Mario Basini meets Professor Mansel Aylward as he prepares to return to Wales to fight the illnesses that bedevilled the Valleys community he came from
WHEN the newly-qualified Dr Mansel Aylward returned to his home town of Merthyr Tydfil in the '60s to work as a GP, he brimmed with the confidence that blooms with youth and a first-class education.
Armed with five-and-a-half years' training at a top London medical school, his skills reinforced by breakthroughs in the treatment of major diseases like cancer, he felt he could handle any problem his patients could throw at him.
'I was wide-eyed and really enthusiastic,' he recalls as we talk in the elegant lounge of the Hilton Hotel in Cardiff. 'I thought that medicine and its allied professions offered a cure for everything.'
Within months he found himself trying to cope with an epidemic so widespread and destructive, it made the cholera that raged through Merthyr Tydfil in the 19th century appear as harmless as the common cold. For all his expertise, he found himself powerless to do much about it.
As many as 80% of the patients he saw in a day had no apparent physical cause for the symptoms they presented to him.
'They were not cases you could cure with a pill,' he says.
'I could not manage their problems by using the conventional medical model.'
He dismisses the notion that they were malingering or that their symptoms existed only in their minds. 'These were people who had real illnesses, who were wretched and complaining and had reason to do so. But I could not understand where the symptoms were coming from.'
Those symptoms ranged from chronic back and neck pain to continuous fatigue, feelings of depression and bowel pain. And if there is no underlying organic 'disease' which causes them, we now know they are the products of a complex of factors which range from the psychological to the environmental and the cultural.
These 'psychosocial' illnesses occur all over Britain. But as you would expect they are much more prevalent in areas of high poverty and deprivation like Merthyr Tydfil. They cost Britain billions of pounds a year since many of the patients who suffer from them become long-term unemployed surviving on disability benefits.
Their devastating effect on an individual can be measured by the fact that experts believe the unemployment they cause has a much more damaging effect on an individual's health than smoking or drinking. Those who remain unemployed for years are, the experts tell us, 30 times more likely to develop life-threatening diseases than those who are in work and who smoke and drink heavily.
Doctors and psychologists struggling to deal with these psychosocial illness are all the more frustrated because they believe that most of those who suffer from them could be back in productive work if we had the knowledge and resources to manage them properly.
Among the questions that still elude doctors and psychologists is just how an individual's psychological make-up interacts with his environment and his local culture to produce these illnesses. And why do many people manage to stay in work while others with the same symptoms at the same level of severity are forced to go on disability benefits?
Dr Aylward is now Professor Mansel Aylward CB, and he has devoted much of his highly successful career as an academic, researcher and government policymaker to tackling the problem he first encountered as a young GP.
Almost 40 years on, he could be on the brink of the breakthrough that will at last provide effective solutions to the problem that has begun to haunt government ministers as well as doctors and psychologists.
Professor Aylward, 61, is about to leave his job as chief adviser, medical director and chief scientist to the Department for Work and Pensions to become Cardiff University's first Professor of Psychosocial and Disability Research. He will also become director of the new UnumProvident Centre for Psychosocial and Disability Research at Cardiff University.
He has developed the centre, funded by a pounds 1.6m grant from the UnumProvident insurance company, with Professor Peter Halligan, professor of Psychology at Cardiff. It opens in October. It will carry out key research into people's attitudes to illness, pain and work and into the relationship between illness and the psychological, social and cultural conditions that affect the individual.
'These are influences we are all prone to,' explains the tall, grey-haired professor with a very Welsh line in eloquence.
'They affect the way in which we respond to illness, the way in which we recover from illness, the way in which illness is propagated and perpetuated.
'And these influences are so important we are looking at a step-change in the way we practise medicine. Nowadays, the hard, recognisable diseases are not the major challenge. We have ways of dealing with them. We are now confronted with this proliferation of subjective health complaints.'
The new centre he will head will first attempt to define the nature of this recently-recognised category of illness and use that to devise ways of dealing with it.
He learned early about the power attitudes created by family background and social conditions can have over our lives. Often, they can cripple us and our ambitions. 'I had friends at both primary school and grammar school in Merthyr who were intellectually very capable and who also had ambitions for the future. They talked about wanting to be this, wanting to be that.
