Harry Keen Pioneering Diabetes Researcher, Staunch NHS Supporter, and Champion of People with Chronic Disease
Total Page：16
File Type：pdf, Size：1020Kb
OBITUARIES Harry Keen Pioneering diabetes researcher, staunch NHS supporter, and champion of people with chronic disease Harry Keen, professor emeritus of human Study, which helped to establish the concept of metabolism (b 1925; q St Mary’s Hospital Medical separate glucose thresholds for microvascular School 1948; CBE, MD, FRCP), d 5 April 2013. and arterial disease. He was the natural choice to chair the 1980 WHO expert committee on Harry Keen was acting as a GP locum in Eltham diabetes mellitus, which introduced the concept when he was called to see a boy whose measles of impaired glucose tolerance and laid the basis had been complicated by bronchitis. He for our current definition of diabetes. examined the boy, left a prescription, collected His experience of an early diabetes clinic— his two shilling fee, and said he would be back where five doctors or more sat at desks in the in a couple of days. same large room and exchanged muttered On his return, the mother told him that Billy comments with their patients—led him to was a lot better. “As we spoke,’’ said Harry, ‘‘a conclude that 10 minutes twice a year was loud hacking cough came from upstairs, and I not enough for the adequate management of commented that he didn’t sound better. ‘Oh no,’ diabetes. He went on to pioneer the diabetes day said the mother, ‘that’s not Billy, it’s Johnny, his centre. brother.’ When I offered to take a look at him, Another idea whose time had come was the she said, ‘I’d rather you didn’t—we really can’t I development of the diabetes nurse specialist, afford it. He’s just the same as Billy, so I’ve given H which he regarded as the most important him some of Billy’s leftover medicine.’ It was 5 development in the treatment of diabetes July 1948 (the first day of the NHS). I told her FOROUNITA since the discovery of insulin. He took to heart that from that day it wouldn’t cost her anything Keen’s experience of an early Robin Lawrence’s dictum that the patient with and eventually walked away feeling much diabetes clinic—where five doctors diabetes must learn to be their own doctor, and lighter in my heart as well as my trouser pocket.” or more sat at desks in the same pressed for the involvement of primary care in Harry was mutualist to the marrow. He had no diabetes management. He himself worked long large room and exchanged muttered time for the politicians and carpetbaggers who past retirement with the largely South Asian later sought to make political or financial capital comments with their patients—led population attending his son’s GP surgery. from the disintegration of the NHS. In the 1980s him to conclude that 10 minutes Fatalism too often characterised diabetes he forced a High Court review of Kenneth Clark’s twice a year was not enough for the care in the early part of his career, and Harry introduction of the internal market, and he adequate management of diabetes helped the transition to outcome measures was founder and president of the NHS Support and standards of care. His maxim was to think Federation. His passion for justice also made Lawrence in the diabetes clinic at King’s College globally, act locally. The global component was him the champion of people afflicted by the Hospital, London, followed by a seminal year achieved with the Declaration of St Vincent, stigma of chronic disease. with the National Institutes of Health (NIH) in which set international benchmarks for diabetes His career spanned the rise of diabetes as a Bethesda, Maryland. He returned to a lecturer’s therapy, and the local component laid the major public health problem and as a clinical post at Guy’s Hospital, London, in 1961, foundation for our national service framework specialty. It began when he joined George becoming professor of metabolic medicine in for diabetes. Pickering, who was at that time measuring the 1971. It is a measure of the man that his other blood pressure of the population around St When Harry began his career no agreed landmark achievements need to compete Mary’s Hospital to establish whether people definition of diabetes existed, and neither was for mention, but his team was the first with hypertension represented a separate there an agreed way of measuring glucose to measure microalbuminuria and to subgroup or one end of a continuum. Harry was tolerance. Blood glucose, he noted, is (like appreciate its significance as the harbinger of tasked to measure the blood pressure of people blood pressure) continuously distributed in the diabetic nephropathy, and he also invented with diabetes and their families. This early population. At what point did a risk factor (the subcutaneous insulin pump therapy. experience