Independent on Sunday
19-04-98

The Lancet
28-03-98

Immunology News
06-98

 

THE INDEPENDENT ON SUNDAY Lewis Wolpert
 19-04-98.

WAYS of engaging the public in debate  on scientific issues, like the applications of genetic technology, are desperately needed.  The way not to do it is for the media to provide images of scientists and their creations  as monsters. But a highly imaginative theatrical venture may have found a brilliant  solution. The latest production of Y Touring is Pig  in the Middle.

The  pair's consultant is exploring the possibility of engineering pigs so that they can be  used as a source of organs for transplants. The girl, a militant vegetarian and fighter  for animal rights, is horrified when her new friend is offered a pig's kidney as a  replacement. What should he do? It is not only a questions of her moral disapproval -he  does not share her conviction that animals should never be used to help people - but also concern about the risks involved in this untried procedure.

The play is moving and engaging and at the end of the performance  a moderator appears and tells us that we are part of a public enquiry into the issues. The  actors, staying in character, return to the stage and engage the audience in a debate, and  answer questions on how they feel; the 'doctor' provides an account of the science. The  debate is vigorous, even heated. Finally a vote on whether we would support such Xenotransplants is taken and the discussion continues as we leave.

Previous Y productions include The  Gift which focused on a young woman with  Friedreich's Ataxia - a crippling and terminal genetic disease, raising issues about  genetic choices (should a pregnancy be terminated for a severe genetic illness, and is it  moral to try and select for particular characteristics like height?), and Cracked, which  deals with depression in a teenager.

 From being an apparently normal and happy girl, the main  character starts truanting and alienates her friends and family. In each case the play is followed by a debate between the characters and the audience. With The Gift  the audience is asked to imagine themselves on a special committee formed  to decide on genetic choices.

The plays, mostly performed in schools,  have been seen by some 70,000 people. Each comes with an information pack for teachers and  is written in consultation with scientists, doctors, and patients. Support from a variety  of organisations including the Wellcome Trust and the Nuffield Council on Bioethics has  meant that schools have not had to pay anything for a performance. The response has been  extremely positive. Teachers have commented that young people were surprised to discover  how strongly they felt about issues relating to organ transplantation but they also became  aware of how complex the issues are

A more formal  evaluation of Cracked showed that it had a significant impact on student attitudes to  mental health. Schizophrenia was much less viewed as dangerous and there was less emphasis  on blaming external factors like bullying as a cause of depression. Students became more  aware of the importance of loneliness and sadness.

If only the media would learn something from these excellent  productions.

THE LANCET Jane de Burgh
28 March 1998

 PIGS  have sacrificed much to the human race; they supply us with sausages and bacon,  and donate their heart valves to replace our own. Now they are at the ethical centre of a  new play touring UK schools and colleges, which debates the issues surrounding organ  donation. Pig in the Middle, written by Judy Upton, is performed by Y Touring Company, the national  theatre company of the Central YMCA.

 This is the third in  a series of plays centred around medical ethics, which sets out to explore science through  the arts. The production is concerned with xenotransplantation, specifically the  transplantation of kidneys from genetically engineered pigs into human beings. Promoting  public understanding and informed debate among young people are the key aims of the  company, and to establish a factual framework for the dramatic presentation, the project  has been completed in collaboration with the Nuffield Council on Bioethics.

 Pig in the Middle sets out to raise awareness, not only of the need for more organ donors,  but also of the complexities and elitism that pervades the world of scientific research.

 The notion of xenotransplantation is often incomprehensible to  the lay population, but it is an issue that touches us all in some way if not on religious  or cultural grounds, then as those who object to the breeding of animals for the purpose  of preserving human life. In addition, the project tackles economic factors. Many individuals may have objections to an expensive treatment such as xenotransplantation.

 Pig in the Middlepresents the audience with four  characters, each representing a particular view--each an embodiment of a sentiment. Ryan  and Gemma are teenagers on dialysis; Ryan loves football, Gemma is a passionate  animal-rights activist. Unknown to them both, their physician Dr Mayhew is on the payroll  of a pharmaceutical company involved in research into xenotransplantation and has her  sights set on Ryan as the first human guineapig.

 Ryan's mother, Sally, represents the rational but emotionally  involved relative torn between the various issues: the risk to her son's health, informed  consent, Ryan's autonomy, and the sense she seems to see in Gemma's arguments.

