Oxford Medicine July 2013

Oxford Medicine THE NEWSLETTER OF THE OXFORD MEDICAL ALUMNI OXFORD MEDICINE . JULY 2013

Contents First Year of OUH NHST Caldicott Review

. . . . . . . .2

. . . . . . . . . . . . . . . .2

Letter from the President . . . . . . .3 Change of Editor OMA Treasurer Osler House

. . . . . . . . . . .4

. . . . . . . . . . . . .4

. . . . . . . . . . . . . . . .5

People in the News

. . . . . . . .6

Profile of Stephen Goss

. . . . . . . .8

With Sadness . . . . . . . . . . . . . . .9 RDM

. . . . . . . . . . . . . . . . . . . . . . . .9

Oxford Medicine and the Mind: Robert Burton to Sir Charles Sherrington . . . . . .10 The Oxford Medical School teaching initiative in Palestine . . . . . . . . . . . . . . . . . .12 “JR”

. . . . . . . . . . . . . . . . . . . . . .13

Oxford Medical School Gazette . . . . . . . . . . . . . . . . . . .13 DARS and You . . . . . . . . . . . . . . .14 OMA Events . . . . . . . . . . . . . . . . .15

2 / OXFORD MEDICINE . JULY 2013

The First Year of the Oxford University Hospitals NHS Trust A year ago Alastair Buchan wrote about the wonderful achievements of our medical school, which will not have come as a surprise to all of us who have benefitted throughout our lives from the outstanding education that it gave us. He referred to the importance of the relationship between the medical school and the NHS, particularly locally with our hospital trust.

The Trust’s relatively weak performance compared with our academic partner over a number of years had been disappointing and fuelled the motivation of many of us to show that could be overcome. The caring and expertise of our staff was certainly not the issue, far from it. That had to be harnessed through good leadership for the potential of the Trust to be realised.

On 1st November 2011 the Oxford University Hospitals NHS Trust came into being as the Nuffield Orthopaedic Centre merged with the Oxford Radcliffe Hospitals NHS Trust.

The case for this merger, which had to be negotiated through the byzantine processes of the Department of Health and the Competition and Collaboration Panel, rested strongly on the improvement of care and experience for patients, such as those with spinal pathology, who would no longer have to move through, or between, departments in neighbouring trusts for their appropriate treatment. An additional justification was the improved use of resources, releasing more from so called ‘back office’ functions to the provision of health care, and ensuring that the excellent buildings available in both Trusts could be used more productively, reducing the use of poor accommodation, unfit for the provision of twenty first century care.

With the establishment of the new organisation, has come enormous pride that the university agreed to our new name. It is unsurprising that the university guards the simultaneous use of the words ‘University’ and ‘Oxford’ very assiduously. Together they constitute a truly internationally recognised brand.

The university’s consent to this was achieved through much discussion, the drawing up of a Joint Working Agreement which is legally binding on both organisations, and the establishment of a formal collaborative structure in which issues of mutual interest can be considered and agreed. The nomination by the university of one of the Non Executive

Directors of the Trust Board, currently the Regius Professor of Medicine, Professor Sir John Bell, and the establishment of a quarterly meeting of a Strategic Partnership Board, alternately chaired by the Vice-Chancellor and myself, are just two of the many commitments made to the satisfaction of both parties.

The huge success of the Biomedical Research Centre and the Biomedical Research Unit in winning second phases of funding of translational research for five years to benefit patients, earlier this year, showed one of many tangible benefits of closer collaboration between the University and the Trust.

So what of the NHS and the Trust’s vision? In spite of the turmoil caused by the Health and Social Care Act of 2012 we are progressing towards Foundation Trust status as all provider units are required to do by that Act. A great deal of work is involved to demonstrate the ability of the Trust to justify greater freedom from the Department of Health’s control, and the consequential enhanced accountability to our members and staff. We hope to achieve this in 2013 and are determined to live up to the cultural change defined by our agreed aspiration to achieve ‘compassionate excellence’ in the healthcare that we provide. Harnessing staff’s energies to such explicit values through behavioral change where necessary will both improve patients’ care and also their experience.

Whatever we have been able to do in the last year, and during the preceding period as we worked for the momentous events of 1st November 2011, could not have been achieved without the commitment by the staff of our four hospitals to the care of our patients.

Earlier I referred to leadership. The Trust has a very capable and hard working executive team which, under Sir Jonathan Michael’s excellent leadership, manages it. My non-executive colleagues and I are very proud to play our part in the Trust’s governance, and I feel truly privileged to have the role that I do in this worthier partner of the medical school that I was so proud to enter rather a lot of years ago.

Fiona Caldicott Chairman, Oxford University Hospitals NHS Trust

Dame Fiona Caldicott to lead review into confidentiality and the sharing of health and social care information

In January 2012 the Future Forum recommendation, subsequently accepted by the Department of Health, was that “The Government should commission a review of the current information governance rules and of their application, to report during 2012.

The aim of the review should be to ensure that there is an appropriate balance between the protection of patient information, and the use and sharing of information to improve patient care” w w w.dh.gov.uk /prod_consum_dh/groups/dh_digit alasse ts/ docume nts/digitalasse t/dh_132086.pdf Dame Fiona Caldicott will lead the review, which will be independent of government. The detailed scope and priorities of the review will be

determined by the review panel. The Department of Health will be expected to respond to its recommendations when the report is published during 2012.

Dame Fiona is the originator of ‘Caldicott Guardians’, the individuals responsible in every NHS and Local Authority organisation for making decisions about sharing identifiable information, and balancing the public interest of protecting confidential information with the public

Fiona Caldicott, Chairman, Oxford University Hospitals NHS Trust

OXFORD MEDICINE . JULY 2013 / 3

interest for sharing the information. Dame Fiona said “It is timely to reconsider the principles of information protection and sharing. Since our first report on the security of patients’ information in 1997, it has become clear that there is sometimes a lack of understanding about the rules and this can act as a barrier to exchanging information that would benefit the patient. On other occasions, this has resulted in too much information being disclosed. These are issues of importance to everyone who uses health or social care services and our review will look across both sectors. We need to examine when and how to seek

and record consent to support the flow of information to enhance patient and citizen care.”

Andrew Lansley, Secretary of State, said ”Ensuring that information is shared for best care and to promote excellent research is central to the Government’s vision for the new health and care system, as is protecting confidential information. This is a complex issue and I am most grateful that Dame Fiona has accepted the challenge — I can think of no better person to complete the review.”

President’s Piece

There are many engaging alumni events to anticipate The subject of this year’s Osler Debate, held as part of the University Alumni weekend on Saturday 21st September at the Said Business School, is Big Data and Drug Discovery. Dr Martin Landray, Reader in Epidemiology will host this event. The amount of digital information now available to us is unimaginable, as very large sets of medical data are now routinely collected – including those from electronic patient records, DNA sequencing and treatment monitoring. Storing and analysing such vast quantities of data is not straightforward, and this session will look at how the Li Ka Shing Centre and the Big Data Institute will enable Oxford to bring health-related datasets together for researchers to use in an anonymised way for powerful new insights into who develops illness, and why.

On Friday 20th September 2013 there is to be a large gathering of Rhodes Scholars of many ages and from many countries and disciplines – over eight hundred have already signed up to come back to Oxford for the day, and we anticipate it will be a celebratory and gala occasion. John Bell, himself a medical Rhodes Scholar, will be speaking on a medical topic … Terence Ryan is planning to speak about the archives at 13 Norham Gardens, over a glass of wine in the early evening – and hopefully in the gardens, with Osler’s study open to view.

In 2014, from Friday March 7th to Sunday March 9th there will be a second reunion in Adelaide, South Australia, with sessions of informal short presentations with a keynote speaker and probably a dinner on the Saturday evening.

The William Osler Society of North America is meeting at Oxford in May 2014. OMA has a watching brief for this event and we are keen to collaborate, to make our transatlantic visitors welcome.

An exhibition is planned at the Bodleian, extended to coincide with this reunion, about Oxford’s Medical Firsts. Conrad Keating has been appointed curator and is busy researching material and deciding what to include showcasing the Bodleian's literary treasures, medical apparatus, medicines and inventions which have led to Oxford’s innovations in medical knowledge and patient care.

November 2014 is the 300th anniv ersary of the death of John Radcliffe. He died of a stroke and we are hoping to compose a celebration of Oxford’s contribution to the study of cerebrovascular disease, drawing on our current high expertise in clinical assessment, imaging and early intervention.

OMA’s links with University Alumni and with Director Christine Fairchild have been invaluable in setting our sights higher. I’m enormously grateful to Jayne Todd for her inspirational ideas about opportunities for meeting, selecting topics to highlight with alumni – she keeps the association alive. I am also extremely grateful to Angela Jones who is taking over, in particular, the organisation of events and regular reunions. Deanna Edsall has done sterling work on the migration of OMA’s data onto the University system DARS. This eight month project has taken a huge amount of careful effort. We are close to finalising and testing the new system and OMA is very appreciative of the work of Dan Keyworth and his DARS team in the University Development Office.

