Sir Ernest Donald Acheson (‘Donald’) was a physician and epidemiologist, who was chief medical officer (CMO) from 1983 to 1991. During this period he had to deal with the sudden huge rise in HIV infection and the bovine spongiform encephalopathy crisis (BSE). In handling these critical issues, he raised the profile of public health, and later he published an important report on health inequalities.
Born in Belfast, Northern Ireland, he was the son of Malcolm King Acheson, a medical practitioner who specialised in public health, and his wife, Dorothy Josephine née Rennoldson whose father, David, was a shipbuilder and ship’s engine manufacturer on Tyneside. His elder brother, Roy Malcolm Acheson [Munk’s Roll, Vol.XII, web], was also a distinguished epidemiologist and professor of community medicine at Cambridge University. Educated at Merchiston Castle School in Edinburgh, he studied medicine at Brasenose College, Oxford and the Middlesex Hospital in London. Qualifying in 1951, he did various house jobs at the Middlesex before being called up to do his National Service in 1953. He joined the RAF and served as an acting squadron leader to the No 1 Central Medical Board for two years.
On demobilisation he returned to the Middlesex as a registrar and clinical tutor. He was then awarded a Radcliffe travelling fellowship by University College, Oxford and spent two years in the USA studying the epidemiology of ulcerative colitis before returning to Oxford in 1959 as a medical tutor at the Radcliffe Infirmary. From 1962 to 1964, he was first assistant to the Nuffield professor of medicine and director of the Oxford record linkage study and in 1965 he was appointed May reader in medicine.
He left Oxford in 1968 to become professor of clinical epidemiology at Southampton University, honorary consultant physician at the Royal South Hants Hospital and founder dean of the school of medicine where he made an outstanding contribution to broadening the teaching of medical students. For the 15 years that he stayed in Southampton, he was involved with research on a wide range of topics such as multiple sclerosis, the aftermath of Hiroshima and cancer incidence in ulcerative colitis. In 1979 he was also appointed director of the epidemiology group at the Medical Research Council and produced some important work on the health risks of asbestos which led to higher safety standards being introduced nationally.
Appointed CMO in 1983, he later remarked of the task that ‘I feel I’m putting my reputation on the line in public quite frequently in this job. If my scientific credibility goes, nobody will believe me. So I must personally satisfy myself of the evidence on every issue’. In the year he began work there had been 28 deaths from Aids, this increased to 121 in two years, with 10,000 possible cases. Armed with this information – and worrying figures from the US – he determined to mount a passionate programme to contain the disease and said that he ‘ate and slept Aids from 1985 onwards’. He launched a huge publicity campaign in the media to educate the public in the perils of unsafe sex and to enlighten them that it was not just a disease confined to the gay community. A reluctant Conservative government was persuaded to release extra funding and to turn a blind eye to illegal drug use so that needle exchanges could be set up. The influence of his campaign spread and he was invited to contribute his methods to the World Health Organization’s guidelines on Aids. By the time that he retired in 1991, the threatened epidemic had become a manageable chronic condition and the numerous hospital beds set aside for cases were redundant.
In 1990 the first cases of new variant Creutzfeldt-Jakob disease appeared and he was belatedly informed by the Ministry of Agriculture, Fisheries and Food that there had been an outbreak of BSE in cattle two years previously. Under pressure to issue a public statement to the media on the subject, Acheson was reported as saying that there was no risk associated with eating British beef. Nearly 10 years later he was censured by the Phillips Committee, for this comment but he claimed that his words had been edited although he did regret what he acknowledged was ‘a slip of the tongue’. Similar controversy arose over a remark he made on the day before he retired. At a press conference he said that breast self-examination was not an accurate method of detecting cancer, thereby completing contradicting the published government guidelines.
On his retirement as CMO he held posts at the London School of Hygiene and Tropical Medicine and University College, London. In the late 1990s the Labour government commissioned him to write a report on inequalities in health care. The Acheson report appeared as the Independent Inquiry into Inequalities in Health Report (London, HMSO, 1998) and it documented the shocking increase in the gap between rich and poor during the Thatcher and Major governments. Many of his 39 recommendations were implemented, such as more money for poorer families, restrictions on smoking in public places, more money for inner city schools and better sex education.
Among his many other appointments, he was a member of the Wessex Regional Hospital Board from 1968 to 1974, a member of the Royal Commission on Environmental Pollution from 1979 to 1983, and of the General Medical Council from 1984 to 1991. President of the Association of Physicians of Great Britain and Northern Ireland in 1979, he was also president of the British Medical Association from 1996 to 1997.
His numerous publications include Record linkage in medicine (Edinburgh, Churchill Livingstone, 1968); Medicine, an outline for the intending student (London, Routledge and Kegan Paul, 1970); The impending crisis of old age: a challenge in ingenuity (Birmingham, University Press, 1982) and his autobiography, One doctor’s legacy: the social lesion (Bury St Edmunds, Arima Publishing, 2007).
His relaxations were listening to music and fishing.
In 1954 he married Barbara Mary née Castle whose father, Reginald Edmund, was a pump manufacturer. She was a staff nurse at the Middlesex Hospital when they met. They had a son and four daughters, one of whom predeceased him. The marriage ended in divorce in 2002 and he married Angela Judith née Roberts the same year. When he died, he was survived by his first wife and family and Angela and their daughter.
RCP editor
[The Guardian www.theguardian.com/society/2010/jan/15/donald-acheson-obituary; The Telegraph www.telegraph.co.uk/news/obituaries/medicine-obituaries/6983349/Sir-Donald-Acheson.html; BMJ 2010 340 419 www.bmj.com/content/340/bmj.c419; Lives of the Fellows of the Royal College of Surgeons of England http://livesonline.rcseng.ac.uk/biogs/E001891b.htm; Lancet www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60428-X/fulltext - all accessed 26 May 2015]