Bill Inman
Encyclopedia
William Howard Wallace "Bill" Inman, MRCP, FRCP, FFPHM (1 August 1929 – 20 October 2005), also known as WHW Inman, was a British doctor and pioneer of methods and systems to detect risks of treatment with drugs. As well as holding positions in health institutions in the UK, he was active in international efforts to co-ordinate drug safety monitoring.
, Surrey in 1929, the son of a businessman. He attended Ampleforth College
where he played rugby
, performed in musicals, and broke their junior cross-country
record.
He went on to Gonville and Caius College, Cambridge, intending to study medicine, but just before he was due to begin clinical training contracted polio. After having spent two years away, much of it on an iron lung
, the university arranged for him to have individual tuition in Cambridge. In 1956 he became the first clinical medical graduate of Cambridge University (before the official founding of the University Medical School, medical students then completing their training in London hospitals), and delivered fifty babies from his adapted wheelchair.
After three years (1956–59) in clinical medicine at Addenbrooke's Hospital
, from 1959 to 1964 Inman worked as a medical adviser to ICI Pharmaceutical Division
, then joined the UK Department of Health and Social Security
as a Senior (later Principal) Medical Officer in 1964. Following the thalidomide
tragedy, he was invited by Sir Derrick Dunlop, the founding Chairman of the independent Committee on Safety of Drugs, to develop a spontaneous adverse drug reaction reporting system, which became known internationally as the yellow card
system.
From 1965 to 1967 Inman designed and directed studies on the role of oral contraceptives in thromboembolic disease. This led to the discovery of the relationship between oestrogen dose and risk of thrombosis and subsequent development of a "mini-pill". He was also involved in key research on sudden asthma deaths, halothane and jaundice, and phenylbutazone and blood dyscrasias. In total Inman published around 100 papers on drug monitoring and safety aspects of various drugs.
After 1975 he drew up proposals for what he termed 'Recorded Release' monitoring method to supplement the voluntary 'yellow-card' scheme, which eventually evolved into the post-marketing
system used by the Drug Safety Research Unit (DSRU). This arose from his conviction that 'post-marketing studies' being created by drug companies were promotional in nature. As he was unable to get official support for what became prescription event monitoring, in 1980 he resigned from the CSM Secretariat to found DSRU independently, and start the 'green card' monitoring scheme.
Despite financial pressures, Inman upheld a principle that studies at his Unit should not be directly sponsored by a pharmaceutical company, lest it restrict his ability to investigate issues which he felt were important. His efforts to raise funds for the DSRU were unwelcome to some in the pharmaceutical industry, and a few attempted to undermine his fund-raising trip to the U.S. However, he raised the necessary finance in four weeks. Inman published a series of bulletins entitled 'PEM News' to report on the progress of prescription event monitoring.
Inman was a consultant to the WHO
from 1966 to 1980, participating in many of the formative meetings setting up international systems. The foundation of the WHO Adverse Reaction Terminology
was created by Barbro Westerholm
, Bruce Royal and Inman. The pilot phase of the drug monitoring programme was positively evaluated by the World Health Assembly
and became an on-going WHO Programme, based until 1978 in Geneva.
In the aftermath of scares over the safety of Eraldin and Practolol
, Franz Gross of the University of Heidelberg convened a conference in 1977. The conference examined the problems of relying solely on spontaneous reporting systems, and the need for adverse reaction data which included information on the number of patients using a particular drug, which connected with Inman's plans for prescription event monitoring.
Inman contributed to an initiative on risk management and communication by Wolfson College, Oxford
in 1984. At this symposium he outlined the problems of communicating risk perception, and demonstrated the huge differences in the views of medical staff of risk within their own fields. He illustrated the comparative annual risk of doing something (smoking) or being somebody (a president of the United States, or a matador). By contrast, he cited examples of drug withdrawals after a single drug-related death of one in two million. In 1984 he was appointed to the first Chair in Pharmacoepidemiology
in the United Kingdom, at the University of Southampton
.
