Obituaries for Graham Dukes  (2 November 1930 –  13 August 2023) and  Elisabet Helsing (1940-2019)

IBFANers will be sad to learn of the passing of Graham Dukes, who was married to the Elisabeth Helsing – the ‘mother’ of breastfeeding in Norway!  Here are some obituaries for both these marvellous people.

 

Obituary in Memory of Dr. Elisabet Helsing

Dr Elisabet Helsing DrMedSci (3 June 1940 – 26 January 2019)

 

Elisabet Helsing, born in Oslo in 1940, began her working life as a school teacher. It was while nursing her own two children that she developed a strong interest in protecting, promoting and supporting breastfeeding. Backed by a young medical officer in the Norwegian National Directorate of Health, Gro Harlem Brundtland –later Norway’s Prime Minister and Director-General of the World Health Organization (WHO) ‒she developed official pamphlets with practical advice for mothers on how to succeed at breastfeeding. In 1968, she founded Ammehjelpen, the mother-to-mother breastfeeding support group, which rapidly expanded across the country and was credited with the dramatic rise in breastfeeding in Norway over the subsequent decade. In 1969, she enrolled in nutrition studies at the University of Oslo to bolster her scientific credentials and lend weight to her campaign for breastfeeding. Her interests grew to nutrition policy more broadly, something later reflected in her doctorate from the University of Athens in 1989 where she compared the evolving national nutrition policy in Norway and Greece.

Elisabet’s international career started in Norway in 1973, through the FAO-led Freedom from Hunger Campaign, for which she organized international conferences and awareness-raising on international nutrition issues. At the 1974 World Food Conference she convinced the Norwegian Minister of Agriculture to propose breastmilk as acommodityto be accounted for in national food balance sheets, highlighting its economic value. Later, in Niger, she worked on emergency nutrition relief with the International League of Red Cross Societies and the national ministry of health. In Bangladesh, with the World Food Programme, she supervised the implementation of a feeding programme for over half a million women and children. On a private basis  she started a self-help project for women (Nijera Kori, “we do it ourselves”),which developed into a well-known national activist NGO, still operating today.

Between 1978 and 1981, Elisabet coordinated a Norwegian Agency for Development Cooperation (NORAD) project to investigate the potential use of fish-protein concentrate in emergency relief worldwide (and concluded in the negative). In 1980 to 1981, she also coordinated an international multi-centre study on breastfeeding among working mothers in Brazil, Sri Lanka and Tanzania, hosted by the Institute for Nutrition Research at the University of Oslo. From 1981 to 1984, she worked as a Senior Executive Officer in the Norwegian National Directorate of Health on international nutrition-related questions. This inclued collaboration with WHO on  the implementation of the International Code of Marketing of Breast-milk Substitutes, often in the face of strong industry opposition.

In 1984, Elisabet  became the first regional adviser for nutrition in the WHO Regional Office for Europe in Copenhagen. During her 12 years in the job, she raised the profile of nutrition-policy development and implementation. With the breakup of the Soviet Union in 1990, there were even more demands on her time and creativity with the addition of twenty new Europen states. She spearheaded the roll-out of the Baby-friendly Hospital Initiative (BFHI), strengthened nutrition surveillance and dietary surveys, and was an early adopter of emerging issues such as the rise in obesity. Elisabet further helped to found the World Alliance for Breastfeeding Action (WABA) in 1991, taking on a number of leadership roles. It was also while in WHO that she met her husband, Dr. Graham Dukes, a WHO medico-legal expert on the side-effects of drugs, with whom she shared the rest of her life and numerous common interests.

Back in Norway, in 1996, Elisabet remained engaged in issues relating to infant nutrition, advising Norwegian government agencies as a senior executive officer at the Norwegian Board of Health’s Section for International Affairs and Public Health. She lectured and supervised students at the University of Oslo and took an interest in breastfeeding as a human right both of the mother and the child. From 1999 to 2003, she served as president of the Federation of European Nutrition Societies (FENS).

