuss the role of the radiologist in medical imaging and aspects of his forthcoming book on Radiology, Art & Science (title to be determined). In particular, Michael talks about how the history of visual art and film shall be incorporated in his narrative, making the contents accessible to a broad range of readers.

 

Colin Sanderson (CCS): One of the things I would like to explore with you is your own upbringing and formation: how it was that you came to study medicine? And I also noticed that in your undergraduate degree at University College, London, you actually did what is called an intercalated degree in the History of Medicine. So maybe you would like to kick off with that, Michael? Did you come from a medical family?

 

Michael Robert Jackson (MRJ): I do yes. My Mum is a doctor and she works both as a GP and as then eventually an Associate Specialist in Renal Medicine at Addenbrookes Hospital. On my father’s side of the family, also multiple doctors are going back into the preceding history. So, there is a medical heritage in the family, but there was a bit of a fork-in-the-road where, between GCSEs* and A Levels, I thought that I wanted to be an architect and my A Level choices had been based on that. During that Summer, I had a bit of a rethink and thought, well actually, I think it is medicine that I wanted to do. [* General Certificates of Secondary Education, generally taken aged 16.] Having not thought about that fork-in-the-road for a little while, it is quite difficult to pin down exactly what brought about that change of heart, but I think it was partly revising for the GCSEs. I was enjoying revising for Biology, in particular. Some of the History of Medicine featured in little by-lines in the textbook that I was using when revising for Biology GCSE began to sway me that way.

      And I think also, – it will sound a little bit vain, at the time, – but the TV show ER was a big hit at that time; perhaps I fancied myself as the next George Clooney [laughs] There was a definite arts-science fork-in-the-road, when I was around sixteen. But I went down the medical route.

You have mentioned the intercalated degree that I did in the History of Medicine at the Wellcome Unit at UCL, and that really gave an opportunity for expanding horizons into a more arts-like sphere. Bill Bynum was my supervisor while I was doing that; I enjoyed that a great deal, himself and the other tutors there who gave us fabulous lectures. That stayed with me to this day, in terms of thinking about medicine in a more analytical way and in terms of its role in society and how things come to be within medicine and professional.

 

CCS: You mentioned Bill Bynum, but of course, the other great name at Wellcome was Roy Porter.

 

MRJ: Absolutely. I was very fortunate to have been taught by Roy as well. Very sadly, he died not too long after I had done my year at the Wellcome. He gave fabulous, very erudite lectures and obviously has written quite voluminously and impressively on the history of medicine and one of his books was key reading during that year, and I have dipped into when opportunity has allowed in more recent years as well. [Editorial Comment: Dr Roy Porter died in 2002. In 1993 he gave a lecture entitled “The Two Cultures: A Historical Perspective” at an Interalia conference in Bristol.]

 

CCS: So, digging into your own childhood, Michael. Was the visual realm very big in your household; or, the musical realm; or, literature?

 

MRJ: My Dad was a keen artist; he was a solicitor by profession, but certainly during weekends and particularly Summer holidays, he would take his watercolours and pastels out when we were on holidays. Although not a professional, he was quite an accomplished artist in many respects, and I have fond memories of doing paintings and drawings alongside my Dad, and so I suppose that was a prominent influence throughout childhood.

      My Dad was quite cultured in terms of liking to visit cultural centres across Europe. And at the time, there was an element of being dragged round another Cathedral, [laughs] and you know that element that perhaps some of it was slightly wasted on young children in Summer holidays. But I think that appreciation of art and architecture perhaps fed in from that to some degree. I probably have been more of a visual thinker in terms of how I learn and process information.

 

CCS: Visual thinking is, of course, is a big thing in the Scottish tradition. It arose between the algebraicists at Cambridge in mathematics and the more visual, geometric school in Scotland.

But also, when you mention Cathedrals, I think of Milan Cathedral with, apparently in the crypt, there was a great écorché figure, you know? Like a flayed figure, with all the skin removed.

 

MRJ: Yes. I have seen! I mentioned the fork in the road at sixteen, and having gone full steam ahead with medicine into my A Levels, and actually the Summer after that fork in the road, I was fortunate to visit Italy, including Bologna, and Milan, and Padua - on something of a History of Medicine pilgrimage, if you like. The figure in Milan Cathedral was striking – in some ways like something out of the horror movie, this figure with the muscles exposed and the flesh ... is it St Bartholomew?

 

CCS: It does. As you know, medicine and surgery are very important to me as my grandfather was an ophthalmic surgeon, and I had other medical people in the family. I have a picture of that écorché figure, which I assume he either took himself or might have purchased at Milan Cathedral. It is fascinating that you did this sort of pilgrimage on art.

