The following transcript is computer generated

Show: The Relax Back UK Show (UK Health Radio)
Host: Mike Dilke
Guests:
1. Dr. Sam Wass (Developmental Psychologist & Neuroscientist) — Children’s Early Vision, Behavior, & Eye Tests
2. Dr. David McKean (Interventional Radiologist) — Spinal Electrochemotherapy for Metastatic Tumors
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[00:00 – 00:56] Episode Introduction
[00:02] Mike Dilke:
“Hi, I’m Mike Dilke and you’re listening to the Relax Back UK Show. Hi, and thank you for joining me on the Relax Back UK Show. The first guest today is Dr. Sam Wass, and we talk about the importance of eye tests for young children.”
[00:15] Dr. Sam Wass:
“If I’m not so good at recognizing an emotion across a room because I can’t see the smile so clearly, then that’s another way in which an early impairment of vision can have cascading impacts on later development.”
[00:27] Mike Dilke:
“Then it’s Dr. David McKean.”
[00:29] Dr. David McKean:
“With this technique, you’re passing a voltage, you’re passing electricity across the tissues. At a certain threshold, that causes the cell membranes—the membrane around each cell in that area—to become slightly more permeable. It allows more of the chemotherapy to get into those tissues.”
[00:51] Mike Dilke:
“He explains electrochemotherapy. So please do stay tuned for a great show. Thank you!”
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[00:57 – 04:37] Part 1: Dr. Sam Wass on Child Psychology & Early Vision
[00:57] Mike Dilke:
“Dr. Sam Wass is a psychologist. My first question to him was: what is the difference between a psychiatrist and a psychologist?”
[01:05] Dr. Sam Wass:
“A psychologist deals with the mind, and if you’re a doctor, then you generally come at psychology from a PhD where you’ve done research into a particular area of psychology. Psychiatrists tend to be medically trained and are allowed to prescribe drugs. They also sometimes provide psychological treatments, but they can prescribe drugs, whereas psychologists generally can only prescribe talk therapy. That’s the main difference. I’m a psychologist, not medically trained—everyone in my family is medical apart from me—but I’m a psychologist and neuroscientist, so I do a lot of work on brain development.
Particularly into the topic that we’re going to be talking about today, which is a lot about children’s early visual experiences. One of the things that we do a lot of work on is putting miniature cameras on children in the 0 to 5 age range and using it to capture their visual environment. We look at how your environment changes as you get older, as you move from home to nursery settings to school settings, how it differs between children, and the role that early eyesight plays in informing long-term development. That’s one of the things I want to talk about today.”
[02:23] Mike Dilke:
“So you get to see what they see. Is that what you mean?”
[02:27] Dr. Sam Wass:
“Exactly. We capture the child’s perspective on things. I guess there are a couple of ways in which this is important for what we’re going to be talking about today: the importance of getting an early sight test. Atypical early sight is often quite hard to diagnose. You can pick it up—there are various cues like sitting close to screens, rubbing their eyes, headaches, or squinting—but it’s also very easy for a child to have a sight impairment and for it not to be diagnosed, for the very simple reason that they don’t know that the world looks different to them than what it’s supposed to look like. You don’t compare typical vision to atypical vision.”
[03:04] Mike Dilke:
“Presumably parents don’t necessarily know how kids develop. Maybe it would be good to explore the sort of things that parents could be looking out for to suggest that there might be an issue with their child’s sight. Are there some obvious, easy things to spot?”
[03:25] Dr. Sam Wass:
“There are a few, like sitting close to screens, rubbing eyes, or squinting. But the really important thing that we want to emphasize for this campaign with Specsavers is that there’s a lot of good quality research suggesting that even a child who can scrape through an eye test can have an undiagnosed problem that can impact their subsequent development.
Children are very good at doing this thing called accommodation, where you actually bend the lens slightly. Long-sightedness is actually quite common in children, but you tend not to pick it up because you’re doing this process of accommodation where you’re distorting the lens in order to pick it up. The reason that taking them to a sight test early on is important is because even if they’re managing to get by, there’s good quality research that the effort involved in doing these processes of accommodation or compensatory mechanisms can still get in the way of their subsequent development. There are a few things that you can watch out for, but also some things that you just can’t pick up unless you take them to an eye test.”
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[04:38 – 08:58] School Classroom Demands, Whiteboards & Social Vision
[04:38] Mike Dilke:
“On the whole, children are often quite resilient and just get on with it. You said that they can compensate by using the muscles in their eyes—accommodation. But presumably there are other ways of dealing with the fact that you can’t always see things that well, and you just deal with it and get on with it, because that’s what kids very often just do.”
