British Journal of Addiction (1992) 87, 851-855
JOURNAL INTERVIEW 31
Conversation with Hans Halbach In this occasional series we record the views and personal experience ofpeople who have specially contributed to the evolution of ideas in the Journal's field of interest. Professor Halbach contributed over many years to WHO'S programme on drug misuse and the formation of international policies. For 15 years he was editor of Drug and Alcohol Dependence.
BJA: Tell me a little about how you started in the addictions, your training and how you got interested in the whole area? HH: I started in an area which in those days had hardly anything to do with psychology or behaviour, but I was in one of the best schools of chemistry in Europe, with Hans Fischer, Munich, Nobel Prize winner for the elucidation of the chemical structure of blood and leaf pigments. The work was tough but exciting. After a doctorate in chemistry I studied medicine. By the time I had passed the exams in medicine the war broke out. The better part of the war was spent in aviation medicine. The problems were how to survive in high altitudes, how much oxygen do you need, how high can you go up without or with oxygen. There were many theoretical aspects, too. An example: the Allied Airforces had dropped leaflets telling the German pilots that flying at very high altitudes in pressurized cabins could be quite dangerous because if the cabin is shot at, the sudden de-pressurization would have an effect such as the disintegration of a deep-sea fish brought up to the surface. A bit exaggerated. I tried to find out. There is a contraption where you can have yourself shot up in no time to simulated high altitudes. I did it up to 19 km and nothing happened except for the trouble through lack of oxygen. It is still a world record, I believe. After the war I joined the Institute of Pharmacology, University of Munich. It had been severely bombed and had to be rebuilt from almost nothing. In the beginning experimental scientific work was hardly feasible, except for teaching. In the early 1950s I somehow got excited about the 'cocktail liytique', a French
invention based on chlorpromazine (the first antipsychotic), mixed with other substances to protect vital functions. That opened up an entirely new era of anaesthesiology, and I developed a collaboration with anaesthetists as a pharmacologist providing the theoretical basis for their techniques. When in 1954 the World Health Organization looked for a successor to the retiring chief of the Section on Addiction Producing Drugs, I accepted the job, inter alia because the salary of an assistant professor could hardly support a family with three children. BJA: Tell me about how you began to enter WHO work at that stage? HH: In those days, WHO's business, as inherited from the League of Nations, was to advise the United Nation's Commission on Narcotic Drugs as to which drugs should be controlled under the various international treaties for 'narcotics control'. Soon new developments required a thorough overhaul of these treaties. In the course of redrafting WHO was to point out that classification on the basis of chemical similarity is impossible, and that the salient criterion for control is the drug's impact on individual and social or public health—now an evident truth. It was in this context and in the 1959 Kelynak Lecture that I coined the phrase "drugindividual-society" as a triangular model, now a platitude of course. Speaking of dangerousness: as a corollary of control, quite a few doctors, in order to avoid cumbersome prescription writing and because they are afraid of dependence development, appear to refrain from prescribing opiates when they are indicated. This is deplorable. So we tried to forestall
851
852
Journal Interview
that by bringing into the Psychotropics (Vienna) Convention, the notion of therapeutic usefulness versus dangerousness. The greater the relative usefulness the less strict the control. WHO also saw to it that in both the Single and Vienna Conventions, the requirements of prevention and treatment were not entirely forgotten. In all this I had invaluable assistance from Expert Committees with key figures such as Nathan Eddy and Dale Cameron of the Committee on Problems of Drug Dependence (US National Academy of Science), and Fraser, Isbell, Martin, Wikler, and others from the Addiction Research Centre, Lexington.
