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Philip James

Philip James 130 x 180Born just before the Second World War, I was brought up in the mountains of Wales. Age 11 I was sent away by the local authority to Ackworth, a Quaker boarding school in Yorkshire, England, because my father, headmaster of the local grammar school, had recently died. We took our food rationing books to Ackworth. There, (unknown to me until much later) we were fed under the directions of Phyllis Williams, Hugh Sinclair’s nutritionist, who had helped to implement the British wartime food policy, without which Britain might well have succumbed early on.

At Ackworth we were taught to think internationally. My mother taught me this also, because she supported the education of children in what is now Zimbabwe. Then I decided to train in medicine and go to London, which was easier to reach than the medical school in South Wales. By luck I was interviewed by two Nobel prizewinners, and entered University College. After a science as well as a medical degree, I surprised everybody including myself by ending up with excellent jobs and my career was set on a rosy course!

Then I told my boss, Lord Rosenheim, that I could not stand British medicine as it was so primitive, and that I planned to emigrate. He fixed for me to go to the British Medical Research Council Tropical Metabolism Research Unit in Jamaica, to examine child malnutrition. I ended up there in clinical charge of John Waterlow’s metabolic unit for babies with kwashiorkor and marasmus. So I had to learn nutrition on the job as well as doing research.

When John Waterlow transferred from Jamaica to the London School of Hygiene and Tropical Medicine, I was invited to join him as senior lecturer, and to revamp the nutrition course for postgraduates. I soon found that I was at best 48 hours ahead of the students. At the School I learned about public health and discovered the brilliance of Jerry Morris, Geoffrey Rose and others who were engrossed in tropical public health, population control, development issues, and other critical topics.

Then I was asked to go to Montserrat in place of John Waterlow, to deal with a political problem. Local leaders were claiming that the poor scholastic achievement of students was because the UK government deprived children of proper nutritional support. Bike Aksu, a PhD student, and I suddenly realised that while the children were indeed malnourished by official standards, they actually were almost all stunted (small) rather than wasted (thin).This led to the new classification of malnutrition.

Back in the UK we proposed investing in epidemiological analyses of obesity. We were landed with writing the first analysis of the obesity problem and its research needs for the UK government and the Medical Research Council. Then I was asked to join Roger Whitehead at the Dunn Nutrition Institute in Cambridge and to set up the Clinical Nutrition Centre. Thus started an exciting time. John Cummings and the late Sheila Bingham joined us, to take on the very odd problem of obesity and also to deal with the mysterious new factor – dietary fibre. The missionary surgeon Denis Burkett and physician Hugh Trowell in Uganda, were claiming that dietary fibre was crucial for avoiding the bowel and metabolic disorders of the Western world.

Then Jerry Morris phoned me, and asked me to do a TV series with him and a famous entertainer, Roy Castle, setting out why good diets and plenty of exercise were important for health. I refused, because as a reputable medical research worker I could not afford to be seen to be involved in something as crude as TV! Jerry persisted, asking me if I understood anything about the social responsibilities of science. I was shamed into agreeing, and ended up making six ten minute programmes for prime-time viewing on Sunday night. We filmed in working class family kitchens, and worked out from scratch how to limit fat, sugar and salt, which at that time were not seen to be of much importance by any senior nutritionist in the UK. Our shows turned out to be the most popular and discussed programmes on diet and nutrition that the BBC had put on since the Second World War. I had completely underestimated the importance of speaking out on public health problems.

Then in 1980 Jerry Morris, who died this year at the great age of 99, asked me to chair the infamous National Advisory Committee for Nutrition Education (NACNE), This followed the same principles, but was repeatedly attacked and then its publication sabotaged by a cabal in the Department of Health involving a Health Minister, a senior Department of Health official, and the British Nutrition Foundation (which is what we would now call a BINGO, paid for by the major British food industries and involving most if not all the top nutritionists in Britain). Caroline Walker and Geoffrey Cannon tell this story in their book The Food Scandal. This taught me how readily scientists become seduced, and that public health is a dangerous occupation if we seek to contribute new approaches which threaten big industry.

Nevertheless as the then Director of the Rowett Research Institute near Aberdeen, I was dragged into the International Union of Nutritional Sciences and also into endless WHO, Scottish, British, EU and UN consultations. I came to realise that almost all the analyses, writing – and manoeuvring – had to be done personally in ‘spare’ time. This was true when helping Scotland’s health department with then one of the world’s highest cardiovascular death rates; the English government who were allergic to any initiatives in public health; and the EU trying to cope with their dawning realisation that the food chain was its biggest business. Even WHO did not know how to deal with the combination of malnutrition and the so called ‘diseases of affluence’; and the UN Standing Committee on Nutrition was horrified to discover from us that the UN itself was often the biggest handicap to coherent public health developments affecting lower income countries!

For the last ten years I have been privileged to be in London running the International Obesity Task Force with a network of colleagues across the world. Now I have been ‘kicked upstairs’ to become president of its scientific association the International Association for the Study of Obesity.

Overall what have I learned? This, I think. If you can marshal your arguments properly, recruit allies to the cause and – crucially – immediately agree and adjust when you get something wrong, then it is indeed possible to contribute something to this enormously important field of public health.

I suppose that for me public health nutrition has been my hobby. So in my next life I will go in for public health nutrition as a career, instead of starting out as a clinical researcher fixated with understanding exactly why people succumbed to a particular disease, and imagining that measuring fluxes and biochemical pathways with new fancy techniques was the way to go!

I qualified in physiology (1959) and medicine (1962) at University College London before postgraduate medical qualifications. Then I worked at the UK’s MRC Unit in Tropical Metabolism in Jamaica for three years with a year at the Massachusetts General Hospital in Boston, USA, and then became a senior lecturer at the London School of Hygiene.

Ran the Dunn Clinical Nutrition Centre 1974-1982 and was Director of the Rowett Research Institute 1982-1999. Chaired and wrote the first public health nutrition policy reports for Scotland, and several policy reports for the UK, before chairing and writing reports for WHO Europe (1986), and then the WHO 797 report on diet and public health for malnourished and chronic disease prone countries (1990). In 1996 established the International Obesity Task Force (IOTF), responsible for drafting the first WHO Technical Report (2000) on the prevention and management of obesity. Persuaded Tony Blair to create the UK Food Standards Agency, and the EU a DG SANCO and then the EU Food Standards Agency. Chaired and wrote the UN Commission’s report on global issues in nutrition. Was Vice President of the International Union of Nutritional Sciences. Is President of the International Association for the Study of Obesity.