My great thanks also go to Derek Jewell for his work as Editor of Oxford Medicine over several years. The publication has grown to be an exemplar of how a subject newsletter for alumni should flourish.

He oversaw the transition to electronic dispersion with minimum loss of interest and a great saving on time and costs.

We welcome John Morris who has taken over from Derek as Editor and who is due to succeed me as OMA President in September. I hope he will find that our processes are tighter and more fit for purpose, and I look forward to seeing how his strategy for the future bears fruit. I expect he will wish to engage especially with pre-clinical alumni, and aim to welcome back to Oxford those who migrated away for their clinical years. If and when they return, they will find the Medical School is in good shape and in good hands.

Peggy Frith

4 / OXFORD MEDICINE . JULY 2013

Sir John Gurdon wins Nobel Prize for work done at Oxford

Sir John Gurdon has won the Nobel Prize in Physiology or Medicine 2012 for his discovery at the University of Oxford that the specialisation of cells is reversible, challenging the dogma that mature cells are irreversibly committed to their fate.

He wins the award jointly with Shinya Yamanaka. Sir John B Gurdon was born in 1933 in Dippenhall, UK. He did his undergraduate degree at Christ Church, Oxford, starting off studying Classics but switching to Zoology. He received his doctorate from the University of Oxford in 1960 and was a postdoctoral fellow at California Institute of Technology. He returned to Oxford as Assistant Lecturer in Zoology at the Department of Zoology in 1962.

A classic experiment It was while he was at Oxford's Department of Zoology that he carried out a classic experiment published in 1962. He hypothesised that the genome of a mature cell might still contain all the information needed to drive its development into all the different cell types of an organism. He replaced the immature cell nucleus in an egg cell of a frog with the nucleus from a mature intestinal cell.

This modified egg cell developed into a normal tadpole. The DNA of the mature cell still had all the information needed to develop all cells in the frog.

Gurdon's landmark discovery was initially met with scepticism but became accepted when it had been confirmed by other scientists.

It initiated intense research and the technique was further developed, leading eventually to the cloning of mammals, the Nobel Assembly says.

Oxford stem cell biologist Professor Sir Richard Gardner, who knows Sir John and his research well, says the Nobel Prize for work that began in Oxford is 'entirely warranted'. He says: 'He’s been a highly regarded leader in the field for many, many years.'

Sir Richard explains that, after it was shown that DNA was the genetic material, it was realised that an embryo would need all the genetic information contained in our DNA to develop into all the tissues of the body. But an adult liver cell would only need a subset of genes, and a nerve cell would need a different subset. The question was what happened in the nerve cell to the DNA that was not needed?

'John showed that the genes were still there but inactive, and could be made active again,' says Sir Richard, who came to Oxford from Cambridge soon after Sir John went the other way. 'It showed us how cell specialisation happened: cells retained expression of some

genes, but suppressed others.

'The key thing he showed was that as cells specialise, genes are not lost and that they are potentially accessible ... It’s also vitally relevant to the current excitement around regenerative medicine.'

Professor Chris Graham of Oxford University's Department of Zoology, one of Sir John's first students who worked with him at Oxford in the 1960s, says: 'He showed that you could take several nuclei from one individual and produce genetically-identical animals – that was his great achievement. People had talked about cloning a good deal but with John Gurdon’s work it became a reality.'The importance of this work was immediately recognised: the early 1970s saw a substantial number of books about the ethical and biological consequences of cloning. The work that he did then is marvellous, but he has my admiration for the series of experiments he has done throughout his career. For instance, in 1971 at Oxford his was the first group to translate messenger RNA from a mammal into a protein – he showed that what was believed to be rabbit haemoglobin messenger RNA did indeed carry a message.'

Julian Savulescu, Uehiro Professor of Practical Ethics at Oxford says: 'This is not only a giant leap for science; it is a giant leap for mankind. Yamanaka and Gurdon have shown how science can be done ethically. Yamanaka has taken people’s ethical concerns seriously about embryo research and modified the trajectory of research into a path that is acceptable for all. He deserves not only a Nobel Prize for Medicine, but a Nobel Prize for Ethics. 'Before Yamanaka’s breakthrough, which built on Gurdon’s work, this research could only be done on cells derived from live human embryos. Many people objected to the creation of embryos for research, describing it as cannibalizing human beings. They even objected to the use of embryos no longer required for IVF. This led GW Bush to introduce laws that retarded the field for years.

Yamanaka was able to overcome all those objections and resuscitate the field. 'Yamanaka has opened the door to a completely new kind of medicine: regenerative medicine. Until now, dead or damaged tissue and organs, for example in the brain or heart, have been replaced by scar tissue. This results in loss of function, such as inability to talk or walk after a stroke, or heart failure after a heart attack.

'Regenerative medicine offers the prospect of replacing dead or damaged human parts with new functioning ones. It also opens a radically new way of studying the origin of disease: by creating tissue with disease, it can be

experimented on in the laboratory, instead of in humans and animals. This is good for humans and good for non-human animals used in experiments. This is as significant at the discovery of antibiotics. Given the millions, or more lives, which could be saved, this is a truly momentous award.'

Sir John joined Cambridge University in 1972 and has served as Professor of Cell Biology and Master of Magdalene College.

Gurdon is currently at the Gurdon Institute in Cambridge.

Sir John has worked on frog embryology all his career, continuing to go into the labs in Cambridge 50 years on from the work he began in Oxford. Shinya Yamanaka discovered in 2006 how intact mature cells in mice could be reprogrammed to become immature stem cells. Surprisingly, by introducing only a few genes, he could reprogram mature cells to become 'induced pluripotent stem cells' or iPS cells: immature cells that are able to develop into all types of cells in the body.

Research during recent years has shown that iPS cells can give rise to all the different cell types of the body. These discoveries have also provided new tools for scientists around the world and led to remarkable progress in many areas of medicine. For instance, skin cells can be obtained from patients with various diseases, reprogrammed, and examined in the laboratory to determine how they differ from cells of healthy individuals. Such cells constitute invaluable tools for understanding disease mechanisms and so provide new opportunities to develop medical therapies.

OXFORD MEDICINE . JULY 2013 / 5

Big Data Institute The Prime Minister, David Cameron and Sir Ka-shing Li from the Li Ka Shing Foundation together marked the launch of the new Li Ka Shing Centre for Health Information and Discovery on the Old Road Campus in Oxford. The Centre, which will house up to 600 scientists when complete, will initially comprise the Target Discovery Institute which will house research generating comprehensive data about disease using genomic and chemical screens. The Big Data Institute will be built as a second linked phase. The Centre is supported by a ÂŁ20m gift from the Li Ka Shing Foundation and ÂŁ10m for big data research from the Higher Education Funding Council for England.

Drug target discovery Through the Target Discovery Institute, the Li Ka Shing Centre, will use high-throughput and automated approaches to speed the early stages of drug discovery, by identifying better targets for drug development in important diseases such as cancer, diabetes, dementia, psychiatric conditions and inflammatory diseases.

The pharmaceutical industry is hampered by companies' inability to embark on such extensive and detailed studied of potential targets.

This can lead to companies spending literally billions of dollars identifying and developing drugs that are actually not acting on a promising biological pathway – slowing down the process of drugs being available for human health. The work at Oxford sees academia stepping in to fill that critical gap.

Big data The potential of 'big data' to revolutionise health research and offer patients better, safer and more personalised treatments will be a major focus of the centre, which will be unique worldwide in providing a dedicated centre of excellence in the emerging field of big data in medicine. These two related areas of activity harness novel 21st-century opportunities in healthcare and represent the first examples of these types of research endeavours in academia anywhere in the world.

The Li Ka Shing Centre, through the Big Data Institute, will develop approaches for generating, storing and analysing large datasets in medical science for a better understanding of human disease and its treatment.

Bringing health-related datasets together for researchers to use in an anonymised way, and making use of new tools to scrutinise that data to gain insights, will provide powerful new insights into who develops illnesses and why.

Storing and analysing such vast quantities of data is not straightforward. Making sense of large amounts of complex data, making the right comparisons to generate robust and useful answers, and ensuring the security of the data needs to protect personal privacy are all important challenges.

These research opportunities and challenges will be at the core of the new Big Data Institute. Oxford University already has world-leading expertise in this area: pioneering the introduction of genomics into medical care, leading giant cohort studies like the Million Women Study and UK Biobank, running some of the largest clinical trials of treatment worldwide, and establishing methods for global disease surveillance in malaria and other major infectious diseases.