[05:08] Dr. Sam Wass:
“One of the things that comes across a lot from these studies about head cameras, capturing a baby’s, toddler’s, and young child’s perspective on the world, is how it changes around the time we start school. A lot of the time when you’re young, you’re in control of your visual environment. If I’m interested in something, I can pick it up and bring it close to me. Young children tend to pay attention to things close to them much more, and fingering and moving it around are really important in helping our awareness of objects to develop. When you’re very young, you only get a flat picture of the world because you can’t move around in it. Moving around and looking at how things change as you’re moving is very important for helping your visual processing to develop. But that’s all about you being in control, which is fine, and as you say, you can compensate.
One of the things that’s really important is how vision changes around the time you start school in particular. I was quite struck—I’m a parent governor of my kids’ school, and I was in my middle daughter’s reception class observing. Various children were sat on the carpet while the teacher was writing something up on a whiteboard. Some of the children were quite far away, and the teacher was writing really quite small. I was thinking: goodness me, this is placing a new demand on these children’s eyesight, having to focus on something that’s far away.
That’s the type of thing that you can’t really compensate for. When you’re age four and you’ve just started class, you can stick up your hand and say, ‘Excuse me, I can’t read the writing,’ but you have to have a lot of guts to do that at age four when you’re brand new in a class. They do compensate, but the way they compensate is by looking away from the board, looking at their foot instead, or starting a conversation with their friend. At that point, it tends to get flagged up not as a sight issue, but as an attention issue or a behavior issue. That is why there is really good quality research that particularly around these moments where we’re putting children in a situation where they can’t just compensate or do something differently, particularly in school settings, it’s really important.”
[07:14] Mike Dilke:
“Are we just putting them in that situation too early? With my kids, they actually went to a different sort of school and didn’t learn to read or write until quite a bit after four or five. That’s probably a whole other series, but give us a quick thought on that.”
[07:30] Dr. Sam Wass:
“It’s interesting, and it’s a really good question. About the reading and writing, I don’t know. One of the other things that I’m aware of is other ways that we use vision in a similar way, a lot to do with things like emotion recognition. We read a lot of emotions. One of the big things that we’re working on when we’re young is not just about reading, writing, and arithmetic; it’s things like understanding thoughts and feelings in other people. A lot of the cues for that are very visual, and a lot of the emotions that you express on your face are very fast, quite subtle, and quite fast. If I’m not so good at recognizing an emotion across a room because I can’t see the smile so clearly, then that’s another way in which an early impairment in vision can have cascading impacts on later development.
Another way is early language learning. There’s some really important research that one of the things that we do to learn language is: I look where the adults around me are looking as they’re talking. I work out from looking at their eyes what they’re looking at in the real world, and that’s how I learn. More often than not, when I say ‘bottle,’ I’m actually looking at a bottle, and that’s a really important tool for learning language. Again, I need to use my eyesight quite subtly to do that.
There are ways that we can put the specific challenges that I mentioned about writing on a board and getting them to copy that to later in development, but these other things like gaze following and recognizing emotions on people’s faces are really hard to move to later in development.”
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[08:59 – 12:49] How the Brain Constructs Vision & Eye Test Anxiety
[08:59] Mike Dilke:
“And they’re actually probably more important than reading and writing.”
[09:01] Dr. Sam Wass:
“They are more important in a lot of ways. We’re just developing some new training around these foundational aspects of learning, like learning to see. The raw information that hits your retina is just like a flat image. It’s a 2 centimeter by 2 centimeter flat image that you get at the back of the retina in a child—it’s about 3 centimeters by 3 centimeters in an adult. Imagine trying to work your way around the environments that we live in with just a 2 centimeter squared flat map to go on. It’s an amazingly hard thing, but that’s what we do, because the raw image…”
[09:37] Mike Dilke:
“It’s amazing we do it at all and we’re not always tripping over things and bumping into things.”
[09:41] Dr. Sam Wass:
“It’s the work that our brains do. Our eyes get this very limited amount of information, and our brains construct from that this really complex model of the world.”
[09:53] Mike Dilke:
“They fill in the missing bits.”
[09:56] Dr. Sam Wass:
“They fill in the missing gaps, and they do it based on prior knowledge, prior experience, and prior expectations. I know roughly how big a face is, so I can use that prior knowledge to work out, just from seeing a face, how close that face is to me. Lots and lots of really clever things that our brains figure out to do in terms of how to do this.
These are absolutely crucial forms of early learning, all impacted by atypical development. All of the research into medical conditions like amblyopia (lazy eye), strabismus (squints), and that type of thing—a lot of them are compensatory. You have a core deficit in one eye and your brain is learning to compensate. Again, the earlier you can pick up these problems, the less you get into these compensatory mechanisms, and the less you interfere with these normal processes that our brains go through of learning how to figure out what the really dense, complex visual information that hits our eye really means.”
