This is Derek Hockaday talking with much investor at his home in Fallbrook on the 4th of June to one for Martin.
Just tell me how you came to come to Oxford. What led to that?
Well, the immediate reason was that Richard Doll later Sir Richard Doll was appointed Regis, professor of Medicine.
Prior to that, he had going to be deputy director of the MRC Clinical Research Centre at North Park.
And I was all set really for a shift to North Park, but then somewhat out of the blue became the Regis professor appointment.
And in those days, it was still a little bit of money around.
And Richard was able to bring three or four of his sort of chosen junior colleagues with him.
These included Malcolm Pike, Richard Peto, the Peter Smith and myself and one or two others.
And so we were able to come to posts at Oxford.
So in July 1969, I think it was.
I became a clinical lecturer in Richard Dols department, the department at the Regis Professor of Medicine.
And now that was. Were you in the main building up in the George Pickering's Road area, or were you in over towards the institute?
We were in the George Pickering area and a very prominent person there,
and somebody who I remember very fondly was John Oliver, who is who was first assistant.
And I found John very supportive and helpful person.
Some people found him a little difficult at times. I always found John extremely helpful and I was very pleased to have him around.
Obviously, there were others left over from George Pickering's time.
Perhaps the most notable would be Laurie Bailin, who was who's now a professor in Australia, where he'd be retired now.
But at that time he was, I think he was one of the first assistant to the Regis professor and a very good clinician, another very nice person.
And there were lots of other, very pleasant people there, too.
I'm interested what you said about Joan, because your sort of medicine was in German sort of medicine and he was a laboratory worker.
It's very good that he was able to facilitate your sort of supplies.
Well, I can give you one reason why I was in favour from word go.
And that's simply we both were derived from University College Hospital and John Lewis said, absolutely.
So John Arnold was very, very loyal to you C-H, and there were quite a lot of people around.
But if you were from UC H, then that certainly gave you a good start in the John and rigidly had been there.
No. Well, Richard Richard, certainly the MRC Statistical Research Unit,
which is the outfit I joined when I joined Richard Doll in 1966 that was based at University College Hospital Medical School,
but Richard himself was not a graduate of fussy age. I can't remember exactly which medical school he came from, but it wasn't UK age.
What led you to go towards epidemiology and statistics and research in that sort of field?
Yes. Well, that that is actually an interesting question.
When I was at school,
I had always assumed design is going to become an engineer because I've always been deeply interested in mechanical devices and engineering devices.
And when I went into the lower sixth form at my school, I went into the maths, physics and chemistry six four.
But my headmaster intervened and said that was not what he hoped I would do.
And at that stage, after a lot of bargaining, he persuaded me to go into the biological sixth form and do botany, zoology, chemistry and physics.
And that, of course, meant that I then became a doctor because I think of the 12 boys in that class, 11 became doctors.
Even at that time, I was very interested in data on how and why and and quite numerical.
And during my medical training, I was always very interested in aetiology and pathogenesis and how things,
how they occurred in the community for infectious diseases, how they spread and things of that sort.
So that interest was always very latent. Now, after I qualified, I actually made a remarkable and unusual decision.
I decided, in fact, to take time away from clinical medicine and to learn about statistics and computing.
And I was fortunate enough to obtain a post in the Department of Statistics at Rotherham,
said Experimental Station, which is actually an agricultural show.
But that, of course, was headed by Dr Frank Yates, who is the officer in Yates, a highly distinguished statistician.
And I worked there with two people. I work with Dr Brian Leach, who is a veterinary epidemiologist, and we're Dr Michael Healy.
Michael Healy, eventually becoming professor of medical statistics at the London School of Hygiene and Tropical Medicine.
And I also became very closely involved with an obstetrician gynaecologist, Leonard Baron from Newcastle,
and we started analysing data and writing papers together while I was there.
He was up in New York. He was up in Newcastle. Tragically or sadly, he was late 80s.
He died last December, a very valued friend and colleague.
After a while, I decided that I had probably learnt enough about statistics and computing as much as I wanted to learn anyway,
and I decided to go back to clinical medicine, which I did for a while.
So I actually completed my house appointments very late.
Both of them were done at Barnet General Hospital and the first one was done with.
The surgical job was done with David Bailey,
who had been first met at first surgical assistant at U.S. age and who I knew well, who was very good to me.
And the second was with Dr. Oliver Garrard Garrard, who was a distinguished physician, and I learnt a lot there at the end of the year.
I was uncertain whether to continue with clinical medicine or whether to move into epidemiology.
It was really meeting Richard Doll and talking to Richard Doll that persuaded me that I would actually like to become an epidemiologist.
And that's how it answered. Yeah, I met Richard at Rotherham St.
Richard quite often came to Rotherham, said he was doing quite a lot of work with Michael Healey, right?
And so that's really how I first met Richard, and that's where we met and those around, you know,
and I met while we were still at school and we first met when I was 17 and she was 15.
And it she was really, quite frankly, so beautiful that I tell you it was the first time I saw her.
And it produced a relationship, a happy relationship.
But she was the last it. We've now we're now well beyond our diamond wedding.
So there is some reason I always connected with references to that room.
And you are. No, you are absolutely right.
Because Anne, she worked as a secretary at UCL and she worked for Jay-Z Young and she worked for Linda Brown, George and she.
She then went and worked. Rossum stayed in Frank Gates's departments.
Have I when she went there because you were there, you know, she was there.