 The plot unfolds, as does the comprehensive exploration of each point of view.

 The play ends, and the theatre is transformed into a daytime TV chat show,  complete with designer-clad compere. Gemma, Ryan, Dr Mayhew, and Sally return to the stage  remaining in character to debate with the audience who address their questions to the  fictional characters. This effective didactic approach helps them to develop opinion in an  open debate, uninfluenced by media indoctrination or dogmatic views. Individuals are  presented with all the options, and more than enough information to aid their decision;  with the twofold aim of preparation and follow-up, a 150-page teacher's pack is made  available to each school.

 For many years, theatre groups and educationalists have  collaborated to educate and inform students through the medium of drama.  Theatre-in-education productions have toured schools, successfully bringing social themes  to the debating forum. Essential, especially when there has been a danger of dismissing  children and adolescents as too intellectually immature to consider these sensitive  issues.

 However, they are well able to enter into a moral debate, often  with intuition and sensitivity. Young people are an opinionated section of society, ardent  in their views about issues such as animal rights. Therefore a suitable forum that  encourages freedom of speech and sets out to represent the facts as clearly and honestly  as possible is both desirable and productive.

An audience of children and young adults, seems the ideal one in  which to start. Perhaps the earlier we encourage our children to consider ethical matters,  the more rounded and informed the views of future society will be.

 How we reach a personal conclusion about these issues is complex,  and requires the ability to think objectively rather than subjectively, to evaluate  critically any "acquired views" that we may have, or to refuse to succumb to the  powerful persuasions of the media. Projects such as Pig in the Middle can teach the skills of  rationalisation in an accessible form and can give valuable insight into the real world.
Jane de Burgh

IMMUNOLOGY NEWS Kirstie Urquhart
June 1998

IN 1996 the Nuffield Council on  Bioethics produced a report on Xenotransplantation which was widely reported in the press.  However the council felt that the issues raised in the report should be widely debated by  the public and thought it unlikely that many people would wade through 100 odd pages of  text, however interesting. So they commissioned Y Touring to produce an original play , Pig in the Middle  which has just finished a nation-wide tour.

The play  written by Judy Upton follows a well-established format developed by the company Y  Touring. Two previous projects looked at genetic testing (The Gift) and mental illness  (Cracked). The first hour is taken up by a conventional performance, immediately followed  by an hour long debate involving the audience and the cast who stay in character to file  questions.

16 year old Ryan and Six former Gemma meet at the renal unit  whilst undergoing dialysis. Despite their differences (Ryan is mad keen on football and  clubbing, while Gemma would rather spend her free time helping out at the local animal  sanctuary and sabotaging fox hunts) romance blossoms. Until that is, Ryan is offered the  opportunity to be one of the first patients to benefit from a new treatment, a kidney from  a pig.

Suddenly Ryan is caught between his own desire to get back into  the youth football team, his mothers fears over the risks involved in the new treatment,  his doctors reassurances and warnings that he might have to wait a very long time for a  human kidney, and Gemma's opposition to any new treatment involving the use of animals.  Gemma and her friends stage a demonstration outside the hospital, which prompts the government to put the Xenotransplants programme on hold in order to stage a public  inquiry. At this point the audience become members of the inquiry committee.

I thoroughly enjoyed the performance of  Pig in the Middle which I saw, the penultimate one in its current tour (the final  performance took place at the House of Commons). The play managed to address all the major  issues involved in xenotransplantation whilst being witty and entertaining. The acting was  superb and I particularly admired the actors bravery in being prepared to answer questions  thrown at them in the totally improvised debate - participating in this play involves far more than learning a script!

 In its tour of schools and  short run at the Edinburgh International festival Pig  in the Middle has been seen by 12,560 students,  teachers, governors, MPs and members of the public. At the end of the show the audience  are asked to vote on two questions: is it right to use animals for this form of treatment  and should the research be allowed to go ahead given the safety concerns? At the performance I saw there was a clear majority in favour of the first but rather more  ambivalence with regard to the second.

 The Nuffield Council and Y Touring are keen to stage a second  tour but inevitably this depends on obtaining sufficient funding.

 Kirstie Urquhart

	For further information about this project, email our Tour Producer David Jackson