[11:14] Mike Dilke:
“An awful lot, not just reading and writing, the whole development of your mind, body, and soul depends on this stuff. Hence, it is vital to make sure that young children can see properly, and if they can’t, to help them. With that in mind, there are eye tests at school early on, aren’t there, to make sure that this is all working and functioning properly?”
[11:25] Dr. Sam Wass:
“It’s certainly recommended to go to a proper NHS-funded eye test. The NHS funds free eye tests for people at Specsavers and others, and it is worth going to that because there are quite a few things that are covered in the proper eye test that aren’t done in school.
One of the things that we’re talking about with this is some of the things that can pull parents back from doing this. One is just simply not realizing that there’s a problem to start with, as we mentioned earlier. It’s very easy for a child not to have a problem and for you not to pick it up. But also around this idea of resistance, fear, and worry about medical procedures. The survey from Specsavers said that 45% of young children were worried before their first eye test.
From my point of view as a psychologist, I think there’s a lot of very justifiable reasons why this is, to do with fear of the unknown—the same things that you or I feel. Everybody is worried about something when they’ve got no idea what they’re going to be letting themselves in for. The really important thing from the point of view of parents is realizing that the unknown is very different for a child compared to you or me. We know roughly what we’re expecting, and we’ve been through lots of similar experiences. Even if we’ve never had an eye test before, we’ve done lots of similar things in the past, which helps us to imagine what the room is going to look like, what the lighting is going to be like, what we’re going to be asked to do, and what the sensory aspects of the world are.”
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[12:50 – 17:33] What Happens at a Child Eye Test & Why Reassurance Backfires
[12:50] Mike Dilke:
“What does it actually consist of? If you’re taking your four- or five-year-old child to an optician—Specsavers or whoever it might be—for this free NHS test, what actually happens? Presumably it can all happen with your child sitting on your knee so they get some comfort from that?”
[13:08] Dr. Sam Wass:
“We’ve been working with Specsavers to say one of the really important things is getting a really clear idea about what’s involved in it. There’s a really nice step-by-step procedure of exactly what’s going to happen on the Specsavers website.
In terms of the sensory things—what’s the lighting going to look like, what’s going to be cold to touch, what’s going to be hard to touch. Another thing is a worry about what exactly I’m going to have to do. This idea of a test is something that we try to hold back from testing young children too much, for good reasons, because children don’t really enjoy being tested.
One of the things that’s on the Specsavers website, as well as this description of what the room is going to be like, are these ‘Optomonster’ sight prompts. This is a playful way that you can do at home of getting used to: how many fingers is this monster holding up? Who’s wearing three glasses? What color is this small detail? They get used to this idea that they’re going to be looking at things.”
[14:10] Mike Dilke:
“I was going to ask about what they actually have to say during the test, because these children haven’t learned to read or recognize letters yet. In my experience, all eye tests involve: what letter is that? What number is that? What do the kids do?”
[14:28] Dr. Sam Wass:
“They get through it a lot with things like comparisons: which of these two things are the same? Which of these things are different? Asking them to match pictures and symbols, and preferential looking: look at the one that’s smaller, and that type of stuff. They’re very well designed nowadays, so that you can do exactly the same tests of acuity separately eye by eye without actually requiring you to be able to read letters and numbers.
We know that these things happen through developmental cascades. We know that there’s a big process of learning how to see. We know that development is very plastic, very adaptive. An early problem, if it’s not picked up, can lead to cascading problems in other areas. We’re really trying to raise awareness about the importance of doing this type of thing during early life. It is very well designed around this idea that you don’t have to be able to read; you just have to be able to ask questions.”
[15:26] Mike Dilke:
“Presumably all little kids want to please people, particularly their parents. Is there an element that children might cheat—cheat is not quite the right word, but pass the test or try and pass the test just to please the adults there? How can you stop that?”
[15:54] Dr. Sam Wass:
“You stop that through the way that the tests are designed. You come through to the threshold and then you go past it. It’s things like: look at the one that is the similar, match a pattern, or tell me which of these four in this grid is the same as the comparison one. You show them one picture, and then you say, ‘I’ve got four different ones, point to one.’ You can’t actually do that by chance, and it’s designed so that you can’t do that by chance. It’s not just a question of saying, ‘Does this look normal to you?’ because from a child’s point of view, they won’t do that. It’s exactly the same way as an adult eye test where you have to read the letters out that get smaller and smaller, and you can’t fake it: you can either read the ones that are at your limit or not. They do exactly the same thing, but in terms of pattern matching and that type of stuff, so you can’t fake it.
