Professor Richard Moxon FRS and Dr Hugh Bethell MBE on preventative medicine
Dr Hugh Bethell (1960) is a general practitioner, and with colleagues at Alton Cardiac Rehabilitation Centre he has set up the “Staywell” programme which aims to combat all the diseases and debility associated with inactivity. He was awarded an MBE in 1995 for services to medicine. Professor Richard Moxon (1960) is Emeritus Professor of Paediatrics and a Professorial Fellow of Jesus College, University of Oxford. He is a Fellow of the UK Royal College of Paediatrics and Child Health and of the UK Academy of Medical Sciences and was elected a Fellow of the Royal Society in 2007.
Richard and Hugh both studied Natural Sciences at St John’s in the 1960s and have remained friends ever since. Here they talk about their career paths, share their ideas about preventative medicine and offer advice for Johnians starting out in the medical profession.
What first encouraged your interest in science and medicine more specifically?
Hugh: I gained my place at St John’s in Engineering, but when I got there I changed my mind because I thought that being a doctor might be more valuable! It was a good call really because my maths was a bit rubbish. The engineering tutor sent me off to see Dr Bertram, and the change was effected with minimal fuss. I don’t suppose you could do that now.
Richard: I had wanted to be a doctor from a young age, although it’s hard to discern how and why this resolute commitment happened so early in my life. The notion that you could save a person’s life, and be held in awe by your friends, thrilled and impressed me. I had some aptitude for biology and was lucky to get a place at St John’s to study Medicine.
Can you tell us a little about your respective career journeys?
Hugh: My initial chosen career was dermatology but while studying for the necessary exams I spent time working for eccentric cardiologist Dr Peter Nixon. He introduced me to the use of exercise for the treatment of heart patients. When I abandoned dermatology because of the surfeit of acne, warts, psoriasis and eczema, I entered general practice in Alton. There I found a wonderful new Sports Centre which was prepared to allow me to develop a physical training programme for patients recovering from heart attacks. Since then I have been promoting the idea of physical activity as the most effective way of improving the health of the nation. My main obsession is the need for everyone to get more active so that they can avoid the chronic diseases of later life and the frailty of old age. To add years to life and life to years.
Richard: I became a junior doctor at age 25. My decision to specialise in paediatrics was serendipitous. I helped a friend by acting as a locum so he could go skiing and discovered the special challenges and satisfactions of looking after children. It was not until I had the opportunity to do further training in child health in Boston, USA that I became hooked on research and decided to pursue a career as a clinician-scientist.
What is the most surprising thing you have learnt from your research?
Hugh: While lifespan has been increasing over the past few decades, healthspan – the period of healthy living – has actually been decreasing. Nowadays the average sedentary person endures about 20% of lifespan with a chronic disease or disability. For those who exercise regularly the figure is around 5%.
Richard: How completely overwhelming are the excitement and challenges of investigating new ideas about diseases. It becomes a driving force, a consuming part of each day – it’s really a kind of insanity that has never left me. I love thinking about science and how it can be used to move medical knowledge forward.
What is the best way for individuals to help prevent and lessen the impact of major epidemics and lessen the strain on the NHS?
Hugh: Vaccines have to be the first line of defence. However most of those who have required intensive care or died from Covid have had one or more chronic conditions, including obesity, diabetes, heart disease, lung disease and frailty. The most effective prevention of all these is regular moderate or vigorous exercise. Our best long-term protection against a very wide spread of communicable and non-communicable diseases is maintaining a high level of cardiorespiratory fitness.
Richard: No intervention in the history of medicine has been as dramatic as the impact of immunisation. It is to vaccines that we turn to fight deadly infections, as we have just witnessed during the SARS-Covid pandemic. In preventing infection by immunising individuals (direct protection), vaccines prevent so many deaths and disabilities and the associated costs to the NHS. But immunisation also protects whole communities through indirect protection (often called herd immunity) through the reduction of person to person spread of microbial pathogens.
Encouraging the public to get vaccinated and exercise is no longer as radical as it once seemed. How do you think attitudes towards preventative healthcare have changed over the years?
Hugh: As far as the use of exercise is concerned, attitudes may have changed but there is no evidence that application has. Indeed we are fatter and less fit than we were in the 1990s. Part of the problem is that we eat about 50% more than we tell ourselves and exercise about 50% less (social desirability bias). Regarding physical fitness, there is absolutely no correlation between people’s perceived level of fitness and their actual fitness.
Richard: The most profound change in the public’s perception of immunisation has been the impact of the internet and social media as a primary source of information – and unfortunately – misinformation. As with all aspects of medicine, the spread of rumours about potentially harmful side effects of vaccines is a major issue. When people are assessing the balance between the benefits and risks of being immunised, the reliability of the information they access is crucial. Social media platforms have become increasingly powerful in influencing decision-making, and countering misinformation is a major societal challenge.
If you could encourage politicians to create one piece of healthcare policy, what would it be?
Hugh: Tax sedentary behaviour? That could be a bit tricky. The best measure might be to include the level of physical activity in the Quality and Outcomes Framework (QOF) which is a voluntary annual reward and incentive programme and helps to decide GPs’ pay. Neither BMI nor exercise levels are currently included; if they were and they helped to determine GP income, it would be a powerful incentive for exercise promotion.
Richard: The most important policy decision would be to radically change the credentials required of those who are appointed to positions in Whitehall and Westminster. Currently, there is a shocking lack of scientific expertise among those who are charged with developing and implementing policies, including health care. As Kate Bingham (who headed up the Vaccine Task Force) made clear in her Romanes Lecture 2021, a background that includes exposure to STEM (Science, Technology, Engineering and Medicine) must be comprehensively integrated into the credentials of those who fashion government policy.
Do you have any advice for Johnians starting a career in medicine?
Hugh: Great decision! The NHS has many failings but it does have the enormous benefit of relieving doctors of the need to promote themselves and financially they have no incentive to apply unnecessary treatments/operations.
Richard: Identify an area of health care that is important, challenging and interesting to you personally – and go for it!
Professor Richard Moxon’s book How Vaccines Prevent Meningitits and Other Killer Diseases is available to purchase online.
You can purchase Dr Hugh Bethell’s book Get Off the Couch Before its Too Late on Amazon or direct from email@example.com. You can also visit Hugh’s blog here.