I thought we might talk about making visible the invisible, and that case of an échorché figure, whereby dissection you remove the skin and expose the musculature, is obviously making visible the invisible in a very physical way.

      God and gods were generally invisible. And, of course, there was a ban on making images of God or gods…. Iconoclasm, destruction of the images of gods. But we can jump to Goethe and the idea that symbols are part of the visible world, but are also outside the world – I am quoting from a book by Alberto Perez-Gomez on that. And then Paul Klee, making visible the invisible: things in the imagination.

      We get the big leap over to the actual making visible the invisible through things like microscopy, telescopy, into photography, and then into your field.

You went on to specialise in Radiology, and then in Paediatric Radiology, and you are currently Consultant Radiologist at the Royal Hospital for Children and Young People. Maybe you could say a word about the difference between being a radiologist and actually being a radiographer, the person, or the “drawing” through X-rays.

 

MRJ: Historically, it has been a distinction that the radiographer is the technician making the acquisition of the image, and the Radiologist is in the business of making an interpretation and diagnosis or some sort of assessment of disease processes on the basis of the imaging. And certainly, in this country, and replicated to a broad extent across the world, Radiologists have a medical degree whereas Radiographers train in a non-medical route. As Radiologists do Ultrasound, even acquiring images and fluoroscopic examinations, the distinctions are not always clear.

      In recent years, that distinction has become a bit less clear cut. So, Radiographers are now involved in reporting – well most radiology exams, certainly plain films – Reporting Radiographers are found in most hospitals these days. In relation to Ultrasound, there are Radiographers independently conducting and reporting Ultrasound, but usually in the context of being assessed by a team of Radiologists as well.

      One of the themes in the book that I try to tease out is that we are engaged in a very multidisciplinary activity, and the Radiology Department cannot function, – both Radiologists and Radiographers are an integral part of the process, as are other members of the staff in the Department, such as Radiology Department assistants, and nursing staff, admin staff. Clearly the Radiology Department itself does not fulfil any useful role unless it is in the context of health care being provided by clinical colleagues, and nursing and all the other allied health professionals involved in delivering, hopefully, excellent health care.

      The team dimension is quite important, and the distinctions involved are sometimes a bit fuzzy and ambiguous.

 

CCS: You and I met in April 2017, when you participated in the Edinburgh Science Festival at Summerhall, which is the former Royal (Dick) Veterinary College. You presented in the Old Anatomy Lecture Theatre a talk with your friend and colleague, Hugh Turvey, one of Britain’s leading X-ray artists.

      You mention the teamwork in what you do. But the Radiologist does a lot more than just the X-rays, with which we are most familiar, probably, from either the dentist or breaking a leg. I notice that on your self-description on ResearchGate you list as disciplines, Paediatrics and Radiology, but then, under skills and expertise: neuroimaging, imaging, computed tomography, magnetic resonance, medical imaging, ultrasound imaging, 3D imaging, clinical imaging, ultrasonography, diffusion imaging, Doppler ultrasonography, cancer imaging, paediatric radiology.

      Talk a little bit about this range of imaging techniques open to you now.

 

MRJ: An important role of the Radiologist is sometimes in judging what imaging is most appropriate in the clinical situation. You mentioned quite a few different modalities, but certainly, in our own Department, X-rays are probably numerically the most frequently undertaken examinations.

      We are also making use of more complex imaging techniques such as CT and MRI in cases where we need to get very detailed information about particular conditions. Often rather than one modality being the best, there is a view of these imaging modalities being hierarchically ranked – plain films being the most basic, then perhaps Ultrasound, and then MRI or CT and so on. They are very much complementary to one another. Often a plain film is all you need to make a diagnosis. Judgment of the Radiologist in that situation is actually to draw a line and say I don’t think we have to do anything else here.

      Quite often, we are synthesising information from each of these modalities. They give a slightly different complexion on the disease process or a diagnosis we are trying to make. This is something I try to draw out in the book, in the same way, that art obviously has multiple different media that an artist might employ to convey a message, we are trying to tease out what the message is through these modalities to make sense of what is going on with a patient, and in doing so, no single image might be the answer.

      You might have two views of a structure on an X-ray: looking from a frontal projection and a lateral projection of something like the knee, where it is a fracture. Versus, when we are using more complex modalities like CT and MRI, we may be able to construct images from any anatomical plane and in doing so, looking from any possibly perspective we can possibly imagine.

      But at the end of the day, we have to distil all of that complex information a shortish, hopefully, report that clinicians can make sense of and act on to the benefit of the patient concerned.