Another thing that we put in on these tips is this idea that it’s really important when you’re talking to a child, as well as telling them what’s involved because they just don’t know, to normalize it. Children don’t really understand about difference, and they don’t really understand where difference comes from. It’s very easy to think that if you go to an eye test, this is something that you can fail and that might reflect badly on you if you do fail it.
One of the things that we talk about that’s really important is that if it does turn out that you need corrected eyesight after this test, it’s not your fault. It’s not because you’ve done something wrong; it’s just because—with my kids, I’ve got a five-year-old and a seven-year-old, and we talk lots about this idea that half of you comes from mummy and half of you comes from daddy. The idea of genetics: there’s a lot of difference that you have no control over, and it’s not your fault. They’re just things that you inherit. That’s a really important idea to be getting across to children: if they do need corrected sight, it’s not because they’ve done something wrong.”
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[17:33 – 23:48] Distraction, Giving Choices & Specsavers Resources
[17:48] Dr. Sam Wass:
“A lot of the time it is just a question of awareness raising. People might have a child who has a problem that you’re not picking up. Almost all parents want the best for their children. One of the other challenges that we do encounter is sometimes you get very natural parents wanting to help their child, but not really necessarily understanding the best way to help them.
You get this all the time around children starting school. When I’m dropping off my kids at the first day of school, there’s always a couple that you see who are flailing at the fear of starting school, and the parent is walking along next to them in a super-cheerful voice saying, ‘It’s going to be fine! You’re going to have a lovely time! You’re going to make lots of new friends! Don’t be scared!’ At which point the child’s wails just intensify!
There is really good quality research—I was quite pleased to look this up when we were putting together these tips for Specsavers—that too much reassurance can actually be counterproductive. A child interprets you telling them repeatedly that there’s nothing to be worried about as a sign that there really might be something there to be worried about, planting the idea of being worried in the first place when it might not have occurred to them.
All of the research says better things to do are just distraction: make sure that they’ve got something to be thinking about all of the time, rather than just telling them what’s coming up and saying, ‘Don’t be scared, don’t be scared, don’t be scared.’ It is important to get the parents right. Mostly it’s well-intentioned, but sometimes people don’t naturally do the thing that’s the most evidence-based way to actually help your child.”
[19:25] Mike Dilke:
“Presumably these techniques are useful not just for sight tests, but for other medical tests and other trips to the doctor. I’m thinking back to when my kids were small, going for vaccinations. I have to admit I used Twiglets—a packet of Twiglets got me through that on many occasions!”
[19:46] Dr. Sam Wass:
“That’s lovely! There are lots of different things that we can be doing that help. Where there’s actual physical discomfort—obviously this doesn’t apply to an eye test, but where there’s actually physical discomfort involved—there’s some really nice research about the power of touch. There is a massive difference to how much physical pain you feel at something like an injection if you’re actually touching.
The other thing I wanted to talk about a little bit is this idea of control. Just like this fear of the unknown, nobody likes being in situations where they’re not in control. A lot of the issues that a lot of people, adults as well as children, have with these medical-type procedures is that you’re out of control.
All of the research about that is: this is something that you want to do with your children because you want it to help their long-term development, for the reasons that we were talking about earlier in the interview. They don’t have a choice about whether to do it or not, but you can fake a feeling of control by giving them choices over the small details, like: who do you want to sit with? Where do you want to sit? Which seat do you want to sit in? Do you want to hold my hand or not? What side do you want me to sit on? Do you want to take a toy with you? What type of toy do you want to take?
Again, these are things that apply equally to adults. During COVID, I was talking lots about how some of the reasons people found COVID so hard was just being out of control of your life. Any way that you can fake a feeling of control, or control over the small details even if you don’t have control over the big picture, really helps. That applies to vaccinations just as they apply to eye tests. It’s like that old trick: you try and get a child to eat a pile of spinach, and they’ll often sit and refuse. Then you cut it up into two halves and say, ‘Okay, you can choose which of those halves that you eat.’ It’s amazing how often that works, just that feeling that I’m in control.”
[22:23] Mike Dilke:
“Don’t let the secret out, Sam! Don’t tell the mums!”
[22:27] Dr. Sam Wass:
“We like children eating spinach, just like we like children taking eye tests!”
[22:33] Mike Dilke:
“Yeah, of course! This is fascinating, and I suspect that I could talk to you for a whole mini-series on how children think and what children get up to. For now, coming back to the topic of eye tests, there must be a good resource if people have smaller children and they’re starting to think about this, just to go over some of the things that we’ve spoken about and give some good information about getting a child to an eye test. What’s a good information source?”