That's the thing to do in there. No, I don't. I don't think it's I and was working at Rotherham instead before I went there.
And she continued to work there for quite a while afterwards.
That's something that I was wondering about when you joined Richard Doll.
Were you at that stage doing your own number crunching or were you already relying upon big computers?
No, by then, by the time I joined Richard, so most of the stuff we did was being done on computers.
But on the other hand, the desk calculator was also the vital bits of equipment we had the highly obnoxious bronze figure machines,
which which are dreadful to use, and we also had really quite nice machines made by facet desk calculators and also, I think, electronic calculators.
Just about beginning to appear. But no, we used the University of London computing facilities and I I was competent enough to do what I needed to do.
The University of London computers. So when you moved to Oxford, how did the facilities for computing compare with London's?
Well, I think the facilities for computers at Oxford probably were better, right?
Although I had less to do with them immediately than I did while I was in London, because most of the work I did at Oxford was collaborative.
And usually the even in those early days would involve somebody who was more experts at computers and computing than I was.
I mean, fortunately, I had learnt enough to understand how things worked and what programmes did what and what results meant and things.
Things of that sort.
But nonetheless, I wasn't really after I can do what's really in the frontline of computing, and that would be the boundaries set up,
which is that if this was indeed then based in Bambi Road and the computer that was in use when I arrived there,
this computer and which seemed to do what was required, but of course, compared with what we have now was laughable.
I remember Jim, then men were dinky. So was there a sort of little subsection there?
Well, what happened was I came I came with Richard in 1969,
and the one of the first things I said about doing in my spare time to the distress of my family was to write my MDA thesis.
And this was on the basically all the benefits and risks of oral contraceptives and air in which I have done a lot of work
and I'd done a lot of work on that topic while still at the statistical unit in the Multi Statistical Research Unit.
So that occupied my spare time. During the day, I was doing all sorts of other things.
Other projects of various sorts, some of were MRC projects and some of them the other sorts of projects.
And I I stayed as a lecturer in Richard's department until 1972,
when I then went to the United States for six months and worked with a man called Herschel Drake on drug safety studies.
He ran an outfit called the Boston Globe Drug Surveillance Programme.
So I worked with him in 1972. That wasn't a sabbatical.
It was unpaid leave. But I may say I was paid twice as much in America as I was in Britain.
When I came back for a short while, I was acting director of the DHS,
as it was then the DHS as a cancer unit, a unit which had been directed by Richard Doll.
But he was sort of reaching retirement age. And but I was it was while I was doing that job that I was asked if I would become
would accept the post of this sort of social media dimension that was in late 72.
I was asked, no, sorry in 1973. Mm-Hmm. And I did agree to that.
So I became head of that group, and that group was based in Kimball Road.
It was I took over the premises that had been occupied by my priest, predecessor Alice Stewart.
And it was one of the people, roadhouses, and that's where Jim and others were based.
So that's why Jim was there and indeed why I was there.
When you were working with Richard Perle before you came to Oxford.
First few years in Oxford. Was he somebody who very much directed the group?
Or did each member more or less do what interests me and the bit of each, really?
Richard was certainly always interested in what members of his outfit were doing, and he was always available for advice and encouragement,
and he would read through draughts of papers very carefully and often was a co-author.
But he for the most part,
he did let people pursue subjects that interested them precisely provided that they
were relevant to their image and important and that they were going to be done well.
Now, in fact, it's worth mentioning here that one of the first tasks I was given when I joined
the MRC Statistical Research Unit in 1966 at UCLA under Richard's direction.
One of the very first things I was asked to do was to investigate the possible relationship between venous thromboembolism and oral contraceptive use.
And I set up one of the definitive studies which showed that there was a very marked increase in risk of venous thromboembolism.
The relative risk was about eight for the oral contraceptives that didn't use.
It was a hospital based case control study. So that was something that Richard asked me to do.
One on behalf of the MRC one hospital group 19 hospitals was included in that study.
And it gave such clear results that it gave me an enormous insight into the methodology of studies established to examine the safety,
in particular a widely used medications. And it launched my career in two directions.
First of all, in the direction of drugs and drug safety, and during my working life, I worked very, very extensively with the CSM and the MHRA.
And secondly, on the field of fertility and control of fertility with which in which I work very extensively with the World Health Organisation.
So a lot of my work went sort of in the woman's health is and the other branch really went more broadly into the drug safety in direction.
MHRA Did you say what the Medicines and Healthcare Products Regulatory Agency, what used to be this?
Well, the CSM, I think, is the Commission on Human Medicines and the Dunlop Committee is and started off.
You remember, following thalidomide, all those horrors I put in about 30 years or one or other of their bodies.
And in fact, I only stopped. Yeah. In fact, I did some work last year at the age of 77, so but I don't think I likely do anymore.
And did that mean a lot of travelling up to London? Yes. One day a week or.
Oh well, I did a lot of travelling up to London anyway, as I did lots of other things.
But the CSA meetings were monthly, but at one time I was also doing the.
There was a separate adverse reactions drug and the drug committee that was considered an adverse
drug reactions and that used to meet also monthly and they wouldn't be at the same time.
So even even in that area, I could be trundling up to London for two days a month.
But as I said they were, I was still heavily involved with the MRC and various other bodies, so I did plenty of commuting to London.
And how much reviewing, you know, looking at projects. And so for the MLC, would you have done a lot?