But that synthesis of that information is also heavily reliant on the whole of écorché figures and anatomical textbooks. Making sense of those images on a daily basis requires having drawn on anatomy textbooks and the diagrams they involve, and previous cases. It is a complex synthesis of all that information and different visual traditions, in terms of the anatomy diagrams and so forth – that short radiology report, the end product, draws on quite a lot of visual information to bring it all together.

 

CCS: You told me that you are hoping that your book on “Radiology, Art & Science” should be useful to the general reader, but also for clinicians and for other Radiologists and indeed for patients.

      Honestly, you have given yourself a large task in writing this book, and I admire you for it; I know that through your thinking about history, you think about deep history. You have shown me a picture which you have from cave art: what 30,000 BC or something?

      So maybe you would like to say something about this deep historical thinking about image-making and how it feeds into your attitude towards your own profession, the interpretation of images, the synthesis of images, and then for these different readers.

 

MRJ: I don’t know whether we will manage to please all of those different groups that you mentioned. But I am certainly trying to make it an accessible format for people can read regardless of their background.

      In terms of going back into the deep past – just in the previous discussion, I was mentioning that in making sense of modern, twenty-first-century imaging technology, we are drawing on traditions that go back quite far.

      Admittedly the medical textbooks I used in medical school were published towards the end of the twentieth century, rather than anything further back than that. But they, in turn, will have drawn on previous anatomy textbooks. There is this kind of visual heritage that you trace back like a family tree.

      Yes, it does go way back to what most sources think is the most consistent form of cave art. Hands and stencils are consistent features in caves right across the world in early human culture.

      It is this remarkable consistency of this approach to early art, alongside the animals that they were hunting and so forth.

      And I was struck by the similarity the hand stencils, with the very first radiograph of a human subject, which is that of Bertha Roentgen, the wife of Wilhelm Roentgen who discovered radiographs in 1895, – and the immediacy of that image, Bertha Roentgen, identifiable as a hand, and you can see a ring on her finger – I think it is her wedding ring, – of the left hand, and that kind of resonance of you know, okay. In simple terms, it is a picture of a hand. You could draw a line there. But then actually the way the image of the cave art was created: it is analogous in terms of technique. You have a projectile agent, most commonly the red ochre, being projected onto the hand or the subject of interest, from a point source, and then onto a planar surface, the flattish cave wall, and that is directly analogous to the acquisition of a radiograph using a point source of electromagnetic radiation and then those beams passing through the hand, – in a way that admittedly, that the paint didn’t – onto a flat surface in terms of the photographic plate and these days a radiographic detector plate.There is quite a strong visual analogue in those images, and it is quite interesting to explore that dimension.

      Moving forward from that, the mythological origin of painting or drawing is – according to Pliny the Elder – that the daughter of a potter in ancient Corinth [Editorial Comment: it is Dibutadis], is said to have drawn an outline of her lover using a candle or a lamp on a table onto the wall of the pottery to keep a likeness of her lover before he embarked on a long voyage.**

[** As the origins of drawing and painting lie in this legend, including drawing with light (photography), and with other forms of radiation (radiography), it is worth recalling this classic paper: Robert Rosenblum ‘The Origin of Painting: A Problem in the Iconography of Romantic Classicism,’ The Art Bulletin Vol.39, No.4, Dec 1957, pp.279-290.]

      Again, we have got a point source of electromagnetic radiation. The image being projected onto a flat surface, directly analogous to the radiographic techniques.

      You can say it is a superficial resemblance. But it was quite difficult to draw a line in the sand as to exactly where to begin when exploring the historical traditions on which radiographic imagery relies. So, I felt it was reasonable to go back.

 

CCS: You stimulate so many thoughts. The names of Apelles or Zeuxis come to mind: ancient Greek painters.

      You know that I am a word-nerd. Sciography, the study of shadows, comes in there.

 

MRJ: Yes, and we celebrated 125 years. It was November 8th that Roentgen’s discovered X-rays, 8th November is recognised as both World Radiography Day and International Day of Radiology. On an annual basis. The Scottish Radiological Society recent meeting done as an online meeting just last month. So that was one thing we were celebrating. The other thing we were marking was 40 years since the first body MRI scan was performed in Aberdeen, and Professor Frank [Francis] Smith gave an interesting talk on the early days…

      So interesting to explore, because when you see the first very pixellated and fuzzy images and fuzzy. It is just astonishing how far the technology has come in a relatively short period of time. The cross-sectional imaging, within my life time, from humble, primitive, pixellated images to these astonishing, exquisite images of the body in just a few decades. It is a remarkable story.

 

CCS: You are keeping up with Continual Professional Development, CPD as they call it now, must be quite onerous.