Oxford Medical Firsts

Exhibition at the Bodleian Library November 2013 to May 2014

To be truly pioneering requires tenacity and a spirit of enquiry Oxford Medical Firsts is the subject of the Bodleian Library's winter exhibition, which will run from November 2013 until May 2014. The exhibition will chronicle Oxford's contribution to medicine from medieval origins to its present status as one of the world's leading centres of medical research.

This exhibition, curated by the medical historian, Conrad Keating, will showcase Bodleian literary treasures, medical apparatus, medicines and inventions which have led to outstanding innovations in medical knowledge and patient care.

The exhibition will be accompanied by Keating's book Great Medical Discoveries: An Oxford Story. The exhibition will show Oxford's overall contribution to medical science and human well-being, with William Osler as a central figure.

OT Extra, the monthly alumni ebulletin, is sent on the first Thursday of every month.

The electronic companion to Oxford Today magazine, it brings you news from across the University, information about Oxford's alumni activities, special offers and the latest features from the OT magazine website.

Dependent on the news we have each month, we send differing versions of OT Extra based on where you live or what your interests are. Keep us updated with your current electronic postal address to get the news most relevant to you! oma@medsci.ox.ac.uk

6 / OXFORD MEDICINE . JULY 2013

People in the News Dorothy Bishop Professor of Developmental Neuropsychology and a Wellcome Principal Research Fellow at the Department of Experimental Psychology in Oxford and Adjunct Professor at The University of Western Australia, Perth. Her research aims to increase our understanding of why some children have specific language impairment (SLI), a condition diagnosed when the child has unusual difficulty in language acquisition, despite normal development in other areas. Professor Bishop was runner up in the ‘Good Thinking’ 2012 science blog awards.

Robert Carroll has been awarded DM for”Immune phenotype and function in long term renal transplant recipients”. I was part of the Oxford Kidney Unit and Nuffield Department of Surgical Sciences but am now a nephrology consultant at the Central Northern Adelaide Renal and Transplant Service, South Australia.

David M Clark, Professor of Experimental Psychology and Fellow of Magdalen College, is appointed CBE for services to mental health.

Professor Clark's research focuses on cognitive approaches to the understanding and treatment of anxiety disorders and has led to the development of new and effective cognitive therapy programmes for panic disorder, hypochondriasis, social phobia and post-traumatic stress disorder. He is National Clinical Advisor for the UK's Improving Access to Psychological Therapies programme.

Raymond Dw ek, Director of the Glycobiology Institute, Emeritus Professor of Glycobiology and Emeritus Fellow of Exeter College, is made a CBE for services to UK-Israel scientific collaboration. He is Special Advisor on Biotechnology to the President of Ben Gurion University of the Negev and played an instrumental role in helping to establish the National Institute for Biotechnology in the Negev.

Jeremy Farrar has been appointed as the new Director of the Wellcome Trust.

Professor Farrar is currently Professor of Tropical Medicine and Global Health at Oxford, Global Scholar at Princeton University and Director of the Wellcome Trust’s Major Overseas Programme in Vietnam. His research interests are in infectious diseases and tropical health, and include emerging infections, infections of the central nervous system, influenza, tuberculosis, dengue, typhoid and malaria. He was appointed OBE in 2005 for services to Tropical Medicine, and he has been awarded the Ho Chi Minh City Medal from the Government of Vietnam, the Oon International Award for his work on H5N1 avian flu, the Frederick Murgatroyd Prize for Tropical Medicine by the Royal College Physicians and the Bailey Ashford Award by the American Society for Tropical Medicine and Hygiene. He chairs the International Severe Acute Respiratory and Emerging Infection Consortium, a global initiative to share data about emerging diseases that could become epidemics or pandemics.

Les Iversen, Visiting Professor in the Department of Pharmacology, was appointed CBE for services to pharmacology. Professor Iversen is the Chair of the Advisory Council on the Misuse of Drugs.

Simon Hay, Professor of Epidemiology and Research Fellow in the Sciences and Mathematics at St John’s has been elected by the Board of Trustees as the 52nd President of the Royal Society of Tropical Medicine and Hygiene.

Andrew Judge winner of National Institute for Health Research – Health Services and Delivery Research Programme for “Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and costeffectiveness study” Patrick Rorsman has been awarded the 2013 Albert Renold Prize Lecture. This most prestigious honour is awarded in recognition of outstanding achievement in research on the islets of Langerhans. Patrik will deliver his lecture in Barcelona at the European Association for the Study of Diabetes on Tuesday 24th September 2013. This is a great achievement for Patrik and OCDEM and recognises many years of outstanding work by Patrik in this field.

Jocelyn Wiggins has been inducted into the Department of Internal Medicine Clinical Excellence Society, entitled Academiae Laureati Medici at the Geriatrics Centre, University of Michigan. She is one of the inaugural members of the society, which is designed to recognize clinical excellence in the DOIM. Dr. Wiggins joined our division faculty after completing her geriatric medicine fellowship here in 1997. She is currently an Associate Professor in Internal Medicine. In addition, she is one of the key leaders in the Geriatrics Center, taking on the role of Associate Chief of the Division of Geriatrics and Palliative Medicine, as well as Medical Director of the Geriatrics Center Clinics & Turner Geriatric Clinic. She is also a superlative teacher, working with residents and fellows, both in the outpatient clinic and the inpatient geriatric consult team.

Fellows of the Royal Society 2013

Judith Armitage is Director of the Oxford Centre for Integrative Systems Biology and a professor in the Department of Biochemistry, as well as a fellow of Merton College. Her current research looks at bacterial behaviour, in particular environmental sensing and the control of flagellar motor rotation.

Andrew Wilkie is Nuffield Professor of Pathology at the Weatherall Institute of Molecular Medicine. His research looks to better understand the mechanisms underlying

OXFORD MEDICINE . JULY 2013 / 7

human congenital disorders, particularly those affecting the skeletal system. In 1995 he discovered the cause of Apert syndrome and has also made major contributions to the role of elomere dynamics in congenital anomalies. Many of his findings have led to the development of diagnostic tests in clinical use today.

Fellows of the Academy of Medical Sciences 2013

Barbara Casadei is British Heart Foundation Professor of Cardiovascular Medicine and Honorary Consultant Cardiologist at the Department of Cardiovascular Medicine. Her research aims to understand the mechanisms underlying atrial fibrillation and to identify new therapeutic targets for the prevention and treatment of this arrhythmia. Professor Casadei’s programme has strong focus on patient-based research comprising mechanistic studies in human atrial myocytes, prospective investigations in cohorts of patients, and clinical trials.

Michael English is Wellcome Trust Senior Research Fellow in Clinical Science at the Kenya Medical Research Institute (KMRI) and Professor of International Child Health at the Nuffield Department of Medicine. His work has included developing national, evidence-based guidelines for care of severely ill children and newborns and long-term studies on initiating and establishing best practices within rural government hospitals. He also provides advice to the Kenyan government and works with the World Health Organisation on a range of issues related to child and newborn survival.

Russell Foster is Professor of Circadian Neuroscience and Head of the Department of Ophthalmology, where his research spans visual and circadian neurobiology, focusing on the mechanisms whereby light regulates vertebrate circadian rhythms. He has been internationally recognised for his discovery of non-rod, non-cone ocular photoreceptors. In collaboration with the Oxford Eye Hospital, his research group is exploring the impact of retinal disease on sleep and circadian rhythm disruption. Russell Foster also received the 2012 Holst Memorial Lecture Award for his research achievements.

Keith Hawton is Professor of Psychiatry, Consultant Psychiatrist and Director of the Centre for Suicide Research. His research focuses on suicide and self-harm, using epidemiological and interview approaches to examine long-term trends, find causes and develop effective treatment and prevention measures. His research has resulted in treatment and prevention initiatives that have shown to have major benefits in reducing risk of further self-harm and preventing suicide. Professor Hawton is also a member of the Oxford Medical Alumni Executive Council.

Paul Klenerman is Wellcome Trust Senior Research Fellow in Clinical Science at the Nuffield Department of Medicine, where his research aims

to understand T cell responses to viruses, especially hepatitis C virus and HIV. His research group aims to produce better new vaccines against HCV for prevention and treatment of disease by applying their understanding of the role of host immune responses in determining the outcome of viral infections. They have also established a Translational Immunology lab at the John Radcliffe Hospital to try and bring some of these techniques closer to patients.

Xin Lu is Director of the Ludwig Institute for Cancer Research and Professor of Cancer Biology at the Nuffield Department of Medicine, where her research looks to identify molecular mechanisms that suppress tumour growth and metastasis. Her discovery of the ASPP family of proteins connects cell polarity, cell proliferation and cell death to development and tumour suppression. Her group focuses on the understanding of how to selectively kill cancer cells by studying the role of ASPP proteins in tumour suppression pathways with the aim of identifying therapeutic targets.