Yeah, a lot, but not as much as I ended up doing for W.H.O., but I put huge amounts of effort into W.H.O.
I the the the the section that deals with human reproduction.
The control of fertility was certainly during the time I was principally active.
A very important part of W.H.O. I don't know how important it is now.
I hope it's still very important because too many people see same day Graeme Smith was involved with David and David and I.
We had many a chuckle together and you travel up together sometimes.
David's wonderful sense of humour used to pop up every, every meeting, really.
He used to. He used to laugh at me a lot because I always insisted on eating polio medicine,
sometimes chocolate during the meetings, and he he he was tickled pink by that.
I didn't quite know quite why he found it so funny, but it was quite funny.
Now, while you were involved with contraceptives, did you get into the world of fertilisation?
And I mean, stepped in it with the role that only.
Only indirectly, insofar as that area of activity was a major interest to W.H.O. because W.H.O. was not only concerned with control of fertility,
but also with infertility, which is a tragic problem just as unwanted children can be a tragic problem.
So the I certainly served on all this with Steptoe at W.H.O., but I never did any research in those areas.
And now, you know, to the outsider, the contraceptives seem to veer to and fro a bit as to their dangers.
And would you agree with that or?
Well, I think one of the major problems right the way through was with the media and the 10 still to the 10 still to be true.
I, they often report inaccurate information and sometimes information that is completely wrong.
And because contraception at that time at least was the sort of subject that always caused people to pick up their ideas.
Any finding that you came out with or others came out with would excite a lot of attention in the media, especially if it was bad news.
And I may say an awful lot of the work I did resulted in good news.
Yes. For instance, we were very much involved in demonstrating that oral contraceptive use has no important effect on breast cancer.
It does in current use by young people.
It increases risk by a tiny amount because the disease is so rare in users who are young.
The effect is really barely detectable even in huge studies.
And of course, the balance of benefit and risk for oral contraceptives is definitely now been shown in many studies, including those of our own.
To be positive, the benefits outweigh the risks. That doesn't mean there are no risk, but the benefits outweigh the risks.
The the other thing I would say is that although I was very interested in contraception,
not just oral contraceptives, but other approaches, including sterilisation and also an abortion,
but I became more generally interested in women's health, and I became increasingly interested in the old reproductive cancers and in breast cancer.
I became interested in the menopause and its consequences, perhaps especially osteoporosis,
but also called it kind of the cardiovascular consequences.
And also in the 1980s onwards, I became heavily involved in these screening issues in relations,
especially the breast and service that turned out to be an interesting area.
Were you involved in the herpes and cervical cancer story?
Not here again. Not not directly in that.
I mean, we didn't collect samples that were then investigated for evidence of herpes infection,
but we did do studies that were very relevant to the infectious aetiology or the basically infectious aetiology of cancer of the cervix.
We did a very risky study in which we investigated the husbands of women who had only ever had one partner,
but women who nonetheless had cancer of the cervix.
And we found that essentially all the women who to the best of our endeavours investigations had only ever had one partner, either husband.
We found that in every case virtually, that was not true for their husband.
And obviously, that supported the notion that there was an infectious agent of his herpes was of interest in the early days.
But of course, is human papillomavirus subtypes really the underlying problem with with cancer, the cervix and and people don't.
Really speaking, don't get.
Certainly the common forms of cervical cancer without human papillomavirus, but other things may accentuate the effect of human papillomavirus.
So how did you find that out by talking to the husbands at length?
I mean, was that sort of evidence is that this is published?
Derek, unfortunately in The Lancet.
But we we interviewed the women as part of a study of the aetiology of cancer, the cervix, and it was done by a careful interview.
And then we let a long time interval pass it, and we then undertook a study of the factors affecting disease and illness in the men themselves.
But we also incorporated the questions that we wanted to ask about sexual partners,
and I'm happy to say that no link was made at the time between the two sets of interviews.
I may say this this study obviously went through. An ethics committee was done in the 1980s.
The interviewing of the men was all done by David Skegg, right?
Hugh Davies, of course, later became vice chancellor.
Until very recently, he's been vice chancellor of the University of Otago in New Zealand, and David had the courage to do these tricky interviews.
But we did leave a long gap. Yes, and there was no obvious linkage between the two interviews, but it was a difficult study.
We thought a lot about doing doing it, and we did get ethical committee permission to do it.
And it is written up in The Lancet. Good to go to the meeting with.
No prescribing is to be straight with the man today or for symptoms.
Has that proven to be bad news or good news? Well, I don't think anybody for a long time would dream of prescribing still being wrong.
The the we got very heavily into the investigation of hormone replacement therapy.
It followed on on very logically from other work we've done and interested in menopause and postmenopausal events.
The initially, as you know,
the message in relation to hormone replacement therapy was feminine forever and
long term use of primary principally conjugated equine oestrogens was encouraged,
especially in the United States. Then it was discovered that unopposed oestrogen has increased the risk of thromboembolism.
This is why I'm sorry I might say increase the risk of of endometrial cancer,
but unopposed stimulation of the end of each year, resulting in endometrial cancer that caused a bit of a hiccup.
And that led to the incorporation of a progestogen component in hormone replacement therapy because
the progesterone would suppress the oestrogenic stimulation of the endometrium that later on,
other problems began to emerge.
