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Around 1961

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Around 1961 Children`s ward as it was in 1950s (in fact taken 1943) As house officer, 1957-8 (2nd row, in spectacles)
As registrar, 1960 (2nd row, in spectacles) With husband, Bob Cohen,  c 1961 With husband as HM The Queen opens new labs, 1984
1997 Barbara Boucher, 2007
 
 
Interview 71 Barbara Boucher

Consultant and Senior Lecturer
Born in London in 1932.


Overview: In 1970, Barbara Boucher became Consultant Physician at The London Hospital, at a time when female consultants were rare, and she worked there until 1998. She was also Senior Lecturer at Queen Mary, University of London, from 1970 to 1999. She has undertaken research on many aspects of diabetes and on improving diabetes care, especially for pregnant women. Through her work in the East End of London, she has raised awareness about causes of diabetes amongst Asian people in Britain. She has found links between vitamin D deficiency and Type 2 diabetes, and identified Betel-nut chewing as a risk factor.

Please note that Overview relates to date of recording 24 July 2007

 Short samples

1 When she studied obstetrics as a student at The London Hospital Medical College in the 1950s, she quickly realised that many of the mothers who had stillbirths did so as a result of having diabetes. [ 59 secs ]

2 Before the 1980s, there were no hand-held meters for getting immediate measurements of blood sugars and, even when they became available, Dr. Boucher had to fight to obtain them for women with diabetes at the pregnancy clinic. [ 64 secs ]

 
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01 Decided against political career. Chose medicine as revenge on doctors! Medical schools wanted Latin, didn`t want women. One offer - London Hospital Medical College.
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02 1st MB at Queen Mary. 2nd MB. Medical college, Whitechapel. Intercalated MSc in anatomy. Clinical work started 1954. Learnt from patients & from Dick Bomford ran clinics outside working hours caught on 50 years later!
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03 Carbohydrate exchanges. Line diets. Eating fat encouraged. Complications emerging. Slow to realise need for control. Urine testing only. Reverse testing. Some thought high sugar required insulin death resulted. Glass syringes. Boiling in test tubes.
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04 Reverse testing started USA. Morning insulin dose depended on evening urine test & vice-versa. Patients adjusted own treatment.
Tablets introduced for Type 2 better without?
Dick Bomford`s humanity good example.
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05 Huge clinics. Long hours. Patients waited. Did all education - none in community. Sorted problems now done by DSN. Got some of first DSNs appointed.
Waiting led to hypos.
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06 Change in 1960s from dietitians issuing orders to listening. Already had chiropodists in 1950s re-introduced with shared care. Consultants got what they requested.
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07 During obstetrics training saw babies of diabetic mothers die & mothers with complications may have led me into diabetes care. With Wendy Savage set up shared care. Kings had reduced mortality. Few young doctors chose diabetes.
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08 Qualified 1957. House jobs. Resident pathology jobs. Junior clinical lectureship - met husband couldn`t work in same firm became NHS Registrar. Retained attachment to Stuart Mason in diabetes & endocrinology encouraged adjusting diabetes to lifestyle. Became Senior Registrar, then in 1970 Consultant in General Medicine with Special Interest in Radioisotopes. Began diabetes research.
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09 In 1960s, did diabetic clinic & treated emergencies hypos. Admitted, so could talk re causes. Treated ketoacidosis with too much insulin people died. No bedside blood sugar testing.
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10 In 1960s, tablets considered answer to Type 2. Tolbutamide first. Chlorpropamide led to more hypos. Phenformin led to lactic acidosis. Type 2 complications. In late 1960s I was convinced of need for control: older diabetologists weren`t.
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11 Having children no more problematic than being woman in medicine in 1960s.
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12 Became consultant, 1970 maybe first female physician at London Hospital. Eventually ran immunoassay lab & diabetes service. Joint clinics with Wendy Savage at Mile End & obstetricians at Whitechapel. Aim to get good blood sugars.
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13 Learnt to involve patients. Late 1970s, clinics more demanding. Shared care system with John Yudkin & others. Published with Simon Welch re measuring glycosylated haemoglobin. Control abysmal.
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14 Got GPs involved. Specialist nurses Margaret Fisher. Information recorded centrally, measured HbA1c improvements, published 1984. Not enough money to extend service, until supported by Graham Hitman. Before I retired, district-wide service. GPs` role fluctuated. Too much to teach practice nurses in short time. Now evening clinics at last!
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15 In 1980s, hand-held meters for blood sugars transformed pregnant diabetes clinic.
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16 In 1980s move from once-daily long-acting insulin to more frequent doses. Husband, Bob Cohen, showed Phenformin dangerous banned. Metformin good still used.
Change from high-fat line diet to normal eating. Self-help groups.
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17 First patients Cockneys, many Yiddish-speaking Jewish people, then Bangladeshis 50% of deliveries, of gestational diabetes. Appointed advocates. Used Lord Young`s Language Line. Now younger Bangladeshi staff. I managed to make women understand time-consuming.
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18 Began writing letters to patient with copy to GP. Computerisation meant letter written alongside patient. Disadvantage looking at computer, not patient. Need for voice recognition.
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19 1990s changes less time in clinics. American study showed benefits of improved glycaemic control for Type 1 & UKPDS for Type 2 Also showed benefit of controlling blood pressure. Husband helped get money to complete UKPDS.
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20 During 1990s, importance of lipid control realised I was dubious, but eventually convinced. Audits. Control still great effort for patient. Insulin pumps haven`t been answer. Islet transplants?
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21 Measuring HbA1c gradually easier. At BDA meeting, 1981, I was criticised for suggesting it could be used to screen for diabetes. Now beginning to happen.
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22 Improvements realisation that blood sugar control and blood pressure matter. Disposable syringes & needles. Education helping patients to adjust treatment to lifestyle. HbA1c encourages some, threatens others. Specialist nurses. GP surveillance if not just box-ticking to get money.
Need to reduce stress - raises blood sugar.
Government should give more money.
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23 By retirement, 1999, no cure, no easy method of control. Better relationships with patients. Attempts to organise round their needs. Diabetes now on agenda. Still no way of getting islets into people.
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24 Since retirement, some clinical work, mostly research need for Vitamin D among British Bangladeshis & everyone.
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25 Also research, with colleague in Taiwan, to show betel-chewing risk factor for Type 2 diabetes. Last week re-submitted paper showing betel risk factor for heart disease.
Need for large Vitamin D trial, for lifestyle changes, for legislation re junk food. Perhaps I should have done politics!
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