Lionel Tarassenko is Professor of Electrical Engineering at the Department of Engineering Science. He is an expert in the application of signal processing to medical systems, with a strong track record in translation to clinical medicine. He has been a pioneer in developing early warning systems for identifying physiological deterioration in hospital patients.

He is also known for developing 3G mobile technology for the management of long-term conditions such as diabetes.

Mary-Ellen Lynall has been awarded the Meakins McClaran Medal for the outstanding overall performance of a student graduating BM BCh (Oxon) in 2013.

Sanjiva Wijesinha has recently had two Kindle books published: NOT OUR WAR – a book of short stories based on my experience as an army doctor during Sri Lanka's years of war 1983 to 2009. (http://www.amazon.com/Not-Our-Warebook/dp/B00BRSCXPY) FRIENDS – second edition (http://www.amazon.com/Friendsebook/dp/B00BQXLPI6) Anne Andermann has had her recent book “Evidence for Health: From Patient Choice to Global Policy” published by Cambridge University Press.

Ian Unsworth has sent an update from Australia.

“After I’d graduated from Oxford, I specialised in Anaesthesia but became interested in Diving Research with the RN and it was while I was working in Portsmouth, that I was head-hunted to Australia, to set up the first civilian Hyperbaric unit in the Southern Hemisphere, in Sydney in 1968. I worked in the specialty until I left in 2002. As a result, I am referred to as the Grandfather of Australian hyperbaric medicine.”

8 / OXFORD MEDICINE . JULY 2013

Profile: Julian Britton — A Letter from Cumberland Dear John, It is now some eight years since I last set foot in the John Radcliffe Hospital and I gather that some of your readers might like to know what I have been up to since then as well as a few reflections on the past.

I can certainly recommend retirement. It came as a surprise that I did not miss the hospital having been inside one more or less every day for the previous forty odd years. But learning to play the piano and the organ along with dressing sticks keeps me occupied and satisfies my interest in working with my hands. Dressing sticks is the technical description for making traditional shepherds crooks with a horn handle and a hazel shank. I go to evening classes, have provided a crook for a couple of Bishops and occasionally show them, sometimes successfully. I like working with wood. No anaesthetic is required, it does not bleed, there are no letters of complaint and when you make a mistake you simply start all over again. A little surgery is occasionally needed to repair imperfections or damage and so I still use a scalpel and forceps.

Playing the piano or the organ when you have no musical talent is a different story. Mostly it means endless practice and little likelihood of anyone else wanting to hear the result. The interest stems partly from failing to take advantage of piano lessons when I was young, partly from having a daughter who is a professional musician and partly from reading all those applications from medical students when I was the Director of Clinical Studies most of whom had Grade VIII or better in one, or even two, instruments. One year we admitted almost an entire orchestra I seem to remember! I have regular lessons on the organ and have played for a couple of services. On one occasion the priest, also a locum, was a retired Professor of Obstetrics and Gynaecology. One can regard the whole enterprise as one of dementia prevention. Hopefully! Fishing, mostly for salmon, is the other main interest and keeps me in touch with several old friends. John Ledingham is a regular partner and I will be Jonathan Meakins’ guest on the Eagle River in Labrador in July. I tie the necessary flies, which is rather fiddly, but it does involve instruments, threads and knots.

Medicine is almost a distant memory. I have continued to read the BMJ, although, after exactly fifty years, I am about to stop, and it did play an unwitting part in my pursuit of a surgical career. Early on as a clinical student I read a paper in the BMJ from St Bartholomew’s Hospital in London, where I trained and where I met my wife Mona, about cysteinuria.

Later a patient with cysteine stones in the kidney appeared in an exam for the surgical prize. The extra knowledge paid off, success ensured a good surgical house job and thus made the choice of a surgical career easy.

Surgical training in the early 1970’s was still very general. However when I succeeded Charles Webster as an NHS Consultant in 1980, after three happy years as a Reader in the Nuffield Department of Surgery with Peter Morris, it was obvious that further specialisation was inevitable. Charles had a particular interest in cholecystectomy, liver and pancreatic surgery was developing, my new surgical colleagues had predominant interests in other areas and so hepato-biliary and pancreatic surgery became my specialty. By good fortune this led to two significant opportunities. The first was the introduction of endoscopy into biliary work in the early 1980’s (much encouraged by Malcolm Gough and Peter Morris) and the second,

ten years later, was laparoscopic surgery. I have fond memories of trying to peel tangerines inside a cardboard box with primitive laparoscopic instruments in the evenings in the Surgeons Room at the Churchill Hospital.

The third piece of good fortune, as teaching is in the family genes, was to become a Fellow of Green (now Green Templeton) College and then to follow Chris Paine as the Director of Clinical Studies in the mid-eighties.

Both led to a close involvement with students and the University. Young people are always interesting but I rapidly realised that one was in a different league in Oxford. On the Tuesday of my first week in the Medical School Office someone wanted time off to go and climb Everest and on the Friday someone else wanted to go and play cricket for Middlesex in the West Indies. In 1976 the Radcliffe Committee was set up to organise the development of Green, now Green Templeton, College. As a rather junior representative of the potential Fellows listening to Lord Bullock, then the Master of St Catherines, discuss with Jack Lancaster, then the University Surveyor, the exact slope of the roof and the precise dimensions of the windows in the new buildings, which in his plans were not, apparently, of correct Georgian design was quite an eye opener. Then there was the Faculty Board for Medicine which used to meet in the Van Houten Room in the University Offices in Wellington Square, in gowns, on Saturday mornings. It was essential to read the papers beforehand and pay attention for the agenda was gone through at a pace and many items were dealt with in the blink of an eye. Where one sat around the square table was pretty important and watching John Potter, then the Director of Postgraduate Medical Education, and who always sat directly in the line of the Chairman’s eye, was a real education in how to participate in a committee. Peter Jones was the Medical School Secretary at the time and reading his minutes one appreciated the value of Greats (he had a First) in constructing the exact form of words necessary to convey the correct meaning. However he did once tell me, possibly in jest, that writing minutes was the art of writing what should have been agreed rather than what was actually said!

Astute observers amongst your readers will have noted that this letter cannot come from Cumberland as the county ceased to exist nearly forty years ago. However there is still an Oxford University Cumberland Society (and a Westmorland one too), both of which Mona and I occasionally attend, so I thought it might help your, predominantly Oxonian, readers to identify more precisely where we now live. Living in the countryside is rather different to my previous life in Southampton, where I was brought up, London and Oxford. However Mona and I have known the area well for a long time. Her brother has been a dairy farmer locally for many years and our son, who is married with three small children, now runs the farm which is about nine miles away from here just on the English side of the border. I am occasionally asked to help but only, according to the title on my work clothes, as an ‘apprentice labourer and gofer’. About the right level now, I guess.

With kind regards.

As ever,

Julian Britton Humphries House, Scaleby, Carlisle CA6 4NB

OXFORD MEDICINE . JULY 2013 / 9

Thank-you Mary Travers — a late bloomer looks back Mary Travers died a couple of years ago now.

Her death stirred in me emotions I thought were a long time buried. Memories of playing not that well in a folk trio at school, performing in local pubs, singing flat at a school event, unrequited love of our chanteuse… so many memories of a time back in England forty-plus years ago. The weekend of Mary’s death I played Peter, Paul and Mary songs for hours, tear-stained, listening to them again at 30,000 feet on my way to receive the 2009 Roger Bone award from the American College of Chest Physicians (ACCP) for leadership in end of life care. How do we connect the dots?

Looking back, the journey probably began with my parents’ early death. I was too young and too crazed with a new-found and self-centered freedom at university to realize how important it was to say thank-you for all they gave. In classic fashion of some of that wartime generation, my mother ignored, and I think chose purposely to ignore within her untreated depression, some crucial signs. Metastatic colon cancer caught up with her as I was approaching undergraduate finals in ‘75. My father was soon ailing with advancing prostate cancer and his death followed three years later, by which time I had thrown in the towel during a journey of some quite enjoyable selfdestruction and had done just about everything I could to make sure I didn’t leave medical school on time. A few short weeks after medical finals Take 1, I was called to my father’s hospital bed in a large North West London hospital built over the beautiful parkland of my primary school butterflycatching days. I had been visiting Charles Kent in Exeter, whose obituary I wrote for this journal some years ago. After a motorcycle dash back home I regretfully saw my father being put through the ugly rituals of CPR, unsuccessfully as would have been expected, and dead with massive pulmonary embolism.

Not a great visual memory to carry, or any kind of memory, stained as it was by an awful sense that somehow I should have done more. The house physician on the CPR team comforted me. She had been the cox of our second division Osler House first eight and of our 1976 winning ‘tin-pot bow four’ that I had enjoyed so much. I needed that comfort, Barbara.

