George James Miller

Professor George Miller, who has died at the age of 66, was primarily an epidemiologist interested in cardiovascular disease, with the considerable advantage that he was unusually knowledgeable in the fields of biochemistry, haematology, and medical statistics, on which much of his work depended. But he had even wider ranging interests, having also worked on the economics of land and tax policies, based on his study of British history over 1000 years, and which led to two major publications.

George James Miller was born in Liverpool. He graduated from Manchester University's medical school in 1963. After appointments in Manchester, he moved to the University Hospital, Kingston, Jamaica, before joining the clinical scientific staff of the Medical Research Council Epidemiology Unit there. It was during this time that his aptitude for epidemiology emerged. By careful studies of lung function and smoking habits in the community, he showed how a form of pulmonary fibrosis unique to the region was attributable to the habit of smoking black-fat tobacco. In 1971 he returned to the United Kingdom to join the MRC Pneumoconiosis Unit, Penarth, South Wales. While there, he collaborated with his brother, Norman, then working in Edinburgh, to write a paper that was to become the most cited ever published in the Lancet. Based on the results of Norman's unpublished work on cholesterol turnover and a careful analysis of epidemiological and other data culled from the literature, the article proposed that high density lipoproteins (HDLs) protect arteries against the development of atherosclerosis, and that a low HDL level was an important risk factor for coronary heart disease. Though initially received with scepticism, the idea rapidly gained support, and is now acknowledged as the starting point of a line of research that holds promise for a range of new approaches to the prevention of coronary disease. Soon after the publication of this article in 1975, he returned to the Caribbean, but this time to Trinidad, as a member of the MRC's scientific staff in the Caribbean Epidemiology Centre. There he was given the task of setting up a prospective survey of cardiovascular diseases in Trinidad that came to be known as the St James' survey. Other important work in Trinidad concerned HTLV-1 lymphoma-leukaemia, a virus-induced malignancy endemic to the Caribbean.

In 1981 Miller joined the MRC Epidemiology and Medical Care Unit at Northwick Park Hospital in Harrow. The unit's main biomedical interest was in the blood clotting system and the acute, thrombotic component of heart attacks. The then novel working hypothesis was that high clotting factor levels due to genetic and lifestyle influences lead to overactivity of the clotting system and thus increase the risk of heart attacks. Miller's move turned out to be a highly rewarding one for the unit because of the exceptionally strong background he had in both statistics and lipid biochemistry, and later his expertise in the pathways of the blood clotting system. The first Northwick Park heart study had indeed shown associations between some classic clotting factors such as fibrinogen with increased risk of heart attacks. Miller developed this work in the second Northwick Park heart study by including additional clotting factors, newer methods for more accurately indicating the activity of the factors that emerged in the first study, and also new methods for indicating the extent to which the clotting system had been activated. Many of these studies involved collaboration with colleagues in the United States, Europe, and in other UK centres, and George's immense personal charm and infectious laugh, as well as his great organisational skills, undoubtedly contributed substantially to the success of these projects. The findings led him to suggest that some of the clotting factor levels were secondary to inflammatory processes in the arteries affected by the chronic degenerative processes leading to heart attacks, and that the original hypothesis for the first Northwick Park heart study might need to be modified. Miller was also responsible for many imaginative, smaller clinical studies to demonstrate the effects of diet on clotting factors. Dietary fat intake, blood lipid levels such as cholesterol, and clotting factor levels were all highly interdependent. This has helped resolve the debate as to whether coronary heart disease is mainly a condition of unhealthy diet and disordered lipid metabolism, leading to the fatty deposits in the arterial wall, on the one hand, or, on the other, one of a much shorter term, acute thrombotic process. Clearly, the two pathologies are closely related to one another. In a particularly elegant series of studies, Miller and colleagues in the haemophilia centres at the Royal Free and the Hammersmith Hospitals recruited small numbers of patients with different clotting factor deficiencies who took two different isocaloric diets, one high and the other low in fat. The most striking result was that factor IX plays an obligatory role in the post-prandial activation of factor VII, the principal initiator of the clotting process.

When the unit moved to the Charterhouse Square, site of the newly formed Barts and London Medical School, Dr Miller was given a personal professorial appointment. Largely unbeknown to his colleagues, he had also been working on the way in which the fabric of society was shaped by the way in which land was owned and distributed. In 2000 he published his main work, the book On Fairness and Efficiency, and this was followed by a monograph, Dying for Justice, in which he argued that about 50 000 people in England and Wales alone died prematurely each year, losing up to nine years of life from causes that could be attributed to government's unjust forms of taxation. Whether or not one agreed with him, it was hard not to be impressed by the articulate and commanding way in which he explained his views on these topics.

Not long before he was due to retire, he underwent major surgery for cancer of the large bowel, and spent the remaining years of his life in determined resistance to its inevitable progress. He continued to work until not long before he died. George was married three times and had five children.