Sir Alexander Wiseman Macara, always known as ‘Sandy’, was head of the department of epidemiology and public health medicine at Bristol University and Chairman of the British Medical Association (BMA) from 1993 to 1998, during which time he maintained a fierce opposition to the Conservative government’s attempts to introduce a ‘market driven’ National Health Service (NHS).
Born in Irvine, Ayreshire, he was the son of Alexander Macara, a minister of the Scottish Church (as was his grandfather) and his wife Marion née Mackay, who was a civil servant in London before her marriage. Growing up in the manse, he freely acknowledged that the poverty he observed, and the experience of having to raise funds to keep the local hospital going, together gave him a lifelong commitment to the NHS. When he was six years old he contracted paratyphoid fever, acute appendicitis and whooping cough. He had a long spell in hospital and it took him six years to make a full recovery, but the experience was to result in him choosing a career in medicine, inspired by the young consultant (‘an almost God-like figure’) who saved his life. The consultant, Tom Anderson, went on to become a professor of public health and was Macara’s mentor at university. He was educated at Irvine Royal Academy and studied medicine at Glasgow University and the Western Infirmary, Glasgow. Although he suffered from a stammer in his teenage years, he managed to overcome it to the extent that he was a leading light in the university debating society.
Qualifying in 1958, he did house jobs in Glasgow at the Western Infirmary, Southern General and Royal Maternity and Women’s hospitals. During this time in Glasgow, and subsequently in London, he gradually became very much aware of the poverty of the slums and the health problems suffered by the workers, especially on the docks or down the mines. Having passed his diploma in public health at the London School of Hygiene and Tropical Medicine in 1960, he moved to Bristol, inspired by the medical officer of health who was in post at the time, the charismatic Bob Wofinden [Munk’s Roll, Vol.VI, p.473]. He began work as a departmental medical officer to the City and County and honorary community physician. Three years later he became a lecturer in public health at Bristol University. In 1973 he was appointed a senior lecturer in epidemiology and public health medicine and honorary visiting consultant to the Bristol Royal Infirmary. He retired 24 years later in 1994.
In 1967 the Annual Representative Meeting (ARM) of the BMA happened to take place in Bristol and Macara, having attended merely to observe, was excited by what he described as the ‘barely controlled chaos’ of the meeting’ and gradually became more and more involved. Although he had led a march and a hunger strike when a junior doctor in a protest about the trainees’ hospital accommodation, he had not been involved in similar activities since and, until he was 30, he was a member of the Conservative Party, considering it up until then to be ‘the sensible, middle of the road party’. As chair of the BMA’s medical ethics committee from 1982 to 1989, he took on Margaret Thatcher’s Conservative government on such issues as the need to maintain the confidentiality of medical records even from the police; the need for under 16 year old girls to receive confidential contraceptive advice and supplies; the need for official regulations covering IVF treatment and surrogacy; and the potential crisis of the Aids epidemic.
When Jeremy Lee-Potter was forced to stand down as chairman of council in 1993 because he was regarded as being too tolerant of the proposed introduction of an internal market to the health service, Macara was elected in his place for a five year term. The skills he had honed at university came to the fore and his maiden speech was given a two minute standing ovation. Accusing the government of being on a ‘politically inspired mission’ to wreck the NHS, he called the internal market an ‘uncontrolled monster’ and remained implacably opposed to it. He held forth eloquently at over 40 ARMs, perhaps most famously in 1995 when he stated that the reason so many doctors were abandoning their profession was because ‘We are labouring under an alien regime. Not so much an internal market as an infernal bazaar in which considerations of cost reign supreme, while concerns for value and values are relegated to second place’.
An urbane man, he was able to communicate with ministers even if he disagreed with them. An ex-smoker himself, he led an energetic campaign against the tobacco industry (whom he called ‘the merchants of death’) and the need for a ban on smoking in public places. It was an ex-student of his, Sir Liam Donaldson, who, as chief medical officer, eventually introduced the ban. He also campaigned vigorously for all children to receive the controversial MMR injection when it had been discredited by what transpired to be incorrect research. When, towards the end of his period of office, the Labour Party came to power, he was quick to criticise them for not immediately reversing Conservative policy.
For more than 20 years he was a consultant to the World Health Organization and he also was founding secretary general of the World Federation for Education and Research in Public Health. From 2002 onwards he was chairman and president of the National Heart Forum.
He loved music, particularly the organ, and he was a freemason and an elder at his local united reformed church in Bristol. A skilled gardener, he grew asparagus, beans and tomatoes, and like his father before him, prize roses. He also played tennis and golf, although he remarked that his performance at the latter was ‘increasingly undistinguished’.
In 1964 he married Sylvia Mary née Williams, a chemistry and zoology graduate of Cardiff University who became a teacher and deputy headmistress. When he died of cancer, apparently consulting his diary on his deathbed with the suggestion that he cancel his chemotherapy and attend a meeting instead, Sylvia and their children, James and Alexandria, survived him.
RCP editor
[The Guardian www.theguardian.com/society/2012/aug/06/sir-sandy-macara; The Telegraph www.telegraph.co.uk/news/obituaries/9363152/Sir-Sandy-Macara.html; BMJ 2012 345 4644 www.bmj.com/content/345/bmj.e4644; The Herald Scotland www.heraldscotland.com/opinion/obituaries/13063544.Dr_Sir_Alexander_Macara/; Royal College of Physicians of Edinburgh www.rcpe.ac.uk/obituary/sir-sandy-alexander-wiseman-MacAra-frcp-edin; Perspectives in public health 2012 132 198 http://rsh.sagepub.com/content/132/5/198.extract; The Scotsman www.scotsman.com/news/obituaries/obituary-sir-sandy-macara-charismatic-voice-for-the-medical-profession-was-a-fervent-upholder-of-the-nhs-1-2454988; The Independent http://www.independent.co.uk/voices/profile-scalpel-to-blunt-an-axe-dr-sandy-macara-he-is-leading-the-bma-out-of-the-sickroom-but-where-1412918.html; British Medical Association http://bma.org.uk/news-views-analysis/news/2012/june/a-tribute-to-sandy-macara - all accessed 18 December 2015]