 

MRJ: Well, the good thing that stays constant is the anatomy. You know, the anatomy of the human body has not changed too much in perhaps 200,000?

      Although the human frame is broadly similar in appearance, what we have to deal with in the interpretation of imaging examinations, normal variation from one individual to another. Trying to make sense of what we are seeing is whether it is pathology or is it just a normal variant in terms of the shape of the bone. Or just a normal variant appearance of blood vessels but anatomy largely stays the same. So that sort of generic knowledge that moves forward.

      Most of the imaging, in my career so far, has been – in the same way that mobile phones get better and easier to use as time goes by – the technology has impacted in that we get sharper, crisper images and nice additional features to take on board. But then, there are emerging techniques that do require a bit more looking into to evaluate whether they are useful for clinical practice.

      I think in large part working in paediatrics, techniques become established in the adult arena before making their way into paediatric use. Certainly, for techniques that don’t involve ionising radiation, such as Ultrasound and MRI, tend to progress a little faster.

 

CCS: Yes, that distinction between imaging with ionising radiation and other imaging techniques using non-ionising physics is obviously an important one, and takes us into radiodosimetry. I am fortunate to have a large number of books from the late Dr John Boag. He was from and studied in Glasgow and Braunschweig in the mid-thirties, but went on to work with L. H. Gray at Mill Hill and became a specialist in radiodosimetry.

      I know, that the dosage of radiation that you get has crashed enormously over the years. Maybe you would like to say a little bit about that? – The Health & Safety of image-making.

 

MRJ: So, it is an important part within paediatric practice – we place particular emphasis on keeping radiation exposure to an absolute minimum. Children are both more susceptible to the effects of radiation. The other dimension is that an exposure during childhood then has the rest of that child into adult life to potentially manifest itself. Whereas doing examinations towards the end of their lifespan has less risk of ever producing any tangible adverse effect.

But you are right that – although we are very keyed up in terms of making sure that we do keep doses to the absolute minimum – and it is always in the context of a risk-benefit analysis, with more benefit than any potential adverse effects – in recent years the doses have come down dramatically and the technology helps us out in this regard.

      There is a useful document that the World Health Organization put out in relation to paediatric radiology practice, contextualising the risks of ionizing radiation. It was published in 2015, – and even since the publication of that document the doses have probably come down a bit since then. Most examinations in our Department in their analysis would be ranked as a negligible risk; and even at the top end, some of the nuclear medicine studies and so forth are still in their classification of studies as low risk.

      Low risk is not the same as risk-free, but the risk in real terms is really small and diminishing all the time as the technology improves. And for any examination it is always undertaken in the context of forming a risk assessment the child, in adult practice as well, should be getting a benefit from the information delivered by that examination.

 

CCS: Yes, risk. I am rather jumping categories. But we have, of course, been going through this ghastly, global pandemic of COVID-19, and has that impacted your work over and above?

 

MRJ: One thing that has been fortunate about, – I mean we have been having to grasp the positives in a horrific year – children have been largely unaffected by the virus, sad fatalities, and children are not by any means immune to it, but compared to adult cases we have seen relatively few cases harming children. Within my own clinical practice, we have been largely shielded from the effects of the virus directly, but in terms of infection control measures, we have had to be very, very careful within the Department to protect both our patients and members of staff.

      Because people have been, understandably, reluctant to come into hospital. For example, patients with appendicitis – we have seen quite a lot of cases of appendicitis presenting late. So, it has had an impact, in radiology largely shielded from the distressing pictures we have seen on the news. I am full of admiration for NHS colleagues working in more challenging circumstances. So, the pandemic of COVID-19 has had an effect.

 

CCS: At this time, I think it is worth dwelling a bit on this aspect of risk, communication of science, and engagement with science. I think risk and what is not really high risk is sometimes very difficult to get across. I remember once on Newsnight there was and people were asked to rank the risk of developing cancer from smoking, or the danger, the risk of living in Cornwall or in Aberdeen, which you mentioned, because of the granite and background radiation.

      Most pertinently, I suppose we might just mention at this time, with the vaccines coming out: we know of the horrendous anti-vaccine movement. I know it is not your responsibility, but I am sure you know quite enough about it, Michael, to say something about this question of the risk and non-risk, and the risk of not having large enough numbers taking up the vaccine.

 

MRJ: Absolutely. As you say, Colin, it is not my field of expertise specifically; but I would certainly encourage everyone who is eligible and not in a contraindicated group to take the vaccine as soon as it is offered to them. I have been fortunate enough to have the first dose of the vaccine myself last week, and apart from a slight ache in the arm and feeling not quite on top form later in the evening, then no adverse effects, and certainly both in terms of protecting yourself, as an individual, and protecting those around you in the community at large, then the vaccine is our route out what has been a horrific year. I would very much strongly encourage everyone to have it as soon as they are offered it.

