Born in 1927, Julian Tudor Hart (Figure 1) grew up in a home that served, among other things, as a transit camp for anti-fascist refugees from Continental Europe. His mother, Dr Alison Macbeth, was a member of the Labour Party. His father, Dr Alexander Tudor Hart, belonged to the Communist Party and represented the South Wales Miners' Federation in a dispute over medical care; later he volunteered as a surgeon for the International Brigades fighting against General Franco in the Spanish Civil War. Despite the efforts of his parents to discourage him from entering medicine, Julian's ambition was to be a general practitioner in a coal mining community; but as a medical student in Cambridge and London he recognized the dismal reputation of general practice as the least satisfying and most frustrating field of medicine. If serious-minded students were to be turned to this kind of work, the intolerable features of general practice had to modified.1 New recruits to medicine, he argued, should cultivate disciplined anger against the attitudes and circumstances that impeded effective delivery of medical science to sick people.2 These and subsequent opinions were doubtless coloured by his Marxist convictions. Later in life he expanded on his critique of the medical profession, declaring that medical education was `training the wrong people, at the wrong time, in the wrong skills and in the wrong place'.3 Figure 1 Julian Tudor Hart, 1995 [Photograph by Nick Sinclair from the photograph collection of the National Portrait Gallery] Hart graduated in 1952 and after hospital posts and experience in urban general practice he became involved in epidemiological research, first with Richard Doll and later with Archie Cochrane. At that time, the late 1950s, there was a growing perception that each general practice should be regarded as a population at risk4 and that general practitioners needed to couple their traditional curative medicine with the methods and techniques of the epidemiologist and the medical officer of health (in conjunction with colleagues in allied health professions). At the same time, four large changes were underway in medicine. First, the bioethics movement was encouraging patients and their families to share the overall responsibility for healthcare. Secondly, the family practice movement was emphasizing the holistic dimensions of healthcare, including lifestyle factors. Thirdly, the preventive medicine movement was starting to develop guidelines for practice.5 And, fourthly, the advent of new diuretics and sympathetic blocking agents was making the treatment of hypertension easier and freer from side-effects.6 In 1961 he moved to Glyncorrwg, South Wales, and set up a research practice.7
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