BJA: Would you be able to differentiate the role of controls in the developing and developed world, or do you think that there should be international controls across the board.' HH: The international control provisions are binding upon the parties to these treaties; there is no distinction. Practically the whole world is now Party to the Single Convention. About 80% adhere to the Vienna Convention. Attitudes were, however, different. When the Single Convention was being prepared, countries who had been or still were producing opium, said that to reduce production of opium would mean economic loss. The new treaty, they argued, should specifically cover new synthetic drugs which were more dangerous than the opiates, BJA: / suppose there were also other issues besides more difficult to control and from which the developing world (the victims of the old treaties) control through international conventions? HH: After those conventions had been adopted by wanted to be protected. This was in general the the majority of countries the UN Fund for Drug voice of the developing countries. To obviate this Abuse Control (UNFDAC) was established. It discrimination we demonstrated in a study with helped countries to live up to their obligations under N. B. Eddy and O. Braenden that synthetic drugs the treaties and also to reduce the production of with morphine-like effects are as good and as bad, as illicit drugs, for instance by growing tea or vege- a class, as the drugs of natural origin. It is though tables instead of opium or coca, a project which, by easier to control laboratories and factories than a the way, was not a great success. One realized that whole agricultural region. Early in this century an reducing the supply of drugs ought to be comple- American bishop was moved to pity by the poor mented by curtailing the demand, a formidable task people in the Philippines who were on opium. This involving the assessment of the circumstances of the triggered the first treaty, the Hague Convention. If demand. So WHO started epidemiological studies in those days the opium-producing countries had on drug use and abuse and issued a series of been as concerned about alcohol as Western coundocuments with targets and methodology for further tries were concerned about opium, we might have work. There is one aspect which I think has not been had an international convention on alcohol. given enough attention, and that is in relation to control. That is the matter of acculturation of the BJA: Tell me something about setting up the journal, use of a drug. There are some classic examples. Drug and Alcohol Dependence, which you have When the Incas chewed coca leaves ritually nothing edited for over 15 years. bad happened. When the tin mines came and the HH: It was launched in 1975. The director of the labourers were paid out with coca leaves, the trouble publishing company Elsevier-Sequoia in Lausanne began. Immigrants to the Maghreb who had been was aware of the activities of the International using marihuana moderately in their southern home Council on Alcohol and Addictions. We sat together countries exaggerated their consumption, with con- with the Tongues and Mr Bergmans from Elsevier, sequent troubles under the new environmental and after an enquiry among the international circles pressures. Conversely, khat, a traditional stimulant concerned, I thought I might give it a try. But the in the Red Sea area, produced no problems when journal should be scientific and international. That's used in London or New York by immigrants from what I hope it is today, at least to a large extent. those areas who might thus even be protected from heroin. The prohibition of a more or less accultuBJA: Do you get a similar proportion of papers on rated drug has sometimes created greater problems. drugs and alcohol.^ No sooner had Iran and Thailand prohibited, under HH: It's half and half. The United States provide international pressure, the smoking and eating of quite a proportion of the contributions. opium, without preparing the people for such a drastic intervention, than heroin occupied the vaBJA: What are the reasons that the Americans are so cuum and created much greater problems. productive?
Journal Interview HH: There are probably several reasons. They were the first to have national control laws like the Harrison Act. Secondly, they were the first to have well-organized research: remember Eddy in the National Institute of Health. And then they had this unique setting in Lexington. Perhaps the Americans had a more pragmatic approach and were more interested in the mechanisms of dependence and tolerance. BJA: What do you see as the role of ICAA? HH: ICAA was established as a world-wide organization to help solve the problems of alcoholism. It was only with the WHO Expert Committee report on Services for the Prevention and Treatment of Dependence on Alcohol and Other Drugs, 1967, which advocated the so-called combined approach, that ICAA resolved to deal with drug addiction too. That expert committee was a joint effort of my unit and the Mental Health Unit. As a pharmacologist I had always thought it was not reasonable to make this clear separation in view of the similarities, pharmacologically and otherwise, between alcohol and other drugs. Experience in the area of alcoholism might be applicable, mutatis mutandis, to drug abuse and dependence. After the extension of its programme ICAA entered into an official relationship with WHO as a non-governmental organization (NGO). In this capacity ICAA has been attending WHO meetings, expert committees, and scientific groups more or less regularly, but I do not think there has been much material input of information or research data. I feel that is not their strength. ICAA is an agency operating either by itself or helping governments or other bodies to organize conferences and courses of regional or international character on matters of alcoholism and drug abuse, and contributing to information, education and inspiration. BJA: Do you think people concerned about drugs at WHO were aware of Jellinek? HH: Yes, definitely. Between 1951 and 1954 there were four WHO expert committees on alcoholism, all with Jellinek's participation, and a seminar on alcohol in Beirut, arranged by my predecessor P. O. Wolff. In the third report of the expert committee the stages of alcoholism according to Jellinek were defined. So in those days within WHO there was an acute interest in alcoholism. However, when I joined WHO I was not encouraged to continue this line, possibly in order to avoid entanglement with lay organizations.