Elisabet has authored numerous books, contributions and scientific papers, training materials for health workers and practical guides for mothers. In 2003, she was awarded the Norwegian King’s Medal of Merit in Gold for extraordinary services to the people through her work to promote breastfeeding. Her work is all the more impressive when one considers that it came about under the shadow of “Mr P”, as she called the Parkinson’s disease that afflicted her early in life. She never let “Mr P” restrict her professional life, however.

Elisabet Helsing’s contributions to public health nutrition and breastfeeding, in particular, are numerous and indelible. She was always willingly to share her profound knowledge, experience and enthusiasm, to the benefit of her many colleagues, students and friends in the field of nutrition, who have been inspired and moved by her. She will be truly missed by many – in  Norway and in the international nutrition community.

Authored by Kaia Engesveen and Wenche Barth Eide, with Anne Bærug, Grete Botten, Siri Damman, Gerd Holmboe-Ottesen, Isatou Jallow, Kaare R. Norum, Nanna Lien, Arne Oshaug, Jan Ivar Pedersen, Dag S. Thelle, Liv Elin Torheim and Margareta Wandel

Prof Dr Maurice Nelson Graham Dukes was a physician and a lawyer, trained at Cambridge University in Britain and Leiden in the Netherlands. He has worked in drug research, national drug regulation, the World Health Organization, and a consultant for pharmaceutical policies and legal matters. His PhD thesis (Leiden,1963) was on Patent Medicines and Self-Medication.

He started as a Clinical Investigator (latterly Research Manager) of Organon International (1961-1972), and then switched to the Dutch Regulatory Agency, where he became Vice Chairman and Medical Director (1972-1982). He continued his career as Regional Officer for Pharmaceuticals, World Health Organization (Europe) 1982-1991, and became  Director of the Regional Programme, 1987 onwards.  He became Professor of Drug Policy Studies, University of Groningen, in 1986, and Lecturer on Drug Policies, University of Oslo in 1997.He became a senior consultant on drug policy to the World Bank and did missions to many African, Asian and Central European countries. Member of Expert Group on Pharmaceuticals Policy, World Health Health Organization, 2004-2008 (ongoing) Member of International Scientific Advisory Group, U.S. Pharmacopoeia, 2006-2010. Graham was a skilful writer. Among his principal Books and publications:

• Author, The Law and Ethics of the Pharmaceutical Industry (2005)
• Lead author, Drugs and Money (for W.H.O.)  (7th edition, March 2003, preparation for 8th Edition 2008)
• Lead author, Responsibility for Drug-Induced Injury  (1988, Second Edition 1998)
• Editor, Meyler’s Side Effects of Drugs (1975-2006)
• Editor, Side Effects of Drugs Annuals  (1977-1993)
• Author, Drug Utilization Studies (1993)
• Co-Author: Vitamins and Minerals: A Policy Outline (1992)
• Author: Side Effects of Drugs Essays (1991)
• Author: The Effects of Drug Regulation (1985)
• Editor, Int. Journal of Risk & Safety in Medicine 1990-date
• Editor, Medicines and Money (World Health Organization) 1985-date (ongoing – new edition 2008)
• With Elisabet Helsing: A Short History of Eating

But he also wrote non-technical books:  Nursery Rhymes for an Improvable World (2005), and Ghost Story – the History of a Remarkable Car (2007) He authored also many scientific papers. See for example Pubmed and ResearchGate:

https://pubmed.ncbi.nlm.nih.gov/?term=dukes+mn&sort=date

https://www.researchgate.net/scientific-contributions/M-N-Graham-Dukes-34824551

In 2000 he was appointed Officer in the Royal Order of Orange-Nassau.  Graham was married with Elisabet Helsing, and was a close friend to Inga Lunde. Graham will be buried 23 August 2023 in Oslo.

Thanks to Wilbert Bannenberg, HAI Europe Association for alerting us to this news.