[23:06] Dr. Sam Wass:
“The descriptions that I was talking about—what exactly an eye test involves, these practices that I was recommending doing with your children before, the Optomonster sight prompts where they’re little practice ones that you can do at home so a child knows what’s coming up—are all on the Specsavers website. Just Google ‘Specsavers children’s eye test’ and everything comes up on one big page.”
[23:28] Mike Dilke:
“I’m assuming there’s some good stuff on the NHS website as well, because there usually is.”
[23:33] Dr. Sam Wass:
“As I mentioned, the NHS funds free eye tests for everybody because of this research that it’s a really important thing. There’s lots of information on there, too.”
[23:41] Mike Dilke:
“Sam, thank you very much indeed for taking the time to chat. This is important stuff.”
[23:46] Dr. Sam Wass:
“Great. Nice to talk to you, Mike. Thanks for having me.”
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[23:49 – 26:48] Station Break (UK Health Radio)
[23:51] Station Voiceover:
“UK Health Radio – The station that makes you feel good.”
(Musical interlude)
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[26:49 – 31:20] Part 2: Dr. David McKean on Spinal Electrochemotherapy
[26:49] Mike Dilke:
“Dr. David McKean is a radiologist, and he specializes in treating tumors in the spine. When using electrochemotherapy, he uses needles that work as an electrode. My first question to him was: how do you ensure that the needles go to the right place?”
[27:05] Dr. David McKean:
“That’s a really good question, Mike, and thanks for having me on the show again. This is a treatment for a specific type of tumor in the spine. It’s going to be a case where somebody has had an MRI scan, and on that scan we’ll have identified where this tumor is. This is usually going to be targeting tumor in something called the epidural space, which is in the space around the spinal cord, which can be really difficult to get to.
When we perform the procedure itself, we do this using a CT scanner. You’d be in a CT scanner, we use the X-rays to see exactly where we’re going, and we’re able to proceed by putting these electrodes around the tumor under real-time guidance. It’s a very precise procedure.”
[27:56] Mike Dilke:
“So this is real-time: you are working on the patient and looking at the screen of the scanner so you can see exactly what’s happening inside?”
[28:08] Dr. David McKean:
“Exactly that. We’re doing it under CT guidance with really incredible precision to try and target this tumor, which is in this difficult place to get to around the spine. There are things we can do obviously to treat tumor in the bones, like radiotherapy and chemotherapy. But if it’s around the spine, there’s a limit to how much radiotherapy you can give next to the spinal cord without damaging the spinal cord. If you haven’t responded to the radiotherapy and you haven’t responded to conventional chemotherapy, this is where that treatment comes in. It’s sort of a last roll of the dice treatment when everything else has failed; this is something we can do.”
[28:55] Mike Dilke:
“Chemotherapy relies on a blood supply to take the drugs to the vicinity of the tumor. Is the blood supply in this area low, or what’s generally the problem?”
[29:07] Dr. David McKean:
“Some tumors just respond less well to conventional chemotherapy. One of the limitations is actually getting enough of the chemotherapy agent into the tumor, and that’s really what electrochemotherapy is trying to help with.
With this technique, you’re passing a voltage, you’re passing electricity across the tissues. At a certain threshold, that causes the cell membranes—the membrane around each cell in that area—to become slightly more permeable. It allows more of the chemotherapy to get into those tissues.
If you put the voltage too high, it’ll eventually start to permanently damage the cell membranes and cause cell death. You can use this as an ablation technique where you’re trying to kill the tissues, but before you get to that point, you can just use it as a technique to change the permeability of the cell membranes and allow more chemotherapy agent in. That’s what we’re doing in this particular technique.”
[30:16] Mike Dilke:
“What kind of voltage are we talking about here? Is it a car battery you’re hooking up to this thing?”
[30:22] Dr. David McKean:
“It’s a pretty substantial voltage. When you get over about 400 volts per centimeter, you get something called reversible electroporation, where you’re going to get these changes in the cell membrane permeability, but that’s reversible. After a little while, the cell recovers. Once you get over about 800 to 1,000 volts per centimeter, then you get permanent destruction of the cells, so you get permanent cell death, and that’s called irreversible electroporation.”
[30:55] Mike Dilke:
“This is more than a car battery—quite a lot more than a car battery!”
[31:00] Dr. David McKean:
“Yes, but it’s over a very controlled area. What we do is we’re placing these electrodes around the spine, just around the tumor, and then we’re passing a current between these electrodes in a pattern that will hopefully allow the chemotherapy agent into the cancer cells.”
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[31:21 – 36:01] General Anesthesia, Bleomycin Timing & The Vascular Lock
[31:21] Mike Dilke:
“During all this, is the patient under a general anesthetic or a local anesthetic, and do they feel this electric shock?”
