David Barker

Physician and epidemiologist who helped show that chronic diseases have origins in the womb. Born in London, UK, on June 29, 1938, he died of a cerebral haemorrhage in Winchester, UK, on Aug 27, 2013, aged 75 years. David Barker experienced the power of epidemiology first-hand in the late 1960s, when he was living in Uganda and studying the disfiguring mycobacterial infection known as Buruli ulcer disease. It was 7 years after he had qualified as a doctor, and a grant from the UK's Medical Research Council had taken him to Makerere University in Kampala to study the disease, which received wisdom said was mosquito-borne. Barker had his doubts about this hypothesis and carefully observed people who developed the infection. He came to the conclusion that mosquitoes weren't the culprits after all. Instead, it was injuries from the sharp reeds growing near the Nile that triggered Mycobacterium ulcerans infection. “He always talked about that time as giving him confidence in observing things and listening, and that by doing so you could get information that would have an important effect on a lot of people”, says Caroline Fall, Professor of International Paediatric Epidemiology at the University of Southampton, who was Barker's MD student and collaborator. Barker and his family fled Uganda during Idi Amin's time as President. Returning to the UK, he became a senior lecturer in clinical epidemiology at Southampton. His research over the next decade ranged from thyroid disorders and Paget's disease to gallstones and appendicitis. Time and again, says Fall, his work proposed links between the conditions of early life and later disease: “He was fascinated by the way that biology in certain periods of life can have big effects on disease.” In 1979, Barker became Professor of Clinical Epidemiology at Southampton's Medical Research Council Environmental Epidemiology Unit, now the MRC Lifecourse Epidemiology Unit. It was during these years that he noticed the striking resemblance between maps of cardiovascular disease in the 1970s and 1980s, and maps of infant mortality in the 1920s. “That was the serendipitous discovery. It was really as a consequence of looking at the geographic and temporal pattern of non-communicable disease that he stumbled on the notion that the geography of coronary artery disease…was actually very similar to the geography of neonatal and post-neonatal mortality some 70 years earlier”, says Professor Cyrus Cooper, Director of the MRC Lifecourse Epidemiology Unit and Barker's former DM student. Barker and his colleagues, including statistician Clive Osmond, published a study outlining the correlation in The Lancet in 1989, reporting that among 5654 men from Hertfordshire, UK, those with the lowest weights at birth and at age 1 year had the highest death rates from ischaemic heart disease. Barker, who published more than 500 research papers and ten books, wasn't the first researcher to note the link between early life conditions and later disease. But rather than moving on to other research subjects, he made it his life's mission to proselytise the importance of early life to later illness. “He saw how important it was, which other people hadn't. He picked it up and really ran with it”, says Fall. At first, he struggled to get a hearing. The prevailing view was that heart disease, diabetes, and other non-communicable diseases were the result of a person's genetic heritage plus their adult lifestyle. However, Barker stuck to his guns, gathering more data with collaborators in Finland, China, and India, and forming collaborations with developmental physiologists in Adelaide, Auckland, and Toronto. He organised meetings that brought together fetal physiologists and epidemiologists, which later evolved into the International Society for Developmental Origins of Health and Disease. “His science was important but the reason he has had so much impact is because of his missionary zeal. He really brought to the world's attention the role of early development and its relationship to longer term consequences”, says Professor Sir Peter Gluckman, one of Barker's collaborators, now Chief Science Advisor to the Prime Minister of New Zealand. The field Barker championed in the face of controversy has since blossomed and has had a major impact on health policy internationally. Barker had a quick wit and a huge repertoire of jokes that helped him create an academically fruitful environment. He is also remembered by colleagues as an empowering leader. “What he did was say ‘I trust you, go off and do it’. He gave you enormous confidence by giving you that free rein to go off and do things”, says Fall. A fellow of the Royal Society and the Academy of Medical Sciences, he was awarded a CBE in 2006. Barker's first wife, Angela, died in 1980. He is survived by his second wife, Jan, five children from his first marriage, three stepchildren from his second, and 13 grandchildren.