 

CCS: Well, being well over 65 myself, I shall be straight in there as soon as I can. Is the vaccine that you have been given two doses of?

 

MRJ: the published data, in terms of its safety, efficacy a very good, and as far as vaccines go, no qualms in recommending people taking it.

 

CCS: Yes. And very important that they go back for that second dose as well.

You and I had a delightful meeting in the Artiscience Library with my friend and colleague, Bianka Hofmann, working at the Fraunhofer MEVIS Institute in Bremen, and amongst the many things that come out of my thinking about that is the use of Artificial Intelligence in large data and imaging. Has that come across your RADAR: excuse the pun.

 

MRJ: Well, it is beginning to be felt. In my Department we use a machine algorithm in one very specific setting, which is the assessment of bone age on a plain radiograph of the hand. The endocrinology team may have concerns that skeletal development has been accelerated, perhaps by a hormonal disorder, or, on the other hand, that bone development is delayed and occurring more slowly than expected.

      Previously, the way we used to score them involved looking up a textbook, which is now out of print, so the pages were stored in plastic folders, the actual book itself having disintegrated, we had to store multiple things like carpal bones and metacarpals and phalanges, comparing to this textbook, and it was laborious and time-consuming. Now we have an algorithm that does it all for us. So that is a small, niche use that has come into practice.

      And in terms of replacing the Radiologist, we are not quite there yet, because we still need to check images to make sure that the registration has been performed correctly, and then the role of the software is purely to come up with a figure in terms of the bone age. It doesn’t evaluate the bones in terms of other disease processes. For example, we always look at these radiographs to check whether there isn’t an unexpected bone tumour, or some other unexpected finding. The role of the Radiologist has not been completely replaced in that context, and at the moment that is a niche area. So, at the moment, Artificial Intelligence hasn’t had a massive impact, yet.

      But I know that in adult practice, things like lung nodules, which we see less commonly in children than in adults, there are software algorithms to detect those that are assisting adult colleagues. The likelihood is that we shall see more of this come into clinical practice over time.

It is beginning to start in that direction; perhaps been a slower process than the original hype suggested. People need to be a bit patient. It is certainly going to be interesting to see in the role of the Radiologist in the next ten or twenty years.

 

CCS: Yes, indeed.

Now, it is often said of barristers or advocates that you should not ask a question in court that you don’t already know the answer to. But I don’t know the answer to this one: In imaging, in general in biology, microscopy, and so on, one is often concerned and attentive to the idea that artefacts can arise, which are not part of the sample; that in vitro samples are not the same as in vivo, and all the rest of it. In your area of image-making, are there cases where artefacts can come that can baffle you?

 

MRJ: Yes, absolutely, Colin. It is quite a big part of the job making sense of what is real on the image, so to speak, versus an artefactual appearance.

And certainly, working with children, they tend to wriggle around when they have their examination – so movement-artefact is one that we are often contending with, images can become incomprehensible while they are having a scan.

      But a lot of the imaging modalities have specific artefacts related to the way the images are generated, and recognising those particular appearances and not mistaking them for pathology, which they can sometimes mimic, is an important part.

      The discrimination between what is the real image and what is artefactual is sometimes not always so clear cut. For example, where we do Ultrasound scans, where we look at gall stones or renal stones in the kidneys, they cast what we call an acoustic shadow, which is where the sound waves get bounced back from the dense calcification within a gall stone or renal stone and beyond the stone, you don’t get echoes back from tissues deeper to the stone. It has a black line distal to the stone that we call an acoustic shadow. That is an artefact, but actually, it can be quite helpful in terms of assessing the level of calcification within that stone, it produces some clinically useful information.

      And in MRI, there is an artefact related to susceptibility. Although we do rigorous safety checks to make sure patients don’t have metal on their body before going into the scanner, because of the strong magnetic fields, from time-to-time bits of metal that were not known about sometimes slip through the net and cause a lot of artefacts. Or dental braces that are in a patient’s mouth can cause a big black hole in the image that can make it challenging to interpret the nearby surroundings.

      Artefacts, in general, can be a nuisance in that context, but there is now a sequence that specifically uses this sensitivity of ferromagnetic metal to produce signal drop-out, they are called SWI, Susceptibility Weighted Imaging, and that can be useful in detecting small areas of haemorrhage or blood products. So, what was previously a nuisance artefact, – is now producing clinically useful information; and it gets quite difficult to untangle this business of what is the true image versus what is the false image when we have got these sorts of situations to untangle.

