In honour of a great man: DJP Barker

In honour of a great man: DJP Barker

David Barker was a physician and one of the most influential epidemiologists of our time. His ‘fetal programming hypothesis’ (known as the ‘Barker Hypothesis’) transformed thinking about the causes of common disorders such as diabetes, cardiovascular disease and cancer. He challenged the idea that they are explained by a combination of bad genes and unhealthy adult lifestyles, and proposed that their roots lie in early life: “the nourishment a baby receives from its mother, and its exposure to infection after birth, determine its susceptibility to chronic disease in later life”. The environment of the fetus and infant, he suggested, permanently set or ‘programme’ the body’s metabolism and growth, and thus determine the pathologies of old age. He set out these ideas in a series of books, starting with Mothers, Babies and Disease in Later Life in 1994. His initially controversial, but now widely accepted, ideas

have stimulated an explosion of research worldwide into the complex processes of fetal and early childhood development, and how these cause adult disease. This new field of research became known as the Developmental Origins of Health and Disease, or DOHaD. David thought that “the poorer health of people in lower socio-economic groups or living in impoverished places is linked to past and present neglect of the welfare of mothers and babies”. Tackling the epidemics of diabetes and heart disease in the Western world and in developing countries will require, he argued, a shift in focus to prioritise the health and nutrition of adolescent girls, pregnant women and infants. He warned that the effects of poor nutrition could take more than one generation to overcome, and that understanding exactly how they cause disease could take even longer. The last 30 years of his life were dedicated to achieving that understanding.

David’s ideas were rooted in a long interest in, and deep understanding of, basic biology. He was educated at Oundle School, where his biology teacher Ioan Thomas encouraged his enthusiasm for natural history, allowed him to roam the countryside hunting for beetles, and gave him unlimited access to the science labs to classify his finds. When David left school, he led a project to collect plant specimens from the Icelandic offshore island of Grimsey for the Natural History Museum. During his medical degree at Guy’s Hospital, he took a year out to do a BSc in Physical Anthropology, Comparative Anatomy, Embryology and Mammalian Biology. During that time, he studied under the famous zoologist JZ Young, and wrote his first paper, on the effects of testosterone on bone density, published in Nature in 1962.

After qualifying as a doctor in 1962, David became a research fellow at the University of Birmingham, under Tom McKeown, a social epidemiologist, and completed his PhD thesis Prenatal Influences and Subnormal Intelligence, in 1966. This was a harbinger of his later work on fetal programming, but he initially set off in a different direction. With a grant from the Medical Research Council, he became an independent investigator working from Makerere University, Kampala, Uganda, researching Mycobacterium ulcerans infection (Buruli Ulcer). He worked with Scottish surgeon Wilson Carswell, who would later become famous for his work on the origins of AIDS and as the inspiration for the book and film The Last King of Scotland.

When President Idi Amin plunged Uganda into crisis, declaring that westerners

were no longer welcome, David feared for his family’s safety, gathered up his

wife and four young children and drove at night into neighbouring Kenya,

ostensibly for a holiday but actually in flight. He had done enough research

to establish a link between the wounds caused by the razor sharp reeds

growing near the river Nile and transmission of Buruli Ulcer, debunking the theory that it was an insect-borne disease. He had also learned the importance of observing how people lived and listening to them, in order to fully understand disease.

In 1972 David became Senior Lecturer in Clinical Epidemiology in the Department of Community Medicine at the University of Southampton, and was proud to make Southampton the base for the rest of his career. He also worked as a consultant physician at the Royal South Hants Hospital, and was able to recruit able clinicians to join him in academic research. In 1979 Donald Acheson, Martin Gardner and David established the Medical Research Council Environmental Epidemiology Unit and David became Professor of Clinical Epidemiology. He was an inspired teacher, and with Geoffrey Rose set up an annual course in Southampton (Epidemiology for Clinicians) which still runs to this day. He wrote a series of books (Practical Epidemiology, Epidemiology in Medical Practice and Epidemiology for the Uninitiated) and articles in the British Medical Journal, which became ‘the’ introduction to epidemiology for a generation of researchers. In 1984 David succeeded Donald Acheson as Director of the Southampton MRC Unit.

