The great unwashed

July 14, 1995

In the latest in our occasional series, Martyn Kelly talks to Richard Lacey about the latter's first published research, the conclusions of which have become accepted clinical practice

Professor Lacey, in particular, showed a tendency to extrapolate sensational conclusions from incomplete evidence in order to publish his long-standing concerns about food safety." Thus wrote the House of Commons Agriculture Committee in its report on bovine spongiform encephalopathy, or mad-cow disease, in 1990. "BSE has been my disappointment," rues Richard Lacey, professor of microbiology at Leeds University. He remains convinced that BSE represents a major threat to humans despite government protestations to the contrary.

He has been proved right before: on listeria in food and on the dangers of irradiation, for example. He should also take some encouragement perhaps from his earliest research efforts 30 years ago, the conclusions of which have only just become accepted clinical practice.

Lacey arrived at Bristol Royal Infirmary in September 1966 as a senior house officer in pathology. Research started because there was not enough clinical work to fill all the hours he had to spend at the hospital. "In those days junior doctors did work 24 hours a day, every day of the week. You had to be there to do the emergency work on specimens. That meant there was an enormous opportunity to do research. I could do almost what I wanted. "

The subject he chose was the bacterium staphylococcus, part of the normal moist skin flora, found in the groin, armpit and nose. "It's quite benign when multiplying in wet secretions on the skin but when it gets inside the skin you get spots, pustules and boils. The key interest is the means by which it changes from being a harmless surface bacterium. The particular puzzle for many years was that healthy dry skin does not carry any staphylococcus, so the research I started was to follow the question why not? The conclusion was that it disappears partly because of drying, but mainly because normal skin contains fatty acids that inhibit its growth. This was known in vitro, but I wanted to know whether it also happened in vivo. If this was the case we seemed to be doing something very stupid, because whenever someone had an injection, they always wiped the skin with alcohol. Alcohol removes fatty acids but if these are beneficial, why remove them? So I thought, let's remove the fats in various ways and then put staphylococcus on people's arms and see what happens."

The subjects for these experiments were himself and other laboratory staff. "I don't think that we could do it now, but in the 1960s you didn't have to get permission to do an experiment that involved someone. You could just do it if they agreed. I think that if I put in a submission now to do that sort of experiment, the ethical committee would say that they didn't like the idea of challenging otherwise healthy people with potentially dangerous bacteria." In each case, Lacey washed one of the subject's arms with alcohol or another experimental treatment, but not the other. He then applied bacteria from a culture grown in the laboratory, left them there for five hours underneath a sterile label, and then transferred them to an agar plate. In most cases, the bacteria collected from skin cleaned with alcohol, acetone or soap had grown more vigorously than those from unwashed areas.

"I wrote it up without reading the journal's instructions and sent it off in a fairly rough state. But they were very kind and said they would like to publish it so long as they could make some amendments. This was the first experience I had of the interchange between scientists and journals. Usually the comments made by referees are helpful and cover something you haven't thought about because you are too inside the work." It was eventually published in the British Journal of Experimental Pathology in 1968.

"The first thing that happened was that I had a letter from San Francisco from one of the world's leading skin researchers who offered me a job. He asked whether I would like to repeat the experiments in America using Negro prisoners. I said no.

"What is gratifying is that in the last few weeks diabetics have been recommended, if they so wish, to inject themselves with insulin through clothes without having to clean the skin. That is derived from this sort of work, which is quite encouraging. Also, when patients are given injections, there is now a substantial body that does not treat the skin with alcohol. If you remove the inhibitory fats from the skin and bacteria subsequently alight, and remember that you have made a hole through it, then you could cause more infections than you stop. Of course, the other implication is that washing is bad for you."

Lacey moved from Bristol to a consultant's post in King's Lynn and eventually to the chair in microbiology at Leeds in 1983. At the same time, his interests shifted from clinical research to attacking the root causes of disease in our lifestyle. The path from experimental result to public policy is, as Lacey knows to his cost, often brutalising, particularly as the farming and food lobbies are entrenched so firmly at Westminster.

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