A Quiet Hero

You’ve probably never heard of Sir John Crofton, but if you value your lungs, you should certainly toast him.

It was Crofton, half a century ago, who discovered the first 100 per cent cure for the age-old scourge of tuberculosis. Crofton, too, who pioneered the global method currently being used to fight terrifying new drug-resistant strains on Europe’s doorstep. With his campaigning doctor wife, Eileen, he also laid 30 years of groundwork for Britain’s first smoking ban in Scotland.

And now his memoirs are available for the first time, offering fascinating new insights from a life definitively well-lived.

I first met this mild-mannered crusader, aged 95, not long before his death in 2009, when he was still beavering away with quiet determination, bending influential ears and writing the rules of engagement in the war on respiratory disease.

“Technically I retired in 1977, but it’s a very exciting time just now,” smiled the Dublin-born pioneer, pouring tea at his home on the outskirts of Edinburgh. “It puts off the Alzheimer’s, we hope.”

Knighted three decades ago in recognition of his contribution to world health, he continued to criss-cross the globe advising and inspiring experts less than half his age, from New York health tsars to Chinese party apparatchiks. His achievements, arguably as important as Alexander Fleming’s discovery of Penicillin, won him the Union Medal in 2005, and the 2008 Edwin Chadwick Medal for outstanding contribution to public health. He marked his 95th Birthday with a speech on TB at the European Parliament in Brussels.

“With TB there’s never much time to rest on one’s laurels,” said Crofton, who brought a much-needed long perspective to the front line against the disease. Indeed, the current global epidemic has key factors in common with the one that confronted him when he was drafted in to Edinburgh’s crowded hospital wards.

It was the 1950s, and the first new antibiotics were producing patchy results among more than 50,000 TB patients in a depressed, post-war Britain. While some recovered, others relapsed and died in the classic way – the chest pains, the coughing of blood, the body’s slow “consumption”. Until, that is, the doctor and his team hit upon a simple but revolutionary idea.

“Failure was always due to patients developing resistance to a drug,” recalled Crofton, then the professor of Respiratory Diseases and Tuberculosis at EdinburghUniversity.  “So we decided to try with three drugs at the same time to be on the safe side – and to our astonishment we found we were curing everybody.”

Sceptics ate their words as the disease disappeared completely in Edinburgh within six years, and by 1987 programs of mass BCG vaccinations had helped bring Britain’s toll to just 5,500. For the vast majority of the population, the classic bloody handkerchief of TB was relegated to TV Dickens adaptations, while the “Edinburgh Method” was rolled out in 23 European countries and North America. Crofton subsequently co-authored Clinical Tuberculosis, a basic guide for non-specialist health workers, which is now in its third edition after printing 150,000 copies in 20 different languages. It is no exaggeration to say that his efforts have saved millions of lives across the globe.

Cristobal_Rojas_TB deathYet poverty remains a formidable enemy. Five decades after that first breakthrough, a new and almost untreatable strain of TB mounting its most alarming offensive since World War Two on the former Soviet fringes of Europe – a pattern repeated in pockets of Africa, where TB is the number one cause of death among AIDS patients.

“We should be worried,” said Crofton, a man not given to alarmism. “There are a number of new drugs approaching clinical trial at the moment, so there is hope – but I think we’ll have a period where we will lose a lot of patients, particularly in the developing world.”

The big problem, now as in the 1950s, is drug resistance – the ability of Mycobacterium tuberculosis to mutate and become immune to existing remedies, particularly where courses of medication are incorrectly administered or left unfinished.

“People feel better in three or four weeks, and say I’m cured and I don’t need to go on taking this stuff,” sighed Crofton. “They have other priorities, especially poor people – like where the next meal is coming from.” Yet this simple lapse in treatment encourages the mutation of extreme drug-resistant strains (XDR-TB), requiring the development of ever more complex and expensive cocktails of antibiotics – if indeed, they are treatable at all.

Even without the new strains, the arithmetic of TB is dizzying. Humanity’s most persistent plague, ingrained in modern slums as it was in the bones of Egyptian mummies, it kills 5000 people every day. According to the World Health Organisation (WHO), nearly 2 billion people – one third of the world’s population – carry the bacterium in their bodies, of which 8 million will contract the disease and almost 1.5 million die annually. An untreated carrier is likely to infect 15 others in a year, by sneezing, speaking or simply breathing.