We did the study in the mid-nineties, which we we thought would be a safety study looking at hormone replacement therapy and thromboembolism,
and we thought it was a safety study because nobody believed that hormone replacement therapy, as opposed to the bill, caused thromboembolism.
And this study was largely funded by sharing much to their credit.
I may say because as it turned out, when we completed the study,
we found that hormone replacement replacement therapy did have a two to threefold effect on increasing the risk of thromboembolism.
So that was another problem for HRT. In the early days, it was believed that HRT is protective against cardiovascular disease,
and I must admit that some of the early studies did support that point of view,
but they were probably due the results and probably due to the artificial selection of people at low risk of coronary myocardial infarction,
the artificial nection of people at risk of these, this condition for hormone replacement therapy.
And so the early results were reassuring, and it wasn't really until randomised controlled trials were done, in particular,
a huge American study called the Women's Health Initiative that the full picture came out about the benefits and risks of hormone replacement therapy.
And there was an increase small increase the risk of arterial disease.
In that study, venous thromboembolism was confirmed. There was also some increase in the risk of breast cancer.
There were, of course, beneficial effects on osteoporosis.
But the balance of benefit and risk for many women looked looked unfavourable and pull in replacement therapy has been used less and less now.
Now is this misused clearly for women who have severe menopausal symptoms, but they will rarely use it for more than perhaps three or four years,
whereas in the past, some advocates claim that women should use HRT for 25 30 years ago, taking it until until they died, if you like.
So the HRT story, too has been quite interesting.
One to get back to your oral contraceptives any real difference between the so-called generations of pill?
Oh boy, has that been a controversial one?
Well, there's no doubt that the early, very high oestrogen or most,
most high oestrogen pills that were in use when I did these MRC studies and the study in the 1960s,
there's no doubt that they carried a higher risk than pills containing less oestrogen
and that emerged fairly early on and let manufacturers to modify their formulations.
The early formulations contained considerably more oestrogen that was necessary the the then the later,
then which obviously emerged in relation to a new generation of progestogen as the after the after the initial pills,
we used the early pills with the high dose of oestrogen new pills came in, which used low doses of oestrogen and indeed lower doses of progestogen.
Those was sort of second generation pills.
But then a new generation of pills appeared in the late 80s and the 90s, using New Progestogen as the third generation progestogen.
And the argument about whether they carry a greater risk thrombosis and embolism in the second generation pills innocent still continues.
Generally speaking, most people accept that they do carry a slightly higher risk of thrombosis and embolism than the second generation pills,
and that the industry in particular still continues to fight this call.
And because many of those progestogen as their babies and their more expensive pills,
they would obviously refer them to be prescribed to the generic ones which make up the second generation pills.
Now, obviously, medicines always on the move.
You know, things are changing, and I've always thought that sometimes epidemiological studies may not have been asking a question that was important,
such as aspirin and particularly vascular disease as people found aspirin and thrombotic.
And there would have been a lot of good studies before that never asked about aspirin therapy.
How often did that sort of thing that I'm I'm absolutely sure.
Sure, that's true. The sometimes associations are sort i.e. you're chasing specific hypotheses, but certainly in epidemiological studies.
Findings, unexpected findings may pop out of the data and the interest in the, you know,
the protective effect of aspirin against myocardial infarction that was clearly apparent in the database held by Dr Hirsch or Jake in Boston.
When I went when I went to work with him in 1972, that was one of the things that we had observed and it was because they had a big database.
They had lots of diseases and lots of exposures. They were they had probes.
Sophisticated programmes that look for drug disease associations.
That was one that came out very consistently and interestingly enough, at that time, Peter Elwood, Cardiff was with Archie,
Cochrane was running, I think, one of the very first trials of aspirin on the basis that it might protect against Mark.
I thought I'm not quite sure where the idea would come up from there,
perhaps from basic research on the effects of aspirin in vitro or something of that sort.
And when we conveyed the results from Boston to Peter because I knew Peter was doing this study,
he broke the code in his study and he found that he was showing usually a
protective effect and in a way that's where the modern aspirin story started.
Mm hmm. But there are there are certainly other chance effects in these.
I mean, we now live in the days where there are enormous databases, huge numbers of diagnoses,
huge numbers of exposures and quite a lot of information on confounding factors.
And people can dredge data endlessly for drug disease associations.
I mean, think of the way that people now dredged data for genetic associations.
I mean, the endless nightmares they're looking for gene disease associations.
And so one has to be on one's toes in trying to sort these things out.
The social and community medicine, what's its relationship to epidemiology?
Is it putting into practise epidemiological findings or is it more than that?
Well, social and community medicine was my time when I was appointed as what was called the social medicine came from Alice Stewart's department.
The third part was devoted to social medicine.
The community bit came from the fact that community medicine was then a popular new name for what we might now call public health and used to do.
And indeed. And so that's why we became social and community medicine.
I mean, the those titles covered a very wide range of possibilities.
Obviously, looking at the importance of social factors and behavioural factors in relation to disease would be an obvious one from the from the name,
but also looking at the community based problems and looking at health care
and using epidemiological methods to try and evaluate the benefits or risks,
perhaps of different types of health care. And now all I personally was always interested.
Most in the clinical side of epidemiology is most interested in investigating investigating
diseases and what might cause them and what might prevent them and how they might be treated.
But there were other people working within that discipline whose interest might be entirely
on the organisation of health care and the evaluation of different types of health care.
So it's it was it was a title that really covered a huge range of possible topics.