 

CCS: And that is a matter of years of experience as much as anything, rather than necessarily direct training to make these judgments.

 

MRJ: Yes, that is something we alert our trainees to as they are coming through, and particularly the MRI artefacts are various ones which are well recognised in terms of the way the data is acquired and specific to particular sequences that are performed. Sometimes they can be tricky to make sense of, and so that is, yes, perhaps where experience comes in.

 

CCS: I want to invite you to think back towards the book that you have been working on, – “Radiology, Art & Science” – in terms of the medical humanities, which is now offered in Edinburgh as an intercalated degree. How will you be satisfied when it comes out and is reviewed?

      Dr. Iain McClure, who I believe is one of your colleagues at the Sick Kids’ Hospital, an expert in autism and a main force behind introducing the study of medical literature in the Edinburgh degree as an intercalated degree. So coming out with an MA besides your M.B.Ch.B and so on.

The other person that I must mention is Sir Kenneth Calman, the former Chief Medical Officer in Scotland, and latterly Chancellor of Glasgow University, – himself an oncologist but he actually in his retirement did a postgraduate degree looking at all the people who either incorporated medics in their literature or were themselves medical but wrote – I am thinking of people like A. J. Cronin, famous for Dr Finlay’s Casebook, on the television in my youth, or, Arthur Conan Doyle, who studied in Edinburgh, went on to write all the great Sherlock Holmes books and stuff.

      So, medical humanities as an intercalated degree.

 

MRJ: If it ended up being required reading for some of these courses, then I would be delighted.

 

CCS: That is a very good answer.

 

MRJ: There is certainly an overlap with those types of courses and the ambitions which they set out with to think more broadly about the practice of medicine…. I homed in, focusing on imaging. Applicable to medicine more broadly. Yes. So, we can contextualise it.

      One or two literary references make it into the book, but it is largely, earlier, I am a visual person, so most of the cultural contextualisation is in relation to visual art. I am also a big movie-fan, movies and TV also get lots of mentions as well. I hope it has broad appeal, to people who are involved in working in imaging, but then also artists, a similar sort of overlap of art and science, I hope will find it of interest. And then, anyone who has ever had a scan, which is pretty much most of the population, would, I hope, find something of interest.

      It is difficult to know exactly where it will fit in the library catalogue. But there is plenty of culture, high and low, included, perhaps not quite so much by way of literature. Most artistic movements from the Renaissance era onwards as well as the cave paintings get a mention, and plenty of films is in there also.

      We were talking about artefacts and how it can be difficult to know whether the artefact is an impediment to the imaging or whether it is useful. I was interested in the way that particularly film-makers have used what could be considered an artefact, for example, the plane being out of focus, as a particular narrative device. Focus pull is often used to draw our attention to things in a movie, and it is notable that a lot of CGI family movies use focus when they have no business to really, because everything in a CGI family movie could be in absolutely crystal-clear focus. The elements that are out of focus are as much a part of the narrative tool as those that are in focus. So that, for me, had some interesting parallels with what is the true image and what is artefact. There is plenty of accessible content in the book, hopefully, some insightful aspects that are of more interest to the medical humanities.

 

CCS: I am confident that it is going to find a wide-ranging audience. Although, I would be most interested in how your clinicians-readers respond to it. The so-called BioArt has been a growing genre of visual arts over decades now; famously starting with Eduardo Kac and such people – putting genes into a rabbit to make it glow in the dark. We could get onto the ethical responsibility of such art and so on.

      But, even just this morning, I was noticing a call for applicants for a position at the University of Windsor, Ontario, Canada, in their new sort of art lab, so to speak: the Incubator at Windsor, for a joint research and teaching colleague, an MFA graduate.

      I profess that this thing I call artiscience is a paradoxically specialist thing itself. But it is been growing so much over the last few years. I am confident about your book’s forthcoming.

 

MRJ: Thank you for allowing me to make use of the Artiscience Library. It is been an absolutely fantastic resource, and I am very grateful for your help.

      The deadline to finish the book is April. In terms of word count, I am definitely over halfway, and as more chapters get completed, it becomes, in theory, a bit easier to do the remaining ones because of the process of elimination what belongs in what chapters. It is quite a nebulous concept trying to fit perhaps all of Art History and History of Radiology in one tome in some respects. Caused me a bit of head-scratching, but I think it is beginning to come together now.

Illustrations were initially a little bit of a headache, but actually, lots of artists have been very accommodating in allowing me to use their work as illustrations. I won’t list them for fear of excluding someone. Certainly, there are some great illustrations contained within the book. So even if people get enjoyment from the pictures and don’t bother reading the text, then I think it will have achieved something, hopefully.

