Hugh Tunstall-Pedoe
Year: October 9th, 2002
Location: Minneapolis, Minnesota
Interviewed by: Blackburn, Henry
Abstract
Tunstall-Pedoe gives a rollicking account of the vagaries of CVD epidemiology and prevention in the UK. He started out with Jerry Morris, then joined with Geoffrey Rose, and is now at Dundee on his own, having begun with the dream of Morris, the Tower Hamlets Coronary Register, in 1969. He became rapporteur for many WHO projects, and then a major leader and spokesman for CVD epidemiology and prevention.
There are fine anecdotes, in which one can find origins for his sometimes controversial UK stature. For example, at a national conference he once remarked that “the notion of leaving lifestyle risk factors alone is typically British. It combines extreme arrogance with impotence!” His major masterpiece is the study he guided and the monograph he edited on MONICA, the international WHO surveillance program.
This interview is a major resource about the UK picture of prevention and epidemiology. (Henry Blackburn)
Quotes
HTP: I was recruited by Jerry Morris to run a Heart Attack Register in London’s Tower Hamlets. There had been two other British studies preceding it, one in Oxford and one in Edinburgh. This was a collaborative, multi-center study and it was really an attempt to put coronary care as it was practiced then in perspective. There was this paradox at the time that the coronary care enthusiasts were saying they were halving mortality from disease. And that was at the time that in Britain at least, population CHD mortality rates were still increasing. And unless you put what happened in the coronary care units into a community perspective, you had to have the same denominator for both. This was very educational for me and for others because so many clinical statements are based on nebulous denominators.
HTP: But the Attack Registers got people together from different countries, it initiated people who hadn’t really thought about things into cardiovascular epidemiology and into studying what was happening and it put death outside hospital into perspective. And I suspect, at that time, in fact that we were really witnessing the unchanged natural history of the disease. I don’t think that any of the medical interventions that went on 30 years ago had much of an impact on disease. I now think, and I think a lot of epidemiologists haven’t caught up with this, that medical interventions, drugs and things really do change the natural history of a disease.
HB: We were also late to come to that view. We demonstrated very early in MHS that the slope of the last 15 years has been much steeper for in-hospital survival.
HTP: But, the interesting thing is that clinicians had hang-ups on prevention, which prevented them from accepting it. One of them is that if someone eventually dies of the disease, you haven’t prevented it. So you can save someone from drowning and they can drown 20 years later…
HB: Even Russ [Luepker] sometimes says we’re just delaying disease. He may not accept consciously that we really are preventing it as well as delaying.
HTP: What I’ve said is anything that reduces risk is prevention. One analogy is that the cumulative risk of a coronary death in men and women is very similar. But if we were able to reduce the coronary incidence, the specific coronary incidence in men to what it is in women, we would have achieved a miracle. We would have said we had prevented disease and no one would have denied that. So I think lifetime risk is a totally different story. And, in fact, what happened to coronary disease after the Second World War in many industrialized countries was that coronary disease invaded the younger age groups. Whereas it had always been there probably in the older ones.
HTP: I went to a debate at the Oxford Union. You know, this was a debate – – not actually an official University thing. It was funded by a drug company and it was related to the atherosclerosis discussion group. And this debate, it must have been in the middle eighties, was on the subject: “Risk factors were best left alone.”
HB: Don’t alarm the public.
HTP: I wasn’t one of the principal speakers at this, but I spoke from the floor. Let me remember exactly what I said. What I said was the question in 1980, whatever it was, was not whether to leave risk factors alone, but the most effective method of changing them. And I [said I] thought that the motion of the debate was typically British. Because I said it combined extreme arrogance with impotence.
HB: Beautiful.
Discussing the character and personality of our pioneers:
HTP: Groen examined Daan Kromhout’s thesis.
HB: Really?
HTP: And Daan tells this story very well. You probably ought to get it from him. But, [after the defense] Groen invited him over and laid on a meal and treated him with great kindness and courtesy. And on the table were all Groen’s publications and he then said rather timidly and rather nicely to Daan, “It’s a very good thesis, but you don’t mention any of my work.” [ed. Pow!]
HB: That’s nice. What a nice way to do it. Most people would have just destroyed him at the examination.
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