853
BJA: But what about drugs and alcohol in WHO now? HH: To accommodate the international narcotics control organs of the UN, definitions of drug addiction and habituation had been devised by WHO. They were outdated and had to be replaced by up-to-date descriptions, since definitions are strictly possible in the exact sciences only. Besides, the term 'addict' was emotionally loaded with untoward consequences for the individual concerned. Instead, the term 'dependence' was elected as the common criterion in describing groups (categories) of substances liable to be abused. Of course, alcohol was included. \
BJA: As I understand it, drugs and alcohol were part of the Mental Health Division in WHO? HH: After several years of abstention WHO revived its interest in alcoholism. Joy Moser of the Mental Health Division admirably collected information from wherever it was available and put it in some order. The resulting reports and WHO offset publications gave an insight into the problem on a global level.
BJA: Do you think the Mental Health Division was the place for drugs and alcohol? HH: After I had retired from WHO the functions were separated administratively. Questions relating to international control were left in the unit of drug dependence within the Division of Prophylactic and Therapeutic Substances (previously the Division of Pharmacology and Toxicology which I headed) and whose terms were considered incompatible with W H O ' S orientation towards developing countries. Later on the control business was again transferred to a new Division of Drug Policy and Management. The clinical and social side was given to the Mental Health Division. This administrative separation between two entirely different divisions was frankly deplorable. If the control people are left to themselves they may not be aware of the effects of control on consumption, treatment or prevention.*
'Shortly after this interview had taken place all the facets of drug abuse and control were again assembled together in the new Programme on Substance Abuse (PSA) "to emphasize WHO's strong commitment to combat drug abuse and to intensify action in this and the related area of alcohol abuse". Hopefully, the new setup will restore a reasonable balance between the prohibition/control and the preventive/curative approach.
854
Journal Interview
BJA: Tell me, you left WHO in 1970 and then went onto ...? HH:... Hoffman LaRoche in Basle, as a consultant. One of their strong points was (and still is) the development of psychoactive drugs including, of course, basic research into the mechanisms of action. The consultation concerned ways and means of ascertaining the efficacy and safety of drugs, not only psychoactives, touching in many respects on the programme in drug efficacy and safety which I had developed in WHO after Dale C. Cameron had taken over the responsibility for drug dependence and abuse.
interest, the European competence in research is considerable. One might ask whether the unification of Europe will have an impact just on European research as such, or in regard to the rest of the world. There are many international links already. Roche, for example, has two excellent and completely independent research institutes, one in Switzerland and one in the USA, where they do basic research which has no immediate connection whatsover with the development of drugs. Three Nobel Prizes came from the Basle Institute. There are many research-oriented drug companies on both sides of the Atlantic.
BJA: So really your career has been as an academic pharmacologist and physician? HH: Physician for a short time during the war because, as I said, I had just finished my medical training when the war broke out.
BJA: What do you think we can learn from Eastern Europe? HH: Now, what is Eastern Europe? Until a couple of years ago you could define it by the iron curtain. What we can learn at present is difficult to say but we should keep our eyes open.