But nonetheless, epidemiological principles, I think still underlie the different sorts of investigations were undertaken,
whether they were in the health care area or in the more clinical area.
So in a way to see if the difference between looking up to one person and looking after a flock and you know,
some people put their emphasis on what happens to the folk. Others are concerned at the time with one particular.
Well, absolutely right. And certainly, people concerned with the organisation of health care would be very concerned with the flock.
But of course, using every person based epidemiological methods,
the individual is of great importance to because you would have to be collecting data from and about individuals.
You just mentioned here something that you might not bring up, but which I think is of some interest.
And that is that when I was appointed to The Post in 1973, which I took up in 1974,
the the chair and social media medicine in my job description was a charge to look at.
The future of academic, academic, general practise good, and at that time, that was quite a difficult thing to be asked,
especially apps in a medical school like Oxford, because I think general practise at that time was still regarded as somewhat second best.
And there were people whom I shall certainly not name who thought there was no academic content in general practise,
which of course, you and I know is absurd. So I did meet a certain amount of opposition in trying to further this.
However, early on I got involved with an amazing chap called John Hessler, who was a general practitioner.
And I think in Reading or Hindley, I think it's only fair.
And John was such a dynamic force, and he and I worked really hard together to try and develop academic general practise,
and we worked closely with the Royal College of General Practitioners.
We got some money from the Dorothy McKenzie Trust, Royal College of General Practitioners and eventually with Rosemary Roos help.
We got sufficient together to appoint a reader in general practise.
And that, of course, was my dear friend and colleague Dr Coffey.
Yes. And Godfrey and I worked very, very happily together over more than two decades,
and academic general practise at Oxford now is really a very important part of the medical school.
And so I do feel a little pride in a way that that was something we managed to achieve against a background of some opposition.
And you know, I was going to ask you about the medical students with,
did you would you see yourselves starting with general practise when the medical students went out to the general practitioners?
Or were you more asking epidemiological questions about general practise?
Oh, you know, I can't remember exactly what the medical students did before we began to get with
with regard to general practise before Godfrey and I started to try and pull.
You've started to appoint tutors and say, Well, we got some support from the dean of the school, more support from me.
And then, of course, students went out to general practise.
I think they did have an attachment before then.
I'm not sure about that. But once we began to formalise it,
then they were being taught important parts about aspects of disease or point of view in primary
care and the interface between primary and secondary care and all those sorts of things.
The girlfriend and I, we worked so closely together because the department community developed a social community.
Medicine eventually became the brunt of community medicine, general practise and then the Department of Public Health and Primary Care.
That's how it was when I retired in 2000, and Godfrey and I worked hand-in-glove.
Godfrey, although an excellent clinician, was deeply interested in preventive medicine and in epidemiological methods,
and we we produced Joint Teaching Programme for general epidemiology and public health and primary care.
And so we would have common teaching programmes and often teach with general practitioners.
And of course, we're were really great general practitioners around.
I mean, Andrew Marcus Schofield, oh, people like that immensely, right?
The general practitioners in Oxford and yes, Andrew Marcus and Theo Schofield being just two of them.
Martin Lawrence, Yes, the late Martin Lawrence was, of course, another very bright star and many others too.
Uh oh yes, we we have had very good people and we managed to appoint some remarkably good judges.
And anyway, I think we did manage to establish the base.
Was it subsequently developed into something very good, the general after?
I'll just mention this very quickly. When I retired and Caulfield had retired before Michael Schofield, another I man, he was you sage.
He was a Houseman when I was a student, so Godfrey and I knew each other well.
When Godfrey retired and then I retired, David Weatherall was.
Determined to separate general practise from from public health said the departments became separate and golfing, I opposed this.
But David was wise and powerful and said the department did split.
Martin Lawrence would probably become head of the advanced general practise, but he tragically died from cancer of the colon around that time.
And instead, David meant it. Now David is a member of my department.
He was trained in both community medicine and general practise, and he was.
He was an amazingly effective head of departments, especially from the research point of view.
And he really, I think, has built built general practise enormously during the 10 years that he was around,
I suppose from about 2000 to 2010 or 2011 or whatever it was, David decided to retire at 60.
Mm hmm. Uh, he's he's he said. He said to me, I think the time is right.
The the the the effort I put in, as has left its mark.
Yes. I always thought the business of the students living with the GP's that was was universe or was it just wasn't it?
Wasn't it? But that's to be very, exactly the very.
Now how much did you see the students? Otherwise, I mean, lectures, tutorials, what we we developed a course that was repeated six times a year.
Right? Which was a two week module. And it would include it was small, obviously small group based and the the groups.
The most of the times were about 12 people and perhaps 14 sometimes.
And just doing you for that.
Yes, we would have we would appoint a tutor for each group, although the tutor would bring in other people to lead sessions.
And so some of whom would come from the NHS and some who come in the academic department.
And we would have a series of seminars and exercises and some for a while goodly while public health visits to the.
Some of our NHS colleagues were keen that we should continue with some public health visits to places like Far More Reservoir,
for instance, and students like this, and drew a budget for a long, long time.
They used to go to British Leyland and the they would have a session at Epsom Sessions and Occupational Health.
And I always remember. I can't resist mentioning this, but at that time, British Leyland, as you probably know, this were building Rolls-Royce bodies.
And for a long, long period,
Rolls-Royce bodies were built there and they were enormously carefully filled with any deficit with the lead containing material.
