Professor Denis (Denny) Anthony Mitchison (1919-2018)
Leading Pioneer of Twentieth-Century Research on Tuberculosis
By Amina Jindani MD. FRCP
Scientific Advisor – World Without TB, Coordinator INTERTB St George’s, University of London.
No other person can lay claim to having saved more lives in the fight against tuberculosis in the twentieth century than Denis (Denny) Mitchison, who died peacefully at his home in London on 2 July 2018 at the ripe old age of 98. He is survived by two children, four grandchildren and two great grandchildren.
Born on 6 September 1919 to a family of scientific and scholarly distinction, Denis Anthony Mitchison was the son of a labour politician Dick Mitchison and his wife, the well-known writer Naomi Mitchison (née Haldane). His uncle was the famous biologist JBS Haldane and his grandfather, the equally well-known physiologist, John Scott Haldane.
Educated at the Dragon School, Oxford, and the Abbotsholme School near Rocester in Staffordshire, Mitchison went on to Trinity College, Cambridge, where he studied Natural Sciences obtaining a 1st class degree and a senior scholarship. He then changed to medicine, qualifying from University College London in 1943, following which he carried out post-graduate training in pathology.
He played a major role in the treatment of tuberculosis (TB) by participating in the first ever clinical trial held at the Royal Brompton Hospital in London in 1946 which compared streptomycin with bed-rest alone for the treatment of the disease. Mitchison’s subsequent collaborative work showed that domiciliary treatment of tuberculosis was as effective as treatment in hospitals — something that led to the ambulatory treatment of patients and the closure of sanatoria across the world — a great economic benefit to the health services globally.
His most important contribution however, in collaboration with other colleagues, was in identifying a combination of drugs which led to the reduction of treatment duration for tuberculosis from 18 to 6 months. These-short term regimens are the basis of current standard therapy worldwide.
Professor Mitchison continued his life-long interest in the treatment of TB with a pivotal role assigned to him in the clinical trials organised by the Tuberculosis Research Unit of the Medical Research Council (MRC). Following the identification of the decisive importance of drug-resistant tubercle bacilli treatment, he was appointed in 1964 as Director of a new MRC Unit on Drug Resistance in Tuberculosis at the Royal Postgraduate Medical School.
He then worked on developing effective treatment for tuberculosis at a cost sufficiently low to be affordable in developing countries. The framework of this work was a series of clinical trials in the United Kingdom and in larger numbers, in East Africa, India, Hong Kong, Singapore and Czechoslovakia. He established TB laboratories in Kenya, Uganda, Tanzania, and Zambia and Hong Kong. He authored more than 300 papers on tuberculosis and received many awards including the British Thoracic Society Medal and the Stop TB Partnership Kochon Prize.
In 1984 he was made a Companion of the Order of St Michael and St George. After his retirement in 1985 he continued working, first at the Royal Postgraduate Medical School Hammersmith, and then at St George’s University of London. Mitchison’s most abiding contribution was his protracted and tireless struggle to eradicate tuberculosis which is the world’s deadliest infectious disease which affects over 10 million people a year and which, in fact, is preventable and curable. Tuberculosis claims more than 1.7 million lives a year — more than HIV and malaria combined. While the discovery of streptomycin by Professor Waksman was the starting point, Mitchison led the world by developing the modern treatment for tuberculosis — something that has led to millions of lives being saved worldwide. His ideas, relentless drive and organizational skills formed, for over 65 years, the underpinning of most of the clinical trials which resulted in successful tuberculosis therapy.
Research shows that of the 10 million new cases a year half die without treatment. Unfortunately treatment can only be provided to some 3 million people each year which results in 2 million deaths from the disease. Over a 65-year period it can easily be said that his work contributed to the saving of almost 200 million lives globally. An alternative way of assessing his unique contribution to this field is that without his incisive trials, tuberculosis therapy would be longer in duration (18 months rather than the current 6 months), resistance rates to current drugs would be higher and the present research emphasis on dormant bacteria would not have developed.
The battle against tuberculosis has been a collaborative effort involving many scientists from across the world. Starting from the first trial on streptomycin in 1946, Professor Mitchison’s work stands out prominently in identifying through laboratory experiments the steps that have led to successful trials in humans leading to the establishment of ambulatory treatment, and eventually to a reduction in treatment duration from 18 months to 6 months. In this endeavour he was a hard task master who never spared anybody — not even himself.
Denis Mitchison will be greatly missed not only by his family, to whom he was a loving patriarch, but also by the academic world and those struggling to eradicate a curable disease which still kills some 5,000 people a day, to whom he was a giant in the field of research and an indefatigable champion in ridding the world of this scourge.
Also read: The Times Higher Education: Denis Mitchison, 1919-2018
Tributes paid to tuberculosis expert who worked on the first randomised controlled clinical trial