BJA: Did you manage to do research of a pharmacological nature, or supervise research, while you BJA: WHO has got this slogan "Health for all by the were working for WHO? year 2000". It seems to me that it is going to be quite HH: All the WHO recommendations and decisions hard for them to reach that in the drugs and alcohol regarding narcotics and psychotropics control were field. based on results of scientific research. Already in HH: Obviously it could not mean that by the year 1958 I suggested that not only the dependence- 2000 everyone is going to be healthy and no-one will producing drugs should be screened, but all kinds of be ill any more. What it means is that appropriate untoward drug effects deserved attention and ways health care ought to be available to everyone. The and means should be sought to get hold of definition in the WHO constitution of health as the information at the earliest possible stage, as was highest possible level of physical, mental, and social done in regard to dependence liability. It took 3 well-being is also often misunderstood. It means, of years for the thalidomide disaster to convince the course, the highest level under the prevailing administration of WHO, and governments, of the circumstances. There could not be any idea of urgent need for action. As an immediate measure an ridding the world of drug and alcohol abuse within international system was developed for the collec- the next 8 years, but WHO must work toward tion of early information on adverse drug reactions ensuring that the highest attainable standards in including data pertinent to drug abuse. As a regard to prevention and treatment of substance corollary the principles and requirements of the pre- misuse are reached. clinical and clinical study of safety and efficacy were laid down in a series of expert reports. These texts BJA: What about the WHO as an international were well received, especially where governmental research collaboration centre? regulations hardly existed. The WHO unit of Drug HH: Traditionally WHO has entertained collaboraDependence became the Division of Pharmacology tive research programmes in almost every one of its and Toxicology, with 'Drug Dependence' under activities. Nevertheless, in the mid-1960s DirectorDale Cameron as one section among others. The General Candau wanted to give the organization a new activities led also to contacts with the pharma- solid scientific base. A WHO Medical Research ceutical industry. Centre was envisaged. The British were very interested, and the Scots even more so; they wanted BJA: Do you think that in 1992 and with Europe to have it in Edinburgh. In 1967 a Division of attempting to unite in some way, that this will act Research in Epidemiology and Communication scientifically and research-wise as a powerful force? Science was established at WHO Headquarters in HH: Quite broadly, not only in regard to our area of Geneva. To begin with, a high-powered scientific
Journal Interview staff developed mathematical models and refined statistical methods. I had hoped that with their help the drug monitoring project could become a truly epidemiological exercise. Alas, after initial enthusiasm this global research enterprise fell apart. Perhaps it was too sophisticated. Besides, WHO's basic orientation changed when the new DirectorGeneral introduced himself and his goal of doing away with the social injustice in the world. BJA: If you were choosing your career again? HH: I grew up in an area of heavy industries, coal
855
and steel, and felt that science was the thing to do, and chose to begin with the fundamental discipline of chemistry. I told you how I got into medicine and how the circumstances brought me into the business of international administration, coupled with science. If I were to choose a career now I would probably wish to base it on a broad education in natural sciences. BJA: What sort offamily did you come from? HH: A family of printers and bookmakers, since 1832.
JOURNAL INTERVIEW 31
Conversation with Hans Halbach In this occasional series we record the views and personal experience ofpeople who have specially contributed to the evolution of ideas in the Journal's field of interest. Professor Halbach contributed over many years to WHO'S programme on drug misuse and the formation of international policies. For 15 years he was editor of Drug and Alcohol Dependence.
BJA: Tell me a little about how you started in the addictions, your training and how you got interested in the whole area? HH: I started in an area which in those days had hardly anything to do with psychology or behaviour, but I was in one of the best schools of chemistry in Europe, with Hans Fischer, Munich, Nobel Prize winner for the elucidation of the chemical structure of blood and leaf pigments. The work was tough but exciting. After a doctorate in chemistry I studied medicine. By the time I had passed the exams in medicine the war broke out. The better part of the war was spent in aviation medicine. The problems were how to survive in high altitudes, how much oxygen do you need, how high can you go up without or with oxygen. There were many theoretical aspects, too. An example: the Allied Airforces had dropped leaflets telling the German pilots that flying at very high altitudes in pressurized cabins could be quite dangerous because if the cabin is shot at, the sudden de-pressurization would have an effect such as the disintegration of a deep-sea fish brought up to the surface. A bit exaggerated. I tried to find out. There is a contraption where you can have yourself shot up in no time to simulated high altitudes. I did it up to 19 km and nothing happened except for the trouble through lack of oxygen. It is still a world record, I believe. After the war I joined the Institute of Pharmacology, University of Munich. It had been severely bombed and had to be rebuilt from almost nothing. In the beginning experimental scientific work was hardly feasible, except for teaching. In the early 1950s I somehow got excited about the 'cocktail liytique', a French