And around that area where they were doing that work on the bodies,
it was a line beyond which no female of reproductive age was allowed to regress because of lead.
And you can imagine the sort of general response of the delightful young lady.
Is she now proof of being stopped at this words?
That was a rule. So if you were, if you were going to keep that rule, then you wouldn't go to Bell.
So we all accepted it and was it wasn't about lead poisoning there.
I don't think so. I think it was all enormously carefully controlled.
I think Bell had pretty good occupational health service and you're looking just sort of medical surgical grand rounds.
I did go sometimes and very occasionally I might be on something.
Uh, I was. I, as any question might sort of turn off.
I have to admit I I used when I used to go,
I had always felt some trepidation because I just wondered whoever was conducting the round where they might produce some impossible question.
Because they might they might find a question about health service organisation,
about health economics, about morbidity, mortality, well, distribution of disease.
You know, anything would be regarded as fair game. And and there's, you know, one or two of our colleagues might not have been above throwing.
Googly and bowling are good, and I'm just trying to formulate this, whether there is anything I should have asked you about that I haven't.
Well, I'm I mean, obviously I did a lot of research and I did write a large number of research papers over the years and since my retirement,
I've written another 40. Wow. Well, from our data, much of it from my.
That's the Oxford FBA contraceptive study, which is a prospective study started in 1968, and I only terminated follow up in 2010.
And it generated huge amounts of data about women's health generally, but also especially about contraception, about other aspects of women's health.
So obviously, I spent a lot of time doing research the I think it might be worth mentioning that I became very,
very involved with the breast cancer screening programme in.
I was asked to chair the National Advisory Committee when at the time that the breast cancer screening programme was started,
and I was asked indirectly by Sir Patrick Forrest,
who has read this massive surgery in Edinburgh, who had done written the Forest Report,
which is a report in which the government based their decision, set up a programme.
So I chaired that committee and I also helped set up the programme.
But the greatest praise for setting up the programme was undoubtedly go to Neil Grey meal and I would hand in glove.
He was terrific. He's he's and he's a remarkable polymath, an amazingly good organiser.
And I think the reason that we managed to set up a good programme is much more huge more than it is to me.
Nonetheless, I had the frankly difficult task of chairing the National Advisory Committee,
which advised the government and which also advised the field and right from the word go.
The breast cancer screening was quite controversial and I was I chaired that committee for two, I think actually for 10 years the end.
And then I was asked to chair the National Advisory Committee on the Cervical Cancer Screening to survive.
The cancer screening has been around since the very early days of the 1960s,
but it only became a proper programme end the 1980s and nationally supported it under control of the national director.
My very dear colleague Juliette Patnaik, somebody else?
This is my word for well over two decades, she's still director.
Mm-Hmm. Terrific. Terrific director. And I think it was really she that got me asked to chair that one.
And that that was pretty tricky, too.
I mean, one of the decisions we made, for example, we made many,
but one that we made was the decision that the national programme shouldn't begin until age 25 rather than age 20.
And if you actually look at the data and look at the statistics, that is the most sensible thing to do in both not only financially,
but much more importantly, much more importantly in terms of benefit risk.
And that was grossly hugely controversial thing.
And I mean, we we got we were involved during the time I worked as chairman of those committees, and I put a lot into it.
We were involved with all sorts of difficult questions. Then to my amazement, I was asked to chair.
I think it was in 2006, well into retirement.
I was asked to chair the National Advisory Committee on Screening for Bowel Cancer.
I wasn't an expert on bowel cancer, but I did know something about screening and I did that for three years, the first four years.
But I decided when I hit 75 that I wouldn't chair any more national programmes because not just because young people should do these things,
but also because one becomes a little nervous. And this one is.
Using one's onions unknown to oneself, just I think it's the danger of going on for too long.
Yeah, and I was really rather determined not to do that.
But those screening programmes, they I mean, they were enormously interesting.
I put a lot into them. They have been they've certainly the breast cancer screening programme has proved to be quite a controversial programme.
Lesson one time is around. Nothing to do with me that, you know, the benefit and risk is being questioned more in recent years.
And but that it did did form quite quite an important part of my work.
I've stressed W.H.O. I did endless work on all sorts of committees in the reproductive field for W.H.O.
The other thing I did is put a lot of effort in is that I was a member of the Royal Commission on Environmental Pollution.
Richard Doll was a member when he retired. He suggested I should serve as if I didn't know enough to do it, and I agreed.
Now, at the time I joined it,
it was hugely rewarding because it was chaired by Richard Southwood and I declare himself with our vice chancellor and Dick,
who is just terrific, so wonderful to work with.
Another sadly dick has died, of course, as well. Yes.
And I said to such to complete rotations of the Royal Commission, Environmental Pollution and Dick chaired the first one.
And I mean, the second one was chaired by somebody else. But it was also very interesting.
But dick, it was just so great to work with Dick,
and he became a really rather close friend and somebody who I hope there's always been a bit of a hero for me got involved with this.
He did, which it said it would get involved the AC.
I think that was a pretty uncomfortable thing for him. I think everybody who was involved is he found that pretty uncomfortable.
And then McRae, was he NHS employed?
Yes, Neal. Yes, he he came as a public health doctor and he was he was NHS employed throughout.
How much did you have to do with, say, I had it together over anybody else and.
Yes, I I felt very I felt it very important to work with and to help my NHS colleagues as much as I could,
even though they were much more concerned with the organisation of health care.
