Martin Pule spent his childhood dismantling radios, computers and any other devices he came across, reassembling them in alternative ways and pressing them into new services. Even allowing for childish curiosity, it speaks to a different way of conceptualising the world – as a miscellany of parts, only temporarily constituted in their current forms. Most of us are just pleased to come across a device already disposed to work.
War in the Blood (BBC Two) was about what happens when such a child grows up, becomes a doctor and turns that mindset towards the human body. “I realised that cells are machines you might take apart, and genetic code is not really that dissimilar to computer programmes.” Now at the University College London’s Cancer Institute, he became a pioneer of CAR T-cell therapy. As he explains it to the viewer, with the unhurried simplicity of someone with knowledge to share and nothing to prove, this is the process of taking a leukaemia patient’s or a donor’s T-cells (the mainstay of our immune systems; they hunt and kill cells infected with viruses) and inserting into them a piece of DNA that teaches them to recognise cancer cells, which they would otherwise ignore, and treat them with the same lethal force they do viruses. Then they return the T-cells to the patient and … well, you hope for the best.
The therapy has recently started phase-one trials – the first tests on humans. The subjects must be terminally ill patients who have run out of treatment options and are willing to undergo the intervention knowing that, of course, it may not work. So far, however, the research suggests that the approach may eventually become a cure for all cancers.
The programme follows two such patients: middle-aged former military man Graham Threader, who was diagnosed with leukaemia in August 2015, and 18-year-old Mahmoud Kayiizi, who has relapsed with the same disease after several rounds of treatment and a bone marrow transplant. Mahmoud looks both younger and much older than his years. “I just want to live,” he says from his hospital bed with a literally bone-deep weariness. “It would be heartbreaking for my mum …” Graham will be treated with his brother’s donated cells, Mahmoud with his own, both weaponised in Dr Pule’s laboratory and administered by a team led by Dr Claire Roddie.
It is a film about love, hope and the tempering of both with realism. Doctors must do it with patients, being careful neither to fan the flames of optimism with their knowledge of the studies coming out of the US (which has more data on the therapy than we do) or douse them with their appreciation of how long any path to any cure must be.
At one point, Mahmoud’s consultant, Dr Ben Carpenter, mentions the risk of something and his mother, Fatuma – her face bright with hope and faith – says: “It’s not a risk. You are saving him.” The doctor pauses, balancing duty with care, kindness with honesty, professional ethics with human impulse. “There are definite risks involved,” he replies gently. “But we know the risks of not doing this are much higher.”
Spouses must guide spouses, as Melly does for Graham, reminding him to weigh his quality of life – and his family’s life – against prolonged suffering in the name of treatment, however pioneering. Sometimes the normal dynamic reverses: patients must guide loved ones and children must do so for parents. After good initial results, Mahmoud cautioned his mother about being “too hasty”. He doesn’t want her to celebrate too early. Much, much older than his years, then.
At an hour and 40 minutes, it was a film that was able to do justice to all its parts. It twined them round each other immaculately, keeping the march of the days and the clinical results clear to the uninitiated viewer without losing sight of the intimacy between everyone involved, or distancing the viewers from Graham or Mahmoud’s experiences, which lay at the heart of everything. It did a particularly fine job of honouring the dual perspective that exists in any clinical trial – the immediate, patient-based focus on individual treatment and outcomes by the administering doctors, and the detached, long-term view the scientists developing the treatment must take – without letting the more naturally sympathetic former outweigh or diminish the latter.
There was agony and ecstasy by turns, and endless courage from Graham and Mahmoud and the people that love them. Lives and cells were taken apart and put back together in different forms. Godspeed, everyone.