invention based on chlorpromazine (the first antipsychotic), mixed with other substances to protect vital functions. That opened up an entirely new era of anaesthesiology, and I developed a collaboration with anaesthetists as a pharmacologist providing the theoretical basis for their techniques. When in 1954 the World Health Organization looked for a successor to the retiring chief of the Section on Addiction Producing Drugs, I accepted the job, inter alia because the salary of an assistant professor could hardly support a family with three children. BJA: Tell me about how you began to enter WHO work at that stage? HH: In those days, WHO's business, as inherited from the League of Nations, was to advise the United Nation's Commission on Narcotic Drugs as to which drugs should be controlled under the various international treaties for 'narcotics control'. Soon new developments required a thorough overhaul of these treaties. In the course of redrafting WHO was to point out that classification on the basis of chemical similarity is impossible, and that the salient criterion for control is the drug's impact on individual and social or public health—now an evident truth. It was in this context and in the 1959 Kelynak Lecture that I coined the phrase "drugindividual-society" as a triangular model, now a platitude of course. Speaking of dangerousness: as a corollary of control, quite a few doctors, in order to avoid cumbersome prescription writing and because they are afraid of dependence development, appear to refrain from prescribing opiates when they are indicated. This is deplorable. So we tried to forestall
851
852
Journal Interview
that by bringing into the Psychotropics (Vienna) Convention, the notion of therapeutic usefulness versus dangerousness. The greater the relative usefulness the less strict the control. WHO also saw to it that in both the Single and Vienna Conventions, the requirements of prevention and treatment were not entirely forgotten. In all this I had invaluable assistance from Expert Committees with key figures such as Nathan Eddy and Dale Cameron of the Committee on Problems of Drug Dependence (US National Academy of Science), and Fraser, Isbell, Martin, Wikler, and others from the Addiction Research Centre, Lexington.
BJA: Would you be able to differentiate the role of controls in the developing and developed world, or do you think that there should be international controls across the board.' HH: The international control provisions are binding upon the parties to these treaties; there is no distinction. Practically the whole world is now Party to the Single Convention. About 80% adhere to the Vienna Convention. Attitudes were, however, different. When the Single Convention was being prepared, countries who had been or still were producing opium, said that to reduce production of opium would mean economic loss. The new treaty, they argued, should specifically cover new synthetic drugs which were more dangerous than the opiates, BJA: / suppose there were also other issues besides more difficult to control and from which the developing world (the victims of the old treaties) control through international conventions? HH: After those conventions had been adopted by wanted to be protected. This was in general the the majority of countries the UN Fund for Drug voice of the developing countries. To obviate this Abuse Control (UNFDAC) was established. It discrimination we demonstrated in a study with helped countries to live up to their obligations under N. B. Eddy and O. Braenden that synthetic drugs the treaties and also to reduce the production of with morphine-like effects are as good and as bad, as illicit drugs, for instance by growing tea or vege- a class, as the drugs of natural origin. It is though tables instead of opium or coca, a project which, by easier to control laboratories and factories than a the way, was not a great success. One realized that whole agricultural region. Early in this century an reducing the supply of drugs ought to be comple- American bishop was moved to pity by the poor mented by curtailing the demand, a formidable task people in the Philippines who were on opium. This involving the assessment of the circumstances of the triggered the first treaty, the Hague Convention. If demand. So WHO started epidemiological studies in those days the opium-producing countries had on drug use and abuse and issued a series of been as concerned about alcohol as Western coundocuments with targets and methodology for further tries were concerned about opium, we might have work. There is one aspect which I think has not been had an international convention on alcohol. given enough attention, and that is in relation to control. That is the matter of acculturation of the BJA: Tell me something about setting up the journal, use of a drug. There are some classic examples. Drug and Alcohol Dependence, which you have When the Incas chewed coca leaves ritually nothing edited for over 15 years. bad happened. When the tin mines came and the HH: It was launched in 1975. The director of the labourers were paid out with coca leaves, the trouble publishing company Elsevier-Sequoia in Lausanne began. Immigrants to the Maghreb who had been was aware of the activities of the International using marihuana moderately in their southern home Council on Alcohol and Addictions. We sat together countries exaggerated their consumption, with con- with the Tongues and Mr Bergmans from Elsevier, sequent troubles under the new environmental and after an enquiry among the international circles pressures. Conversely, khat, a traditional stimulant concerned, I thought I might give it a try. But the in the Red Sea area, produced no problems when journal should be scientific and international. That's used in London or New York by immigrants from what I hope it is today, at least to a large extent. those areas who might thus even be protected from heroin. The prohibition of a more or less accultuBJA: Do you get a similar proportion of papers on rated drug has sometimes created greater problems. drugs and alcohol.^ No sooner had Iran and Thailand prohibited, under HH: It's half and half. The United States provide international pressure, the smoking and eating of quite a proportion of the contributions. opium, without preparing the people for such a drastic intervention, than heroin occupied the vaBJA: What are the reasons that the Americans are so cuum and created much greater problems. productive?