Prins Bernhardstraat 1, 5571 GC Bergeijk, the Netherlands

wilbert@haieurope-association.org;

Mob/WhatsApp/Facetime +31 6 20873123; Skype: wilbertb1

Tue 18 Feb 2003 01.33 GMT

Graham Dukes, scientist: The big drug companies exaggerate the cost of research and, in any case, concentrate their expenditure on medicines for people in rich countries

Sarah Boseley, the Guardian

Tue 18 Feb 2003

Graham Dukes won’t have it. He is a long-standing, seasoned observer – one time player – of the pharmaceutical industry and he doesn’t accept their bottom line. The drug company mantra is that without high-priced drugs carrying 20-year patents, there will be no new medicines because they just cannot recoup the vast costs of research and development. Nonsense, says Professor Dukes.

Fallacy number one is that it costs as much as $800m to develop a new drug. That figure came in November 1991 from the Tufts Center for the Study of Drug Development, which receives 65% of its funding from drug companies. It’s the top of the scale – estimates from other studies have varied from $10m to $600m.

“The figures vary so widely that most of them must be wrong,” says Dukes, professor of pharmacotherapy at the University of Oslo in Norway. Many of them include the costs of advertising, marketing and sales, and half the Tufts figure is “opportunity costs of capital” – what the money would have earned if it had been invested in something else instead. No, says Dukes – a reasonable figure to settle on would be somewhere between $100m and $200m per new drug.

So what do we get for that money? Dukes, who was once research manager of the Dutch company Organon, says we have a right to ask the question. The drug giants may be private companies, but they receive tax breaks, benefit from publicly-funded research in our universities and collect a great deal of our money – privately or via the NHS in the UK – in payment for their medicines, which are launched at very high prices.

Yet the really exciting, innovative drugs which make a difference to the health of the people of the planet are not coming through, he says. “I have heard people from the industry say in public that if you look back over 10 years there have only been three or four real breakthroughs. Then they mention Viagra or drugs for rheumatism. “There is something fundamentally wrong. Whether you can say the job is being inefficiently tackled by the industry or they have had bad luck it is difficult to say.”

He cites a study from the National Institute for Health Care Management in the US which showed that roughly 86 new drugs were approved by the Food and Drugs Administration (FDA) every year between 1989 and 2000. Only about 30 each year were new entities – as opposed to “me too” versions of other companies’ existing drugs with slight differences to make them patentable. Only about a dozen each year were fast-tracked by the FDA as potentially important to medical science and in more recent years, the numbers of those have been dropping. In 2001, seven were fast tracked: one was a new Aids drug and the rest promised help to small groups of patients suffering unusual conditions. If that year was fairly typical, and Dukes thinks it was, then it follows that few new drugs of the sort being launched today will make a major impact on the health even of the wealthiest people in the world. And because the drug companies’ research efforts are heavily focused on the needs of an ageing western population, they won’t save lives in poor countries either.

Even as capitalist, money-making enterprises geared only to the wallets of their shareholders, the drug companies have been coming under criticism for the dearth of new blockbusters. This may just be a lull before another big breakthrough, but there are jitters and wobbly share prices around. But increasingly, says Dukes, the wider public is questioning the actions and motivations of an industry which has a vast power for good and enormous profits – the highest of any on the planet.

The way forward, he suggests, is for the industry to start focusing on the neglected tropical diseases that kill so many in poor countries and stymie development. New drugs are needed for tuberculosis and malaria, where resistance is stripping the old ones of their power. New drugs are desperately wanted for diseases that kill and maim like leishmaniasis, which affects 12 million and kills 500,000 without treatment. GlaxoSmithKline’s drug Pentostam costs a phenomenal $150 per patient, but causes a severe reaction in 10% and sometimes death. All doctors have for sleeping sickness is arsenic, which kills many of those it is supposed to cure.

Not only is it morally right, Dukes argues, but it could help solve the drug industry’s problems. “If more of a long-term view is taken, there are developing countries that really are developing. If you are willing to put those drugs they need on the market at very low prices, there will be a reward.” But, he fears, “the idea of large volume turnover with small percentage returns is foreign to the thinking of the drugs industry.”