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Finney DJ (1965). The design and logic of a monitor of drug use. Journal of Chronic Disease 18:77-98.
Video / Audio
Interview of David Finney by Jan P Vandenbroucke, 18 Nov’ 09
The interview of David J Finney was done by Jan P Vandenbroucke, at David Finney’s home, on 18 November 2009. David Finney was in his 92nd year. The purpose of the interview was to gain more insight into the history of research on adverse drug effects, especially the history of development of methods. David Finney’s theoretical work has been so important that his collective writings on methods to assess adverse drug reactions have been republished by the WHO Collaborating Center for International Drug Monitoring at Uppsala*. A pivotal early paper was written by him in 1965 on “The design and logic of a monitor of drug use,” which has an entry in the James Lind Library (Finney 1965). The interview traces the origins of this paper, but also highlights Finney’s long and distinguished career as a biostatistician and his continued involvement in drug safety. After a short introduction by Jan P Vandenbroucke, David Finney talks for almost an hour about his life, his work in statistics, and on adverse drugs effects.
* Writings on pharmacovigilance. Selected articles by David J Finney. The Uppsala Monitoring Centre, 2006. http://www.who-umc.org/
Jan Vandenbroucke’s introduction and guide to the James Lind Library interview with David Finney
Listen to the interview here
David Finney was president both of the Royal Statistical Society and of the Biometric Society. He worked with Ronald Fisher and Frank Yates, had strong links to agricultural science in India, and was the first Professor of Statistical Science at Edinburgh. A short biography is available in wikipedia: http://en.wikipedia.org/wiki/D._J._Finney
On 18 November 2009, Professor David J Finney was interviewed at his home in Edinburgh (in his 92nd year) by Jan P Vandenbroucke. The interview sought insight into the history of research methods to detect adverse effects of drugs. The importance of David Finney’s work in this sphere is reflected in the fact that his writings on methods to assess adverse drug reactions have been republished by the WHO Collaborating Center for International Drug Monitoring, in Uppsala. [Writings on pharmacovigilance. Selected articles by David J Finney. The Uppsala Monitoring Centre, 2006. www.who-umc.org].
A pivotal 1965 paper by Finney entitled “The design and logic of a monitor of drug use” is the article that has been selected for attention in the James Lind Library. The interview traces the origins of this paper, but also highlights Finney’s long and distinguished career as a biostatistician and his continued involvement in drug safety. After a short introduction by Vandenbroucke, Finney talks for an hour about his life, his work in statistics, and adverse drugs effects.
A summary of important points in the interview, and an indication in minutes and seconds of the points at which they are covered, is offered as a guide to the listener. The summary follows David Finney’s thoughts and reminiscences. Names have been checked and, if possible, internet sources of further information have been added. No other information has been checked.
00:00: Introduction by Jan P Vandenbroucke, asking David Finney to describe his career before he entered the field of adverse drug events.
01:21: David Finney describes his family and early upbringing, early school and university years in the 1930s. He obtained a grant to study mathematics at Cambridge and entered statistics almost by accident after an illness. A main influence was John Wishart (see wiki biography http://en.wikipedia.org/wiki/John_Wishart_(statistician)), who worked on statistics in experimentation in agriculture.
06:12: Finney obtained a position with RA Fisher, in the Galton Laboratory in London, and worked with him on genetic linkage. Finney describes how he often assisted other students in interpreting what Fisher had said during discussion sessions about their data or their mathematical work – amongst others an Indian agricultural statistician who later proved important in his life.
09:15: In 1939, Finney was offered a post in Rothamsted experimental station by Frank Yates (wiki biography: http://en.wikipedia.org/wiki/Frank_Yates), and he remained there until 1945. He was mainly involved in consultation work, for example, on tests of insecticides. He developed an interest in probit analysis at this time.
11:00: Finney later wrote a textbook on Probit Analysis. This became a classic, and was reprinted in 2009 by Cambridge University Press (http://www.cambridge.org/uk/catalogue/catalogue.asp?isbn=9780521135900).
12:10: In 1945, Finney was appointed as a lecturer “in the design and analysis of scientific experiments” at Oxford University, where he taught statistics to biological researchers and was available for statistical consultation. Stimulated by JH Burn in the department of pharmacology, he developed an interest in biological assays in pharmacology. He also worked for the forestry department, and was involved in work on penicillin assays. Together with a computing assistant, he worked on a table of logarithms to the base of 2.