Journal Interview HH: There are probably several reasons. They were the first to have national control laws like the Harrison Act. Secondly, they were the first to have well-organized research: remember Eddy in the National Institute of Health. And then they had this unique setting in Lexington. Perhaps the Americans had a more pragmatic approach and were more interested in the mechanisms of dependence and tolerance. BJA: What do you see as the role of ICAA? HH: ICAA was established as a world-wide organization to help solve the problems of alcoholism. It was only with the WHO Expert Committee report on Services for the Prevention and Treatment of Dependence on Alcohol and Other Drugs, 1967, which advocated the so-called combined approach, that ICAA resolved to deal with drug addiction too. That expert committee was a joint effort of my unit and the Mental Health Unit. As a pharmacologist I had always thought it was not reasonable to make this clear separation in view of the similarities, pharmacologically and otherwise, between alcohol and other drugs. Experience in the area of alcoholism might be applicable, mutatis mutandis, to drug abuse and dependence. After the extension of its programme ICAA entered into an official relationship with WHO as a non-governmental organization (NGO). In this capacity ICAA has been attending WHO meetings, expert committees, and scientific groups more or less regularly, but I do not think there has been much material input of information or research data. I feel that is not their strength. ICAA is an agency operating either by itself or helping governments or other bodies to organize conferences and courses of regional or international character on matters of alcoholism and drug abuse, and contributing to information, education and inspiration. BJA: Do you think people concerned about drugs at WHO were aware of Jellinek? HH: Yes, definitely. Between 1951 and 1954 there were four WHO expert committees on alcoholism, all with Jellinek's participation, and a seminar on alcohol in Beirut, arranged by my predecessor P. O. Wolff. In the third report of the expert committee the stages of alcoholism according to Jellinek were defined. So in those days within WHO there was an acute interest in alcoholism. However, when I joined WHO I was not encouraged to continue this line, possibly in order to avoid entanglement with lay organizations.
853
BJA: But what about drugs and alcohol in WHO now? HH: To accommodate the international narcotics control organs of the UN, definitions of drug addiction and habituation had been devised by WHO. They were outdated and had to be replaced by up-to-date descriptions, since definitions are strictly possible in the exact sciences only. Besides, the term 'addict' was emotionally loaded with untoward consequences for the individual concerned. Instead, the term 'dependence' was elected as the common criterion in describing groups (categories) of substances liable to be abused. Of course, alcohol was included. \
BJA: As I understand it, drugs and alcohol were part of the Mental Health Division in WHO? HH: After several years of abstention WHO revived its interest in alcoholism. Joy Moser of the Mental Health Division admirably collected information from wherever it was available and put it in some order. The resulting reports and WHO offset publications gave an insight into the problem on a global level.
BJA: Do you think the Mental Health Division was the place for drugs and alcohol? HH: After I had retired from WHO the functions were separated administratively. Questions relating to international control were left in the unit of drug dependence within the Division of Prophylactic and Therapeutic Substances (previously the Division of Pharmacology and Toxicology which I headed) and whose terms were considered incompatible with W H O ' S orientation towards developing countries. Later on the control business was again transferred to a new Division of Drug Policy and Management. The clinical and social side was given to the Mental Health Division. This administrative separation between two entirely different divisions was frankly deplorable. If the control people are left to themselves they may not be aware of the effects of control on consumption, treatment or prevention.*
'Shortly after this interview had taken place all the facets of drug abuse and control were again assembled together in the new Programme on Substance Abuse (PSA) "to emphasize WHO's strong commitment to combat drug abuse and to intensify action in this and the related area of alcohol abuse". Hopefully, the new setup will restore a reasonable balance between the prohibition/control and the preventive/curative approach.