[31:31] Dr. David McKean:
“This is all done under a general anesthetic. The vast majority of my interventional procedures are just done under conscious sedation, but this one would definitely require a general anesthetic. When you pass 400 volts across the spinal cord, you get a lot of muscle contraction, the patient jumps on the table, and you definitely jump standing beside them. In order for the patients not to feel that, it needs to be done under a general anesthetic.”
[32:05] Mike Dilke:
“Goodness me! The patient is unconscious on the table, you give an electric shock in a very localized area of 400 volts or so. And then is that when you give the chemotherapy, at the same time or a little bit after? How does that bit work?”
[32:25] Dr. David McKean:
“You’d actually give the chemotherapy a few minutes before, maybe 10 to 15 minutes before you do the electroporation, so that chemotherapy agent is going around the bloodstream at the time that you deliver the electric shocks.
The chemotherapy is usually a drug called bleomycin, which is a really effective chemotherapy agent, but it’s not very good at getting into the cells. Once it’s in the cells, it works very well, but it doesn’t have very good cell membrane permeability itself. You give the chemotherapy agent 10 to 15 minutes before, and then as that’s sloshing about, you go zap, zap, zap! That allows the bleomycin to get into the tumor just in the area that you’re targeting.”
[33:15] Mike Dilke:
“The chemotherapy gets into the tumor via the blood. Now, I’m thinking—you have to understand I’m a layman here—getting more blood to the tumor sounds like a bad idea, because the tumor is going to go, ‘Oh goody, this is what I need to grow and possibly metastasize! I want more blood coming to me, thank you very much, now I’ll go ahead and do some real damage!'”
[33:43] Dr. David McKean:
“All the blood vessels going to the tumor are going to be there before we do this. This isn’t going to cause any increase in the blood vessels going there; we’re just taking advantage of that because that’s how the chemotherapy agent is going to get to the tumor as well.
You do actually get a bit of a vascular lock effect after this, by which I mean to say sometimes you get a little bit of a reduction in the blood supply to the tumor after the electroporation as well. The majority of the effect is this chemotherapy. The cancer will have its own blood supply, which it needs to grow, and we’re going to use that blood supply to get the chemotherapy in, and then use the electricity to really ramp up the amount of chemotherapy that gets into the cancer cells, which can just make it much more potent.”
[34:42] Mike Dilke:
“How long does the effect of providing the electric shock last? Is that just while you turn the button on, or does it last for a little while afterwards?”
[34:53] Dr. David McKean:
“The cells will return to a normal permeability pretty quickly. It’s a temporary effect; it’s a reversible effect, provided you don’t go over too high of a voltage.
Then the effect of the chemotherapy agent also takes a bit of time, because this is a chemotherapy agent that only works when the cell divides. When the cell tries to divide, or when the tumor tries to grow, that’s when it’ll work and kill the cell. It works particularly well on fast-growing tumors or very vascular tumors, because that will allow lots of the chemotherapy to get in. But it’s not immediate; nothing happens the same day. You have to give it a few weeks, a few months, and then as you scan the patient in the weeks and months afterwards, you just see this tumor shrinking down. It can be very effective for these patients who otherwise would have no other option, because they’ve usually exhausted all the other treatments that are otherwise available.”
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[36:02 – 41:49] Palliative Goal: Preventing Paralysis & Preserving Quality of Life
[36:02] Mike Dilke:
“Is it a one-off treatment or do you have a course of treatments like this?”
[36:05] Dr. David McKean:
“Usually it’s going to be a one-off treatment. The typical scenario would be a patient who has had metastatic cancer, often had a lot of treatment by this point—lots of chemotherapy and radiotherapy—and unfortunately the cancer is still progressing.
The natural history of having cancer in the spine is pretty terrible, in that eventually that cancer, if it keeps progressing, will start to press on the nerves and press on the spinal cord. That can cause a lot of pain, nerve pain, weakness, you can lose control of your bladder and your bowels, not be able to walk, and so on. That can be very difficult for people at the end of life.
What we’re trying to do with this sort of treatment is to prevent that sort of disease progression. It’s often not going to be a cure, because often these patients will have cancer elsewhere in their body. But if we can stop the cancer from pressing on the spinal cord and stop all those other complications—like not being able to control your bladder or your bowels, not being able to walk, and having pain—if we can prevent that from happening, it can just give people a huge amount of improved quality of life at the end of life.”
[37:24] Mike Dilke:
“Quality of life at end of life. Quality of care when you know you’re going to die, but the last few months are very important.”
[37:37] Dr. David McKean:
“Exactly. You want to be at home, pain-free, mobile, and when conventional treatments have failed, that’s when this can be an option for specific cases.”
[37:53] Mike Dilke:
“Is this something that’s used a lot in this country, or is it just starting to be used?”