      Yes, fingers crossed it should be finished by April. A bit of time is required for the publishers to pull it all together. So, I am full of optimism for next year, having had my first dose of the vaccine, and hoping that gets rolled out to others in a rapid fashion and hopefully, a new book to look forward to by the end of the year as well.

 

CCS: Let us wrap up now, Michael. Thank you very much for taking the time out of your work and for doing this conversation with me. I look forward to the time we can meet face-to-face again and talk more about this because it is endlessly fascinating.

 

MRJ: Thank you very much for your invitation and for all your assistance with the book.

What is yet missing in education and research? And what might arise out of current complex crises?

Current affairs develop fast. Deciding whether and when to make an intervention is difficult. (This Opinion Piece was offered to selected press media on 17th and 19th June 2020. Now superceded, I yet wish to make certain points, hence my publishing it here.)

 

Two aspects of the current COVID-19 story have come to the fore in recent days.

 

On 7th June was the following exchange on the BBC’s Andrew Marr Show. Interviewing the UK Health Secretary, Matt Hancock, Andrew Marr commented: “I was going to say that this is, in a sense, art not science, because these are old figures you are getting. There is a time-lag and so forth…” Mr Hancock replied: “Well. It’s actually science. It’s not art. It is science on which we base these decisions. And science is necessarily looking at uncertainty.” Canadian, Sir William Osler (1849-1919), described medicine as “A Science of Uncertainty and an Art of Possibility.”

 

On 11th June, interviews with Linda Bauld, Professor of Public Health, Edinburgh University, and with Greg Clark, MP, as Chair of the Select Committee on Science & Technology, both emphasised the complexity of the relationship between scientific advice and political decision-making; especially the conflicting demands of social distancing and getting back to work, both important for health and even saving lives. Yet, the need and demands for simple and consistent communication has been a bone of contention.

 

Complex dynamic systems present the greatest challenges in the present century. This is compounded: for we are facing a complex of complex dynamic systems: the COVID-19 crisis, on top of the climate crisis, and now the collateral economic crisis. Each of these are interrelated, and yet, we do not adequately employ what means there are for studying and addressing them in an integrated fashion.

 

What has the study of historical and contemporary relations between arts and science to do with all this – what I and others call “artiscience”? At its simplest it is defined as “the integration and harmonisation of arts and sciences.” Omniscience is not attainable; artiscience is.

 

In the case of Marr and Hancock, the questions are of the art and science of Government: of decision-making, policy-making, and policy implementation. (As I write, Stephen Sackur on HardTalk takes this up with epidemiologist, Dr Ian Lipkin, New York, scientific advisor on the film Contagion.)

 

Those listening have had a rapid exposure to the many sciences feeding into the art of governing: virology, immunology, epidemiology, and mathematics, which serves these sciences, especially statistics. A little knowledge can be a dangerous thing, but total absence of knowledge is even worse. All citizens should endeavour to take a view of the efficacy of our representatives’ policy decisions and implementation in this context.

Let not the phrase “political science” confuse. One might recall Bismarck’s remark: “Politik ist keine exakte Wissenschaft” (Politics is not an exact science). Consider then how the German government has chosen to involve philosophers and humanities scholars in current deliberations. International comparisons are worthwhile, and we should not fail to look at North America.

 

Speaking in Edinburgh in 2011, but addressing Britain, Google Chairman, Eric Schmidt, said: “Over the past century the UK has stopped nurturing its polymaths. You need to bring art and science back together.” Yet the examples he gave were limited. His appealing to polymathy was welcome; but this is not a binary matter, art versus science. It is not STEM, nor even STEAM (including “art”), but it must include the arts & humanities. So SHTEAM? (I can hear Sir Sean Connery voicing that!)

 

More recently, in the USA, the National Academies of Sciences, Engineering, and Mathematics published a Consensus edited by David Skorton and Ashley Bear, entitled The Integration of the Humanities and Arts Sciences, Engineering, and Medicine in Higher Education: Branches from the Same Tree (2018). The title says it all, but it was hardly noticed it seems in the British press.

 

In Canada, most worthy of study is the Arts and Science program at McMaster University, running since 1975. (https://artsci.mcmaster.ca/).

 

Prior generations had to deal with HIV/AIDS, BSE/CJD, Ebola. The Director of the Wellcome Trust, Jeremy Farrar said in 2016: “in truth there wasn’t a solely biomedical solution to Ebola, just as there isn’t a single scientific solution to climate change, to drug-resistant infections, to the challenges of demographic shifts, urbanisation and feeding an ever growing population.” He called for “bridges across disciplines” and “a holistic approach to science and society.”

