Sir Michael David Rawlins

Abstract

Clinical pharmacologist and founding Chair of NICE. He was born in Shrewsbury, UK, on March 28, 1941 and died in Darlington, UK, from sepsis and heart failure on Jan 1, 2023 aged 81 years. In 1973, aged 32 years, Michael Rawlins was appointed to the newly endowed Ruth and Lionel Jacobsen Chair in Clinical Pharmacology at Newcastle University, UK. His employment grade at that time was no higher than senior registrar, and his track record in research, while promising, was still at an early stage. If the appointment board responsible for his professorship was therefore acting on a hunch, its members deserve plaudits for their prescience. In the 33 years that Rawlins held the post, he emerged as a leader of clinical pharmacology in the UK and became Chair and principal architect of a much imitated core feature of the UK health system, the National Institute for Health and Care Excellence (NICE), a leadership role he held until 2013. “He was in many ways the perfect choice”, according to Sir Andrew Dillon, an independent adviser on health-care matters who was Chief Executive of NICE from 1999 to 2020. “A large part of what NICE became was down to him”, says hepatologist Professor Chris Day, Vice-Chancellor and President of Newcastle University. Technological innovation during the second half of the 20th century had yielded a plethora of drugs, devices, and procedures, many of them expensive. There were already methods for assessing the value of such advances, but decisions on which technologies to use and when were still very much a local affair. The phrase “postcode lottery” was becoming an embarrassment to a health system claiming to be national. The UK Government of the day created NICE to devise a more systematic approach to assessment, and to advise which health-care advances were most cost-effective as well as clinically beneficial. Rawlins was chosen to take on the job. “He was very excited to be asked”, recalls Ann Daly, Professor of Pharmacogenetics at Newcastle University. “He was concerned with the postcode lottery and things like that…He saw it as a challenge.” NICE was a novel enterprise. As Dillon puts it, “We had to write the script for the organisation from scratch”. Rawlins began his career with a 1965 degree in medicine from the then St Thomas's Hospital Medical School in London, UK. In 1970, after house jobs and a 2-year lectureship post at St Thomas's, he became a senior registrar at London's Royal Postgraduate Medical School. There, and during a subsequent year-long fellowship at the Karolinska Institute in Sweden, he consolidated his growing interest in the study of individual variations in the response to drugs. On his return Rawlins took up the Newcastle chair, and remained in that post until he retired emeritus in 2006. The non-academic tasks that brought him to public attention, all of them part-time, began in 1979 with his appointment to the UK Government's Committee on Safety of Medicines (CSM), of which he became Vice-Chair in 1987 and Chair from 1993 to 1998. His membership, which included sitting on subcommittees covering topics such as clinical trials and adverse reactions, continued until 1998. During his career Rawlins was also Chair of the Advisory Council on the Misuse of Drugs (1998–2008) and of the Medicines and Healthcare products Regulatory Agency (2015–20). It was Rawlins's background in clinical pharmacology and his CSM experience that made him an ideal choice to run NICE. “And he was politically aware”, says Dillon. “He understood how the interface between politics and science worked, so he was able to negotiate the issues existing between the NHS and the life science industries…He was known and respected by people in politics and the life sciences.” Day adds that Rawlins was an independent thinker and quite irreverent. “Mike had a great sense of humour”, he adds. “Whatever he was doing he seemed to make it enjoyable. And that rubbed off on people working with him.” Some of the success of NICE, especially in its early days, is attributable to the way Rawlins handled controversy. Although certainly amiable, he could also be tough, according to Dillon. “He had strong opinions. When he felt he was right he was able to argue his case…But he also knew when to back down, and do so with good grace.” Day draws attention to Rawlins's legacy at Newcastle University. “Because of his enthusiasm people wanted to work with him. He inspired young people to move into pharmacology.” Rawlins is survived by former wife Elizabeth, from whom he was divorced, and their daughters Lucy, Susannah, and Victoria.