Thank-you. One of her senior colleagues had just made an awful hash of telling me it was all over. How well I understood from that day on, that the words said at the time of death remain with survivors forever.

After my father’s death, I began to pick up the pieces. Some life skills and work ethic learned in Gloucester and Norwich house jobs saw me heading back to Oxford as a senior house

officer. I remember well the laughter round the table when I thanked the selection committee for the earlier opportunity to have second crack at finals.

Later, training in Nottingham and a research degree were all a bit more serious. The gorgeous Oxford DM gown that hangs unused in a closet really should have been travelling with me to the ACCP convocation and award ceremony. DM time in the late 80s was a time, though, without much mirth; when there were 60 accredited senior registrars in Chest Medicine in the UK and only three or four consultant posts coming up each year. Many over-trained physicians were doomed to unfulfilled hopes. As for the family, we were ourselves ‘middle class poor’, back in Oxford with a mortgage we couldn’t afford, and then another housing crash in ‘87. We remain in local memory as “The only people we know who ever made a loss on a Southmoor Road house” — canal-side, for heaven’s sake!

So Canada beckoned. My wife is a Maritimer and was Canada’s first female Rhodes Scholar back in ‘77. I should have known I was probably heading west across the pond, and Halifax and Dalhousie University have been good to us. I was granted citizenship a year or two back. “Why now,” asked the presiding judge at the public ceremony, microphone in hand, “after 17 years?” “Very simple,” I replied. “I waited till I was 55 and didn’t need to sit the exam.” An outrageous thing to say in the circumstances, but it raised a few laughs. I couldn’t handle any more setbacks in Canada.

I had ploughed my Canadian driving test one time after a sleepless night on call as an overseas fellow at Toronto’s Sick Kids Hospital Paediatric ICU (PICU). It was a pretend test done on some abandoned airfield. I was doing OK till I took the wrong turn down a one-way street. “We didn’t do very well, did we sir,” said the examiner.

The rest of the Canadian journey has been mostly very good. Geoff Barker, who was head of that PICU in Toronto, was a huge early influence and it was in that PICU that my interests in end of life really care took off. I can still hear the shrieks of a devastated father just told (by me) that his 6 year old daughter had died after a major cosmetic operation complicated by sepsis. No one knew, even in that august institution, until it was too late, that she had primary pulmonary hypertension. I moved to Halifax in 1993 to take up a faculty position as an ICU physician and Respirologist, and in a single moment that helped to define my next decade and a half, I asked Deborah Cook at a Canadian Critical Care Trials Group

meeting in 1994 if I could help out with the ‘level of care’ study. Dr Cook from McMaster University has been a colleague, mentor and friend without par. Our publications on end of life care in the ICU reached the New England Journal, the Lancet and many other highimpact journals. Her support at a terrible time when an ICU colleague was charged with firstdegree murder (later dismissed) was crucial to my sanity. What a leader! No accolade or award is high enough for this wonderful human being and brilliant physician.

I doubt that anyone in Blighty has read ‘End of Life Care in the Back of a Truck’ in the Canadian Medical Association Journal (22 May 2007), but if they do they will understand why more recently I pay tribute to a young and brilliant Respiratory Therapist. Through pure serendipity a few years ago she turned me, in my post ICU phase, towards care at community level, and has helped me to create the concept and the running of a novel outreach service for patients living with advanced COPD, the stuff of the award from the ACCP back in 2009.

It’s been an interesting journey from the Osler House of three decades ago. For friendships forged in that era I am forever grateful. I have watched with pleasure the successes of some very prominent contemporaries, some of whom were in Canada recently receiving some very special awards. Nick White won’t remember but when I was a lowly SHO he took my wicket in a Cardiology versus NDM cricket match!

John Bell I rowed with off and on over a decade and a half of great memories. Where life goes next in the pre-retirement phase, who can tell – but from somewhat less than promising medical school beginnings and a few stumbles along the way, I think I can say that things have turned out OK; much more than OK. Every year I look forward to an evening in Oxford with ‘the gang’. We decided to do this after Charlie’s tragic death and so we toast absent friends and celebrate still being here.

Mary Travers, you made me cry a couple of years ago; but thank-you for helping to put it all in perspective.

Graeme Rocker Professor of Medicine, Dalhousie University, Head, Division of Respirology Halifax Infirmary, Canada

Dr Rocker was Lead editor of an OUP Specialist Handbook “End of Life Care in the ICU” published in 2010

10 / OXFORD MEDICINE . JULY 2013

An Oxford Manifesto on Health Care ?

Miguel Hernández-Bronchud BA MA, BM BCh (1983), DM (1990), MRCP, PhD, DGHE Hospital of Granollers and Institut Dexeus (Barcelona) Member of the Spanish Commission of Medical Oncology Specialist Training (Ministry of Health, Madrid) Member of the Anti-Cancer Programmes of the Catalan Departm ent of Health e-mail: mhbronchud@telefonica.net

1. Introduction Most people, if asked, will say that health is the most important value in life. But in fact, health and freedom are two fundamental values whose worth is only fully appreciated by humans when these values are under threat or have already been lost. In this early XXIst century, and particularly since 2007-2008, most western countries have been victims of a most serious financial and economic crisis – starting in the United States of America and rapidly spreading to the European Union – perhaps only comparable to the 1929 events. These financial strains are now being felt at all levels of society – in some countries more than in others – but are now reaching previously protected areas like education and health. Healthcare providers were already under severe stress because of demographic changes (like an aging population) and the increased costs and complexity of both diagnostics and therapeutics. Back in 1980-83, when we were medical students at Oxford, several authors already published alarming reports about the future health of healthcare. Now, with less money available, health scandals (like the recent Staffordshire problems in the UK) are reaching the press and causing great social alarm. British PM David Cameron said recently (2013) that NHS boards need to be held more responsible for the hospitals they oversee, and patients need a chance to speak up when something goes wrong. But he also blamed Britain’s Department of Health, nursing organizations and doctors for failing to act.

He said there were three problems in the NHS as a whole. “First, a focus on finance and figures at the expense of patient care,” he said. “Second, there was an attitude that patient care was always someone else’s problem….Third, defensiveness and complacency.” I personally believe his arguments are fundamentally right, and also increasingly applicable to ther EU systems like Spain. Health experts have identified similar problems at U.S. hospitals. The 2010 U.S.A. Affordable Care Act will gradually change the way hospitals are paid by Medicare and other government health insurance plans, to take patient satisfaction into account. Hospitals will also be penalized if patients get sick again too quickly after they are discharged or if they acquire infections while in the hospital. But many in the U.S.A. doubt of the sustainability and financial solvency of “Obama Care”, with a growing U.S. budget deficit and a huge pressure to maintain current military expenses to support global security in an always uncertain world.

2. The National Health Service The National Health Service was essentially a British invention, after the end of World War II, though similar efforts were also in development at that time in other countries like Sweden. The National Health Service (NHS) was introduced in the UK in 1948. This service provided free medical treatment for everyone. In 1911, the National Health Insurance system provided medical care for only 21 million people (in Britain) but left the rest of the population having to pay for medical treatment. It became clear to both Beveridge (a brilliant liberal politician) and the Labour Party that people were being denied medical help simply because they could not afford to pay. The majority of doctors in the UK (similarly to today’s American doctors with regards “Obama Care”) were initially opposed to the introduction of the NHS as they believed that they would lose money as a result of it. Their main opposition to the NHS was their belief that their professional freedom would be jeopardized i.e. that they would treat fewer private patients and, as a result, lose out financially. They also believed that the NHS would not

allow patients to pick their doctor – though this proved to be largely an unfounded worry. Once the NHS was introduced, it did prove to be popular with most people, and 95% of all of the medical profession joined the NHS. In fact, the NHS proved to be too popular as it quickly found that its resources were being used up. From its earliest days, the NHS seemed to be short of money. In other European countries healthcare was organized in slightly different ways but the basic principle of “universal public coverage” based on tax payers was maintained. Even in “fascist” Spain, the NHS was introduced under the General Franco’s dictatorship in the late 1960s, and still works at present in very similar ways to the British NHS (with similar limitations). Today the NHS is regarded by the Conservatives and the Liberal-Democrats/Tories coalition in government in Great Britain as “the country’s most precious asset” , with an increasing investment by 2015 expected to be close to 12.5 billion British Pounds.

3. What was lost?

Perhaps surprisingly, what medical doctors really lost was not so much their basic income but their control on the system. So that although they are by training and expertise still the main “owners of the medical knowledge”, they were gradually deprived of its management, which they lost to technical and often politically appointed management staff . This was done, particularly from the 1980s onwards, under the banners of “costeffectiveness” and with the help of so-called “evidence-based medicine”.