Inman held strong views about the complete separation of safety monitoring between government and industry, and felt that medical evaluation should be separate from the national licensing authority. He was warned that his clashes with authority would prevent him receiving a knighthood. Lord Butterfield
described Inman as "well known world-wide for his foresight and his persistence, which has resulted in his bringing the clinical skills of close observation and detective-like following up of clues to the problems of drug development". Michael O'Donnell
wrote, after reading Inman's autobiography, Feeling Better Doctor?: "I suspect you will agree that the author has earned the accolade of one of those beastly people who are always bringing up awkward subjects and making respectable people feel uncomfortable." To the end Inman expressed disappointment that no system, such as a database of pregnant women's drug histories, had been put in place to prevent another thalidomide tragedy.
, winning the award in 1960 for best new pilot, and only stopping in the early 1990s. When living in Hever
, Kent he regularly went trout fishing, especially at Bewl Bridge. After he retired in 1994 he became medical vice-president of REMAP, which provided bespoke equipment for disabled people.
, and his campaign (with the health editor of The Daily Mirror) to get the pram's specification changed.
Inman's two books: Don't Tell the Patient – Behind the Drug Safety Net, describing his 30 years in drug safety from 1964–94, and his autobiography, Feeling Better Doctor?, give a full account of his life and career.
Life and career
Inman was born at BansteadBanstead
Banstead is a town in the borough of Reigate and Banstead in the county of Surrey, England, on the border with Greater London. It lies south of London, west of Croydon and of the county town of Kingston-Upon-Thames. Banstead is on the North Downs and is protected by the Metropolitan Green Belt;...
, Surrey in 1929, the son of a businessman. He attended Ampleforth College
Ampleforth College
Ampleforth College in North Yorkshire, England, is the largest Roman Catholic co-educational boarding independent school in the United Kingdom. It opened in 1802, as a boys' school, and is run by the Benedictine monks and lay staff of Ampleforth Abbey...
where he played rugby
Rugby football
Rugby football is a style of football named after Rugby School in the United Kingdom. It is seen most prominently in two current sports, rugby league and rugby union.-History:...
, performed in musicals, and broke their junior cross-country
Cross country running
Cross country running is a sport in which people run a race on open-air courses over natural terrain. The course, typically long, may include surfaces of grass and earth, pass through woodlands and open country, and include hills, flat ground and sometimes gravel road...
record.
He went on to Gonville and Caius College, Cambridge, intending to study medicine, but just before he was due to begin clinical training contracted polio. After having spent two years away, much of it on an iron lung
Iron lung
A negative pressure ventilator is a form of medical ventilator that enables a person to breathe when normal muscle control has been lost or the work of breathing exceeds the person's ability....
, the university arranged for him to have individual tuition in Cambridge. In 1956 he became the first clinical medical graduate of Cambridge University (before the official founding of the University Medical School, medical students then completing their training in London hospitals), and delivered fifty babies from his adapted wheelchair.
After three years (1956–59) in clinical medicine at Addenbrooke's Hospital
Addenbrooke's Hospital
Addenbrooke's Hospital is an internationally renowned teaching hospital in Cambridge, England, with strong links to the University of Cambridge. It was founded in 1766 on Trumpington Street with £4,500 from the will of Dr John Addenbrooke, a fellow of St Catharine's College...
, from 1959 to 1964 Inman worked as a medical adviser to ICI Pharmaceutical Division
Imperial Chemical Industries
Imperial Chemical Industries was a British chemical company, taken over by AkzoNobel, a Dutch conglomerate, one of the largest chemical producers in the world. In its heyday, ICI was the largest manufacturing company in the British Empire, and commonly regarded as a "bellwether of the British...
