David Robert Hadden

Professor David Hadden, who died on 26^th February 2014, edited the Ulster Medical Journal from 1984 to 1995, the sixth in a line of Editors recorded in the Journal¹. On taking up the role he instigated modernisation of typeface, cover and illustrations. He had a gift for clear and concise writing which, combined with a genuine desire to support and encourage colleagues, he used to good effect as new authors submitted their first papers to the Journal. After stepping down from the Ulster Medical Journal he became Technical Editor of Diabetic Medicine passing on this role shortly before his death.

Important as his contribution to the Ulster Medical Journal was, it is as an internationally recognised expert on growth, nutrition and diabetes that he will be best remembered. Anticipating the impact of the westernised lifestyle on the epidemic of type 2 diabetes, he set up, in 1972, the Belfast Diet Study, which confirmed that strict adherence to diet alters the natural history of the disease. Subsequently his collaboration with colleagues in Oxford and elsewhere in the UK Prospective Diabetes Study demonstrated for the first time the importance of good control of blood glucose in preventing complications of type 2 diabetes.

His other great contribution was in the management of diabetic pregnancy. The joint diabetes obstetric service he built up was an example copied nationally. He led the involvement of Belfast as major centre and main laboratory in the Hyperglycaemia and Adverse Pregnancy Outcome Study, which highlighted the potentially adverse effects of small increases in blood sugar on the non-diabetic mother – findings that continue to challenge and change practice.

David Hadden came from a well known Irish medical family. His great grandfather was a doctor in Skibbereen, Co Cork, where he treated victims of the Irish potato famine. His grandfather became ship's doctor on an ocean liner, the SS Narnia, bound for Liverpool from New York. The chance event of the ship running aground on Rathlin Island near Ballycastle led to him settling in Northern Ireland and setting up practice in Portadown, where his grandson was born. David Hadden grew up across the road from the practice run by his grandfather, father and aunt. After primary school in the war years, he attended Campbell College, and then medical school at Queen's University, Belfast. Fellow students remember a tendency to be late for lectures often finishing breakfast at the back of the hall, wearing a deerstalker hat in cold weather. Despite this he graduated with honours in 1959, winning the Thomson Medal for top marks in the final examination in medicine.

David Hadden

His training through the early 1960s, in his chosen specialty of endocrinology and diabetes, began in the Royal Victoria Hospital, Belfast. After a Clinical Research Fellowship using the new technique of radioimmunoassay to measure growth hormone, he travelled as Fulbright Fellow to the Johns Hopkins Hospital, Baltimore, USA. His identification and report in the journal Nature of a growth hormone binding protein, although dismissed by conventional thinking at the time, is now recognised as one of the first descriptions of that important regulatory protein. He brought this interest back to Belfast, as the first children with short stature and growth hormone deficiency were treated using growth hormone extracted from human pituitary glands. His own children also remember being lined up in his study each year to have height and weight measured and plotted on a centile growth chart, a tradition later extended to his seven grandchildren.

Continuing his interest in growth and nutrition as MRC Fellow at the Malnutrition Research Unit in Kampala, Uganda, and then the Department of Experimental Medicine in Cambridge under the supervision of Professor RA McCance, he was asked to explore the cause of hypoglycaemia in babies with kwashiorkor. He was able to show that these children were in fact insulin resistant, with abnormally high blood glucose and insulin levels, differing from the more striking cases of total starvation (marasmus). This experience in malnutrition was also carried back to Belfast as he developed his ideas on the treatment of Type 2 diabetes, at least in part a disease of excessive nutrition.

David Hadden with an infant suffering from Kwashiorkor (malnutrition)

Returning to the Metabolic Unit at the Royal Victoria Hospital as Consultant Physician in 1967, he worked there until his retirement in 2001. He was an extraordinarily caring physician, who regarded himself as permanently on-call. The pressure experienced by colleagues from his attention to detail and determination to get things right was balanced by his friendly manner as well as clear personal commitment and example. His clinical work and research covered the full range of endocrinology and diabetes and extended well past formal retirement.

His work and qualities were marked by an Honorary Chair at Queen's University Belfast and lectureships including the 1998 Jorgen Pedersen Lecture of the Diabetes Pregnancy Study Group of the European Association for the Study of Diabetes, the 2006 Norbert Freinkel Lecture of the American Diabetes Association and, in 2012, the first Lifetime Achievement Award of the Irish Endocrine Society. These recognised scientific excellence in the true sense of knowing and sharing work with colleagues.

Of many interests outside medicine, the most memorable was the project to produce Irish linen, possibly inspired by his mother's family, the Johnstons, who had been involved in the linen industry in its heyday. With his wife, Diana, they started by growing flax in a field at their country cottage in Co Down and succeeded, with some difficulty, in arranging for the whole process of retting, spinning and weaving to be done in Northern Ireland. As foreign competition had undermined this once thriving industry, authentic Irish linen had not been manufactured locally for many years.

He is survived by his wife Diana, a doctor and artist, son Robert, neurologist, and daughters Katharine and Emily, engineer and landscape architect respectively.

Professor David Robert Hadden, born May 24^th 1936, died February 26^th 2014