While no one can deny that this approach led to more objective and probably more efficient procedures, few can argue today that most social expectations today and most of the recent advances in molecular medicine – including genomics, epigenomics, proteomics , transciptomics etc – point towards the needs of individuals, rather than “groups”, and require more sophisticated and personalized diagnostic and therapeutics protocols. This is now called “personalized medicine”, a now popular term which I am not sure I fully agree with. The most significant gains have been made for specific genetic markers associated with rare and often severe disorders such as Fragile X Syndrome, Tay-Sachs Disease and Down’s Syndrome. But the list of other medical conditions which require tailored diagnostics and targeted therapies is rapidly increasing, from many cancers with hereditary predisposition (breast and ovarian BRCA1 and 2 cancers, Lynch Syndrome and colon cancers) to many non-hereditary malignancies (several solid tumours and many hematological neoplastic disorders). In fact, the list includes many other non oncological clinical situations, like the R&D projects which led to FDA-approved tests like Amplichip CYP450, which analyzes two genes (CYP2D6 and CYP2C19) that greatly influence a person’s ability to metabolize several important drugs, or VKORC1 in the case of warfarin (the anticoagulant drug).

4. The Human Genome Project The Human Genome Project has clearly influenced matters and by marrying the fields of computing and bioengineering with molecular genetics, the costs of sequencing a complete human genome has fallen from millions of dollars just a few years ago to less than 10,000$ today and perhaps soon less than 1,000 $. For a medical doctor like myself, who trained in Biochemistry at Cambridge University (like 4 other Oxford Medical School students celebrating our 30th anniversary of Clinical Graduation this year 2013), who remembers well personally Cambridge people and teachers like

OXFORD MEDICINE . JULY 2013 / 11

Fred Sanger or Max Perutz, as well as our early DNA days in Sir David Weatherall’s NDM Oxford laboratory (1980-1984, in my case), the situation we are rapidly approaching is tremendously encouraging, though we are still far from its true potential.

5. Pharma and BioTech Over the past 30 years, I have dedicated myself to Oncology and I took a very active part in the pioneering development of growth factors and their clinical applications. For example, recombinant Human G-CSF (subject of my 1990 Oxford DM thesis) used to speed up bone marrow recovery from chemotherapy and to mobilize haemopoietic CD34 positive stem cells into the peripheral blood. As a consultant to two of the most important BioTech companies in the world (Amgen Inc in the USA, and Roche in Europe which incorporated Genentech) I have witnesses how these early R&D efforts soon translated not only in rather meaningful clinical improvements in oncology and haematology, but also into thousands of new jobs worldwide.

6. Regenerative medicine Other areas where clinical approaches will soon require novel and more targeted approaches are the huge field of “Regenerative Medicine” and human stem cells therapies, or the new era of vaccines and immune responses, like in the long-term research efforts in HIV immunity by my friend and colleague, and fellow-student at Oxford Medical School, Prof.

Sarah Rowland-Jones. More new insights into some pediatric rare conditions - with other potential implications for morphogenesis - have come from another fellow-student at both the Cambridge University Biochemical part II course and Oxford Medical School: Andrew Wilkie who in 1995 discovered the cause of Apert syndrome, a severe condition characterised by craniosynostosis (early closure of the cranial sutures) and syndactyly (fusion between the digits) of the hands and feet . They identified two specific mutations within the gene for fibroblast growth factor receptor type 2 (FGFR2), one or other of which is present in ~99% of affected individuals.

7. Chronic Diseases and Public Health Most healtcare problems in the developed world are so-called “chronic diseases”. For most chronic disease , health is not lost in just one day or over one minute or one second, and they are often due to wrong lifestyle habits. Cancers are not produced overnight: they might take several decades to develop . Even most myocardial infarctions or strokes are most often the result of chronic on-going processes, like atherosclerosis. This means that there is definitely a window of opportunity for early detection and prevention, and indeed in Catalonia (Spain), with a life expectancy getting close to 85 years for women and 81 for men, more people age 3075 die from cancer (where most causative risk factors are still unknown, except for smoking of course) than die from cardiovascular causes (partly preventable focusing on risk factors like arterial hypertension, diabetes, high cholesterol etc). Public health refers to populations rather than individuals.

But Public Health policies should be accountable to morals and ethics, as well as to politicians and to society, including to us medical doctors.

8. Hospital management in the XXIst century As stated by Rosner, back in 1989 , in his American book on “Doing Well or Doing Good: the Ambivalent Focus of Hospital Administration”, over the course of the last century, the field of healthcare administration and the organizations in which executives work have changed dramatically.

Hospitals have become large, complex organizations; technology has advanced at an almost unbelievable rate; the financing of healthcare has moved from self-pay to a complicated third-party reimbursement system; and government has taken an increasingly larger role in healthcare delivery.

Despite these increased complications, the field continues to sustain three primary objectives. First, healthcare administrators are responsible for the business and financial aspects of hospitals, clinics, and other health services

organizations, and are focused on increasing efficiency and financial stability. Their roles include human resources management, financial management, cost accounting, data collection and analysis, strategic planning, marketing, and the various maintenance functions of the organization. Second, healthcare administrators are responsible for providing the most basic social service: the care of dependent people at the most vulnerable points in their lives. Third, healthcare administrators are responsible for maintaining the moral and social order of their organizations, serving as advocates for patients, arbitrators in situations where there are competing values, and intermediaries for the various professional groups who practice within the organization. As healthcare services have become increasingly expensive and as the environment for the organizations that deliver these services has become more turbulent and hostile, these three objectives seem more and more contradictory (Rosner 1989; Stevens, 1999).

9. Preliminary Conclusions The truth is that I am seriously concerned about our health care systems and their "moral purpose". This is true not only for the UK but also for the rest of the EU. And it is no longer the traditional debate "public versus private", which I now believe to be totally outdated (belonging more to the 1980's than XXIst century). When I say “Health Care”, I mean the care of our health, rather than “healthcare” which I am afraid now means something different or not identical. In the USA - with Obama Care and the current move towards a more 'universal health insurance model' problems are not fundamentally that different from ours, though socioeconomic connotations may differ - and are equally painful (to both doctors and patients).

The real debate is (or should be) more about: 1. "what is the moral purpose of our health care systems?" and 2. "what can we medical doctors do to achieve this moral purpose?".

3. Finally, how can we make "personalized medicines" (genomics, epigenomics, proteonomics, regenerative medicines, stem cells, immune modulation and new therapies) truly compatible with "standardized evidence-based medicine" and "diagnostic/therapeutic protocols" based on "groups and populations" rather than "individuals" (in spite of the tremendous but at times rather controversial or questionable efforts by NICE, National Institute of Clinical Excellence, in the UK) Again, we - as medical doctors or physicians - seem to have lost control over the management of the health care system, so that although we "own this area of knowledge" we do not any longer control its management. Is it no longer "fun" to be a physician? shall we soon be substituted by computers? will managers and nurses exclusively run the system (as they seem to be doing today, in most respects)? There are many things we can probably do about that - both technical and political- but the first one is to be truly conscious of the problem and of the many unhappy consequences not only for us but also, and above all , for our own patients (and even for the presently "healthy population" ).

In summary, in my modest opinion, we are currently facing most serious threats and challenges to our western Healthcare Systems. Serious enough to justify at least a Statement, if not a full Manifesto for Health Care by Oxford Medical School .

If we physicians do not defend our science, art and moral purpose, who will do it for us? Who will do it for our patients? We should reaffirm our commitment to the principles of Universal Health Care, independently of the mode this is financed and independently on which particular political party runs our governments. We should remember that liberty and individual responsibility are the foundations of civilized society; that the state is only the instrument of the citizens it serves; that any action of the state must respect the principles of democratic accountability ; that rights

12 / OXFORD MEDICINE . JULY 2013

and duties go together, and that every citizen has a moral responsibility to others in society and to himself, including the care of his own health; and that a peaceful world can only be built upon respect for these principles and upon cooperation among democratic societies. We ought to reaffirm that these principles are valid throughout the world. Oxford Medical School is based on clinical excellence and a deep scientific understanding of medical sciences : the classical ones like anatomy, physiology, pathology, biology, pharmacology and biochemistry, and the more modern ones including genomics, epigenomics, proteomics, and stem cells . Freedom, responsibility, tolerance, social justice and equality of opportunity: these are the central values of our democratic systems, and they remain the principles on which an open society must be built. These principles require a careful balance of strong civil societies, democratic government, free markets, sound ethical principles and international cooperation.

References: it is impossible to quote in such short space all of the relevant reference materials, but I recommend these readings:

2. The conceptualization of Health, 1999 (according to Nurses, our invaluable aids and partners in clinical medicine): Med Care Res Rev. 1999 Jun;56(2):123–36 .

3. Rosner, D. 1989. “Doing Well or Doing Good: The Ambivalent Focus of Hospital Administration.” In The American General Hospital: Communities and Social Contexts edited by D. Long and J. Golden, 157–169. Ithaca, New York: Cornell University Press.