, then joined the UK Department of Health and Social Security
Department of Health and Social Security
The Department of Health and Social Security was a ministry of the British government in existence for twenty years from 1968 until 1988, and was headed by the Secretary of State for Social Services.-History:...
as a Senior (later Principal) Medical Officer in 1964. Following the thalidomide
Thalidomide
Thalidomide was introduced as a sedative drug in the late 1950s that was typically used to cure morning sickness. In 1961, it was withdrawn due to teratogenicity and neuropathy. There is now a growing clinical interest in thalidomide, and it is introduced as an immunomodulatory agent used...
tragedy, he was invited by Sir Derrick Dunlop, the founding Chairman of the independent Committee on Safety of Drugs, to develop a spontaneous adverse drug reaction reporting system, which became known internationally as the yellow card
Yellow Card Scheme
The Yellow Card Scheme is the UK system for collecting information on suspected Adverse Drug Reactions to medicines. The Scheme was founded in 1964 after the thalidomide disaster, and was developed by Dr Bill Inman....
system.
From 1965 to 1967 Inman designed and directed studies on the role of oral contraceptives in thromboembolic disease. This led to the discovery of the relationship between oestrogen dose and risk of thrombosis and subsequent development of a "mini-pill". He was also involved in key research on sudden asthma deaths, halothane and jaundice, and phenylbutazone and blood dyscrasias. In total Inman published around 100 papers on drug monitoring and safety aspects of various drugs.
After 1975 he drew up proposals for what he termed 'Recorded Release' monitoring method to supplement the voluntary 'yellow-card' scheme, which eventually evolved into the post-marketing
Postmarketing surveillance
Postmarketing surveillance is the practice of monitoring the safety of a pharmaceutical drug or device after it has been released on the market and is an important part of the science of pharmacovigilance...
system used by the Drug Safety Research Unit (DSRU). This arose from his conviction that 'post-marketing studies' being created by drug companies were promotional in nature. As he was unable to get official support for what became prescription event monitoring, in 1980 he resigned from the CSM Secretariat to found DSRU independently, and start the 'green card' monitoring scheme.
Despite financial pressures, Inman upheld a principle that studies at his Unit should not be directly sponsored by a pharmaceutical company, lest it restrict his ability to investigate issues which he felt were important. His efforts to raise funds for the DSRU were unwelcome to some in the pharmaceutical industry, and a few attempted to undermine his fund-raising trip to the U.S. However, he raised the necessary finance in four weeks. Inman published a series of bulletins entitled 'PEM News' to report on the progress of prescription event monitoring.
Inman was a consultant to the WHO
Who
Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...
from 1966 to 1980, participating in many of the formative meetings setting up international systems. The foundation of the WHO Adverse Reaction Terminology
WHOART
The WHO Adverse Reactions Terminology is a dictionary meant to serve as a basis for rational coding of adverse reaction terms. The system is maintained by the Uppsala Monitoring Centre , the World Health Organization Collaborating Centre for International Drug Monitoring.-Structure:* 32...
was created by Barbro Westerholm
Barbro Westerholm
Barbro Westerholm is a Swedish Liberal People's Party politician. She has been a member of the Riksdag since 2006. Westerholm was previously a member from 1988 to 1999....
, Bruce Royal and Inman. The pilot phase of the drug monitoring programme was positively evaluated by the World Health Assembly
World Health Assembly
The World Health Assembly is the forum through which the World Health Organization is governed by its 194 member states. It is the world's highest health policy setting body and is composed of health ministers from member states....
and became an on-going WHO Programme, based until 1978 in Geneva.
In the aftermath of scares over the safety of Eraldin and Practolol
Practolol
Practolol is a selective beta blocker that has been used in the emergency treatment of cardiac arrhythmias. Practolol is no longer used as it is highly toxic despite the similarity of its chemical formula to propanolol...
, Franz Gross of the University of Heidelberg convened a conference in 1977. The conference examined the problems of relying solely on spontaneous reporting systems, and the need for adverse reaction data which included information on the number of patients using a particular drug, which connected with Inman's plans for prescription event monitoring.