also alerted him to the devastation expression had yet to be invented) turn into a Harry was mentor to a generation. His caused by the vascular complications of condition that warranted intervention? acolytes have sprouted in all directions. What diabetes, and his compass was set. He began by measuring the frequency of cannot be penned on paper is the humanity, the From this beginning he, like Kelly West in the asymptomatic diabetes in the population. In avuncular calm, the resonant probing voice, United States, pioneered diabetes epidemiology 1962 the population of Bedford was invited to the quirky humour, the quizzical smile, and the before the fact. In 1981 he cofounded the leave labelled urine samples on their doorsteps, burning passion to make things better. World Health Organization/International to be collected by boy scouts over the course of He leaves his wife, Nan; a daughter; and a Diabetes Federation’s Cambridge seminar on a weekend. The householder who left a sample son. the epidemiology and public health aspects of sherry was quickly detected and persuaded to Edwin Gale emeritus professor, School of Clinical of diabetes, and as such he bears much of the share more of it with the investigators. Sciences, University of Bristol, Bristol UK responsibility for the subsequent epidemic of Harry progressed from measuring glycaemia [email protected] diabetes epidemiologists. He worked with Robin to measuring its consequences in the Whitehall Cite this as: BMJ 2013;346:f2852 BMJ | 25 MAY 2013 | VOLUME 346 29 OBITUARIES severe dysphasia. He leaves his in internal medicine in hospitals John T D Attenborough wife, Cathleen (née Wade), and six in Montreal and Vancouver before Nicholas Priestly Former general practitioner children. returning to train in radiology in Former general practitioner Camberley (b 1920; q Cambridge Samuel D Nelson Edinburgh and Bristol. In Bath, Westcliff-on-Sea, Essex (b 1939; 1942; MRCS), d 7 March 2013. Cite this as: BMJ 2013;346:f2306 where he worked for 30 years, q Leeds University Medical Having qualified at the age of 22, he was involved in the planning School 1963), died from chronic John T D Attenborough joined the Derrick Dexter and development of a new x ray obstructive pulmonary disease on army in 1943. He served in the department at the Royal United 13 December 2012. Middle East, Italy, Holland, Germany, Hospital and an isotope service. After doing house jobs in Leeds, and finally, as staff surgeon, in He served as honorary secretary of Nicholas Priestly (“Nick”) came to Peshawar, India. In 1945, he met the BMA’s Bath and district branch Westcliff in 1966. He joined with his up with his fiancée, Frances, after during the 1970s and published in two future partners to form a new a separation of two years as she a wide variety of specialty journals, group practice in one centralised had been in India and Burma with as well as writing more humorous surgery. He and his partners steadily the Princess Mary’s Royal Air Force pieces. Literature, mature claret, built up a large practice, but it Nursing Service (PMRAFNS). They and Shakespearean theatre were remained friendly and family oriented. were married in Peshawar. After Former pathologist (b 1923; his lifelong interests. He leaves his Nick retired in 1999 after 33 years in demobilisation in 1946, John joined q Sheffield 1946; MD, FRCPath, wife, Ruth; four children; and four the same practice. Until then he had the family practice in Camberley FRCPC), d 19 March 2013. grandchildren. also been the local medical director and continued his military service in Derrick Dexter did his pathology J G Evison for the deputising service. He worked the Territorial Army for 19 years. He training at St George’s Hospital Cite this as: BMJ 2013;346:f2143 in accident and emergency medicine was senior partner of the practice in Hyde Park, London, where he and administered anaesthesia for for 16 years and retired in 1986. became a reader in pathology. He Alexander Iain Munro local dentists. Nick enjoyed all sports Predeceased by his wife in 2005, emigrated to Canada with his family and was a doctor for the Southend he leaves four children and seven in 1964 and became the director Glen Rugby Club. He played golf; enjoyed grandchildren. of laboratories at the Grey Nun’s walking; and was interested in all John T D Attenborough Hospital, Regina. Apart from a two music, bridge, and travelling. He Cite this as: BMJ 2013;346:f2317 year post in New Brunswick, he leaves his wife, Mary; two children; spent the rest of his working career and three grandchildren. Matthew Walter John Boyd in Regina, as a professor at the Tony Bullock University of Saskatchewan and Cite this as: BMJ 2013;346:f2318 director of laboratories at the Plains Hospital, where his diagnostic skills Emanuel Tuckman were widely sought.