4. Stevens, R. 1999. In Sickness and in Wealth: American Hospitals in the Twentieth Century.

Baltimore. The Johns Hopkins University Press.

5. Jacob S. Health Care in 2020: where uncertain reform, bad habits, too few doctors and skyrocketing costs are taking us. Dorsam Publishing, 1st edition 2012.

6. Feldstein P.J. Health Care Economics, DELMAR series in Health Services Administration, 2012.

7. Public Health Ethics, 2010: a Manifesto. http://phe.oxfordjournals.org/content/1/1/1.extract

1. Personalized Health Manifesto (Berkeley University, 2012) http://www.kauffman.org/newsroom/personalized-health-manifesto-unveiled-attranslation-medicine-alliance-forum.aspxx

Oxford on iTunes U October 2012 marked the fourth anniversary of the launch of Oxford’s iTunes U site. Since the launch: • 20 million downloads from iTunes U • 4,200 podcast items processed • 3,480 academic speakers and contributors • a worldwide audience of 185 countries (including 31% from the USA, 17% from the UK and 7% from China) • mobile users account for 15% of our downloads, with most of those coming direct from Apple iOS devices (iPad 8%, iPhone 5% - of all downloads) If you have iTunes visit Oxford's site! http://itunes.oc.ac.uk/

Content includes: • From Bench to Bedside : 50 talks on Translational Medicine • Oxford Alumni Conference 2012 - over 20 talks from the best of Oxford.

• Alan Turing : A Centenary Conference on the famous mathematician • Engage - Social Media for Dissemination and Public Engagement with Marcus Du Sautoy and colleagues • The Chemistry of the Botanic Garden • First World War: New Perspectives • Children's Language and Literacy and Impairments • Great Writers Inspire - Over 30 short talks on famous writers • Shakespeare's entire First Folio, including original spelling, is being made available to download for free, as Oxford University becomes one of the world’s first universities to add ePubs to iTunes U: • ePubs to accompany Oxford’s 'Approaching Shakespeare' lectures • ePubs to accompany our 'Not Shakespeare: Elizabethan and Jacobean Popular theatre' lectures

OXFORD MEDICINE . JULY 2013 / 13

With sadness…

Dr Geoffrey Barraclough, OBE, b 1924, q. BM BCh 1956, d. 2 December 2012; 1946, aged 88. The son of a shipping executive, he was educated at Eton and Christ Church, Oxford, where he read literae humaniores. In 1943 he joined the Fleet Air Arm. On demobilisation he worked briefly for the family shipping firm before deciding to train as a doctor; he took his Oxford BM in 1956. Geoffrey Barraclough was for almost half a century the English doctor in Kobe, Japan, ministering to its large expatriate community. He worked at the American Hospital in Paris, the Royal London Hospital, and Great Ormond Street, before moving to Kobe, Japan, where for almost half a century he looked after the expatriate community and the crews of ships which docked at its port. He was survived by his Japanese wife, Ikuko, and six daughters, another daughter and a stepdaughter from his first marriage having predeceased him.

Joan Mary Davidson (née Levett) b. 29 January 1920 m. St Hilda’s 1938 q. BM BCh 1944 d. 16 November 2012 aged 93. Joan Davidson’s childhood ballet teacher thought her good enough to study at the Ballet Rambert.

But Joan herself much preferred to become a doctor, and after boarding school, and in spite of her mother's disparaging remarks about her ability, she gained a place at Oxford to study medicine.

Joan qualified BM BCh in April 1944 although she had felt that she had failed her viva. Her first job was at the Children's Hospital in Derby at £130 p.a. She was on duty 24 hours a day so there wasn't much time to spend the money.

Once she bought a book on Child Delinquency, only to find it stolen from her bicycle basket and thrown in a puddle! One patient she remembers was a Rhesus-positive baby who was admitted a bright orange colour and needed a blood transfusion. Six months later to her delight he returned for a check-up, healthy and full of smiles.

Her next job was in Sydenham, in a hospital for quite different patients: Marines with venereal disease, and children. After that, as female doctors were no longer being called up, Joan went back to Oxford to do obstetrics and gynaecology at the Radcliffe. One of the obstetricians was a good dancer and on ward rounds he would tap-dance from bed to bed!

Joan applied to do medical relief work and somewhat reluctantly joined the Church Missionary Society. Reluctantly because she didn't feel she was missionary material.

However Joan was accepted and learned to work happily with others, even if they didn't always see eye to eye. Joan was allocated to a small hospital in India. She learned to tell the patients to take their medicine when the sun was rising, when it was directly overhead and

when it set. Part of the work was in outlying villages, often dealing with malaria and malnutrition. On one occasion she rode home alone on horseback, ignorant of the tigers in the area, and demonstrating unintended courage to her native colleagues.

Singapore followed, in charge of a Children's Hospital, in an area of narrow streets, high-rise buildings and families of three generations crowded into one room. She also started a nurses' training course in basic anatomy and psychology. After a year she relocated to Malaya, to be in charge of clinics in the New Villages, set up in order to move Chinese rubber-tappers to safe quarters, away from communist guerrillas. On Sundays she went to church in St Mary's, Kuala Lumpur, and afterwards, 'Jungle Bashing'. It was here that she met Llewellyn Davidson who was working in the Rubber Research Initiative. They married in 1953.

Joan remembers this period of her life as quite idyllic. She worked part-time and had house servants. So no housework, no cooking, no washing up, no ironing. She had a wonderful husband who came home for lunch, finished work at 4pm, when they would do some gardening until sundown. They would then shower, change and sit with a cool drink until supper was served.

After her children were born, Joan stayed at home to look after them and in 1960 the Davidsons returned to a cold, grey-skied Shropshire in November. Joan became involved in local activities, such as the WI, the local choir, church choir, a painting group, the PCC, Parish Council and Village School Managers Committee.

After fourteen years the Leintwardine doctors encouraged Joan back into medical work, doing locum work and home visits, which she loved.

Even in her 90's, Joan was still active and could often to be seen out in her red car, visiting friends and going to church Hall, Zaida Mary Hall, (née Megrah) b. 1925, m. Somerville College 1945, q. St George’s Hospital, London, 1948. MA, DM, DPM, DCH, FRCP, FRCPsych Consultant psychiatrist and psychotherapist Southampton University and Royal South Hants Hospital, Southampton Zaida (Dr Z M Hall), widow of Ruthven Hall and of Sir Peter Ramsbotham 3rd Viscount Soulbury . d. peacefully from metastatic cholangiocarcinoma on 17th March 2013, after a short illness.

An only child, Zaïda Megrah was educated at St Paul’s Girls School in London and then read medicine at Oxford and subsequently at St George’s Hospital, where she was one of the first female medical students. She wrote her doctorate on the fate and action of vitamin B12 in pernicious anaemia and then trained to be a chest physician. She joined the Bach Choir while

in London and sang with the choir for more than 40 years. There she met Ruthven Hall, and they married in 1950. When he became bursar of Winchester College the couple moved to Winchester, and, with the declining need for respiratory physicians, Zaïda decided to retrain in psychiatry. Although she worked almost full time, she continued to cherish her four sons and her singing, and enjoyed her association with Winchester College. After Ruthven Hall died, she married Sir Peter Ramsbotham in 1985 and shared another 24 years of marriage before his death in 2010.

Zaïda found her niche in psychotherapy, especially for young people. She worked with adolescents from broken homes, often victims of physical and sexual abuse, recognising that their current mental health issues were largely rooted in their early years and their parents’ own mental disorders. She developed an innovative group therapy involving a male co-therapist for female, and later male, victims of sexual abuse.

She continued her work into retirement, finally ceasing at the age of 80. Even during this time she was keen to develop new techniques and in particular used EMDR (eye movement desensitisation reprocessing) to treat posttraumatic stress in her patients. She was a patron of the CISters (childhood incest survivors) network and played a major part in promoting the recognition and treatment of sexual abuse survivors.

Zaïda also wrote about her work and published papers on group therapy, false memory, and child sexual abuse. She spoke out against the threat to confidentiality posed by the digital revolution and helped to shape a code of practice in psychiatry to safeguard patient confidentiality.

For many of her patients she was the first person to understand them and show genuine empathy, thereby enabling them to heal deep wounds; all this began at a time when the medical profession was somewhat naive in its approach to victims of abuse. She will be remembered for her passion, her conviction in her work, and for the example she set as a teacher, trainer, and role model for women in medicine. Zaïda leaves four sons.

