Lives of the fellows

John Philip Bunker

b.13 February 1920 d.4 May 2012
AB Harvard(1942) MD(1945) MRCP(1992) FRCP(1995)

John Bunker was a leading American anaesthesiologist and a pioneer in the development of evidence-based medicine. He was born in Boston, Massachusetts, the son of Philip Hacket Bunker, a lawyer, and Emily Lyon Bunker née Glover, a pianist. He attended Roxbury Latin School in West Roxbury, Boston. As a young boy he made little cork boats and sold them for a nickel apiece on MacMillan Wharf in Provincetown. He then set up his own ship model shop in ‘the boathouse’, his family’s shack on Corn Hill Beach in Truro, Cape Cod. Just before entering medical school he sold a model for $165, enough to purchase his first microscope.

In the summer of 1936, when he was 16, one of his teachers took him and two classmates to Germany. They bicycled along the Rhine, climbed Germany’s highest mountain and watched Jesse Owens win gold at the Berlin Olympics. Hitler sat directly opposite them in the stadium.

Bunker earned his undergraduate and medical degrees from Harvard and then served in the United States Navy from 1946 to 1948, as a surgeon in China and Guam. He recalled: ‘We were responsible for the care of 10,000 Marines. Our practice consisted primarily of appendicitis and relatively minor injuries; the Marines were not in combat and so there were no military casualties. It was a privilege to serve the country, and in the process repay the Navy for my medical school education.’

When he returned, he began his career in anaesthesiology. He undertook postgraduate training at George Washington Hospital and Massachusetts General Hospital, and joined the Harvard anaesthesia faculty in 1950. In 1960 he joined Stanford University, where he was founder and first chairman of the department of anesthesia (previously a division within the department of surgery). From 1972 to 1974 he was visiting professor of preventive and social medicine at Harvard Medical School. On his return to Stanford, he was professor of family, community and preventive medicine (from 1974 to 1986) and then professor of health research and policy (from 1986 to 1989).

Early in his academic career he participated in the anesthesia research program at Massachusetts General Hospital under the leading anaesthsiologist Henry K Beecher. Bunker’s area of interest was primarily the metabolic effects of anaesthesia. The effect of anaesthetic agents on the liver was of special concern, and led in 1963 to an inquiry into the possible hepatotoxic effects of the then-new anesthetic, halothane. Bunker was appointed chairman of the national research council subcommittee of the National Halothane Study, in which capacity he had a unique opportunity to work in close collaboration with a distinguished team of statisticians, epidemiologists, pathologists and internists.

He developed a large body of data on operations and on operative mortality, and raised many questions concerning the practice of surgery. Some of these were developed in his seminal paper ‘Surgical manpower. A comparison of operations and surgeons in the United States and in England and Wales’ published in January 1970 (N Engl J Med. 1970 Jan 15;282[3]:135-44), which subsequently provided the impetus for a searching, nationwide inquiry into the distribution and quality of surgical care in the United States. He went on to edit Costs, risks and benefits of surgery (New York, Oxford University Press, 1977) with Benjamin A Barnes and Frederick Mosteller. The book soon became known as ‘Bunker’s bible’, and is a landmark in the epidemiological study of surgical mortality. Over the years the book has helped set the agenda for an evidence-based approach to surgical methodology and is still bearing fruit to this day.

Bunker was a recipient of fellowships from the National Institutes of Health, the Commonwealth Fund, the John Simon Guggenheim Memorial Foundation and the Henry J Kaiser Family Foundation. Besides Harvard Medical School, he also held visiting professorships at Harvard School of Public Health and in London, at Westminster, King’s College and University College medical schools.

On retiring from his posts in the USA, as a long term Anglophile, he crossed the Atlantic to contribute his intellectual skills to advancing knowledge on cancer care and the health care of the underprivileged. His first appointment in London was as visiting professor at the clinical trials centre at King’s College School of Medicine, directed by his old friend and protégé, Michael Baum. Here he played an active role in educating young British clinical scientists in the epistemology of medicine and co-authored papers on the epidemiology and management of breast cancer. He then went on to work with Sir Michael Marmot, director of the international centre for health and society at University College, London, where he contributed to work on the determinants of health amongst the poorest strata of society. His New England charm and courtesy endeared him to his new friends and colleagues in ‘old England’, where he was perceived as the archetypal American gentleman.

The academic environment in London allowed for a late blossoming of his inherent lifetime humanitarianism. It was also of course no coincidence that Lavinia Loughridge happened to live in London and the fact that she was vice-president of the Royal College of Physicians contributed to his close association with the RCP for the rest of his life.

His great sense of humour and relentlessly positive outlook added to his charm, and for all of these reasons John Bunker was an inspiration and a beacon of light to everyone who knew him. He was survived by his first wife, Mary, his second wife, Lavinia Loughridge, his four children (Jane, Katherine, John and Emily) and his two step-children (Juliet and Jonathan).

Michael Baum

[The Independent 11 July 2012; BMJ 2012 345 4883; The Lancet 2012 380 1052; Stanford School of Medicine ‘John Bunker, Anesthesia Department founder and health-care critic, dies at 92’ – accessed 1 July 2013]

(Volume XII, page web)

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