Tom WallerBMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7438.526 (Published 26 February 2004) Cite this as: BMJ 2004;328:526
General practitioner who helped put harm reduction on the map of British drugs policy
Tom Waller was a campaigning general practitioner who worked ceaselessly for a better deal for people with alcohol and drug problems. In his calm, determined, and persistent way he helped put harm reduction on the map of British drugs policy from the mid-1980s onwards. When harm reduction fell from the policy agenda in the late 1990s he vigorously worked to alert civil servants and ministers to the dangers of ignoring drug related harms, especially HIV and hepatitis C infection.
He worked as a London general practitioner from 1973 to 1988, with a stint as GP trainer and tutor at London medical schools and then lecturer in general practice at University College Hospital/Middlesex Medical Schools. His initiation into problems of drug use came when he was the first medical adviser to the City Road crisis hostel for drug users in London (1978-83). The experience led to the first publication for GPs on treating drug users, Drug Addiction and Poly-drug Abuse: The Role of the GP. He joined the Ministerial Advisory Council on the Misuse of Drugs (ACMD) in 1983. He served on the ACMD working group whose 1988 report AIDS and Drug Misuse was the blueprint for the UK response to injecting related HIV infection. The insights in that document, including the view that “HIV is a greater threat to public health than drug misuse,” helped support pragmatic public health oriented harm reduction interventions, including syringe exchange and methadone prescribing. These interventions subsequently kept the HIV rate among drug injectors in the United Kingdom at an extremely low level.
In his second term on the ACMD (1993-6) he alerted members to the problem of hepatitis C infection. Often a lone voice, he met with considerable complacency from council members and others who did not understand that hepatitis C was likely to cause greater problems for drug users than HIV infection. In 1993 he co-authored (with Roger Holmes) the first article on hepatitis C virus in the United Kingdom.
From the late 1990s he became increasingly involved with drug advocacy organisations. With the shift of UK drug policy to a focus on crime rather than health (in the first Labour term), and with the appointment of the first UK anti-drugs coordinator (or drugs czar) in 1998, Tom realised that the politicisation of the drugs field required a more organised response.
He was a founder and first chair of Action on Hepatitis C (1999-2002), which was established out of concern at the failure of government to act on hepatitis C. He persuaded a wide range of professionals to join the organisation and worked his way around many civil service departments until, realising that the obstacles were political, he organised questions in the House of Commons and a debate in the Lords. Eventually there was ministerial agreement that hepatitis C was an important issue and the Department of Health developed a strategy for it. That the strategy is now about to be implemented is a fitting tribute to Tom.
He was founding director of the UK Harm Reduction Alliance (2000-2). Disappointed that from 1988 the government drugs strategy had failed to address harm reduction and barely mentioned HIV or hepatitis C, Tom helped write a campaigning document in the style of the government drugs strategy—setting out the need for harm reduction. This received a particularly frosty reception from the Department of Health's senior medical officer for public health. However, Tom must have been delighted that the updated drug strategy in 2002 included a section on harm minimisation.
He leaves a wife, Rosa, and three sons.
Thomas Arthur Naunton Waller, former general practitioner and county specialist in substance misuse Suffolk (b Leiston, Suffolk, 1944; q London 1979; DRCOG), died from cancer on 27 November 2003.
[Gerry V Stimson]