Harry Keen 1925–2013

Authors: John C Pickup

Publish Date: 2013/05/28

Volume: 56, Issue: 7, Pages: 1455-1457

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Abstract

Professor Harry Keen MD FRCP CBE died on 5 April 2013 at the age of 87 years His contributions to diabetes research practice and policy are a rollcall of many of the most important advances in this field over the last 50 years but he was also the most remarkable kind generous and inspirational friend colleague and doctor that most of us have had the privilege to meet work with or be treated by He served held office in or was honoured by most of the diabetes organisations throughout the world including the EASD International Diabetes Federation IDF British Diabetic Association Diabetes UK ADA and WHO He was a legendary champion of the National Health Service NHS in the UK and founder of the NHS Support Federation tirelessly opposing what he considered unwelcome or even illegal reforms and holding the Government to account He was a master of the diabetic bon mot many Keenisms like ‘normoglycaemic reentry’ 1 and ‘the patient a collaborator and not a victim’ have gone down in history He was in short one of the foremost diabetologists of his generation universally held in the highest regard and with the greatest affectionHarry Keen was born in London and attended Ealing County School for Boys where he was a gifted swimmer being Schoolboy Champion of London He decided at an early stage to study medicine and relished his training at St Mary’s Hospital Medical School in London where there was a notably scientific approach to medicine Harry was much influenced during his medical student days by the clinician–scientist George Pickering with whom he was to do research when he returned to St Mary’s after qualification 1948 and service in the Royal Army Medical CorpsIt was thanks to George Pickering whose main interest was in fact hypertension that Harry developed a career in diabetes For a number of years Harry did the ‘legwork’ as he called it on Pickering’s project to record the blood pressure of all diabetic patients in the clinic at St Mary’s and their firstdegree relatives Because there were insufficient numbers of young patients with ‘insulindependent diabetes’ in Pickering’s clinic arrangements were made for the young Keen to collaborate with and become a clinical assistant to the famous R D Lawrence consultantincharge of the Diabetes Clinic at King’s College Hospital in London who had diabetes himself and was an early user of insulin It was during the seven years from 1953 with Lawrence that Harry learnt the clinical practice of diabetes and the importance of the longterm diabetes complications that were then just emerging as problems not solved by the introduction of insulinAfter an International Postdoctoral Research Fellowship at the National Institutes of Health NIH in Bethesda MD USA in 1960–1961—‘like going to fairy land’ he said—Harry began his careerlong association with the Department of Medicine at Guy’s Hospital and its Medical School in London which was to be the base for his research and clinical activities until retirement From appointment in 1961 he was promoted from lecturer to senior lecturer reader and in 1971 Professor of Human Metabolism and Head of the Unit for Metabolic Medicine He retired from Guy’s in 1990 and became Professor Emeritus at King’s College London to which Guy’s was by that time attached He was also appointed Honorary Professor at the University of Warwick in 2005Harry Keen’s numerous and outstanding contributions to diabetes research and practice whilst he was at Guy’s Hospital ranged from some of the first epidemiological studies in diabetes to the discovery of microalbuminuria the organisation of the WHO Multinational Study of Vascular Disease in Diabetes the invention of insulin pump therapy Chairmanship of the WHO Expert Committee on Diabetes which formulated new diagnostic criteria for diabetes and the first studies of recombinant human insulin in man At the time I joined Harry in the mid 1970s he was setting up at Guy’s one of the first diabetes centres in the UK a concept that was to be quickly taken up by many centres throughout the country He believed that the diabetes specialist nurse who was then emerging as the key member of the multidisciplinary team of a diabetes centre was arguably the most important advance for the patient since the discovery of insulinHis research contributions are too numerous to describe in any detail One must mention a few however including the groundbreaking Bedford Survey beginning in 1962 which was Harry’s first project at Guy’s Hospital planned with his new chief John Butterfield and Clive Sharp the Medical Officer of Health of the town of Bedford in the UK 2 The intent of the study was to survey the frequency of undiagnosed diabetes by persuading every person in this town of some 40000 people to leave a urine sample on their doorstep over one weekend about 73 did Oral glucose tolerance tests using 50 g of glucose in those days were carried out in people with glycosuria and in a random sample and it was found that many people with glycosuria did not have diabetes and many with clear diabetes did not have glycosuria—a truth we now take for granted urine testing cannot be used to diagnose diabetes 2 Furthermore a large number of people had a marginal elevation of blood glucose that was not easily labelled as diabetic or nondiabetic This was the category Harry and colleagues called ‘borderline diabetes’ which they found was associated like frank diabetes with an increased risk of cardiovascular disease—this being the first identification of what we now call impaired glucose tolerance IGTAt this time in the 1960s Harry was inspired by the new technique of radioimmunoassay which Nick Hales and Philip Randle had used to assay small amounts of insulin With Costis Chlouverarkis he devised in 1963 the first radioimmunoassay for small concentrations of urinary albumin microalbuminuria now internationally recognised as an indicator of early diabetic renal disease 3 With Giancarlo Viberti and colleagues the group later went on to show that elevated microalbuminuria in diabetes was indeed a risk factor for the later development of clinical proteinuria and early death 4The tissue complications associated with diabetes were an interest for Harry for most of his career his 1975 book 2nd edition 1982 on this topic edited with his longtime epidemiology collaborator and friend John Jarrett is still a wonderful read 5 In the 1970s there was still some dispute on whether diabetic tissue complications are caused by the diabetic process probably hyperglycaemia or run in parallel with it Harry reasoned that one might be able to test the theory that complications are caused by poor glycaemic control if only one could achieve and maintain long periods of nearnormoglycaemia impossible with insulin injection regimens of the time He had learnt from R D Lawrence that multiple small injections of shortacting insulin seem to achieve the best blood glucose control and some intriguing studies from Gérard Slama and George Tchobroutsky in Paris reported in 1974 6 showed that a few days of intravenous insulin infusion using a pump carried in a shoulder bag produced excellent control He therefore arrived at the notion of using variablerate subcutaneous insulin infusion to avoid the problems of prolonged intravenous insulin delivery and thereby to maintain strict glycaemic control in type 1 diabetes George Alberti told him that John Parsons at the National Institute for Medical Research in Mill Hill London had a portable pump that was being used to infuse parathyroid hormone into rats Perhaps Harry wondered this could be adapted for insulin infusion in diabetic patients After a first test on the ward with a large pump I was lucky enough to be the young doctor taken on by Harry to develop what we soon named ‘continuous subcutaneous insulin infusion’ or CSII as a feasible longterm intensified insulin treatment 7—first as an experimental procedure and then as a routine treatment for selected patients with type 1 diabetes

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