The young John Crofton first studied its effects on patients in a tented hospital by the Suez Canal in the Second World War. Not long out of Cambridge University, the young graduate learned from a charismatic chest specialist who later recruited him to some of the first clinical trials of the antibiotic streptomycin in London after the war. Until then, the best available treatment was “good food and bed rest” – a prescription which saved barely half of those infected.

Some of history’s most famous names succumbed – among them John Keats, DH Lawrence, Frederic Chopin, Emily Bronte and George Orwell. “No self-respecting artist or poet dreamed of dying of anything else,” said Crofton with a grim smile. “In my generation we practically all got infected by the time we grew up.”

Yet tantalizingly, the disease in its simplest form is now entirely treatable for as little as £10 per patient – if only patients can commit to finishing their course of treatment. With this in mind, governments around the world signed up in 2006 to the Global Plan to Stop TB, aiming to at least halve levels by 2015. It uses the DOTS treatment programme – effectively the offspring of the Edinburgh Method -which allows easy access to more expensive reserve drugs on condition that patients are monitored through the full treatment.

Nobody pretends it will be easy. The WHO Global Response Plan aims to save 1.2 million lives by 2015, with the help of new laboratories and emergency response teams – but needs more than a billion dollars of government funding from around the world. Only hard cash and a steady nerve can hope to bring the crisis under control.

“It’s easy to get frustrated, but if you look back you can see how much you’ve achieved,” Crofton told me. And if proof is needed that persistence eventually pays off, he pointed to another respiratory victory: the successful ban of smoking in public places in Scotland after decades of lobbying.

“The secret was keeping it in the public eye,” said his wife, Eileen Crofton, who was awarded an MBE for her work as director of Scotland’s Action on Smoking and Health (ASH), founded by her husband. “It’s taken 30 years to see the ban implemented, but these things do take time.” More recently Tobacco, a campaigners’ handbook co-authored by Sir John has been selling well globally in languages from Bulgarian to Urdu, with a recent request for 15,000 copies in Hindi and Chinese.

Within three years of my interview, both John and Eileen had passed away, but back in 2007 their energy was astonishing. And after 60 years, their marriage still crackled with vitality. “He’s the optimist, and I’m the pragmatist,” laughed Eileen, seven years younger, who met her future husband in 1945 at a VE day celebration in Northern Ireland, where they were stationed a different hospitals. “He’s like an internal combustion engine!”

When I met them, the pair had been lending their support to what was then a new campaign – Scottish Health Action on Alcohol Problems (SHAAP) – lobbying governments and business to tackle Britain’s binge-drinking culture much as ASH tackled smoking.

“It’s slightly different, because nobody wants prohibition,” said Sir John, who enjoys a glass or two of wine with his meal. “The alcohol industry is pretty ruthless, but nobody is wanting to close down the industry. The difficulty now is that you can buy alcohol anywhere. The two key factors are price and availability.”

As an optimist, he had less time for suggestions of a deeper-rooted modern malaise, or the waywardness of British youths.

“Every generation has said that of the next,” he laughed, waving away the idea. “Actually I’m terribly impressed, working in deprived areas, by the spirited young people you find there working in very difficult situations. People think crime gets worse and worse, when in fact it’s so often getting better.”

Not that he expected to see an end to bingeing in his lifetime. Once a keen climber – there’s apparently a route in the Cairngorms named after him – Crofton was sticking to metaphorical mountains as he approached the end of his life, and gathering his thoughts in the memoirs that have just been published.

Crofton Memoirs“I don’t believe in the afterlife,” he mused, looking through his lounge window at the darkening Pentland Hills. “But I hope I’ve made a small footnote in the history of TB.”

I felt very privileged to have met Sir John, the epitome of quiet determination, and I highly recommend his edited memoirs, Saving Lives and Preventing Misery. 

“The funny thing is I’m not actually all that bright,” he told me as our interview ended, self-deprecating to the last. “I think I’m just good at seeing things that fairly obviously need to be done – and getting on with doing them.”

Get involved with the global fight against TB at: www.stoptb.org

This article is adapted from a piece that originally appeared in SAGA magazine


Posted on: 29 May 2013 in Books, Features, General, Interviews, Journalism
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