'But by the time they were 13 or 14, they had changed. They seemed to have lost the goals they once had. Some people very close to me were competent, bright and enthusiastic people. I thought that one would be a major player in a university and be particularly good at languages. I thought another would have developed into a top engineer and mathematician.
'In both cases it failed to happen. I just shrugged and said 'That's life'. I thought there were some influences that can prove more important than intellectual capability and left it at that until I became a doctor and saw how crippling these other influences can be.'
He has plenty of ideas why some, like him, emerge from a town such as Merthyr Tydfil able to carve out highly successful careers for themselves while others from what seem to be very similar backgrounds fall by he wayside.
'I believe it is a question of attitudes and beliefs. Things that distinguish some people from others include, perhaps, a belief in the work ethic, a belief some have that they can contribute something to life.
'We don't know whether developing these beliefs results from the family that we had or the culture we are living in or the society that we valued at school; but they are some of the things we mean by the social influences that help to shape an individual.'
Despite a career that has seen him work in Cardiff and taken him for long periods to London, he has remained committed to the town that reared him. He has been married to Angela, whom he met at Cyfarthfa Castle Grammar School, for 40 years and has lived at Cefn Coed, two miles from the centre of Merthyr, for most of that time.
He left general practice to start his own research company in the town. He called it Simbec, a combination of the names of his two children, Simon and Rebecca. Its original laboratory and offices were in the grounds of his house.
Among his major research projects was a study of depression in the Valleys. A spin-off of that study was his interest in the mental and physical effects of hormonal imbalances. And that led him to pioneer hormone replacement therapy as a treatment for the illnesses suffered by menopausal women. Britain's first free HRT clinic was at Cefn.
His years as the head of Simbec developed his talents as an entrepreneur and a policymaker as well as a researcher. They would prove to be invaluable in the next phase of his career as a top civil servant.
That began when he took a job as a senior medical officer for Wales based in Cardiff. He moved to London to become a principal medical office for the DHSS before taking his key role with the Department of Work and Pensions in 1966.
His work on disability and on ways of returning the long-term unemployed to work has earned him an international reputation and a clutch of academic honours from institutions all over the world. He travels frequently to address international conferences. Two years ago he became a Companion of the Bath.
He is the architect of a method of measuring disability which is now used by the British Government and has been taken up by a number of other countries.
Estimates suggest that those prevented from working by illness cost Britain around pounds 90bn a year. Professor Aylward and his colleagues believe that figure could be cut by a third if ways could be found of returning many of those who suffer from psychosocial illnesses to work.
He vigorously refutes the suggestion that his main aim is merely to save the Government the money it spends on disability benefits.
'I have been interested in these problems since I was a teenager, long before I had anything to do with government,' he says. And alleviating the suffering caused by these illnesses has been central to his career since he began working as a GP in Merthyr.
He recognises that any successful attempt to deal effectively with psychosocial illness needs the co-ordinated efforts of everybody from local authorities and health carers to central government.
Helping people to overcome their long-term problems and become capable of returning to work will be of little benefit to them if they have no decent and rewarding jobs to go to. 'Everybody must work together to tackle the problem. And if we do not do that, our initiatives to get more people into rewarding work will fail.'
Those able to come off benefits will have to show a more positive attitude to obtaining work.
'They will have to be prepared to be more mobile. People say that 'unless I can get a job here I am not prepared to travel even 10 miles to find work'. That, too, has to change.'
Making a town like Merthyr Tydfil more attractive by creating shopping malls and amenities such as swimming pools is as crucial as improving people's attitudes to work
He attacks the 'benefit culture' that has gown up in an area like Merthyr where expectations of a life spent on benefits and shortened by poverty and illness are passed on from generation to generation.
Getting rid of that culture and revolutionising attitudes to work could be just the incentive investors are looking for to pour more resources into Merthyr. He is affronted by the fact that those who languish in unemployment for many years face shortened lives full of suffering.
'As a doctor I have a duty to ensure that people get into work because that way I am helping them to lead better lives.'