A review of David’s research from 1972 onwards, into the aetiology of thyroid disease, Perthes’ disease, Paget’s disease, gall stones, appendicitis and chronic neurological disease, shows that it led him over and over again to evidence that they are related to nutritional and infective influences in earlier life. He concluded that such influences were likely to underlie the rapid waxing and waning of disease, how formerly common ailments like rheumatic heart disease and bladder stones mysteriously disappeared over the 20th century, while others like cardiovascular disease and diabetes equally mysteriously rose to take their place. The Unit’s detailed mapping of mortality in England and Wales (Atlas of Mortality for Selected Diseases in England and Wales, 1968-1978) led to his observation that areas with the highest infant mortality in 1910 had the highest burden of cardiovascular deaths in the 1970s. He and statistician Clive Osmond, his research partner for nearly 30 years, confirmed strong geographical correlations between infant mortality and adult chronic disease occurring decades later. He concluded that an adverse environment in the womb and during infancy was causally linked to the risk of chronic disease in later life, and the Barker Hypothesis was born.

David devoted the next three decades to the tenacious pursuit of this idea. He took the unusual step of hiring a historian, and started searching for old birth records data. With colleagues at the MRC Unit and in Cambridge, he showed that people of lower birth and infant weight had more cardiovascular disease, hypertension and diabetes in middle age. With the Helsinki birth cohort group, he related patterns of childhood growth to these diseases. With colleagues in India, he showed similar relationships in developing populations. With the Dutch Hunger Winter group in Amsterdam, he showed that exposure of mothers to the Dutch Famine in 1944-1945 left a legacy of diabetes and heart disease in their children. Early in this scientific

journey, David set up collaborations with physiologists in Adelaide, Auckland and Toronto who were studying fetal development in animals. He organized meetings that linked together the hitherto separate worlds of fetal physiology and epidemiology, harnessing strong evidence that early life undernutrition had

lifelong adverse effects, influencing every system in the body. These meetings were forerunners of the Society for Developmental Origins of Health and Disease, and of the international DOHaD conferences.

Although he stepped down as Director of the MRC Unit in 2003, David never retired from his research. He continued to work there (now the MRC Lifecourse Epidemiology Unit) and to contribute to the studies he established, the Hertfordshire Cohort Study and Southampton Women’s Survey. He helped set up the Southampton Initiative for Health, which was designed to find practical ways of improving the diets of low-income UK mothers. He analysed data, wrote papers and travelled the world as a much-sought-after mentor, advisor and speaker. In the last few years he became fascinated by the placenta as the channel of communication between mother and fetus, and spent three to four months every year working at the Oregon Health Sciences University in Portland, USA, a centre of excellence for placental research, and at Emory University in Atlanta, working on the biology of human growth. In 2011, he made his second documentary with the BBC Horizon team, The Nine Months that Made You, explaining the biology underlying fetal programming for a general audience.

David was an inspiring leader and MRC Unit director. Of all his characteristics, his colleagues remember him most fondly for his humour; the Unit was always alive with banter. He was a brilliant raconteur and was often sought as an after-dinner speaker, an activity that he agreed to perform only rarely, but prepared for in meticulous detail, giving astonishing performances. His single-minded pursuit of science left less and less time for other interests, but he enjoyed playing the piano, painting, fishing, cooking and golf. He was a deeply private, thoughtful and caring man, for whom family life was central. His first wife Angela, with whom he had five children, died in 1980. He married Jan in 1983 and was delighted with the addition of her three to his family. Together they created a unique environment at their home in Hampshire, which housed four generations and became a centre for scientific work to which they welcomed visitors from around the world. Jan supported David in all his endeavours, indeed her informality and warmth were central to his research partnerships.

David died suddenly from a cerebral haemorrhage on 27th August 2013 at the age of 75. His discoveries created a new field of research and had a huge influence on the scientific world. He is survived by his wife, eight children and 13 grandchildren, who loved, supported and admired him, and understood they had to share him with science. He published over 500 research papers and 10 books across his career. He was a Fellow of the Royal Society and was awarded a CBE in 2005. His numerous honours included the Royal Society Wellcome Gold Medal (1994), the Prince Mahidol Award (2000) and the International Epidemiology Association Richard Doll Prize (2011).

Written by Caroline Fall, Mary Barker, Clive Osmond and Cyrus Cooper

A memorial service for Professor Barker will be held in Romsey Abbey at 12 noon on Tuesday 12th November 2013, to which all are welcome. There will also be a scientific meeting in his honour, in Southampton, in 2014.