Friday, 14 August 2015

A man for all seasons

The Turnstone - a Doctor's Story. Geoffrey Dean, MD, FRCP, FRCPI, FFCMI. Liverpool University Press, 2002, 

This review was written on November 22nd 2002 and added to in 2008.

Geoffrey Dean was born in England in 1916 but spent the first half of his professional career in South Africa where he practised as a consultant physician in Port Elizabeth. He moved to Ireland in 1968 when he was appointed head of the newly established Medico-Social Research Board. His appointment was earned because of his outstanding interest in and research contributions to epidemiology while living in South Africa. His autobiography combines the story of his personal life with an account of his internationally recognised work in medical epidemiology. The book will be remembered most for his contributions to the epidemiology of porphyria, multiple sclerosis, motor neurone disease, histoplasmosis and lung cancer. Chapters on these subjects make fascinating reading and confirm his gift of combining slow painstaking collection of data from many sources and countries with serendipity, a feature not uncommon among those who have contributed to outstanding scientific progress in medicine and medical progress.

Dean spent 18 years as Director of the MSRB which was established by Erskine Childers, Minister for Health, in 1968. This modestly funded government agency, of which I and a few colleagues interested in public health and health promotion were members, did, under the leadership of Dean, an immense amount of work in dealing with topical social and public health problems which then prevailed in Ireland. His account of his years here will bring back many memories of the circumstances which prevailed here and the excellent record of the Board and its director during the Board’s relatively short life. Like his colleagues on the Board, he failed to understand the decision of a later Minister for Health, Barry Desmond, who discontinued to support the Board and who merged the MSRB with the newly constituted Health Research Board. As he and the Board expected, subsuming the MSRB into an organisation largely controlled by consultants and academics had the expected effect of diminishing the volume of social and public health research and intervention which was and is still urgently necessary in this country.

One chapter records his two years in Bomber Command in the UK after he qualified and the grim casualty problems he had to deal with. Another was his narrow escape from imprisonment by the authorities in South Africa because of his protest about the treatment of prisoners during the Apartheid period. He was one of the very few South African doctors to protest. He describes the support he received in his defence from colleagues abroad and particularly from the members of the Royal College of Physicians in London.

Dr. Dean's account is an important contribution to the medico-social history of Ireland and to the history of medical epidemiology world-wide. He follows in the tradition of the great British epidemiologists in the past who were also practising doctors.

I am adding the following text of my obituary of Geoffrey which was published in the Irish Times in 2008 shortly after his death at the age of 92 years.

Geoffrey Dean, an Appreciation.

Doctor Geoffrey Dean was the first director of the Medico-Social Research Board from 1968 to 1986. He had a remarkable medical career  first as a practising physician and neurologist, and later as a world renowned medical epidemiologist. He was born in the British Midlands in 1916 and qualified at Liverpool University in 1943 after schooling at Ampleforth. In 1947, after two years serving in Bomber Command and becoming a member of the Royal College of Physicians, he emigrated to South Africa where he established a successful consultant practice in Port Elizabeth. In Africa he became interested in porphyria and published a book on the subject based on his remarkable researches into the disease which he traced back to the family which introduced the malady at the time of the Dutch settlement in 1685.

Dean and the Queen
His researches into porphyria led him to his wider epidemiological researches into multiple sclerosis, Friedrich’s ataxia and other neurological diseases, as well as lung cancer and histoplasmosis. His autobiography was published by the Liverpool Press in 1996 and provides details of his role as an internationally acclaimed medical epidemiologist. A major interest was his research into the epidemiology and genetic background of multiple sclerosis. He was closely associated with both the Irish and British Multiple Sclerosis Societies.

Dean’s first visit to Ireland was in the early 1960s when he was asked to investigate the causes of lung cancer in Belfast and in the surrounding countryside.  However he left South Africa in 1968 to become director of the newly established Medico-Social Research Board in Ireland. During his 18 year career as director he conducted inquiries into some of the most pressing social and health problems in this country. They included the growing drug culture, the alleged Sellafield role in causing Down Syndrome (which his investigations refuted), the alcohol culture and its role in cancer and other diseases, agricultural workers’ health problems, the psychiatric services, mental retardation and suicide, and many other medico-social problems. An immense amount was achieved by him and the Board on a shoe-string budget. Both he and the members of the Board greatly regretted that the successful MSRB was subsumed into the newly created Health Research Board shortly after Dean’s retirement.

While in Ireland he was honoured by Queen Elizabeth, University College, Dublin, and the Royal College of Physicians in Ireland.  He had an Irish grandmother on the distaff side.  Her genes must have had some influence in deciding his move from South Africa, where he had a successful consultant practice, to Ireland, a move which was to facilitate his burgeoning epidemiological research and which was to evoke in him a love and pride in his adopted country. 

During the tenure of his appointment in Ireland and up to his death, he continued his international researches. He contributed an immense number of articles to peer reviewed journals, and his last paper on the genetics of multiple sclerosis was published in the American journal Neurology in 2008. A later paper on porphyria and epilepsy is in press.

The long awaited memorial to those of Bomber Command
In chapter 13 of his autobiography he quotes Claude Bernard, the French physiologist ‘’The study of things caused must precede the study of the causes of things’’. He was highly educated and was an excellent and stimulating companion, but his modesty and his constant preoccupation with his researches and publications left little time for socialisation, at least in the public sphere. He was fortunate in the support his received at all times from his wife, Maria, who, by her loyalty and affection, patiently tolerated the many hours he spent in his study and in travel. To her and his extended family in South Africa and Ireland we proffer our sympathy. To them, and to his colleagues and those who knew Geoffrey well, he will be remembered with affection, and with a sense of pride and admiration because of his contributions to the wellbeing of humanity. Like Thomas Moore, whom he admired as his patron saint, Geoffrey was ‘’a man for all seasons’’.

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