Erwin Oskar Hirsch b. 1920 m. Christ Church 1938 d. 3 October 2012 aged 92. Born in Vienna, Austria, he left there at age 18 for Christ Church before coming to the U.S. A. where he joined his parents and sister in Boston. He graduated from Harvard College in 1942 and from Harvard Medical School in 1946. Pursuing hematology research, he devised a method that for the first time successfully transfused blood platelets, today a routine procedure. He was President of the New Jersey Directors of Medical Education, Chairman

14 / OXFORD MEDICINE . JULY 2013

of the Wisconsin Peer Review Commission and Director of Medical Education and Associate Dean at The Medical College of Wisconsin.

During the Korean War he served from 19521954 years as Captain at Valley Forge Army Hospital in Pennsylvania. After eight years of private practice in Providence, RI, he followed his increasing interest in medical education at Princeton Hospital in NJ becoming Dean of Students at the Medical College of Wisconsin.

Robin Gow Willison, b. 16 August 1925 m.

Trinity 1943 q. BM BCh 1951 d. February 2012 aged 87. MRCP Edin 1954, DM Oxford 1968, MRCP Lond 1978, FRCP Edin 1971. Formerly Senior Lecturer in Neurology and head of the Department of Clinical Neurophysiology at the National Hospital, Queen Square. Interest in neurology developed during service as a major in the RAMC at Wheatley and Churchill Hospitals in Oxford, especially working with Ritchie Russell and Whitty and using the new artificial ventilators on paralysed patients. In 1962 he moved to the National Hospital and the Institute of Neurology, progressively increasing the Clinical Neurophysiology and reducing the Neurology components of his work over the next decade. In the late 1970’s he transferred to the hospital Department of Clinical Neurophysiology and became head of department until his retirement in 1990.

Willison made numerous important and fundamental contributions to Clinical Neurophysiology and can reasonably be regarded as one of the founding fathers of EMG as we know it. Much loved husband of Gillian and father of Keith, Clare, Hugh and Victoria and grandfather to their children.

Alumni can subscribe to the Oxford Medical School Gazette for just ÂŁ20. To request a subscription form or provide any feedback, please contact: editors@omsg-online.com

OXFORD MEDICINE . JULY 2013 / 15

Oxford Medical Reunions Reunions in 2013

40 years (1973)

20 years (1993)

Friday 20th September 2013 If you qualified BM BCh in 1973 then we are looking forward to welcoming you to a day comprising talks by Regius Professor Sir John Bell and

by Mr Tom Bulford in the newly refurbished Radcliffe Infirmary followed by a tour of the building. In the evening you and your guests will gather for a Reunion Dinner which to mark the 40th Anniversary of your qualification. Invitations have already been sent for this reunion and booking is open. Please contact Roger Bodley – or the OMA team – if you have not received your invitation.

40 years (1974)

Saturday 5th October 2013 If you qualified BM BCh in 1993 then we are looking forward to welcoming you back to your reunion dinner to mark the 20th Anniversary of your qualification. Invitations have already been sent for this reunion and booking is open. Please contact the OMA team if you have not received your invitation.

Reunions in 2014

Friday 19th September 2014 If you qualified BM BCh in 1974 then we will be looking forward to welcoming you back to a reunion to mark the 40th Anniversary of your qualification.

traditional Family Tea Party at Osler House to mark the 10th Anniversary of your qualification.

2 years (2012) Saturday 7th June 2014 If you qualified BM BCh in 2012 then we will be looking forward to welcoming you to your first medical reunion with an Osler Party to mark the 2nd Anniversary of your qualification.

30 Years (1984) If you qualified BM BCh in 1984 then we will be looking forward to welcoming you back to your reunion to mark the 30th Anniversary of your qualification.

20 y ears (1994) Saturday 4th October 2014 If you qualified BM BCh in 1994 then we will be looking forward to welcoming you back to your reunion dinner to mark the 20th Anniversary of your qualification.

10 y ears (2004) Saturday 16th May 2014 If you qualified BM BCh in 2004 then we will be looking forward to welcoming you and your families back to our

50 years plus (1948-1964) As part of a series of events to mark the tercentary of John Radcliffe, there will be a reunion in September 2014 for all those who qualified BM BCh through the Oxford medical school in the years 1948 to 1964 inclusive. Invitations will be sent.

Reunions in 2015 40 years (1975) Friday 18th September 2015 If you qualified BM BCh in 1975 then we will be looking forward to welcoming you back to a reunion to mark the 40th Anniversary of your qualification.

looking forward to welcoming you back to your reunion dinner to mark the 20th Anniversary of your qualification.

10 years (2005) Saturday 15th May 2015 If you qualified BM BCh in 2005 then we will be looking forward to welcoming you and your families back to our traditional Family Tea Party at Osler House to mark the 10th Anniversary of your qualification.

30 Years (1985) If you qualified BM BCh in 1985 then we will be looking forward to welcoming you back to your reunion to mark the 30th Anniversary of your qualification.

2 years (2013) 20 years (1995) Saturday 3rd October 2015 If you qualified BM BCh in 1995 then we will be

Saturday 6th June 2015 If you qualified BM BCh in 2013 then we will be looking forward to welcoming you to your first medical reunion with an Osler Party to mark the 2nd Anniversary of your qualification.

OMA Events

Contacting OMA

Address: Oxford Medical Alumni Medical Sciences Office, John Radcliffe Hospital, Oxford, OX3 9DU Email: jayne.todd@medsci.ox.ac.uk Website: www.medsci.ox.ac.uk/oma Enquiries: 01865 221690 Fax: 01865 750750 Join fellow Oxonians for three days of academic lectures, informative talks and special visits across the spectrum of academic disciplines. Learn something new, or relearn something old; find out about the most pressing issues for society and how the University is working towards finding solutions; discuss and debate everything you’ve heard with your peers, in the finest tradition of Oxford.

Saturday 21st September 2013 Radcliffe Observatory Quarter walk Oxford Medical Alumni are encouraged to sign up for this guided walk around the Radcliffe Observatory Quarter. Those of you who recall the former Radcliffe Infirmary site will be astonished at the changes. [Tour at 10am]

The 2013 Osler Debate: Big Data and Drug Discovery At 4.15pm a panel discussion led by Dr Martin Landray FRCP, Reader in Epidemiology and Honorary Consultant Physician will take place at the Said Business School. Our ability to generate data has moved light-years ahead of where it was only a few years ago, and the amount of digital information now available to us is essentially unimaginable. And this data isn’t simply linear; genetics and proteomics, to name just two fields of study, generate highdimensional data, which is fundamentally different in scale. For some time, DNA sequencing has held big data’s starring role—after all, a single human genome consists of some 3 billion base pairs of DNA. Researchers are sequencing and analyzing human genomes to ferret out clues to infections, cancer, and noncommunicable diseases.

‘Big data’ in medicine has the potential to revolutionise healthcare research and offer patients better, safer and more personalised treatments. In modern society, very large sets of medical data are now routinely collected, including through electronic patient records, DNA sequencing and treatment monitoring, but storing and analysing such vast quantities of data is not straightforward.

This session will look at how Oxford is addressing some of these research opportunities and challenges, building on worldleading expertise already gained through running some of the largest clinical trials of treatment worldwide. Following an extremely generous

benefaction, the Prime Minister David Cameron and Mr Ka Shing Lee recently opened the Li Ka Shing Centre, and the Big Data Institute which will enable Oxford to continue to develop approaches for generating, storing and analysing large datasets in medical science for a better understanding of human disease and its treatment.

Bringing health-related datasets together for researchers to use in an anonymised way, and making use of new tools to scrutinise that data will provide powerful new insights into who develops illnesses and why.

We aim to follow broadly the pattern that was so successful at Cradle Mountain in 2012 viz. sessions of informal 15–20 min presentations of mutual interest, medical and otherwise; a keynote speaker (or speakers); informal meals together and

probably a dinner/speaker on the Saturday evening; associated attractions: — no Cradle Mountain, but events from the second half of the Adelaide Festival and Fringe would still be on, excellent Galleries and Museum collections and probably an afternoon excursion to one of the local wine areas (McLaren Vale, Clare or Barossa Valley).

Accommodation: we plan to circularise contact details of Hotels (range of prices) in the NE corner of Adelaide's square mile which is adjacent to the main University of Adelaide precinct.

We have yet to decide where we should gather as a group - possibilities include one of the hotel function rooms or somewhere on the University campus.

The local sub-committee will meet again shortly.

If you would like to register an interest in attending this reunion, or want more information: Chris Hughes, Trinity 1953 emandcee@bigpond.com Roger Bodley, Worcester 1970 roger.bodley@btinternet.com or do contact the OMA team.

Oxford Medicine is produced by the Medical Informatics Unit, NDCLS, University of Oxford. Telephone +44 (0)1865 222746.

Ref: OxMed0713/0600

Front cover picture :- Libraray Window by Erin Gordon

2014 Australian reunion

Friday March 7th and Saturday March 8th and Sunday March 9th Adelaide, South Australia Monday 10th is a public holiday in S. Australia participants could extend their stay or have longer time to return home).