[37:58] Dr. David McKean:
“It’s very new. It was really pioneered by some teams over in France. I’d highlight Frédéric Deschamps, who’s my friend over in Paris, who has really done incredible work developing this technique. I performed the first case of this a couple of years ago in my NHS trust in Buckinghamshire, which worked very well. But because it’s so new, we’re really only taking on very selected cases. It really is going to be something for when everything else hasn’t worked. In the cases that we’ve treated, it’s worked very well. There’s only been, I think, probably under 10 cases done in the UK so far.”
[38:48] Mike Dilke:
“As a treatment, it sounds like it might be useful for treating cancers elsewhere in the body. Everybody knows chemotherapy can be a horrible thing and has many side effects. If maybe you could use this to enable you to reduce the dosage of chemotherapy, use it in cancers in other parts of the body—I can see you nodding your head. I’ve not had a novel thought ever in my life, so there’s no reason to start now! I guess other people have thought that and are probably doing it?”
[39:18] Dr. David McKean:
“It’s absolutely an area of active research. There are going to be lots of advances in more targeted cancer treatments and finding ways to increase the effect of the chemotherapy agents that we’ve already got. This is definitely one of those areas.
There are lots of different ways of trying to target chemotherapy to a tumor, but this is definitely one of them. It seems to be particularly useful for this epidural tumor that I was talking about—the tumor around the spine—because it’s such a difficult area to get to otherwise. Radiotherapy is great in the bones, but as I say, there’s just a limit to how much radiotherapy you can give to the spinal cord. This is an alternative to that.
Obviously there’s always the option of surgery, but it’s a big operation to go in and essentially peel away the cancer from around the spinal cord there. Often these patients are very unwell. The prospect of having a very big spinal operation in the last few months of life or last year of life is a big undertaking. Trying to find ways to treat these patients as minimally invasively as possible is definitely going to be an area that we’re going to try and develop.”
[40:51] Mike Dilke:
“That’s a good point: the fact that this is minimally invasive. Essentially it’s just a few needles, admittedly guided in very carefully by you, so there can’t be too much pain afterwards.”
[41:07] Dr. David McKean:
“No. The patients that we’ve treated have not had any pain afterwards, really. It’s very small needles down around the tumor in the spine, and then a cannula in the arm for us to give the chemotherapy agent into the bloodstream. That’s all that’s required for this. It’s not an invasive procedure. It’s done under general anesthetic, but it’s a day case. The patients usually come in in the morning, we treat them that morning, keep them in recovery in the afternoon, and they go home the same day. It’s a minimally invasive, day-case procedure.”
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[41:50 – 48:35] Safety, Patient Story & Hospital Rollout
[41:50] Mike Dilke:
“When it comes to downsides, you mentioned that when the electric shock is actually given, the muscles contract. Muscles contracting very quickly, particularly if someone is frail, can potentially lead to broken bones and that sort of thing. You must do something to prevent that, I’m hoping?”
[42:12] Dr. David McKean:
“Absolutely. We give the patients lots of muscle relaxant. Even though there’ll be a little bit of muscle spasm, it’s not going to be sufficient for them to break any bones or anything like that.
The main complications from the technique are the potential risks of the electricity. That’s going to be the thing that we’re worrying about. If you were to give too much electricity across the tissues, across the spinal cord, you can cause an injury to the spinal cord from that. That’s why we’re very careful as to the position of the electrodes that we put down, and very careful as to the voltage that we use, to try and avoid any of those complications.
The research seems to suggest that your spinal cord is actually pretty resistant to this. In Frédéric Deschamps’ work from Paris, he’s seen relatively few complications in the cases that he’s treated so far, and he’s treated well over 100 patients—probably far more than that by this point.”
[43:15] Mike Dilke:
“In the scheme of things, the technique is relatively new. Over 100 is a lot, but for an invasive technique, it’s relatively small.”
[43:31] Dr. David McKean:
“It’s a technique that’s developing. The evidence so far is very encouraging. This is something that’s used in other areas of the body more routinely, but it’s very new in the spine. People have been using this in the liver and for lesions just under the skin or for breast cancer for a long time, so it’s more established in those other areas, although I think not widely, widely used. Around the spine it’s still very new, but the evidence so far seems to be very encouraging for this specific group of patients who otherwise actually have very few other options. That’s why we’re so excited about it: it’s giving us something to treat these patients where previously we would have said there’s nothing else we can do.”
[44:27] Mike Dilke:
“Is this available on regular healthcare, or do you need private healthcare?”
