Commentary: Professor Harry Keen, clinician, epidemiologist, diabetologist, basic scientist and defender of the UK National Health Service

Harry Keen is arguably the grandfather of diabetes epidemiology, establishing himself at a time when neither specialty was regarded as either interesting or important. He was born in 1925 and qualified in medicine from St Mary’s Hospital Medical School in 1948, shortly before the inauguration of the National Health Service, for which he acquired and retained a strong loyalty. After house jobs and National Service, he embarked on his formative years at St Mary’s under Professor George Pickering, who remained a strong influence. Harry began clinical research at King’s College Hospital, where Pickering had arranged for him to study hypertension in diabetes in the clinic headed by R.D. Lawrence, the second of Harry’s mentors. In 1960–61 he spent a fruitful year with James B. Field in the National Institutes of Health, where he was introduced to the fascinations of laboratory research, including bioassays for insulin and preliminary attempts to isolate islets of Langerhans. He returned to London to join the Department of Experimental Medicine under Professor John Butterfield. Here he was introduced to epidemiology via the planning and execution of the pioneering Bedford Study, later to be followed by participation in the Whitehall Study (now Whitehall 1) originated by Donald Reid and Geoffrey Rose. These studies provided, inter alia, much valuable information about the relations between cardiovascular disease, diabetes and glucose intolerance. The prospective elements of these studies provided much of the data which led to a new definition and classification of diabetes. Indeed, Harry chaired the World Health Organization (WHO) Expert Committee which pronounced on these matters in 1980 and also the WHO Study Group which modified the original proposals in 1985. Largely due to his initiative, a further involvement with WHO led to the Multinational Study of Vascular Disease in Diabetes, a notable example of international scientific collaboration. Along with the epidemiology, Harry continued with clinical and laboratory research (see below). John Parsons at Mill Hill had started treating patients with hypoparathyroidism with subcutaneous infusions of parathyroid hormone, and Harry immediately saw the potential in type 1 diabetes. With John Pickup he set up a research programme which eventually resulted in the present day widespread use of continuous insulin infusion therapy. At Guy’s, Harry headed a diabetes unit which not only provided a successful clinical service—he was one of the pioneers of the use of specialist nurses— but was also a busy research scene. He was also active in other ways within the hospital. Following the initiation of clinical directorates in 1985, he became the first Director of Clinical Services for Medicine, having previously been chair of the Division of Medicine. As an example of his formidable energy he was, at the same time, active in several other spheres—WHO, the British Diabetic Association (now Diabetes UK), International Diabetes Federation, National Institutes of Health and the Department of Health [Chair, Committee on Medical Aspects (COMA)]. In 1989 there was a White Paper on NHS reform. Like many others, Harry saw most of the proposals as damaging to the NHS and he played a leading role in opposition. He later became chair of the NHS Support Federation, which has campaigned in support of the founding principles of the NHS, not least, more recently, in relation to the Lansley legislation. I have mentioned Harry’s formidable energy, which is obvious from the above. I hope I have conveyed his unusually multifarious activities. More difficult to portray is Harry the personality: always engaging, optimistic, ready to engage in civilized dispute (we did not always agree!) and congenitally incapable of saying ‘No’ to a request for a piece of his time. Published by Oxford University Press on behalf of the International Epidemiological Association