Inman contributed to an initiative on risk management and communication by Wolfson College, Oxford
Wolfson College, Oxford
Wolfson College is a constituent college of the University of Oxford in England. Located in north Oxford along the River Cherwell, Wolfson is an all-graduate college with over sixty governing body fellows, in addition to both research and junior research fellows. It caters to a wide range of...
in 1984. At this symposium he outlined the problems of communicating risk perception, and demonstrated the huge differences in the views of medical staff of risk within their own fields. He illustrated the comparative annual risk of doing something (smoking) or being somebody (a president of the United States, or a matador). By contrast, he cited examples of drug withdrawals after a single drug-related death of one in two million. In 1984 he was appointed to the first Chair in Pharmacoepidemiology
Pharmacoepidemiology
Pharmacoepidemiology is the study of the use of and the effects of drugs in large numbers of people.To accomplish this study, pharmacoepidemiology borrows from both pharmacology and epidemiology. Thus, pharmacoepidemiology is the bridge between both pharmacology and epidemiology...
in the United Kingdom, at the University of Southampton
University of Southampton
The University of Southampton is a British public university located in the city of Southampton, England, a member of the Russell Group. The origins of the university can be dated back to the founding of the Hartley Institution in 1862 by Henry Robertson Hartley. In 1902, the Institution developed...
.
Inman held strong views about the complete separation of safety monitoring between government and industry, and felt that medical evaluation should be separate from the national licensing authority. He was warned that his clashes with authority would prevent him receiving a knighthood. Lord Butterfield
John Butterfield, Baron Butterfield
William John Hughes Butterfield, Baron Butterfield, OBE, FRCP was a leading British medical researcher, clinician and administrator....
described Inman as "well known world-wide for his foresight and his persistence, which has resulted in his bringing the clinical skills of close observation and detective-like following up of clues to the problems of drug development". Michael O'Donnell
Michael O'Donnell
Michael O'Donnell , is a British physician, journalist, author, and broadcaster.He became a full-time writer after working for 12 years as a doctor. On BBC Radio Four he was chairman of My Word! and wrote and presented Relative Values...
wrote, after reading Inman's autobiography, Feeling Better Doctor?: "I suspect you will agree that the author has earned the accolade of one of those beastly people who are always bringing up awkward subjects and making respectable people feel uncomfortable." To the end Inman expressed disappointment that no system, such as a database of pregnant women's drug histories, had been put in place to prevent another thalidomide tragedy.
Outside interests
In the 1950s, after the onset of polio he took up glidingGliding
Gliding is a recreational activity and competitive air sport in which pilots fly unpowered aircraft known as gliders or sailplanes using naturally occurring currents of rising air in the atmosphere to remain airborne. The word soaring is also used for the sport.Gliding as a sport began in the 1920s...
, winning the award in 1960 for best new pilot, and only stopping in the early 1990s. When living in Hever
Hever
Hever can refer to one of the following:*Hever, Kent, a village and civil parish in the Sevenoaks District of Kent, England*Hever, Belgium, a small village in the center of Flanders, Belgium*Merkaz Hever, a communal settlement in Israel...
, Kent he regularly went trout fishing, especially at Bewl Bridge. After he retired in 1994 he became medical vice-president of REMAP, which provided bespoke equipment for disabled people.
Personal life
He married in 1962 and had three daughters; another daughter died in infancy. His autobiography tells of how his baby daughter was strangled by an elastic rope in front of her pramBaby transport
Baby transport consists of devices for transporting and carrying infants. A "child carrier" or "baby carrier" is a device used to carry an infant or small child on the body of an adult...
, and his campaign (with the health editor of The Daily Mirror) to get the pram's specification changed.
Inman's two books: Don't Tell the Patient – Behind the Drug Safety Net, describing his 30 years in drug safety from 1964–94, and his autobiography, Feeling Better Doctor?, give a full account of his life and career.