Lives of the fellows

Harry Keen

b.3 September 1925 d.5 April 2013
CBE(1998) MB BS Lond(1948) MRCP(1956) FRCP(1970) MD(1971)

Harry Keen was professor of human metabolism at Guy’s Hospital, London. A leading diabetes specialist, he was also a staunch defender of the National Health Service (NHS) and a champion for those suffering from chronic disease. Born in London, he was the son of Sydney Keen, a tailor, and his wife, Esther née Zenober, whose father, Joseph, was an entrepreneur. His mother had come to the UK from Poland in her early teens, learnt English well enough to become a teacher and then ran a number of dry cleaners shops. Educated at St Anne’s School in Hanwell and Ealing County Boys School, he studied medicine at London University and St Mary’s Hospital. Qualifying in 1948, a few months before the inception of the NHS, he worked as a locum in a single-handed practice in Eltham which, he later remarked, might have been out of the Richard Gordon’s amusing Doctor in the house novels.

After house jobs at the West Middlesex Hospital from 1948 to 1949, he enlisted with the RAMC to do his National Service and served as a captain in Suez for two years. On his return in 1951, he joined the medical unit at St Mary’s, working with Sir George Pickering [Munk’s Roll, Vol.VII, p.464] who was, at the time, investigating hypertension in the local population and measuring their blood pressure. Keen was asked to measure the blood pressure of diabetics and their families and his discovery of the subsequent appalling damage that the vascular complications of diabetes caused its sufferers was to decide his future career. In 1957, Pickering arranged for him to join the diabetic unit at King’s College Hospital, working with Robin Lawrence [Munk’s Roll, Vol.VI, p.275], the founder of the British Diabetic Association (now Diabetes UK) who was an acknowledged authority on the disease.

In 1960 he travelled to the USA and for a year he was a research fellow at the National Institutes of Health in Bethesda, Maryland. On his return he joined the medical department at Guy’s Hospital as a lecturer, rapidly becoming senior lecturer, reader and, in 1971, professor of metabolic medicine. Playing an active role in administration throughout his time at Guy’s, he chaired the division of medicine in 1981 and was vice-chairman of the medical committee executive. In 1985 he became the first director of clinical services for medicine.

A pioneer of diabetes epidemiology, at the beginning of his career there was no agreed definition of diabetes or accepted way of measuring glucose tolerance. In 1962, with John Butterfield [Munk’s Roll, Vol.XI, p.83], he devised and carried out a survey to measure the incidence of asymptomatic diabetes in the population. People in Bedford were asked to leave out labelled urine samples to be collected over the weekend by boy scouts. One resident who provided a sample of sherry was persuaded to share more of the bottle with the researchers. Initial results were published by Keen as ‘The Bedford Survey: a critique of methods and findings’ (Proc Roy Soc Med, 1964, 57, 200-2) and several subsequent papers covered 10 year follow ups. One of the earliest population surveys, the study was the first to identify ‘borderline diabetes’ and this, plus later work and the related Whitehall study of 18000 civil servants, were to provide new and more specific diagnostic tools as laid out by the World Health Organization (WHO) expert committee of 1980, which Keen chaired, and were modified by the 1985 WHO study group.

Amongst other groundbreaking work, he developed a sophisticated microalbuminurea test which detected small amounts of albumin in the urea and thus made possible targeted drug treatment for kidney complications in diabetes. He also developed a better method of insulin administration. In the 1970s, he discovered that a fellow scientist was using a new method of infusing parathyroid hormone into patients with hypoparathyroidism. John Pickup, who was working with him at the time, recalled that ‘Harry thought that mimicking the body’s slow and continuous delivery of insulin might be a good way to maintain control. It was started as an experimental procedure, but it was so successful that it developed into a routine treatment for some patients.’

Agreeing with his mentor, Robin Lawrence, that the patient with diabetes must learn to be their own doctor, and affected by his early experience of a clinic in which five or more doctors sat in a large room muttering to their patients for 10 minutes twice a year, he initiated diabetes day centres and was keen to advance the idea of the diabetes nurse specialist. Internationally he worked enthusiastically to share his findings and, at a meeting in the Italian town of St Vincent in 1989, he was a key participant. With support from the WHO and International Diabetes Federation (IDF), the St Vincent’s Declaration formally recognised the problems of the disease and set out goals for diabetes management in terms of outcome measures such as amputation and blindness. It is now seen as a landmark for governmental attempts to control the disease. Among other activities he was a founder member of the European Diabetes Epidemiology Study Group and a member of the European Association for the Study of Diabetes. He also chaired the parliamentary committee on medical aspects of food and nutrition policy.

From his early days as a locum in South London when he was, for the first time, able to reassure an impoverished woman that he could treat her sick child without charge, he was a firm supporter of the NHS. He was horrified by the 1989 White paper on health service reform which he said filled him with ‘paroxysms of anger’. Not afraid to speak his mind – he remembered as a child of seven marching with his communist dentist uncle singing ‘Down the drain with Chamberlain and don’t forget to pull the chain’ – he set up the NHS Support Federation (NHSSF) and proceeded to sue Kenneth Clarke, then secretary of state for health, for abuse of public office. Retirement in 1991 as emeritus professor, gave him more time to take up the cause of the NHSSF although he also continued his work in the field of diabetes. He wrote numerous articles and bombarded the press with letters over the following years particularly against what he detected as a creeping privatisation of the health service. In 2005 the NHSSF joined with the NHS Consultants Association and Health Emergency to form Keep Our NHS Public (KONP) and, as a member of the steering group he attended meetings regularly until a few months before his death.

Outside medicine, he enjoyed painting, pottery and swimming. In retirement he continued (until six months before his death) to run a diabetes clinic twice a week at his GP son’s surgery in Watford, an area which has a 30% South Asian population. In an interview he explained that he enjoyed meeting the patients in a more leisurely situation and was still trying to discover why it should be the case that people of this ethnic origin suffer from two to three times higher rates of diabetes incidence than ‘the Europids’ as he called them.

In 1953 he married Anna Hélène (‘Nan’) née Miliband, whose father, Samuel, was a leather craftsman. She was the sister of the left-wing intellectual and sociologist, Ralph Miliband. When his nephews, David and Ed Miliband entered politics as members of the Labour Party, Keen remained on friendly terms with them but was sorry that they failed to acknowledge the harm done to the NHS by the last Labour government. When he died of lymphoma ,he was survived by Nan and their children, Michael, a GP, daughter, Judith, and grandchildren, Ben, Sam and Jess.

RCP editor

[The Guardian www.theguardian.com/science/2013/apr/23/harry-keen; The Independent www.independent.co.uk/news/obituaries/professor-harry-keen-pioneer-in-the-field-of-diabetes-and-staunch-defender-of-the-nhs-8572479.html; The Camden New Journal www.camdennewjournal.com/news/2013/may/obituary-death-professor-harry-keen-clinician-and-nhs-activist; BMJ 2013 346 2852 www.bmj.com/content/346/bmj.f2852; Lancet www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61066-1/fulltext?rss%3Dyes European Association for the Study of Diabetes www.easd.org/index.php?option=com_content&view=article&id=165:harry-keen&catid=14; Diabetes stories www.diabetes-tories.com/interview.asp?UID=52 – all accessed 20 November 2015]

(Volume XII, page web)

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