Lives of the fellows

Alberto Malliani

b.11 September 1935 d.15 October 2006
MD(1965) FRCP(2004)

Alberto Malliani was honorary president of the European Federation of Internal Medicine (EFIM). Born in Italy, he graduated in medicine at the University of Sienna in 1959, became an internist and rapidly embarked on an academic career. He had a passion for research, and attracted by the famous North American research centres, he worked as a fellow at Columbia University from 1965 to 1967. He later pursued his contacts in the US as visiting professor at the universities of Utah and Texas, before becoming professor of medicine at the University of Milan and head of the internal medicine department at the L Sacco Hospital in Milan.

Malliani published widely, with more than 200 full-length papers in prestigious journals and in textbooks such as Handbook of physiology and Textbook of pain. He had editorials published in Circulation, American Heart Journal, British Heart Journal, Cardiovascular Research and undertook numerous reviews. He acted regularly as a referee for various medical journals, including Circulation, The Lancet, American Journal of Physiology, Journal of Applied Physiology, British Heart Journal, Heart, European Heart Journal, Brain Research and for the National Science Research Foundation.

The largest part of his research activity was carried out in the area of neural regulation of cardiovascular function. He investigated new types of excitatory reflexes mediated by cardiovascular sympathetic afferent fibres and studied the neural mechanisms occurring during myocardial ischemia, hypertension and congestive heart failure, implicating these excitatory reflexes in the neural mechanisms of cardiac sudden death. This led him to develop a new hypothesis on peripheral mechanisms for cardiac nociception. In 1982, by studying the frequency domains of various cardiovascular signals, he showed that it is possible obtain valuable markers of sympatho-vagal balance using this approach. He summarised his 40 years of research in a book Principles of cardiovascular neural regulation in health and disease, published in 2000 (Boston/London, Kluwer Academic).

Although a distinguished clinical scientist, he will be remembered by all who knew him as having a deep commitment to his fellow man. In the clinical field he had a particular interest in the care of patients with social difficulties, reflecting his central concern for the human elements of medical care. He was secretary of the Italian affiliation of International Physicians for the Prevention of Nuclear War (IPPNW) when this organisation received the Nobel Peace Prize in 1985. He was a co-founder and president of the scientific committee of VIDAS (Volontari Italiani Domiciliari per l'Assistenza ai Sofferenti) – a voluntary association for assisting terminal cancer patients which has provided care for several hundreds patients every year since it was founded in 1984.

Alberto Malliani was a passionate and tenacious advocate of internal medicine in Italy, through his activities, publications and as president of many congresses. He became president of the Italian Society of Internal Medicine in 2002. He joined the administrative council of EFIM as an Italian delegate in 1999, and his commitment and the clarity of his judgements were soon recognised by all. His activities inside the federation were various and considerable. He was a regular contributor to the European School of Internal Medicine in Alicante, and became the coordinator of the EFIM working group on ethics.

In 1999 he was chosen by the executive board to be part of the European team that developed the Charter on Medical Professionalism in collaboration with the American College of Physicians and the American Board of Internal Medicine. Alberto Malliani brought an inspired input on several major issues, particularly on the topic of conflicts of interest. His approach was based on an absolute trust in the values of both evidenced based medical knowledge and of honesty and generosity. After the publication of the Charter in 2002 in The Lancet and in the Annals of Internal Medicine, Alberto's task was only beginning. He continued assiduously to promote the Charter in Italy, and managed to capture the interest not only of the entire medical community but, thanks to his qualities as communicator, also reached the general public through the Italian media. He continued these interests with a leading role in the Alliance Project with the American College of Physicians and the American Board of Internal Medicine, in which the working group explored the relationship between medicine and society.

Alberto Malliani became president-elect of EFIM in 2003, and in 2004 he was proposed and accepted as a Fellow of the Royal College of Physicians. Later that year, he became ill. He never complained but courageously fought his illness. His trust in medicine was sincere but lucid. Neither operations nor chemotherapy could keep him away from his work at the hospital or in his laboratory for long. During the EFIM five congress in Paris in September 2005, he announced with remarkable dignity that he would be unable to take up the position as president of the federation because of his concerns about his future and the effect it might have on the federation. He was awarded the position of honorary president and remained until his last days an active adviser on the executive committee.

Daniel Sereni
Christopher Davidson

(Volume XII, page web)

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