854
Journal Interview
BJA: Tell me, you left WHO in 1970 and then went onto ...? HH:... Hoffman LaRoche in Basle, as a consultant. One of their strong points was (and still is) the development of psychoactive drugs including, of course, basic research into the mechanisms of action. The consultation concerned ways and means of ascertaining the efficacy and safety of drugs, not only psychoactives, touching in many respects on the programme in drug efficacy and safety which I had developed in WHO after Dale C. Cameron had taken over the responsibility for drug dependence and abuse.
interest, the European competence in research is considerable. One might ask whether the unification of Europe will have an impact just on European research as such, or in regard to the rest of the world. There are many international links already. Roche, for example, has two excellent and completely independent research institutes, one in Switzerland and one in the USA, where they do basic research which has no immediate connection whatsover with the development of drugs. Three Nobel Prizes came from the Basle Institute. There are many research-oriented drug companies on both sides of the Atlantic.
BJA: So really your career has been as an academic pharmacologist and physician? HH: Physician for a short time during the war because, as I said, I had just finished my medical training when the war broke out.
BJA: What do you think we can learn from Eastern Europe? HH: Now, what is Eastern Europe? Until a couple of years ago you could define it by the iron curtain. What we can learn at present is difficult to say but we should keep our eyes open.
BJA: Did you manage to do research of a pharmacological nature, or supervise research, while you BJA: WHO has got this slogan "Health for all by the were working for WHO? year 2000". It seems to me that it is going to be quite HH: All the WHO recommendations and decisions hard for them to reach that in the drugs and alcohol regarding narcotics and psychotropics control were field. based on results of scientific research. Already in HH: Obviously it could not mean that by the year 1958 I suggested that not only the dependence- 2000 everyone is going to be healthy and no-one will producing drugs should be screened, but all kinds of be ill any more. What it means is that appropriate untoward drug effects deserved attention and ways health care ought to be available to everyone. The and means should be sought to get hold of definition in the WHO constitution of health as the information at the earliest possible stage, as was highest possible level of physical, mental, and social done in regard to dependence liability. It took 3 well-being is also often misunderstood. It means, of years for the thalidomide disaster to convince the course, the highest level under the prevailing administration of WHO, and governments, of the circumstances. There could not be any idea of urgent need for action. As an immediate measure an ridding the world of drug and alcohol abuse within international system was developed for the collec- the next 8 years, but WHO must work toward tion of early information on adverse drug reactions ensuring that the highest attainable standards in including data pertinent to drug abuse. As a regard to prevention and treatment of substance corollary the principles and requirements of the pre- misuse are reached. clinical and clinical study of safety and efficacy were laid down in a series of expert reports. These texts BJA: What about the WHO as an international were well received, especially where governmental research collaboration centre? regulations hardly existed. The WHO unit of Drug HH: Traditionally WHO has entertained collaboraDependence became the Division of Pharmacology tive research programmes in almost every one of its and Toxicology, with 'Drug Dependence' under activities. Nevertheless, in the mid-1960s DirectorDale Cameron as one section among others. The General Candau wanted to give the organization a new activities led also to contacts with the pharma- solid scientific base. A WHO Medical Research ceutical industry. Centre was envisaged. The British were very interested, and the Scots even more so; they wanted BJA: Do you think that in 1992 and with Europe to have it in Edinburgh. In 1967 a Division of attempting to unite in some way, that this will act Research in Epidemiology and Communication scientifically and research-wise as a powerful force? Science was established at WHO Headquarters in HH: Quite broadly, not only in regard to our area of Geneva. To begin with, a high-powered scientific
Journal Interview staff developed mathematical models and refined statistical methods. I had hoped that with their help the drug monitoring project could become a truly epidemiological exercise. Alas, after initial enthusiasm this global research enterprise fell apart. Perhaps it was too sophisticated. Besides, WHO's basic orientation changed when the new DirectorGeneral introduced himself and his goal of doing away with the social injustice in the world. BJA: If you were choosing your career again? HH: I grew up in an area of heavy industries, coal
855
and steel, and felt that science was the thing to do, and chose to begin with the fundamental discipline of chemistry. I told you how I got into medicine and how the circumstances brought me into the business of international administration, coupled with science. If I were to choose a career now I would probably wish to base it on a broad education in natural sciences. BJA: What sort offamily did you come from? HH: A family of printers and bookmakers, since 1832.
