Observations BMJ Confidential

Chris Butler: Wants to snuggle up to bacteria

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1770 (Published 09 April 2015) Cite this as: BMJ 2015;350:h1770


Chris Butler is professor of primary care at the University of Oxford, professor of primary care medicine at Cardiff University, and a practising GP in Mountain Ash, south Wales. He is the only GP on the Medical Research Council’s Efficacy and Mechanism Evaluation Board and is on the jury for the Longitude Prize. His patients know better than to expect an antibiotic when they have a cold, as he is leading several trials in the field of common infections, including a new trial of the cost effectiveness of antivirals in primary care as part of the EU funded PREPARE consortium. The growth of antibiotic resistance, he believes, is one of the most important public health issues of the day—the “global warming of medicine.” His solutions include better ways of determining who will and won’t benefit from antibiotics at the point of care and of living more harmoniously with our environment, including microbes.

What was your earliest ambition?

To be a fireman, actor, writer, paediatrician, physician, psychiatrist, GP, and then an academic GP, in that order.

Who has been your biggest inspiration?

All of the great clinicians at Groote Schuur Hospital in Cape Town, who I was so privileged to be taught by: Ames, Benatar, Kirsch, Stein, and Vogelpoel, to name but a few. I’m fortunate to have been apprenticed in a system that so strongly cherished rigour in clinical history taking, physical examination, and communication.

What was the worst mistake in your career?

Thinking that I needed to specialise. Medical generalism is the disruptive innovation on which we should build sustainable healthcare. Developing implementation science to better apply what we already know will make massive inroads into society’s biggest challenges. The National Institute for Health Research has been tremendous in beginning to re-balance health research priorities.

What was your best career move?

A degree in English literature was a fantastic grounding for clinical medicine. Studying the anatomy and physiology of works of literature has also been invaluable for medical research, where there is also a theme, plot, and denouement. Research stories should be exciting and dramatic and should demand elegance in their telling.

Bevan or Lansley? Who has been the best and the worst health secretary in your lifetime?

Bevan, although not in my time, was best, because of his bold conviction that the reason for gaining power is to share it. In my lifetime they have all generally fragmented healthcare. Why does price always seem to trump value or quality (for example, in buildings or, say, commissioning GP out-of-hours care)—and why does the delusion persist that the market will make it all better?

Who is the person you would most like to thank, and why?

My mother, who loved me unconditionally and was largely unappreciated at the time, always went the extra mile. She was a radiographer in a TB clinic and gave me a sense of wonder at the miracle of antibiotics. She saw TB treatment evolve and once told me about her childhood friend, who, before penicillin, died from diphtheria. She had a respect for antibiotics, which we need to regain.

To whom would you most like to apologise?

My paediatrician partner, Judith, who, because she understands my origins and professional passions and shares my love of our children, keeps me balanced, despite me so often being a big pain in the butt.

If you were given £1m what would you spend it on?

I’d use some for completing the resurrection of our cottage in the Black Mountains and some for supporting children’s education in my home town in South Africa.

Where are or were you happiest?

Professionally, I am in a state of elated “flow” when fine tuning a draft research paper.

What single unheralded change has made the most difference in your field in your lifetime?

The integration of clinical epidemiology with the patient centred clinical method.

Do you support doctor assisted suicide?

My mother, during a long and pointless final illness, asked me to help her end her life. I regret that doctors were not allowed to “help her out,” as she requested.

What book should every doctor read?

John Steinbeck’s Of Mice and Men. It asks questions about loyalty and our caring for people of different ability, especially in a context of social deprivation, and about whether we would do the kind (right) thing even if it were seen as wrong.

What poem, song, or passage of prose would you like mourners at your funeral to hear?

My daughter, Caitlin, reading TS Eliot’s Wasteland, then any of Johannes Kerkorrel’s songs, followed by everyone belting out Cwm Rhondda together. Sorry, it might be a long funeral!

What is your guiltiest pleasure?

I once had a vegetarian partner, and I would sometimes sneak out for an illicit steak and kidney pie; sadly, this may still occasionally happen.

If you could be invisible for a day what would you do?

Invisible as well as small? I’d snuggle up to commensal bacteria to gain a better understanding of the interactions that trigger their transformation from symbiosis into pathogenic hellfire.

What television programmes do you like?

British psychological cop shows: it’s hard to beat things like Happy Valley and The Fall.

What is your most treasured possession?

The portrait my 17 year old daughter, Eva, did of me (see above). She captured my agony and ecstasy.

What, if anything, are you doing to reduce your carbon footprint?

I cycle whenever I can. Cycle-friendly cities will help contain obesity, cardiovascular disease, depression, and probably infections too; improving health and reducing carbon are much the same thing. Public health demonstrates that small, sustained changes make huge differences when taken up by large numbers of people.

What personal ambition do you still have?

To make a contribution to us all living in better harmony with our environment, including a less adversarial relationship with microbes; and to have one or two original thoughts and see them through.

Summarise your personality in three words

Irreverent, empathetic, insecure.

Where does alcohol fit into your life?

I’ve been lucky: alcohol has generally been a pleasant friend, but I’ve seen many lives where it has been a vicious enemy.

What is your pet hate?

Obsession with process, especially when it’s at the expense of positive outcomes. The byzantine UK research permission process (especially “R&D”) is a prime, Kafkaesque example.

What would be on the menu for your last supper?

Vegetable biryani from the Cinnamon Tree.

Do you have any regrets about becoming a doctor/academic?

I have been privileged to practise medicine on three continents, which has opened so many windows to the rich tapestry of human life. It has given me the ability to prescribe lifesaving drugs such as antibiotics and the awesome responsibility to do that wisely. It’s been a blast; no regrets, no surrender.

If you weren’t in your present position what would you be doing instead?

A full time GP at Cwm Taf in south Wales, or a medical officer at Cecilia Makiwane Hospital, Mdantsane, in the Eastern Cape province of South Africa.


Cite this as: BMJ 2015;350:h1770

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