16:40: In 1949, Finney was invited to Chapel Hill, USA, to teach in the summer school of the department of statistics. He taught a general course on biological assays, which led to a second very influential book: “Statistical methods in biological assays” (1952). On the transatlantic boat voyage home he met his future wife, a young American who was visiting Europe for the first time. They married in 1950.
18:40: In 1952 the United Nations Food and Agriculture Organization invited him to India to visit an agricultural centre where the student whom he had met in Fisher’s laboratory was working. Finney was accompanied by his wife and 6 month old daughter. They visited Kashmir and took a great liking for India, which they visited repeatedly. Together with Frank Yates, Finney wrote a report on the statistical needs of Indian agricultural science, and this led to the institution of an Indian agricultural statistical centre which, at the time of the 2009 interview with Finney, was celebrating its 50th anniversary.
21:25: Finney left Oxford in 1954 and became head of a new statistical unit in Aberdeen, with emphasis on agricultural statistics. He stayed there until 1966, when the unit moved to Edinburgh.
Thalidomide and adverse drug events: In 1962 he had a one-year sabbatical at Harvard University’s department of statistics. The head of that department, Frederick Mosteller, was on leave and funds were available for a visitor. As the department of statistics did not have working space for Finney, it arranged space for him in the department of preventive medicine at the medical school. David Rutstein, the head of that department, (obituary in New York Times: http://query.nytimes.com/gst/fullpage.html?res=9A0DEED91639F93AA25751C0A960948260 ) suggested that Finney should look into “this thalidomide tragedy” (McBride 1961; Klingberg 2010) and consider what contributions statisticians might make to predicting and preventing such tragedies in the future. The subject was totally unknown to Finney. As there were ‘no data’, Finney started thinking about ways to collect data that would be helpful.
27:40: Finney wrote a report that was assessed by Rutstein, and, with Rutstein’s encouragement, was distributed to ministries of health in the UK and the USA, as well as to WHO. This report was the basis of a 1963 paper, and thereafter of the 1965 paper on “The design and logic of a monitor of drug use” which is featured in the James Lind Library.
29:00: Returning to Scotland in the late summer of 1963, Finney was contacted by Hans Halbach, a German pharmacologist who was responsible at WHO for proposing steps to avoid new adverse event disasters associated with drugs. Halbach had seen Finney’s report and invited him to Geneva. This was the start of a series of meetings and a long-standing collaboration (see further below).
31:15: The UK ministry of health had similar concerns, and Finney’s report had been read by Sir Derrick Dunlop, professor of therapeutics at Edinburgh, who had been requested by the ministry to chair a committee on the safety of drugs. The committee had a subcommittee on adverse events, which Finney was invited to join.
33:30: Finney witnessed and was instrumental in the birth of the ‘Yellow Card System’ to help practising doctors to report adverse events. For details of this system, Finney refers listeners to Bill Inman’s autobiography (“Don’t tell the patients”) (Obituary of Inman in Telegraph: http://www.telegraph.co.uk/news/obituaries/1501625/Professor-Bill-Inman.html). Finney collaborated closely with Inman on the committee, and strongly promoted computerization of reports of adverse events.
40:30: By 1978, ‘Yellow card systems’ had been established in several countries, and this lead to the idea of a central registry of these national systems. The facility was initially hosted for 2 or 3 years in Washington DC by the FDA. As WHO did not want it to be an in-house facility in Geneva, a Swedish member of the WHO committee suggested that a centre could be established in Uppsala (http://www.who-umc.org/). Several Swedes, including Barbro Westerholm, were active and collaborated in setting up dictionaries, definitions and retrieval systems.
45:25: Later, several attempts were made to obtain information that would be more systematic than a ‘Yellow Card System’, for example, by listing either all prescriptions and coupling them to all events, or vice versa. These principles, and the idea of “Prescription Event Monitoring”, had been set out in Finney’s 1965 paper.
51:16: Closure of interview, with several themes:
- Did the systems really ‘detect’ new events, or were they mainly instrumental in providing data once a suspicion had arisen?
- How did Finney’s original mathematical and statistical career help him in devising his “monitor”?
- What was the significance of the thalidomide tragedy: why did it prove to be the turning point that led governments to set up systems for the study and detection of adverse events?
64:41: Dr Finney ends the interview by recalling the 2008 anniversary meeting of the Uppsala Monitoring Centre, which he attended as ‘a figure from the past’ – reflecting on the enthusiasm of the new and young people from so many diverse countries who currently contribute to the field.
The editors are grateful to:
Elsevier Ltd. for making a pdf of this article available (letter to Iain Chalmers from Natalie Qureshi, 01 October 2012). For conditions of further reproduction, see here.