Lives of the fellows

David James Purslove Barker

b.29 June 1938 d.27 August 2013
CBE(2005) BSc Lond(1959) MB BS(1962) PhD Birm(1966) MRCP(1968) MD(1973) MFPHM(1974) FRCP(1979) FFPHM(1979) Hon FRCOG(1993) FRS(1998) Hon FRCPCH(2003) Hon DSc Birm(2003)

David Barker, physician and epidemiologist, was known for his theory that the chronic diseases coronary heart disease, type two diabetes and cancer are caused by poor nutrition and other environmental factors during foetal life and early childhood. His work opened up a new field of science, the developmental origins of health and disease, which has shown that plasticity during early development enables the environment to ‘programme’ the body’s metabolism, and thus influence the pathologies of later life. His ideas had a major impact on science and public health.

David was born in Chelsea, London, the son of Hugh, an engineer, and Joye, a concert cellist. He was educated at Beaudesert Park School and then Oundle, where his interest in the natural world was sparked by his biology teacher, Ioan Thomas. He loved to roam the countryside around the school, collecting beetles.

David wanted to be a doctor from an early age, and entered Guy’s Medical School in 1956. He intercalated in anthropology, anatomy, embryology and mammalian biology, and published his first paper, on testosterone and bone density, in Nature in 1962 (‘Effect of testosterone on oestrogen-induced bone formation in mice.’ Nature. 1962 Jun 16;194:1088-9). In 1963, a year after qualifying, he became a research fellow in the department of social medicine at the University of Birmingham, working under Tom McKeown [Munk’s Roll, Vol.VIII, p.311], who had a strong influence on his thinking. He completed his PhD thesis on ‘Prenatal influences and subnormal intelligence’ in 1966. This work was a harbinger of his later interest in foetal programming.

From Birmingham, David was seconded to Makerere University, Uganda, to research Mycobacterium ulcerans infection (‘Buruli ulcer’). He worked with the Scottish surgeon Wilson Carswell, who would later become famous for his work on the origins of AIDS. When President Idi Amin plunged Uganda into crisis, declaring westerners unwelcome, David hurriedly gathered up his young family and drove at night into neighbouring Kenya. He had done enough research to establish that Buruli ulcer, previously thought to be mosquito-borne, was transmitted by wounds caused by the razor sharp reeds growing near the river Nile. Uganda left a strong impression on him and he gained a lifelong interest in the health problems of the developing world.

In 1972, David became a senior lecturer in epidemiology at the University of Southampton. Alongside research, he worked clinically as an honorary consultant physician at the Royal South Hants Hospital. In 1979, Donald Acheson [Munk’s Roll, Vol.XII, web], David and Martin Gardiner established the Medical Research Council (MRC) environmental epidemiology unit and David became professor of clinical epidemiology. He was an inspired teacher, and with Geoffrey Rose [Munk’s Roll, Vol.IX, p.451], set up an annual course in Southampton (‘Epidemiology for clinicians’), which still runs to this day. His books (Practical epidemiology [Edinburgh, Churchill Livingstone, 1973], Epidemiology in medical practice [Edinburgh, Churchill Livingstone, 1979] and Epidemiology for the uninitiated [London, British Medical Association, 1979]) and articles in the British Medical Journal became the introduction to epidemiology for a generation of researchers.

In 1984, David succeeded Acheson as director of the MRC unit. His research into the aetiology of thyroid disease, Perthes’ disease, Paget’s disease, gallstones and appendicitis led him to evidence that they were related to nutritional and infective influences in earlier life. He carried out detailed mapping of mortality rates in the UK (Atlas of mortality for selected diseases in England and Wales 1968-1978 [Chichester, Wiley, c.1984]) and realised the similarity of geographical distribution for the UK’s biggest killer in the 1970s (cardiovascular disease) and infant mortality at the beginning of the 20th century. This observation led him to put forward ‘The Barker hypothesis’, that coronary heart disease and other chronic diseases have their roots in impaired foetal and childhood development.

David devoted the rest of his life to the pursuit of this idea, captured in a series of books such as Mothers, babies and disease in later life (London, BMJ Publishing Group, 1994). With statistician Clive Osmond in Southampton and Nick Hales in Cambridge, he showed in the Hertfordshire cohort that people of lower birth weight had more chronic disease in adult life. With Johan Eriksson, in the Helsinki cohort, he related patterns of childhood growth to adult chronic disease. With colleagues in India, he showed similar relationships occurring in developing populations. With Tessa Roseboom in Amsterdam, he showed that exposure of mothers to the 1944 to 1945 Dutch famine left a legacy of chronic disease in their children. David built collaborations with physiologists Jeffrey Robinson in Adelaide, Peter Gluckman and Jane Harding in Auckland, and Mark Hanson in Southampton, who studied foetal development in animals. He linked together the hitherto separate worlds of foetal physiology and epidemiology, harnessing incontrovertible evidence that early life nutrition had lifelong effects on every system of the body. David’s work ultimately led to a new global focus on improving maternal health in order to improve the health and capacity of future generations.

David stepped down as director of the MRC environmental epidemiology unit in 2003, but continued to work in Southampton, in Portland, USA (with placental physiologist Kent Thornburg) and at Emory University, Atlanta (with Michelle Lampl, an authority on human growth). He made a documentary The nine months that made you with the BBC Horizon team in 2011. Over his career he published over 500 original research articles and wrote ten books. He was a fellow of the Royal College of Physicians, the Royal College of Obstetricians and Gynaecologists, and the Royal College of Paediatrics and Child Health. He was made a fellow of the Royal Society in 1998 and was awarded a CBE in 2005. His many awards and honours included the Royal Society Wellcome gold medal in 1994, the Royal College of Physicians’ Lord Rayner medal in 1994, the Feldberg Foundation medical and biological science prize in 1995, the Prince Mahidol award in 2000, the Butterfield award of the National Institute of Child Health and Human Development in 2007, and the Richard Doll prize from the International Epidemiological Association in 2011.

One of David’s most striking characteristics was his humour, an important ingredient in his working relationships and collaborations. He was a brilliant raconteur and after-dinner speaker. He created an MRC unit where science could prosper, but was also alive with banter and fun. His passion for science left little free time, but he enjoyed reading, painting, fishing and golf. Family life was important to him. His first wife Angela (née Coddington), with whom he had five children (Peter, Mary, John, Simon and Ruth), died in 1980. He re-married in 1983, to Jan, who added her three children (Toby, Fran and Beccs) to his family. Together they created a unique environment at Manor Farm, East Dean, which became a centre for scientific work and attracted visitors from around the world.

David Barker died suddenly from a cerebral haemorrhage and was survived by his wife, eight children and 13 grandchildren.

Caroline HD Fall

[The Guardian 11 September 2014 – accessed 12 December 2014; The Telegraph 20 October 2013 – accessed 12 December 2014; The Lancet 2013 382(9899) 1170; BMJ 2013 347 5703; MRC Lifecourse Epidemiology Unit: Professor David Barker CBE FRS In Memoriam – accessed 12 December 2014; The Barker Theory – accessed 12 December 2014]

(Volume XII, page web)

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