But obviously, they were concerned with preventive medicine and infectious diseases and vaccines, preventative vaccines, maternal and child health.
But that health care organisation was a very dominant problem for them,
and I had the again, the tremendous pleasure of working very closely with Alex Gatherer.
He also died recently, and if he fell ill to a good age, he went on working for W.H.O. for a long time right after his retirement.
And I went to a lot of his meetings and I tried try to work with the the practitioners,
the NHS practitioners and I used to go to regional meetings and so on and so forth, and I think I managed to make a useful contribution.
I hope so. And of course, the other person I work with very closely in the same way was Rosemary Booth and afterwards, Ronnie Pollock.
Yes. And again, you know, Rosemary, another great Oxford style and a wonderful lady.
Tremendous to work with. Always immensely kind to me.
I remember when I first was first appointed, Rosemary said.
She said actually my first script, she said, laughing, but she came to see me.
And she said I thought, who is is very young at home and young man, she is yours.
I was quite young and I think she didn't know me very well.
And then we become 35. And I was I was appointed at 37 right and the rosemary was terrific throughout.
And it was said that region gradually over the years lost its influence.
Well, you will know, Derek, how much Rosemary contributed towards the technical school and the things.
We try to do what would you collaborate with their own?
And what sort of things would you be doing?
I went I went to Rosemary's Regional Medical Office at meetings at which many planning issues would be discussed.
Most of them organisational and managerial, but some of them more clinical.
And I managed to contribute to the quilt,
the quite a few the things that they were considering and to offer some epidemiological input to population matters that would come up at the meeting.
I worked very closely for the Regional Medical Research Committee.
I used to chair their all their committees and offer advice advice to the region.
Rosemary would often ask me for my view on some steps that she was going to take in relation to
the clinical school and one she she often used to ring me up or ask me if I'd come and see her.
We often used to drink a sherry together, Rosemary USU manager, producer, Sherry late afternoon, and we would we would chat, chat about things.
But equally, Rosemary is very interested in what we were doing.
She always wanted to know what we were working on, and she was very interested, for instance, in breast cancer research.
And of course, she eventually died from the disease.
And she so so there was a lot of interaction quite well.
It was fairly informal, but the regional medical officer meetings and the assembled armadillo meetings,
regional and district medical officer meetings,
I used to attend faithfully and a lot of I think what I managed to contribute would be through that sort of medium and.
U.S. general travelling around the world, presumably, well, the a lot of the things I was working on were very topical when I was working on them,
so I was invited to give talks at many conferences in different parts of the world.
And also, I became a consultant to their projects, also collaborative drug surveillance programme, and I was there as a consultant for many years.
I used to go two or three times a year to work with them for a week, and W.H.O. certainly generated some interesting interest in foreign travel.
So yes, I think I did my share of travelling around the globe.
Did you get involved with nutritional side of things in there?
Well, the the answer to that is not personally to any great extent, but you will know, Derrick, that it was a considerable interest in my department.
Yes. And I must admit something else that I really tried hard to do in my department was to be really,
genuinely interested in what my colleagues were doing.
And I wanted to know what they were doing, and I wanted to try to support them and encourage them.
So I certainly would discuss will be get involved in that area when plans were being drawn up, say by somebody like Jim Manuel or Andrew Neil.
People who had an interest in diet and more than one DPhil student in our department researched in the nutritional area.
So although I didn't do any sort of hands-on work in that area myself, it was certainly an important interest in the development.
You must have supervised a lot of details. I did. That's great.
Helpful is it's hard work. But what I said when I gave a little speech at my departure dinner was that if I look back on my life, uh,
professional life, then I would have to say that the most rewarding thing was working with the DPhil students.
The We had wonderful DPhil students.
We were blessed with many of them being Rhodes scholars.
I mean, David Skegg been, for example, but with them in many, many, many others.
And they turned out to be such amazing people and such a pleasure to work with.
And it was possible they would work often on something that either I myself wanted to pursue or something my department wanted to pursue.
Because, as you know, DPhil students always have to find a project. Some know exactly what they want and they come, but most don't.
And so it was possible to work very, very closely with the Hmong, often on something very close to the heart.
And I used to see my fellow students frequently, and I just great enjoyed working with them.
And almost all the ones we had did remarkably well and and have have gone to interesting posts in different parts of the world.
I can think of only two who for whom it didn't work out.
One was a young man in South Africa who I think was just somehow overwhelmed by the complexity of what.
But again, is the Oxford environment involved in that?
Well, I think I think both those people go as much support as could be offered both in the parliament and more importantly, from colleges.
I think I think in both cases, the colleges did everything they could, but the load on them is, Oh, really?
Oh gosh, yes. I mean, people come from a closely supervised world and really act.
Ultimately did did their own patch.
And and I think it's for some people who come perhaps from the heavily supervised activity or from a very underdeveloped activity,
see the kind of environment they meet.
And also it could be very difficult. But mostly they were just fantastic.
They didn't walk on those roads enough. Of course, nothing to build is great, and some of them came on other funds, often from their own country.
And they were they were all terrific, really.
I mean, even those two tragedies they mentioned to you, they were there.
Just very sad. Yes. How many people did you have to reject who were applying to do it?
Do you feel? Erm,
we if we had gone as far as getting to the Applications Committee of the Clinical Medicine Board and being accepted by the Applications Committee,
we would certainly never define rejection. So is that where the main selection occurred?