[44:38] Dr. David McKean:
“We’ve performed these in the NHS; I haven’t performed them privately. But it’s so new that the process of arranging these is not straightforward, because it requires essentially a lot of sign-offs from various people along the chain: the surgeons, the oncologists, your medical director, because it’s something that’s so new that people need to consent that they’re willing to go ahead with this. It’s not something that’s widely available. I know that myself and Steve Morgan, who’s another interventional radiologist down in Bristol, have performed some cases. I know that the technique of electroporation is definitely used for other areas of the body quite widely across the country, but I wouldn’t say it’s in very wide use at the moment. I suspect that will grow over the next few years.”
[45:45] Mike Dilke:
“Thank you very much indeed for chatting. This does sound as if it can potentially help quite a lot of people. If people are listening and would like to find out a little bit more about this, what’s a good information source?”
[46:09] Dr. David McKean:
“You’re right, there probably isn’t much in the literature aimed at the public; that’s a very good point, Mike. I need to put something out there.”
[46:16] Mike Dilke:
“You need to write a book!”
[46:18] Dr. David McKean:
“I am going to add something to this on my website, because it’s so interesting and so new. But there’s no question that there are loads of patients out there who could benefit from this if we could just create the referral pathway, find ways to get people access to this treatment, and train radiologists to provide it.
The first patient we treated was a lovely guy who had had every other treatment under the sun: surgery, vertebroplasty, radiofrequency ablation, radiotherapy, chemotherapy, everything. Despite all that, the tumor just kept progressing, and he was getting a lot of symptoms. We treated him, and over the next couple of months, as we scanned him, you could see the tumor just melting away.
He basically got another Christmas and another few months at home with his family, relatively pain-free, mobile, walking, without any bladder or bowel symptoms. But as I say, it was a palliative procedure, and he eventually passed away from other metastases around Easter. Afterwards, we spoke to his family at length, we were able to go to his funeral and speak to quite a lot of the family, and they were just incredibly grateful, because it just made a huge difference to them and to him just for those last few months, to not have all the other complications that they knew were imminent if something wasn’t done. There’s definitely lots of other patients who this could benefit, but we’re still at the early stages of just beginning to set up these services. It’s an exciting new development.”
[48:07] Mike Dilke:
“It certainly sounds like it’s worthwhile. If you have a website, just give that.”
[48:16] Dr. David McKean:
“Sure, it’s drdavidmckean.com.”
[48:23] Mike Dilke:
“David, thank you very much indeed for chatting.”
[48:26] Dr. David McKean:
“Pleasure. Take care.”
[48:30] Mike Dilke:
“Thank you very much to my guests today. They were Dr. Sam Wass, talking about eye tests for young children—he’s a psychologist—and Dr. David McKean, talking about electrochemotherapy—he’s a radiologist. Thank you to you for listening, and have a healthy week. Until next week!”
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[48:45 – 51:45] Show Wrap-Up & Station Close
(UK Health Radio jingle, music, and sign-off)
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300-Word Summary: Key Points Discussed
This episode of the Relax Back UK Show explores two distinct medical advances: early childhood visual development and minimally invasive spinal electrochemotherapy.
Developmental psychologist and neuroscientist Dr. Sam Wass discusses research tracking young children’s visual environments via head-mounted cameras. Young children often mask farsightedness through physiological accommodation—actively bending their eye lenses. Upon entering school, sudden distance demands like viewing classroom whiteboards expose these deficits. Struggling children look away, leading teachers to mistake visual strain for inattention or behavioral issues. Furthermore, clear eyesight is foundational for social-emotional growth: decoding subtle, rapid facial expressions and tracking adult gaze during early language acquisition. Free NHS eye tests at opticians like Specsavers require no reading ability, using playful symbol and pattern matching. To alleviate pre-test anxiety reported by 45% of children, Dr. Wass cautions against excessive reassurance (“don’t be scared”), which inadvertently signals danger. Instead, parents should use distraction, normalize genetic differences, and offer small choices—such as picking their seat or bringing a toy—to instill a comforting sense of control.
Next, interventional radiologist Dr. David McKean explains electrochemotherapy (ECT) for inoperable metastatic tumors in the epidural space surrounding the spinal cord. When standard radiotherapy and chemotherapy have reached their toxicity limits, CT-guided needle electrodes are placed around the tumor under general anesthesia and muscle relaxants. Intravenous bleomycin is infused beforehand. Pulsed electrical currents (~400 V/cm) induce reversible electroporation, temporarily opening cancer cell membranes to allow bleomycin to flood inside while producing a vascular lock that throttles tumor blood flow. Performed as a day-case procedure, this palliative treatment shrinks tumors over several weeks, relieving pain and preventing spinal cord compression. While not a cure for systemic cancer, it preserves patient mobility, bowel and bladder continence, and vital quality of life during their final months.