 

In recent days, David McCoy, Professor of Global Public Health at Queen Margaret University of London wrote: “We have lots of scientists who are expert in one or two things, but perhaps not enough who have breadth and the confidence to straddle the divides between the natural sciences and the social sciences and the humanities. For me, that is what is required, and that is what is missing.”

 

Approaching complex matters from an artiscient point of view (Weltanschauung), raises questions that are rarely if ever raised by other specialists.

 

So, while many are asking what should happen post-COVID; and viewing it as a time of opportunity. The challenges are great, yet, whereas it would be no panacea, one development which colleagues and I wish to see, is the establishment of an Institute for Artiscience, as an effective centre for artiscient research and education. That, briefly, is the “What”, and the need is “Now”. The “Where and the How” remains to be seen

PRESS RELEASE: “An Exceptional Acquisition for the Artiscience Library, Edinburgh, Scotland”

 

What makes the acquisition of one book worthy of an International Press Release from a small, if extraordinary, Library in a corner of Edinburgh? The answer lies in the exceptional nature of the book and its International associations.

The book is a copy of the first US edition of George Steiner’s “The Death of Tragedy” Alfred A. Knopf, 1961. Steiner studied at the University of Chicago, at Harvard, and at Balliol College, Oxford. After a spell at the Institute for Advanced Study at Princeton, he became Gauss Lecturer there, then, in 1961, a founding Fellow, later Extraordinary Fellow, of Churchill College, Cambridge; Professor of English and Comparative Literature at Geneva, 1974-1994; and Norton Professor of Poetry at Harvard, 2001-2002.

Yet, the book’s great significance lies in the handwritten inscription: “For Charles and Pamela Snow, / in gratitude and / admiration / George Steiner / (March 16, 1961)” This makes it a key document in the history of the famous, or infamous, “Two Cultures Affair”. The phrase “Two Cultures” refers to C. P. Snow’s contention that between “literary intellectuals” and scientists there existed a “gulf of mutual incomprehension – sometimes … hostility and dislike, but most of all lack of understanding.” Traceable in Snow’s writings to the 1930s, this came to world attention through his 1959 Rede Lecture at Cambridge University. It caused heated discussion in both the UK and the USA, to which further fuel was added in 1962, when Cambridge literature don, F. R. Leavis, attacked not only Snow’s views, but the man himself.

Over time, the phrase “Two Cultures” entered the language and it remains in common use. Witness, recently, the Consensus Report of the US National Academies of Sciences, Engineering and Medicine, 2018, entitled “Branches from the Same Tree” (p.22). The Artiscience Library has a paradoxically specialised rubric, for it is devoted to the study of “historical and contemporary relations between the arts and sciences”, in all meanings of those terms. It contains some 25,000 items: books, journals and manuscript material.

Of the Artiscience Library, international Bioartist, Oron Catts, University of Western Australia, said: “My collaborator, Dr Ionat Zurr, and I, from SymbioticA at UWA, have visited all the great art/science centres around the world. This acquisition for the Artiscience Library only adds what was already a great, a unique treasure-house of inspiration.”

In response, the owner of Summerhall, Robert McDowell said: “In his First Edinburgh University Festival Lecture, for the 50th anniversary of the Edinburgh International Festival, George Steiner said that an Arts Festival in the late twentieth century should be attending also to Science and Technology. At Summerhall, formerly the Royal (Dick) Veterinary College, in hosting the Artiscience Library we have sought to respond positively to that message.”

Richard Demarco, Demarco European Art Foundation, said: “In 1997, in Dundee, Colin Sanderson and I organised a conference entitled Steiner, Art and Science: A City Responds. To our delight, and that of the Principals of Dundee University and Abertay University and of the Lord Provost, George Steiner and his wife chose to attend in person.”

James Howie, Co-Founder and Board Member of “ASCUS Art & Science”, said: “At Summerhall, the Artiscience Library provides the theory and history of artiscience, as we, in the ASCUS Laboratory, provide practical, hands-on, artiscient experience and training. The conjunction of the two provides unique synergy.” (www.ascus.org.uk/artiscience-library).

Colin Sanderson, Founder & Director of the Artiscience Library, said: “To sustain the world-class educational and inspirational character of The Artiscience Library, we rely on the support of many people. The acquisition of this particular item, thanks to the exceptional generosity of an anonymous donor, is particularly thrilling. It is our present intention to add an ex libris bookplate of the Artiscience Library, inscribed: ‘To the Memory of two great literary scholars: George Steiner and David Daiches’. Both were highly artiscient."

"It is a profound and tragic irony, that George Steiner died, February 3rd, just as we were achieving this acquisition.”