You feel the the where I first explain where more people would often approach you in the format and and you would encourage them.
I think in fact, we reject we rejected very, very few people.
I would say most people who wanted to come and work with us, we accepted.
I mean, obviously, we absolutely lapped them up.
If you were a Rhodes scholar or another Dominion scholars, we knew they would be great.
But but the majority of the others came often with funds from home and they came with good credentials.
And actually, we didn't have too many people, a handful, perhaps.
What else would you like to say? Well, I know you've done very well.
I mean, I think I I think I ended up doing what suited me best.
Mm-Hmm. And because I was able to combine an interest in methods and solving problems
with with with medicine and clinical medicine has always been close to me,
and my interests have always been quite been close to clinical medicine.
And that's tended to be the sole variable, which most of my work has been done.
But how I would have worked out as a clinician, I don't know.
I I have a feeling that I might have been troubled by being too conscientious and just kind of worrying
too much about the people looking after and whether I'd really done the best I possibly could for them.
I think I think if you if you consider the people in surgical practise, I I never really thought of being a surgeon.
People who succeed in surgery tend to have pretty robust personalities, and I don't think that they can survive if they take too much anxiety.
And perhaps no doubt. I agree. That doesn't mean to say that they're not terrific people.
Many of them are, and I count many amongst my dear friends.
That's a bit less true, perhaps in on the side bets as opposed to surgery, although that can be.
There's also can be very harrowing. So I think maybe taking into account my personality and my interests and the way things panned out,
I've been very, very fortunate in the way my my career develops.
And you mentioned Dennis Stewart. And I was just thinking epidemiology would seem a subject that women aren't so notable in number and achievement.
Well, general practise, of course, is something that attracts some particular a lot of women on our general practise and the ABCs of GP's,
the quite a lot of people want women went into public health.
Yes, and yes it did. Indeed. And certainly a lot of my fellow students or women ride around and they were outstandingly good.
I mean, if you if you look at if you look around now,
I suppose the most outstanding woman you would pick out is Valerie Burrell, who who is now Dame Valerie Burrell.
And she is. She directs the Cancer Epidemiology Research Unit and is has done lots of really very good work.
There are a lot of people in her unit are women, but a lot of know. A lot of my colleagues were always women.
I think the public health and epidemiology do it to appeal to women, and I think that for some of them,
it it might offer a career in which they were less like to be called out a bit in the middle of the night.
And we have to be realistic about this if you have three small children.
It's not great to be called up in the middle of the night,
but I don't see in that in any way, depreciating the tremendous contribution that women make.
And I think I have had the privilege to encourage and bring along quite a few.
And did did you get involved in prostate cancer at all?
Not, not directly. No, it wasn't.
The breast, cervix, endometrium and ovary were the Kansas that I was most interested in, but I always, you know,
kept an eye on the male reproductive cancers to testicular cancer and in particular, prostate cancer.
And obviously, I've been close to the question of prostate cancer screening because that's a hugely
contentious area and an area which is not followed in present in the United Kingdom.
The it is the opinion that the National Screening Committee and I agree with this.
The risks still outweigh the benefits using PSA as the as the substance you're measuring.
We need better screening methods for prostate cancer.
It may be that screening by PSA can save a few lives from prostate cancer,
but at a terrible cost in terms of the diagnosis of cancers that would never have killed person and had the disease.
The people who undergo radical investigation and often radical treatment and you know that it is the false positives as well as false negatives,
of course, that have to be considered so carefully in any screening programme.
And there's a big, big problem for prostate cancer. So.
I've I've certainly had less interest in the aetiology of prostate cancer, not as much to say about it even now,
but certainly in early diagnosis, the screening an isolated incident that involved some extent with that, unless you say something I don't know.
And there's virtually no one else goes to be questioned.
But Richard Dolan is to it. They had different views.
Yes, I think it's well known that Richard and Alice didn't see each other.
I mean, Alice was clearly an extremely evil woman, and she had, of course,
clinical origins she worked with which, you know, do you know, I think you see LJ LJ here.
And so her clinical knowledge was was good.
She made notable discoveries about the effects of radiation in utero, especially in relation to leukaemia.
I'm absolutely sure really why she and Richard didn't see eye to eye.
I'm quite sure the underlying conflict.
But there's certainly there was something there.
And it's true. The gossipy question it may be, but it certainly there was.
I mean, so in your view, she wasn't pushing evidence that she shouldn't have been and sort of exaggerating.
Well, of course, you know. Oh, well, there may have been an endless argument about the effects of very low dose radiation,
very innocent people still under the influence of very low dose ionising radiation in relation to cancer.
And certainly, I think Richard and Alice had different views on that.
You know, it may have been in part that I may say in this position,
when I was appointed, I obviously had to see how it was I was to give her department.
And at first I did sense of hostility, but it didn't last.
You know, I'm sure she soon, soon soon became friends and she was actually very kind to me and helped me, which she could.
She was a very, very tough lady and a very remarkable lady, Alice.
And in some ways, I suppose you could say the hard act to follow.
But of course, her involvement Michael was totally different from a different world and different.
Absolutely. Totally different. It is. And so they were never they would set out to make it work.
You couldn't make it completely direct. Yes. And she, of course, had followed while while he was a distinguished, distinguished person.
Yeah. Well, Martin, that's terrific interview. Thank you very much indeed.
We'll have to see it's a movie.